UNIVERSTY OF GONDAR

COLLEGE OF MEDICNE AND HEALTH SCIENCE

SCHOOLE OF MIDWIFERY
Obstetrics and Gynecology
FOR 3rd Year comprehensive Nursing Students
BY: Agumas Eskezia (BSc, MSc)

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Reproductive anatomy and physiology

05/23/2021 UOG 2
 Learning objectives
At the end of this chapter the students will be able to:
• Describe anatomy of the Female pelvis and
Female External & internal genitalia
• Differentiate organs contained in the pelvic cavity
• Describe the physiology of menstruation
• Explain the embryology of the fetus and placenta
• Describe the fetal circulation
• Mention parts of fetal skull with its features

05/23/2021 UOG 3
 Reproductive anatomy and physiology
Out line
 Introduction to obstetrics gynecology nursing
 Anatomy of the female pelvis
 female reproductive organ
 The menstrual cycle
 Fetal and placenta formation (embryology)
 Fetal circulation
 Fetal skull

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 Introduction
 The importance of the obstetric and gynecology
nursing are:
 Equip the nurse with the knowledge and

understanding of the Anatomy and physiology of

reproductive organ be able to apply it in practice
 Develop skills in carrying out antenatal care and

be able to detect any abnormality, recognize and

prevent complications.
 Select high risk cases for hospital delivery and

provide health education.

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 Int…
 Develop skills in supporting the women in labour,
maintain proper records, and deliver her safely and
resuscitate her new born when necessary.
 Be able to care for the mother and baby during the
post partum period and be able to identify
abnormalities and help them to get-over it.
 Be ready to offer advice to support the mother and
understand her problems as a mature, kind and
helpful nurse.

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 Definition of terms
Obstetrics - is a medical specialty focusing on the
care of woman during pregnancy , child birth and
postpartum.
Gynecology - is a medical specialty focusing on
disorders or diseases of reproductive system.

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 Female pelvic bones
 The pelvis:
- Is the area of transition between the trunk and the
lower limbs.
- is a ring shaped series of bones that form the pelvic
girdle.
There are four pelvic bones:-
- Two innominate or hip bones
- Sacrum
- Coccyx
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 Pelvis…

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 Pelvis…
A . Each innominate bone is formed by fusion of three
bones
 The ileum
 The ischium
 The pubic bone

1.The ilium the large flared out part consists of different

parts in it like:-
-Iliac crest-upper border of the ilium
- Anterior- superior iliac spine found in front of the iliac
crest and can be felt as a bony prominence
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 Pelvis…
-Anterior-inferior iliac spine found short distance below the
iliac crest.
- Iliac fossa the concave anterior surface of the ilium.
2. The ischium
- the thick lower part of the innominate bone.
- It has a large prominence known as the ischial tuberosity
on which the body rests when sitting.
-Behind and a little above the tuberosity is an inward
projection, the ischial spine.
-In labour the station of the fetal head is estimated in relation
to ischial spines.
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 Pelvis…
3. The pubis
 The pubic bone forms the anterior part.
 The space enclosed by the body of the pubic bone, the
rami and the ischium is called the obturator foramen.
B. The sacrum
 wedge shaped bone consisting of five fused vertebrae.
 sacral promontory The upper border of the first sacral
Vertebra.
 The anterior surface of the sacrum is concave and is
referred to as the hallow of the sacrum.

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 Pelvis…
C. The coccyx:
Consists of four fused coccygeal vertebrae.
It is triangular in shape with its base uppermost.
The 1st coccygeal vertebra articulates with lower
end of the sacrum at the sacro-coccygeal joint

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 Pelvis…
Pelvic joints
There are four pelvic joints
Two sacro-iliac joints
One symphysis pubis
One sacro –coccygeal joints

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 Pelvis…
Pelvic ligaments
Each of the pelvic joints is held together by
ligaments
-Interpubic ligaments at the symphysis pubis (1)
-Sacro iliac ligaments (2)
- Sacro coccygeal ligaments (1)
- Sacro tuberous ligament (2)
- Sacro spinous ligament (2)

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05/23/2021 UOG 17
 Pelvis…
Function of pelvis
Adapted for child bearing
Allow movement of the body
Permits the person to site and kneel
Transmits the weight of the trunk to the leg
Affords protection to pelvic organs and a lesser
extent to the abdominal contents.

