Methodological Instructions to Lesson 1 for Students Theme: Organization of Obstetric and Gynecological center. Aim icon

Methodological Instructions to Lesson 1 for Students Theme: Organization of Obstetric and Gynecological center. Aim




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Methodological Instructions to Lesson 1 for Students

Theme: Organization of Obstetric and Gynecological center.

Aim: to acquainted with the structural units of Maternity Home, to learn the main principles of working and tasks of Admitting Office, First and Second obstetric departments, Obstetric Suite, Pathologic pregnancy department and Infants department.

Professional Motivation: appropriate organization of obstetric care, keeping sanitary rules gives a possibility to decrease postpartum infective diseases, prevent intrahospital infection, and decrease perinatal and maternity mortality. It has medical and social importance.

Basic Level:

  1. Structure and tasks of Admitting Office.

  2. Taking of general and epidemiological history.

  3. The main infecting agents of intrahospital infection.

  4. Revealing of intrahospital infection and ways of their spreading.

  5. Order of sanitary disinfection of the patients.

  6. Order of disinfection of wards and their cyclic regimen.

  7. Order of instruments disinfection.

  8. Order of writing of patients history and labor.
^

Students’ Independent Study Program


I. Objectives for Students’ Independent Studies

You should prepare for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:

1. The main units of Obstetric and Gynecological center: female dispensary, obstetric hospital, gynecological departments.

2. Structure and principles female dispensary of working .

3. Medical documents of female dispensary.

4. Examination of pregnants in the female dispensary.

5. Structure of the Obstetric hospital.

6. Principles of Sanitary inspection room working, its main rules.

7. Pregnants which undergo hospitalization to the Second obstetric department.

8. Sanitary-hygienic regimen of Maternity Home working.

9. Structure of the Obstetric suite.

10. Sanitary-hygienic regimen of Obstetric suite working.

11. Principles of postnatal wards working.

12. Peculiarities of the Second obstetric department working.

13. Peculiarities of sanitary-hygienic rules in Infants department.

14. Sanitary-hygienic demands to the medical stuff of the obstetric hospital.

15. Mother’s and infant’s staying together: indications, predominance, rules of

the working of medical stuff in these wards.

16. Working of Pathologic pregnancy department.

17. Prevention of intrahospital infection.

18. The main forms of medical documents of Maternity Home.

Key words and phrases: Obstetric Hospital structure, Maternity Home, Sanitary-hygienic regimen, Obstetric suite.

Summary

Structure of the Obstetric Hospital:

  1. Admitting office.

  2. First obstetric department.

  3. Second obstetric department.

  4. Infants department.

  5. Pathologic pregnancy department.

The Admitting office composes of Filter and Sanitary Inspection Room.

In the Filter medical nurse perform:

  • Woman’s interrogation;

  • General inspection of the patient;

  • Taking woman’s temperature;

  • Taking epidemiological history.

From Sanitary Inspection Room a woman goes into Room for seeing patients (clipping hair and nails, wiping nails with disinfecting solution are performed in it), than in Toilet room, after – in Shower room.

First obstetric department consists of Obstetric Suite (1-2 prenatal wards, 2 delivery rooms, room for seeing a woman, small operative room, large operative room, a ward for a woman in labor with eclampsia), postnatal wards.

Second obstetric department has the same structure as the first obstetric department. Besides it has isolators for hospitalization women with tuberculosis, viral hepatitis, syphilis.

The main indications to hospitalization in the second obstetric department:

  • Increased temperature up to 37.6 C without clinical manifestation of infection;

  • After amniotic fluid gush more than 12 hours;

  • Thrombophlebitis of any location in the acute stage;

  • Inflammatory diseases of kidneys and urinary system in the acute stage;

  • Inflammatory diseases of birth canal;

  • Dead fetus;

  • Tuberculosis;

  • Acute respiratory diseases;

  • Skin diseases.

Women in labor with increased temperature in labor, with increased temperature of unknown etiology during 24 hours, and puerperants with postpartum infection should be transferred into the second obstetric department.

Predominance’s of Mother’s and infant’s staying together:

  • Better production of milk in postpartum period due to stimulation of Prolactin reflex;

  • Decreasing of maternal postpartum inflammatory diseases due to Oxytocin reflex;

  • Decreasing of infant’s postpartum inflammatory diseases by means of early contamination of infant’s skin by maternal microflora;

  • Psychoemotional support.

