Landmarks of Pelvis & Types of Pelvis PDF

## **Landmarks of Pelvis** * There are nine landmarks of pelvis as shown in Figure 3: * Sacral promontory * Ala or wings of sacrum * Sacroiliac joint * Iliopectineal line * Iliopubic eminence * Pectineal line * Pubic tubercle * Pubic crest * Symphysis pubis ## *...

## **Landmarks of Pelvis** * There are nine landmarks of pelvis as shown in Figure 3: * Sacral promontory * Ala or wings of sacrum * Sacroiliac joint * Iliopectineal line * Iliopubic eminence * Pectineal line * Pubic tubercle * Pubic crest * Symphysis pubis ## **Types of Pelvis** * There are four types of pelvis as shown in Figure 4: * Gynecoid pelvis: * Oval at the inlet * Generous capacity * Wide subpubic arch * Typical female pelvis * Pelvic brim is a transverse ellipse and most favorable for delivery. * Android pelvis: * Triangular in shape at the inlet * Narrow subpubic arch * Male-type pelvis * Pelvic brim is triangular. * Anthropoid pelvis: * Oval inlet but the long axis is oriented vertically rather than side to side. * Favors occiput posterior position. * Pelvic brim is an anteroposterior ellipse. * Platypelloid pelvis: * Flattened at the inlet * Prominent sacrum * Favors transverse presentations * Very short ## **Diameters of Pelvis** **Brim or Inlet** * **True conjugate/conjugate vera/anatomical conjugate (11 cm):** The distance between the midpoint of the sacral promontory to the inner margin of the upper border of symphysis pubis. * **Obstetric conjugate (10 cm):** Distance between midpoints of sacral promontory to the middle-inner surface of symphysis pubis. * **Diagonal conjugate (12 cm):** Distance between the lower borders of symphysis pubis to the midpoint on the sacral promontory. * **Oblique diameter (12 cm):** Distance between one sacroiliac joint to the opposite iliopubic eminence. * **Transverse diameter (13cm):** The distance between the two farthest points on the pelvic brim over the iliopectineal lines. * **Right or left** denotes the sacroiliac joint it starts. **Cavity** * **Anteroposterior (12 cm):** It measures from the midpoint on the posterior surface of the symphysis pubis to the junction of second and third sacral vertebrae. * **Transverse (12 cm):** It cannot be measured as the points lie over the soft tissue covering the sacrosciatic notches and obturator foramen. **Outlet** * **Anteroposterior (12 cm):** It extends from the lower border of symphysis pubis to the tip of coccyx. * **Transverse:** There are two transverse diameters. * **Bispinous (10 cm):** The distance between the tips of two ischial spines. * **Intertuberous (11 cm):** The distance between the inner borders of ischial tuberosities. ## **Female Organs of Reproduction** * **Reproductive system consists of:** * External genitalia * Internal genitalia * Accessory reproductive organs. ### **External Genitalia** * External genitalia is also referred to as vulva or pudendum, including: * Mons pubis * Labia majora * Labia minora * Clitoris * Glands within the vestibule * External urethral orifice * Vaginal orifice * Bartholin glands * Anus ### **Internal Genitalia** * Internal genitalia includes: * Vagina * Uterus * Fallopian tubes * Ovaries ## **Accessory Reproductive Organs** * Includes: * Pelvic floor muscles * Pelvic fascía * Pelvic cellular tissue * Female urethra * Urinary bladder * Pelvic ureter * The breast ## **Breast** * Breasts are modified sebaceous glands * Concerned with lactation following childbirth. * Shape of the breast varies * Size of the base is fairly constant, extending from 2nd to 6th rib in the midclavicular line. * Structure: * Areola * Montgomery glands * Nipple * Lactiferous ducts * Lactiferous sinuses * Lobes of the mammary gland ## **Menstrual Cycle** * Regular natural change that occurs in the female reproductive system, specifically the uterus and ovaries. * Makes pregnancy possible. * First period usually begins between 12 and 15 years of age, known as menarche. * Menstruation stops occurring after menopause (between 45 and 55 years of age). * Menstrual bleeding typically lasts for 2-7 days. **Phases of the Menstrual Cycle** * The menstrual cycle is governed by hormonal changes. * The cycle can be divided into different phases based on events in the ovary (ovarian cycle) or in the uterus (uterine cycle). * The first day of the menstrual cycle starts on the first day of menstruation when blood starts coming out of the vagina. * The average length of a menstrual cycle is 28 days. **Four Main Phases of the Menstrual Cycle** * **Menstrual phase (day 1–5):** Uterus sheds its inner lining of soft tissue and blood vessels through the vagina. * **Follicular phase (day 1-13):** Pituitary gland secretes a hormone that stimulates the egg cells in the ovaries to grow, and one of these egg cells begins to mature in a sac-like structure called a follicle * **Ovulation phase (day 14):** The pituitary gland secretes a luteinizing hormone that causes the ovary to release the matured egg cell. * **Luteal phase (day 15–28):** The egg cell released during the ovulation stays in the fallopian tube for 24 hours (if not fertilized it disintegrates). ## **Human Sexuality** * Sexuality plays a very important role in everyone's life. * It refers to various sexually-related aspects like physical and