The document summarizes obstetric anatomy, including the fetal skull, pelvis, and diameters important for labor and delivery. It describes:
1) The fetal skull diameters and how they change with flexion/deflexion of the head during birth. Moulding can reduce diameters by up to 1cm. Complications like caput succedaneum and cephalhematoma are also outlined.
2) The female pelvis is described through its planes, diameters, and four types (gynecoid, android, anthropoid, platypelloid). Key diameters include the true conjugate (11cm), obstetric conjugate (10.5cm), and diagonal conjugate (12cm).
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
Pelvis and fetal skull are main entities to learn mechanism of labour, having clear concepts regarding the pelvic diameters, there importance, and engaging diameters of fetal skull helps to learn and manage labour process in a better way.
This topic includes difference between female and male pelvis, various pelvis types, general description of pelvis bones, division of pelvis, landmarks of pelvis, plane, axis, sacral angle, diameters of inlet, cavity and outlet.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. The Fetal Skull
Anatomy
Diameters
Molding
Caput Succedaneum
Cephalhematoma
3. •The vault : From the orbital ridge to the nape of the neck
(frontal, parietal, occipital bones). It is compressible.
•The Face: Root of the nose to junction of head and neck.
4.
5. Transverse Diameters of the Fetal Skull
Biparietal Diameter 9.5 cm Between the 2 parietal
eminences
Bitemporal Diameter 8.5 cm.
Bimastoid Diameter 7.5 cm. Between the 2 mastoid
processes (Not reducible
nor destroyable even by
destructive procedures
Supra-subparietal 8.25 - 9 cm. Asynclitic head
6. 6
Length Presentation
1-Suboccipito-bregmatic 9.5 cm. Flexed vertex
2-Suboccipito-frontal 10.5 cm. Partially deflexed vertex
3-Occipito-frontal 11.5 cm. Deflexed vertex
4-Mento-vertical 13.75-14 cm. Brow
5-Submento-bregmatic 9.5 cm. Face
6-Submento-vertical 11.5 cm. Face Not fully extended
7. Length Presentation
1-Suboccipito-bregmatic
Nape of neck to centre of bregma
9.5 cm. Flexed vertex
2-Suboccipito-frontal
Nape of neck to 2.5 cm. In front of
bregma
10.5
cm.
Partially deflexed vertex
Diameter distending the
vulva after crowning
3-Occipito-frontal
Root of nose to occipital
protuberance
11.5
cm.
Deflexed vertex
Diameter distending the
vulva in face presentation
4-Mento-vertical
Point of chin to above posterior
fontanelle
13.75-
14 cm.
Brow
5-Submento-bregmatic
From below chin to centre of
bregma
9.5 cm. Face
6-Submento-vertical
From below chin to infront of post.
fontannelle
11.5
cm.
Face Not fully extended
8. Fetal Skull Circumferences
The Suboccipito-Bregmatic X Bipareital (28 cm.)
These are the engaging diameters of well flexed vertex presentation.
Occipito-frontal X Biparietal (33 cm.)
These are the engaging diameters in deflexed vertex presentation ( OP position).
Mento-vertical X Biparietal (35.5 cm.)
This is the largest head circumference ( Brow presentation)
9. Engaging Diameters of Fetal Skull
Well Flexed Head Circle of 9.5 cm.
The engaging Diameter is the
Suboccipito-Bregmatic diameter
A deflexed Head An oval
The longer occipito-frontal
diameter Of 11.5 cm. Is exposed.
Greater Deflexion
of the Head
An oval
The longer mento vertical
diameter of 13.75-14 cm. is
exposed
Full Extension of
the Head
A circle of 9.5 cm.
The engaging dimeter is the
submento-vertical diameter
10. Moulding…
Reshaping of the fetal skull:
Obliteration of the sutures.
Overlapping of the bones of
the vault:
One parietal bone overlaps
the other.
Both overlap the occipital
bone.
It accounts for diminution of
the biparietal diameter and
suboccipitobregmatic
diameters by 0.5-1 cm. 0r
even more.
