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Men should examine their testicles monthly for any lumps or other changes. They should also do a self-examination of their testicles before starting any new medication or treatment. A man will know his testicles by touch, but it can be difficult to find them in the groin area without looking.  A man should pull back the skin of his scrotum and look for two round, oval-shaped organs that are about the size of large eggs.  The left and right testicles are not always the same size, but they should be similar in size to one another. A man may notice an increase in discomfort if he has a hernia or if he has been sitting in one position for too long. What is Testicular Self-examination (TSE) Testicular Self-examination (TSE) refers to the procedure which involves observing or assessing one’s testicles by the person so as to find out any abnormality such as nodules, inflammation and mass on the testes. The change in th size, shape and colour are detected via the examination.  Examination of the scrotum can unveil some disorders such as hernia, hydrocele or tumour of the testicle. It’s therefore crucial that every male becomes conversant with TSE because it helps in early detection of testicular cancer.  Testicular cancer remains the commonest cancer affecting men between the ages of 15 and 34 and can as well occur in men outside this age range.   Conducting Testicular Self-examination (TSE) once a month greatly increases the chances of detecting a cancerous lump or mass early enough in order to seek effective treatment. Testicular cancer  like breast cancer is usually detected by the man himself as a firm, painless lump in the testicles. As early diagnosis is crucial in achieving successful treatment, men should endeavour to carry out testicular Self-examination once a month — looking for unusual changes in the appearance  and feel of the scrotum. TSE should commence during adolescence so as to know what is normal for you and also make you confident in your examination.  The time is not difficult or time-consuming. The most convenient time to carry out the procedure is usually after a warm bath or shower when the scrotum is loose and more relaxed. You should use both hands during the examination. Read : Discover Incredible Facts About Human Placenta Purposes of Testicular Self-examination Specifically, it is carried out:  Procedure for Testicular Self-examination Recommendations We recommend that every Tofortians (male) should endeavour to perform testicular examination regularly and report to the doctor any abnormality discovered. This is because testicular cancer and prostate cancer can be detected earlier and prompt treatment can be given to save the man. 

Postnatal Exercises: After you have a baby, it is crucial to take care of your body. This means getting enough rest, eating healthy foods, and exercising. Exercise can help you lose the pregnancy weight, get stronger, and feel good about yourself. However, it is important to know what kind of exercises are safe to do after you have a baby. You have to avoid exercises that put too much strain on your body. I hope this article will help you find the best post-natal exercise routine that suits your pre-pregnancy body. What are postnatal exercises? This is an exercise carried out by a woman soon after delivery in order to improve circulation, strengthen pelvic floor and abdominal muscles and prevent transient long-term problems. These exercises may include circulatory exercises, pelvic exercise, abdominal exercises, abdominal tightening, pelvic tilting, rectus check, and  knee rolling. Read: The best and safe exercises during pregnancy. Postnatal exercises are designed to reduce the risk of developing certain problems and make it easier to recover from the birth. They are important for the mother’s body to return to its pre-pregnancy shape. These exercises can be done at home, but they should be done under supervision of a health professional. Different types of postnatal exercises Postnatal exercises include: Why It’s So Important to Exercise During Postpartum period Exercises during puerperium is associated with the following benefits:  Guidelines for Postnatal Exercises If you’re a new mom, you’re probably wondering what kind of exercise you can do to get your body back into shape. Here’s a quick rundown of what to do and what to avoid when it comes to postnatal exercises. Do: Avoid: The bottom line After giving birth, it’s important to give your body time to recover. This means no strenuous exercise for at least the first six weeks. But that doesn’t mean you have to just sit around and do nothing. There are plenty of gentle postnatal exercises that can help you heal, feel better and get your strength back. So what kind of exercise is safe after pregnancy? Walking is a great place to start. It’s low impact and easy on your body. You can also do some light stretching and strengthening exercises. But avoid anything that puts too much strain on your abdomen or back. This includes sit-ups, crunches and any other exercises that involve rounding your back. If you want to start a more formal exercise routine, talk to your doctor or midwife first. They can give you the green light and let you know what exercises to avoid. In general, it’s best to wait until your six-weeks postpartum period before engaging yourself in strenuous activities.

