First stage of labour – first stage of labour starts from regular onset of labour pain or contraction to the full dilatation of the cervix.
Second stage of labour -It is starts from the fully dilatation of cervix to end of the delivery or baby out .
3rd stage of labour – it is started from end of the delivery or baby out till delivery of placenta .
4th stage of labour -It is starts from after delivery of placenta till one hour for close observation of the mother to watch bleeding.
In second stage of labour, mechanism of labour takes place means baby will come out from the uterus through pelvic by series of movement,that series of movement occur in fetal head and trunk in the process of adaptation this is called mechanism of labour in LOA or ROA
Lie – Longitudinal
Presentation – Cephalic
Position -LOA OR ROA ( left occipitoanterior or Right occipitoanterior position.
Attitude – Flexion
Denominator – Occiput
Presenting part – Vertex
Steps or events in mechanism of labour-
1-Engagement of head
2-Flexion of the head
3-Internal rotation of head
4-Crowning
5-Extension of head
6-Restitution
7- Internal rotation of shoulders and external rotation of head
8-Birth of shoulders and trunk. by lateral flexion
During pregnancy the uterus enlarged due to development of the fetus.
Enlarged uterus pushed heart to upwards The heart moves slightly outward
The heart also rotates little to the left
This causes slightly changes occur in position of heart
Some times due to changes in position of heart may cause palpitation.
The Apex beat of the heart is felt in 4th intercostal space.
Normal apex beat of heart in non pregnant state in 5th intercostal space mid-clavicular line .
Apex beat of heart in pregnancy about 2.5 cm outside the mid clavicular line and in 4th intercostal space .
Due to Increase blood flow through the internal mammary vessels in of breast soft continuohissing murmur sound may be audible in the left second and third intercostal space which is called mammary murmur .
Doppler echo cardiography test of the heart shows ( increase in the left ventricles of heart at the time of diastole when it is filled with blood .
Right atrium receives blood from venacava and left atrium receives blood from the lungs,these both chamber bigger than normal . which is seen in Doppler echo cardiography.
Third heart sound (S3):It is an extra heart sound heard after the normal “lub-dub”.It happens during diastole (when the heart relaxes and fills with blood).Cause: rapid filling of blood into the ventricle.In pregnancy, it can be normal due to increased blood volume.
Fourth heart sound (S4): is another extra heart sound, heard just before the normal “lub-dub”.It happens when the atria push blood forcefully into the ventricle.It is rarely heard in pregnancy.
ECG is normal, but may show a slight left axis deviation to the changed position of the heart in pregnancy.
CARDIAC OUTPUT
The cardiac output starts to increase from 5th week of pregnancy.It reaches its peak at about 30 to 34 weeks .( Increase 40 to 50 %)There after cardiac output remain stable till term .
Cardiac output varies with body position. It is lowest in sitting or supine position. It is highest in lateral or knee-chest position.During labour, cardiac output increases by about 50%.
HiImmediately after delivery, cardiac output and MAP rise further.This is due to blood from uterus entering maternal circulation.
Cardiac output returns to pre-labour level within 1 hour.
It returns to normal pregnancy level within 4 weeks.
Increase in cardiac output is due to increased blood volume, stroke volume, and heart rate.
During pregnancy, systemic vascular resistance (SVR) decreases.(. SVR means how much the blood vessels resist blood flow in the body.)
This decrease is due to hormones like progesterone, nitric oxide (NO)( Nitric oxide lowers blood pressure by relaxing and widening blood vessels.),
prostaglandins, and ANP.(ANP is a heart hormone that lowers blood pressure by removing extra fluid and relaxing vessels.(ANP means Atrial Natriuretic Peptide (a hormone from the heart).These substances cause relaxation of smooth muscles in blood vessels.So, blood vessels become wide (vasodilation)Because vessels are wide, resistance to blood flow decreases.
Especially diastolic BP and MAP fall by about 5–10 mmHg, following the decrease in SVR
In pregnancy, venous pressure changes in the body.
Antecubital venous pressure (in arm) remains normal.
Femoral venous pressure (in leg) increases during pregnancy.
It becomes higher especially in the later months.
This happens due to pressure of the pregnant uterus on veins.
The pressure is more on the right side due to uterine rotation.
Femoral venous pressure rises from about 8–10 cm H₂O to 25 cm H₂O (lying).
It becomes even higher in standing position.
This increased pressure leads to swelling (edema), varicose veins, and piles.
These symptoms improve with rest because venous pressure decreases.
CENTRAL HAEMODYNAMICS
During pregnancy, there is increased blood volume.
But central pressures like CVP, MAP, and PCWP do not change much.
CVP means pressure in large veins near the heart.
MAP means average blood pressure in the arteries.
PCWP means pressure in the lungs’ blood vessels.
These pressures stay stable because the body adapts to changes.
There is a decrease in systemic vascular resistance (SVR).
There is also a decrease in pulmonary vascular resistance.
Colloid osmotic pressure (protein pressure in blood) decreases slightly.
These changes help maintain balance and prevent major changes in central hemodynamics.
SUPINE HYPOTENSION SYNDROME
In late pregnancy, the large uterus presses on the inferior vena cava (IVC).
The IVC is a vein that returns blood from the lower body to the heart.
When a woman lies in supine (on the back) position, this pressure increases.
Due to this, blood return to the heart decreases.
This can cause low blood pressure (hypotension).
It may also cause fast heartbeat (tachycardia) and fainting (syncope).
The body sometimes tries to compensate by using collateral veins.
These include paravertebral and azygos veins. If collateral circulation does not work well, symptoms become severe.
Symptoms quickly improve when the patient is turned to the left lateral positio
REGIONAL DISTRIBUTION OF BLOOD FLOW
During pregnancy, blood flow is redistributed in the body.
