OB Review version2 PDF

NORMAL OB By Sir V MALE REPRODUCTIVE SYSTEM INTERNAL STRUCTURES:  SPERM ANALYSIS RESULT n ml semen/ejaculation: 3-5ml n sperm count /ml: 20M-150M Clomid n sperm count/ejaculation: 400M n Lifespan: 3-5 days / 72hrs n pH: 7-8 n Morphology: 30% n Motility: 50% n Viability : 50% ...

NORMAL OB By Sir V MALE REPRODUCTIVE SYSTEM INTERNAL STRUCTURES:  SPERM ANALYSIS RESULT n ml semen/ejaculation: 3-5ml n sperm count /ml: 20M-150M Clomid n sperm count/ejaculation: 400M n Lifespan: 3-5 days / 72hrs n pH: 7-8 n Morphology: 30% n Motility: 50% n Viability : 50% FEMALE REPRODUCTIVE SYSTEM EXTERNAL STRUCTURES: FEMALE REPRODUCTIVE SYSTEM INTERNAL STRUCTURES: OVARIES (FEMALE GONADS) Size: 4cm x 2cm Color: grayish white Functions: 1. gonad/sex gland 2. estrogen/Progesterone 3. Ovulation OVARIES FALLOPIAN TUBES Length : 3-4 inches Parts: 1. Interstitial 2. Isthmus 3. Ampulla 4. Infundibullum Functions: 1. Site of fertilization 2. transports the fertilized egg to uterus UTERUS Size : 3”x2”x1” Weight: 50-60 grams Shape: pear-shaped Location: Suspended between the urinary bladder and the rectum Position: Non-Pregnant: anteverted Pregnant:retroverted FUNCTIONS OF THE UTERUS 1.Organ of menstruation 2.Site of implantation 3. Houses & nourishes the POC 4.Aids in labor & delivery CERVIX Parts: Internal OS: effaces Cervical Canal: operculum External OS: dilates LAYERS OF THE UTERUS 1.Perimetrium - Outer 2.Myometrium - Middle 3.Endometrium - Inner PARTS OF THE UTERUS 1.Fundus – Upper triangular portion 2.Corpus – Body 3.Isthmus – Lower part 4.Cervix – Mouth/ Entrance UTERUS VAGINA Length : 3”- 4” Functions: 1.copulation 2. Passageway of menstrual discharge 3. Birth canal Environment: Acidic- pH 4-5 Duoderleine bacilli BREAST: MAMMARY GLANDS BREAST MAMMARY GLANDS AND MILK EJECTION REFLEX LOBULES ACINI CELLS (milk) SUCKING LOBES (15-20 each breast) PPG OXYTOCIN MILK GLAND CELLS LACTIFEROUS DUCTS – LACTIFEROUS SINUS NIPPLE MILK IS EXPRESSED PELVIS Supports and protects the reproductive and other pelvic organs 2 Divisions: 1. False Pelvis 2. True Pelvis PELVIS : 4 TYPES Gynecoid Anthropoid Android Platypelloid PELVIS 3 Parts of the True Pelvis Inlet Cavity Outlet PELVIS Boundaries of the True Pelvis ANTERIOR POSTERIOR LATERAL Sacral INLET Superior Pubis Ilium Prominence CAVITY - - - OUTLET Inferior Pubis Coccyx Ischial Spines DIAMETER OF THE PELVIS ANTERIOR- TRANSVERSE OBLIQUE POSTERIOR INLET 11 cm 13cm 12cm CAVITY 12cm 12cm 12cm OUTLET 13cm 11cm 12cm FETAL SKULL-PELVIS RELATIONSHIP Fetal Skull – most important part because Most frequent presenting part Largest part of the fetal body Least compressible FETAL SKULL 3 Main Bones Frontal Bones Parietal Bones Occipital Bones FETAL SKULL Sutures: Frontal Suture Coronal Suture Sagittal Suture Lamboidal Suture FETAL SKULL Fontannels: Anterior fontannel – diamond (12-18 mos.) Posterior fontannel – triangular (2-3 mos.) REGIONS OF THE FETAL SKULL 1.Face- Mento-Vertical Diameter (13.5 cm) 2.Brow/ SINCIPUT 3. VERTEX 4. Occiput- Subocciput bregmatic (SOB)- 9.5 cm FETAL SKULL Attitudes: Flexion Extension FETAL PRESENTATION Cephalic Breech Transverse FETAL LIE- relationship of the long axis of the uterus and long axis of the fetus Longitudinal Transverse FETAL POSITIONS FETAL STATION Maternal Landmark : Ischial Spines -5 -4 -3 -2 -1 At Level of Ischial Spines = station 0 = engaged +1 +2 +3 +4 +5 MENSTRUATION - periodic, cyclic discharge of blood from the uterus - blood loss (30-80cc) - iron loss (12-29mg) MENSTRUAL PERIOD vs MENSTRUAL CYCLE - 3-5 days; maximum of 7 days - average of 28 days/cycle - ranges from 23-35 days; maximum of 40 days - occurs during puberty, 9-17 y/o average of 12 y/o - onset is menarche MENSTRUATION: ORGANS INVOLVED 1ST HALF (Est) 2ND HALF (Prog) 3RD DAY HYPOTHALAMUS 13TH DAY FSHRF LHRF ANTERIOR PITUITARY GLAND Maturation FSH LH¸ ovulation of oocytes OVARIES ESTROGEN PROGESTERONE GF CL UTERUS Increased vascularity Thickening of endo & myo of endometrium CONCEPTION OVUM - female sex cell or gamete - released through ovulation - life span : 24 hours - two layers: corona radiata and zona pellucida CONCEPTION SPERM CELLS - Parts : head, neck and tail - Lifespan : 48 to 72 hours (3-5 days) - Types: a. gynosperm – large oval head – X – acidic b. androsperm – small head – Y – alkaline REPRODUCTION