Download Midwifery 1 150363

Midwifery 1
150363
Anatomy of reproductive system
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Female pelvis
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The woman’s pelvis is adapted for child
bearing, transmits the weight of the trunks to
the femur.
It protects pelvic and abdominal contents.
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Pelvic bones
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Four pelvic bones
-Two innominate (hip bones)
-one sacrum
- One coccyx
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Illium: is the large flared-out part. Illiac crest
is the upper border.
Ischium: is the thick lower part. It has a large
prominence known as ischial tuberosity, on
which the body rests during sitting.
Ischial spines is an inward projection behind
tuberosity.
It is important in labor.
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Pubic bone: forms the anterior part.
The two pubic bones meet at the symphysis
pubis and the two inferior rami form the pubic
arch.
Obturator foramen is the space enclosed by
pubic bone, the rami and ischium.
All the the three pelvic bone contribute to the
formation of acetabulum.
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Sacrum: is a wedge shaped consists of 5 fused
vertebrae/
The upper border of the first vertebra juts
forward and is known as sacral promontory.
The anterior surface of the sacrum is concave
referred to as hollow of the sacrum.
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Coccyx: is a vestigial tail.
It consists of four fused vertebrae forming
triangular bone.
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Pelvic joints
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There are four pelvic joints:
1- one symphysis pubis: is formed at the junction of
of two pubic bones.
Two sacroiliac joints: are the strongest joints in the
body, join the sacrum to the illium and thus connect
the spine to the pelvis.
One sacrocooygeal joint: is formed where
The base of the coccyx articulates with the tip of the
sacrum.
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Pelvic ligaments
Each of the pelvic joints is held together by ligaments.
 Interpubic ligaments at the symphysis pubis
 Sacroiliac ligaments
 Sacrococcygeal ligaments
two other ligaments are important in midwifery:
 The sacrotuborous ligament: runs from the sacrum to the
ischial tuborosity
 The sacrospinous ligament: runs from the sacrum to the
ischial spines.
 These two ligaments form cross sciatic notch and form the
posterior wall of the pelvic outlet.
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the true pelvis
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Is the boney canal through which the fetus
must pass during birth.
It has brim, cavity and outlet.
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1- The pelvic brim
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Is round where sacral promontory projects in to it.
The midwife needs to be familiar with the fixed
points in on the pelvic brim.
1- sacral promontory
2-sacral al or wings
3-sacroiliac joints
4- iliopectineal line (the edge formed at the inward
aspect of the ilium.
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5- superior ramus of pubic bone
Upper inner border of the symphysis pubis
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Diameters of the brim
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The anteroposterior diameter: is a line from the
sacral promontory to the posterior border of upper
surface of the symphysis pubis named obstetrical
conjugate and measures 11cm. It represents the
available space for the passage of the fetus.
Oblique diameter: is a line from one sacroiliac joint
to the iliopectineal eminence in the opposite side.
Transverse diameter: is a line between the points
furthest apart on the iliopectineal lines and measures
13 cm.
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2- Pelvic cavity:
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A curved canal extends from the brim above
to the outlet below.
The anterior wall is formed by pubic bones
and symphysis pubis and it’s depth is 4cm.
Posterior wall is formed by the curve of the
sacrum.
All it’s diameters measure 12cm.
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3- the pelvic outlet
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Described as anatomical and obstetrical.
The obstetrical outlet is significant because it
contains the narrow pelvic strait through
which the fetus must pass.
It lies between the sacrococcygeal joint, the
two ischial spines and and the lower border of
the symphysis pubis.
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False pelvis
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Is the part of the pelvis situated above the
pelvic brim.
Is formed by the upper flared-out portions of
the illiac bones, and protects the abdominal
organs.
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The four Pelvic types
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Traditional obstetrics characterizes four types of
pelvises:
Gynecoid: Ideal shape, with round to slightly oval
(obstetrical inlet slightly less transverse) inlet: best
chances for normal vaginal delivery.
