Documenti di Didattica
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By;Asmare.T(BSC,MID)
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Function of pelvis
Adapted for child bearing Allow movement of the body Permits the person to sit and kneel Transmits the weight of the trunk to the leg Affords protection to pelvic organs and a lesser extent to the abdominal contents
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The ilium
Is the large flared out part of the innominate bone Is made up of a relatively flat of bone above and part of acetabulum below. It has the following characteristics: The external aspect is gently curved and has a roughened surface to which are attached the gluteal muscles of the buttock. The greater part of the inner aspect is smooth and concave forming the iliac fosse. The ridge which surmount these two surface is known as iliac crest, which serves for the attachment of the muscles of the abdominal 7 2/13/2014 wall.
The ilium
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The ischium
The lowest constituent bones of the innominate bone Formed by the following parts; The head forms the lowest two-fifths of the acetabulum, where it fuses with the ileum and pubis.
Below the acetabulum a thick buttress of bone pass down and terminates in ischial tuberosity the part which the weight of 2/13/2014 9 the body rest on when sitting.
The ischium
The ischium forms the lower boundary of the large foramen, the obturator foramen or foramen ovale. On its internal aspect the ischium forms the side wall of the true pelvis. Protruding in wards from its posterior edge, about 5cm above the tuberosity, is a conspicuous projection known as the ischial spine which is use to estimate the station of fetal head. Lesser sciatic notch is situated between the ischial spine above and ischial tuberosity below. 2/13/2014 10
The pubis
The smallest of the three bones forming the innominate bone and form the lower one fifth of the acetabulum. The right and left pubic bones unite with each other anteriorly at the square shaped pubic bodies. They are fused by a pad of cartilage, the symphysis pubis. The upper surface of the body forms a crest, the pubic crest, which ends laterally in the pubic tubercle.
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Is situated in the posterior part of the pelvis and consists of five fused sacral vertebrae. The anterior surface is smooth, and is concave from above down wards and slightly so from side to side forming the hollow of the sacrum. The sacral alae are the widened out wings of bone on each side of the 1st sacral vertebra. Promontory of the sacrum is the center point of the upper border of the 1st sacral vertebrae which with the base of the 5th lumbar vertebra, protrudes over the hollow of the sacrum. 2/13/2014 12
The sacrum
The coccyx
Consists of four fused coccygeal vertebrae. It is triangular in shape with its base uppermost. The 1st coccygeal vertebra articulates with lower end of the sacrum at the sacro-coccygeal joint. The remaining three vertebrae mere rudimentary nodules of bone; they are smooth in their inner surface where they support the rectum, while their lowest most tip are attached to the external anal sphincter and anococcygeal body. 2/13/2014 13
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Pelvic joints
There are four pelvic joints Two sacro-iliac joints One symphysis pubis One sacro-coccygeal joints
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Each of the pelvic joints held together by ligaments These are: pubic ligaments sacro-iliac ligament sacro-coccygeal ligaments
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The sacro- tuberous ligament and sacrospinous ligaments cross the sciatic notch and form the posterior wall of the pelvic out let.
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ramus of the pubic bone meets the ilium) 6. Inner border of the superior ramus of pubic bone. 7. Upper inner border of the body of pubic bone 8. upper inner border of symphysis pubis
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Extends from the in let above to the out let below. Formed by the hollow of the sacrum. The posterior wall is deeply concave and approximately 12cm in length. The anterior wall is formed by symphysis pubis and is approximately 4cm long.
The lateral walls comprise the greater sciatic notch, the internal surface of a small portion of the ileum, the body of the ischium and the 2/13/2014 27 foramen ovale.
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Dimensions.
The diagonal conjugate is measured anteriorposteriorly from the lower border of the symphysis pubis to sacral promontory and measures 12-13cm. It may be estimated pervaginum as a part of pelvic assessment. The oblique diameter passes from the sacro-iliac joints to the opposite ilio- pectineal eminence. It measures12cm. The transverse diameters is a line between the points farther most a part on the ilio- pectineal lines and measures 13 cm. The sacro- cotyloid diameter is a line passing from the promontary of the sacrum to the ilio- pectineal eminence and it measures 9.5 cm on each side.
