Gynecology and Obstetrics

1. 13 Gynecology and Obstetrics

2. Gynecology The medical specialty that studies the anatomy and physiology of the female genital system and uses diagnostic tests, medical and surgical procedures, and drugs to treat female genital diseases.

3. Obstetrics The medical specialty that studies the anatomy and physiology of the female reproductive system and uses diagnostic tests, medical and surgical procedures, and drugs to monitor normal pregnancy and childbirth and treat diseases.

4. Figure 13-1 Female genital and reproductive system

5. Anatomy and Physiology (cont’d) The function of the female genital and reproductive system is to display the female secondary sexual characteristics, produce ova (eggs), and, when appropriate, conceive and bear children.

6. Figure 13-2 Abdominopelvic cavity.

7. Anatomy of the Female Genital and Reproductive System Ovaries Small egg-shaped glands about 2 inches in length that are near the end of a uterine tube Gonads or sex glands in a female

8. Anatomy of the Female Genital and Reproductive System (cont’d) Ovaries (cont’d) Function as part of the female genital and reproductive system and the endocrine system Contain follicles that rupture and release ova (eggs) during the menstrual cycle Secrete hormones estradiol, progesterone, and testosterone that affect puberty, menstruation, and pregnancy

9. Figure 13-3 Ovaries, fallopian tubes, and uterus

10. Uterine Tubes About 5 inches in length Held in place by the broad ligament Function is to transport an ovum from the ovary to the uterus Also known as oviducts or fallopian tubes Anatomy of the Female Genital and Reproductive System (cont’d)

11. Figure 13-4 Uterus

12. Uterus An inverted pear-shaped organ about 3 inches in length Fundus is the rounded top of the uterus The corpus, or body, of the uterus is its widest part The body narrows and becomes the cervix (neck of the uterus). Anatomy of the Female Genital and Reproductive System (cont’d)

13. Uterus (cont’d) Within the uterus is the hollow intrauterine cavity, which narrows into the cervical canal. The wall of the uterus is composed of three layers: perimetrium, myometrium, and endometrium. Anatomy of the Female Genital and Reproductive System (cont’d)

14. Vagina A short, tubelike structure about 3 inches in length The fornix is the area of the vaginal canal that is behind and around the cervix. Covering the inferior end of the vaginal canal is the hymen, although it is sometimes absent Anatomy of the Female Genital and Reproductive System (cont’d)

15. Vagina (cont’d) The vaginal introitus is the opening to the outside of the body. During menstruation, it transports the shed endometrium to the outside of the body. It holds the penis during sexual intercourse. It is the part of the birth canal that takes the baby to the outside of the mother’s body. Anatomy of the Female Genital and Reproductive System (cont’d)

16. The Vulva External Genitalia Labia majora Labia minora Clitoris Vaginal introitus Glands that produce lubricating secretions Additional Structures urethral meatus mons pubis. Anatomy of the Female Genital and Reproductive System (cont’d)

17. Figure 13-5 External female genitalia

18. Breasts Composed of adipose (fatty) tissue and glands, the breasts (or mammary glands) are a part of the integumentary system. Because of their function, they are also a part of the female reproductive system. They develop at puberty. They contain lactiferous lobules that produce milk to nourish the newborn after birth. Anatomy of the Female Genital and Reproductive System (cont’d)

19. Figure 13-6 Breast

20. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception: The anterior pituitary gland begins to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to stimulate the ovaries at the onset of puberty.

21. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception: FSH stimulates a follicle in the ovary to enlarge and produce a mature ovum and secrete estradiol, which causes the development of female sexual characteristics.

22. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception: LH stimulates a single follicle each month to rupture and release its mature ovum. LH stimulates the ruptured follicle (corpus luteum) to secrete estradiol and progesterone.

23. Figure 13-7 Hormones secreted by the ovaries

24. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception (cont’d) The Menstrual Cycle With the onset of puberty, the female begins to ovulate and menstruate. Menarche is the beginning of menstruation, which occurs with the first menstrual period, or menses.

25. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception (cont’d) The Menstrual Cycle (cont’d) Menstrual phase Days 1-6 Proliferative phase Days 7-13 Ovulation Day 14 Secretory phase Days 15-26 Ischemic phase Days 27-28

26. Figure 13-8 The menstrual cycle

27. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception (cont’d) Conception Spermatozoa reach the ovum 24 to 48 hours after sexual intercourse. Chemicals secreted by the ovum attract the spermatozoa. Only one spermatozoa penetrates the ovum; this is the moment of fertilization, or conception.

28. Figure 13-9 An ovum and spermatozoa D. Philips / Photo Researchers, Inc.

29. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception (cont’d) Conception (cont’d) The resulting cell has 46 chromosomes and is known as a zygote. Pregnancy begins at the moment of conception.

30. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception (cont’d) Conception (cont’d) A zygote immediately begins to divide as it moves through the fallopian tube. The inner mass of cells of the zygote becomes the amnion and the embryo. The developing embryo floats in and is cushioned by the amniotic fluid.

31. Physiology of Sexual Maturity, Oogenesis, Menstruation, and Conception (cont’d) Conception (cont’d) After 4 days of development, the zygote is known as an embryo. After 8 weeks, it is known as a fetus. Gestation is from the moment of conception to the moment of birth, approximately 38 to 42 weeks.

32. Figure 13-10 A fetus at 9 weeks’ gestation Photo Lennart Nilsson/Albert Bonniers Forlag

33. Figure 13-11 Fetal footprint

34. Physiology of Labor and Delivery The process of labor and childbirth is known as parturition; it is divided into three stages. First stage of labor―Cervical dilation, effacement, rupture of membranes Second stage of labor―Crowning occurs, the baby is delivered, and the umbilical cord is clamped and cut Third stage of labor―Delivery of placenta, suturing of the episiotomy if one was performed

35. Figure 13-12 Labor and Delivery

36. Figure 13-13 Crowning of the fetal head

37. Figure 13-14 Cutting the umbilical cord

38. The Newborn A newborn who is between 38 and 42 weeks’ gestation is a term neonate. A newborn between 28 and 37 weeks’ gestation is preterm, or premature. The skin of the newborn is covered with vernix caseosa, a thick, white, cheesy substance that protects the skin from amniotic fluid in the uterus.

39. Figure 13-15 Term neonate

40. The Newborn (cont’d) The first stool is meconium, a thick, greenish-black, sticky substance. On the top of the head, the anterior fontanel, or soft spot, is a soft area that bulges when the newborn cries. There is also a smaller posterior fontanel at the back of the head that allows the brain to grow before the bones fuse together.

42. Diseases and Conditions Ovaries and Uterine Tubes Anovulation an anovulatory cycle is a menstrual cycle in which ovulation fails to occur. Ovarian cancer

43. Diseases and Conditions (cont’d) Ovaries and Uterine Tubes (cont’d) Polycystic ovary syndrome (PCOS) is a condition in which there is an imbalance of a woman's female sex hormones. Salpingitis Pelvic inflammatory disease (PID) is a general term for infection of the uterus lining, fallopian tubes, or ovaries.

44. Figure 13-16 Polycystic ovary syndrome

45. Diseases and Conditions (cont’d) Uterus Leiomyoma Uterine fibroids benign tumors that develop in the womb (uterus). Leiomyosarcoma Malignant tumors that develop in the womb (uterus).

46. Figure 13-18 Leiomyoma CNRI/Photo Researchers, Inc.

47. Diseases and Conditions (cont’d) Uterus (cont’d) Endometrial cancer Endometriosis disorder that occurs when cells from the lining of the womb (uterus) grow in other areas of the body Myometritis Inflammation of the muscular wall of the uterus

48. Figure 13-17 Endometriosis Z. Binor/Custom Medical Stock Photo, Inc.

49. Diseases and Conditions (cont’d) Uterus (cont’d) Retroflexion of the uterus a uterus that is tilted backwards instead of forwards. Uterine prolapse is falling or sliding of the womb (uterus) from its normal position into the vaginal area

50. Diseases and Conditions (cont’d) Menstrual Disorders Amenorrhea is the absence of a menstrual period in a woman of reproductive age Dysfunctional uterine bleeding (DUB) is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable structural or organic pathology.