Uterine blood flow increases from about 50 ml/min to 750 ml/min near term.
This increase helps in fetal growth and development.
It is due to uteroplacental and fetoplacental vasodilation.
Vasodilation is caused by hormones like progesterone, estrogen, nitric oxide, prostaglandins, and ANP.
Blood vessels become less responsive to constricting hormones like angiotensin II. Pulmonary (lung) blood flow also increases. Renal (kidney) blood flow increases to about 400 ml/min.
Blood flow to skin and mucous membranes increases up to about 500 ml/min. This increased blood flow causes warmth, sweating, and heat sensation in pregnant women.
In later month of pregnancy due to development of the fetus the uterus also enlarged .
Due to. Enlargement uterus the diaphragm also elevate by 4 cm above .
Due to elevation of diaphragm Total lung capacity also reduced 5 percent
Diaphragmatic excursion is increased by 1-2 cm during pregnancy.( But What is Diaphragmatic excursion? ,Let me explain
When you inhale or breath in diaphragm moves down .
When you exhale or breath out diaphragm moves up
This movement of the diaphragm up and down
Progesterone relaxes lungs blood vessels so that blood can flow more easily and pulmonary resistance decreases .
Subcostal angle increases from 68 degree to 103 degree .( What is subcostal angle ? And How it is increase during pregnancy let me explain
Subcostal angle is formed between the right and left lower ribs below the chest .this angle increases because due to development of the fetus uterus enlarged and push diaphragm upward ,and due to diaphragm ribs moves outward and subcostal angle increases.
Chest circumference increases by 5 to 7 cm in pregnancy during Respiratory system physiological changes during pregnancy.
The mucosa oxf nasopharynx becomes red and swollen congested.this may cause nasal stiffness or block
Increase tidal volume in pregnancy (Tidal volume means amount of air you breathe in and breath out during one normal breath .
Normal tidal volume – 500 ml
In pregnancy tidal volume increases by about 30 to 40 Percent
Physiological changes during pregnancy are the normal changes in woman’s body that occur to support the growth and development of the fetus .
THERE ARE MANY PHYSIOLOGICAL CHANGES OCCUR DURING PREGNANCY IN ALL SYSTEM OF THE BODY
1-Changes in Reproductive system
2- Changes in cardiova
3- Changes in Urinary system
4- Changes in Gastrointestinal system
5-Changes in Endocrine system
1-PHYSIOLOGICAL CHANGES IN PREGNANCY OF REPRODUCTIVE SYSTEM
Uterus
Cervix
Vagina
CHANGES IN VULVA
Vulva becomes swollen (edematous) during pregnancy.
Blood supply increases, so it looks more vascular. .
Superficial veins become enlarged (varicosities). These varicose veins are common in multiparous women.
Labia minora become darker due to pigmentation. Labia minora increase in size (hypertrophy). All these changes are normal during pregnancy.
CHANGES OCCUR iN UTERUS DURING PREGNANCY
1-WEIGHT –
In non pregnant state the weight of the uterus is 50 gm but after pregnancy it is 20 times increase and teached to 1000 gms .
2-VOLUME –
In non pregnant state the volume of the uterus is -10 ml but after pregnancy it is increased to around 5 litres
3-SHAPE –
the uterus shape change during pregnancy. Elongated to oval by second month of pregnancy
Round shape of uterus ( by midgestation)
Oval to elongated shape at term
4_CHANGES IN MUSCLE LAYER OF UTERUS
Hyperplasia and hypertrophy occur in muscle fibers during pregnancy.
1-Outer longitudinal layer Location: Outer surface of the uterus Muscle fibers: Run lengthwise (top to bottom) Function: Helps in pushing the fetus downward during labor Contributes to contractions 2. Middle vascular layer -the middle layer arranged in criss- -cross pattern.and give the figure of ‘8’ form .(What “figure of 8” means in the uterus? The circular muscle fibers of the uterus wrap around the blood vessels and cervix in a special way. When you look from above, their arrangement looks like the number 8 ) This is why it is called figure-of-8 fibers
This middle layer muscle fibres called as living ligature
A ligature is a surgical tie used to stop bleeding. These muscle fibers naturally squeeze blood vessels after childbirth. So they act like a living, natural tie (ligature) to prevent postpartum bleeding.
Location: Middle layer of the myometrium Muscle fibers: Special feature: Rich in blood vessels Function: Provides blood supply to the uterus and placenta Helps in strong contractions during labor Important for controlling bleeding after delivery 3. Inner circular layer
Location: Just beneath the endometrium (inner lining)
Muscle fibers: Run around the uterine cavity (circular)
Function:
Helps in closing the uterine cavity
Supports placental attachment
Plays a role in labor contractions and involution
CHANGES IN POSITION OF THE UTERUS
During early pregnancy (up to 8 weeks), the uterus is anteverted and this position. The enlarged uterus lies on the urinary bladder, making it unable to fill properly.
This leads to frequency of micturition (frequent urination).
After 8 weeks, the uterus rises upward and becomes more erect.
The long axis of the uterus aligns with the axis of the pelvic inlet.
Near term, in multipara (women with previous births), due to lax abdominal muscles, there is more anteversion.
In primigravida (first pregnancy), strong abdominal muscles hold the uterus firmly against the maternal spine. Thus, the position of the uterus changes throughout pregnancy depending on growth and muscle tone of the uterus.
As the uterus grows, it moves upward into the abdominal cavity
While growing, it rotates slightly to the right side (called dextro-rotation).
This happens because the rectosigmoid colon is present on the left side.
Due to this, the uterus cannot expand on the left, so it shifts to the right.
The front (anterior surface) of the uterus turns toward the right side.
The left cornu of the uterus comes closer to the abdominal wall.