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Dimensions The diameters of the cavity - The cavity is circular in shape and all diameter are equal in length. Anterior- posterior diameters posses from the mid point of symphysis pubis to the junction of the 2nd and 3rd sacral vertebrae and measures 12cm. The oblique diameter- pass obliquely in the plane of the cavity parallel to the oblique diameters of the brim. It measures 12cm. The Transverse diameter- passes in the plane of the cavity between the points far most apart in the lateral pelvic walls and measures 12cm.
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Dimensions The diameters of out let The anterior-posterior diameter passes from the lower border of the symphysis pubis to the sacro-coccygeal joint and measures 13cm. There are two transverse diameters; The 1st is a line passes between the two ischial spines. It measure 11 cm. The 2nd is a line passing between the inner borders of the two ischial tuberosities and measures 11cm The oblique diameters is
said to be between the obturator foramen and the sacrospinous ligament.
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Types of pelvis
Based on the shape of the brim, there are four main groups of pelvis Gyneacoid Android Platypelloid Anthropoid
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Gynaecoid pelvis(50%)
It is the normal female type. Inlet is slightly transverse oval. Sacrum is wide with average concavity and inclination. Side walls are straight with blunt ischial spines. Sacro-sciatic notch is wide. Subpubic angle is 90-1000.
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Gynaecoid
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Anthropoid
Android
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Muscles
Bulbo-cavernous muscles arise from the
central point of the perineum and pass forwards around the vagina lying superficial to bartholins glands and the vestibular bulbs, and deep to the labia. They are inserted into the corpora cavernous of the clitoris in the upper part of the pubic arch. Its action is to diminish the size of the vaginal orifice and to cause engorgement of clitoris during sexual activity.
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canal, lying below the internal sphincter and the levator ani. Anteriorly it enters in to the formation of the perineal body and posteriorly some of its fibers are attached to the tip of the coccyx. Its function is to close the lumen of the anal canal.
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Muscles
The membranous sphincter of the urethra is
composed of muscle fibers passing above and below the urethra and attached to the pubic bones.
spine and pass to the upper part of the coccyx and lower border of the sacrum, in front of the sacro-spinous ligament. It helps to stabilize the sacroiliac and sacro-coccygeal joints.
the body of pubic bones. Its fibers sweep posteriorly below the bladder on either side of the urethra and the lowest third of the vagina, to enter the perineal body. The longest fibers gain insertions into ano-cocygeal body and the coccyx. They surround and support the urethra, vagina and rectum. It helps in controlling micturition and defection, as well as 48 normal sexual function. 2/13/2014
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II.The anatomy of the female Genital Organs External Genitalia Vulva is formed from the following structures; Mons pubis is a pad of fatty tissue situated in front of the symphysis pubis. It is covered by skin and pubic hair which develop at the time of puberty and appears triangular in distribution. Purpose protect the junction of the pubic bone from trauma.
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External Genitalia
External Genitalia
Labia minora are two thin smaller folds of
skin lying longitudinally with the labia majora. The area they in close is known as the vestibule - Anteriorly they divided in to two folds. The upper folds surround the clitoris and unite to form the prepuce. The two lower folds are attached to undersurface of the clitoris and are known as the frenulum. - Posteriorly, the labia minora unite to form a thin fold of skin, the fourchette.
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Con
External Genitalia
Clitoris:- is small extremely sensitive erectile structure situated with in the folds of the prepuce and frenulum. It is about 2.5 cm long and is composed of two corpora cavernose. It consists of the glands, body and two crura. It is analogue to the penis in the male and highly vascularized
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3.The bartholins ducts and glands:- are situated in the superficial perineal pouch posterior to the vestibular bulb. It secretes abundant alkaline mucus during sexual excitement which helps in lubrication. 4.Vestibuler bulb:- are bilateral masses of erectile tissues situated beneath the mucus membrane called vestibule. Each bulb lies on either side of the vaginal orifice deep to the labia majora and minora and anterior to bartholins glands.
