Midwifery and Gynecological Nursing

Female Pelvis: True Pelvis and False Pelvis There are 4 types of pelvis humans have. Female pelvis are Gynecoid pelvis and the male pelvis are Android pelvis. A gynaecoid pelvis is a very good pelvis for females for childbearing and labor. The female pelvis plays a very vital role in pregnancy to give birth of a child. Structure of Female Pelvis: The female pelvis consists of 2 innominate bones, one sacrum and a coccyx. These innominate bones consist of a pair of ilium, a pair of ischium and a pair of the pubis. Landmarks of Female Pelvis: There are 9 landmarks present in the female pelvis which are listed below: Female Pelvis Landmark of Female Pelvis     Joints of Female Pelvis:   3 joints are present in the female pelvis. Classification of Female Pelvis: The female pelvis is divided into two parts: A. False Pelvis: It is formed by the upper flared-out portion of the ilium. It protects the abdominal organs. It has no obstetrical importance. B. True Pelvis: The true pelvis is the bony canal through which the fetus passes during birth. ✩ The true pelvis has three parts: Diameter of True Pelvis: ⇨ True pelvis has ⇨ All the diameters of the inlet, cavity and outlet are described below: INLET It is formed by the sacral promontory, the iliac bones laterally and the pubic bones anteriorlyShape: Transversely oval or Heart shape ➥Diameter of Brim or Inlet: ➢Anteroposterior Diameter(11 cm) It is the line from the sacral promontory to the upper border of the symphysis pubis.This diameter is of three types-➩True Conjugate or Anatomical ConjugateIt extends from the sacral promontory to the top of the symphysis pubis.●Its normal measurement is 11 cm or more.➩Obstetrical conjugateIt is the distance between the midpoint of the sacral promontory to prominent bony projection in the midline of the symphysis pubis●Its measures 10 cm➩Diagonal ConjugateDistance between the lower border of the symphysis pubis to the down point on the sacral promontory.●It is 12 cm ➢Transverse Diameter(13 cm) It is the distance between the two far ther points on the pelvic brin over the iliopectineal lines. ➢Oblique Diameter(12cm) It starts from the sacroiliac joint to the opposite iliopubic eminence. CAVITY The cavity extends from the brim above to the outline below.The shape is almost roundedAnterior border: symphysis pubisPosterior border: sacral hollowLateral border: soft tissue ➥Diameter of cavity: Anteroposterior diameter – From the midpoint of the surface of the pubic symphysis to the junction of the 2nd and 3rd sacral vertebra.All diameters – As there are other organs, tissue and mass present in the cavity, it is very difficult to measure other diameters. So all the diameters of the cavity are considered as 12 cm.   OUTLET OUTLET This outlet has greater practical significance because it includes the narrow pelvic strait through which the fetus must pass.It is diamond-shaped. ➥Diameter of outlet:     Obstetrical Outlet: Anteroposterior – lower border of the symphysis pubis to tip of sacrum -11 cmTransverse (bispinous) – between two ischial spines -10.5 cm.     Anatomical Outlet: Anteroposterior – lower border of ps to tip of coccyx -13 cm Transverse (bituberous) – between 2 ischial tuberosity-11 cm.   Diameter Of Female Pelvis REFERENCE: DC Dutta’s Textbook of OBSTETRICS  

MTP Act, 1971 ➢Introductions: The Medical Termination of Pregnancy (MTP) Act, 1971, provides an overview of the legislation governing the termination of pregnancies in India. Enacted in 1971 and amended in 2002, the act aims to ensure safe and legal abortions. ➢Objectives: ➢Legal Abortion: ➢When pregnancy can be terminated? ➢Who can terminate the pregnancy? ➦Experience minimum 3yr who is registered in state medical register➦6 months of house surgeon-ship in gynaecology or experience of working in the department of gynaecology –1yr➦A Practitioner who has assisted RMP in 25 cases of Medical termination of pregnancies, at least 5 of which have been performed independently in a hospital established or maintained by the Government or a training institute approved for this purpose by the Government. ➢Required by a RMP (Registered Medical Practitioner) ➨Up to 20 wks PG Degree or Diploma in OBG ➨Completed 6 months as House Surgeon in OBG ➨At least one yr experience in dept of OBG at any hospital that has all facilities. ➢Where pregnancy can be terminated? – PLACE ➢Consent: Violation of The ACT:

