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obstetricial nursing
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Obstetricial nursing
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OBSTETRICAL NURSINGEXCERPT
Birth usually feels like a steamy kitchen—similar to holiday preparations, except the smells are different. The smell
of sweat is more acrid, there are some fetid odors, there is the smell and steam rising from blood. The air is thick,
pungent, fertile. It is hard not to be reminded of fresh straw and night stars. There is near and heady promise.
~ Penny Armstrong & Sheryl Feldman, A Midwife's Story ~
Overview of Philippine Obstetrics
Latin origin: Obstetrix
Midwife
FROM WOMB TO TOMB
PUBERTAL DEVELOPMENT
Puberty
9-12 years of age in females
12-14 years old in males
Central nervous system control
Hypothalamus
Pituitary gland
Pubertal Development
Androgen
adrenarche
Estrogen
thelarche
menarche
Secondary Sex Characteristics
ANATOMY AND PHYSIOLOGY
OF THE MALE REPRODUCTIVE SYSTEM
External Structures
Scrotum
Testes
Penis
Internal Structures
Epididymis
Vas Deferens
Seminal ducts Ejaculatory ducts
Prostate gland
Bulbo-urethral glands
Urethra
ANATOMY AND PHYSIOLOGY OF FEMALE
EXTERNAL STRUCTURES
Glans Clitoris
Urethral Meatus
Vaginal Orifice / Vaginal Opening
Vestibule
Perineum
ANATOMY AND PHYSIOLOGY OF FEMALE
INTERNAL STRUCTURES
VAGINA
,Forms part of the birth canal
UTERUS
Hollow, pear-shaped fibromuscular organ
Functions:
Organ of menstruation
Site of implantation
Retainment and nourishment of product of conception
Consists of 3 parts:
Corpus
Isthmus
Cervix
Composed of 3 muscle layers:
Perimetrium
Myometrium
Endometrium
FALLOPIAN TUBES
4 inches long from each side of the fundus
Peristaltic movements in the tubes cause the transport of the mature ovum from the ovaries to the uterus.
AMPULLA – widest part at the outer third or outer half where fertilization takes place
OVARIES
Sex glands
Produce and expel ova or egg per cycle
Produce estrogen and progesterone
Estrogen
Inhibits production of FSH (Follicle Stimulating Hormone)
Causes hypertrophy of Myometrium
Stimulates growth of the ductile structures in the Breasts
Increases quantity and pH of the cervical mucus causing it to become thin and watery
Progesterone
Inhibits production of LH (Luteinizing Hormone)
Facilitates transport of the fertilized ovum through the fallopian tube
Increases endometrial tortousity.
Inhibit uterine and gastrointestinal motility.
Decreases muscle tone of the urinary tract
Increase musculoskeletal motility
Decreases renal threshold for lactose and dextrose.
Causes fluid retention.
Increases basal fibrinogen levels thus decreasing hematocrit and hemoglobin levels.
Increases basal body temperature after ovulation.
ANATOMY AND PHYSIOLOGY
PELVIS STRUCTURES
made of 4 bones:
Ilium – iliac crest
Antero-posterior iliac spines
Ischium
Pubis
Sacrum
Coccyx
True and False Pelvis
False Pelvis
offers landmark for pelvic measurement
,Directs the fetus into the true pelvis at the latter part of the gestation.
True Pelvis
Inlet Diameter:
Antero-posterior
Transverse 13cm
Oblique 13cm
Mid Pelvis SIPSS
Sacral promontory accessible
Ischial spines are not prominent
Pelvic wall are not convergent
Sacrum is curved
Sub pubic arch is wide
Outlet
Anteroposterior 9.5 to 11cm
Intertubrous 11cm
Posterior sagital 7cm
Pelvic Types or Variations
Gynecoid
Anthropoid
Platypelloid
Android
MENSTRUAL CYCLE
Amenorrhea
Menorrhagia
Metrorrhagia
Polymenorrhea
Oligomenorrhea
Menstrual cycle
Regular occurance of ovulation throughout the reproductive life of a woman
It is divided into two phases:
Follicular (proliferative)
Luteal (secretory)
Menstrual Cycle
STRUCTURES INVOLVED
Hypothalamus
Anterior Pituitary Gland
Ovary
Uterus
Menstrual Cycle
Two simultaneous cycles:
ovarian cycle and
Follicular,
Ovulatory,
Luteal phase
Menstrual phase
endometrial cycle
Proliferative
Ovulation
Secretory
Menstrual phase
NEUROENDOCRINOLOGY OF REPRODUCTION
Hypothalumus
GnRH
, HORMONES REGULATING MENSTRUAL CYCLE
FSH (Follicle Stimulating Hormone)
LH (Luteinizing Hormone)
Gonadotrophins
Estrogen
Inhibits production of FSH (Follicle Stimulating Hormone)
Causes hypertrophy of Myometrium
Stimulates growth of the ductile structures in the Breasts
Increases quantity and pH of the cervical mucus causing it to become thin and watery
Progesterone
Inhibits production of LH (Luteinizing Hormone)
Facilitates transport of the fertilized ovum through the fallopian tube
Increases endometrial tortousity.
Inhibit uterine and gastrointestinal motility.
Decreases muscle tone of the urinary tract
Increase musculoskeletal motility
Decreases renal threshold for lactose and dextrose.
Causes fluid retention.
Increases basal fibrinogen levels thus decreasing hematocrit and hemoglobin levels.
Increases basal body temperature after ovulation.
THE GROWING FETUS
The beginning of pregnancy
Ovum
Zygote
Embryo
Conceptus
Fertilization of one ovum by one sperm resulting in a fertilized ovum (zygote).
Usually occurs in the distal outer third of fallopian tube
Implantation
Blastocyst
Trophoblast
Embryoblast
THE PROCESS OF APPOSITION
EMBRYONIC STRUCTURES
The decidua
It is the pregnant endometrium if fetilization occurs.
Deciduabasalis
Deciduacapsularis
Decidua Vera
Chorionic Villi
Serves as the anchor of the trophoblast on the deciduas
Syncytiotrophoblast
Cytotrophoblast
The Amniotic Membranes
Amnion
Chorion
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