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External Genitalia
External Genitalia
Blood supply:- The vulva is supplied with blood from two main arteries The femoral artery in the upper part of the thigh. The internal pudendal artery running along the pubic arch. The blood drains through corresponding veins. Lymphatic drainage:- some drainage in to the inguinal glands and some is in to the external iliac glands. Never supply:- is from the branches of pudendal nerve and the perineal nerve. 2/13/2014 62
Internal genitalia
The vagina Is a tube (canal) which extends from the vulva to the uterine cervix. It is longer in posterior wall (9cm) than anterior (7cm). The vault of the vagina is divided in to four fornices by the projection of the cervix. Anterior Posterior Two lateral fornices The posterior fornix is the largest. The vaginal walls are pink in appearance and 2/13/2014 thrown in to small folds known as rugae. 63
The vagina
Structures Vaginal wall is composed of four layers. - The layers from in to out wards are : i. Mucus coat lined by stratified squamous epithelium. ii. Sub mucous layer iii. Muscular layer inner circular and outer longitudinal iv. Fibrous coat
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The vagina
Contents There are no glands situated in the wall of the vagina. The vagina contains a small amount of fluid which is derived from two sources; Alkaline mucus which secrete from the glands of the cervix, The vaginal blood vessels which allow serous fluid to transude through the vaginal wall into its lumen. The vaginal fluid is acidic in reaction having a 2/13/2014 PH of about 4.5 during reproductive life. 65
The vagina
Relations Anterior the bladder and the urethra Posterior - lowest 2/3 perineal body - Middle third rectum - Upper third pouch of Douglas. Lateral - upper 2/3 pelvic fascia at the base of the broad ligament. Lowest third -two levator anmuscles -bulbo-cavernmuscles. Superior Uterine cervix Inferior hymen and the structures of the vulva 2/13/2014 66
The vagina
Blood supply Arterial supply from the vaginal, the uterine (descending branch), the middle haemorrodial, the inferior vesical and pedundial arteries The vein drains in a corresponding manner. Lymphatic drainage The lowest 2/3 drain to the horizontal inguinal groups along with those of the vulva. Upper 1/3 drain to the internal iliac and sacral glands. Nerve supply is from the sympathetic and pelvic splanchnics nerves 2/13/2014 67
The vagina
Functions Entrance for spermatozoa Exit for menstrual flow and products of conception Helps to support the uterus Organs for sexual intercourse Helps to prevent infection
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The Uterus
Is a hollow, flattened, muscular pear shaped organ situated between the bladder and rectum in non pregnant state. It is normally anteverted and anteflexed It measures 8cm in length 5cm width and 2-3 cm thick. Its weight is approximately 57gm.
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The Uterus
It consists of the following parts. a) Body or corpus Comprise the upper 2/3 of the uterus Lies between the isthmus and the opening of the fallopian tubes. b) Cervix Forms the lower third of the uterus and measures about 2.5 cm in length. It is conical in shape The cervix projects through the anterior wall of the vaginal which divides it in to an upper is the supravaginal portion and lower is the infravaginal portion.
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The Uterus
SUPRA VAGINAL CERVIX lies out side and above the vagina Superiorly it meets the border of the uterus at the isthmus. Is separated in front from the bladder by parametrium. Posteriorly it is covered by the peritoneum.
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The Uterus
INFRAVAGINAL CERVIX- is the part which projects in to the anterior vaginal wall between the anterior and posterior fornices. a) The internal os-opens in to the cavity of the uterus It dilates during labor. In competence of the cervix at this level results in spontaneous abortion. b) The external os opens in to the vagina at the lower end of the cervical canal. c) The cervical canal lies between the internal and external os It is fusiform in shape. 2/13/2014 72
The Uterus
FUNCTIONS OF THE CERVIX It helps to prevent infection entering the uterus. It dilates and withdraws during labor to enable vaginal delivery of the fetus and placenta.
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The Uterus
STRUCTURES
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The Uterus
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The Uterus
The form, size and situation of the uterus vary at different periods of life and under different circumstances. In the fetus:- the uterus is contained in the abdominal cavity projecting beyond the superior aperture of the pelvis. The cervix is considerably larger than the body. At puberty- it is pyriform in shape and weights from 14 to 17 gm. 2/13/2014 78
The Uterus
In the adults- the position of the uterus
depends on the condition of the bladder and rectum. When the bladder is empty the entire uterus is directed forward and is at the same time bent on itself at the junction of the body and cervix, so that the body lies up on the bladder. as the bladder ,fills the uterus gradually becomes more and more erect until with a fully distended bladder the fundus may be directed back ward toward the sacrum.