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 Pelvis…
The regions of the pelvis
The false pelvis – lies above the pelvic brim and
consists mainly of the iliac fosse.
 It has little importance in obstetrics
The true pelvis - is the bony canal through which
the fetus must pass during birth.
 It consists of three constituent parts;
The in let or brim of the pelvis
The cavity
The out let

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 Pelvis…
The pelvic brim / in let:-
 Is round except where the sacral promontory
projects in to it.
 It is wider transversely than in the anterior
posterior dimension
The pelvic cavity:-
Extends from the inlet above to the out let below.
The posterior wall is deeply concave and
approximately 12cm in length.
The anterior wall is formed by symphysis pubis
and is approximately 4cm long.
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 Pelvis…
The pelvic outlet:-
Are two described as the anatomical and the
obstetrical outlet.
•The anatomical out let - It is diamond in shape .
Is formed by the structures which mark the lower
border of the pelvis- these are:
The lower border of the sympysis pubis
The pubic arch
The inner border of the ischial tuberosity.
The sacro – tuberous ligament
The tip of the coccyx.
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 Pelvis…
The obstetric outlet:-
Is of the space between the narrow pelvic strait
and the anatomical outlet it includes:-
The lower border of the symphysis pubis
The ischial spine
The sacro-spinous ligament
The lower border of the sacrum

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 Pelvis…
The pelvic floor or pelvic diaphram
The pelvic floor is a strong diaghram of muscle slung like a
hammock from the walls of the pelvis.
Formed by the soft tissues that fill the outlet of the pelvis.
 Through it the urethra, the vagina and the anal canal
passes.
Function of the pelvic floor
Providing support for the pelvis organs.
The muscles are responsible for voluntary control of
micturation and defecation.
For passive moment of the fetus.
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 Pelvis…
The main important muscels of pelivic floor are:
A. Levater ani muscles are arising from the lateral pelvic
wall and decussate in the midline between the urethra, the
Vagina and rectum. It contains pubococcyges muscle, ileo
coccyges and pubo rectalis.
B. Pubococygeous muscle is constructed in such away that it
can expand enough for child birth and contract the pelvis
supported.
The perineum:-is a pyramid of muscle and fibrous tissue
located between the vagina introits and the anus, measures
4cm in each direction.
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05/23/2021 UOG 25
 Important Diameters of the pelvis
Inlet
 Diagonal conjugate - a line from the sacral promontory

toward the lower boarder of the symphysis pubis and

measures 12.5 cm.
 It is measured by pelvic examination

Mid cavity
 Interspinous diameter- a line between the two ischial

spines and measures 11 cm.

The pelvic out let
 Pubic arch
 Intertuberous diameter

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 Features of normal female pelvis
♣ Sacral promontory is not prominent or un
reachable.
♣ Rounded brim
♣ The cavity is shallow with straight sides
♣ Smooth (blunt) ischial spines
♣ The sacrum is smoothly concave (curved)
♣ Wide sciatic notch.
♣ The pubic arch is round
♣ Sub pubic angle 900

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 Features of normal female pelvis

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Types of pelvis
Based on the shape of the brim, there are four main
groups of pelvis
Gyneacoid
Android
Platypelloid
Anthropoid

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 Gynaecoid Pelvis (50%)
 It is best for child bearing
It is the normal female type.
Inlet is slightly transverse oval.
Sacrum is wide with average concavity and
inclination.
Side walls are straight with blunt ischial spines.
Sacro-sciatic notch is wide.
Subpubic angle is 90-1000.
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 Android pelvis (20%)
♠It is a male type because it resemble to male pelvis
♠Inlet is triangular or heart-shaped with anterior narrow
apex.
♠Side walls are converging with projecting ischial spines.
♠Sacro-sciatic notch is narrow.
♠Subpubic angle is narrow <900.

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Anthropoid pelvis (25%)
All anterio posterior diameters are long.
All transverse diameters are short.
Sacrum is long and narrow.
Sacro-sciatic notch is wide.
Subpubic angle is narrow.
 Ischail spines are not prominent.
 Women of this type tends to be tall with narrow
shoulder.

