Obstetrics and Gynecology

Nursing

For 3rd year BSC nursing trainee Oct

2012 E.C

Organized by Demeke A
.

Introduction to Obstetrics and

Gynecology Nursing
 Definitions 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.
Conception & fertilization - the union of egg & sperm in the bench
mark of the beginning of pregnancy.
Pregnancy - the condition of having a developing conception with in the
maternal body.
The state from conception to delivery of the fetus.
The normal duration is 280 days counted from the 1st day of last
menstrual period.
Embryo-human conceptus from fertilization through eight weeks of
pregnancy.
Fetus- from eight weeks until delivery.
 Gestational age- duration of pregnancy expressed in completed weeks
and is calculated from the first day of last normal menstrual
period(LNMP/LMP).
Developmental age(fetal age)- is age of the offspring calculated from
time of implantation.
Gravid- pregnant
Gravidity- total number of pregnancy including abortion
Parity- total number of deliveries after 28 WKs of gestation
Prenatal - occurring before birth
Intranatal - occurring with in birth
Postnatal - occurring after birth
Primigravida - a women pregnant for the 1st time
Multigravida- a women pregnant more than one times
Primiparas - a women having born one child
Multipara- a women having born more than onechild
Grundmultipara- a women born more than five child
 Anatomy and physiology of female reproductive system

The female pelvis

Definition:- The pelvis is a hard bone which supports and protects the
pelvic organs and the contents of the abdominal cavity and through
which the fetus passes during the process of birth.
Function of Pelvis
 The primary function of the pelvis girdle is to allow body movement
 Permits the person to sit and kneel
 For child bearing
 Transmit the weight of the trunk to the legs
 Takes the weight of the sitting body on to the ischial tuberosity
 Support and protects pelvic organs
 Body shape or posture
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Pelvic outlet

8
Anatomy of female bony pelvis and fetal skull

Which bone compose the bony pelvis?

 2 innominate bones ---illium
---ischium
----pubis
 Sacrum
 Coccyx
 Pelvic Bones
The pelvis made up of or composed of five bones. These are:
• two innominate bones (nameless or hip bones)
• One sacrum
• One coccyx
The Innominate Bones
Each innominate bone composed of three bones such as Ilium, ischium
& pubis.
These three bones are joining in the cup shaped depression known as
acetabulum.
1. The Ilium
 Is a large flared outer part of the in nominate bone.
When the hand is placed on the hip, it rests on the iliac crest, which is
the upper border.
 Cont…
 At the front of iliac crest can be felt a bony prominence known as the
anterior superior iliac spine.
 Approximately 2.5cm below anterior superior iliac spine is found the
anterior inferior iliac spine.
 There are two similar points at the other end of the iliac crest namely
the posterior superior and the posterior inferior iliac spine.
2. The Ischium
 Is the thick lower part of the innominate bone.
 It has a large prominence known as ischial tuberosities on which the
body can rest when sitting.
 Behind and approximately 2.5 cm above the ischial tuberosities there
is an inward projection known as ischial spines which divides the
greater and lesser sciatic notches and this is the main indicating tool
for the station of the presenting part during labor.
 The pubis
.
 The pubis bone is the smallest of the three components of the
innominate bones.
 The right and left pubic bones are fused by a pad of cartilage known
as symphysis pubis it has two rami the superior and inferior ramus.
 The inferior ramus forms the pubic arch. And also it has a body.
 The space enclosed by the body of the pubic bone, rami and the
ischium is called obturator foramen.
The Sacrum
 Is a wedge shaped bone consists of five fused vertebrae and the upper
border of the first sacral vertebrae just forward known as promontory
of sacrum.
 Laterally the sacrum extends in to a wing or ala.
 Five pairs of holes or foramen pierce the sacrum and through these
nerves from emerge to supply pelvic organs.
 The posterior surface of the sacrum is roughed to receive attachment
of muscles. .
The Coccyx (A Vestigial Tail)
The coccyx consist four fused coccygeal vertebrae forming a small
triangular bone which articulate with the sacrum.
What is the pelvic brim?
 It is the inlet of the pelvis which divides the pelvic cavity into false
and true pelvis
 It is formed by the sacral promontory,ala of the
. pectienal eminience
sacrum, arcuate line of the
pectinal line of the pubis , pubic crest and
symphysis pubis
The pelvic brim is oval in shape
The pelvic cavity is round in shape
Land marks of out let
Ischial spine
Ischial tuberosity
Pubic arch
Tip of coccyx
 .
The pelvic outlet is diamond in shape
• Lower border of symphysis pubis, ischial
tuberosities And tip of coccyx
Measurements of the Brim of the Pelvis
.
1. Anteroposterior diameter of the brim
 Obstetric conjugate: is measured 1.25cm down from the upper
border of symphysis pubis to promontory of the sacrum and it is
about 11cm.
It is named as obstetric conjugate because it represents the available
space for the passage of the fetus.
 Anatomical conjugate: measures slightly more than the
obstetrical conjugate because it extends from the promontory of
the sacrum to the center of the upper surface of symphysis pubis
and is measure 12cm.
 Diagonal conjugate: is also measured from the apex of the pubis
arch to the sacral promontory and is about 13cm.
2. Oblique diameter of the brim
Is measured from sacroiliac joint to iliopectineal eminences it is about
12 cm.
3.Transverse diameter of the brim is measured from the right
iliopectineal line to the left iliopectineal line which is about 13 cm.
.
Measurements of the Cavity of the Pelvis
The cavity is circular in shape and although it is not possible to measure
its diameters exactly they are all considered to be 12cm.
Measurements of the Outlet of the Pelvis
Anteroposterior diameter of outlet
Is measured from the apex of the pubic arch to sacrococcygeal joint
which is measured 13 cm.
Oblique diameter of the out let
Is said to be between the obturator foramen and the sacrospinous
ligaments is taken as being 12cm.
Transverse diameter of the out let
Is a line between the two ischial spines or the two ischial tuberosities
both measurements being the same in the normal pelvis which is
measured 11cm. It is the narrowest diameter in the pelvis.
 Pelvic shape

