Operational Medicine Medical Education and Training

Obstetrics/Pediatrics

CORRESPONDENCE COURSE

U.S. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

SUBCOURSE MD0584 EDITION 200

OBSTETRICS/PEDIATRICS

The birth of a child is usually a wonderful and exciting event. Despite the occasional magazine or newspaper article extolling the virtues of having a child at home with an experienced midwife in attendance, we are still generally conditioned to having the baby in a hospital complete with attending physician.

Sometimes, however, the baby decides to be born before the mother can get to the hospital. In such a case, you may be called upon to assist in the birth. Birth is a natural process with the mother doing the delivering and someone else, perhaps you, assisting in the delivery.

Also, as much as children are wanted, there are times when some adults lose control and abuse a child. You need to know something about child abuse in case you find yourself examining a child you suspect has been abused.

This subcourse deals with childbirth outside a medical treatment facility, pediatric emergencies, and child abuse. A lesson on the female and male reproductive systems is included to allow you to review these systems. Your attention to learning the material given in this subcourse will prepare you to deal with situations involving childbirth and children.

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Length: 114 Pages

Estimated Hours to Complete: 5

Format: PDF file

Size: 0.4 MB

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Anyone may take this course. However, to receive credit hours, you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston, Texas. Enrollment is normally limited to Department of Defense personnel. Others may apply for enrollment, but acceptance is not guaranteed.

Internal Female Organs

Obstetrics/Pediatrics

Distance Learning Course
114 Pages
Est. 5 Hours
0.4 MB pdf file

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Anatomy of Labor

TABLE OF CONTENTS

 

INTRODUCTION

1 THE REPRODUCTIVE SYSTEMS

Section I. The Female Reproductive System

Section II. The Male Reproductive System

Section III. Events of Pregnancy

Exercises

2 NORMAL AND EMERGENCY CHILDBIRTH

Section I. General Information

Section II. Complications of Pregnancy

Section III. Management of Mother and Newborn During

Normal Delivery in an Emergency Setting

Section IV. Abnormal Deliveries

Section V. Complications of Labor and Delivery

Exercises

3 PEDIATRIC EMERGENCIES

Section I. Differences Between a Child's Body and an Adult's Body

Section II. Patient Assessment

Section III. Special Considerations of the Ill or Injured Child

Section IV. Pediatric Emergencies

Section V. Trauma in Children

Exercises

4 CHILD ABUSE

Exercises

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LESSON 1

THE REPRODUCTIVE SYSTEMS

Section I. THE FEMALE REPRODUCTIVE SYSTEM

1-1. INTRODUCTION

a. Reproduction Defined. The mechanism by which life is maintained is reproduction. Reproduction can be defined as the process by which a single cell duplicates its genetic material, thus allowing an organism to grow and repair itself.

Reproduction, therefore, maintains the life of a member of a species. Additionally, reproduction is the process by which genetic material is passed from generation to generation.

b. Major Types of Reproduction. There are two major types of reproduction: asexual and sexual. Only one parent is involved in asexual reproduction. The parent cell may divide and become two new cells, or the new organism may arise from a part of the parent cell. In the case of humans, sexual reproduction takes place. This requires the participation of two parents. Each parent produces special reproductive cells called sex cells or gametes. In this sense, reproduction maintains the continuation of the species. If a species loses its reproductive capability, the species no longer survives. It becomes extinct.

c. Female Reproductive System Functions. The female reproductive system has specialized organs to carry out its three important functions. These functions are the production of egg cells, the disintegration of nonfertilized egg cells, and the protection of the developing embryo.

1-2. EXTERNAL GENITALIA

The vulva and its parts make up the external genitalia. The word vulva is a term that has been designated to stand for the external genitalia of the female.

a. Mons Pubis. The elevated, fatty tissue covered with coarse pubic hair which lies over the symphysis pubis is the mons pubis. Pubic hair appears at puberty. The function of the mons pubis is to protect the pelvic bone.

b. Labia Majora. The labia majora are large, longitudinal folds of skin and fatty tissue which extend back from the mons pubis to the anus. The outer surfaces are covered with hair. The inner surfaces are smooth and moist. The corresponding structure in the male is the scrotum. The function of these folds is to protect the entrance to the vagina.

c. Labia Minora. The labia minora are two folds of skin lying within the labia majora and also enclosing the vestibule. In front, each labium minus (minus = singular of minora) divides into two folds. The fold above the clitoris is called the prepuce of the clitoris. The fold below is the frenulum. No pubic hair is on these structures.

d. Clitoris. The clitoris is a small projection of sensitive, erectile tissue which corresponds to the male penis. The female urethra, however, does not pass through the clitoris. As in the male penis, the clitoris is covered by prepuce.

e. Urinary Meatus. The urinary meatus is the small opening of the urethra which is located between the clitoris and the vagina.

f. Vaginal Orifice. This is the opening to the vagina from the outside.

g. Bartholin's Glands. These are bean-shaped glands located on each side of the vaginal orifice. They provide lubrication of the vagina.

h. Perineum. The perineum is the area between the vaginal orifice (opening) and the anus.