As a result, the cervix shifts toward the left side (called levorotation).
This brings the cervix closer to the left ureter.
CHANGES IN SHAPE OF THE UTERUS
In the non-pregnant state, the uterus has a pyriform (pear) shape.
In early pregnancy, this pyriform shape is maintained.
By around 12 weeks, the uterus becomes globular (round).
This happens due to uniform enlargement of the uterus.
As pregnancy progresses, the uterus continues to increase in size.
By around 20 weeks, it again becomes pyriform or ovoid (oval shape).
In late pregnancy (after 36 weeks), the uterus becomes more spherical (rounded).
These shape changes occur due to growth of fetus and stretching of uterine muscles.
VASCULAR SYSTEM CHANGES IN UTEROUS
In the non-pregnant state, the uterus receives blood mainly from the uterine artery and less from the ovarian artery.
n pregnancy, both uterine and ovarian arteries supply equal amount of blood.
The arteries become spiral in shape, reaching
maximum spiraling at about 20 weeks.
After 20 weeks, these arteries straighten out. The uterine artery diameter doubles and blood flow increases about 8 times.
This increase is due to hormones like estrogen and progesterone.
The veins become dilated and valveless, allowing easy blood flow.
Many new lymphatic channels develop to support increased circulation.
These vascular changes are maximum at the placental site, and the uterus enlarges unevenly, with fundus growing more than the body.
BRAXTON -HICKS CONTRACTION
Braxton Hicks contractions are mild uterine contractions that occur during pregnancy.
They are named after John Braxton Hicks, who first described them.
These contractions start very early in pregnancy and happen naturally.
They can be felt as the uterus becoming hard and then soft again.
They are irregular, infrequent, and painless.
They do not cause opening (dilatation) of the cervix.
Most women do not notice them in early pregnancy. Near term, they become more frequent and slightly uncomfortable.
Finally, they change into true painful labour contractions.
CHANGES IN LENGTH OF THE UTERUS –
Before pregnancy the length of the uteus is 7.5cm
After pregnancy the length of the uterus increases to 35 cm
CHANGES IN BREADTH OF THE UTERUS
Breath increases from 5cm to 22.5cm
CHANGES IN THICKNESS OF UTERUS
Thickness increases from 2.5cm to 20cm
CHANGES IN ISTHMUS
Cervix and isthmus form lower uterine segment.it dilates during last trimester measures 7.5cm to 10 cm in length
CHANGES IN CERVIX
Cervical changes occur early in pregnancy due to hormones.
The tissues (stroma) of the cervix increase in number and size (hyperplasia and hypertrophy).
More fluid collects in and between these tissues, making it soft.
Blood supply (vascularity) increases, especially below the surface layer.
This causes a bluish color of the cervix.
The glands in the cervix also grow and become larger.
All these changes make the cervix very soft, called Goodell’s sign.
This softening starts as early as 6 weeks of pregnancy.
It helps in early diagnosis and makes cervical dilatation easier during labour.
Cervical secretion –
During pregnancy, the cervix produces more mucus (secretion).
This secretion becomes thick, sticky, and increased in amount.
It is called physiological leucorrhoea of pregnancy (normal discharge).
This happens mainly due to the hormone progesterone.
The mucus contains protective substances like immunoglobulins and cytokines.
It helps to protect the uterus from infection. The thick mucus forms a plug in the cervical canal (mucus plug).
This plug seals the uterus and protects the baby. Under microscope, the mucus shows changes due to progesterone effect.
The cervix does not change in length but becomes thick and soft.
In early pregnancy, the cervix is directed backward (posterior).
After the fetal head engages, it becomes aligned with the vagina.
The relation of the cervix with surrounding structures remains unchanged.
The isthmus starts unfolding from 12 weeks of pregnancy.
It helps in forming the lower uterine segment. In primigravida, cervix becomes thin (effacement) near term.
In multipara, the cervix may be slightly dilated before labor.
CHANGES I VAGINA
In early pregnancy increased blood circulation to the vagina so that the color form light pink to purple blue which is known as ‘chadwick’s sign
CHANGES IN OVARIES
The corpus luteum grows and works actively in early pregnancy.
It reaches its maximum size around 8 weeks (about 2.5 cm) and may look cystic.
Its color changes from bright to yellow, then becomes pale later.
After some time, it starts shrinking as placental hormones take over.
This happens due to decreased human chorionic gonadotropin (hCG) from the placenta. Around 12 weeks, it undergoes degeneration and may become calcified by term.
It produces estrogen and progesterone to support early pregnancy.
These hormones maintain the uterine lining (decidua) and prevent new ovulation. So, both ovarian and uterine cycles stop during pregnancy, and sometimes a luteoma (ovarian enlargement) can occur.
Decidual reaction means the ovary shows temporary changes during pregnancy. Because of high pregnancy hormones,
some cells on the surface of the ovary change into special pregnancy cells called decidual cells.
This change is called metaplasia, which means one type of cell changes into another type.
These decidual cells appear in patchy layers on the ovary.
The same hormones also affect some immature or undeveloped follicles in the ovary.
These follicles may change into structures similar to the corpus luteum, a process called luteinization.
All these changes are normal in pregnancy and help the body support the developing baby
CHANGES IN FALLOPIAN TUBE
During pregnancy, the uterus grows upward, especially the fundus (top part).
Because of this, the fallopian tube is lifted up and becomes almost vertical.
The fimbrial end is held in position by the infundibulopelvic ligament.
The tube is attached to the uterus slightly lower due to the large growth of the fundus.
Its total length increases a little during pregnancy.
The tube becomes congested (more blood flow occurs).
The muscle layer of the tube becomes thicker (hypertrophy).