Appearance of the placenta at term Human placenta is a circular flat organ through which the fetus obtains oxygen and nourishment in-utero and performs functions which the fetus cannot perform itself in-utero. Its name is derived from Latin for “pancake,” which is descriptive of its size and appearance at term. It is also describe as a descoid-shaped organ, which otherwise called “afterbirth“. Situation/Location: Before delivery, the placenta is situated in the upper uterine segment. Shape: The human placenta is a flat, roughly circular structure. Size: It’s about 20–22cm in diameter and 2.5cm thick in the centre and becomes thinner towards the circumference. Weight: Normal human placenta weighs about one-sixth of the baby’s weight(450g). Gross structure of Human Placenta The human placenta has two surfaces which are: maternal and fetal surfaces. Maternal surface This surface is dark red in colour due to maternal blood in intervillous spaces and part of the basal decidua will have been separated with it. The surface is arranged in about 18–20 lobes which are separated by sulci.  The lobes are made of lobules, each of which contains a single villus with its branches. Sometimes, deposits of lime salts are present — making the surface gritty. Although it has no clinical significance. Fetal surface This is the surface that faces the baby in-utero and it has a white shiny appearance or bluish gray in colour with a smooth surface. The amnion covering the fetal surface of  the  placenta  gives  it  a whitish, shiny  appearance.  Branches of the umbilical veins and arteries are visible and spreading out from the insertion of the umbilical cord which is normally in the centre.. The umbilical cord is inserted usually at the centre and blood vessels radiating down to its circumference. The amniotic membrane covers the fetal surface, which consists of a double membrane:  The Chorion: This is derived from the trophoblastic tissue. It is a thick, opaque, friable membrane which continues with a placental edge and cannot be separated from it.  The chorion is the outer layer of amniotic membrane adherent to the uterine wall. The Amnion: This is a smooth, tough translucent membrane derived from the inner cell mass. It covers the placenta and the umbilical cord and secretes the amniotic fluid. The inner layer of the amniotic sac contains an amniotic fluid and covers the fetal surface of the placenta and is what gives the placenta its typical shiny appearance. Functions of human placenta Respiratory function: As pulmonary exchange of gases does not take place in the uterus the fetus must obtain oxygen and excrete carbon dioxide through the placenta. It also aids exchange of oxygen and carbon dioxide from the mother to the fetus. Nutrition functions: Food for the fetus derives from the mother’s diet and has already been broken down into forms by the time it reaches the placental site. Nutrients such as glucose, amino acids, and minerals pass into the foetal circulation through it. The placenta is able to select those substances required by the fetus, even depleting the mother’s own supply in some instances. Storage: It metabolizes glucose and can also store it in the form of glycogen and reconverts it to glucose when it is needed by the fetus. It also stores  iron  and  other  fat  soluble vitamins. Excretory functions: The waste products of metabolism such as urea, or  uric acid are returned to maternal circulation through the placenta. The main substance excreted from the fetus is carbon dioxide.  Protective functions: It provides partial protection from infection (e.g. micro-organisms). It provides a limited barrier to infection with the exception of the treponeona of syphilis and few bacteria can penetrate. Viruses, however, can cross freely and may cause congenital abnormalities as in the case of the rubella virus and HIV virus. Endocrine functions: It produces hormones such as Human   chorionic   gonadotropin (HCG) produced by the cytotrophoblastic layer of the chorionic villi; human placental lactogen(hpL) that has a role in glucose metabolism in pregnancy; oestrogen and progesterone which all help to maintain the viability of the gestation.  When  the activity of the corpus luteum begins to decline, the  placenta  takes  over  the  production  of  oestrogen, which   is   secreted   in   large   amounts   throughout pregnancy. Anchorage/stability: The chorionic villi passes deeply into the decidua and anchors the placenta firmly. Examination of placenta Requirements for the procedure Aims of the examination Procedure Complications Arising from Human Placenta Placenta remains an essential organ that connects mother and foetus for exchange of gases and nutrients as well as removal of waste products of metabolism. However, anomalies or complications can occur in it which include: 