1-3. INTERNAL GENITALIA

a. Uterus or Womb.

(1) Description/information. The uterus is a hollow, muscular, pear-shaped organ. It is located in the pelvic cavity between the urinary bladder and the rectum. During a woman's child-bearing years, the uterus is about 7.5 centimeters long, 5 centimeters wide, and 2.5 centimeters thick. The uterus has three anatomical divisions: the fundus, the body, and the cervix. The fundus is the upper, convex part of the uterus. This part is just above the entrance to the uterine tubes. The body is the central portion of the uterus, and the cervix is the lower, neck-like part of the uterus.

(2) Walls. The walls of the uterus are made up of three layers: the endometrium, the myometrium, and the parietal peritoneum. The endometrium, the inner layer, attaches itself to the myometrium layer and lines the uterus. This layer is sloughed off during menstruation or post- delivery. The middle layer, which is composed of smooth muscle, is the myometrium. This layer is made up of longitudinal, circular, and spiral muscular fiber which interlaces. The myometrium is thickest in the fundus and thinnest in the cervix. During childbirth, this muscle layer is capable of the very powerful contractions necessary for a normal birth. The third layer, the parietal peritoneum, is the outer layer which is a serous membrane. This outer layer of uterine wall is incomplete, covering only part of the uterine body and none of the uterine cervix.

(3) Functions. The uterus has three major functions which occur during these events: pregnancy, labor, and menstruation. During pregnancy, the uterus holds the fertilized ovum. The ovum is deposited in the uterus where it grows and develops through the embryo and fetal stages. During the birth process, the uterus produces powerful contractions to expel the mature infant. And, finally, during a female's menstrual phase, the inside lining of the uterus detaches and sloughs off, the uterus expelling its fluid contents.

b. Uterine Tubes, Fallopian Tubes, or Oviducts.

(1) Description/information. These tubes are known by all three names listed above. The name commonly used is fallopian tubes. These two tubes extend from the ovaries to the uterus. An ovum discharged from an ovary passes through one of these tubes to the uterus. Each tube is about 10 centimeters long (4 inches). The tube is located between the folds of the broad ligaments of the uterus. The tubes are attached to the uterus at one end but not attached to the ovaries at the other end. At the ovary end, the tubes are open, funnel-shaped, and close to the ovary. The funnelshaped ends of the tubes are called the infundibulum, and the fringe or finger-like processes at the tube ends are called fimbriae.

(2) Functions. The uterine tubes are ducts for the ovaries although the tubes are not attached to the ovaries. Additionally, the tubes are the site of fertilization. Fertilization normally takes place in the outer one-third of the tube.

c. Ovaries.

(1) Description/information. The ovaries are two almond-shaped glands. They are located on either side of the uterus, below and behind the uterine tubes. The ovaries are detached from the uterine tubes and held in position by a series of ligaments. During the second phase (preovulatory phase) of the menstrual cycle, one of the 20 to 25 primary follicles developed during the menstrual phase matures into a Graafian follicle, a follicle ready for ovulation. During the maturation process, this follicle increases its estrogen production. The rupture of the Graafian follicle with the release of the ovum is the beginning of ovulation.

(2) Functions. One function of the ovaries is to produce ova (female reproductive cells capable of developing, after fertilization, into new individuals). Also, the ovaries discharge ova (ovulation) and secrete the female sex hormones progesterone, estrogen, and relaxin. The ovaries in the female correspond to the testes in the male reproductive system.

d. Vagina.

(1) Description/information. The vagina is a muscular, tubular organ lined with mucous membrane. This organ is about 10 centimeters (4 inches) long and extends from the hymen to the cervix. The vagina extends upward and backward between the rectum and the bladder and is attached to the uterus.

(2) Structure. The lining of the vagina is made up of smooth muscle which is longitudinally and circularly arranged in many folds called rugae. The folds of the lining permit the organ to expand when necessary. The hymen is the fold of mucous membrane at the orifice (opening) of the vagina.

(3) Functions. The vagina serves as a passageway for menstrual flow, receives seminal fluid from the male, and serves as the lower part of the birth canal.

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