psychosocial development, behavior, attitude, and social customs associated with the individual's sense of gender, relationships, sexual activity, selection of sexual partner, and reproduction. * Human sexual behavior is completely different from other animals, which are driven by a 'force' to reproduce. * People have sex for variety of complex factors. * It is the way in which humans experience and express them as sexual being and is an integral part of their personalities. ### **Human Sexual Characters** * **Primary sexual characters** are directly related to reproduction. Examples include the sex organs (male and female genitalia). * **Secondary sexual characters** distinguish one sex from the other, but are not essential for reproduction. Examples include the presence of breast in females, and facial hair and scrotal hairs in males. ### **Factors Influencing Sexuality** * **Biological Factors:** Sexual behavior depends on the level of sex hormone production by gonads (testes and ovaries), the adrenal cortex, the pituitary gland, and the hypothalamus. * **Learning Factors:** Environmental factors shape behavior. Learning theory emphasizes the importance of rewards and punishments in the learning process. ### **Principles to be Follow Regarding Sexuality** * Individualized approach: Each child is unique and should receive individualized information from parents who know, understand, and love the child. * Same-sex parents can provide better information regarding sexuality to their children. * Parents should only decide the appropriate time for providing information about sexuality to their child. * Parents should provide timely and appropriate information. * Delay should be avoided in providing accurate and responsible information to children to prevent experimentation and serious consequences. ### **Stages of Sexual Development** * **Prenatal sexual development:** Six weeks after conception, the XY chromosome directs the undifferentiated gonads to become testes. * **Childhood development:** From the beginning itself, there are differences in toys and play preferences, exploration. By seven years of age, children acquire a sense of privacy and know about social restrictions among boys and girls. * **Puberty:** For females, secondary sexual characters develop first, followed by menstruation. For males, growth, androgens (testosterone) cause pubertal changes. * **Adolescence:** Adolescence is a time when young people enjoy more autonomy, and adjust to the physical, emotional, and social changes during the period from childhood to adulthood. Adolescence is a time when young people enjoy more autonomy in their relationships with others. * **Adulthood:** People experience physical changes, illnesses, or emotional tragedies, like loss of a husband, which can lead to a loss of interest in sexual activity. * **Old age:** With aging, people experience physical changes, illnesses, or emotional tragedies. There is a decline in the function of the ovaries and a decrease in estrogen production. The average menopause age is 45-50 years. Decline in estrogen leads to atrophy and shrinking of vaginal walls and labia majora, decreased vaginal lubrication with painful intercourse, and consequently a decline in sexual interest and behavior. In men, decreased testosterone levels leads to a decrease in the volume and force of ejaculation and sperm count, but viable sperms may still be produced. ## **Physiology of Sex** * Four main stages: * **Excitement:** Involves vasocongestion, increased blood flow, enlargement, and erection in men. Women experience increased vaginal lubrication and swelling. * **Plateau:** Vasocongestion peaks, penile erection intensifies in men. Women experience increased breast engorgement. * **Orgasm:** Intense and pleasurable feeling occurring at the peak of sexual arousal. Involves rhythmic contractions in the genital and pelvic organs. * **Resolution:** Excitement and plateau gradually reverse, muscles relax, and the body returns to an unaroused state. ## **Sexual Dysfunction** * Dyspareunia: Painful sexual intercourse * Vaginismus: Spastic contractions of the outer third of the vagina occur closing the vaginal opening, preventing intercourse. * Anorgasmia: A woman cannot have an orgasm. * Low sexual desire. * Discrepant sexual desire: * Impotence: * Premature ejaculation: * Inhibited male orgasm: ## **Fetal Development** * **Embryology:** The branch of biology that studies the prenatal development of gametes (sex cells), fertilization, and development of embryo and fetus. * **Developmental Stages of Fetal Development:** * **Gametogenesis:** The process of formation of male and female gametes in gonads (spermatogenesis in the testes and oogenesis in the ovaries). * **Ovulation:** The process whereby a secondary oocyte is released from the ovary following rupture of a mature Graafian follicle and becomes available for conception. * **Fertilization:** It is the process of fusion of the spermatozoon with the mature ovum. * **Implantation:** The process of embryo attaching itself to the uterine wall, typically occurs in the endometrium of the anterior or posterior wall of the body of the uterus near the fundus on the sixth day (corresponding to the 20th day of a regular menstrual cycle). * **Decidual Stage:** The