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The Uterus
During menstruation:-the uterus is enlarged, more vascular, and its surface rounder; the external orifice is rounded, its labia swollen, and the lining membrane of the body thickened, softer, and of a darker color.
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The Uterus
After parturition-the uterus nearly
regains its usual size, weighinig about 42gm; but the cavity is larger than in the virgins state, its vessels are tortuous, and its muscular layers are more defined; the external orifice is more marked, and its edges present one or more fissures.
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The Uterus In old age - the uterus becomes atrophied, and denser in texture, a more distinct separates the body and cervix. The internal orifice is frequently, and the external orifice occasionally, obliterated, while the lips almost entirely disappear.
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The Uterus
RELATIONS ANTERIOR uterovesical pouch and bladder. POSTERIOR- recto uterine pouch of Douglas and the rectum. LATERAL broad ligaments, the fallopian tubes and ovaries. SUPERIOR- the intestines INFERIOR the vagina.
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The Uterus
UTERINE SUPPORTS (ligaments) Transverse cervical ligaments and (mackenrodts) Uterosacral ligaments Pubocervical ligaments Broad ligaments Pass from the sides of the uterus to the lateral walls of the pelvis. Together with the uterus it forms a septum across the female pelvis dividing the cavity in to two portions.
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The Uterus
BLOOD SUPPLY From the uterine artery, a branch of the hypo gastric artery. Veins drains to the corresponding manner. LYMPHATIC DRAINAGE- lymph is drained from uterine body to the internal illiac glands and also from the cervical area to many other pelvic lymph glands. Nerve supply -from autonomic nervous system, sympathetic and parasympathetic via sacral plexus
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The Uterus
FUNCTION OF THE UTERUS To prepare a bed for the fertilized ovum. To nourish the fertilized ovum for the gestation period To expel the product of conception at full term. To involutes following child birth
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FALLOPIAN TUBES
Are paired structures which are attached with the lateral angle of uterine cavity. They run along the upper margin of the broad ligament and 10 cm in length. It has four portions 1.The interstitial portion- is 1.25 cm long and lies within the wall of the uterus. Its lumen is 1mm wide
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FALLOPIAN TUBES
2.The isthmus is another narrow part which extends for 2.5 cm from the uterus. It acts as reservoir for spermatozoa because its temperatures is lower than other. 3.The ampulla- is the wider portion where fertilization usually occurs & it is 5 cm in length. 4.The infundibulum- is the funnel shaped fingered end which is composed of many processes know as fimbriae.
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FALLOPIAN TUBES
RELATIONS
Anterior, posterior and superior the peritoneal cavity and the intestine Lateral the side walls of the pelvis. Inferior the broad ligaments and ovaries. Medial the uterus.
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FALLOPIAN TUBES
LAYERS OF THE TUBE It consists of three coats 1.The external or serous coat is the peritoneum. 2.Middle or muscular coat- consists of inner circular and outer longitudinal layer of smooth muscles which helps for peristaltic movement of the fallopian tube. 3.The internal or mucous coat-is line by columnar and ciliated epithelium. Beneath the lining is a layer of vascular connective tissue.
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FALLOPIAN TUBES
SUPPORT - by the infundibulo pelvic ligaments. These ligaments are formed from folds of the broad ligament and run from the infundibulum of the tube to the side walls of the pelvis. Blood supply:- is via the uterine and ovarian arteries; venous return is by the corresponding veins. Lymphatic drainage- is in to the lumbar gland. NERVE SUPPLY is from the ovarian plexus.
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FALLOPIAN TUBES
FUNCTIONS
Propels the ovum towards the uterus. Receives the spermatozoa as they travel up wards Provides a site for fertilization Supplies the fertilized ovum with nutrition during its continued journey to the uterus.
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THE OVARIES
Are two nodular bodies which produce ova and hormones estrogen and progesterone. POSITION They are attached to the back of the broad ligament within the peritoneal cavity Size 3 cm in length, 2 cm in width and about 1 cm in thickness and weight from about 6gm.