Umbilical cord is a key structure because fetus in-utero can not  survive without obtaining oxygen and nutrients from maternal blood stream which is connected to the fetal surface of the placenta by  umbilical cord.   Abnormal cord either in structure or function can absolutely affect the fetal growth and development.  Hence, healthy umbilical cord is very essential for healthy pregnancy.  What is umbilical cord? Umbilical cord is otherwise known as funis, refers to a thread-like structure that extends from the fetal surface of the placenta to the umbilical portion of the fetus.  Normal length of umbilical cord The  diameter of umbilical cord is about 1-2cm while that of length is 40-60cm with an average of 50cm.  A cord is considered to be short when it measures less than 40cm. However, there is no definite length considered to be an anomaly.  Development of umbilical cord Umbilical cord is formed at the 5th week of pregnancy. It is highly essential for life and any disruption in its structure can result  in a fetal stillborn. It transmits blood vessels (two umbilical arteries and one large vein which supply the fetus with nutrients and aid in removal of waste products.  These vessels are protectively embedded within a white gelatinous substance called  Wharton’s jelly which is developed from primary(embryonic) mesoderm. Loss of Wharton’s jelly may put the fetus at risk of cord compression and, hence fetal distress. Naturally, the umbilical cord falls off within 7-10 days after birth through a process known as dry gangrene. Nerve supply to Umbilical cord The cord has no nerve supply and this makes cutting it at birth painless to the baby.  The whole cord is covered with a layer of amnion which is continuous with that covering of the placenta.  Umbilical cord  appears helical(95%) due to winding of the blood vessels.  However, umbilical cords of absolutely straight(5%) appearances are more prone to disruptions of blood flow.   Placental attachments can be in the center, off-center, on the edge, or in the membranes. The membranous insertions of the umbilical cord are known as velamentous insertions. These placental cord designs have flaws that can lead to cord tears.   Function of the umbilical cord  Care of the newborn umbilical cord  The cord normally falls off within 7-10 days by necrotic dry gangrene.  There is no specific care for cord, rather maintenance of optimal environmental and personal hygienes are advocated for the baby. Below are tips for cord care: Physiological changes in umbilical cord during delivery: Considerable physiological changes occur in umbilical cord following delivery and clamping of the cord by the midwife.  We shall look into these changes for better understanding. Labour and delivery cause a lot of changes in the baby’s systems and not only in the umbilical cord. The birth of a baby brings the essential functions of the cord in-utero to an end. The baby needs to adapt to extrauterine life. Therefore, at clamping and cutting of the umbilical cord by midwife during delivery, the followings occur: Major changes in umblical cord after delivery The cessation of the placental results in the collapse of the umbilical veins, the ductus venosus, and hypogastric arteries: Other subsequent changes: Examination of umbilical cord at birth During the examination of the placenta and  membranes following delivery, the cord is usually examined for any abnomality. These steps are involved:  Steps in educating newly delivered  primigravida on umbilical cord care General baby care poses a great concern and challenge to first time mothers. The tips on cord care above will be of help to the  midwife instructing the mother. However, below are simple steps to follow: Phase 1: Preparation  Phase 2: Demonstrate the procedure as follows: Phase 3: Observe the following while you do the procedure Complications resulting from improper cord care Failure to observe these simple tips about cord care could result to the following problems: Conclusively, I hope you have learnt more on umbilical cord and what to expect during health education on care of umbilical cord. With these hints you can no longer feel naive when your midwife is teaching you or with other women the proper cord care.  Read: Abnomalities of umbilical cord and their management. Proper umbilical cord care helps to keep your baby free from infections. This in turn boosts his/her health and fitness. If you find this piece resourceful, share to others. I hope to hear from you via your comment below. Always stay safe. Tofort cares!

Labour remains challenging moment for the skilled birth attendant as he or she would be striving to ensure safe mother and healthy baby during delivery. Most pregnant women appear to be happier as they approach the last day of their third trimester due to the joy of having their baby in their arms. While some are embattled psychologically with fear of pain.  In this article, we shall consider why the uterus goes into labour and what labour is all abour. What is labour? Labour is the physiological process involving regular and rhythmic uterine contractions and retractions with progressive cervical dilation, in which the foetus, placenta and membranes are expelled from the uterus through the birth canal after 24th weeks of gestation. It can also be defined as the process by which a woman gives birth.  The whole process is achieved by the rhythmic contraction and retraction of the uterine fibres and progressive dilatation of the cervical Os.  The foetus is considered to be viable — capable of surviving outside the uterus after 24th weeks of gestation. Thus, evacuation of the product of conception by the contraction and retraction of the uterus before the 24th week of gestation is not labour but abortion . The uterine contractions can occur naturally and spontaneously or through artificial use of medicines. Labour is considered to be normal when it occurs spontaneously at term (37-40 weeks of gestation) with the foetus presenting by vertex, the whole process completed by unaided naturally maternal efforts, does not exceed 24 hours without any complications to both mother and baby.  