ESSENTIAL OBSTETRICS AND GYNAECOLOGY PDF
This is the fifth edition of a popular, highly readable primer in obstetrics and gynaecology. It has been thoroughly updated and reconfigured to key into the new. Request PDF on ResearchGate | Essential Obstetrics & Gynaecology | Essential Obstetrics & Gynaecology is a textbook written to suit the new UK. This book is aimed at students of medicine, midwifery and nursing, and covers all the topics likely to be needed at this level in appropriate depth. The book is.
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Affairs, Department of Obstetrics and Gynecology, Albert Einstein Medical Center/ Thomas. Jefferson . The primary goal of this book is to provide the basic in-. Ian M Symonds; Sabaratnam Arulkumaran; E M Symonds Essential obstetrics and resourceone.info - Free ebook download as PDF File .pdf), Text File .txt) or . American College of Obstetrics and Gynecology (ACOG) with. Charles R. B. . The primary goal of this book is to provide the basic in- formation about obstetrics .
These ligaments and their peritoneal covering form the lateral boundaries of the rectouterine pouch of Douglas.
They cover the Fallopian tubes 6 The Fallopian tubes The Fallopian tubes or uterine tubes are the oviducts. They extend from the superior angle of the uterus, where the tubal canal at the tubal ostium opens into the lateral and uppermost part of the uterine cavity. The tubes are approximately 10—12 cm long and lie on the posterior surface of the broad ligament, extending laterally in a convoluted fashion so that, eventually, the tubes open into the peritoneal cavity in close proximity to the ovaries.
The tubes are enclosed in a mesosalpinx, a superior fold of the broad ligament, and this peritoneal fold, apart from the tube, also contains the blood vessels and nerve supply to the tubes and the ovaries.
They are generally benign. The lumen of the tube is narrow and the longitudinal and circular muscle layers are well differentiated.
The ampulla is a widened section of the tube and the muscle coat is much thinner. The widened cavity is lined by thickened mucosa. The infundibulum of the tube is the outermost part of the ampulla. The tubes are lined by a single layer of ciliated columnar epithelium which serves to assist the movement of the oocyte down the tube. The tubes are richly innervated and have an inherent rhythmicity that varies according to the stage of the menstrual cycle and whether or not the woman is pregnant.
The ovaries The ovaries are paired almond-shaped organs that have both reproductive and endocrine functions. They are approximately 2.
Each ovary lies on the posterior surface of the broad ligaments in a shallow depression known as the ovarian fossa in close proximity to the external iliac vessels and the ureter on the lateral pelvic walls. Each has a medial and a lateral surface, an anterior border, a posterior border that lies free in the peritoneal cavity, an upper or tubal pole and a lower or uterine pole.
The anterior border of the ovary is attached to the posterior layer of the broad ligament by a fold in the peritoneum known as the mesovarium.
This fold contains the blood vessels and nerves supplying the ovary. The tubal pole of the ovary is attached to the pelvic brim by the suspensory ligament infundibulopelvic fold of the ovary.
The surface of the ovary is covered by a cuboidal or low columnar type of germinal epithelium. This surface opens directly into the peritoneal cavity. The development of malignant disease in the ovary leads to the shedding of malignant cells directly into the peritoneal cavity as soon as the tumour breaches the surface of the ovary.
The disease is silent and often asymptomatic and thus presents late. As a result of these characteristics, the prognosis is generally poor unless the disease is diagnosed when it has not extended beyond the substance of the ovary.
These follicles can also be found in the highly vascular, central portion of the ovary: the medulla. The blood vessels and nerve supply enter the ovary through the medulla. The internal iliac artery arises at the level of the lumbosacral articulation and passes over the pelvic brim, continuing downward on the posterolateral wall of the cavity of the true pelvis beneath the peritoneum until it crosses the psoas major and the piriformis muscles.
It then reaches Superior vesical artery Urinary bladder Round ligament External iliac artery Anterior branch of internal iliac artery Uterine artery Intestine and rectum Internal iliac artery Fallopian Common iliac tube artery Ureter Fig.
It then continues as the umbilical artery, which shortly after birth, becomes obliterated to form the lateral umbilical ligament. Thus, in fetal life, this is the major vascular network, which delivers blood via the internal iliac anterior division and its continuation as the umbilical artery to the placenta.
The branches of the two divisions of the internal iliac artery are as follows.