1. Gynecoid; typical female pelvis found in 50%

women
Rounded slightly oval inlet
Stright pelvic sidewalls with roomy pelvic cavity
• Good sacral curve
• Ischial spine are not prominent
• Pubic arch wide
2. Android; typically male pelvis found in 1/3 white
.
and 1/6 of non white women
• Pelvic brim is heart shaped ,Convergent sidewalls
• Narrow pubic arch and Prominent spine
3. Anthropoid 25% white women and 50% non white
women
• Pelvic brim APD>TD
• Long and narrow pelvic canal with long sacrum
• Stright pelvic sidewall
4. Platypelloid;
 3% women .
 Pelvic brim TD>APD
 Kidney shape
 Sacral promontory pushed forward
Pelvic walls
The inner aspect of the bony pelvis is coverd with
muscles
 Above the brim____ iliacus and psoas
 Sidewalls ______ obturator internus and its fascia
 Posterior wall ___ pyriformis
 Pelvic floor _____ levater ani and coccygeus
Pelvic ligament
 Sacrospinous ligament ; .lateral aspect of the sacrum
to ischial spine
 Sacrotubers ligament; lateral aspect of the sacrun to
inner aspect of ischial tuberoicity
 Sacroillic ligament; medial surface illium to
sacrum
 Illiolubar ligament; illiac crest to lumbar vertebrae
Adequacy of the pelvis to achieve vaginal delivery
• Sacral promontory can not be felt
• Ischial spine are not prominent
• Subpubic arch accept 2-finger
The female reproductive organs
 Cont…

The female reproductive organs consist of external genitalia, collectively known as

the vulva and internal reproductive organs: the vagina, uterus, two uterine tubes
and two ovaries.
The external reproductive organs (the vulva)
Commonly known as the vulva—includes all structures visible externally from the
pubis to the perineum, that is, mons pubis, labia majora, labia minora, clitoris
and perineum.
The mon’s pubis:
a pad of fat lying over the sysmphsis pubis
It is covered with pubic hair from the time of puberty.
Purpose – protect the junction of the pubic bone from trauma.
The labia majora (greater lip): 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.
The labia minora (lesser lips): are two smaller folds of pink skin lying
longitudinally with the labia majora.
The area they in close is known as the vestibule in which the opening of the
urethra and vagina are situated.
The clitoris: is a small sexual organ corresponding to the male penis; the
.
visible knob- like portion is located near the anterior junction of the
labia minora, above the openings of the urethra and vagina.
The prepuse a retractable piece of skin surrounds and protects the
clitoris.
The function of the clitoris is to induce the orgasm of sexual intercourse.
The vestibule: is the area enclosed by the labia minora in which the
opening of the urethra and the vagina is situated.
The urethral orifice: lies 2.5 cm posterior to the clitoris and
immediately in front of of the vaginal orifice.
The vaginal orifice: also known as the introitus of the vagina.
The orifice is partially closed by the hymen, a thin membrane that tears
during sexual intercourse or during the birth of the first child.
Bartholin’s glands: are two small glands that open on either side of the
vaginal orifice & lie in the posterior part of the labia majora.
They secrete mucus, which lubricates the vaginal opening.
.
The internal reproductive organs