The inner lining (epithelium) becomes flat. Some areas also show decidual reaction
CHANGES IN BREAST
Breast changes in pregnancy are more noticeable in primigravida (first pregnancy).
The breasts increase in size early in pregnancy. This happens due to growth of ducts and alveoli (milk-producing parts).
The connective tissue also becomes thicker (hypertrophy).
Myoepithelial cells increase, helping in milk ejection later.
Blood supply increases, so veins (called Louis veins) become visible under the skin.
The axillary tail of the breast enlarges and may become painful.
Skin stretching may cause marks or irritation (striae).
NIPPLES AND AREOLA
During pregnancy, the nipples become larger, erect, and darker (pigmented)
Small glands around the areola (5–15 in number) become enlarged.
These glands are called Montgomery’s tubercles.
They were not visible before pregnancy but now become prominent.
They are present around the nipple.
Their secretion keeps the nipple soft, moist, and healthy.
In the second trimester, another lightly pigmented outer area appears.
This is called the secondary areola.
SECRETION
Colostrum (first milk) can be squeezed from the breast from about 12 weeks of pregnancy.
At first, it is clear and sticky. By around 16 weeks, it becomes thick and yellowish.
Colostrum is the early milk produced before actual breastfeeding starts.
If a woman who has never breastfed shows breast secretion, it is a sign of pregnancy.
In later months, more colostrum can be expressed from the nipple.
This is a normal change during pregnancy. It prepares the breast for feeding the baby after birth.
WEIGHT GAIN DURING PREGNANCY
Total weight gain during pregnancy is -12 kg
REPRODUCTIVE WEIGHT GAIN
,- Fetus – 3.3 kg
2- placenta -0.6 kg ( 600 gms )
3 – Liquor -0.8 kg ( 800 gns)
4-Uterus -0.9 kg -900 gms
5- Breast – 0.4 kg (400 gms)
NET maternal weight gain
1- Increase in blood volume -1.3 kg
2-Accumulation of fat and protein- 3.5 kg
3-Increase extracellular fluid -—1.2 kg
CUTANEOUS CHANGES DURING PREGNANCY
1-Chloasma gravidarum (in pregnancy)
It is also called the “mask of pregnancy.”
It is a dark pigmentation (brown patches) on the face.
Common sites: cheeks, forehead, nose, and chin. Caused by increased hormones (estrogen & progesterone).
More common in pregnant women with sun exposure.
It is harmless (no danger to mother or baby). It may increase during pregnancy and become more visible.
Usually fades or disappears after delivery
2-LINEA NIGRA
Linea nigra
Linea nigra is a brownish-black line in the middle of the abdomen.
It extends from the chest (sternum) to the pubic area (symphysis pubis).
It occurs due to increased pigmentation during pregnancy.
Main cause is melanocyte stimulating hormone (MSH).
Estrogen and progesterone also help in this change.
Similar pigmentation can be seen in women taking oral contraceptive pills.
It is a normal change in pregnancy.
The pigmentation usually disappears after delivery
STRIAE GRAVIDARUM
Striae gravidarum
Striae gravidarum are slightly depressed (sunken) stretch marks on the skin.
They vary in length and width. Commonly seen on abdomen (below umbilicus), thighs, and breasts.
They occur due to stretching and tearing of deeper skin layer (dermis).
At first, they appear pink or reddish. After delivery, blood vessels shrink and marks become white, shiny (striae alba).
Hormones like aldosterone and skin stretching both cause them.
Controlled weight gain and oil massage (like olive oil) may help reduce them.
They can also occur in obesity, generalized edema, and Cushing syndrome.
They are normal and harmless in pregnancy.
Vascular spider (Spider angioma)
It is a small red spot with tiny blood vessels spreading out like a spider.
Found on face, neck, chest, and arms.Caused by increased estrogen hormone in pregnancy.When pressed, it may fade and then refill with blood.
It is harmless and normal in pregnancy.
Usually disappears after delivery.
Palmar erythema
Palmer erythema
It means redness of the palms (hands). Seen mainly on thumb and little finger areas.
Caused by increased blood flow and estrogen.
Palms feel warm and look red.
It is not painful and harmless.
usually goes away after delivery.
Hematological changes during pregnancy
Blood volume is markedly raised during pregnancy
The increase of blood volume starts from 6th week after that it increases rapidly.
It reaches a maximum increase of about 40–50% compared to non-pregnant level.
This maximum level is reached around 30–32 weeks of pregnancy.
After that, the blood volume remains almost the same (static) till delivery (term).
PLASMA VOLUME
Plasma volume also starts to increase by 6 weeks .
It increases gradually and reach maximum around 30 weeks of gestation.
Plasma volume increases more than RBCs Causes hemodilution Leads to physiological anemia of pregnancy
Total plasma volume increases to the extent of 1.25 litres.
The plasma volume increase is greater in multigravida.multiple pregnancy and large baby
CHANGES IN RBCs AND HAEMOGLOBIN
.RBC mass increases by about 20–30%
Total increase in RBC volume is about 350 ml
This increase is due to higher oxygen demand during pregnancy
RBC mass starts increasing from about 10 weeks
It continues to increase till term (no plateau)
Iron supplementation increases RBC mass up to 30%
Reticulocyte count increases by about 2%
Erythropoietin level increases and stimulates RBC production
Plasma increases more than RBCs during pregnancy
This causes hemodilution (dilution of blood)
Hematocrit level decreases
Total hemoglobin mass increases by 18–20% But hemoglobin concentration appears decreased At term, hemoglobin falls by about 2 g/dL
Number of RBCs decreases by 15–20% (relative fall) After delivery, excess hemoglobin is broken down Released iron is stored in the body
4 Comments to “PHYSIOLOGICAL CHANGES DURING PREGNANCY”
The entire external surface of the body cover by the skin .
