ANATOMY AND PHYSIOLOGY

The Mammary Glands The mammary glands are accessory organs of the female reproductive system that are specialized to secrete milk following pregnancy. They are located in the subcutaneous tissue of the front thorax within the elevations which are called breasts. A "nipple" is located near the tip of each breast, and it is surrounded by a circular area of pigmented skin called the "areola." A mammary gland is composed of fifteen to twenty irregularly shaped lobes, each of which includes alveolar glands, and a duct (lactiferous duct) that leads to the nipple and opens to the outside. The lobes are separated by dense connective tissues that support the glands and attach them to the tissues on the underlying pectoral muscles. Other connective tissue, which forms dense strands called "suspensory ligaments," extends inward from the skin of the breast to the pectoral tissue to support the weight of the breast. The breasts are really modified sweat glands, which are made up of fibrous tissues and fat that provide support and contain nerves, blood vessels and lymphatic vessels. Cervix The lower one-third of the uterus is the tubular "cervix," which extends downward into the upper portion of the vagina. The cervix surrounds the opening called the "cervical orifice," through which the uterus communicates with the vagina. Fallopian Tubes The fallopian tube extends from the uterus to the ovary. This tube carries eggs and sperm and is where fertilization of the egg, or "ovum" takes place. The fallopian tubes lie in the pelvic portion of the abdominal cavity and each tube reaches from an ovary to become the upper part of the uterus. This funnel-shaped tube is about three inches in length. The larger end of the funnel is divided into feathery, finger-like projections which lie close to the ovary. These beating projections, along with muscle contractions, force the ovum down the funnel's small end, which

opens into the uterus. After sexual intercourse, sperm swim up this funnel from the uterus. The lining of the tube and its secretions sustain both the egg and the sperm, encouraging fertilization and nourishing the egg until it reaches the uterus. If an egg splits in two after fertilization, identical or "maternal" twins are produced. If separate eggs are fertilized by different sperm, the mother gives birth to un-identical or "fraternal" twins. Labia Minor The labia (singular, labium) minor are flattened lengthwise into folds located with the cleft between the labia major. These folds extend along either side of the vestibule. They are composed of connective tissue that is richly supplied with blood vessels, causing a pinkish appearance. In the back, near the anus, the labia minor merge with the labia major, while in the front they converge to form a hood-like covering around the clitoris. Ovary Ligaments Each ovary is attached to several ligaments that help to hold it in position. The largest of these, formed by a fold of peritoneum, is called the "broad ligament." It is also attached to the uterine tubes and to the uterus. At its upper end, the ovary is held by a small fold of peritoneum, called the "suspensory ligament," which contains the ovarian blood vessels and nerves. At its lower end, it is attached to the uterus by a rounded, cord-like thickening of the broad ligament, called the "ovarian ligament." The "peritoneum" is a two-layered membrane that supports the abdominal organs, produces lubricating fluid that allows the organs to flow smoothly over each other, and protects against infection. Ovaries The ovaries are a pair of oval or almond-shaped glands which lie on either side of the uterus and just below the opening to the fallopian tubes. In addition to producing eggs or "ova," the ovaries produce female sex hormones called estrogen and progesterone. The ovaries produce a female hormone, called estrogen, and store female sex cells or "ova." The female, unlike the male, does not manufacture the sex cells. A girl baby is born with about 60,000 of these cells, which are contained in sac-like depressions in the ovaries. Each of these cells may have the potential to mature for fertilization, but in actuality, only about 400 ripen during the woman's lifetime. Pregnant and prenatal both come from the same Latin roots. "Prae" means "before" and "nascor" means "to be born". Nascor is also the derivative of nature, innate and native. Only a few years ago, the word, "pregnant" was seldom used in mixed company. Polite society referred to a pregnant woman as "expecting" or "being in the family way." Uterus The uterus or "womb" is a hollow, muscular organ in which a fertilized egg, called the "zygote," becomes embedded and in which the egg is nourished and allowed to develop until birth. It lies in the pelvic cavity behind the bladder and in front of the bowel. The uterus usually tilts forward at a ninety degree angle to the vagina, although in about 20%% of women, it tilts backwards. The uterus is lined with tissues which change during the menstrual cycle. These tissues build under the influence of hormones from the ovary. When the hormones withdraw after the menstrual cycle, the blood supply is cut off and the tissues and unfertilized egg are shed as waste. During pregnancy, the uterus stretches from three to four inches in length to a size which will accommodate a growing baby. During this time, muscular walls increase from two to three