.
The female internal reproductive organs include; the vagina, cervix, uterus,
uterine tubes and ovaries.
The vagina
The vagina is a hollow distensible fibro muscular tube that extends from
the vaginal orifice in the vestibule to the cervix.
It is approximately 10 cm in length and 2.5 cm in diameter.
During sexual intercourse and child birth, the vagina temporarily widens
and lengthens.
Function
The vagina allows the escape of the menstrual fluids
Receives the penis & the ejected sperm during sexual intercourse
Provides an exit for the fetus during birth
The uterus
The uterus is a hollow pear-shaped muscular organ located between the
bladder & the rectum.
The position of the uterus is anteversion & anteflexion
Anteversion means that the uterus leans forward & anteflexion
.
means that it bends forward upon itself.
When the woman is standing, the uterus is in an almost horizontal
position with fundus resting on the bladder.
Function
The main function of the uterus is to nourish the developing fetus
prior to birth
It prepares for pregnancy each month & following pregnancy
expels the products of conception.
Structure
The non-pregnant uterus is 7.5 cm long, 5 cm wide & 2.5 cm
depth
The uterus consists the following parts
The cornua are the upper outer angles of the uterus where the uterine
tubes join. .
The fundus is the domed upper wall between the insertions of the
uterine tubes.
The body or corpus make up the upper two-thirds of the uterus & is
the greater part.
The cervix or neck protrudes in to the vagina. The upper half, being
above the vagina, is known as the supravaginal portion, while the
lower half is the infravaginal portion.
The internal os (mouth) is the narrow opening between the isthmus
& the cervix.
The external os is a small round opening at the lower end of the
cervix
Layers
The uterus has three layers
The endometrium: is the inner layer of the uterus.
.
The endometrium is constantly changing in thickness throughout the
menstrual cycle.
The myometrium is the middle and the thick layer in the upper part of
the uterus.
The perimetrium is the outer most layer and a double serous
membrane.
Uterine tubes
The uterine tubes, also known as fallopian tubes, are two very fine
tubes leading from the ovaries in to the uterus.
Each uterine tube has 10-12 cm length and 1 cm diameter.
The uterine tube has four portions.
The interstitial portion: is 1.25 cm long and lies within the wall of
.
the uterus. Its lumen is 1 mm wide.
The isthmus: is another narrow part that extends for 2.5 cm from
the uterus.
The ampulla: is the wider portion where fertilization usually
occurs. It is 5 cm long.
The infundibulum: is the funnel- shaped fringed end that is
composed of many processes known as fimbriae.
One fimbria is elongated to form the ovarian fimbria, which is
attached to the ovary.
Functions
 Pushs the ovum towards the uterus.
 Receives the spermatozoa as they travel up wards
 Provides a site for fertilization
 Supplies the fertilized ovum with nutrition during its continued
journey to the uterus.
The ovaries
.
The ovaries are components of the female reproductive system and
the endocrine system.
Function
 The ovaries produce oocytes & the hormones estrogen &
progesterone.
 The function of the ovaries is similar with tests in males as the
ovaries produce female sex hormones (estrogen & progesterone)
and tests produce male sex hormones (testosterone and androgen).
.
 The Female Reproductive Hormones and
the Menstrual Cycle
The five main hormones that regulate the female
reproductive system are:
1. Gonadotropin Releasing Hormone (GnRH) is produced
by a part of the brain called the hypothalamus.
When it circulates in the blood, it causes the release of two
important hormones from the pituitary gland in another
specialized part of the brain.
2.Follicle Stimulating Hormone (FSH) is produced by the
pituitary gland during the first half of the menstrual cycle.
It stimulates development of the maturing ovarian follicle and
controls ovum production in the female, and sperm
production in the male.
3. Luteinizing Hormone (LH) is also produced by the
pituitary gland in the brain.
.
It stimulates the ovaries to produce oestrogen and
progesterone.
It triggers ovulation, and it promotes the development of the
corpus luteum.
After ovulation, the lining of the empty follicle grows and
forms a yellow body in the ovary called the corpus luteum,
which temporarily functions as a hormone-producing organ.
It secretes oestrogen and progesterone for about the next 14
days.
Oestrogen thickens the fatty tissues in the wall of the uterus in
case pregnancy occurs.
Progesterone stops further ovulation from occurring during the
pregnancy.
4. Oestrogen is a female reproductive hormone, produced
primarily by the ovaries in .the non-pregnant woman.
It promotes the maturation and release of an ovum in every
menstrual cycle.
It is also produced by the placenta during pregnancy.
5. Progesterone is produced by the corpus luteum in the
ovary; its function is to prepare the endometrium for the
reception and development of the fertilized ovum.
It also suppresses the production of oestrogen after ovulation
has occurred.
The length of the menstrual cycle is typically 28 days, but it
can be highly variable.
In some women it may be as short as 21 days or as long as
39 days.
The menstrual cycle is best understood if we focus first on
. and then on events
events occurring in the ovaries,
occurring in the uterus.
We are going to describe as ovarian and menstrual cycle in
turn.
The Ovarian Cycle
The ovarian cycle is associated with the maturation and
release of an ovum, and the ‘just in case’ preparation for
its fertilization and implantation in the uterus.
The ovarian cycle consists of two consecutive phases, each
of about 14 days’ duration.
Events are measured from ‘day 1’, which is the first day of
the last normal menstrual period (LNMP).
The Follicular Phase: Days 1-14
. follicles containing
During this period, a few ovarian
immature ova develop and mature under the stimulation of
FSH and LH.
Usually by day 14, only one follicle has become fully
mature, and the ovum it contains is ready to be released.
Note that only one time interval is fairly constant in all
females.
The time from ovulation to the beginning of menstruation,
which is almost always 14-15 days, however, the time of
ovulation is variable and difficult to predict accurately.
The Luteal Phase: Days 15-28
. luteum activity,
This phase is the period of corpus
during which the uterus is prepared ‘just in case’ of
pregnancy.
After ovulation has occurred, the corpus luteum begins
to secrete progesterone, as well as a small amount of
oestrogen.
Progesterone maintains the uterus in a state ready to
receive and nourish an embryo.
The lining of the uterus (the endometrium) becomes
thicker, more richly nourished by blood vessels, and
more receptive to the fertilized ovum.
The Uterine Cycle
.
The function of the uterine cycle is to prepare the lining
the uterus, called the endometrium, to receive a possible
of

