PARTS OF THE URINARY

URINARY SYSTEM IN SYSTEM AND THEIR

FUNCTIONS, CHANGES IN

OBSTETRICS THE URINARY SYSTEM

DURING PREGNANCY ,
LABOUR AND PUERPERIUM
RECAP OF THE URINARY
SYSTEM
This consists of the following
1. 2 kidneys
2. 2 ureters
3. 1 bladder
4. 1 urethra
KIDNEYS
These are 2 bean shaped glands positioned at the back of the
abdominal cavity, high up under the diaphragm.
The right kidney is displaced a little downwards by the liver, sothe
2 kidneys are not quite level.
FUNCTIONS OF THE KIDNEYS
1. Excretion of soluble waste from the blood
2. to prevent substances that are needed by the body from being
lost
3. helps in the formation of red blood cells.
URETERS
These are two tubes that convey urine from the kidneys to the urinary bladder.
They are composed of
1. an outer coat of fibrous tissue continuous with the fibrous capsule of the
kidneys.
2. a middle muscular coat, which consists of involuntary muscle fibres disposed
of in 3 layers
A. inner longitudinal layer
B. middle circular layer
C. outer longitudinal layer
3. an inner lining of mucous membrane covered by transitional epithelium
arranged in longitudinal folds
BLADDER
The bladder is a muscular distensible organ which acts as a reservoir for urine
until it is convenient for it to be voided.
The bladder is pyramidal in shape with its base triangular .
Although the bladder is a pelvic organ, it may rise into the abdomen when it
is full, during pregnancy too. During labour also, it becomes an abdominal
organ as it is displaced by the gravid uterus.
This organ is very important in midwifery due to its proximity to the uterus.
It also consists of
1. a lining of transitional epithelium forming the rugae
2. a middle layer of tissues on which the epithelial lining rests
3. a muscle coat known as the detrusor muscle
URETHRA
This is a narrow tube . It opens into the vestibule
2.5 cm below the clitoris from the internal meatus
(orifice) of the bladder.
It forms the final passage of urine outside the body.
CHANGES IN THE URINARY SYSTEM
DURING PREGNANCY
CHANGES IN THE URINARY SYSTEM
DURING PREGNANCY
Obvious changes are seen in the kidneys and ureters during
pregnancy.
These are largely as a result of the effect of the hormone
progesterone ( pregnancy sustaining hormone).
It has been noticed that Renal blood flow increases by as much as
70 to 80 percent by the 16 the week of pregnancy. The kidneys
increase in weight and lengthen by 1cm. These 2 major factors
account for the changes in the urinary system as is explained
below;
CHANGES IN THE URINARY
SYSTEM DURING PREGNANCY
1. the hormone progesterone is particularly said to relax
the walls of the ureters and allow dilatation and kinking
of these tubes leading to slowing down /stasis of urinary
flow
2. the compression of the ureters against the pelvic brim
by the enlarging uterus during pregnancy also results in
urinary stasis and an increased risk of urinary tract
infections during pregnancy
CHANGES IN THE URINARY
SYSTEM DURING PREGNANCY
3. there is urgency of micturition during pregnancy; this is a
sudden compelling urge to urinate partly because of the effects of
progesterone.
4. there is also urge incontinence which is the loss of bladder
control, varying from a slight loss of urine after sneezing,
coughing, to complete inability to control urination.
Pressure from the growing uterus and fetus compounds the
severity of urgency of micturition and urge incontinence.
A significant number of women experience these uncomfortable
problems but they spontaneously resolve during the puerperium.
CHANGES IN THE URINARY SYSTEM
DURING LABOUR
1.In labour, the downward pressure exerted by the fetus on the
lower uterine segment of the uterus ( when head descent is taking
place) compresses the urinary bladder leading to frequency of
micturition. This situation is worsened by the increased
production of urine by the kidneys.
2. in addition the maternal urinary system processes both maternal
and fetal wastes, further increasing the total volume of urine to be
excreted in labour.
3. at the end of labour ( 3rd stage) however, a full bladder may
prevent the uterus from involuting as required. It is therefore
mandatory to empty the bladder to prevent obstetric complications
like postpartum haemorrhage.
CHANGES IN THE URINARY
SYSTEM DURING PUERPERIUM
1. Painful or difficult micturition due to tears and lacerations or episiotomy
2. Women may experience retention of urine in the first few days after labour due to
laxity of the abdominal muscles,
3. There may be atony of the bladder
4. There may be compression of the urethra by edema or hematoma
5. There may be reflex inhibition due to stitched perineum or bruised urethra.
REVIEW OF URINE TESTING
A urinalysis is performed at every visit to exclude abnormalities.
Tests for the presence of proteins, sugar and acetone in the urine
are done at the ANC.
A woman can be shown how to test her own urine, but it is more
advantageous to obtain the client’s urine specimen at the health
facility so that possible contamination is ruled out.
A mid stream specimen may be collected and sent to the
laboratory for culture to exclude asymptomatic bacteria
As it is, asymptomatic women are unaware of a disease.
REVIEW OF URINE TESTING
If there is suspicion of contamination, a clean midstream specimen of urine
should be obtained in the following manner;
1. explain procedure to client and have her cooperation.
2. Client is educated/ counselled to wash her vulva thoroughly with clean
water
3. Client is taught to stand over the toilet seat, then bend forward. This is
known as standing ASTRIDE. This way, urine passes directly downwards
without passing the vaginal or rectal orifices.
4. She should pass some urine which is discarded, then pass the rest into a
clean container/ receiver.
5. Urine collected this way is almost sterile and further tested at the laboratory.
CONTINUATION OF URINE
TESTING.
6. wash and dry hands, thank client
7. document findings.