obs & gynae-1
NURSING COURSE CODE: NCN312
Credits: 3
Instructor: Sampson Nyame
Course Content Overview
Unit 1: Female Reproductive Organs
External and Internal Genitalia: Anatomy and functions
Accessory Organs of Reproduction: Breast structure, function, and physiology of lactation
The Bony Pelvis: Measurements and ligaments
The Fetus: Skull structure, development, and changes at birth
Fertilization: Development of ovum
Placenta: Development, structure, functions, and abnormalities at term
Unit 2: Normal Pregnancy
Physiology and Clinical Features: Of normal pregnancy
Diagnosis: Methods of diagnosing pregnancy
Minor Disorders: Common complications and their management
Antenatal Care: Importance of prenatal care
Nutrition and Personal Hygiene: Dietary needs and hygiene in pregnancy
Health Education: Educating patients about pregnancy
Fetal Circulation: Overview of circulation during pregnancy
Unit 3: Abnormal Pregnancy
Bleeding in Early Pregnancy: Abortion and ectopic pregnancy
Bleeding in Late Pregnancy: Antepartum hemorrhage
Pregnancy Induced Hypertension: Conditions like eclampsia
Unit 4: Normal Labour
Physiology of Labour: Understanding the labour process
Signs and Stages of Labour: Management during labour
Normal Puerperium: Physiological changes and management after childbirth
Unit 5: Effects of Various Conditions on Pregnancy
STDs and Infections: Impact on pregnant women and fetus, including HIV, HBV, malaria, and diabetes
Care of the Newborn: Resuscitation and management techniques
Unit 6: Drugs Used in Obstetrics
Examples: Oxytocin, antacids, morphine, etc.
Unit 7: Obstetric Emergencies
Types of emergencies: Antepartum hemorrhage, obstructed labour, pre-eclampsia, and postpartum hemorrhage
The Female Reproductive System
Structure: Divided into external and internal genitalia, facilitating copulation, fertilization, fetal development, and childbirth.
Components: Internal (ovaries, fallopian tubes, uterus, vagina) and external (vulva, clitoris) organs.
Development: Originates from Müllerian ducts around the 6th week of gestation, maturing during puberty under the regulation of hormones like estrogen.
External Genitalia (Vulva)
Provides protection to internal reproductive organs and plays roles in sexual pleasure and childbirth.
Key Components
Mons Pubis: Fatty tissue over the pubic bone, covered with pubic hair during puberty.
Labia Majora: Larger outer skin folds that protect internal organs, also hairy.
Labia Minora: Smaller inner folds without hair, highly vascularized.
Urethral Opening: Exit point for urine from the bladder.
Clitoris: Erectile organ rich in nerve endings, sensitive during arousal.
Vaginal Opening: Entry point for the penis and birth canal during delivery.
Bartholin Glands: Secrete lubricating fluid during arousal.
Hymen: Thin membrane partially covering the vaginal opening, may tear during intercourse or tampon use.
Perineum: Area between the vaginal opening and anus.
Internal Genitalia
Essential for reproduction: Include ovaries, fallopian tubes, uterus, and vagina.
Vagina
Structure: Muscular and tubular, extends from vaginal opening to cervix.
Functions: Sexual intercourse, menstrual flow, childbirth as the birth canal.
Uterus (Womb)
Structure: Hollow, pear-shaped organ with three main parts:
Fundus: Upper part where fallopian tubes enter.
Body: Middle segment for implantation of fertilized ovum.
Cervix: Lower section connecting to the vagina, producing changing mucus during the menstrual cycle and pregnancy.
Layers of the Uterus
Perimetrium: Outermost thin membrane covering the uterus.
Myometrium: Thick muscular layer responsible for contractions during childbirth.
Endometrium: Innermost layer thickening for implantation and shedding during menstruation if no implantation occurs.
