Cmca PPT Week 4

KOLEHIYO NG
LUNGSOD NG
DASMARIÑAS
BRGY. BUROL MAIN, CITY OF DASMARIÑAS,
CAVITE, PHILIPPINES 4114
ION Faculty
Care of Mother, Children and
Adolescent (Well)
AY 2024-2025
ANTEPARTUM
THE FEMALE REPRODUCTIVE
ANATOMY & PHYSIOLOGY
THE BONY PELVIS
THE BONY PELVIS
The female bony pelvis has two unique
functions:
• To support and protect the pelvic

contents
• To form the relatively fixed axis of the
birth passage
The ILIUM is the broad, upper prominence of the hip.
>ILIAC CREST – the margin of the ilium.
>ANTERIOR SUPERIOR ILIAC SPINE - the anterior terminal

point of the iliac crest
>ANTERIOR INFERIOR ILIAC SPINE- the anterior lower point

in the iliac crest
POSTERIOR SUPERIOR ILIAC CREST - the posterior terminal point
of the iliac crest
ILIAC FOSSA - the concave anterior portion
ILEOPECTINEAL LINE OR LINEA TERMINALIS - an imaginary line

or ridge which divides the false from the true pelvis.
The ISCHIUM, the strongest bone, is under the ilium and below the
acetabulum.
ISCHIAL TUBEROSITY – where the weight of the seated body rests.

ISCHIAL SPINES – serve as reference points during labor
The shortest diameter of the pelvic cavity is between the ischial
spines.
Clinical significance of the ischial spines:
Somewhat encroached on the pelvic cavity, so if they are too
prominent, they may offer some degree of obstruction to the
passage of the baby.
Serves as a useful landmark when making a vaginal examination to
assess the progress of descent of the fetal presenting part
(determining the “station”)
The PUBIS forms the slightly bowed front portion of the innominate bone.
SYMPHYSIS PUBIS - point of union of the two pubic bones at the
anterior midline
PUBIC ARCH – the triangular space below the junction of the symphysis
pubis
CLINICAL SIGNIFICANCE: If the angle formed is acute , it is very
possible that the ischial spines are too close to one another resulting
in a narrow pelvic cavity
The SACRUM is a wedge-shaped bone
formed by the fusion of five
vertebrae.
SACRAL PROMONTORY – a
projection into the pelvic cavity on
the anterior upper portion
The small triangular bone last
on the vertebral column is the
coccyx.
SACROCOCCYGEAL JOINT –
point of coccygeal and
sacral articulation
RIGHT AND LEFT SACROILIAC JOINTS – the points of union between
the sacrum and the ilium.
SACROCOCCYGEAL JOINT – between the sacrum and the coccyx
SYMPHYSIS PUBIS – the junction of the two pubic bones which are
united by a pad of cartilage.
SACROILIAC LIGAMENTS – the strongest in the whole body; connects the
sacrum to the iliac bones on each side.
SACROTUBEROUS LIGAMENTS – between the sacrum and the ischial
tuberosities; one on each side
SACROSPINOUS LIGAMENTS – between the sacrum and the ischial spines
one on each side
INTERPUBIC LIGAMENTS – strengthens the symphysis pubis
SACROCOCCYGEAL LIGAMENTS – between the 5th sacral vertebrae and
the coccyx
Pelvic Diaphragm:
Deep fascia
Levator ani
Coccygeal muscles
Iliococcygeus
Pubococcygeus
Puborectalis
Pubovaginalis
The upper border of the true pelvis and is typically
rounded.
RIGHT OBLIQUE DM
LEFT OBLIQUE DM
A curved canal with a longer posterior than anterior wall
• Situated at the lower border of the true pelvis
• Size can be determined through the assessment of
the transverse diameter
• Interspinous diameter (10.5 cm)
• Most common female pelvis (50%)
• Inlet is rounded, with the AP diameter a
little shorter than the T diameter
• Posterior segment is broad, deep, and
roomy, and the anterior segment is well
rounded
• Has a wide and round pubic arch
• Normal male pelvis
• Inlet is heart shaped
• AP and T diameters adequate for birth
• Posterior sagittal diameters is too short, and the
anterior sagittal diameter is long
• Midpelvis has prominent ischial spines, convergent
sidewalls, and a long, heavy sacrum inclining forward
• Android outlet has a narrow, sharp, and deep pubic
arch
• AP diameter is short, T diameter is narrow
• Approximately 20% of female pelvis
• Arrest of labor is frequent, requiring difficult forceps
manipulation
• Prone to extensive perineal laceration
• Inlet is oval
• Long AP diameter, short T diameter
• Posterior and anterior segments are deep
• Posterior and anterior sagittal diameters extremely long
• Variable ischial spines, straight side walls, and a narrow and
long sacrum
• Outlet has a normal or moderately narrow pubic arch
• Approximately 25% of female pelvis
• Refers to the flat female pelvis
• Inlet is a distinctly transverse oval
• Short AP and extremely short T diameter
• Short posterior & anterior sagittal diameters
• Has variable ischial spines, parallel side walls, and a
wide sacrum with a deep curve inward
• Outlet has an extremely wide pubic arch
• Only 5% of female pelvis
• ESTROGEN
-contributes to “femaleness”
-3 classical estrogens: Estrone, B-Estradiol, and Estriol
-Controls the development of the female secondary
sex characteristics:
• Breast development
• Widening of the hips
• Deposits of tissue (fat) in the buttocks and mons
pubis
• ESTROGEN
-Assists in the maturation of the ovarian follicles and
cause endometrial proliferation
-Amount is greatest during the proliferative (follicular or
estrogenic) phase of the menstrual cycle
-Estrogens inhibit FSH production and stimulate LH
production
• ESTROGEN
-Myometrial contractility increases in both
uterus and fallopian tubes Increases
-Uterine sensitivity to oxytocin increases
PROGESTERONE
-Secreted by the corpus luteum
-Found in greatest amounts during the secretory (luteal or
progestational) phase of the menstrual cycle
-Decreases uterine motility and contractility caused by estrogens
-Causes the endometrium to further increase its supply of nutrients
-Hormone of pregnancy
-Prepares the breast for lactation
• PROSTAGLANDINS
-Oxygenated fatty acids that are produced by the cells of the
endometrium
-Two primary types of prostaglandins are groups E and F:
• PGE – relaxes smooth muscles & potent vasodilator
• PGF – potent vasoconstrictor; increases muscular and
arterial contractility
-Critical to the rupture of the graafian follicle, thereby
releasing the mature egg cell
• Has two phases:
-The follicular phase (days 1 to 14)
-The luteal phase (days 15 to 28)
***For a typical 28-day cycle