11. A: Well flexed Head
B: Partially Flexed Head
C: Deflexed Head
D: Face Presentation
E: Brow presentation
12. Superior long. Sinus
Falx cerebri
Inferior long sinus
Vein of Galen
Tentorium Cerebelli
Overmoulding
Occurs in case of
obstructed labor.
There is overstretch of the
falx cerebri which tears
from its attachment at the
tentorium cerebelli.
Subsequently there is
injury of the vein of Galen
with ICH.
13. The Scalp Tissues
There are Five layers of scalp tissue
Skin: The outer covering containing hair.
Subcutaneous tissue
Muscle Layer: containing the tendon of Galae.
Connective tissue: a loose layer.
Periosteum: covers the skull bones and attached at the suture line
14. Caput Succedaneum
Diffuse scalp edema resulting
from venous congestion due to
prolonged pressure on the fetal
head by the pelvic bones.
It is soft and boggy to touch
It usually disappears
Localized caput…?
It is usually few mm. Thick but
may be large and lead to
misinterpretation of the station
of the head.
The presence of caput may
have medico-legal implication:
The baby was living
Labor was difficult
D.D…Cephalhematoma
15. Cephalhematoma
This swelling is due to bleeding between the skull bone and periosteum.
Bleeding occurs due to friction between the overriding bones and periosteum
during molding.
It is just as likely to occur during a normal delivery as during more difficult
labor.
A low prothrombin level is probably a contributory cause
16. Caput Succedaneum Cephalhematoma
Cephalhematoma is not present at birth but appears 2-3
days.
The swelling is limited by the periosteum. It therefore
can NOT lie over a suture.
The head is more red ad bruised in appearance than in
caput succedaneum.
The swelling may increase and it takes 6 weeks at least to
disappear.
18. The Female Pelvis
Four Bones articulated at Four Joints.
False pelvis: above the pelvic brim and has no
obstetric importance.
True pelvis: below the pelvic brim. It is the bone
defined tunnel that the infant must traverse at birth.
22. The Planes of the pelvis
Plane of the pelvic inlet.
Plane of the cavity: Plane of greatest Pelvic Dimensions
Plane of the mid pelvis (plane of obstetric outlet)
Plane of the Anatomical outlet
23. Plane Of The Pelvic Inlet
passing with the boundaries of pelvic brim and making an angle of 55o
with the horizon (angle of pelvic inclination).
24. Plane of the Pelvic Cavity
It is the plane of greatest pelvic dimensions.
It passes between the middle of the posterior
surface of the symphysis pubis and the junction
between 2nd and 3rd sacral vertebrae. Laterally, it
passes to the centre of the acetabulum and the
upper part of the greater sciatic notch.
It is a round plane with diameter of 12.5 cm.
Internal rotation of the head occurs when the
biparietal diameter occupies this wide pelvic plane
while the occiput is on the pelvic floor i.e. at the
plane of the least pelvic dimensions.
25. Plane Of Obstetric Outlet
It is the plane of least pelvic dimensions.
It passes from the lower border of the symphysis pubis anteriorly, to the ischial
spines laterally, to the tip of the sacrum posteriorly.
It is the plane of the pelvic floor.
The head is considered engaged if the vault reaches it.
This is the plane where the pelvic axis turns forwards.
26. Plane Of Anatomical Outlet
It passes with the boundaries of anatomical outlet and consists of 2 triangular
planes with one base which is the bituberous diameter.
Anterior sagittal plane: its apex at the lower border of the symphysis pubis.
Anterior sagittal diameter from the lower border of the symphsis pubis to the centre of the
bituberous diameter: 6-7 cm
Posterior sagittal plane: its apex at the tip of the coccyx.
Posterior sagittal diameter from the tip of the sacrum to the centre of the bituberous
diameter: 7.5-10 cm
27. The consequences of walking upright…
When a women stands erect:
The pelvic inlet makes an angle of about 55° with the horizon.
The pelvic outlet makes an angle of 15° with the horizon
If the angle made by the inlet is greater than 55° this may
make the descent of the fetal head in the pelvis difficult.
28. The Obstetric Pelvic Axis
This represents the
path that the
presenting part must
follow for delivery to
occur:
The upper part moves
downward
approximately in a
straight line till the
level of the ischial
spine.