The skin is composed of three layers
1- Epidermis(
2- Dermis
3- Hypodermis
The skin is first line of defense against pathogen , UV rays , chemicals, and mechanical trauma .
The skin also controles temperature (The skin regulates body temperature through sweating and heat retention and controls water loss by acting as a barrie)
skin wound happens when the top layer of the skin (epidermis) is damaged or broken.
Definition of wounds
Wound refer as damage to the integrity of biological tissue such as skin and mucous membranes
TYPES OF WOUND
1- Closed wound
Definition:
A closed wound is an injury where the skin remains intact, but there is damage to the tissue, blood vessels, or muscles under the skin.
No external bleeding is seen, but internal injury may occur.
2- Open wound
Open wounds occur when the skin splits or cracks, exposing underlying tissues to the external environment.
Wound status divided into four
Wounds are divided into 4 classes based on how clean they are and how much contamination or infection risk they have.
Class 1 injury –
Class 1 injury is a pure, uncontaminated wound with no inflammation, mainly closed, and does not penetrate alimentary, genitals, respiratory, or urinary tracts.
Class 2 injury is a clean, uncontaminated wound that enters the alimentary, genital, respiratory, or urinary tracts under controlled circumstances.
Class 3 injury is a contaminated wound caused by gastrointestinal leakage or break in sterile procedure, increasing infection risk
Class 4 injury is a dirty, infected wound from accidents or trauma that was not properly treated, often showing dead tissue.
WOUND HEALING
Wound healing is the process by which the body repairs and restores damaged skin or tissues after injury.
TYPES OF WOUND HEALING
Wound healing is classified as primary , secondary,and tertiary
PRIMARY HEALING
Primary healing is the healing of a well non_infected wound such as surgical wound
SECONDARY HEALING
Secondary healing happens when wound cannot heal normally and where primary healing fails .This occurs when the infection is present in wound .
and due to infection
due to low oxygen level (hypoxia)
due to weak immune system
wound edges not closed it is opened (dehiscence)
IN SECONDARY HEALING THE WOUND IS
Open
Large
Edges are not closed together
so the body cannot close it directly .the body forms granulation tissue because it needs to repair and rebuild the wound .
TERTIARY HEALING
In tertiary wound healing where the wound is left open for some time due to infection ,there may be dirt or contamination so the doctor first leave it open to drain pus or fluid or to reduce infection ,then wound is cleaned regularly ,infection is controlled then doctor closes this wound using sutures
Sacral promontory is the anterior projecting margin of the first sacral vertebra (S1). It forms the posterior boundary of the pelvic brim and is an important landmark used in measuring pelvic diameters, especially the conjugate diameters in obstetrics.
2-Alae or wing of the Sacrum –
The ala or wings of sacrum is located on either side of the first sacral vertebra, lateral to the sacral promontory, forming the upper lateral part of the sacrum .
3-Sacroiliac joints
Sacroiliac joint is the joint between the sacrum and ilium . There are two sacroiliac joint present in each side of the pelvis
4-Iliopectineal lines
Iliopectineal line is a ridge on the inner surface of the hip bone formed by the arcuate line of the ilium and the pectineal line of the pubis. It forms the lateral boundary of the pelvic brim .
5-Iliopectineal eminence
The iliopectineal eminence is a bony prominence at the junction of the ilium and pubis, formed by the meeting of the arcuate line and pectineal line.
6-Superior Ramus of the pubic bone
The superior ramus of the pubic bone is the upper branch of the pubis extending from the body of the pubis to the ilium. It forms part of the pelvic brim and contributes to the structure of the pelvis.
7-Upper inner border of the pubic bone .
It is a sharp ridge on the superior ramus of the pubic bone, on its inner side.
8-Upper inner border of the symphysis pubis
upper margin of the pubic symphysis on its inner (pelvic) side
1. Which of the following forms the posterior boundary of the pelvic brim?
A. Pubic symphysis
B. Iliopectineal line
C. Sacral promontory
D. Pubic tubercle
Answer: C. Sacral promontory
2. The iliopectineal line is formed by:
A. Sacrum and ilium
B. Arcuate line + pectineal line
C. Pubic crest + pubic tubercle
D. Sacral ala + ilium
Answer: B. Arcuate line + pectineal line
3. The anterior boundary of the pelvic brim is formed by:
A. Sacrum
B. Ischium
C. Upper border of symphysis pubis
D. Sacroiliac joint
Answer: C. Upper border of symphysis pubis
4. The sacroiliac joint is formed between:
A. Sacrum and ischium
B. Sacrum and ilium
C. Ilium and pubis
D. Pubis and ischium
Answer: B. Sacrum and ilium
5. Iliopectineal eminence is formed by junction of:
A. Sacrum and ilium
B. Ilium and ischium
C. Arcuate line andh pectineal line
D. Pubis and ischium
Answer: C. Arcuate line and pectineal line
6. Ala of sacrum is formed from:
A. Body of sacrum
B. Spinous process
C. Transverse process of S1
D. Coccyx
Answer: C. Transverse process of s1
7. Which structure divides false pelvis and true pelvis?
A. Pubic crest
B. Pelvic brim
C. Sacroiliac joint
D. Pubic tubercle
Answer: B. Pelvic brim
8. Which structure is used to measure pelvic diameters?
A. Pubic crest
B. Sacral promontory
C. Ischial spine
D. Pubic tubercle Answer: B. Sacral promontory 9- Iliopectineal line is part of:
A. Pelvic outlet
B. Pelvic cavity
C. Pelvic brim
D. Sacrum only Answer: C. Pelvic brim
Wound healing is the natural process by which the body repairs damaged tissue after an injury (such as a cut, burn, or surgical wound). It restores the skin or tissue to its normal structure and function.