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THE OVARIES
RELATIONS
Anterior the broad ligament. Posterior the intestine. Lateral the infudibulopelvic ligaments and the side walls of the pelvis. Superior the fallopian tubes. Medial the uterus and ovarian ligaments.
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THE OVARIES
SUPPORTS From above by the ovarian ligament medially, and the infundibulo pelvic ligaments laterally. Attachment of ovary- infundibulo pelvic ligament to the pelvic wall. Ovarian ligament- to the uterus. Mesooverium to the broad ligament
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THE OVARIES
Structures
The ovary is composed of medulla and cortex covered with germinal epithelium. The medulla- is the central portion and point of entry for blood vessels, lymphatic and nerves. The hilum where these vessels enter lies just where the ovary is attached to the broad ligament and this area is called the mesovarium. 2/13/2014 98
THE OVARIES
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THE OVARIES
Blood supply
Is from the ovarian arteries and drains by the ovarian veins. Lymphatic drainage- is to the lumbar glands. Nerve supply- is from the ovarian plexus.
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Physiology of the female reproductive organs Hormones and their function A. Hypothalamus Hypothalamus produces a specific releasing and inhibitory hormones or factors which have effect on the production of pituitary hormones. I) Gonadotrophic releasing hormones(GnRH) Concerned with the synthesis, storage and release of gonadotrophic hormones (FSH and LH) II) Prolactin inhibitory factor/ hormones(PIF) Inhibits the release of TSH
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Hormones
III) Thyrotrophin releasing hormone Stimulates the release of TSH IV) Corticotrophin releasing hormone(CRH) Stimulate the release of ACTH
(adrenocorticosteriod hormones)
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Hormones
B. PITUITARY HORMONES 1) Anterior pituitary (Adenohypophsis) i) Gonadotrophins hormones - FSH and LH. FSH- stimulate the growth and maturation of primary oocytes of which only one develops into a mature follicle. In conjunction with LH, it is also involved in ovulation and steriodogenesis. LH- is steroidogenesis but along with FSH, it is responsible for full maturation of graffian follicle and ovulation.
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C. Ovarian hormones 1.Estrogen - is produced by granulosa cells under the influence of FSH. Function (actions) Responsible for secondary sexual characteristics. Inhibition of FSH secretion from ovary (negative feedback mechanism). Growth of myomentrium, endometrium, alveoli and ducts of the breast.
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Myometrial stimulation (increase myometrial contractility). Stimulation of protein synthesis in the liver. Promotion of calcifications of the bone. Angiogenesis (new blood formation). Influences the production of cervical mucus and the structure of the vaginal epithelium.
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2.Progestrone-produced by the corpus luteum under the influence of LH. Actions Growth of ducts and lobules of the breast, inhibition of prolactin synthesis. Relaxation of smooth muscles of the uterus, blood vessels, GI and urinary tract. Secretary changes and decasualization of the endometrium.
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Hormones
Vasodilatation. Thermogenic (increase BBT). Hyperventilation (decrease concentration of co2
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3.Androgens - produced by the theca interna cells. They are source for estrogen synthesis. 4.Inhibin and Relaxin
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PUBERTY
Is the stage of life at which secondary sexual
characteristics appear: It is marked by neuro-endocrine changes. Pulsative releases of GnRh seen at this time. Ovarian steroid hormones start to be secreted. The H-P-O axis becomes coordinated.
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PUBERTY
Hypothalamo-Pitutary-Ovarian(HPO) - Axis has different stage of life, in Puberty stage : -Hypothalamus become more insensible to estrogen negative feed back. Hence increasing amount of GnRH , FSH and LH are secreted, which in turn stimulate the ovary to secret estrogen and progesterone.
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PUBERTY
Notable changes at this time are: Breast development. Marked physical growth. Increase in the transverse diameter of the pelvis. Growth of pubic and auxiliary hair. Menarche the 1st menses.
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The menstrual cycle PHASE OF OVARIAN CYCLE 1.Follicular phase:- hormonal feedback promote the development of single dominant follicle. Its average length is 10-14 days. 2. Luteal phase: - the time from ovulation to the onset of the menses. Average length 14 days.
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The menstrual cycle Each growing follicies start to secrete estrogen hormone; this results uterine endometrial proliferation. Maximum estrogen level provides negative feedback on pituitary FSH secretion (which begins at midpoint of the follicular phase). Estrogen also stimulates LH production through the follicular phase.