embryo in case of fertilization.

The beginning of the uterine cycle is marked by the onset of
menstruation.
Following menstruation this the endometrium begins
thickening again, stimulated by estrogen hormone
secretion.
After ovulation, progesterone secretion allows the
endometrium to undergo the ultimate changes that will
make it suitable to accommodate the embryo if there is
fertilization.
In the absence of fertilization, the uterine cycle begins
again. The average cycle length is 28 day.
The Menstrual Phase: Days 1-5
. ovulation, the corpus
If fertilization does not occur after
luteum will degenerate and production of progesterone will
decrease, so the stimulus for maintaining the thick
endometrium will disappear.
The reduction in progesterone causes the shedding of the
thick endometrial lining.
The endometrium was richly supplied with blood vessels to
nourish the fetus if a pregnancy occurred, so when it
disintegrates and passes down the vagina, some blood is
mixed in with it.
Menstruation usually occurs at monthly intervals throughout
the reproductive years, except during pregnancy.
Breastfeeding a baby also suppresses menstruation.
The Proliferative Phase: Days 6-14
The concentration of oestrogen. in the blood is rising during
this period, following the end of menstruation, as the
ovaries prepare for the next ovulation at around day 14.
During this phase the endometrium grows thicker and
becomes more richly fed by blood vessels in preparation
for the possibility of fertilization and pregnancy
The Secretary Phase: Days 15-28
During this phase, the blood concentration of progesterone
increases, which causes even more blood vessels to grow
into the endometrium.
This makes the endometrium receptive to the fertilized
ovum.
 .
If the ovum is fertilized and the embryo implants in
the endometrium and a placenta develops, it
produces a hormone called human chorionic
gonadotropin (HCG) throughout pregnancy.
The detection of HCG in a woman’s urine is the
basis of most pregnancy tests.
HCG signals the corpus luteum to continue to supply
progesterone to maintain the thick, nourishing
endometrium throughout the pregnancy.
Reading Assignment .
Current Issues in Maternal Newborn Nursing and
Care of the Family in a Culturally Diverse Society
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10/11/2022 Demeke Andebet 44