DEFINITION OF WOUND HEALING
Wound healing is the physiological process by which the body repairs and restores damaged tissue after an injury by regeneration of cells and formation of new tissue.
TYPES OF WOUND
1. Closed Wound A closed wound is a type of injury in which the skin remains intact but the underlying tissues are damaged. There is no break in the skin surface, but bleeding may occur internally. Examples Contusion (bruise) – caused by blunt force trauma leading to bleeding under the skin. Hematoma – collection of blood under the skin or tissue. Crush injury – caused when body tissue is compressed between two hard surfaces. Characteristics Skin is not broken. Internal bleeding may occur. Swelling, pain, and discoloration may be present. 2. Open Wound An open wound is a type of injury in which the skin or mucous membrane is broken, exposing the underlying tissue. Examples Incision – clean cut caused by a sharp object such as a knife or surgical blade. Laceration – irregular tear of tissue. Abrasion – superficial injury caused by friction (scraping of skin). Puncture wound – caused by sharp pointed objects like nails or needles. Characteristics Break in the skin surface. Bleeding occurs externally. Higher risk of infection.
FOUR CATEGORIES OF WOUND STATUS
1. Class I Injury (Clean Wound) A Class I wound is a clean wound with no infection or inflammation. The wound is usually made under sterile conditions, and the respiratory, gastrointestinal, genital, or urinary tract is not entered. Examples Surgical incision during a sterile operation Hernia repair surgery Characteristics No contamination No infection present Low risk of infection 2. Class II Injury (Clean-Contaminated Wound) A Class II wound occurs when the respiratory, gastrointestinal, genital, or urinary tract is entered under controlled conditions without unusual contamination. Examples Surgery involving stomach or intestine Gall bladder surgery Characteristics Mild contamination Controlled surgical procedure Slight risk of infection 3. Class III Injury (Contaminated Wound) A Class III wound is a fresh traumatic wound with significant contamination or a major break in sterile technique during surgery. Examples Open traumatic wounds Wounds with spillage from the gastrointestinal tract Characteristics Moderate contamination Increased risk of infection 4. Class IV Injury (Dirty or Infected Wound) A Class IV wound is a wound that already has infection or dead tissue present before treatment. Examples Old traumatic wounds with dead tissue Wounds with pus or severe infection Characteristics Heavy contamination Infection already present Very high risk of complications
Definition of Wound Healing Wound healing is the natural physiological process by which the body repairs and restores damaged tissue after an injury.
TYPES OF WOUND HEALING
1. Primary Wound Healing (Healing by Primary Intention) Definition: Primary wound healing occurs when the edges of the wound are clean, close together, and are closed immediately by sutures, staples, or adhesive. Explanation: In this type, the tissue loss is minimal and the wound edges are directly approximated (joined together). Healing occurs quickly with less scar formation. Examples Surgical incision Clean cut by a sharp object Characteristics Clean wound Minimal tissue damage Edges are closed with sutures or staples Rapid healing Small scar formation Low risk of infection 2. Secondary Wound Healing (Healing by Secondary Intention) Definition: Secondary wound healing occurs when the wound edges cannot be brought together, so the wound heals naturally by formation of granulation tissue. Explanation: In this type, there is more tissue loss and the wound is usually left open. The wound heals slowly through granulation, contraction, and epithelialization. Examples Pressure ulcers (bed sores) Large traumatic wounds Burns Characteristics Large wound with tissue loss Wound left open Formation of granulation tissue Slower healing process Larger scar formation Higher risk of infection 3. Tertiary Wound Healing (Delayed Primary Closure) Definition: Tertiary wound healing occurs when the wound is initially left open duePro to contamination or infection and closed later after cleaning and treatment. Explanation: This method allows time to reduce infection and remove dead tissue before closing the wound surgically. Examples Contaminated traumatic wounds Wounds with infection that are closed later Characteristics Wound initially left open Later closed with sutures after treatment Moderate healing time Reduces risk of infection
Wound healing process or phases
Phases of Wound Healing Wound healing occurs in four phases. These phases occur in an organized sequence to stop bleeding, prevent infection, repair damaged tissue, and strengthen the wound. 1. Haemostasis Phase Haemostasis is the first phase of wound healing and begins immediately after injury. Process When a wound occurs, blood vessels constrict (vasoconstriction) to reduce blood loss. Platelets accumulate at the wound site. Platelets release chemicals that help in blood clot formation. A fibrin clot forms and acts like a temporary plug to stop bleeding. Functions Stops bleeding. Forms a protective clot over the wound. Provides a base for the next stage of healing. Duration Occurs immediately and lasts for a few minutes to hours after injury. 2. Inflammation Phase The inflammatory phase begins soon after haemostasis and usually lasts 1–4 days. Process Blood vessels dilate (vasodilation) to increase blood flow to the injured area. White blood cells such as neutrophils and macrophages migrate to the wound. These cells destroy bacteria and remove dead tissue and debris. Signs of Inflammation Redness Swelling Heat Pain Functions Prevents infection. Cleans the wound area. Prepares the wound for new tissue formation. 3. Proliferation Phase This phase usually occurs from about the 4th day to 3 weeks after injury. Process Fibroblast cells produce collagen, which helps rebuild tissue. Granulation tissue forms, filling the wound space. New blood vessels develop (angiogenesis). Epithelial cells grow over the wound surface to cover it. The wound gradually contracts and becomes smaller. Functions Formation of new tissue. Repair of damaged blood vessels and skin. Closure of the wound. 4. Remodeling (Maturation) Phase This is the final phase of wound healing and may last several weeks to months or even years. Process Collagen fibers rearrange and become stronger. The newly formed tissue gains strength and flexibility. Scar tissue forms and gradually becomes lighter in color. Functions Strengthens the healed tissue. Improves the structure of the repaired area. Completes the healing process.