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The menstrual cycle At the end of the follicular phase (just prior to ovulation) FSH induce LH receptors, then with LH stimulation secretion of progesterone will takes place. After sufficient degree of estrogenic stimulation the pituitary LH surge is triggered(activated), this is the cause of ovulation then occurs 24- 36 hrs later.
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The menstrual cycle Estrogen level begin to rise again as result of corpusluteum secretion. Progesterone level rise after ovulation, it is a presumptive sign of ovulation has occurred. Both estrogen and progesterone level remain elevated till the demise of corpusluteum, then the next cycle will continue.
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The menstrual cycle There are three phases in the endometrial cycle.
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The menstrual cycle Prostaglandin f2-initiate uterine contraction. Decreases local uterine blood flow. Physical expel of the blood which result in menstruation.
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IV. EMBRYOLOGY
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Is a science that deals with the origin and development of individual organism. FERTILIAZATION- is the union of the ovum and spermatozoa. Following ovulation as the ovum is extruded from the graafian follicle it is surrounded by a ring of mucoploysaccharide fluid (the zone pellucid) and a circle of cells (the corona radiate.) Fertilization usually takes place at the ampulla.
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IV. EMBRYOLOGY
Mr.SPERM
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EMBRYOLOGY cont..
Immediately after penetration of the ovum the chromosomal material of the ovum and the spermatozoa fuse. The resulting structure is called a zygote. The occurrence of fertilization depends on: Maturation of both sperm and ovum. Ability of the sperm to reach the ovum Ability of the sperm to penetrate the zonapellucida and cell membrane and achieve fertilization. 2/13/2014 134
EMBRAYOLOGY cont..
IMPLANTATION- is a contact between
the blastocyst and the uterine endothelium. It occurs approximately 8 to 10 Days after fertilization. Once fertilization is complete the zygote migrates towards the body of the uterus aided by muscular contraction of the fallopian tubes.
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EMBRYOLOGY cont..
It takes 3 to 4 days for the zygote to reach the body of the uterus. This time the zygote consists 16 to 50 cells and is termed as a morula. When fluid filled cavity appears in the morula a blastocyt is formed, these is after 3 or 4 days. The cells of a blastocyst are arranged in to layers the outer layer is called the trophoblast which eventually develops in to the placenta and membrane. The inner layer is called the embryoblast which later gives rise to the embryo (fetus).
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EMBRYOLOGY cont..
All tissue products of conception (embryo, fetus, fetal membranes and placenta) are called conceptus. On day 4 after fertilization the blastocyst enters in to the uterine cavity. By day 7 starts embedding it self in to the prepared endometrium which is now called the deciduas. This process is called implantation. Once implanted the zygote is an embryo (the period from the end of ovum stage until measurement reaches approximately 3cm, 54-56 days). Fetus- period end of embryo stage until birth.
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EMBRYOLOGY cont..
First trimester (0-12 wks) Susceptible to teratogens. Heart function at 3-4 weeks. Eye formation at 4-5 weeks Arm and leg buds at 4-5 weeks Recognizable face at 8 weeks
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EMBRYOLOGY cont..
Brain rapid grows. External genitalia at 8 weeks. Placenta formed at 12 weeks. Bone ossification at 12 weeks. Fetal circulation function properly at 8-12 weeks.
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EMBRYOLOGY cont..
2nd trimester (13-27 weeks)
Less danger from teratogens after 12 week. Facial features formed at 16 week. Fetal heart beat heard by 16 to 20 week with fetoscope. Lanugo appears (hair over the body). Vernix present. Length 10 inches (2.5 cm), weight(0.23-0.27 kg). Most organs become capable of functioning.
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EMBRYOLOGY cont..
3rd trimester (28-42 weeks)
Iron stored. Surfactant production begins in increasing amount. Size; 15 inches. Testes descend in to scrotum in male at 28-32 week. Calcium stored at 28-32 week.
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EMBRYOLOGY cont..
Reflexes present at 28-32 week. Subcutaneous fat deposits at 36 week. Lanugo disappears from the body Average size 18-22 inch, Term is reached and birth is due at 38-40 weeks.
