Introduction

Obstetrics and Gynecology

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At the end of the session student should understand
Definition of obstetric and gynecology

Aims of obstetric and gynecology

anatomy and Physiology of female pelvis

External Perineum

Location and types of uterus

Hormone and its production

Menstrual Cycle

Anatomy and Physiology of female breast

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 Somaliland’s Maternal Mortality Rate (MMR) has
fallen to 396 maternal deaths per 100,000 live
births from 418 in 2014. However, the figure of
418 was generated from a verbal autopsy maternal
mortality survey which was conducted by World
Health Organization, Regional office (WHO-EMRO),
WHO Country office, University of Aberdeen, and
Data and Research Solutions (DARS) in 2014.

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 To have healthy mother and baby
 Reducing the number of maternal and child mortality
rate.
 Minimizing the complication and discomfort during
 Pregnancy (Antenatal)
 Labour
 Puerperium (postnatal)

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 Obstetrics : is the branch of medicine which deals
with the birth of the children and care of women
before, during and after giving birth to the child,
including the management of
 Pregnancy (Antenatal)
 Puerperium ( postnatal period) under both normal and
abnormal circumstances and
 Labor

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Gynecology: is the branch physiology and medicine
which deals with the function and disease specific
to women and girl, specially whose affecting the
reproductive system .

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Female Pelvis: - is a bony ring interposed

between the trunk and lower extremities which

forms a bony canal through which the fetus

pass during the process of child birth

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Sacrum
Illium
Ischium
Pubis
Sacroilliac Joints
Symphysis Pubis
Coccyx

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Divided into three passageways:
Brim -inlet
Cavity
Outlet

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 The pelvic brim is the edge of the pelvic inlet.
It is an approximately apple-shaped line
passing through the prominence of the
sacrum, the arcuate and pectineal lines, and
the upper margin of the pubic symphysis

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 is almost round in shape in normal female pelvis
except where the sacral promontory projection in to
it.
 Diameter of the brim
◦ Anterior posterior diameter
◦ Oblique diameters
◦ Transverse diameter

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 Anteropostrior Oblique Transverse

Brim 11 12 13

Cavity 12 12 12

Out let 13 12 11

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 is the cavity extend from the brim above to the
out let below
 The cavity is circular in shape
 measure 12cm

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1. Anatomic out let: - is formed by the lower
border of each of the bones together with
the sacrotuberous ligament.
2. The obstetrics out let: - the narrow pelvis
strait lies between the sacrococcygeal joints,
the ischial spines, and the lower border of the
symphysis pubis.
◦ This out let is diamond- shaped.

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 N.B: - if one of the following measures is
reduced by one cm or more the pelvis said to
be contracted and
 May give rise to difficult in labour

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Pelvis categorizes in to four according to the
shape of the brim
1. Gynaecoid pelvis (true female pelvis)
2. Android pelvis (male type pelvis)
3. Anthropoid pelvis (oval type pelvis)
4. Platypelloid pelvis(flat or kidney type pelvis)

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 Gynaecoid pelvis
◦ Round brim
◦ Straight side wall and well curved sacrum
◦ Blunt ischial spine
◦ Round sciatic notch
◦ 90 degree sub-pubic arch angle
◦ Generous for pelvis

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Android
 Heart shaped brim
 Narrow fore pelvis
 Convergent side wall
 Prominent ischial spine
 Narrow sciatic notch
 Less than 90 degree sub pubic angle

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Anthropoid
 Long oval brim
 Narrowed fore pelvis
 Sacrum is long and deeply concave
 Women this type of pelvis are tall and narrow shoulder
 Divergent side wall
 Blunt ischial spine
 Wide sciatic notch
 Greater than sub pubic angle

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Platypelliod
 Kidney shaped brim
 Wide fore pelvis
 Blunt ischial spine
 Divergent side wall
 Wide sciatic notch
 Greater than 90 degree sub pubic arc angle
 Anterior posterior diameter decrease , but transverse
diameter increase

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External Perineum

Perineum

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Internal Organs (pg 235)
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 The paired structure wich attached to the
lateral aspects of uterine cavity.
 It has four parts: intramural, the isthmus,

ampulla and infundibulum.