Anterior division The anterior division provides the structure for the umbilical circulation as previously described. It also provides the superior, middle and inferior vesical arteries that provide the blood supply for the bladder. The superior and middle branches, having passed medially to the lateral and superior surfaces of the bladder, anastomose with branches from the contralateral vessels and with the branches of the uterine and vaginal arteries.
It also forms the middle haemorrhoidal artery. It initially runs downward in the subperitoneal fat under the inferior attachment of the broad ligament towards the cervix. The artery crosses over the ureter shortly before that structure bladder approximately 1. In cross-section, the vagina is H-shaped and it roversion in the pouch of Douglas. The uterus may also be is capable of considerable distension, particularly during curved anteriorly in its longitudinal axis, a feature that is parturition when it adapts to accommodate the passage of described as anteflexion, or posteriorly, when it is described the fetal head.
Anteriorly, it is intimately related to the as retroflexion. Posteriorly, It consists of a body or corpus, an isthmus and a cervix.
The corpus uteri consists of a mass of smooth muscle cells, the myometrium, arranged in three layers. The external Sacrum layers contain smooth muscle cells that pass transversely Tube across the uterine fundus into the lateral angles of the uterus, where their fibres merge with the outer layers of Ovary Cervix the smooth muscle of the Fallopian tubes and the ovarian and round ligaments. The muscle fibres in the middle layer Uterus Coccyx are arranged in a circular manner and the inner layer con- tains a mixture of longitudinal, circular and oblique Bladder The cavity of the uterus is triangular in shape and is Symphysis flattened anteroposteriorly so that the total volume of the cavity in the non-pregnant state is approximately 2 mL.
It Clitoris is lined by endometrium that consists on the surface of mucus-secreting columnar epithelium. The nature of the Labium maj. Rectum endometrium depends on the phase of the menstrual Labium min. External anal cycle. Following menstruation, the endometrium in the sphincter proliferative phase is only 12 mm thick.
By the second Urethra Anus half secretory phase of the cycle the endometrium has Vagina Internal anal grown to a thickness of up to 1 cm. The internal os posterior surface of the broad ligament. Like the anterior opens into the uterine cavity through the isthmus of the ligaments, the broad ligaments play only a weak support- uterus. In non-parous women the external os is round or ive role for the uterus. In the lum is passed, for example, when taking a Pap smear. The They arise from the anterolateral surface of the uterus just transition between this epithelium and the stratified squa- below the entrance of the tubes and extend diagonally and mous epithelium of the vaginal ectocervix forms the squa- laterally for cm to the lateral pelvic walls, where mocolumnar junction.
The exact site of this junction is they enter the abdominal inguinal canal, and blend into related to the hormonal status of the woman.
Some of the the upper part of the labia majora. These ligaments have cervical glands in the endocervical lining are extensively a weak supporting role for the uterus but do play a role in branched and mucus-secreting. If the opening to these maintaining its anteverted position.
Dewhurst's Textbook of Obstetrics & Gynaecology 9th Edition Pdf
In pregnancy, they glands becomes obstructed, small cysts may form, known become much thickened and strengthened, and during as nabothian follicles. The outer longitu- direction of entry of the presenting part into the pelvic dinal layer merges with the muscle layer of the vagina. The isthmus of the uterus joins the cervix to the corpus The cardinal ligaments transverse cervical ligaments uteri and in the non-pregnant uterus is a narrow, rather form the strongest supports for the uterus and vaginal poorly defined, area some 23 mm in length.
In preg- vault and are dense fascial thickenings that extend from nancy, it enlarges and contributes to the formation of the the cervix to the fascia over the obturator fossa on each lower segment of the uterus, which is the normal site for pelvic side wall. Medially, they merge with the mass of the incision of caesarean section. In labour it becomes a fibrous tissue and smooth muscle that encloses the cervix part of the birth canal but does not contribute significantly and the vaginal vault and is known as the parametrium.
The to the expulsion of the fetus. Close to the cervix, the parametrium contains the uterine arter- Supports and ligaments ies, nerve plexuses and the ureter passing through the ureteric canal to reach the urinary bladder.
Ian M Symonds; Sabaratnam Arulkumaran; E M Symonds Essential obstetrics and gynaecology.pdf
Lower down, of the uterus the muscular activity of the pelvic floor muscles and the The uterus and the pelvic organs are supported by a integrity of the perineal body play a vital role in preventing number of ligaments and fascial thickenings of varying the development of uterine prolapse see Chapter The pelvic organs also depend for support on the integrity of the pelvic floor: a particular The Fallopian tubes feature in the human female is that, an upright posture having been adopted, the pelvic floor has to contain the The Fallopian tubes or uterine tubes are the oviducts.