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EMBRYOLOGY cont..
THE DECIDUA- is the endometrium after
implantation. It has three parts 1.The decidua basalis- the part of the endometrium lying directly under the embryo (the portion where the trophoblast cells establish communication with maternal blood vessels). 2.The decidua capsularis- the portion of endometrium that stretches or encapsulates the surface of the trophoblasts. 3.The decidua vera- the remaining portion of the uterine lining.
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EMBRYOLOGY cont..
CHORIONIC VILLI
As early as the 11th or 12th day after conception the tropoblastic cells have sent out processes in to the endometrium. The outgrowths becomes finger like and termed chorionic villi. The chorionic villi have a central core of loose connective tissue surrounded by a double layer of trophoblastic cells.
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EMBRYOLOGY cont..
The outer layer (syncitotrohblast or the syncitial layer)- produce various placental hormones as HCG, human placental lactogen, estrogen and progesterone. The inner layer (cytotrophoblast or langhans layer). It appears to be functional in early pregnancy but then disappears between the 20th and 24th weeks. Protects the growing embryo and fetus from infection.
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THE PLACENTA
Is formed from the traphoblast and deciduas basalis. The placental barrier is formed by the syncitiotrophoblast, cytotrophoblast, the basement membrane and fetal vascular endothelial cells. The placenta on overage has a diameter of 18 cm, a thickness of 23 mm, a volume of 497ml, and a weight of 508 grams.
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THE PLACENTA
It has two surfaces; maternal and fetal surface. The maternal surface is made of deciduas basalis and dark red in color. The fetal surface is smooth, white and is covered by amnion. The branching fetal vessels are visible under the amnion.
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THE PLACENTA
FUNCTIONS OF PLACENTA
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THE PLACENTA
THE PLACENTA
Its purpose is to act as fail-safe measure to ensure that the corpus luteum of the ovary continues to produce progesterone and estrogen. Forms the basis for pregnancy test. Estrogens is produced as a 2nd product of the syncitial cells of the placenta. It contributes to the mothers mammary gland development in preparation for lactation and stimulates the uterus to growth to accommodate the developing fetus.
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THE PLACENTA
Progesterone- maintain endometrial
lining of the uterus during pregnancy. It reduces contractility of the uterine musculature during pregnancy which prevents abortion and premature labor.
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THE PLACENTA
Human placental lactogen (HPL) (chorionic somatomamotropin): Is produce by placental trophoblasts (as early as 3rd week) and detected in serum by 4th week after ovulation. Its main action is resetting of CHO and fat metabolism of mother so as to ensure adequate supply of glucose and energy to the fetus.
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Other action includes. Gluconeogenesis inhibition. Inhibitions of peripheral uptake of cellular glucose and insulin hyper insulinism maintain maternal blood glucose level. Increase uptake of amino acid and ketones by placenta.
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ANATOMICAL VARATION OF THE PLECENTA AND CORD 1.Succenturiata lobe of placenta A small extra lobe is present, separate from the main placenta and joined to it by blood vessels which run through the membrane. Danger the small lobe may be retained in the utero after delivery and if it is not removed it may lead to hemorrhage and infection. Identification- on inspection the placenta will appear torn at edge or torn bold vessels may extend beyond the edge of the placenta.
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THE PLACENTA
2.Circumvallate placenta- in this situation an opaque ring is seen on the fetal surface. It is formed by a doubling back of the chorion and amnion.
separate lobes are present each with a cord leaving it. The bipartite cord joins a short distance from the two parts of the placenta. Danger- the extra lobe may be retained during delivery.
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4.A tripartite placenta is similar to bipartite but with three distinct lobes. 5.Battledore insertion of the cord- the cord is attached at the very edge of the placenta Danger- likely it is detached up on applying traction during active management of 3rd stage of labor. 6.Velamentous insertion of the cord- it is inserted in to the membrane some distance from the edge of the placenta. The umbilical vessels run through the membranous from the cord to the placenta. Danger- the vessels may tear with cervical dilatation and would result in sudden blood loss.
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To transport oxygen and nutrients from placenta to the fetus. To return waste products from the fetus to the placenta Allows fetal mobility.