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 Platypelloid pelvis
♦It is a flat female type.
♦It has kidney shaped brim.
♦All anteroposterior diameters are short.
♦All transverse diameters are long.
♦Sacro-sciatic notch is narrow.
♦Subpubic angle is wide.
♦ The ischial spines are blunt.

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Gynaecoid Anthropoid Android 35
 Female reproductive organs
The female reproductive organs consists of:-
 External genitalia, collectively known as the vulva and
 Internal reproductive organs like vagina, uterus, two
uterine tubes and two ovaries.
The vulva includes:-
 mons pubis,
 labia majora,
 labia minora,
 clitoris and
 perineum.
.
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 External genitalia…
The mons pubis:-
 a pad of fat lying over the symphysis pubis.
 It is covered with pubic hair from the time of puberty.
 protect the junction of the pubic bone from trauma
Labia major-
 are two large rounded folds of fatty tissue covered by
skin which meet anteriorly at the mons pubis.
 Contains sebaceous glands, sweet glands and hair
follicle.

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 External genitalia…
Labia minora –
 are two smaller folds of pink skin lying longitudinally
with the labia majora.
 The area they inclose is known as the vestibule in which
the opening of the urethra and vagina are situated.
Clitoris:-
 is small extremely sensitive erectile structure.
 It is about 2.5 cm long and is composed of two
corpora covernose.
 It consists of the glans, body and two crura.

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 vestibules:- is a triangular space bounded anteriorly by
the clitoris, posterior by the fourchette and on either said
by labia minus.
 Hymen-is a thin membrane which covers the introitus in
virgin

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 Clitoris cont..
 It is analogue to the penis in the male and highly
vascularized
 Function to induce orgasms of sexual intercourse.

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 Internal reproductive organ
Female Internal Reproductive organs
The vagina
Is a tube (canal) which extends from the vulva to
the uterine cervix.
It is longer in posterior wall (9cm) than anterior
(7cm).
The vaginal walls are pink in appearance and
thrown in to small folds known as rugae.
 The vaginal fluid is acidic in reaction having a PH
of about 4.5 during reproductive life.

05/23/2021 UOG 43
 Internal reproductive organ…
 Structures
Vaginal wall is composed of four layers.
The layers from in to out wards are :
1.Mucus coat lined by stratified squamous
epithelium.
2.Sub mucous layer
3.Muscular layer – inner circular and outer
longitudinal
4. fibrous coat

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 Internal reproductive organ…
Uterus:-
o A hallow pear shaped muscular organ located in
the true pelvis between the bladder and rectum.
– 7-8 cm long, 5-7 cm wide, 2-3 cm thick
– projects superior-anteriorly over urinary bladder
o The main function of the uterus is to nourish the
developing fetus prior to birth and prepare it self
for pregnancy each month.
o Following pregnancy expels the products of
conception.
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 Internal reproductive organ…
The uterus consists of the following parts:-
Cornua:- the upper outer angle of the uterus where the
uterine tubes joins.
Funds:- the domed shaped upper wall between the insertion
of the uterine tubes.
Body or cavity or corpus:- made up the upper two third and
the greater part.
Isthmus:- -A narrow area between the cavity and the cervix.
-A transitional zone between body and cervix
Cervix or Neck:- the part protruded into the vagina.

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 Internal reproductive organ…

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 Internal reproductive organ…
Structures of the uterus
Perimetrium/serosa - outer serous coat,
peritoneum supported by thin layer of
connective tissue
Myometrium/muscular coat - 12-15 mm
smooth muscle, main branches of blood vessels
and nerves of uterus are in this layer
Endometrium/mucosal coat - inner mucous
coat

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 Internal reproductive organ…

