OBSTERICS
Definition - branch of medicine that deals with the phenomena of labor, its
antecedent and its sequel, under normal and abnormal
circumstances.
Aims of Obstetrics - that every pregnancy culminates in a healthy mother and a
healthy baby.
Vital Statistics- to aid in the reduction of deaths from pregnancy and labor.
Birth- complete expulsion from the mother of a fetus
irrespective of whether the cord has been cut
or the placenta is attached.
Abortus- less than. 500 Gms or less than 25 cms. Long or 20 wks gestational age.
Birth rate- no. Of live births /1000 population.
Fertility rate- no. Of births / 1000 female population.
Live birth- when the infant shows signs of life.
Stillbirth- no signs of life.
Neonatal death- death within the first 29 days of life.
Early neonatal death- on the first 7 days of life.
Late neonatal death- death after 7 days but before 29 days.
Stillbirth rate [fetal death rate]- number of stillborn infants /1000 infants
born[including live births and stillbirths].
Neonatal mortality rate- neonatal deaths /1000 live births.
Perinatal mortality - sum of stillbirths and,neonatal deaths.
Perinatal mortality rate - number of stillbirths plus neonatal deaths/1000 live birt
hs.
Low birth weight - infants born weighing less than2500 Gms.
Term infant - born between 37_42 wks.
Pre_term - born before 37 wks. [Premature].
Post term - born after 42 wks.
Direct maternal death - death of a mother from obstetrical complications of
pregnancy, labor and puerperium or from intervention
s,omissions or incorrect treatment.
Indirect maternal death - maternal deaths not directly due to obstetrical
causes but from a previously existing disease, or whic
h developed during pregnancy, labor and puerperium
which was aggravated by the pregnancy.
Non_maternal death - death from accidental or incidental causes not related to
pregnancy.
Maternal mortality rate - number of maternal deaths/ 100,000 live births.
Reproductive mortality - deaths from pregnancy and use of contraceptive
techniques.
Significant Developments in Obstetrics
Diagnosis - improvement in prenatal care and diagnosis of problems.
Birthing facilities.
Advances in treatment
Common causes of maternal mortality.
Hemorrhage.
Hypertension.
Infections
OBSTETRICS
-ANATOMY of the Female and Male Reproductive Tract
The. FEmale : External ; INternal
EXternal:
Vulva - Pudendum
Mons veneris- mons pubis
Labia majora
Labia minora - prepuce , frenulum
Vestibule
Fourchet
Clitoris
Bartholin's glands
Urethral orifice
Vagina - letter H-shaped
Functions - for passage of menstrual blood
- passage of fetus during labor
- receive penis during sexual intercourse
Connects internal and external organs of reproduction
Hymen- imperforate;
Carunculae myrtiformes - c. Hymenales
Relations: anteriorly- urinary bladder
Posteriorly : Rectum( Pouch of Douglas or recto
Uterine. Pouch
Acidic pH- Lactic acid secreted by Lactobacillus acidophilus
(Normal inhabitants of the vagina
Perineum - supported by :
Pelvic diaphragm- levator ani and coccygeus muscles
Urogenital diaphragm- deep transverse perineal muscles,
Constrictor urethra and fascia
Perineal body-bulbocavernosus, superficial transverse
Perineal, external anal sphincter
Site of episiotomy and lacerations during childbirth
INTERNAL GENERATIVE ORGANS
Uterus - Layers of the uterine wall
Perimetrium - serosa
Myometrium- contractile layer
Endometrium- mucosa, responds to hormonal changes
Functions:
SIte of implantation and growth of fetus
Contracts during labor to expel the fetus
Organ of menstruation
Size.: 2.5-5 cms- before puberty
6-8 cms- adult nulliparous
9-10 cms- multiparous
Anatomical relationships-
Anteriorly-urinary bladder
Posteriorly- rectum
Position- ante versoflexion
Parts: fundus
Cornua
Body
Cervix- internal os, external os
Isthmus
Supravaginal, infravaginal portion(portovaginalis
Cervical glands- Nabothian cysts
Ligaments:
Round ligaments- terminate into respective labia majora
Utero sacral
Cardinal _transverse cervical or Mackenrodt ligaments
Broad ligaments ; mesosalpinx