Women with complicated pregnancy, fetoplacental insufficiency, danger of pregnancy interrupting, extragenital pathology, for prenatal care should be hospitalized in the Pathologic pregnancy department

^ II. Tests and Assignments for Self – assessment.

Multiple Choice.

Choose the correct answer / statement:

1. What are the main indications to hospitalization in the second obstetric department?

A – Pregnancy induced hypertension;

B – Anemia;

C – Acute pyelonephritis;

D – Dead fetus;

E – Syphilis.

2. How many days is working each delivery room?

A – One;

B – Two;

C – Three;

D – Four;

E – Five.

3. A delivery room should be disinfected by means of disinfecting solution:

A – Once a day;

B – Twice a day;

C – Three times a day;

D – Once in two days;

E – Once a week.

Real - life situations to be solved:

4. A 25-year-old woman in labor with symptoms of respiratory diseases was admitted to the sanitary inspection room. In which department she should be hospitalized?

5. The puerpera of the first obstetric department on the third day after labor complains of increased temperature, lower abdominal pain, purulent lochia. After pelvic examination endometritis is diagnosed. What is the most appropriate management of this patient?

6. A 23-year-old woman in labor was admitted to the Maternity Home. She had viral hepatitis 8 years later, pediatric diseases. Three months later she had acute respiratory disease. In which department she should be hospitalized?


III. Answers to the Self- Assessment.

1. C, D, E. 2. C. 3. C.4. In the second obstetric department. 5. A puepera is transferred into the second obstetric department and treatment of endometritis is prescribed. 6. In the first obstetric department.

Visual Aids and Material Tools:

Charts

Equipment:

Students must know:

  1. The structure of the Obstetric Hospital.

  2. The main tasks and principles of working of the Obstetric Department.

  3. Indications to woman in labor admission to the first and second obstetric departments.

  4. Demands for the keeping of sanitary rules in the Obstetric department.

Students should be able:

  1. To perform disinfection of pregnant woman during admission in the Obstetric Home.

  2. To make general investigation of the pregnant woman.

  3. To evaluate of the data of history and medical documents for solving of the question about hospitalization of the woman in the second obstetric department.

References:

1. Хміль С.В. Акушерство. – Тернопіль: Укрмедкнига. – 1998. – С. 12-33.

2. Obstetrics and gynaecology. Williams & Wilkins Waverly Company. – Third Edition.- 1998. – P. 2-24.

Approved on Session of Department of Obstetrics and Gynecology with course of Infant and Adolescent Gynecology _______________ protocol No ___________


The Head of Department: ____________________ S.P. Polyova


Methodological Instructions to Lesson N 2 for Students


Theme: Clinical anatomy and physiology of female reproductive tract.

^ Aim: to apply the knowledge of anatomy and physiology of female reproductive tract in practical obstetrics.

Professional motivation: deep knowledge of anatomy and physiology of female reproductive tract is necessary to diagnose the abnormalities of structure of external and internal organs and reveal pathological process.

Basic level:

1.Structure of external and internal female reproductive organs.

2. The suspensive, fixative and supportive apparatus of reproductive organs.

3. Blood supply and nerve supply of female reproductive tract.

4. Lymphatic drainage of female reproductive tract.

Students’ Independent Study Program

^ I. Objectives for Students’ Independent Studies

You should prepare for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:

        1. The structure of external female reproductive organs

        2. What is vaginal vestibule?

        3. Where does the urethral meatus open?

        4. Where do the meatuses of the Bartholin’s glands open?

        5. Structure of vagina, peculiarities of vaginal epithelium.

        6. Self-cleaning of vagina.

        7. Structure of uterus and its parts.

        8. Structure of uterine cervix, shape of its vaginal part.

        9. What is isthmus of uterus?

        10. Definition of lower segment of uterus.

        11. What is contractile ring?

        12. Pelvic peritoneum.

        13. Pelvic cellular spaces.

        14. Suspensive apparatus of the uterus.

        15. Fixative apparatus of the uterus.

        16. Supportive apparatus of the uterus.

        17. Structure and function of ovaries.

        18. Structure and function of fallopian tubes.

        19. Blood supply of female generative organs.

        20. Nerve supply of female generative organs.

Key words and phrases: external and internal female reproductive organs, perineum, low segment of the uterus, blood supply of female reproductive organs

Summary

The external genitalia are referred to collectively as the vulva. The vulva includes the mons pubis, labia majora, labia minora, clitoris, vulvavaginal (Bartholin’s) glands, fourchette, and perineum. The most prominent features of the vulva, the labia majora, are large folds of skin that contain sebaceos glands and lie medially and contain no hair but have a rich supply of venous sinuses, sebaceus glands, and nerves. The labia minora may vary from scarcely noticeable structures to leaf-like flaps measuring up to 3 cm in length.

