Obstetric and Gynecological Nursing - The Carter Center

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Layers:- The uterus has three layers, of which the middle muscle layer is by far the thickest. The endometrium: - forms a lining of ciliated epithelium (mucous memberane) on a base of connective tissue or stroma. It is constantly changing in thickness through out the menustral cycle. The myomatrium or muscle coat: - is thick in the upper part of the uterus and is sparser in the isthmus and cervix. It has three parts: Outer longitudinal, middle oblique and inner circular. The perimetrium is a double serous memberane, an extension of the peritoneum, which is dragged over the uterus. Blood supply – The uterine artery arrives at the level of the cervix and is a branch of the internal iliac artery. The blood drains through corresponding veins. Nerve supply – from the autonomic nervous system, sympathetic and para smpathetic via pelvic plexus. 2.3.5 Fallopian tube or uterine tube Function-Propels the ovum towards the uterus • Receives the spermatozoa as they travel up wards 24
• provides a site for fertilization • It supplies the fertilized ovum with nutrition during its continued journey to the uterus Position - extend laterally from the cornea of the uterus towards the side walls of the pelvis Supports - are held in place by their attachment to the uterus. Structure - Each tube is 10cm long. It has four portions - The interstitial portion is 1.25cm long and lies with in the wall of the uterus. Its lumen is 1 mm wide. - The isthmus is another narrow part which extends for 2.5cm from the uterus - The ampoule is the wider portion where fertilization usually occurs. It is 5 cm long. - The infundibulum is the funnel - shaped fingered end which is composed of many process known as fimbriae. One fimbria is elongated to form the ovarian fimbria which is attached to the ovary. 2.3.6 The ovaries Function: - produce ova and the hormones estrogen and progesterone Position: - they are attached to the back of the broad ligamentnear the fimbriated end of the fallopian tube. 25
Page 1 and 2: LECTURE NOTES For Nursing Students
Page 3 and 4: Preface This lecture note offers nu
Page 5 and 6: Acknowledgement My deepest apprecia
Page 7 and 8: 2.3.5 Fallopian tube or uterne tube
Page 9 and 10: CHAPTER SIX : ABNORMAL PREGNANCY 12
Page 11 and 12: 8.5 Subinvolution 225 Review Questi
Page 13 and 14: LIST OF FIGURES Figuer 1. Normal Fe
Page 15 and 16: ABBRIVATIONS ACTH Adreno cortico tr
Page 17 and 18: CHAPTER ONE INTRODUCTION Care of ch
Page 19 and 20: Hemorrhage, sepsis (infection), tox
Page 21 and 22: CHAPTER TWO ANATOMY OF FEMALE PELVI
Page 23 and 24: sacrum is concave and is referred t
Page 25 and 26: diamond in shape. The obstretrical
Page 27 and 28: Table 2 .Features of the four types
Page 29 and 30: The Fetal Skull The fetal head is t
Page 31 and 32: Regions of the Skull A. The occiput
Page 33 and 34: . Suboccipitofrontal 10cm from belo
Page 35 and 36: Figure 6 . Female external genitali
Page 37 and 38: Position:- In the non-pregnant fema
Page 39: • Round ligament - Ligaments form
Page 43 and 44: maturation of reproductive organs a
Page 45 and 46: Thispain, called mitlelschmerz may
Page 47 and 48: 2.5. The Breast Anatomy The female
Page 49 and 50: Amplulla: the widened-out portion o
Page 51 and 52: Review Questions 1. List different
Page 53 and 54: the ampullar portion. The functiona
Page 55 and 56: Blastocyst Trophoblast Inner cell m
Page 57 and 58: penetrate. Viruses, however, can cr
Page 59 and 60: Figure 10 . The fetal circulation (
Page 61 and 62: Appearance of the Placenta at Term
Page 63 and 64: Identification On inspection, the p
Page 65 and 66: Placenta infarction Placental infar
Page 67 and 68: Oarl cavity feels salivation Gums-
Page 69 and 70: • Creatinine and BUN decrease bec
Page 71 and 72: - Increase in the lower extermities
Page 73 and 74: - Lower part cervix and isthmus cha
Page 75 and 76: 6. Fainting: - In early pregnancy f
Page 77 and 78: women feels it at 18-20 weeks the m
Page 79 and 80: Multipara a woman who has given bir
Page 81 and 82: The Obstetric History 1. Past Obste
Page 83 and 84: Breast Examination Asses the size,
Page 85 and 86: 1.2 Fundal Palpation Purpose- To kn
Page 87 and 88: 3. Deep pelvic Palpation: (3 rd Leo
Page 89 and 90: Auscultation: Check Fetal heart, ra
Page 91 and 92:
• Rest at least 10 hrs at night a
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CHAPTER FOUR NORMAL LABOUR At the e
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- Labour is said to be established
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To assess progress of labour - Stat
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Relief of pain & promotion of comfo
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Uterine contraction - Frequency per
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advanced labour women may be assess
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Method - by abdominal palpation ide
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Eg. Partograph Name _______________
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- Caput - Sutures and Fontanelles.
