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OB UNIT 2 - Anatomy of female reproductive system
Bsc nursing (blaw 213)
Kerala University of Health Sciences
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Textbook of Obstetric and Gynecological Nursing for KUHS FEMALE PELVIS The pelvis is a skeletal ring often referred to as pelvic girdle formed two innominate (hip) bones, the sacrum and the coccyx. Innominate (hip) bones: Each innominate (hip) bone is made up of three bones: Ilium, Ischium and Pubis. Ilium is large flared out part. The concave inner surface is iliac fossa and curved upper border is the iliac crest. At the front of iliac crest, there is bony prominence known as anterior superior iliac spine and below is anterior inferior iliac spine. On posterior side of iliac crest, similar bony prominence called posterior superior and posterior inferior iliac spine are located. Ischium forms parts of acetabulum above and the thick lower part is the ischial tuberosity. The slight projection behind and just above the tuberosity is called ischial spine. Ischial spine helps to assess the station of the head during labor. Pubis is a small bone that has a body and two projections called superior ramus and the inferior ramus. Two pubic bones meet at the symphysis pubis. Two inferior rami form the apex of pubic arch. Sacrum: The sacrum is a bone consisting of five fused vertebrae and lies between the two ilium on each side. The prominent upper border is known as sacral promontory. The smooth concave anterior surface is referred to as hallow of the sacrum and the areas on either side are the alae or wings. Coccyx: It is a small triangular bone which articulates with the lower end of the sacrum. During labor the coccyx moves backward to enlarge the pelvic outlet. Divisions of Pelvis False pelvis: It is the part of the pelvis situated above the pelvic brim. It is formed upper portions of the iliac bones. Function of false pelvis is to support the gravid uterus. True pelvis: It lies below the pelvic brim. The fetus passes through the bony canal during labor. It is divided into three planes: Brim, cavity and outlet. i. Brim: It is the upper boundary of true pelvis. It is bounded upper margin of symphysis pubis in linea terminalis on sides and sacral promontory at back. ii. Cavity: It is circular in shape and is the space between the brim and that of outlet. Outlet: It is bounded lower margin of symphysis pubis in front, ischial tuberosities on sides and tip of sacrum posteriorly. Pelvic Joints Sacroiliac joint Four pelvic joints are as follows: Sacroiliac Sacrococcygeal Symphysis Different pelvic joints are shown in Figure 1. Pelvic Ligaments Sacroiliac ligament Pubic ligament Sacrotuberous ligament Sacrospinous ligament Iliolumbar ligament Sacrococcygeal joint Symphysis pubis Different pelvic ligaments are shown in Figure 2. Fig. 1: Pelvic joints Textbook of Obstetric and Gynecological Nursing for KUHS FEMALE PELVIS The pelvis is a skeletal ring often referred to as pelvic girdle formed two innominate (hip) bones, the sacrum and the coccyx. Innominate (hip) bones: Each innominate (hip) bone is made up of three bones: Ilium, Ischium and Pubis. Ilium is large flared out part. The concave inner surface is iliac fossa and curved upper border is the iliac crest. At the front of iliac crest, there is bony prominence known as anterior superior iliac spine and below is anterior inferior iliac spine. On posterior side of iliac crest, similar bony prominence called posterior superior and posterior inferior iliac spine are located. Ischium forms parts of acetabulum above and the thick lower part is the ischial tuberosity. The slight projection behind and just above the tuberosity is called ischial spine. Ischial spine helps to assess the station of the head during labor. Pubis is a small bone that has a body and two projections called superior ramus and the inferior ramus. Two pubic bones meet at the symphysis pubis. Two inferior rami form the apex of pubic arch. Sacrum: The sacrum is a bone consisting of five fused vertebrae and lies between the two ilium on each side. The prominent upper border is known as sacral promontory. The smooth concave anterior surface is referred to as hallow of the sacrum and the areas on either side are the alae or wings. Coccyx: It is a small triangular bone which articulates with the lower end of the sacrum. During labor the coccyx moves backward to enlarge the pelvic outlet. Divisions of Pelvis False pelvis: It is the part of the pelvis situated above the pelvic brim. It is formed upper portions of the iliac bones. Function of false pelvis is to support the gravid uterus. True pelvis: It lies below the pelvic brim. The fetus passes through the bony canal during labor. It is divided into three planes: Brim, cavity and outlet. i. Brim: It is the upper boundary of true pelvis. It is bounded upper margin of symphysis pubis in linea terminalis on sides and sacral promontory at back. ii. Cavity: It is circular in shape and is the space between the brim and that of outlet. Outlet: It is bounded lower margin of symphysis pubis in front, ischial tuberosities on sides and tip of sacrum posteriorly. Pelvic Joints Sacroiliac joint Four pelvic joints are as follows: Sacroiliac Sacrococcygeal Symphysis Different pelvic joints are shown in Figure 1. Pelvic Ligaments Sacroiliac ligament Pubic ligament Sacrotuberous ligament Sacrospinous ligament Iliolumbar ligament Sacrococcygeal joint Symphysis pubis Different pelvic ligaments are shown in Figure 2. Fig. 1: Pelvic joints Unit 2 I Review of