As the labia are spread, the vaginal introitus, guarded by the hymenal ring, is seen. Usually, the hymen is represented only by a circle of carunculae myrtiformes around the vaginal introitus. The hymen may take many forms, however, such as a cribriform plate with many small openings or a completely inperforate diaphragm. The fourchette represents the posterior portion of the vestibule just above the perineal body. Most of the vulva is innervated by the branches of the pudendal nerve. Anterior to the urethra, the vulva is innervated by the ilioinguinal and genitofemoral nerves. This area is not anesthetized by a pudendal block and repair of paraurethral tears must be supplemented by additional subcutaneous anesthesia.

The perineum represents the inferior boundary of the pelvis. The superficial and deep transverse perineal muscles cross the the pelvic outlet between the two ischial tuberosities and come together at the perineal body. They divide the space into the urogenital triangle anteriorly and the anal triangle posteriorly. The urogenital diaphragm is a fibromuscular sheet that stretches across the pubic arch. It is pierced by the vagina, the urethra, the artery of the bulb, the internal pudendal vessels, and the dorsal nerve of the clitoris.

^ Bartholin’s glands are situated just posterior to the vestibular bulbs, and their ducts emty into the introitus just below the labia minora. They are often the site of gonococcal infections and painful abscesses.

The vagina is a flattened tube extending postersuperioly from the hymenal ring at the introitus up to the fornices that surround the cervix. Its epithelium, which is stratified squamous in type, is normally devoid of mucous glands and hair follicles and is nonkeratinized. Deep to the vaginal epitheliun are the muscular coats of the vagina, which consist of an inner circular and anouter longitudinal smooth muscle layer. An important anatomic feature is the immediate proximity of the posterior fornix of the vagina to the pouch of Douglas, which allows easy access to the peritoneal cavity from the vagina, by either culdocentesis or colpotomy.

The uterus consists of the cervix and the uterine corpus, which are joined by the isthmus. The uterine isthmus represents a transitional area wherein the endocervical epithelium gradually changes into the endometrial lining. In late pregnancy, this area elongates and is referred to as the lower uterine segment.

The cervix is generally 2 to 3 cm in length. The portion that protrudes into the vagina and is surrounded by the fornice is covered with a nonkeratinizing squamous epithelium. At about the external cervical os, the squamous epithelium covering the exocervix changes to simple columnar epithelium, the site of transition being referred to as squamocolumnar junction. The cervical canal is lined by irregular, arborized, simple columnar epithelium, which extends into the stroma as cervical “glands” or crypts.

The uterine corpus is a thick, pear-shaped organ, somewhat flattened anterposteriorly, that consists of largely interlacing smooth muscle fibers. The endometrial lining of the uterine corpus may vary from 2 to 10 mm in thickness, depending on the stage of the menstrual cycle. Most of the surface of the uterus is covered by the peritoneal mesothelium.

Four paired sets of ligaments are attached to the uterus. Each round ligament inserts on the anterior surface of the uterus just in front of the fallopian tube, passes to the pelvic side wall in a fold of the broad ligament, transverses the inguinal canal, and ends in the labium major. The uterosacral ligaments are condensations of the endopelvic fascia that arise from the sacral fascia and insert into the posteroinferior portion of the uterus at about the level of the isthmus. This ligament contain sympathetic and parasympathetic nerve fibers that supply the uterus. The cardinal ligaments are the other important supporting structures of the uterus that prevent prolapse.

There are four peritoneal folds. Anteriorly, the vesicouterine fold is reflected from the level of the uterine isthmus onto the bladder. Posteriorly, the rectouterine fold passes from the posterior wall of the uterus, to the upper fourth of the vagina, and thence onto the rectum. Laterally, the two broad ligaments each pass from the side of the uterus to the lateral wall of the pelvis. Between the two leaves of each broad ligament are contained the fallopian tube, the round ligament, and the ovarian ligament, in addition to nerves, blood vessels, and lymphatics.