The trajectory then
changes to become a
curvilinear path
directed forward and
downward
29. At the level of the Ischial Spine
The plane of obstetric outlet (plane of the least pelvic
dimensions).
The levator ani muscles.
The obstetric axis of the pelvis changes its direction.
The head is considered engaged when the vault is felt
vaginally at or below this level.
Internal rotation of the head occurs when the occiput is at
this level.
Forceps is applied only when the head at this level (mid
forceps) or below it ( low and outlet forceps).
Pudendal nerve block is carried out at this level.
Normal level of the external os of the cervix.
30. Four types of Female Pelvis
The Caldwell-Moloy’s classification
They differ in:
Shape of the pelvic inlet
Shape of the side-walls
Character of the subpubic arch
Four types do exist:
Gynecoid: 50%.
Android: 20%.
Anthropoid: 25%.
Platypelloid: 5%. The truth is that the
majority of the pelves are
a mixture of all the 4
types.
31. Gynecoid
Android
Rounded
Trans. Diameter Slightly
behind the centre
Heart shaped
Trans. Diameter
Near the sacrum
Anthropoid Platypelloid
AP diameter>Trans.
Wide Trans. diameter
32. Types of female Pelvis
Gynecoi
d
Android Anthropoi
d
Platypelloid
Female Male-like Ape-like Flat
50% 20% 25% 5%
Inlet Rounded Triang. AP-oval Trans-oval
Cavity Wide and
shallow
Narrow
and deep
Wide Wide
Subpubi
c angle
Wide
>90
Narrow
<70
<90 >90
Ischial
Spines
Not
prominent
Inward
projection
Prominent Not
prominent
I.S.D Wide Reduced Reduced Wide
Walls Parallel Convergen
t
Parallel Divergent
33. The Ideal Obstetric Pelvis
Brim Round or Oval transversely
No undue projection of sacral promontory.
AP diameter: 12 cm.
Transverse diameter: 13 cm
The plane of pelvic inlet not more than 55°.
Cavity Shallow with straight side-walls.
No great projections of ischial spines.
Smooth sacral curve
Outlet Pubic arch rounded
Subpubic angle >80°.
Intertuberous diameter of at least 10 cm.
34. The True Conjugate = 11 cm
The Obstet. Conjugate = 10.5cm
The Diagonal Conjugate = 12 cm
35. Diameters of the Inlet
Antero-posterior Diameters
True Conjugate
Obstetric Conjugate
Diagonal Conjugate
External Conjugate
from the tip of the sacral promontory to
the upper border of the symphysis pubis.
from the tip of the sacral promontory to
the most bulging point on the back of
symphysis pubis which is about 1 cm
below its upper border. It is the shortest
antero-posterior diameter
From the tip of sacral promontory to the
lower border of symphysis pubis.
12 cm.
10.5 cm.
12-12.5
cm.
20 cm.
36. Transverse Diameters
Anatomical
Transverse Diameter
Obstetric
Transverse Diameter
between the farthest two
points on the iliopectineal
lines.
It lies 4 cm anterior to the
promontory and 7 cm behind
the symphysis.
It is the largest diameter in
the pelvis.
It bisects the true conjugate
and is slightly shorter than
the anatomical transverse
diameter.
13 cm.
12 cm.
37. Oblique Diameters
Right and left
oblique diameters
Right and left
Sacro-cotyloid
diameters
From the right Sacro-iliac
joint to the left ilio-pectineal
eminence and vice-versa.
From the right ilio-pectineal
eminence to the
promontory of the sacrum
(rt.)
12 cm.
9-9.5
cm.
38. Interspinous diam. = 10.5 cm.
Anato. Ant. Post diam= 11 cm.
Obstet. Ant. Post diam= 13 cm.
39. Diameters of the Outlet
Antero-Posterior Diameters
Anatomical
antero-posterior
diameter
Obstetric
antero-posterior
diameter
From the tip of the coccyx
to the lower border of
symphysis pubis.
From the tip of the sacrum
to the lower border of
symphysis pubis as the
coccyx moves backwards
during the second stage of
labour.