Anatomy and Physiology of Female Reproductive System Anterior longitudinal ligament Iliolumbar ligament Anterior sacroiliac ligament Sacrotuberous ligament Inguinal ligament Sacrospinous ligament Fig. 2: Pelvic ligaments Landmarks of Pelvis There are nine landmarks of pelvis as shown in Figure 3: 1. Sacral promontory 2. Ala or wings of sacrum 3. Sacroiliac joint 4. Iliopectineal line 5. Iliopubic eminence 6. Pectineal line 7. Pubic tubercle 8. Pubic crest 9. Symphysis pubis Sacral promontory Sacroiliac joint Iliac crest Ala of Iliac sacrum fossa Anterior sacral foramen Sacrum Pelvic brim Anterior superior iliac spine Anterior inferior iliac spine Acetabulum Ischial spine Obturator foramen Pectineal line Ischiopubic ramus Pubic symphysis Pubic tubercle Pubic crest Fig. 3: Landmarks of pelvis 21 Unit 2 I Review of Anatomy and Physiology of Female Reproductive System Anterior longitudinal ligament Iliolumbar ligament Anterior sacroiliac ligament Sacrotuberous ligament Inguinal ligament Sacrospinous ligament Fig. 2: Pelvic ligaments Landmarks of Pelvis There are nine landmarks of pelvis as shown in Figure 3: 1. Sacral promontory 2. Ala or wings of sacrum 3. Sacroiliac joint 4. Iliopectineal line 5. Iliopubic eminence 6. Pectineal line 7. Pubic tubercle 8. Pubic crest 9. Symphysis pubis Sacral promontory Sacroiliac joint Iliac crest Ala of Iliac sacrum fossa Anterior sacral foramen Sacrum Pelvic brim Anterior superior iliac spine Anterior inferior iliac spine Acetabulum Ischial spine Obturator foramen Pectineal line Ischiopubic ramus Pubic symphysis Pubic tubercle Pubic crest Fig. 3: Landmarks of pelvis 21 Unit 2 s Review of Anatomy and Physiology of Female Reproductive System Transverse 13 cm Fig. 5: Diameters of pelvis Diameters of Pelvis To summarize text on diameter of pelvis, Figure 5 is given along with Table 2 to complement it. Brim or Inlet Anteroposterior diameter True conjugate (11 cm): It is the distance between the midpoint of the sacral promontory to the inner margin of the upper border of symphysis pubis. TABLE 2: Diameters of pelvis 1. True conjugate 11 cm Anteroposterior Obstetric conjugate 10 cm Diagonal conjugate 12 cm Oblique diameter Right oblique 12 cm Left oblique 12 cm Transverse diameter 13 cm 2. Cavity Anteroposterior 12 cm Transverse 13 cm 3. Outlet Anteroposterior 12 cm Transverse Bispinous 10 cm Intertuberous 11 cm 11 12 cm Unit 2 s Review of Anatomy and Physiology of Female Reproductive System Transverse 13 cm Fig. 5: Diameters of pelvis Diameters of Pelvis To summarize text on diameter of pelvis, Figure 5 is given along with Table 2 to complement it. Brim or Inlet Anteroposterior diameter True conjugate (11 cm): It is the distance between the midpoint of the sacral promontory to the inner margin of the upper border of symphysis pubis. TABLE 2: Diameters of pelvis 1. True conjugate 11 cm Anteroposterior Obstetric conjugate 10 cm Diagonal conjugate 12 cm Oblique diameter Right oblique 12 cm Left oblique 12 cm Transverse diameter 13 cm 2. Cavity Anteroposterior 12 cm Transverse 13 cm 3. Outlet Anteroposterior 12 cm Transverse Bispinous 10 cm Intertuberous 11 cm 11 12 cm Textbook of Obstetric and Gynecological Nursing for KUHS inner Obstetric surface conjugate symphysis (10 cm): pubis. Distance between midpoints of sacral promontory of Diagonal conjugate of point on the sacral promontory. (12 cm): Distance between the lower borders symphysis pubis to Right or left denotes the sacroiliac joint from which it starts. Oblique diameter (12 cm): Distance between one sacroiliac joint to the opposite iliopubic the Transverse iliopectineal diameter lines. points on the pelvic brim (13 cm): It is the distance between the two farthest eminence Cavity Anteroposterior (12 cm): It measures from the midpoint on the posterior surface of the to the junction of second and third sacral vertebrae. symphysis pubis notches and obturator foramen. Transverse (12 cm): It cannot be measured as the points lie over the soft tissue covering the sacrosciatic Outlet Anteroposterior (12 cm): It extends from the lower border of symphysis pubis to the tip of coccyx. Transverse: There are two transverse diameters. (i) Bispinous (10 cm): It is the distance between the tips of two ischial spines. (ii) Intertuberous (11 cm): It is the distance between the inner borders of ischial tuberosities. Textbook of Obstetric and Gynecological Nursing for KUHS inner Obstetric surface conjugate symphysis (10 cm): pubis. Distance between midpoints of sacral promontory of Diagonal conjugate of point on the sacral promontory. (12 cm): Distance between the lower borders symphysis pubis to Right or left denotes the sacroiliac joint from which it starts. Oblique diameter (12 cm): Distance between one sacroiliac joint to the opposite iliopubic the Transverse iliopectineal diameter lines. points on the pelvic brim (13 cm): It is the distance between the two farthest eminence Cavity Anteroposterior (12 cm): It measures from the midpoint on the posterior surface of the to the junction of second and third sacral vertebrae. symphysis pubis notches and obturator foramen. Transverse (12 cm): It cannot be measured as the points lie over the soft tissue covering the sacrosciatic Outlet Anteroposterior (12 cm): It extends from the lower border of symphysis pubis to the tip of coccyx. Transverse: There are two transverse diameters. (i) Bispinous (10 cm): It is the distance between the tips of two ischial spines. (ii) Intertuberous (11 cm): It is the distance between the inner borders of ischial tuberosities. Unit 2 Review of Anatomy and Physiology