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Echanism of Labour in a Normal Vert
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ERGOMETRINE: 0.5mgs. in a syringe w
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1. Separation of the placenta Mecha
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3. Controlled cord traction with ou
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Advantage: It allows the placenta t
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Inspect the umbilical cord a) Check
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Ergometrine Route Time to act Durat
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The guiding principles is to watch
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B. Delayed cord clamping The cord c
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- Method of delivery- spontaneous o
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4.4. Episiotomy Definition: The mak
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4. Lateral: The incision is begun o
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Layers to be repaired 1. Vaginal wo
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CHAPTER FIVE THE NORMAL PUERPERIUM
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Lochia- discharge from the uterus d
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5.2 Management of the Puerperium An
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answer her questions and through ou
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CHAPTER SIX ABNORMAL PREGNANCY At t
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One fetus may be died and be retain
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Management of Pregnancy - Early dia
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are labeled as ‘ Twin one ‘ and
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a) Both twins presenting by the ver
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- The urine will smell of acetone,
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The liver is affected in sever case
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Moderate - Preeclampsia is usually
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Management during labour The nurse/
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35% with in the first few hours aft
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- The volume of urine and the album
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Type 1 placenta praevia - The major
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Diagnosis - Using ultrasonic scanni
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Complications • Post partam haemo
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If the blood loss is revealed; More
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- Rarely, Rhesus- isoimmunization -
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The mother should rest in bed. An u
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The first encounter may not result
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The degree of haemolysis and the nu
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Transmission of infection to the fe
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Post natal care Separation of the b
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giving several short pushes during
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- Maternal hyperglycemia should be
Page 191 and 192:
Review Questions 1. List the differ
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All ill fitting part is associated
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On auscultation The fetal heart bea
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cord prolapse). - Sedation often ne
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up gently delivery slowly taking 2
Page 201 and 202:
Diagnosis On palpation - the head i
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Complications Maternal Fetal - Obst
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make sure no cord prolapsed and to
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If diagnosed during the first stage
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Management Encourage the mother to
Page 211 and 212:
7.2.1 Atonic Postpartum Hemorrhage
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Cause - Delivery through partially
Page 215 and 216:
Management of Severe PPH in a Healt
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Cause in 1 st stage 1) In-efficient
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4 Reduced pelvic out let. A forceps
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- If the fetus is not alive and the
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Methods of determining C.P.D. 1. De
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3 Placenta percrata- through muscle
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2. Tonic contraction and Bandl’s
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Condition of the baby - Usually sti
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3. Control head, keep it flexed, so
Page 233 and 234:
Review Questions 1. What are the co
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More severe infection may consist o
Page 237 and 238:
Prevention The best method of treat
Page 239 and 240:
Managing Puerperal sepsis 1. Isolat
Page 241 and 242:
8.5 Subinvolution Sub involution is
Page 243 and 244:
CHAPTER NINE INDUCTION OF LABOUR At
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Table 6 .Bishops Score System Induc
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- Fluid balance chart - Urine test
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Nipple stimulation, which releases
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Conditions in which trial of scar i
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CHAPTER TEN OBSTETRIC OPERATIONS At
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Indication for forceps delivery - F
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In the infant: Bruising: Severe bru
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10.2 Caesarean Section Caesarean se
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Possible indications include: - The
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types of decapitating hooks and kni
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procedure is extremely rare in cont
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- The head must be engaged. - The w
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CHAPTER ELEVEN CONGENITAL ANOMALIES
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A single remiuterus results when on
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E. Persistence of male (Wolffcan) d
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CHAPTER TWELVE INFECTION OF THE FEM
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Sign Major Minor Cervical motion Ab
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- Gentamycin iv or in loading dose
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In those persons with recurrent les
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Presentation Sign and symptom A wom
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Risk Factor Studies have indicates
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ecto vaginal fistula. Other types m
Page 289 and 290:
12.6 Prolaps of the Uterus A descen
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- If no symptoms are present and th
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Forced inversion caused by excessiv
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therapy may be initiated to prevent
Page 297 and 298:
Local disorders of the genital trac
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. Missed abortion This is the term
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The membranes may have ruptured and
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operation. Many mothers do not make
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I. Septic abortion Infection may oc
Page 307 and 308:
Dysmenorrhea Definition-Dysmenorrhe
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esult from tension, anxiety (stress
Page 311 and 312:
Implantation may occur in the fimbr
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the rupture is on the mesenteric si
Page 315 and 316:
Diagnosis - The presence of interna
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Causes of infertility Female - Vagi
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Benign A. Fibrocystic breast diseas
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- Pain in the breast - Blood staine
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Treatment - Oestrogen - Progesteron
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E. Gently squeeze the nipple of eac
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- Poor uterine contraction - Subinv
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cervical canal and are multiple. Th
Page 331 and 332:
Vulval Cysts Bartholin’s cyst- It
Page 333 and 334:
GLOSSARY Abortion Termination of pr
Page 335 and 336:
Intra uterine growth retardation Fe
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Obstetric and Gynecological Nursing - The Carter Center

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