ounces to about two pounds and these powerful muscles release the baby through the birth canal with great force. The womb shrinks back to half its pregnant weight before a baby is a week old. By the time the baby is a month old, the uterus may be as small as when the egg first entered. Superstition, myth or ignorance have surrounded the menstrual period since the beginning of time. This is largely due to a primitive fear of blood. The word, "taboo," may stem from the Polynesian word for menstruation, but not all legends are negative; a girl's first menses is celebrated in some societies, because it is a sign that she can bear children. Vagina The vagina is a muscular passage which forms a part of the female sex organs and which connects the neck of the uterus (called the "cervix") with the external genitals. The vagina, which is approximately two and one-half to four inches long, has muscular walls which are supplied with numerous blood vessels. These walls become erect when a woman is aroused as extra blood is pumped into these vessels. The vagina has three functions: as a receptacle for the penis during love-making; as a outlet for blood during menstruation; and as a passageway for the baby to pass through at birth. According to The Guiness Book of World Records, a Russian peasant woman who lived in the 18th Century holds the record for the most children born to one mother. She had sixty-nine children within forty years. She produced sixteen pairs of twins, seven sets of triplets, and four sets of quadruplets! Vulva The vulva is made up of several female organs which are external. These include a small, rounded pad of fat which protects the pubic bone. Reaching down almost to the anus are two folds of fatty tissue, called the "larger lips," to protect the inner genitals. Just inside are two "smaller lips," which enclose the opening of the urethra (which comes down from the bladder) and the vagina. At the upper end, are small projections, called the "prepuce," that protect the clitoris. The clitoris is a very small, sensitive organ with numerous nerve endings that, like the penis, contain tissues which fill with blood when sexually aroused. Abdominal Layers 1. Skin The skin of the lower abdominal wall is incised in a transverse direction just above the pubic hairline in the majority of cases (side to side rather than up and down). A longitudinal (up and down) incision is frequently employed. 2. Subcutaneous tissue 3. Fascia Rectus fascia a dense shiny white layer of fascia. This fascia layer is incised to expose the two rectus abdominal muscle which are big muscle running from the rib cage to the pubic bone.

4. Muscle These are the main muscle employed to do sit ups (rectus). The two muscles meet in the middle where they are sometimes fused but quite often, however, they are separated as the result of the stretching from the distended uterus. These muscles are now separated (without cutting them) and pulled to the sides to create a space between them.

I.

PATHOPHYSIOLOGY

Release of FSH by the anterior pituitary gland

Development of the graafian follicle

Production of estrogen (thickening of the endometrium)

Release of the luteinizing hormone

Ovulation (release of mature ovum from the graafian follicle)

Ovum travels into the fallopian tube

Fertilization (union of the ovum and sperm in the ampulla)

Zygote travels from the fallopian tube to the uterus

Implantation

Development of the fetus/embryo & placental structure until full term

PRELIMINARY SIGNS OF LABOR

Lightening (descent of the fetal

Braxton Hicks Contraction (false labor)

Ripening of the cervix (Goodells Sign

head into the pelvis)

>begin and remain irregular >1st felt abdominally >pain disappears with ambulation >do not increase in duration and intensity >do not achieve cervical dilatation

wherein the cervix feels softer like consistency of the earlobe

TRUE LABOR

Uterine Contractions >increase in duration and intensity >1st felt at the back & radiates to the abdomen >pain is not relieved no matter what the activity >achieve cervical dilatation

SHOW (pink-tinge of blood, a mixture of blood and fluid)

Rupture of Membranes (rupture of the amniotic sac)

Failed to progress labor

increase risk for fetal distress (meconium staining)

Increase risk of fetal death

Emergent cesarean delivery (the incision made on the lower part of the abdomen)

Expulsion of the fetus

Expulsion of the placenta