EASY WAY TO LEARN THE
BASICS OF
OBSTETRICS &
GYNAECOLOGY
(Short learning notes)
(Compiled Notes for Easy Learning)
PALWASHA KHAN
(BSN RN)
, CONTENTS: Page No
INTRODUCTION TO OBSTETRICS AND GYNAECOLOGY 04
1) The basic terminologies and introduction to Obstetrics and 04
gynaecology
CHAPTER 1 2) Overview of female reproductive system 04
3) Anatomy and Physiology of breast 11
4) Shapes of female pelvis and childbirth 12
5) Normal physiology of menstruation 13
NORMAL PHYSIOLOGY & DIAGNOSIS OF PREGNANCY: 16
1) Introduction to embryology 16
CHAPTER 2 2) Fertilization and normal fetal development by weeks 17
3) Fetal skull 18
4) Structure and functions of placenta 25
5) Normal physiological changes during pregnancy 26
6) Diagnosis of pregnancy 27
CHAPTER 3 ANTENATAL CARE 28
CHAPTER 4 MINOR DISORDERS IN PREGNANCY 32
CHAPTER 5 ABORTIONS 35
CHAPTER 6 ANTEPARTUM HEMORRHAGE 41
CHAPTER 7 DISTURBANCES OF AMNIOTIC FLUID 44
CHAPTER 8 PREMATURE RUPTURE OF MEMBRANES 48
CHAPTER 9 PRETERM OR PREMATURE LABOR 50
CHAPTER 10 PROLAPSED UMBILICAL CORD 51
CHAPTER 11 CEPHALOPELVIC DISPROPORTION 52
CHAPTER 12 COMMON MEDICAL DISORDERS IN PREGNANCY 58
CHAPTER 13 ECTOPIC PREGNANCY 63
CHAPTER 14 GESTATIONAL TROPHOBLASTIC DISEASE 64
CHAPTER 15 ISOIMMUNIZATION 66
CHAPTER 16 MULTIPLE PREGNANCIES 68
CHAPTER 17 CONCEPT OF FETAL LIE, PRESENTATION, 70
DENOMINATOR, ATTITUDE & POSITION
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, CHAPTER 18 PHYSIOLOGY & MANAGEMENT OF NORMAL LABOR 77
CHAPTER 19 MALPRESENTATION & MALPOSITIONS 84
CHAPTER 20 RETAINED PLACENTA 88
CHAPTER 21 UTERINE RUPTURE 89
CHAPTER 22 SHOULDER DYSTOCIA 89
CHAPTER 23 POST PARTUM HEMORRHAGE 90
CHAPTER 24 POST NATAL CARE 92
CHAPTER 25 CARE OF NEW BORN 94
SECTION TWO – GYNAECOLOGY
CHAPTER 26 MENUSTRAL CYCLE AND ITS ABNORMALITIES 95
CHAPTER 27 PELVIC INFLAMMATORY DISEASE 96
CHAPTER 28 FAMILY PLANNING 97
CHAPTER 29 UTEROVAGINAL PROLAPSE 104
CHAPTER 30 BREAST CANCER 105
SECTION THREE- MULTIPLE CHOICE QUESTIONS
CHAPTER NO 1:
3
, INTRODUCTION TO OBSTETRICS AND GYNAECOLOGY
Learning objectives:
After reading this chapter students will be able to Understand:
The basic terminologies and introduction to Obstetrics and gynaecology
Overview of female reproductive system
Shapes of female pelvis and childbirth
Normal physiology of menstruation
Menstrual disorders
Breast
Definitions:
Obstetrics is that branch of medicine, which deals with the management of pregnancy, labour and puerperium.
Gynaecology is that branch of medical science, which treats diseases of the female genital organs.
FEMALE REPRODUCTIVE SYSTEM
INTRODUCTION:
The female reproductive system is made up of the internal and external sex organs that function in reproduction of
new offspring.
In humans, the female reproductive system is immature at birth and develops to maturity at puberty to be able to
produce gametes, and to carry a fetus to full term.
Labia majora: These are the two large folds which form the boundary of the vulva. They are composed of
skin, fibrous tissue and fat and contain large numbers of sebaceous glands. Anteriorly the folds join in front of
the symphysis pubis, and posteriorly they merge with the skin of the perineum. At puberty hair grows on the
mons pubis and on the lateral surfaces of the labia majora
Labia minora: These are two smaller folds of skin between the labia majora, containing numerous sebaceous
glands. The cleft between the labia minora is the vestibule. The vagina, urethra and ducts of the greater
vestibular glands open into the vestibule.
Bartholin's glands: These glands are located beside the vaginal opening and produce a fluid (mucus) secretion.
Clitoris: The clitoris corresponds to the penis in the male and contains sensory nerve endings and erectile
tissue but it has no reproductive significance.
Hymen: The hymen is a thin layer of mucous membrane which partially occludes the opening of the vagina. It
is normally incomplete to allow for passage of menstrual flow.