of Female Reproductive System Follicular phase days Primordial Primary Secondary follicles follicles follicles O o O Atresia O o O Single, selected Selection tertiary follicle O o O P Atresia Constant development Selection of one dominant of follicles secondary follicle begins (2 months) each new menstrual cycle Ovarian cycle phases Follicular phase Luteal phases Selected Ovulation Corpus Corpus Degrading tertiary follicle luteum albicans corpus 0 7 14 21 28 Day of menstrual cycle Uterine cycle phases Proliferative Menses phase Secretory phase Menstruation 0 7 14 21 28 Day of menstrual cycle Pituitary Ovulation FSH hormone levels LH 0 7 14 21 28 Ovarian Estrogen hormone level Progesterone 0 7 14 21 28 Day of menstrual cycle Fig. 10: Menstrual cycle 33 Unit 2 Review of Anatomy and Physiology of Female Reproductive System Follicular phase days Primordial Primary Secondary follicles follicles follicles O o O Atresia O o O Single, selected Selection tertiary follicle O o O P Atresia Constant development Selection of one dominant of follicles secondary follicle begins (2 months) each new menstrual cycle Ovarian cycle phases Follicular phase Luteal phases Selected Ovulation Corpus Corpus Degrading tertiary follicle luteum albicans corpus 0 7 14 21 28 Day of menstrual cycle Uterine cycle phases Proliferative Menses phase Secretory phase Menstruation 0 7 14 21 28 Day of menstrual cycle Pituitary Ovulation FSH hormone levels LH 0 7 14 21 28 Ovarian Estrogen hormone level Progesterone 0 7 14 21 28 Day of menstrual cycle Fig. 10: Menstrual cycle 33 Textbook of Obstetric and Gynecological Nursing for KUHS 1 Menstrual phase 4 Luteal phase 2 Follicular phase Phases of menstrual cycle 3 Ovulation phase Fig. 11: Phases of menstrual cycle Uterus sheds Endometrium its inner lining begins to Egg cell develop Menstrual fluid Follicle Fig. 12: Menstrual phase (day Fig. 13: Follicular phase (day Egg Fimbriae Egg Leads to next menstrual cycle Fig. 14: Ovulation phase (day 14) Fig. 15: Luteal phase (day Textbook of Obstetric and Gynecological Nursing for KUHS 1 Menstrual phase 4 Luteal phase 2 Follicular phase Phases of menstrual cycle 3 Ovulation phase Fig. 11: Phases of menstrual cycle Uterus sheds Endometrium its inner lining begins to Egg cell develop Menstrual fluid Follicle Fig. 12: Menstrual phase (day Fig. 13: Follicular phase (day Egg Fimbriae Egg Leads to next menstrual cycle Fig. 14: Ovulation phase (day 14) Fig. 15: Luteal phase (day Textbook of Obstetric and Gynecological Nursing for KUHS To prevent vertical transmission of To prevent underweight and stunting. To prevent the risk of some forms of childhood cancers. Domains of the Preconception Care Package The package of care interventions has been given in tabular form preconception care package are shown in Figure 17. preconception (Table 3) and domains of TABLE 3: Package of preconception care interventions Areas addressed the preconception care package Examples of interventions Nutritional conditions Screening for anemia and diabetes Supplementing iron and folic acid Information, education and counseling Monitoring nutritional status Supplementing energy and nutrient dense food Management of diabetes, including counseling people with diabetes mellitus Promoting exercise lodization of salt Tobacco use Screening of women and girls for tobacco use (smoking and smokeless tobacco) at all clinical visits using (ask, advise, assess, assist, arrange) Providing brief tobacco cessation advice, pharmacotherapy (including nicotine replacement therapy, if available) and intensive behavioral counseling services Screening of all (men and women) and advising about harm of smoke and harmful effects on pregnant women and unborn children Genetic conditions Taking a thorough family history to identify risk factors for genetic conditions Family planning Genetic counseling Carrier screening and testing Appropriate treatment of genetic conditions or national screening among populations at high risk Contd Textbook of Obstetric and Gynecological Nursing for KUHS To prevent vertical transmission of To prevent underweight and stunting. To prevent the risk of some forms of childhood cancers. Domains of the Preconception Care Package The package of care interventions has been given in tabular form preconception care package are shown in Figure 17. preconception (Table 3) and domains of TABLE 3: Package of preconception care interventions Areas addressed the preconception care package Examples of interventions Nutritional conditions Screening for anemia and diabetes Supplementing iron and folic acid Information, education and counseling Monitoring nutritional status Supplementing energy and nutrient dense food Management of diabetes, including counseling people with diabetes mellitus Promoting exercise lodization of salt Tobacco use Screening of women and girls for tobacco use (smoking and smokeless tobacco) at all clinical visits using (ask, advise, assess, assist, arrange) Providing brief tobacco cessation advice, pharmacotherapy (including nicotine replacement therapy, if available) and intensive behavioral counseling services Screening of all (men and women) and advising about harm of smoke and harmful effects on pregnant women and unborn children Genetic conditions Taking a thorough family history to identify risk factors for genetic conditions Family planning Genetic counseling Carrier screening and testing Appropriate treatment of genetic conditions or national screening among populations at high risk Contd Unit 2 Review of Anatomy and Physiology of Female Reproductive System