SEXUAL INTERCOURSE EJACULATION SPERMATOZOA IN THE UTERUS IN 90 SECONDS FALLOPIAN TUBES IN 5 MINUTES ATTACHES ITS HEAD ON THE OVUM RELEASE OF HYALASE IN CORONA RADIATA REPRODUCTION (CONT..) RELEASE OF ACROSIN IN ZONA PELLUCIDA FERTILIZATION BLASTOMERE MORULA (16 BLASTOMERES) “MULBERRY MASS” BLASTOCYST REPRODUCTION (CONT..) TROPHOBLAST – CHORIONIC VILLI - HCG IMPLANTATION – APPROX 7 DAYS AFTER FERTILIZATION DECIDUA FETAL MEMBRANES 1. Chorionic – placenta 2. Amniotic – BOW and umbilical cord AMNIOTIC FLUID Volume : 500-1200ml; average is 1000ml Composition : 99% H20, 1% solid particles; pH 7-7.25 Vernix, uric acid, urea, albumin, lecithin, sphyngomyelin LS ratio Appearance : clear and colorless – straw-colored > if green: meconeum- possible fetal distress > if golden: bilirubin- Rh Incompatibility > if gray: infection  THE UMBILICAL CORD (Funis) Function : transport 02 and nutrients to fetus, unoxygenated blood and water to placenta Blood Vessels : AVA Length : 50-55 cm Insertion : center of the placenta 1. knots – increases perinatal loss 2. cord coil – nuchal cord THE PLACENTA - From chorionic villi and Decidua Basalis - Weight = 500gms at term; has 15 to 20 cotyledons - Produces: estrogen, progesterone, HPL, HCG 2 SIDES 1. Maternal – Duncan – periphery to center 2. Fetal – Schultz – center to pheriphery FETAL DEVELOPMENT 1. Pre-embryonic – 1st 2 weeks after fertilization 2. Embryonic – 2 weeks to 2 months 3. Fetal – 2 months to birth MILESTONES IN FETAL DEVELOPMENT First Month - heart functions as early as 16th day - development- nervous system; maternal hypoglycemia Second Month - sex differentiation starts - assumes human form - presence of amniotic fluid FHR determination by Doppler Third Month - renal system is functional - sucking reflex is present - placenta is fully developed and functional MILESTONES IN FETAL DEVELOPMENT Fourth Month - FHT by fetoscope - sex differentiation is complete - quickening for multipara - Ig G transport from mother to fetus - lanugo appearance begin Fifth Month - vernix appears - FHT by stethoscope -Quickening for primigravida MILESTONES IN FETAL DEVELOPMENT Sixth Month - surfactant production begins -Hears external sound Seventh Month - continued growth and development - Bone ossification 8th Month - subcutaneous fat is present - iron transfer from mother to fetus - lanugo disappears 9th Month - testes descends in scrotum - vernix disappears SIGNS AND SYMPTOMS OF PREGNANCY Presumptive Signs - Amenorrhea - Morning Sickness (4-6 weeks gestation) - Breast Changes - Quickening (16-20 weeks) - Chloasma (“mask of pregnancy”) - Urinary Frequency SIGNS AND SYMPTOMS OF PREGNANCY Probable Signs - Enlarged Uterus 12 weeks – above symphysis pubis 20 weeks – at umbilicus - Hegar’s and Goodell’s Sign - Chadwick’s Sign - (+) Urinary Pregnancy Test 2 wks after the first missed period SIGNS AND SYMPTOMS OF PREGNANCY Positive Signs - Ultrasound evidence after 6 weeks (between 8-12 weeks) - FHT - Quickening felt by the examiner SIGNS AND SYMPTOMS OF PREGNANCY Mrs. M is 8 months pregnant. She left home Matt born on the 38th week in 2009, Kurt and Ruselle born on the 32nd week in 2013, Clara born on the 39th week in 2016. She had an ectopic pregnancy at 12th week in 2018. G5 P3 T2 P2 A1 L4 M1 GPTPALM G5P322141 GTPALM G5P 22141  ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT Estimating Fetal Growth McDonald’s Rule - Fundic height measurement cm - Fundic height in cm = AOG in weeks - Or FHt x 8/7 = AOG in weeks - (2nd trimester and up) ASSESSMENT OF FETAL GOWTH AND DEVELOPMENT Bartholomew’s Rule - 5th month of pregnancy = fundus at the level of the umbilicus - Early 9th month = below xyphoid process - End of 9th month = at 8th month level FETAL MOVEMENTS (Kick count/hr) Quickening – 1st fetal movements primigravida – 20 weeks multigravida – 16 weeks Average : 16-20 weeks Peak : 28-38 weeks Normal : 5-10-15 times/hr ULTRASOUND Uses: To diagnose pregnancy Confirm presence, size and location of the placenta and amount of amniotic fluid Detect fetal abnormalities and defects Determine fetal position and presentation, fetal sex Determine fetal maturity by means of biparietal diameter, placental grading ULTRASOUND Preparation of the client: - Full bladder - Drink a glass of water every 15 minutes 1 ½ hours prior to procedure (