The oviducts are bilateral muscular tubes (about 10 cm in lenth) with lumina that connect the uterine cavity with the peritoneal cavity. The tubes are lined by a ciliated, columnar epithelium that thrown into branching folds. That segement of the tube within the wall of the uterus is referred to as the interstinal portion. The median portion of each tube is superior to the round ligament, anterior to the ovarian ligament, and relatively fixed in position. This nonmobile portion of the tube has a fairly narrow lumen and is referred to as the isthmus. The ampullary and fimbriated portions of the tube are suspended from the broad ligament by the mesosalpinx and are quite mobile. The ampullar portion of the tube is the most common site of ectopic pregnancies.

The ovaries are oval, flattened, compressible organs, approximately 3x2x2 cm in size. They are situated on the superior surface of the broad ligament and are suspended between the ovarian ligament medially and the suspensory ligament of the ovary or infundibulopelvic ligament laterally and superiorly.The blood supply to the ovaries is provided by the long ovarian arteries, which arise from the abdominal aorta immediatly below the renal arteries. The ovary also receives substantial blood suply from the uterine artery through the uterine-ovarian arterial anastomosis. The venous drainage from the right ovary is directly into the inferior vena cava, whereas that from the left ovary is into the left renal vein.

^ II. Tests and Assignments for Self – assessment.

Multiple Choice.

Choose the correct answer / statement:

1. The two main anatomic divisions of the uterus are the

A - Corpus and fundus;

B - Cornu and fundus;

C - Corpus and cervix;

D - Cervix and isthmus.

2. The uterus is supported by:

A - Uterosacral ligaments;

B - Cardinal ligaments;

C - Round ligaments;

D - Broad ligaments;

E – A, B, C;

F - All of the above.

3. Which of the following doesn’t supply the uterus?

A - Ovarian artery;

B - Uterine artery;

C - Vaginal artery.

Real - life situations to be solved:

4. During examination of female reproductive organs it was diagnosed, that the height of perineum is 6 cm. What does it mean?

III. Answers to the Self- Assessment.

1. A. 2. F.3. C. 4. It mean that during labor it can be ruptured.

Visual Aids and Material Tools:

Charts

Equipment:

Students must know:

1.Structure of external and internal female reproductive organs.

2. The suspensive, fixative and supportive apparatus of reproductive organs.

3. Blood supply and nerve supply of female reproductive tract.

4. Lymphatic drainage of female reproductive tract.

Student should be able to:

1. To recognize on moulage, tables anatomic landmarks, ligaments of the uterus, blood vessels, muscles of the perineum.

2. During examination of external generative organs diagnose any abnormalities of structure.


References:

1. Хміль С.В. Акушерство. – Тернопіль: Укрмедкнига. – 1998. – С. 34 - 56.

2. Danforth’s Obstetrics and gynaecology. - Seventh edition.- 1994. – P. 1-10. .

3. Obstetrics and gynaecology. Williams & Wilkins Waverly Company. – Third Edition.- 1998. – P 31 - 54.

4. Basic Gynecology and Obstetrics. – Norman F. Gant, F. Gary Cunningham. – 1993. – P. 2 - 11


Approved on Session of Department of Obstetrics and Gynecology with course of Infant and Adolescent Gynecology ______________ protocol No ___________


The Head of Department: ____________________ S.P. Polyova

Methodological Instructions to Lesson 3 for Students

Theme: Fertilization and conceptus’ development.

Aim: be acquiented with the stages of embryonic development, to know the critical periods in the conceptus development and teratogens influence in its development. To learn the signs of “interm” fetus, “mature” fetus, its antropomethrical characteristics.

^ Professional Motivation: the learning about the female reproductive anatomy and the main function of the female sex organs, structure and development of the embryos and fetus is the scientific basis of obstetrics and gynecology. Life of a new individual begins after egg’s fertilization. From this moment genetically predisposing factor occurs that stimulating fetus to growing and development. Learning of the embryo’s and fetus’ development stages, influence of teratogenes factors in the critical periods of the embryo’s development have considerable scientific and practical importance.

Basic Level:

  1. Hypothalamus and Pituitary Gland System importance in regulation of Menstrual Cycle.

  2. Principles of back interaction between Pituitary Gland’ and Ovary functions.

  3. Uterus structure, cyclic changes in histophysiology of the endometrium during menstrual cycle.

  4. Follicule’ and ovum’ structure.

  5. Stages of the human conseptus development.

  6. Development of the membranes, types of placentation in mammals and humans.

  7. Influence of teratogenes in critical periods of embryo’ and fetus’ development.
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