Areas addressed the preconception care package Examples of interventions Environmental health Providing guidance and information on environmental hazards and prevention Protecting from unnecessary radiation exposure in occupational, environmental and medical settings Avoiding unnecessary pesticide alternatives to pesticides Protecting from lead exposure Informing women of childbearing age about levels of methyl mercury in fish Promoting use of improved stoves and cleaner liquid gaseous fuels Creating awareness and understanding of fertility and infertility and their preventable and unpreventable causes Defusing stigmatization of infertility and assumption of fate Screening and diagnosis of couples following months of attempting pregnancy, and management of underlying causes of fertility, including past STIs Counseling for diagnosed with unpreventable causes of Interpersonal violence Health promotion to prevent dating violence Providing comprehensive sex education that addresses gender equality, human rights and sexual relations Combining a linking economic empowerment, gender equality and community mobilization activities Recognizing signs of violence against women Providing health care services (including care), referral and psychosocial support to victims of violence Changing individual and social norms regarding drinking, screening and counseling of people who are problem drinkers, and treating people who have alcohol use disorders unwanted and rapid successive pregnancies Keeping girls in schools Influencing cultural norms that support early marriage and forced sex Providing comprehensive sex education Providing contraceptives and building community support for preventing early pregnancy and contraceptive provision to adolescents Empowering girls to resist forced sex Engaging men and boys to critically assess norms and practices regarding violence and forced sex Educating women and couples about the dangers to the ba and mother of short birth intervals Contd. 37 Unit 2 Review of Anatomy and Physiology of Female Reproductive System Areas addressed the preconception care package Examples of interventions Environmental health Providing guidance and information on environmental hazards and prevention Protecting from unnecessary radiation exposure in occupational, environmental and medical settings Avoiding unnecessary pesticide alternatives to pesticides Protecting from lead exposure Informing women of childbearing age about levels of methyl mercury in fish Promoting use of improved stoves and cleaner liquid gaseous fuels Creating awareness and understanding of fertility and infertility and their preventable and unpreventable causes Defusing stigmatization of infertility and assumption of fate Screening and diagnosis of couples following months of attempting pregnancy, and management of underlying causes of fertility, including past STIs Counseling for diagnosed with unpreventable causes of Interpersonal violence Health promotion to prevent dating violence Providing comprehensive sex education that addresses gender equality, human rights and sexual relations Combining a linking economic empowerment, gender equality and community mobilization activities Recognizing signs of violence against women Providing health care services (including care), referral and psychosocial support to victims of violence Changing individual and social norms regarding drinking, screening and counseling of people who are problem drinkers, and treating people who have alcohol use disorders unwanted and rapid successive pregnancies Keeping girls in schools Influencing cultural norms that support early marriage and forced sex Providing comprehensive sex education Providing contraceptives and building community support for preventing early pregnancy and contraceptive provision to adolescents Empowering girls to resist forced sex Engaging men and boys to critically assess norms and practices regarding violence and forced sex Educating women and couples about the dangers to the ba and mother of short birth intervals Contd. 37 Unit 2 Review of Anatomy and Physiology of Female Reproductive System Areas addressed the preconception care package Examples of interventions diseases Vaccination against rubella Vaccination against tetanus and diphtheria Vaccination against hepatitis B Female genital mutilation (FGM) Discussing and discouraging the practice with the girl and her parents partner STOP Screening women and girls for female genital mutilation FEMALE to detect complications Informing women and couples about complications of GENITAL FGM and about access to treatment Carrying out defibulation of infibulated or sealed girls MUTILATION and women before or early in pregnancy Removing cysts and treating other complications Areas addressed the preconception care package Mental health Nutritional Human conditions subfertility deficiency Virus Too early, (HIV) Genetic unwanted and Psychoactive conditions rapid successive substance use preventable Female genital pregnancies Interpersonal mutilation diseases violence Environmental Sexually health transmitted Tobacco use infection Fig. 17: Domains of preconception care package An Agenda for Action: Learning from Experience, Supporting Change In February 2012, World Health Organization (WHO) meeting brought together researchers, practitioners and program managers with experience in preconception care, as well as United Nations Agencies and partner organizations to achieve a global consensus on the place of preconception care as part of an overall strategy to prevent maternal and childhood mortality and morbidity. An agenda for action was agreed upon at the meeting, including actions to: services. Build regional and national capacity to plan, implement and monitor preconception care programs and Stimulate and support country action. Carry out demonstration projects in selected countries. Document and disseminate good preconception care practices. 