Fallopian Tubes
Two tube-like structures from the uterus to the ovaries, primarily transporting ova. Fertilization typically occurs in the ampulla, the widest part of the tube.
Ovaries
Small, oval organs on either side of the uterus. Functions include:
Oocyte Production: Release of ova during ovulation.
Hormone Secretion: Production of estrogen and progesterone, regulating the menstrual cycle and preparing the uterus for pregnancy.
The Bony Pelvis
Structure: Basin-shaped skeletal structure at the lower trunk end, formed by bones connecting the vertebral column and lower limbs.
Importance: Crucial in obstetrics for forming the birth canal during delivery.
Functions of the Bony Pelvis
Supports abdominal and pelvic organs (uterus, bladder, rectum).
Forms birth canal during childbirth.
Transfers body weight from trunk to lower limbs.
Provides attachment for muscles and ligaments.
Protects reproductive organs.
Bones that Form the Pelvis
Consists of four bones:
Two Hip Bones (Innominate Bones): Each composed of iliac, ischial, and pubic components meeting at the acetabulum.
Sacrum: Forms the posterior pelvic wall, connects spine to pelvic bones.
Coccyx: Tailbone, moves backward during childbirth to increase pelvic outlet size.
Divisions of the Pelvis
False Pelvis (Greater Pelvis): Supports abdominal organs but not used in childbirth.
True Pelvis (Lesser Pelvis): Forms the birth canal, containing the uterus, cervix, vagina, rectum, and bladder.
Pelvic Planes
Pelvic Inlet: Superior pelvic aperture, bounded by sacral promontory, iliac lines, pubic symphysis, serves as the entry to birth canal.
Pelvic Cavity: Space between inlet and outlet, where fetal head rotates during labor.
Pelvic Outlet: Lower opening; boundaries include coccyx, ischial tuberosities, and pubic arch, serving as exit during delivery.
Types of Female Pelvis (Caldwell–Moloy Classification)
Gynecoid Pelvis: Most common, favorable for vaginal delivery (rounded inlet, wide pubic arch).
Android Pelvis: Male-type pelvis with heart-shaped inlet leading to difficulties in labor.
Anthropoid Pelvis: Oval inlet causes common occipito-posterior positions during labor.
Platypelloid Pelvis: Flat pelvis leads to delayed engagement of fetal head.
Pelvic Diameters (Measurements)
Crucial to determine vaginal delivery feasibility, with measurements including:
Anteroposterior Diameter: True conjugate is about 10.5 cm.
Diagonal Conjugate: Measured during examination at about 12.5–13 cm.
Transverse Diameter: Farthest points of pelvic brim ranging around 13 cm.
Interspinous Diameter: Between ischial spines at about 10 cm, narrowest part.
Outlet Diameters: Anteroposterior (11–12 cm) and transverse (10–11 cm).
Pelvic Ligaments
Sacroiliac Ligaments: Connect sacrum to ilium.
Sacrotuberous Ligament: Connects sacrum to ischial tuberosity.
Sacrospinous Ligament: Connects sacrum to ischial spine.
Pubic Ligaments: Support symphysis pubis.
Changes in Pelvis During Pregnancy
Hormonal effects lead to relaxation of ligaments, widening of symphysis pubis, and increased joint mobility for childbirth.
Obstetric Importance of the Pelvis
Determines delivery type (vaginal or caesarean). Influences fetal engagement and labor mechanism stages (engagement, descent, flexion, internal rotation, extension, external rotation, expulsion).
Clinical Conditions Related to Pelvis
Contracted Pelvis: Smaller than normal, leading to obstructed labor.
Cephalopelvic Disproportion (CPD): Fetal head too large for pelvis, often requires cesarean section.
Pelvic Fractures: Can affect future pregnancies and delivery.
Accessory Organs – The Breast (Mammary Glands)
Breasts function to produce milk (lactation), containing 15-20 lobes, subdivided into smaller lobules containing alveoli (milk-producing cells).
