O.B. Prelim Notes !

Female Reproductive System

1. External - vulva or pudendum

a. Mons pubis/veneris - a pad of fatty tissues that lies over the

symphysis pubis covered by skin and at puberty covered by short
pubic hair that serves as cushion or protection to the symphysis
pubis and surrounding delicate tissues from trauma.
Tannerscale - tool used to determine sexual maturity rating.

b. Labia Majora – means “large lips” - a longitudinal fold, that

extends from the symphysis pubis to the perineum; Two folds of
skin with fat underneath; contain Bartholene’s glands
c. Labia Minora – means “nymphae” – a soft and thin longitudinal
fold that is located in between the labia majora; two thin folds of
delicate tissues; form an upper fold encircling the clitoris called
the prepuce and unite posteriorly called the fourchette.
2 sensitive structures of labia minora:

c.1. clitoris – means “key”- anterior, pea shaped erectile

tissue composed of so many nerve endings
which is the sight of sexual arousal in female.
(Greek-key)

c.2. fourchette - Posterior, tapers posteriorly of the labia

minora

- very sensitive to manipulation, oftenly torn during

vaginal delivery.

- common site – episiotomy.

d. Vestibule – an almond shaped, narrow space area seen when the

labia minora are separated,
that contains the hymen, vaginal orifice and
bartholene’s glands.

i. Urinary Meatus – small opening of urethra that serves for

urination; external opening of the urethra; slightly behind and to
the side are the openings of the Skene’s Glands.
ii.Skenes Glands/or Paraurethral Gland – two small mucous
secreting substances that serve for lubrication; often involved in
infections of the external genitalia.
 iii.Hymen – a membranous tissue that covers vaginal orifice,
membranous tissue
* Carumculae mystiforms - healing of a torn hymen

iv.Vaginal Orifice – external opening of vagina

v.Bartholene’s Glands/or Paravaginal Gland or Vulvo Gland
- 2 small mucus secreting substance that secrets alkaline
substances- responsible for the acidity of the vagina.
( Believed to secrete a yellowish mucous which acts as a
lubricant during sexual intercourse. The openings are
located posteriorly on either side of the vaginal orifice)

Alkaline – neutralizes acidity of vagina

Ph of vagina - acidic

Doderleins bacillus – responsible for acidity of vagina

a. Perineum – a muscular structure that is located in between the

lower vagina & anus; contains muscles which support the pelvic
organs, the arteries that supply blood and the pudendal nerves
which are important during delivery under anesthesia.

2. Internal:

A. Vagina – female organ of copulation; passageway of menstruation &

fetus

- it is 3 – 4 inches or 8 – 10 cm long of dilated canal located

between the bladder and

the rectum. Contains*

Rugae – permits considerable amount of stretching without tearing

B. Uterus - Organ of menstruation, site of implantation and retainment

and nourishment of
the products of conception. It is a hollow, thick walled
muscular organ. It varies in size, shape and weights.

Size - 1 inch thick; 2 inches wide; 3 inches long

Shape: non pregnant = pear shaped or inverted avocado

Pregnant = ovoid
 Weight : Non pregnant: – 50 - 60 grams

Pregnant: - 1000 grams

4th stage of labor - 1000 grams

2 weeks after delivery - 500 grams

3 weeks after delivery - 300 grams

Normal State - 5 - 6 weeks after delivery - 50 – 60 grams

Entire Process is “Involution of Uterus”

Three parts of the uterus

fundus - upper cylindrical layer

1. corpus/body - upper triangular layer

2. cervix - lower cylindrical layer
* Isthmus – known at the lower uterine segment during pregnancy

* Cornua - junction between fundus & interstitial

Muscular compositions: there are three main muscle layers

which make expansion possible in every direction.

1. Endometrium - inside uterus, in lines the nonpregnant uterus.

Muscle layer for menstruation. Sloughs off during menstruation.
* Decidua - thick layer; Once implantation has taken place, the
uterine endothelium is termed decidua. Occasionally,
a small amount of vaginal spotting appears with
implantation because capillaries are ruptured by the
implanting trophoblasts = implantation bleeding . .
.Implication: this should not be mistaken for the
LMP(Last Menstrual Period)

*Endometriosis – “ectopic endometrium” abnormal

proliferation of endometrial

lining outside uterus.

Common site: ovary.

Signs/symptoms: persistent dysmennorhea and low back

pain.