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 Internal reproductive organ…
Uterine tube
– 10-12 cm long, 1 cm diameter
– Extend laterally from cornua of uterus
– 4 parts
 Infundibulum
– distal end
– 20-30 fimbriae
– ovarian fimbria is attached to ovary
 Ampulla
– widest and longest part, over 1/2 its length
– fertilization occurs here
– Most common site for ectopic pregnancy
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 Internal reproductive organ…
 Isthmus -short 2.5 cm, narrow, thick-walled part of
tube that enters the uterine cornua
 The interstitial portion- is 1.25 cm long and lies within
the wall of the uterus.
-Its lumen is 1mm wide
FUNCTIONS of tube
 Propels the ovum towards the uterus.
 Receives the spermatozoa as they travel up wards
 Provides a site for fertilization
 Supplies the fertilized ovum with nutrition.
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 Internal reproductive organ…

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 Internal reproductive organ…
THE OVARIES
Are two nodular bodies which produce ova and hormones
estrogen and progesterone.
Size 3 cm in length, 2 cm in width and about 1 cm in
thickness and weight about 6gm.
Structures
Composed of medulla and cortex covered with germinal
epithelium.
The medulla- is the central portion and point of entry for
blood vessels, lymphatic and nerves.

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 The menstrual cycle
 Is a periodic uterine bleeding in response to cyclic
hormonal changes.
It is hallmark of reproductive year.
Characteristics of normal menses
Interval 21-35 days
Amount 30-80 ml
Duration 1-8 days, average 5 days
The blood is arterial (85%) oxygenated the rest 10-15% is
deoxygenated.
Color dark red and non clotted in nature

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 PHASE OF OVARIAN CYCLE
1.Follicular phase:- hormonal feedback promote the
development of single dominant follicle.
 Its average length is 10-14 days.
2. Luteal phase: - the time from ovulation to the
onset of the menses.
 Average length 14 days.

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• Phase of endometrial cycle
 Because of the systemic effects of estrogen, the
endometrium undergoes histologic cyclic changes that
culminate in menstruation.
 The superficial 2/3 of the endometrium is called the
decidua functionalis and is composed of stratum
spongiosum – superficial zone.
 The decidua basalis- is the deepest region of endometrial
and doesn’t undergo significant monthly proliferation. It is
the source of endometrial regeneration after each menses.

05/23/2021 UOG 56
 There are three phases in the endometrial cycle.
1.Menstrual phase:- start from day 1 and usually
lasts 3 to 5 days.
 During this phase there is irregular sloughing of
the superficial 2/3 of endometrium (decidua
functionalis) accompanied by blood. Expulsion of
the blood is aided by uterine contraction.

05/23/2021 UOG 57
2.Proliferate phase- starts near the end of the
menstrual phase the basal layer of the
endometrium (decidua basalis) under the
influence of estrogen; proliferate to
regenerate the superficial layer that is
shaded during menses.
 At the beginning of this phase endometrium
is relatively thin (1-2mm)

05/23/2021 UOG 58
3.Secretary phase- extends from ovulation to the
onset of the next menses.
 The proliferative endometrium, under the
influence of progesterone is changed to secretary
type.
 Glands becomes tortuous and exhibit secretary
activity
 Stromal cells are separated by interstial
endometrium

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05/23/2021 UOG 60
 Embryology

Is a science that deals with the origin and

development of individual organism.
FERTILIAZATION-
 is the union of the ovum and spermatozoa.
 Occurs after the release of ovum in the ampulla
portion of the fallopian tube.

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 Embryology…
Sperm egg

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 Embryology…
Development of fertilized ovum
Immediately after penetration of the ovum the
chromosomal material of the ovum and the spermatozoa
fuse. The resulting structure is called a zygote.
 After fertilization division of cells takes place and the
fertilized ovum divided into two, four, eight, sixteen and
soon until a cluster of cell is formed known as the
morula.
 Those division occurs quite slowly about once every
12 hours.
05/23/2021 UOG 63
 Embryology…
Next a fluid filled cavity or blastocele appears in the
morula which is now become as the blastocyst.
 Around the outside of the blastocyst there is a single layer
of cell known as the trophoblast while the remaining cells
are clumped together at one end forming the inner cell mass.
 The trophoblast will form the placenta and chorion while
the inner cell become the fetus, umbilical cord and the
amnion.
 Embeding of the blastocyst is normally completed by the
11th day after fertilization & the endomatrium closed over it
completely.
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 Embryology…
Development of fertilized ovum