39 Unit 2 Review of Anatomy and Physiology of Female Reproductive System Areas addressed the preconception care package Examples of interventions diseases Vaccination against rubella Vaccination against tetanus and diphtheria Vaccination against hepatitis B Female genital mutilation (FGM) Discussing and discouraging the practice with the girl and her parents partner STOP Screening women and girls for female genital mutilation FEMALE to detect complications Informing women and couples about complications of GENITAL FGM and about access to treatment Carrying out defibulation of infibulated or sealed girls MUTILATION and women before or early in pregnancy Removing cysts and treating other complications Areas addressed the preconception care package Mental health Nutritional Human conditions subfertility deficiency Virus Too early, (HIV) Genetic unwanted and Psychoactive conditions rapid successive substance use preventable Female genital pregnancies Interpersonal mutilation diseases violence Environmental Sexually health transmitted Tobacco use infection Fig. 17: Domains of preconception care package An Agenda for Action: Learning from Experience, Supporting Change In February 2012, World Health Organization (WHO) meeting brought together researchers, practitioners and program managers with experience in preconception care, as well as United Nations Agencies and partner organizations to achieve a global consensus on the place of preconception care as part of an overall strategy to prevent maternal and childhood mortality and morbidity. An agenda for action was agreed upon at the meeting, including actions to: services. Build regional and national capacity to plan, implement and monitor preconception care programs and Stimulate and support country action. Carry out demonstration projects in selected countries. Document and disseminate good preconception care practices. 39 Textbook of Obstetric and Gynecological Nursing for KUHS Create national platforms and partnerships to ensure health programs Leverage on existing public political commitment Assess the strengths health and weaknesses of the Early child development Adolescent health preconception care Nutrition system in place Immunization HIV Environmental health Violence prevention Mental health Preconception care Explore innovative ways implementation strategy and channels in delivering Adapt the intervention preconception care interventions Schools package Workplaces Delivering the Civil society groups intervention package Electronic health technologies Identify target population Mobilize financial resources Strengthen human Maximizing the gains for resources maternal and child health Establish a plan for monitoring and evaluation Fig. 18: A strategy for country action The action plan for the prevention and control of diseases which was discussed at 66th World Health Assembly in May 2013, calls governments to reduce modifiable risk factors for diseases and underlying social determinants. Preconception care, as the National Policy framework, is recognized as an important contributor to disease part of prevention and control (Fig. 18). WHO Support to Countries WHO supports regions and countries in implementing a process to improve availability of and access to preconception care interventions: Create platforms and partnerships to advance preconception care interventions. Introduce professionals in countries to international experience, research, evidence and good practices. Provide a methodology to analyze and understand the strengths and weaknesses of the preconception care system in place, and opportunities for improvement. Explore various delivery strategies for preconception care interventions, and their comparative advantages in terms of coverage, feasibility, acceptability and cost. Adapt the package of preconception care interventions to regional and country priorities, and health systems contexts. Explore and document innovative ways to deliver preconception care outside the traditional maternal and child health programs, while recognizing the importance of integrated delivery mechanisms. Develop a roadmap to make changes over time. Monitor, evaluate and document progress. Textbook of Obstetric and Gynecological Nursing for KUHS Create national platforms and partnerships to ensure health programs Leverage on existing public political commitment Assess the strengths health and weaknesses of the Early child development Adolescent health preconception care Nutrition system in place Immunization HIV Environmental health Violence prevention Mental health Preconception care Explore innovative ways implementation strategy and channels in delivering Adapt the intervention preconception care interventions Schools package Workplaces Delivering the Civil society groups intervention package Electronic health technologies Identify target population Mobilize financial resources Strengthen human Maximizing the gains for resources maternal and child health Establish a plan for monitoring and evaluation Fig. 18: A strategy for country action The action plan for the prevention and control of diseases which was discussed at 66th World Health Assembly in May 2013, calls governments to reduce modifiable risk