Factors Affecting Wound Healing Wound healing can be influenced by several factors. These factors may slow down or delay the healing process. Proper management of these factors helps the wound heal faster and prevents complications. Extrinsic Factors Affecting Wound Healing Extrinsic factors are external factors that influence the healing of a wound. 1. Infection Control Infection is one of the most important factors that delay wound healing. Explanation Bacteria entering the wound can damage tissue and cause inflammation. Infection increases pain, swelling, and pus formation. It slows the formation of new tissue. Prevention Proper wound cleaning Sterile dressing Use of antibiotics when necessary 2. Wound Environment A clean and moist wound environment promotes faster healing. Explanation A moist environment helps new cells grow easily. A dry wound may cause tissue damage and slow healing. Proper dressing helps maintain the correct environment. 3. Nutrition Good nutrition is essential for tissue repair and cell growth. Important nutrients Protein – helps repair tissues. Vitamin C – important for collagen formation. Zinc – supports immune function and tissue repair. Iron – helps transport oxygen to tissues. Poor nutrition can delay wound healing. 4. Smoking and Alcohol Consumption Smoking and alcohol can slow the healing process. Smoking Reduces oxygen supply to tissues. Decreases blood circulation. Alcohol Weakens the immune system. Interferes with nutrient absorption. Both can increase the risk of infection and delay healing. 5. Medication Some medications can interfere with wound healing. Examples: Steroids – reduce inflammation but slow tissue repair. Chemotherapy drugs – affect cell growth. Certain anti-inflammatory drugs. These medications may delay collagen formation and tissue repair. 6. Mechanical Stress Mechanical stress means pressure, friction, or repeated movement on the wound area. Explanation Excessive pressure can damage new tissue. Movement can reopen the wound. This is common in pressure ulcers. Proper positioning and rest help reduce stress on the wound. 7. Wound Management Proper wound care is very important for healing. Good wound management includes: Cleaning the wound Removing dead tissue (debridement) Proper dressing Maintaining hygiene Poor wound care can lead to infection and delayed healing. Intrinsic Factors Affecting Wound Healing Intrinsic factors are internal conditions of the body that influence healing. 8. Chronic Diseases Certain diseases can slow down wound healing. Example: Diabetes Mellitus Explanation High blood sugar damages blood vessels. Reduces blood flow and oxygen supply to tissues. Increases the risk of infection. 9. Age Age affects the speed of wound healing. Young people heal faster because cell growth is active. Older adults heal more slowly due to reduced tissue regeneration. 10. Obesity Obesity can delay wound healing. Explanation Poor blood circulation in fatty tissues. Increased risk of infection. Higher tension on wound edges. 11. Psychological Factors Mental health also affects healing. Explanation Stress and anxiety can reduce immune function. Poor sleep and depression may slow the healing process. A positive psychological state helps improve
Intrinsic Factors Affecting Wound Healing Intrinsic factors are internal conditions of the body that influence the process of wound healing. These factors depend on the patient’s physical condition, body functions, and genetic makeup. 1. Age Age plays an important role in wound healing. Explanation Young individuals usually heal faster because their cells regenerate quickly. Older adults heal more slowly due to reduced cell division, decreased collagen production, and reduced blood circulation. Effect Delayed tissue repair Slow formation of new cells 2. Health Status The overall health condition of a person affects wound healing. Explanation A healthy person heals faster because body systems function properly. People with chronic illnesses such as Diabetes Mellitus, anemia, or heart disease may experience delayed healing. Effect Reduced tissue repair Increased risk of infection 3. Immune Response The immune system protects the body from infection. Explanation A strong immune system helps destroy bacteria and clean the wound. A weak immune response may allow infection to develop. Effect Delayed healing Increased risk of wound infection 4. Nutritional Status Adequate nutrition is essential for tissue repair and regeneration. Important nutrients Protein – necessary for cell growth and tissue repair Vitamin C – helps in collagen formation Zinc – supports immune function Iron – helps supply oxygen to tissues Effect Poor nutrition slows wound healing. 5. Blood Supply Adequate blood supply is necessary for proper healing. Explanation Blood delivers oxygen, nutrients, and immune cells to the wound site. Poor blood circulation reduces oxygen and nutrient delivery. Effect Delayed tissue repair Slow formation of new blood vessels 6. Tissue Perfusion Tissue perfusion refers to the flow of oxygenated blood to body tissues. Explanation Good tissue perfusion ensures that tissues receive enough oxygen and nutrients. Poor perfusion leads to tissue damage and slow healing. Effect Delayed wound healing Increased risk of tissue death (necrosis) 7. Humoral Factors Humoral factors are chemical substances in body fluids that regulate healing. Explanation These include hormones, growth factors, and enzymes. They help control cell growth, inflammation, and tissue repair. Effect Imbalance in these factors can delay healing. 8. Genetics Genetic factors influence how the body responds to injury. Explanation Some individuals may naturally heal faster due to genetic traits. Genetic conditions can affect collagen production and immune response. Effect Variation in healing speed among individuals 9. Wound Characteristics The nature and condition of the wound also influence healing. Examples Size of the wound Depth of the wound Presence of infection or dead tissue Effect Larger or deeper wounds usually take longer to heal. 10. Cellular Activity Cellular activity refers to the function of cells involved in healing, such as fibroblasts and epithelial cells. Explanation These cells help produce collagen and new tissue. Proper cellular function is necessary for tissue regeneration. Effect Reduced cellular activity slows the healing process.
