Obstetrics 1 (POINTERS)

August 25, 2015

Dr.Marcial
Some notes on what she said may come out for
tomorrow's quiz:
* Placement of indwelling catheter- proper
placement of the Foley Indwelling catheter should
always be in the urethral opening. Had it been
placed in the vaginal opening, no output will be
collected (n.b. knowledge of the anatomy of the
female reproductive system)
* mons pubis- is actually a fat pad in the anterior of
the abdominal wall and the female genital system
* Round ligament- terminates in the Labia majora,
and serves to anchor the uterus to its midline
position (note the bilateral placement of the round
ligament)

menstrual blood. As such, a virgin can menstruate. bleeding is not always present in first sexual contact
* imperforate hymen- a complete membranous
cover of the vaginal opening, which offers no route
for discharge of menstrual blood. Cases as these are
seen in PE as a bulging membrane over the vaginal
opening filled with fluid. Cyclical occurrence
coincides with menstrual cycle of patient
*bulbocavernosus muscle- aka as the banana cutter
muscle, capable of strong muscular contractions torn in multigravid patients
*pudendal block- this is performed outside from
the gluteal area to a direct insertion of local
anesthesia to the pudendal nerve, common approach
to desensitizing in labor.
* fimbriae ovarica- longest of the fimbriae which
"catches" or harvests the released ovum

* Male vs female embryo in development- all are

designed females (being female is default) , but
embryo with the Y-chromosome differentiate into
males by the 5th month due to the expression of the
SRY gene

*smoking and ectopic pregnancy- smoking

(nicotine) causes the destruction of the cilia within
the fallopian tube, rendering the transit time of the
ovum to the uterus to be slower, may most often
result to ectopic pregnancy

* SRY gene- determinant of maleness; located in

the SR locus of the Y-chromosome. Expression of
this gene signifies the activation f the AntiMullerian Hormone, thereby negating the X-factor
for femaleness.

*isthmus- this develops into the lower uterine

segment (LUS) during pregnancy - in caesarian
delivery, incision is made on LUS - in dystocia, the
lower uterine segment ruptures

*openings of the vestibule- total of 6 openings:

1. Urethral opening
2. Vaginal opening
3. Opening of the ducts of Bartholin's glands (2) aka
major vestibular glands
4. Opening of paraurethral glands (2) aka minor
vestibular glands

*cervical widening during labor - the cervical

stroma (of parasympathetic innervation) is pulled up
by uterine muscle contactions (of sympathetic
innervation)
* uterine corpus (body) is muscular
cervix is stromal

* clinical correlation for the opening of gland ductsin cases of infection, as in a Bartholin's cyst, the
opening may be plugged. Plugging may be due to
sebaceous material, folliculitis etc, which may cause
abscess formation

*normal fimbriae- normal fimbriae must be

"blossomed" to catch the ovum, much like the
flowers of a gumamela (Hibiscus flora sinensis). In
some cases, as in Pelvic Inflammatory Disease
(PID) caused by Gonorrhea or Chlamydia, the
fimbriae may "close", leading to infertility

* hymen misconceptions- a hymen normally has

slits, or minute opening for the normal passage of

*retrograde menstruation- in cases of retrograde

menstruation, with the accumulation of
Supplemental by the OB team. (2018)

hemosiderins, cellular adhesions may proliferate,

also leading to the closing of the fimbriae

*lumbar pains in pregnant women - due to

compression of sciatic nerve, also limping gait

*uterus weight- the uterus can expand during and

after childbirth, such that by the weight of the
uterus, parity of a woman can be determined

*cervix - composed of elastin, collagen,

proteoglycans and 10% smooth muscle
- softens on pregnancy due to progesterone
-"fishmouth" cervix - multigravid

*broad ligament- this is the ligament which serves

as a structural support for the uterus, and is
anchored to the:
Ovary by the mesovarium
Fallopian tube by the mesosalpynx
Around the uterus by the mesoteres

*Pelvis- pelvis for pregnancy= Gynecoid

*relaxin- hormone that enables pelvic bones not to
break and become malleable
*linea terminalis- separates false from true pelvis

*endometrium - the functional layer that thickens

with estrogen
- upon progesterone withdrawal, there will be
shedding or the sloughing off as menstruation
(withdrawal bleeding)
*myoma - tumor within the myometrium
*myometrium - consist of muscles arranged in
'figure of 8' where, at the center of the each are the
spiral arteries
- during uterine contractions, the myometrium
contracts now compressing the spiral arteries
thereby inhibiting blood loss
- if uterus is not contracted= hemorrhage
*"mickey mouse" myoma - tumor located beneath
serosa
- ttt: dissection with myomectomy

*true conjugate- tip of sacrum to tip of symphysis

pubis
*obstetric conjugate - tip of sacrum to nearest
point of symphysis pubis
- most important
- Diagonal conjugate minus 1.5-2 cm
- 10 or more is compatible with pregnancy
*diagonal conjugate - tip of sacrum to outermost
portion of symphysis pubis
*perineal body - serves as support (from vaginal
orifice to anus)
*ovaries- master gland in HPO (hypothalamus
Pituitary Ovarian) axis
*turner's- with uterus but no ovaries

Supplemental by the OB team. (2018)