Android: triangular inlet, and prominent ischial
spines, more angulated pubic arch.
Anthropoid: inlet transverse is greater than inlet
obstetrical diameter.
Platypelloid: Flat inlet with shortened obstetrical
diameter
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The pelvic floor
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Is composed of muscle fibers of the levator ani, the
coccygeus, and associated connective tissue which
span the area underneath the pelvis.
It is important in providing support for pelvic viscera
(organs), e.g. the bladder, intestines, the uterus (in
females), and in maintenance of continence as part
of the urinary and anal sphincters.
It facilitates birth by resisting the descent of the
presenting part, causing the fetus to rotate forwards
to navigate through the pelvic girdle.
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Pelvic muscles
Superficial Muscles of the Pelvic Floor
 The most superficial layer of muscles in the female
pelvic floor looks like a figure 8.
 1- External anal sphinctor: encircles the anus
 2- Transverse perineal muscle: pass from ischial
tuborosities to the center of the perineum.
 3- Bulbocavernosus muscles pass from forwards
around the vagina to clitoris just under pubic arch.
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4-ischiocavernosus muscle pass from ischial
tuberosities along pubic arch to clitoris.
5- membranous sphincter of the urethra is
composed of muscle fibers passing above and
below urethra and attached to pubic bones.
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Deep layer
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Are three pairs of muscles known as levator ani
muscle.
Each levator ani muscle (left &right)consist of the
following:
Pubococcygeus muscle: pass from pubis to the
coccyx forming deepest part of perineal body.
iliococcygeus muscle: line covering the obturator
foramen to the coccyx.
Ischiococcygeus muscle: passes from the ischial
spine to the coccyx, infront of the sacrospinous
ligament.i
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Perineal body
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Is a pyramid of muscle and fibrous tissue
sotiuated between the vagina and rectum.
It measures 4 cm in each direction.
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External genitalia
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The term vulva applies to female external
genitalia and consists of:
The monis veneris
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It consists of:
1- Mons Pubis : The mons (also called mons
venereum) is the rounded fatty mass over the
pubic bone covered with hair and coarse skin.
 It also contains sebaceous and sweat glands
called the apocrine glands.
 These glands release a secretion with a
characteristic smell that increases sexual
attraction.
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female reproductive system
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The female reproductive anatomy consists of
the external genital organs, the internal genital
organs and the breasts, which are the
accessory organs of reproduction.
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2- Labia Majora
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The labia majora are bilateral folds of skin with
underlying fat extending backwards from the mons
pubis.
Posteriorly they merge into the perineum in front of
the anus.
Their outer surface becomes covered with hair at
puberty. But the inner surface remains smooth,
moistened by the secretions from the sebaceous and
other glands deep inside.
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3- Labia Minora :
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The labia minora are delicate flaps of soft skin which
lie within the labia majora.
They may be of different sizes in different women.
Their inner surfaces remain in contact with each
other.
Anteriorly, they unite to enclose the clitoris between
them, forming the prepuce and frenulum from before
backwards.
The labia minora contains no fat but are so vascular
that they become turgid during sexual stimulation.
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4- Vestibule :
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The vestibule is the part of the vulva lying
between the two labia minora.
It has two important openings – (a) the
external urethral opening -(b) the vaginal
opening which is a larger opening behind the
urethral opening.
In virgins, the opening of the vagina is
covered by a thin incomplete membrane,
called the ‘hymen’
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5- Clitoris :
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The clitoris is present in the upper part of the
vestibule at the point where the two labia minor
meet.
It is a small cylindrical structure homologous to the
penis in males. Like the male penis, it also has a
glans, a prepuce and two corpora cavernosa which
are attached to the pubic bones.
The clitoris is made up of erectile tissue and is
richly supplied with nerves, making it the most
erotically sensitive part of the body.
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6- Bartholin’s glands :
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These are small pea-sized glands situated
inside the vestibule on either side of the
vaginal opening. They produce a mucoid
secretion
At times of sexual excitement that help to
lubricate the vagina and vulva.