• FOLLICULAR PHASE
-The immature follicle matures as a result of FSH
-The mature graafian follicle appears on about the 14th day
under dual control of FSH and LH
• Cumulus Oophorus
• Zona Pellucida
-Just before ovulation, the mature oocyte completes its first
meiotic division, yielding a:
• Polar body: a small cell
• Secondary oocyte: which matures into an ovum
THE OVARIAN CYCLE
-As the graafian follicle matures and enlarges, it
comes close to the surface of the ovary
-The ovum is discharged near the fimbria of the
fallopian tube and is pulled into the tube
-Mittelschmerz: mid-cycle pain (for some)
-Body temperature increases about 0.3-0.6oC 24-48 hours
after ovulation
-The ovum takes several minutes to travel through the
ruptured follicle to the fallopian tube opening
• LUTEAL PHASE
-Begins when the ovum leaves its follicle
-Corpus luteum develops from the ruptured follicle
-If the ovum is fertilized and implants in the endometrium, the
fertilized egg begins to secrete hCG
-If fertilization does not occur, within about a week after ovulation,
the corpus luteum begins to degenerate into corpus albicans
THE FOLLOWING
ILLUSTRATES
THE OVARIAN CYCLE
FSHRH LHRH
7-8 days following
ovulation... (no fertilization)
Hypothalamus
stimulates the
APG to produce
Corpus
FSH and LH
Albicans
Decreased A new ovarian

Progesterone & cycle begins
Estrogen
Average Length
of The Cycle
Average Length
of Menses
Age of Onset
•Characteristics of discharge: dark, reddish color &
has a musty odor due to the decomposition of
blood elements & a mixture of ↑ secretion of vulvar
sebaceous gland.
•Amount of blood loss – 30-80mL
•Amount of iron loss – 0.5-1mg daily
1. Sensation of heaviness & weight in the pelvic
region, mild backache & cramping
2. Slight nervous irritability – feeling of tenderness
and anxiety
3. Bladder & GIT irritability
4. Changes in body weight – 1 to 3 lbs. shortly
before the onset of menstruation w/c they lose
promptly as menstruation begins
• MENSTRUAL PHASE
• PROLIFERATIVE PHASE
• SECRETORY PHASE
• ISCHEMIC PHASE
✔ Days 1 – 7 with an average of at least 5 days in the
menstrual cycle
✔ The following products are discharged from the uterus
during menstrual flow or menses:
❑ Blood from the ruptured capillaries
❑ Mucin from the glands
❑ Fragments of endometrial tissue
❑ Microscopic, atrophied, and unfertilized ovum
✔Days 8-14 of the menstrual cycle
✔Estrogen peaks just prior to ovulation,
✔Cervical mucus at ovulation is clear, thin, watery,
alkaline, shows ferning pattern; and has spinnbarkeit
greater than 5cm
✔Body temperature may drop slightly, then rises sharply
at ovulation and remains elevated under influence of
progesterone
✔ Days 15-26 of the menstrual cycle
✔ Estrogen drops sharply, and progesterone dominates
✔ Uterine endometrium becomes corkscrew or twisted in
appearance and dilated with quantities of glycogen and
mucin
✔ The capillaries of the endometrium increase in amount
until the lining takes on the appearance of rich, spongy
velvet
✔ Days 27-28 of the menstrual cycle
✔ Both estrogen and progesterone levels drop.
✔ If fertilization does not occur, the corpus luteum in the
ovary begins to regress.
✔ The endometrium of the uterus begins to degenerate.
✔ The capillaries rupture, with minute hemorrhages, and
the endometrium sloughs off.
•During the first half of the cycle:
–Cervical mucus is thick and scant
–Sperm survival is poor
•At the time of the ovulation:
–Cervical mucus becomes thin and copious
–Sperm penetration and survival is excellent
•During the second half of the cycle:
–Cervical mucus becomes thick and sperm survival is
again poor
An interesting property of cervical mucus just before
ovulation when estrogen levels are high is the ability to
form fernlike patterns on a microscope slide when
allowed to dry
THE END ☺

Cmca PPT Week 4

Uploaded by

Copyright:

Available Formats

Cmca PPT Week 4

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cmca PPT Week 4

Uploaded by

Copyright:

Available Formats

KOLEHIYO NG

• To support and protect the pelvic

>ILIAC CREST – the margin of the ilium.

>ANTERIOR SUPERIOR ILIAC SPINE - the anterior terminal

>ANTERIOR INFERIOR ILIAC SPINE- the anterior lower point

ILIAC FOSSA - the concave anterior portion

ILEOPECTINEAL LINE OR LINEA TERMINALIS - an imaginary line

ISCHIAL TUBEROSITY – where the weight of the seated body rests.

***For a typical 28-day cycle

Decreased A new ovarian

You might also like