05/23/2021 UOG 65
The placenta
The placenta is a complex organ which originates from the
tropblastic layer of the fertilized ovum.
When fully developed it serves as the interface between the
mother and the developed fetus.
 It carrying out functions that the fetus is unable to perform for
itself.
The placenta on overage has a diameter of 18 cm, a thickness of
23 mm, a volume of 497ml, a weight of 508 grams and villous
surface area of 15m2.
 The placenta is completely formed and functioning 10 weeks
after fertilization.
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 Appearance of the Placenta at Term
The placenta measures about 20 cm in diameter
and 2.5cm thick from its center. It weighs
approximately one sixth of the baby’s weight at term.
It has two surfaces:-
 1.The maternal surface maternal blood gives this
surface a dark red colour and part of the basal
decidua/ part of uterus/
 The surface is arranged in about 20 lobes.

05/23/2021 UOG 67
2.The fetal surface:- The amnion covering the fetal surface
of the placenta gives it a whitish, shiny appearance.
Branches of the umbilical veins and arteries are visible and
spreading out from the insertion of the umbilical cord which
is normally in the center.
The aminotic sac consists of a double memberane
Chorion – Outer layer adhere to the uterine wall.
Amnion.-The inner layer of the aminotic sac containing an
aminotic fluid and cover the fetal surface of the placenta and
are what give the placenta its typical shiny appearance.

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 FUNCTIONS OF PLACENTA
1.Respiration 4. Excretion
2.Nutrition 5. Protection
3.Storage 6. Endocrine activity
Storage - The placenta metabolises glucose and can also
stores it in the form of glycogen and reconverts it to
glucose as required. The placenta store iron and the fat
soluble vitamins.
Excretion -The main substance excreted from the fetus is
carbon dioxide; bilrubin will also be excreted as red blood
cells are released relatively frequently.
05/23/2021 UOG 69
Protection - It provides a limited barrier to infection with
the exception of the treponeona of syphilis and, few
bacteria can penetrate. Viruses, however, can cross freely
and may cause congenital abnormalities as in the case the
rubella virus and HIV virus.
Endocrine function- placenta secretes certain hormones:
Human chorionic gonadotropin (HCG)
Estrogens
Progesterone
placental lactogen (HPL) has a role in glucose metabolism
in pregnancy.
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 THE UMBILICAL CORD
Connects the placenta to the fetus.
It has average length of 50 cm (range 30-100 cm) and
diameter of 0.8-2 cm.
It contains two umbilical arteries, one umbilical veins and
Wharton’s jelly (jelly like substance which surrounds the
blood vessels).
FUNCTIONS
To transport oxygen and nutrients from placenta to the
fetus.
To return waste products from the fetus to the placenta
Allows
05/23/2021 fetal mobility. UOG 71
 AMNIOTIC FLUID/liquor amnion
The amniontic fluid is a clear, pale straw in colour.
It secreted by the amnion and fetal urine also
contributes to the volume from the 10th weeks of the
gestation on wards.
 The normal amount is from 500cc-1500cc.
 If the total amount exceeds 1500 ml, the condition
is known as polyhdramnous and if less than 300ml it
is known as oligohydraminous.

05/23/2021 UOG 72
 Function of Amniotic fluid
 Allows for free movement of the fetus
Protects the fetus from injury
Maintains a constant temperature for the fetus
During labour it protects the placenta and umblical
cord from the pressure of uterine contraction
 Aids effeciement of the cervix and dilation of the
uterus.

05/23/2021 UOG 73
 The fetal circulation
 As the placenta acts as the intermediary organ of
transfer between the mother and fetus, fetal circulation
differs from that required for extra uterine existence
 The fetus receives oxygen through the placenta

because the lungs do not function as organs of

respiration in the uterus.
 To meet this situation the fetal circulation contains

certain special vessels that shunt the blood around the

lungs, with only a small amount circulating through
them for nutrition.

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05/23/2021 UOG 75
 The fetal skull
 Is a bony box like cavity which contains and
protects the delicate brain.
It is the most important part of the fetus because;
It contain the delicate brain
It is the least compressible part of the fetus.
It is the most difficult part to deliver whether it
comes first or last.
It is the largest part of fetus.