11cm
13 cm
40. Transverse Diameters
Anatomical
Transverse
Diameter
(Bituberous)
Obstetric
Transverse
Diameter
(interspinous)
Extends between the inner
aspects of the ischial
tuberosities.
Extends between the tips
of the ischial spines. It is the
smallest diameter of the
pelvis.
11cm
10.5 cm.
Tom’s Dictum: If the sum of the Bituberous diameter and Post.
Sagittal diameter is less than 15, the pelvic outlet is
contracted . This is an indication of performing a Cesarean
section.
41. The Plane of the Outlet
Anterior Sagittal Plane
Posterior Sagittal Plane
42. Pelvic Soft Tissues
The Formation Of The Lower Uterine Segment
The Levatores Ani
The Perineal Muscles
Formation of the birth canal during labor
The Episiotomy
43. The formation of the lower uterine segment
It is the part between the vesico-uterine fold of peritoneum superiorly and the
cervix inferiorly.
It develops as early as the 16th week by incorporating the upper part of the
cervix in the lower part of the uterus to accommodate for the presenting part
of the fetus.
44. Differentiation of the Uterine Segments
The passive lower segment is derived from the isthmus.
The physiologic retraction ring develops at the junction of
upper and lower uterine segments.
The Pathologic retraction ring develops from the physiologic
ring in case of obstructed labor
45.
46. Formation of the Birth Canal During Labor
The lower uterine segment, cervix and vagina become a single canal that allow
for the passage of the baby to the outside.
Hypertrophy of the vaginal muscle layer and unfolding of the rugae allow for
the accommodation of the fetus without damage.
47. Formation of the Birth Canal During Labor
Level of Internal os
The cervix is obliterated, taken-up or effaced: It is reduced from a length
of 2-2.5 cm to a mere paper thin circular orifice.
The lower uterine segment, cervix and vagina become a single canal that
allow for the passage of the baby to the outside.
Hypertrophy of the vaginal muscle layer and unfolding of the rugae allow
for the accommodation of the fetus without damage.
48. The Levatores Ani
A hammock of muscle sweeping down from the pelvic brim and
investing the urethra, vagina and rectum.
Two gaps:
An anterior gap bridged by the urogenital diaphragm transmitting the
urethra and vagina.
A posterior gap transmits the rectum and anal canal.
49. The resistance and shape of the pelvic floor
play an important role in facilitating rotation
and flexion of the presenting part.
As the presenting part descends:
The anterior portion of the pelvic floor is pressed
outwards against the SP.
The posterior part becomes stretched into a thin-walled
tube.
The perineal body stretches and thins from 5 cm.
To 0.05 cm. and is displaced downward.
50.
51.
52.
53.
54. The Episiotomy
(Perineotomy)
Delivery of the fetus through the musculo-fascial support
of the pelvic floor requires significant stretching of these
structures and often results in trauma.
The purpose of the episiotomy is to substitute a surgical
incision limited to a reparable portion of the perineum.
55. The Following Are Incised…
The Fourchette.
The vaginal mucosa and
submucosa.
The interdigitating fibers
of the suerficial and deep
transverse perinii & the
pubococcygeus muscle
group.
The inferior fascia of the
urogenital diaphragm.
In mediolateral
episiotomy, the medial
portions of the
bulbocavernosus is also
incised
ischiocavernosus
Bulbocavernosus
Pubococcygeus
Iliococcygeus
Coccygeus
Superficial transverse perinii
57. As the journey progresses…
The fetal head descends along the pelvic axis.
It must rotate to accommodate the appropriate
diameters of the head to the pelvic diameters.
The reference points during this journey:
The ischial spine is the pelvic reference point
The presenting part is the fetal reference point.
58. Fetal Presentation & The Presenting Part
Fetal Presentation:
Is the fetal pole that presents at the pelvic inlet:
Cephalic: Head First
Breech: Feet or Buttocks
Shoulder: back or abdomen
The Presenting part:
Is the part of the fetus first touched by the examining fingers during pelvic
examination.
59. The Fetal Lie
Refers to the relationship between the fetal longitudinal axis and that of the
mother.