Diagnostic test: biopsy, laparoscopy

Drug of choice: 1. Danazole (Danocrene)

 Action: a. to stop menstruation

b. inhibit ovulation

2. Lupreulide (Lupron)

Action: a. inhibit FSH/LH production

2. Myometrium – largest part of the uterus

- it is the muscle layer responsible for delivery
process

- it is a smooth muscles considered to be the living

ligature of the body.

- power of labor, responsible for the contraction of

the uterus

3. Perimetrium – muscle layer that protects entire uterus

C. Ovaries – Almond shape, dull white sex glands near the fimbrae, kept
in place by ligaments.

2 female sex glands that serves for two functions:

1. ovulation

2. Production of two hormones

D. Fallopian tubes – 2 - 3 inches long that serves as a passageway of

the sperm from the uterus to the ampulla of the
passageway of the mature ovum of fertilized ovum from
the ampulla to the uterus. Widest part (ampulla) spreads
into fingerlike projections called (fimbrae) responsible for
the transport of mature ovum from ovary to uterus;
fertilization takes place in its outer third or outer half.

4 significant segments

1. Infundibulum – most distal part of Fallopian Tube, trumpet or funnel

shaped, swollen

at ovulation
 2. Ampulla – outer 3rd or 2nd half, site of fertilization

3. Isthmus – site of sterilization – bilateral tubal ligation

4. Interstitial – most dangerous site of ectopic pregnancy

* Cortex of the ovary – releases the matured ovum

B. Male Reproductive System

1. External
Penis – the male organ of copulation and urination. It contains of a
body of a shaft consisting of

3 cylindrical layers and erectile tissues. At its tip is the most

sensitive area comparable to

that of the clitoris in the female – the glands penis.

3 Cylindrical Layers

2 corpora cavernosa

1 corpus spongiosum

Scrotum – a pouch hanging below the pendulous penis, with a medial

septum dividing into

two sacs, each of which contains a testes. It is the cooling

mechanism of testes

- < 2 degrees C than body temperature

Leydigs cell – release testosterone

* pure sperm plus secreting substance equals SEMEN*

Male and Female homologues

Male Female

Penile glans Clitoral glans

Penile shaft Clitoral shaft

Testes Ovaries

Prostate Skene’s gands

 Cowper’s Glands Bartholene's glands

Scrotum Labia Majora

PREGNANCY – presumptive, probable, positive

Presumptive Probable Positive

1st Trimester
Goodel's- change of consistency of cervix Ultrasound
Breast changes Chadwick’s- blue violet discoloration of evidence
Urinary frequency vagina (sonogram) full
bladder
Transvaginal –
empty bladder
Fatigue
Amenorrhea Hegar's- change of consistency of isthmus
Morning sickness Elevated BBT – due to increased
Enlarged uterus progesterone
Positive HCG or (+)pregnnacy test
2nd Trimester
Fetal heart tone
Cloasma Ballottement – bouncing of fetus when Fetal movement
Linea negra lower uterine is tapped sharply, sign of Fetal outline on x-
Increased skin myoma ray
pigmentation Enlarged abdomen Fetal parts
Striae gravidarium Braxton Hicks contractions – painless palpable
Quickening irregular contractions

XI. High Risk Pregnancy

First Trimester Bleeding – abortion or eptopic

Abortions – termination of pregnancy before age of viability (before

20 weeks)

Age of viability – 20 - 24 weeks

Intrauterine death or Stillbirth – after the age of viability

1. Spontaneous Abortion – also known as miscarriage

Causes: 1.) chromosomal alterations

2.) blighted ovum

 3.) plasma germ defect

Classifications:

a. Threatened – pregnancy is jeopardized by bleeding and

cramping but the cervix is
closed; can give progesterone

b. Inevitable – moderate bleeding, cramping, tissue protrudes

form the cervix
(Cervical dilation) cervix is open

Types:

b.1. Complete – all products of conception are expelled.

Nursing Management: no need for D & C, just

emotional support!

b.2 Incomplete – Placenta and membranes retained.

Management: for D& C

b.3 Habitual – 3 or more consecutive pregnancies result

in abortion usually related to incompetent cervix. Present 2nd
trimester

Incompetent cervix – abortion

Surgery: a. McDonalds procedure – temporary

circlage on cervix

* During delivery, circlage is removed.

NSD

Side Effects: infection.

b. Shirodkar – permanent surgery on cervix.

CS

b.4 Missed – fetus dies; product of conception remain in

uterus 4 weeks or longer; signs of pregnancy cease. (-)
pregnancy test, scanty, dark brown bleeding

Management: induced labor with oxytocin or vacuum

extraction

c. Induced Abortion – therapeutic abortion to save life of mother

based on the
 principles of twofolds effect - choose
between lesser evil.