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 The fetal skull
Therefore adaptation between the skull and the
pelvis is necessary:-
 To allow the head to pass through the pelvis
without complication.
 For understanding of the land marks and
measurements of the fetal skull .
 To enable health professionals recognize
normal presentation and position and
 To facilitate delivery with the least possible
trauma to the mother and fetus.
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 The fetal skull
♦Division of the fetal skull
The fetal skull is divided into three parts:
♣The vault – is the large dome shaped part above
the imaginary line drown from below the occipital
protuberance to the orbital ridges.
♣The face - area extending from the orbital ridges
to the junction of the chin and neck.
♣The base - is composed of bones which are firmly
united to protect the vital centers in the medulla.

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 The fetal skull
Bones of the vault
•There are five main bones in the vault of the fetal
skull.
♠One occipital bones – lies at the back of the head
and forms the region of the occiput.
 Its ossification center is known as occipital
protuberance.
It is roughly triangular in shape.
In its lower part it forms the margins of the
foramen magnum.
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 The fetal skull
♠Two parietal bones – lie on either side of the skull.
The ossification center of each bone is called
partial eminence.
They are the largest of the cranial bones.
Roughly square in shape and curves as they lie
over the parietal lobes of the brain.
♠Two frontal bones – form the forehead or sinciput.
Their ossification centers are named frontal
eminence or frontal bosses.
Fuse in to a single bone by 8 years

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 The fetal skull

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 The fetal skull
Sutures
Is an area of membrane between the skull bones
where ossification has not been completed.
Overlap during the process of moulding at the time
of birth.
Types of sutures
A. The lambdoidal suture
 is shped like the Greek letter lambda and
separates the occipital bone from the two parital
bones.
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 The fetal skull
B. The sagital suture lies between the parital bones
C. The coronal sutrue separetes the frontal bones
from the parital bones, passing from one temple to
the other.
D. The frontal suture runs between the two haves of
the frontal bone.

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 The fetal skull
Fontanels
Are areas where two or more suture meet.
There are 6 fontanels, but only two are of great obstetrical
importance.
♥The anterior fontanel or bregma :-is formed where the
sagital, coronal and frontal sutures meet.
It is diamond in shape.
It is much longer than posterior fontanel.
Pulsation of cerebral vessels can be felt through it.
Normally closes at 18 months of age

05/23/2021 UOG 84
 The fetal skull
♥Posterior fontanel
occurs at the junction of the lambdoidal and sagital sutures.
It is very small and triangular in shape
It is normally closes by 6 weeks of age
The Regions of the skull
♦Vertex
♦Occiput
♦Sinciput (brow)
♦Face

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 The fetal skull
A. The occiput lies between the foramen magnum and the
posterior fontanelle. The part below the occipital
protuberance is known as the suboccipital region.
B. The vertex is bounded by the posterior fontanelle, the
parital eminences and the anterior fontanelle.
C. The sinciput or brow extends from the anterior fontanelle
and the coronal suture to the orbital ridges.
D. The face is small in new born baby. It extends from the
orbital ridges and the root of the nose to the junctions of the
chin and the neck. The point between the eye brows is
knowns as the glabella. The chin termed the mentum and is
an 05/23/2021
important land mark. UOG 86
 The fetal skull

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 The fetal skull
Diameters of the skull

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 The fetal skull
Presenting diameters':-
-Some presenting diameters are favorable than the
others for easy passage through the pelvis and this
will depend on the attitude of the head.
- The term attitude describe the degree of flexion or
extension of the head on the neck.
- Vertex presentation:- When the head is well flexed
the sub-occipito bregmatic diameter (9.5cm) and the
biparital diameter (9.5cm) present.

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 The fetal skull
- Face presentation:- when the head is completely
extended the presenting diameters are sub –mento
bregmatic(9.5cm) and the bitemporal (8.2cm)
present.
-Brow presentation:- when the head is partially
extended and the mento vertical diameter (13.5cm)
and the bitemporal diameter (8.2cm) presents.
- If this presentation persists vaginal birth is un
likely.

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 THANK YOU!

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