2. Episiotomy- from vagina opening back 3. Skid marks B. Internal 1. Vagina- birthcanal a. Muscular b. Connects external genitalia with center of the pelvis c. Passage of sperm, baby, menstruation, protects uterus from pathogens and trauma d. Has vaginal vault, fornix (next to cervix), ruggae to stretch 2. Uterus- womb a. Hollow, muscular, thick-walled b. Anteverted- tilted forward c. Weighs 2 oz and then 2 pounds when pregnant d. Anchored only at the cervix OB Notes 11
e. Ligaments Broad ligament- centrally placed Round ligament- assists broad Ovaarian ligament- ovaries to uterus Cardinal ligament- main support (prevents prolapse) Indundibulopelvic- supports ovaries Uterosacral- supports uterus and cervix; has nerve fibers (pain) 3. Fallopian Tubes- oviducts a. Dynamic, restless b. Consists of isthmus, ampulla (fertilization), fimbrae c. Tube has cilia to propel egg toward uterus d. Functions: 1) Transport egg- 3 to 4 days to uterus 2) Fertilization 3) Nourish the egg/zygote 4. Ovaries a. Almond Shape b. Scarred and pitted after puberty c. Secrete estrogen- female characteristics 5. Bony pelvis a. Supports and protects pelvic contents b. Provides fixed access for birth passage c. Structure 1) Two immovable bones- connected by symphysis pubis 2) Pelvic floor- muscular part that overcomes gravity 3) False pelvis- above linea terminalis (pelvic inlet), supports uterus, directs baby into true pelvis for delivery 4) True pelvis- Has ischial tuberosities a) Below linea terminalis b) pelvic inlet c) Pelvic cavity d) Pelvic outlet 5) Pubic arch- one ischial tuberosity to the other d. Pelvic type 1) Gynecoid- most common (50%) a) heart shaped b) all diameters adequate 2) Android (20%) a) normal male pelvis b) Decreased capacity for birth c) Often too narrow- head molding d) May require vacuum or c-section 3) Anthropoid (25%) a) narrow b. capacity decreases 4) Platypelloid (5%) a) flat- flatter in the back b) Narrow from front to back 6. Breasts- mammary glands a. Specialized sebaceous glands b. Supported by Cooper’s ligaments c. Nipple, area, tubercles of Montgomery (papilla that secrete a lubricant during breastfeeding), and lactiferous ducts IV. Female Reproductive Cycle A. Menstrual Cycle OB Notes 12
1. Characterized by bleeding and flow (secretions, bacteria, WBC) 2. Menstrual phase a. Sloughing off of endometrium b. Hormones decrease 3. Proliferative Phase a. After menstruation until ovulation b. Increased estrogen especially 4. Secretory Phase a. After ovulation b. Endometrium prepares for a fertilized egg c. Increased estrogen and progesterone, increased vascularity 5. Ischemic phase a. Pre-menstrual b. Hormone levels decrease c. Small blood vessels rupture (menstruation) d. Arteries constrict e. Decreased blood supply and oxygen- cramps in muscle B. Ovarian Cycle 1. Follicular Phase- before ovulation a. FSH released and goes to ovaries from pituitary b. Graffian follicle begins to mature- moves to outer portion of ovary and ruptures through (ovulation) c. fimbrae picks it up and it takes 3-4 days to get to uterus d. Mittleschmerz- spotting (24-48 hours)—pain e. Secretions increase and thin f. Progesterone causes change in temperature
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