decidua is the endometrium of the gravid uterus. It is so named because much of it is shed following delivery. ## **Fetal Membranes** * Consists of two layers: outer chorion and inner amnion. * **Chorion:** Thick, opaque, friable membrane that is formed out of chorion leaves and ends at the placental margin. * **Amnion:** The smooth, slippery, glistening inner-most membrane that lines the amniotic space. It is filled with fluid and is called 'Bag of waters'. ## **Placenta** * **Functions:** * Respiration: Fetus obtains oxygen and excretes CO₂. * Excretion: Fetus excretes waste products such as urea, uric acid, and creatinine. * Storage: Fetus stores glucose, iron, and vitamins. * Nutrition: Fetus obtains all nutrients and develops. * Protection: Fetus is protected against noxious agents circulating in the maternal blood. * Enzymatic function: * Endocrine function: * Immunological function: ## **Fetal Blood Circulation** * **Structure:** * Umbilical vein: * Two umbilical arteries: * Ductus venosus: * Foramen ovale: * Ductus arteriosus: * Hypogastric arteries: * **Pattern of Blood Flow:** Blood flows from placenta through the umbilical vein, ductus venosus, inferior vena cava, right atrium, foramen ovale, left atrium, left ventricle, aorta, subclavian arteries (to cerebral and coronary arteries), superior vena cava, right atrium, right ventricle, pulmonary artery, ductus arteriosus, descending aorta, hypogastric arteries, and umbilical arteries. ## **Fetal Skull** * Oval shaped at term, larger compared to the other parts of the skeleton. * **Regions:** * **Vertex:** * **Brow or sinciput:** * **Face:** * **Bones:** * **Frontal bones:** 2 * **Parietal bones:** 2 * **Temporal bones:** 2 * **Occipital bone:** 1 ## **Sutures of Fetal Skull** * **Frontal suture:** * **Sagittal suture:** * **Coronal suture:** * **Lambdoidal suture:** ## **Fontanels of Fetal Skull** * **Anterior fontanel:** Largest fontanel, diamond shaped. * **Posterior fontanel:** Small triangle shaped fontanel. ## **Diameters of the Fetal Skull** * **Transverse diameters:** * Bimastoid diameter * Bitemporal diameter * Super subparital diameter * Biparietal diameter ## **Variations are Mainly of Two Types** * **Hereditary variations:** * **Environmental variations:** ## **Human Chromosomes** * The normal chromosomal complement in human beings is 2n=46 (22 pairs of autosomes and a pair of sex chromosomes). * **Diploid** means normal chromosome number in a human being. * **Haploid** is found in gametes, meaning n = 23 * **Polyloid** refers to a multiple of n (23) (e.g. triploid = 69, tetraploid = 92 chromosomes). * **Aneuploid** refers to any chromosome number that is not a multiple of n (23) (e.g. 2n + 1 (Down syndrome) or 2n-1 (Turner syndrome). ## **Causes of Chromosomal Aberrations** * **Non-disjunction:** During cell division, two members of a chromosome pair fail to separate, meaning both pass to the same daughter cell. * **Radiation** ## **Common Genetic Disorders** * **Thalassemia** * **Cystic fibrosis** * **Hemophilia A** * **Sickle Cell anemia** * **Fragile X-syndrome** * **Congenital adrenal hyperplasia** * **Duchenne type muscular dystrophy** * **Myotonic dystrophy** * **Spinal muscular atrophy** * **Familial retinoblastoma** * **Neurofibromatosis** ## **Prenatal Diagnosis** * Prenatal diagnosis must be made for mothers with advanced age, a case of an X-linked disorder, or having already had a child with genetic disorders. Some of the procedures carried for prenatal diagnosis are: * **Amniocentesis:** * **Fetoscopy:** * **Chorionic villus sampling:** * **Fetal blood sampling:** * **Ultrasonography:** ## **Impact of Genetic Conditions on Families** * **Psychological Impact:** * Mental trauma * Depression * Feelings of insecurity and inferiority * Fear of burden * Fear of leaking the truth * Fear of inheritance of the trait * **Social Impact:** * Social and educational problems * Problems finding a suitable partner * Social phobia * **Financial Impact:** * Costly genetic testing * Costly treatment * Job loss * Financial burden * **Scope of Genetics in Nursing:** Nearly all diseases now recognized to have a genetic component and this revelation has transformed genetic nursing practice from a nearly hidden specialty with a visible contribution to the genetic and overall health of individuals and families. ## **Role of Nurses in Genetics** * **Genetic nursing** is a holistic practice that includes assessing, planning, implementing, and evaluating the physical, spiritual, ethical, and psychosocial aspects of patients and families who have genetic concerns. Key roles of nurses include: * Following up on positive newborn screening tests * Taking comprehensive family histories * Assessing the client and family's strengths and weaknesses, family functioning, needs and interactions * Planning, implementing, managing and evaluating screening and testing programs * Monitoring and evaluating clients with genetic disorders * Coordinating care and services * Providing health education * Advocating for clients and families * Developing nursing care plans * Clarifying and interpreting genetic counseling and testing information * Supporting and counseling families * Identifying the possibility of a genetic component * Participating in public awareness programs