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, Vestibular glands: The vestibular glands (Bartholin's glands) are situated one on each side near the vaginal
opening. They are about the size of a small pea and have ducts, opening into the vestibule immediately lateral
to the attachment of the hymen. They secrete mucus that keeps the vulva moist.
Perineum: The perineum is the area extending from the base of the labia minora to the anal canal. It is roughly
triangular and consists of connective tissue, muscle and fat. It gives attachment to the muscles of the pelvic
floor
INTERNAL ORGANS:
VAGINA:
It is a fibromuscular tube lined with stratified squamous epithelium, connecting the external and internal organs of
reproduction.
It has four walls: anterior, posterior and two lateral walls. The length of the anterior wall measures 7.5 centimeters
and the posterior wall is about 9 centimeters. The difference is due to angle of insertion of the cervix through the
anterior wall. The projection of the cervix through the anterior vaginal wall at the top of the vagina (vault) creates
clefts known as fornices. There are four fornices (anterior, posterior and two laterals)
The vagina serves as excretory channel for menstrual blood and uterine secretions, organ for sexual intercourse and
passage for the fetus during birth.
The vaginal secretion is very small but sufficient to make the surface moist. Between puberty and the menopause,
lactobacillus acidophilus bacteria are normally present which secretes lactic acid maintaing the pH between 4.9- 3.5 in
reproductive age groups. This acidity inhibits the growth of most other microbes that may enter the vagina from the
perineum.
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,UTERUS:
The uterus is a hollow fibromuscular organ situated between the bladder and rectum. It is normally anteverted and
anteflexed. It measures 8 centimeters long, 5 centimeters wide and 1.25 centimeters thick.
It has the following parts.
1) Fundus: The fundus is the broad curved upper area in which the fallopian tubes connect to the
uterusThe part that is above the opening of the fallopian tubes is called the fundus.
2) Body or corpus the main part of the uterus, starts directly below the level of the fallopian tubes and
continues downward until the uterine walls and cavity begin to narrow
3) Isthmus: the isthmus is the lower, narrow neck region; and the lowest section,
4) Cervix is the lower most part of the uterus which is cylindrical in shape and measures about 2.5
centimeters. It has two openings the internal os and the external os with cervical canal in between.
The uterine wall consists of three layers named as Perimetrium,Myometrium and the Endometrium
RELATIONS OF THE UTERUS:
Anteriorly: The uterus and the cervix is related to the uterovesical pouch and the superior surface of the bladder
Posteriorly: The uterus is related to the recto-uterine pouch of Douglas and the rectum.
Lateral: to the uterus are the broad ligaments, the uterine tubes and the cervix
Superior: to the uterus lie the intestines
Inferior: To the uterus is the vagina.
7
,SUPPORTING LIGAMENTS OF THE UTERUS:
There are several key supporting ligaments of the uterus. They are described further below.
FALLOPIAN/ UTERINE TUBES: The Uterine tubes are paired structures which are attached to the lateral
angle of uterine cavity. It consists of the isthmus (the straight part), ampulla (the tortuous part) and the
infundibulum. It is about 10cm long and extends from the sides of the uterus between the body and the fundus.
The end of the each tube has finger like projections called fimbria, which is in close association with the
ovary.They lie in the upper free border of the broad ligament and their trumpet-shaped lateral ends penetrate the
posterior wall, opening into the peritoneal cavity close to the ovaries.
OVARY: Ovaries are paired sex glands or organs that lie on the shallow fossa on the lateral walls of the pelvis. Each
measures 2.5 to 3.5cm long, 2cm wide and 1cm thick. Each is attached to the uterus by the utero-ovarian ligament, to
the lateral pelvic wall by infundibulo pelvic ligament and to the posterior wall of the broad ligament by the meso-
ovarium.
Structure of the ovaries: They are covered by a single layer of germinal epithelium. The substance of the ovary has
cortex and medulla. The cortex is the functional layers which include primordial follicles, mature follicles, Graffian
follicles, corpus luteum and corpus albicans. Medulla consists of loose connective tissue, muscle cells, blood vessels
and nerves and hilus cells.
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, DIFFERENT FEMALE PELVIS:
It is a skeletal ring formed by two innominate or hip bones (ilium, ischium, and pubis) and the sacrum and
coccyx.
TRUE AND FALSE PELVIS:
True pelvis: It is formed by the upper flared out portions of the ilium
True pelvis: It is the bony canal through which the fetus passes during child birth consists of the Brim, Cavity and
outlet.
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, INLET/BRIM: It is almost rounded with the anterioposterior diameter being the shortest. It makes the boundary
between the true and false pelvis. Diameters (Anterio posterior and transverse are given in Fig below)
CAVITY: The cavity extends from the brim above to the outlet below. Its shape is almost rounded.
OUTLET: It is located at the end of the true pelvis and the beginning of the pelvic wall.
Obstetrical outlet: This outlet has greater practical significance, because it includes the narrow plevic straight through
which the fetus must pass. It is diamond shape.
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