Ovary:
 Ovaries are a paired sex gland organ.
 Each ovaries attached to the uterus by utero-

ovarian ligaments and to the lateral pelvis by

infundibulo pelvic ligaments.
 The substance of the ovaries has cortex and

medulla

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Muscular organ that serves for
reception, implantation,
retention and nutrition of
fertilized ovum
Fundus –
body of uterus
Cervix - part of the uterus that
extends into the vagina
Internal Os - part of the
muscular layer of the uterus
External Os - opening
between the uterus and
vagina

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Uterine Wall
Endometrium -
highly vascular lining
involved in menstrual
cycle
Myometrium -
muscles that form
the uterus
epimetrium/
Peritoneum -
continuation of the
peritoneal cavity
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Puberty - broad term, entire transitional stage
between childhood and sexual maturity
Menstruation - periodic uterine bleeding that
begins approximately 14 days after ovulation
Menarche - first menstruation
Ovulation - release of mature ovum from
ovary
Anovulatory - no release of ovum

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Periods are initially irregular, unpredictable, painless
and anovulatory
After one or more years, rhythm develops to produce
mature ovum and to prepare uterus for pregnancy
Cycle usually lasts 28 days,
Controlled by a feedback system of three different
cycles
Hypothalmic-pituitary
Ovarian
Endometrial

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At birth, a female baby is born with thousands of small eggs
(also called ova) in her ovaries
At puberty the ova begin to mature and the girl enters into a
menstrual cycle
One egg is selected to mature completely - a single egg is
called an “ovum”
The ovum enlarges into a cyst called a “graafian follicle”
When the graafian follicle reaches the surface of the ovary, the
ovum is released from the graafian follicle and goes into the
fallopian tubes. This is called “ovulation”
If there is no fertilization, the ovum will disintegrate.
The “corpus lutem” is the place from the ovary that the ovum
is released from (the graafian follicle). It is like a scar which
contains cells which produce estrogen and progesterone.

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Control
center of the
brain
Hypothalam
us
stimulates
the Pituitary
Gland

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Produces hormones involved in the menstrual
cycle (Follicle Stimulating Hormone and
Luteinizing Hormone)

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Hypothalamus releases Gonadotropin-Releasing
Hormone
Which stimulates the Anterior Pituitary to release
Follicle-Stimulating Hormone
Which stimulates the ovaries for the
development/maturation of graafian follicles and
an increased production of estrogen
The Anterior Pituitary also releases Luteinizing
Hormone
The increase in estrogen causes a surge in FSH
and LH which then causes ovulation.

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The graafian follicle becomes the corpus
luteum which produces progesterone and
estrogen to nourish endometrium.
If no implantation occurs, corpus luteum
degenerates, causes estrogen and
progesterone to decrease.
This cuts off the blood supply to the
endometrium causing it to slough off.
Then the cycle restarts in response to the
decrease in estrogen.

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Day one is the first day of the menstrual cycle
Follicular Phase:
Days 1-14, the length will vary. This phase ends
with ovulation.
During this phase FSH, LH and estrogen increase
Luteal Phase
Exactly 14 days
Corpus Luteum secretes estrogen and progesterone
Progesterone promotes implantation
As CL degenerates, progesterone levels decrease and
cycle starts again

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Assumes 28 day cycle
Menstrual Phase: day 1-5 - sloughing of
functional layer of endometrium
Proliferative Phase: day 5 until ovulation - rapid
growth of endometrium
Secretory Phase: day of ovulation (day 14) to 26
- endometrium prepares for implantation. It is
full, thick and nutritive
Ischemic Phase: day 27-28 - corpus luteum
degenerates, estrogen and progesterone
decrease, blood supply to endometrium is cut
off and bleeding begins
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Source - Anterior Pituitary
Release in response to a decrease in estrogen
and progesterone at the end of the menstrual
cycle
Action - stimulates development of graafian
follicle and ovarian production of estrogen

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Source - Anterior Pituitary
Released in response to decrease of estrogen
and progesterone at the end of the menstrual
cycle
Action - stimulates ovulation and
development of corpus luteum

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Source - Ovaries Produced in corpus luteum.
Produced by placenta after 12 weeks
Produced under the influence of FSH
Actions - responsible for secondary sex
characteristics (breasts, shape), increased size
and weight of uterus, causes proliferation
(growth) of uterine endometrium

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 Source - Ovaries and Corpus Luteum

Actions - Prepares uterus for implantation

 Inhibits uterine contractions until uterus is
prepared for labour

 Regulates storage of body fat

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Source - produced by most organs in the
body, including uterus
Actions - Regulation of hormone activity,
plays a part in ovulation, fertility, changes in
cervix and cervical mucus, menstruation,
abortion and onset of labor

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 The breasts are specialized organs, which are
located on the anterior chest wall. Is more
developed female than male breast, as their
primary function is to produce milk for
nutrition of the infant and baby
 Contain mammary glands
 Consist of connective tissue that serves as
support

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 Each breast contain 15-25 clusters called
lobes
 Each lobule is connected by ducts that open
into the nipples
 The nipples are made up of erectile tissue
 The pigmented around the nipples are called
the areola

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 Breast size is determined primarily by
heredity
 Size also depends on the existing fat and
glandular tissue
 Breasts may exhibit cyclical changes,
including increased swelling and tenderness
prior to menstruation
 Benign breast changes refer to fibrocystic
disease
 Lumps or masses that are noncancerous

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 Women need to examine their breasts
monthly BSE
 This is a proactive approach to detect
possible breast cancer
 A supplement to clinical exams and
mammography
 Best time for a BSE is a week after
menstruation

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