60. Position
It refers to the relationships of a designated point on the
presenting part “Denominator” to the walls of maternal
pelvis.
P
LA
LT
A
RA
RT
RP LP
61. As the fetal head descends through the birth canal, the suboccipito-bregmatic
diameter successively occupies the :
Transverse diameter of the inlet.
Oblique diameter of the cavity.
AP diameter of the outlet
62. What is the predominant fetal head position?
During labor, in 90% of vertex presentation, The head assumes either a LOA
or a ROP position
The sagittal suture occupies the Right Oblique diameter of the pelvis.
The right oblique diameter of the pelvis goes from the left iliopectineal
eminence to the Right sacroiliac joint.
63. Why should the head rotate?
The larger transverse diameter of the pelvis is more posterior.
However the presence of the sacral promontory pushes the head
anteriorly towards a smaller transverse diameter.
The head will therefore rotate to take advantage of the greater oblique
diameter at that level
64. Why the LOA or the ROP are favored over
the LOP or ROA?
The presence of the sigmoid colon in the post left
quadrant of the pelvic inlet pushes the head
anteriorly towards the pubis.
The sagittal suture is tending to occupy the wider
Right oblique diameter rather then the left oblique
diameter which is encroached upon by the sigmoid
colon.
Thus a LOA or a ROP positions are favored in 90%
of cases.
65. The Stations of the Fetal Head
The location of the presenting part with
reference to the ischial spine is designated the
station of the presenting part.
The head is said to be engaged when the
vertex is felt at the level of the ischial spine.
In that instance, the biparietal diameter
should have negotiated the inlet. This is
because:
The distance from the plane of the inlet to the
spine is 5 cm.
The distance from the vertex to the biparietal
diameter is 4.5 or less
66. The Stations of the Bony Pelvis
Station -5
Station 0
Station +5
-5
0
+5
•The station 1 cm. Below the inlet is station -4.
•The station below the spine are numbered from +1 to +5 : The perineum
67. The Fetal Head Has Five Fifths…
0 : Head Not Palpable
1 : Sinciput felt – Occiput Not Felt
2 : Sinciput felt – Occiput Just Felt
3 : Sinciput easily felt – Occiput
Felt
4 : Sinciput High – Occiput easily
Felt
5 : Complete above pelvic brim
eht evoba htfif
-5
0
+5
Editor's Notes
Needs definition:
vault
Bimastoid
Suprapareital-subpareital
Inferior view with lig
labeling
Pelvic Planes:
These are imaginary planes lie as follow:
(1) Plane of pelvic inlet:
passing with the boundaries of pelvic brim and making an angle of 55o with the horizon (angle of pelvic inclination).
(2) Plane of mid cavity ( plane of greatest pelvic dimensions):
- pass between the middle of the posterior surface of the symphysis pubis and the junction between 2nd and 3rd sacral vertebrae. Laterally, it passes to the centre of the acetabulum and the upper part of the greater sciatic notch.
- It is a round plane with diameter of 12.5 cm.
- Internal rotation of the head occurs when the biparietal diameter occupies this wide pelvic plane while the occiput is on the pelvic floor i.e. at the plane of the least pelvic dimensions.
(3) Plane of obstetric outlet (plane of least pelvic dimensions):
passes from the lower border of the symphysis pubis anteriorly, to the ischial spines laterally, to the tip of the sacrum posteriorly.
(4) Plane of anatomical outlet:
passes with the boundaries of anatomical outlet and consists of 2 triangular planes with one base which is the bituberous diameter.
a- Anterior sagittal plane: its apex at the lower border of the symphysis pubis.
b- Posterior sagittal plane: its apex at the tip of the coccyx.
Anterior sagittal diameter: 6-7 cm
from the lower border of the symphsis pubis to the centre of the bituberous diameter.
Posterior sagittal diameter: 7.5-10 cm
from the tip of the sacrum to the centre of the bituberous diameter
Effect of the inclination of the pelvis on the engagement of the fetal head
Anatomical axis (curve of Carus):
- It is an imaginary line joining the centre points of the planes of the inlet, cavity and outlet.
- It is C shaped with the concavity directed forwards.
- It has no obstetric importance.