They downward pressure of the viscera and the pelvic organs. The tubes are approx- from the anterior aspect of the cervix across the superior imately cm long and lie on the posterior surface of surface of the bladder to the peritoneal peritoneum of the the broad ligament, extending laterally in a convoluted anterior abdominal wall.
It has a weak supporting role. These liga- The tubes are enclosed in a mesosalpinx, a superior fold ments and their peritoneal covering form the lateral of the broad ligament, and this peritoneal fold, apart from boundaries of the rectouterine pouch of Douglas.
The the tube, also contains the blood vessels and nerve supply ligaments contain a considerable amount of fibrous tissue to the tubes and the ovaries. It also houses various embry- and non-striped muscle and extend from the cervix onto ological remnants such as the epoophoron, the paroopho- the anterior surface of the sacrum.
These Laterally, the broad ligaments are reflected folds of peri- embryological remnants are significant in that they may toneum that extend from the lateral margins of the uterus form para-ovarian cysts, which are difficult to differentiate to the lateral pelvic walls. They cover the Fallopian tubes from true ovarian cysts. They are generally benign. Beneath this layer extending from the emergence of the interstitial lies the cortex of the ovary, formed by stromal tissue and portion until it widens into the next section.
The collections of epithelial cells that form the Graafian folli- lumen of the tube is narrow and the longitudinal cles at different stages of maturation and degeneration. These follicles can also be found in the highly vascular, The ampulla is a widened section of the tube and the central portion of the ovary: the medulla.
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The blood vessels muscle coat is much thinner. The widened cavity is and nerve supply enter the ovary through the medulla. The infundibulum of the tube is the outermost part of the ampulla.
The tubes are richly innervated and The major part of the blood supply to the pelvic organs is have an inherent rhythmicity that varies according to the derived from the internal iliac arteries sometimes known stage of the menstrual cycle and whether or not the woman as the hypogastric arteries , which originate from the is pregnant.
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The ovaries The internal iliac artery arises at the level of the lum- bosacral articulation and passes over the pelvic brim, con- The ovaries are paired almond-shaped organs that have tinuing downward on the posterolateral wall of the cavity both reproductive and endocrine functions. It then reaches 3. Each ovary lies on the posterior surface of the broad ligaments in a shallow depression known as the ovarian fossa in close proximity to the external iliac Superior vesical artery vessels and the ureter on the lateral pelvic walls.
Each has Urinary a medial and a lateral surface, an anterior border, a poste- bladder rior border that lies free in the peritoneal cavity, an upper or tubal pole and a lower or uterine pole.
Round ligament The anterior border of the ovary is attached to the poste- rior layer of the broad ligament by a fold in the peritoneum External known as the mesovarium. This fold contains the blood iliac artery vessels and nerves supplying the ovary.
The tubal pole of the ovary is attached to the pelvic brim by the suspensory liga- ment infundibulopelvic fold of the ovary. The lower pole is attached to the lateral border of the uterus by a musculofi- brous condensation known as the ovarian ligament.
Anterior The surface of the ovary is covered by a cuboidal or low branch columnar type of germinal epithelium. This surface opens of internal directly into the peritoneal cavity. The disease is silent and artery and often asymptomatic and thus presents late.
As a result of these characteristics, the prognosis is generally rectum Ovarian Fallopian Common iliac Ureter poor unless the disease is diagnosed when it has not artery tube artery extended beyond the substance of the ovary. They descend behind the peritoneum at the upper margin of the greater sciatic notch, it divides on the surface of the corresponding psoas muscle until into anterior and posterior divisions.The size of the uterus depends on the hormonal status of the female.
Weeks of pregnancy yeast infections may thrive in this environment and 60 Candida infections are common in pregnancy. These follicles can also be found in the highly vascular, The ampulla is a widened section of the tube and the central portion of the ovary: the medulla. Each ovary lies on the posterior surface of the broad ligaments in a shallow depression known as the ovarian fossa in close proximity to the external iliac Superior vesical artery vessels and the ureter on the lateral pelvic walls.
Gaseous exchange occurs across the type I cells and the type II cells secrete a surface-active phospholipid surfactant that is essential in maintaining LA the functional patency of the alveoli.
Malcolm Symonds Ian Symonds.
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