factors for diseases and underlying social determinants. Preconception care, as the National Policy framework, is recognized as an important contributor to disease part of prevention and control (Fig. 18). WHO Support to Countries WHO supports regions and countries in implementing a process to improve availability of and access to preconception care interventions: Create platforms and partnerships to advance preconception care interventions. Introduce professionals in countries to international experience, research, evidence and good practices. Provide a methodology to analyze and understand the strengths and weaknesses of the preconception care system in place, and opportunities for improvement. Explore various delivery strategies for preconception care interventions, and their comparative advantages in terms of coverage, feasibility, acceptability and cost. Adapt the package of preconception care interventions to regional and country priorities, and health systems contexts. Explore and document innovative ways to deliver preconception care outside the traditional maternal and child health programs, while recognizing the importance of integrated delivery mechanisms. Develop a roadmap to make changes over time. Monitor, evaluate and document progress. Textbook of Obstetric and Gynecological Nursing for KUHS Developmental Stages of Fetal Development Various process or developmental stages occur before the development of fetus. They are as follows: Gametogenesis Spermatogenesis Oogenesis Ovulation Fertilization Implantation Decidua Development of fertilized Development of fetus Gametogenesis It is the process of formation of male and female gametes in gonads. Figure 21A. Spermatogenesis is the process of formation of spermatozoa in testis. The process is described in Oogenesis is the process of formation of mature ovum (egg) in the ovary. The process is discussed in Figure 21B. Ovulation: Ovulation is a process where a secondary oocyte is released from the ovary following rupture of a mature Graafian follicle and becomes available for conception. Only one secondary oocyte is likely to rupture in each ovarian cycle which starts at puberty and ends in menopause. Mechanism Ovulation, prompted luteinizing hormone from anterior pituitary occurs when the mature follicle ruptures and releases secondary oocyte into peritoneal cavity. The ovulated secondary oocyte, ready for fertilization is still surrounded zona pellucida and few layers of cells called corona radiata. Germ cells Mitosis Spermatogonia Primary spermatocyte (46, XY) First meiotic division Secondary spermatocytes 23, X 23, Y Second meiotic division 23, X 23, X 23, Y 23, Y A Spermatids Fig 21A Textbook of Obstetric and Gynecological Nursing for KUHS Developmental Stages of Fetal Development Various process or developmental stages occur before the development of fetus. They are as follows: Gametogenesis Spermatogenesis Oogenesis Ovulation Fertilization Implantation Decidua Development of fertilized Development of fetus Gametogenesis It is the process of formation of male and female gametes in gonads. Figure 21A. Spermatogenesis is the process of formation of spermatozoa in testis. The process is described in Oogenesis is the process of formation of mature ovum (egg) in the ovary. The process is discussed in Figure 21B. Ovulation: Ovulation is a process where a secondary oocyte is released from the ovary following rupture of a mature Graafian follicle and becomes available for conception. Only one secondary oocyte is likely to rupture in each ovarian cycle which starts at puberty and ends in menopause. Mechanism Ovulation, prompted luteinizing hormone from anterior pituitary occurs when the mature follicle ruptures and releases secondary oocyte into peritoneal cavity. The ovulated secondary oocyte, ready for fertilization is still surrounded zona pellucida and few layers of cells called corona radiata. Germ cells Mitosis Spermatogonia Primary spermatocyte (46, XY) First meiotic division Secondary spermatocytes 23, X 23, Y Second meiotic division 23, X 23, X 23, Y 23, Y A Spermatids Fig 21A Unit 2 Review of Anatomy and Physiology of Female Reproductive System Germ cells Mitosis Oogonia Primary oocyte (46, XX) Arrested first meiotic division (up to puberty) Maturation of Graafian follicle Completion of first meiotic division Secondary oocyte 23, X First polar body 23, X Ovulation Not fertilized Fertilized Degeneration Completion of second within 24 hours meiotic division Female Second polar pronucleus 23, X body 23, X B Figs 21A and B: (A) (B) Oogenesis If not fertilized, secondary oocyte degenerates in a couple of days. If a sperm passes through corona radiata and zona pellucida and enters the cytoplasm of the secondary oocyte, then fertilization takes place. Fertilization It is the process of fusion of the spermatozoon with the mature ovum. Fertilization is most likely to occur if intercourse takes place around the time of ovulation. More often, fertilization occurs in the ampullary part of the uterine tubes (Fig. 22). During ejaculation, out of hundreds of millions of sperms that are deposited in the vagina, only a few thousand capacitated spermatozoa enter the uterine tube while only reach the ovum due to muscular contractions of the uterine tube. It takes a few minutes for the sperm to reach the fallopian tube. The mature sperm penetrates the zona pellucida and cell membrane surrounding ovum. After the entry of one sperm, the membrane is sealed to prevent entry of any further sperm. Following penetration of the sperm into the ovum, the egg is fertilized and becomes an embryo. The fertilized ovum (zygote) with 46 chromosomes continues its passage through the fallopian tubes and undergoes division into 2 cells cells cells 16 cells and SO on, until a ball of cells called morula is formed. On 4th day, morula reaches the uterine cavity. On day, morula is covered a film of mucus. The fluid passes through the canaliculi of the zona pellucida which separates the cells of the morula and is called blastocyst. 