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7- Perineum :
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The perineum is the less hairy cutaneous area
lying between the vaginal orifice in front and
the anus behind.
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8- Vaginal orifice: known as introitus of the
vagina and and is partially closed by the
hymen.
9-Urethral orifice: lies 2.5 cm posterior to the
clitoris.
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Internal structure
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1- Vagina:
The vaginal wall is a thick, fibromusclar tube that
forms the inferior- most region of the femalereproductive tract and measures about 4 inches in
length in an adult female.
It connects the uterus with the outside of the body
anteromedially.
It is also the exit canal for blood discharge during
menstruation and the baby during a vaginal
childbirth.
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2- Cervix:
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The cervix is situated between the vagina and the
uterus.
It mucous membranes helps to either allow for the
passage of sperm or the obstruction of sperm.
The sperm must pass through the cervix to reach an
unfertilized egg.
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When a baby is born it must pass through the cervix
as it exits the uterus and enters the vagina.
Cervical cancer is the greatest cancer concern for
woman. Yearly pap smear cultures can monitor and
detect abnormalities.
It is common to have cervical cysts that cause no
difficulties to cause concern. They can be monitored
for changes and enlargement.
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3- Uterus:
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This muscular organ is made up of three layers from deep to
superficial:
1- endometrium: can be further divided into Stratum Basalis and
Stratum Functionalis which is the growth filled with blood
and sluffed out on the next menstartion.
A fertilized egg implants itself into the wall of the endometrium
where it will develop throughout the pregnancy.
Its also made up of 2 main parts. The Fundus which it the dome
top of the uterus and the Body which is inferior to the fundus
and superior to the cervix.
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2- Myometrium: this is a thick layer in in the
upper part of the uterus and is more sparse in
the isthmus and cervix.
3- perimetrium: is a double serous membrane
and extension of the peritonium which is
draped over the uterus.
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Uterine parts
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The body or corpus: makes up the upper two thirds
of the uterus and is the greatest part.
Fundus: is the upper domed wall between the
insertion of the uterine tubes.
The cornua: are the upper outer angles of the uterus
where the uterine tubes join.
The cavity: is the space between the anterior and
posterior wall.
Isthmus: is a narrow area between the cavity and the
cervix.
The cervix or neck: protrudes in to the vagina.
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cervix
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Internal os narrow
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4- Fallopian Tubes or uterine tubes:
The fallopian tubes extend superiolaterally off the
uterus and connects with the ovaries. These tubes
have finger like projection's called Fimbrae at the
end of the tube near the ovary.
These finger like projections help to collect mature eggs
released by the ovaries. Fertilization of the egg
happens mostly in the first one third of the fallopian
tube.
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5- Ovaries:
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Women have an ovary on each side of the uterus. Each month
the ovaries release an egg which is then fertilized or sloughed
off. They also produce estrogen and progesterone which help
with reproductive function.
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Ovarian cysts form when an egg in the ovary begins to
mature and grow but is not released.
It can cause pain if it twists and infection and possible death
if it bursts.
If one ovary is removed, there is still a good chance of
becoming pregnant and releasing enough estrogen to help
regulate body needs
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6- Breast
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-Mammory glands are composed of glandular tissue and a variable
amount of fat.
They are also have a complex secretory product called breast milk.
Breast milk travels through a passageway called the Lactiferous duct,
which travels from the alveoli to the nipple.
The nipple is a centrally located projection on the breast comprised partly
of erectile tissue.
The Areola is the darkened region of the breast that surrounds the nipple.
An areola may vary in color depending on whether or not a woman has
given birth.
Self screening checks on your own/Signs and symptoms of breast cancer
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Female pelvis and reproductive organs
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The primary function of pelvis is to allow
body movement.
Pelvic characteristics gives rise to no
difficulties in child birth, providing the fetus
of it’s normal size.
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