Infundibulo pelvic or suspensory ligament of the ovary
Uteroovarian ligament
Blood supply- uterine arteries , ovarian arteries,
Lymphatics
Nerve supply- Frankenhauser ganglion
Fallopian tubes- oviducts
Parts:interstitial
Isthmus
Ampulla
Infundibulum
Fimbriae- fimbria ovarica
Mucosa - ciliated , movements towards the uterus
Length- 2.5-5 cms long
Most common site of ectopic pregnancy
Function- site of fertilization
Transports the fertilized egg towards the uterine cavity
Ovaries- endocrine function- secretes estrogen and progesterone
Site of ovulation
Ligaments- mesovarium
Uteroovarian ligament
Suspensory ligament or infundibulo pelvic ligament
Parts- tunica albuginea- outermost covering
Cortex- outer layer , contains oocytes which maturie into follicles
Medulla- contains blood supply and nerves
THE FEMALE PELVIS
BOnes: Innominates- right and left:- ilium, ischium and pubis
Sacrum
Coccyx
Joints; Symphysis pubis , sacroiliac and sacrococcygeus
Linea terminalis- imaginary line between the true and the false pelvis.
The false pelvis is above the linea terminalis and the true pelvis
Is below.
Planes and diameters of the Pelvis:
Pelvic inlet( superior strait)
A-P -diameter or OB conjugate- shortest di ameternbetween
the sacral promontory and symphysis pubis- 10 cms.
Transverse diameter - greatest diameter between the linea
Termi nalis
Oblique diameter- right anf left - 13 cms
Diagonal conjugate- lower margin of the symphysis pubis
Sacral promontory
Midpelvis- transverse diameter - interspinous( ischial ) spines
About 11.5 cms
Pelvic outlet:
A-P: 9.5-11.5 cms
Transverse-11cms
Pelvic shapes- Caldwell- Moloy classification
Gynecoid
Android
Anthropoid
Platypelloid
HUMAN SEXUALITY - Discovering the Reproductive/Sexual Period of
the Female
Just like in the male, the female should be sexually mature before
She can perform her role in the reproductive process
Sexual maturity in the female is reached once changes in her
.Body become apparent. These cjhanges in her body occur during
The peri od called puberty. In the female secondary changes during
Puberty have some similarities with those of the male.
In the female secondary changes affect the shape and contour
Of her [Link] pubertyv fatty tissues tend to concentrate inthe
Thighs and buttocks, giving shApe and contour to her body. For the
First time the female experiences growth of pubic hair in the form of
An inverted triangle. But unlike the pubic hair of the male which
Assumes an upright triangle in form.
Together with the growth of pubic hair (pubarche) the female also
The female also notices that hair grows also in the axilla.
. There is also broadening of her hips which does not occur in the
Male.
Also there is marked development of the breasts because of the
Development of the mammary glands.(thelarche)
All these changes are in preparation for her menstruation.
Menarche-is the term referred ro her first menstruation. Which
Occurs between ages 12-15 and which marks the beginning of a
Female ‘s reproductive life
Normal menstruation occurs regularly interrupted only by periods
Of pregnancy , until she reaches menopause, when the woman
Reaches 40-50 yrs old.
Discovering the Reproductive/ Sexual Period of the Male
Sexual maturirty is the readiness of the male to assume his role in the
Reproductive process. In the male, sexual maturity is evidenced by the
Appearance of secondary sexual characteristics during puberty. Which
Occur as a result of the secretion of testosterone, the male hormone
Which is produced in the testes.,plus the appearance of a beard and
Moustache.
The male shoulders also start to widen during puberty.
The tone of his voice deepens and his Adam’s apple becomes
Prominent.
These changes in his physical make up are accompanied by changes
In his psycho-sexual behavior.
The most positive sign of sexual maturity is his ability to produce
Sperms beginning during puberty, which is evidenced by nocturnal
Emissions, which occurs when he is asleep.
The sex cell of the male is called spermatozoon