Complications of Wound Healing 1. Infection Infection occurs when microorganisms (bacteria) enter the wound and multiply. Explanation It causes redness, swelling, pain, and pus formation. Infection damages new tissue and delays the healing process. Result Slow healing Increased risk of further complications 2. Inflammation Cyst An inflammatory cyst is a fluid-filled swelling that develops due to inflammation in the wound area. Explanation It may occur when tissue irritation or infection causes fluid accumulation. The cyst may appear as a small lump under the skin. Result Discomfort Delay in proper healing 3. Keloid Formation Keloid is the excessive growth of scar tissue at the site of a healed wound. Explanation Collagen production becomes too much during healing. The scar becomes large, raised, and spreads beyond the original wound area. Result Thick raised scar Cosmetic problem 4. Incisional Hernia An incisional hernia occurs when abdominal tissue or intestine protrudes through a weak surgical wound in the abdominal wall. Explanation It usually develops after abdominal surgery when the wound does not heal properly. Weak muscles allow internal organs to push outward. Result Swelling or bulge near the surgical scar May require surgery 5. Scar Formation A scar is the fibrous tissue that replaces normal skin after a wound heals. Explanation It occurs because the body repairs the wound with collagen fibers instead of normal skin. Some scars may become thick or visible. Result Permanent mark on the skin 6. Pigmentation Pigmentation refers to change in the color of the skin at the healed wound site. Explanation The skin may become darker or lighter than the surrounding skin. It occurs due to changes in melanin production during healing.
Result Cosmetic change in skin color
Diameter of the pelvis brim ,cavity and outlet is very important to find out any abnormality.
The brim of the pelvis is the bony rim (edge) that forms the boundary of the pelvic inlet .
Brim of the pelvis formed by these landmarks ‘
THE PELVIS INLET ALSO CALLED BRIM
The pelvic brim is formed by these landmarks from back to front .
1-Sacral promontory
2-Alae of the sacrum
3-Sacroiliac joints
4-Iliopectineal lines
5-Iliopectineal eminencies
6-Upper border of the superior pubic rami
7- Pubic tubercles
8-Pubic crest
9-Upper border of the symphysis pubis
What is brim
the pelvic brim is the bony ring that separates the false pelvis from the true pelvis.
Diameters of pelvic brim – 3 types
1- Antero-Posterior diameter
3 types of diameter present in Anterior posterior diameter of the pelvis brim .
1- True conjugate.– Measured from sacral promontary to upper border of the symphysis pubis – 11 cm
2- Obstetric conjugate – Measured from sacral promontary to middle of the symphysis pubis -10 cm
3- Diagonal conjugate – Measure from the sacral promontary to lower border of symphysis pubis -12 cm ( Largest)
2- Transeverse diameter
Transverse diameter of pelvic brim = 13 cm (approximately) It is the widest diameter of the pelvic inlet (brim). Measured between the farthest points of the iliopectineal lines It is the largest diameter of the pelvic brim Average length: ≈ 13 cm
3-Oblique diameter – Measure from the sacroiliac joint to iliopubic eminence
Oblique diameter of pelvic brim means the distance from one sacroiliac joint to the opposite iliopubic eminence. Two oblique diameters: right and left Measured from: Right sacroiliac joint to→ Left iliopubic (iliopectineal) eminence Left sacroiliac joint to → Right iliopubic eminence Average length: ≈ 12 cm
Sacro- cotyloid diameter -it is the distance from the middle point of sacral promontory to iliopubic eminence which is 9.5 cm (there are two sacrocotyloid diameter)
Diameter of Pelvic cavity
WHAT IS PELVIC CAVITY
Pelvic cavity is is the space within the true pelvis between the pelvic inlet and pelvic outlet that contains pelvic organs .
in the pelvic cavity ,the shape is almost round so anteroposterior ,transverse ,and oblique diameters are nearly equal .12 cm
There are 3 types of pelvic cavity diameters
1-Anteroposterior diameter – It is extends from the centre of the posterior surface of the pubic symphysis which is present anteriorly to the to the junction of the second and third sacral vertebrae .the diameter is 12 cm .
2-Transverse diameter – the transverse diameter of pelvic cavity is the widest side to side distance of the pelvis but we can not measure it exactly because the point we need measure are not on hard bones but on soft tissues that cover the sacrosciatic notches and obturator foramina.
What is Pelvic outlet ?
Pelvic outlet is the inferior opening of the true pelvis through which the fetus passes during delivery.
it appears diamond shaped because of its boundaries: Anterior: Lower border of symphysis pubis Lateral: Right & left ischial tuberosities Posterior: Tip of coccyx
. 1 -Anteroposterior diameter (AP diameter)
It is from the lower border of the symphysis pubis to .
Anatomical – Tip of the coccyx( used for anatomy study)
Obstetrics – Tip of the sacrum(to assess during child birth ) the diameter is 13 cm .
2. Transverse diameter
Transverse diameter of pelvic outlet is the distance between the two ischial tuberosities (about 11 cm).
a- Bituberous diameter
Bituberous diameter is the distance between the two ischial tuberosities at the pelvic outlet (about 11 cm).
The transverse diameter of the pelvic outlet is also called the bituberous (intertuberous) diameter.
b- Bispinous / Interspinous diameter.
It is the narrowest transverse diameter of the pelvis (important in labor). Key points Measured between right and left ischial spines Also called interspinous diameter Average measurement: ≈ 10.5 cm Assessed clinically during vaginal examination
A midwife is a trained heath professional who specializes in providing care ,support and guidance to women during pregnancy ,labor ,birth ,and the postpartum period as well as offering assistance with newborn care .midwives focus on promoting normal child birth ,preventing complication and ensuring the health and well being of both mother and baby
SCOPE OF MIDWIFERY
Scope of midwifery means the range of activities ,responsibilities and areas of care in which a midwife is trained and authorized to work .
Nice explanation
Excellent about physiological changes during pregnancy
Thank you
Thank you