43 Unit 2 Review of Anatomy and Physiology of Female Reproductive System Germ cells Mitosis Oogonia Primary oocyte (46, XX) Arrested first meiotic division (up to puberty) Maturation of Graafian follicle Completion of first meiotic division Secondary oocyte 23, X First polar body 23, X Ovulation Not fertilized Fertilized Degeneration Completion of second within 24 hours meiotic division Female Second polar pronucleus 23, X body 23, X B Figs 21A and B: (A) (B) Oogenesis If not fertilized, secondary oocyte degenerates in a couple of days. If a sperm passes through corona radiata and zona pellucida and enters the cytoplasm of the secondary oocyte, then fertilization takes place. Fertilization It is the process of fusion of the spermatozoon with the mature ovum. Fertilization is most likely to occur if intercourse takes place around the time of ovulation. More often, fertilization occurs in the ampullary part of the uterine tubes (Fig. 22). During ejaculation, out of hundreds of millions of sperms that are deposited in the vagina, only a few thousand capacitated spermatozoa enter the uterine tube while only reach the ovum due to muscular contractions of the uterine tube. It takes a few minutes for the sperm to reach the fallopian tube. The mature sperm penetrates the zona pellucida and cell membrane surrounding ovum. After the entry of one sperm, the membrane is sealed to prevent entry of any further sperm. Following penetration of the sperm into the ovum, the egg is fertilized and becomes an embryo. The fertilized ovum (zygote) with 46 chromosomes continues its passage through the fallopian tubes and undergoes division into 2 cells cells cells 16 cells and SO on, until a ball of cells called morula is formed. On 4th day, morula reaches the uterine cavity. On day, morula is covered a film of mucus. The fluid passes through the canaliculi of the zona pellucida which separates the cells of the morula and is called blastocyst. 43 Unit 2 Review of Anatomy and Physiology of Female Reproductive System The decidua differentiates into three layers: 1. Superficial compact layer 2. Intermediate spongy layer 3. Thin basal layer After the interstitial implantation of blastocyst into the compact layer of the decidua, the different portions of the decidua are renamed as: Decidua basalis: It lies between the blastocyst and uterine muscle. This part later forms placenta. Decidua capsularis: This is the superficial compact layer which overlies blastocyst. With fetal growth, the decidua capsularis bulges into the uterine cavity and fuses with the decidua parietalis. Decidua parietalis: This is the decidua lining of the rest of the uterine cavity. Development of Fertilized After the blastocyst embeds into endometrium, outer trophoblastic cells proliferate to form three layers: 1. Syncytiotrophoblast: It is the outer layer, which makes nutrients in the maternal blood accessible to the developing embryo. 2. Cytotrophoblast: Inner layer, which produces beta hCG hormone. 3. Mesoderm: The third layer, which develops to chorionic vesicle with its membrane called chorion. It forms body stalk and umbilical cord. The trophoblast develops to form the placenta and inner cell mass develops to form fetus. The cells differentiate into the following three layers: 1. Ectoderm: Develops into central and peripheral nervous system and the epidermis. 2. Endoderm: Forms the dermis, skeleton, urinary bladder, skeletal and smooth muscles. 3. Mesoderm: Forms heart, blood vessels, liver, pancreas, bones and muscles. Embryo The word embryo (Greek: Swelling within) refers to the growing organism from the second to the eighth week of life. During this time, it develops from a tiny cell cluster into a little growth of about 1 inch in length. As this development proceeds, the placenta, a special organ of interchange, begins to grow between the embryo and uterus. The embryo is connected to the placenta the umbilical cord. The placenta acts as filter and barrier. It allows the embryo (and in later stage) the fetus, to absorb food and oxygen from blood and to eliminate CO2 2 and other wastes from its own blood in return. At the same time, however, the two blood systems remain completely separate. Development of Fetus First trimester: During first three months of pregnancy, the product of conception grows from just visible speck to the fertilized ovum to a lively embryo. At the end of first trimester, the following changes occur: All organs are formed and heart starts beating. The fetus becomes less vulnerable to the effect of most of the drugs, infections after embryonic period. Facial features form and there is rapid development of brain. The fetus becomes human in appearance. External sex organs are visible, but positive sex identification is difficult. neck, nail beds begin to form, nose, mouth and eyelids become tooth buds form. Rudimentary kidneys excrete small amounts of urine into the amniotic sac. Fetus is about 2 inches long and weighs about 45 g. 45 Unit 2 Review of Anatomy and Physiology of Female Reproductive System The decidua differentiates into three layers: 1. Superficial compact layer 2. Intermediate spongy layer 3. Thin basal layer After the interstitial implantation of blastocyst into the compact layer of the decidua, the different portions of the decidua are renamed as: Decidua basalis: It lies between the blastocyst and uterine muscle. This part later forms placenta. Decidua capsularis: This is the superficial compact layer which overlies blastocyst. With fetal growth, the decidua capsularis bulges into the uterine cavity and fuses with the decidua parietalis. Decidua parietalis: This is the decidua lining of the rest of the uterine cavity. Development of Fertilized After the blastocyst embeds into endometrium, outer trophoblastic cells proliferate to form three layers: 1. Syncytiotrophoblast: It is the outer layer, which makes nutrients in the maternal blood accessible to the developing embryo. 