Location and General Description
Positioned on anterior chest wall from the 2nd to the 6th rib and from the sternum to mid-axillary line, lying over pectoralis major and serratus anterior muscles.
External Structure of the Breast
Nipple: Projection with openings for lactiferous ducts, surrounded by areola, rich in nerve endings for breastfeeding.
Areola: Pigmented area with sebaceous glands that maintain nipple health during breastfeeding.
Internal Structure of the Breast
Lobes: Milk-producing units within the breast.
Lobules: Smaller units containing alveoli for milk production.
Alveoli: Milk-secreting cells surrounded by myoepithelial cells.
Lactiferous Ducts: Transport milk to the nipple.
Lactiferous Sinus: Stores milk before reaching the nipple.
Supporting Structures of the Breast
Cooper's Ligaments: Support and maintain breast shape; damage leads to sagging.
Adipose Tissue: Determines breast size but does not affect milk production.
Blood Supply of the Breast
Supplied by internal thoracic artery, lateral thoracic artery, and intercostal arteries;
Venous drainage through axillary and internal thoracic veins.
Nerve Supply
Innervated by intercostal nerves (4th-6th), providing sensation and triggering milk ejection reflex.
Lymphatic Drainage of the Breast
Important in breast cancer spread; primarily through axillary lymph nodes (75%), internal mammary nodes, and supraclavicular nodes.
Development of the Breast
During Puberty: Under estrogen and progesterone, breast enlargement, duct development, and fat deposition.
During Pregnancy: Hormonal influence leads to increased vascularity and lobule enlargement; colostrum is produced.
Physiology of Lactation
Phases:
Mammogenesis: Mammary gland development.
Lactogenesis: Initiation of milk secretion post-delivery.
Galactopoiesis: Maintenance of milk production stimulated by infant suckling.
Hormonal Control of Lactation
Prolactin: Stimulates milk production from the anterior pituitary.
Oxytocin: Causes milk ejection, released from the posterior pituitary.
Let-Down Reflex (Milk Ejection Reflex)
Occurs when the baby suckles, triggering oxytocin release and subsequent milk ejection from mammary glands.
Composition of Breast Milk
Nutrients: Proteins, fats, carbohydrates (lactose).
Immunological Components: Immunoglobulin A (IgA), white blood cells, antibodies.
Vitamins and Minerals: Calcium, iron, vitamins A, B, C, and D.
Types of Breast Milk
Colostrum: Produced in the first 3-4 days, yellowish, rich in antibodies and protein, protecting newborn.
Transitional Milk: Between days 4-10 postpartum, increased fat and lactose.
Mature Milk: After 2 weeks postpartum, providing balanced nutrients for infant growth.
Functions of the Breast
Production of breast milk, nourishment of infants, antibody transfer, and promotion of bonding.
Benefits of Breastfeeding
For the Baby: Ideal nutrition, infection protection, brain development promotion, allergy risk reduction.
For the Mother: Uterine contraction, postpartum hemorrhage reduction, weight loss facilitation, breast cancer risk reduction.
Common Disorders of the Breast
Mastitis: Inflammation leads to pain and swelling, often due to a bacterial infection.
Breast Engorgement: Excessive milk accumulation causing painful swollen breasts.
Cracked Nipples: Often due to improper breastfeeding technique.
Breast Cancer: Most common cancer in women; early signs include lumps, skin changes, and nipple discharge.
Ovulation
Process: Release of mature ovum from ovarian follicle into the fallopian tube, typically around day 14 of a 28-day cycle.
Physiology of Ovulation
Controlled by hormones (GnRH, FSH, LH) affecting the hypothalamus, pituitary gland, and ovaries.
Stages of Ovulation
Follicular Phase: Development of several follicles; one becomes dominant (Graafian follicle) with increasing estrogen.
Ovulatory Phase: LH surge causes rupture of the mature follicle, releasing the ovum.
Luteal Phase: Corpus luteum forms from the