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The membranes (sac) it has two layers: 1.Chorion - is the smooth opaque outer most fetal
membrane. Purpose support the sac that contains amniotic fluid.
Offers support to amniotic fluids. It produce the amniotic fluids. It produce phospholipids that initiates the formation of prostaglandins.
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AMNIOTIC FLUID Is a clear fluid in which through the fetus floats and is also called liquor amnion. It is present in the sac from the early months. The normal amount is from 500cc-1500cc. It is alkaline in reaction and has 99% of water. The remaining 1% contains; mineral salt, urea from the fetal urine in late pregnancy, trace of protein, fat, CHO, enzymes, lanugo, bile pigments, placental hormones.
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Maternal vessels in the decidua. Fetal vessels in the placenta. Fetal urine. APPEARANCE: Its normal color is clear fluid. Meconium stained- sign of fetal distress except in cases of breech presentation. Golden- sign of hemolytic disease. Milky appearance because of vernix caseosa.
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DEVELOPMENT OF EXTERNAL GENITAL ORGANS The origins of external genital organs are urogenital sinus. Endodermal cloacae divided by a coronally vertical partition known as urorectel septum. The dorsal part of endodermal cloacae differentiates to form rectum and anal canal. The ventral part form urogenital sinus and differentiates in to three parts.
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UTERINE MALFORMATION
Agenesis- complete absence of the uterus and vagina Imperforate hymen.
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V. Fetal circulation
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V. Fetal circulation
As the placenta acts as the intermiditary organ of transfer between the mother and fetus, fetal circulation differs from that required for extra uterine existence. The fetus receives oxygen through the placenta because the lungs do not function as organs of respiration in the uterus. To meet this situation the fetal circulation contains certain special vessels that shunt the blood around the lungs, with only a small amount circulating through them for nutrition.
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There, the oxygenated blood from the placenta is mixed with deoxygenated blood from the lower parts of the fetal body. This blood continues through the vena cava to the right atrium. As the blood relatively high in oxygen enters the left atrium of the fetal heart, a large proportion of it is shunted directly in to the left atrium through an opening in the artial septum called the foramen ovale. The more highly oxygenated blood that enters the left atrium through the foramen ovale is mixed with a small amount of deoxygenated blood returning from the pulmonary veins. This mixture moves in to the left ventricle and is pumped in to the aorta.
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Fetus
Foramen ovale Ductus arteriosus Umbilical aa.(within fetus) Umbilical v.(within fetus) Ductus venosus
The ductus arteriosus is obliterated and becomes a ligament. Functional closure takes 3-4 days; anatomic closure is completed by 3 weeks. The constriction seems to be stimulated by a substance called bradykinin, which is released from the lungs during their initial expansions.
The foramen ovale closes after the umbilical cord is tied and cut. A large amount of blood is returned to the heart and the lugs. With the lungs now functioning there is equal pressure on both atria as the vessels constrict. Failure of the foramen ovale to close spontaneously results in an artial septal defect, which may or may not require surgery later
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forehead or
sinciput. Their ossification centers are named frontal eminence or frontal bosses. Fuse in to a single bone by 8 years
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Types of sutures Lambdoidal suture separate the occipital bone from the two parietal
bones. It is shaped like the Greek letter Lambda
Sagital suture- runs between the two parietal bones and runs
from the anterior fontanel in front to the posterior fontanel behind.
occurs at the junction of the lambdoidal and sagital sutures. It is very small and triangular in shape It is normally closes by 6 weeks of age
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1.Caput succedaneum is an
edematous swelling of the subcutaneous tissues of the fetal skull. It occurs in early rupture of membranes in the 1st stage of labor, because there is no bag of fore waters to take the pressure of dilating cervix off the fetal head.
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to bleeding between the skull bone and periosteum which covers it. The bleeding occurs because of friction between the skull bones and the periosteum. Characteristics It is not present at birth, but appears 2-3 days after wards . The swellings is limited by the periosteum and can there fore only occur over the bone , although it may be bilateral . It can not lie over a suture.
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Excessive molding
Occurs when labor is prolonged or where the skull bones are not completely ossified ( as in prematurity ). Upward molding Occurs when the baby delivers in the persistent occipito posterior position and the after coming head of the breech passes through the pelvis. It can result in intracranial hemorrhage .
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