Psychological changes in first stage of labour: The first stage of labor is the longest phase. This phase can take 9 hours for primigravida mothers and 5 hours for multigravida mothers. ✩The Changes are listed below:- 1) Cervical Dilation: The cervix begins to open or dilate to allow the baby’s passage through the canal. This is achieved through uterine contraction. 2) Uterine Contractions: The muscles of the uterus contract and tighten that causing the cervix to dilate. This contraction became more intense as labor progresses. 3) Rupture of the amniotic sac: In the first stage of labor, the amniotic sac surrounding the breaks which leads to the release of amniotic fluid. This event is referred to as “water breaking”. 4) Effacement: The cervix gradually thins out and becomes softer. It is measured in percentages.      100% Effacement = A Completely Thin Cervix5) Increase pelvic pressure:As labor progresses, pelvic pressure gets increases. A mother may feel pressure in the pelvic region. 6) Backache and cramping: A mother will experience backaches and cramps during all the stages of pregnancy. 7) Increase vaginal discharge: An increase in vaginal discharge may happen in the first stage. Marcus and blood often come out through the vagina. 8) Changes in vital signs: Blood pressure, heart rate and respiration rate increase due to maternal stress. 9) Hormonal Changes: During the first stage, a huge amount of hormonal changes, especially estrogen and progesterone level changes happen in the mother’s blood.

PARTOGRAPH   ✯Definition of Partograph:- A partogram or partograph is a composite graphical record of maternal and fetal data on the progress of labour on a single sheet of paper. ✯Inventor of Partograph:- In, 1954 Friedman prepared the cervicography. In 1972 Philpott and Castle developed the first partograph, by utilizing Friedmar’s cervicograph, and adding the relationship of the presenting part to the maternal pelvis.     Sample of Partograph by WHO ✯Components of Partograph:- Patient identification: Patient Name, Gravida Para, Patient ID Number, Date of Admission, Ruptured Membranes. Time: It was recorded at an interval of one hour. Fetal Heart Rate: recorded every 30 minutes. State of membranes and colour of liquor:‘I’ – Intact‘C’ – Clear‘M’ – Meconium stained Cervical dilatation of the head. Uterine contraction. Drugs and fluids. Blood pressure at every 2 hr, and pulse at every 30 min. Oxytocin: Concentration is noted in the upper box and dose is noted in the lower box. Urine analysis. Temperature record. ✯Advantages of Partograph:- ➦ Provide important information on a single sheet of paper.➦ Early prediction of the progress of labour.➦ Help to prevent maternal mortality and fetal mortality.     REFERENCE: World Health Organization

UTERINE PROLAPSE 🔎Definition: Uterine prolapse is a condition where the uterus slips from its normal position and pelvic cavity into the vagina. It happens when your tissue or muscle of the uterus becomes weak. Complete uterine prolapse, in which the uterus protrudes through the vaginal hymen is known as procidentia. 🤔Etiology/Cause: ⚠️Risk Factor: 🔴Using tobacco and smoking makes your lung condition bad and due to chronic cough you may leads to uterine prolapse. 𛲢Stages: ⇨First degree: The cervix drops into the vagina. ⇨Second degree: The cervix drops to the level just inside the opening of the vagina. ⇨Third degree: The cervix is outside the vagina. ⇨Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. 🤧Signs and Symptoms/ Clinical Manifestation: Most of the people with uterine prolapse have not experienced any signs or symptoms, but some uterine prolapse symptoms are listed below: If the situation goes to the level of procidentia, then symptoms may include bleeding, vaginal discharge and ulceration. 🩺Diagnostic Evaluations: 🏥Management: ⇒NON-SURGICAL MANAGEMENT:- ⇒SURGICAL MANAGEMENT:- 🛡️Prevention:

 POSTPARTUM PSYCHOSIS  ⇒DEFINITION:-  Postpartum Psychosis is an acute mental disorder or a psychotic reaction occurring following childbirth or abortion.  🔴Postnatal psychosis or puerperal psychosis is a psychological emergency.  Postpartum Psychosis ⇒CLINICAL MANIFESTATION:- Hallucinations – sensing falls, visions, smells or sounds which is not really present. Delusions – It is basically a false belief Mood changes such as mania or depression  Depersonalization (some people describe this as an out of body experience)  Disorganized thinking or behaviours Insomnia – It is a sleeping disorder in this you may find yourself very hard to stay asleep Self-harming – Women with this postpartum psychosis have this type of intention to harm themself. She might commit suicide or may try to kill their child. ⇒ETIOLOGY:- History of Mental Illness – If the patient has any past history of other mental illness. Schizophrenia  Bipolar Disorder Number of pregnancies family history of mental health condition – If any other family members have any kind of psychotic disorder then the pregnant mother also has a chance to get this mental problem. Sleep deprivation Hormone changes – hormonal disbalances due to pregnancy can also be the causes of postpartum psychosis. Other medical conditions Post pregnancy stress can affect mothers mental health ⇒Diagnostic Evaluation:- History Collection Physical Examination Blood Test Urine and other body fluid test Mental Status Examination Test Imaging Tests                 ⇾CT Scan                 ⇾MRI ⇒Treatment:- ▲Medication Antipsychotic Mood stabilizers Antiseizure drug Lithium ▲Electroconvulsive Therapy (ECT) It is the therapy in which electrical shock is provided to the patient in a very low amount and for very short time only. ⬛ With these proper nursing care is very important to totally cure the mental health problems.