A. Ectopic Pregnancy – occurs when gestation is located

outside the uterine cavity.
Common site : tubal or ampular

Dangerous site : interstitial

Unruptured Tubal rupture

○ missed period ○ sudden , sharp, severe pain.

Unilateral radiating to shoulder.

○ abdominal pain within 3 -5 ○ shoulder pain (indicative of intraperitoneal

weeks of missed period (maybe
generalized or one sided)
○ scant, dark brown, vaginal
bleeding
bleeding that extends to diaphragm and
phrenic nerve)
○ + Cullen’s Sign – bluish tinged
umbilicus – signifies intra peritoneal
bleeding
○ syncope (fainting)

○ vague discomfort

Nursing Care: Surgery:

➢ Vital Signs * Fallopian -

Salphingectomy
➢ Administer IV fluids * Abdominal -
Exploratory Laparotomy
➢ Monitor for vaginal bleeding * Uterus -
Hysterectomy
➢ Monitor I and O
 Second trimester bleeding – small and incompetent cervix

A. Hydatidiform Mole “bunch or grapes” or gestational

trophoblastic disease. – with fertilization.
– Progressive degeneration of chorionic villi. Recurs.
– Gestational anomaly of the placenta consisting of a bunch of clear
vesicles.
– This neoplasm is formed form the selling of the chronic villi and
lost nucleus of the fertilized egg.
– The nucleus of the sperm duplicates, producing a diploid number
46 XX
– It grows & enlarges the uterus vary rapidly. ( progressive
degeneration of corionic villi )
Use: methotrexate to prevent choriocarcinoma

Assessment:

Early signs - vesicles passed thru the vagina

- Hyperemesis gravidarium due to increase

HCG

- Fundal height

- Vaginal bleeding ( scant or profuse)

Early in pregnancy - High levels of HCG

– Pre eclampsia at about 12 weeks

Late signs: - hypertension before 20th week

- Vesicles look like a “ snowstorm” on sonogram

- Anemia

- Abdominal cramping

Serious Late complications : - hyperthyroidism

- Pulmonary embolus

Nursing care:

• Prepare for D & C

• Do not give oxytoxic drugs – may cause embolism
 Teachings:

a. Return for pelvic exams as scheduled for one year to

monitoring HCG
and assess for enlarged uterus and rising titer could
indicative of

choriocarcinoma

b. Avoid pregnancy for at least one year . Can have sex

provided the partner
will use condom for protection

Third Trimester Bleeding “Placenta Anomalies”

A. Placenta Previa – it occurs when the placenta is

improperly implanted in the lower uterine segment,
sometimes covering the cervical os.

- Abnormal lower implantation of placenta.

* candidate for CS

Total – complete cover of the cervical os

Partial – 5%

Low

Assessment:

Outstanding signs and symptoms:

➢ FRANKBRIGHT RED PLEEDING, PAINLESS BLEEDING

➢ Engagement (usually has not occurred)
➢ Fetal distress
➢ Presentation ( usually abnormal )
Complications:

➢ Internal examination
➢ Sudden fetal blood loss
Diagnostic Examination:

➢ Ultrasound
Note: Avoid: sex, IE, enema – may lead to sudden fetal blood loss

Double set up: delivery room may be converted to OR

Nursing Care:
 ➢ NPO
➢ Bed rest
➢ Prepare to induce labor if cervix is ripe
➢ Administer IV
Note Alert : Surgeon – in charge of sign consent, RN as witness

MD explain to patient

A. Abruptio Placenta - it is the premature separation of

the placenta form the implantation site.
– It usually occurs after the twentieth week of
pregnancy.
• (due to use of cocaine ) – PIH
Assessment:

➢dark red, painful bleeding

➢board like or rigid uterus/abdomen
➢Concealed bleeding/hemorrhage (retroplacental)
➢Couvelaire uterus (caused by bleeding into the
myometrium)-inability of uterus to contract due to
hemorrhage.
➢ Severe abdominal pain
➢ Dropping coagulation factor (a potential for DIC)
Complications:

➢ Sudden fetal blood loss

➢ placenta previa & vasa previa
General Nursing Care:

➢ Infuse IV, prepare to administer blood

➢ Type and crossmatch
➢ Monitor FHR
➢ Insert Foley
➢ Measure blood loss; count pads
➢ Report signs and symptoms of DIC
➢ Monitor v/s for shock
➢ Strict I & O