2. Cytotrophoblast: Inner layer, which produces beta hCG hormone. 3. Mesoderm: The third layer, which develops to chorionic vesicle with its membrane called chorion. It forms body stalk and umbilical cord. The trophoblast develops to form the placenta and inner cell mass develops to form fetus. The cells differentiate into the following three layers: 1. Ectoderm: Develops into central and peripheral nervous system and the epidermis. 2. Endoderm: Forms the dermis, skeleton, urinary bladder, skeletal and smooth muscles. 3. Mesoderm: Forms heart, blood vessels, liver, pancreas, bones and muscles. Embryo The word embryo (Greek: Swelling within) refers to the growing organism from the second to the eighth week of life. During this time, it develops from a tiny cell cluster into a little growth of about 1 inch in length. As this development proceeds, the placenta, a special organ of interchange, begins to grow between the embryo and uterus. The embryo is connected to the placenta the umbilical cord. The placenta acts as filter and barrier. It allows the embryo (and in later stage) the fetus, to absorb food and oxygen from blood and to eliminate CO2 2 and other wastes from its own blood in return. At the same time, however, the two blood systems remain completely separate. Development of Fetus First trimester: During first three months of pregnancy, the product of conception grows from just visible speck to the fertilized ovum to a lively embryo. At the end of first trimester, the following changes occur: All organs are formed and heart starts beating. The fetus becomes less vulnerable to the effect of most of the drugs, infections after embryonic period. Facial features form and there is rapid development of brain. The fetus becomes human in appearance. External sex organs are visible, but positive sex identification is difficult. neck, nail beds begin to form, nose, mouth and eyelids become tooth buds form. Rudimentary kidneys excrete small amounts of urine into the amniotic sac. Fetus is about 2 inches long and weighs about 45 g. 45 Textbook of Obstetric and Gynecological Nursing for KUHS Second trimester: During these months, the fetus grows fast. At the end of 2nd trimester: FHR can be heard with stethoscope. Eyes remain closed and body growth accelerates. Vernix translucent and appears pink. caseosa is the skin of the fetus skin is wrinkled, Sex is visible. Skeleton is calcified. After birth, survival is possible, but the fetus is at serious risk. Production of lung surfactant occurs. Average length is around 20 cm and weight is 560 g. Third trimester: During these months fetus gains maturity. Skin is whitish pink. Sucking reflex is stronger and eyes begin to open and shut. Skull is formed. Testes are in the scrotum, if a male child. Lightening occurs. Fetal Hb begins to convert to adult Hb. Kicks rapidly. Fetus is about 31 cm long and weighs about 3 kg. The events have been summarized in Table 4. TABLE 4: events 0 hour Fertilization 24 hours 2 cell stage of zygote 42 hours 4 cell stage 72 hours 12 cell stage 96 hours Morula enters uterine cavity 5th day Blastocyst 7th day Implantation 11th day Implantation completed 12th day Primary villi 16th day Secondary villi 21st day Tertiary Villi day Fetal heart, circulation day Chorion frondosum day Cotyledons day Fetal stage Textbook of Obstetric and Gynecological Nursing for KUHS Second trimester: During these months, the fetus grows fast. At the end of 2nd trimester: FHR can be heard with stethoscope. Eyes remain closed and body growth accelerates. Vernix translucent and appears pink. caseosa is the skin of the fetus skin is wrinkled, Sex is visible. Skeleton is calcified. After birth, survival is possible, but the fetus is at serious risk. Production of lung surfactant occurs. Average length is around 20 cm and weight is 560 g. Third trimester: During these months fetus gains maturity. Skin is whitish pink. Sucking reflex is stronger and eyes begin to open and shut. Skull is formed. Testes are in the scrotum, if a male child. Lightening occurs. Fetal Hb begins to convert to adult Hb. Kicks rapidly. Fetus is about 31 cm long and weighs about 3 kg. The events have been summarized in Table 4. TABLE 4: events 0 hour Fertilization 24 hours 2 cell stage of zygote 42 hours 4 cell stage 72 hours 12 cell stage 96 hours Morula enters uterine cavity 5th day Blastocyst 7th day Implantation 11th day Implantation completed 12th day Primary villi 16th day Secondary villi 21st day Tertiary Villi day Fetal heart, circulation day Chorion frondosum day Cotyledons day Fetal stage
OB UNIT 2 - Anatomy of female reproductive system
Course: Bsc nursing (blaw 213)
University: Kerala University of Health Sciences
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