It is also said to be established when there are  regular painful rhythmic uterine contraction and cervical dilatation of about 4 cm in primigravida and 3cm in multigravida.  Causes of onset of  labour The uterus has the intrinsic power to expel its contents before term as cases of miscarriage, preterm labour or induction before term. You might wonder why throughout pregnancy, the uterus remains sedated.  The actual cause of onset of  labour is not properly known. However, reasons why the uterus remains quiescent during pregnancy and triggers off contraction at term could be associated with the following: Probable/warning/premonitory signs of labour These are signs that show that labour is likely to occur soonest and may include the following: Lightening:  This occurs towards the last week of the third trimester of pregnancy when women experience a sign of relief as the gravid uterus no longer crowds the lungs because of the sinking down of the lower uterine segment into the pelvis, causing the presenting part to descend.  This is usually referred to as “Give of the pelvis“. Lightening occurs because of the widening of the joints and ligaments of pelvic joints, symphysis pubis and the softening, relaxation and sagging of the pelvic floor muscles in combination with the  formation of the lower uterine pole. This physiologic effect is caused by pregnant hormones particularly the relaxin  synthesized by the placenta.  Frequency of micturition:  This occurs during the first trimester due to pressure of weighing the pregnant  uterus on the urinary bladder resulting in frequent urge to micturate but it gets relieved during the second trimester.   During the third trimester, there is Increased irresistible  urge to void because the foetal head has descended,  causing greater pressure on the bladder (lightening).  Braxton Hicks’ contractions:  These ‘practice’ contractions begin from the 16th week of pregnancy and improve the uterine blood flow to the placenta. They also help in the formation of the lower uterine pole towards the last trimester of pregnancy.  This is Nature’s way  of training and sensitising the uterus for the anticipatory future functions (delivery).  Reduction in the Amniotic fluid:  Amniocentesis helps to detect reduction in liquor, which may account for the drop in the maternal weight towards term or that the uterus is approaching labour. Effacement of the cervix:  This refers to when the cervix is “ripped” and ready to go into delivery. It implies that the cervix can cooperatively dilate with commensurate uterine contractions.    Effacement can also refer to the “taking up” of the cervix, which means the cervical ring has been drawn up to form part of the lower uterine segment. When the cervix shortens, the cervical Os can admit a tip of one or two fingers.  Shortening of the cervix is usually looked for in the interest of mother or baby, or when labour has to induced.   True labour Vs False Labour True labour is also called true pain and refers to a physiological  process characterized by regular uterine contractions, dilatation of the cervix and expulsion of fetus, placenta and membranes.  Recognition of true labour Regular uterine contractions: When the uterine contraction and retraction occurs in a regular interval — maintaining a consistent rhythm, the uterus is said to be in labour. Dilatation of the cervix:  This refers to the opening of the neck of the womb. Cervical dilatation occurs in agreement with the contraction and shortening of the longitudinal and oblique muscle fibres of the upper segment.  When the cervix dilates, it becomes obvious that the uterus is definitely trying to empty its contents. Show: “Show” refers to blood-stained mucus which is released or discharged from the cervix as it dilates. The “show” is a tenacious mucus that plugs the cervix during pregnancy. It mixes with blood from severed blood vessels around the cervix as it dilates. However, false labour otherwise called false pain or spurious labour and refers to irregular and erratic uterine contractions lasting 2 to 3 minutes and pain a pregnant woman experienced with no accompanying changes in cervix(e.g. no “Show” or cervical dilatation).  Difference between true labour and false labour True labour False labour Regular rhythmic uterine contractions Uterine contractions are irregular and erratic. Duration of contraction rarely exceeds 60 seconds. Contractions may last  2 to 3 minutes Back ache may be present Back ache absent Cervix is effaced Cervix is not effaced Progressive cervical dilatation Cervix may not dilate “Show” is present No “show” Membranes may or may not be intact.

Description of Breasts The breasts are the two mammary glands and accessory organs of reproduction. Shape: They are hemi-spherical in shape but many times the shape depends on the amount of adipose tissue. Circular in nullipara but pendiclous in women who have borne children and lactated. Situation: They are situated on the superficial fascia of the anterior chest wall, lying over the pectoralis major muscle. They extend from the second rib above to the sixth rib below and from the lateral margin of the sternum to the mid axillary line. Gross Structure of  Breasts Areola: Over the centre of each breast is a circular area about 2.5cm in diameter. The areolar is pink coloured Caucasian, brown for blacks in nullipara and brownish in women who have born respectively. Nipple: In the centre of the areolar is the nipple. It is a flat shaped protuberance situated about the level of the 4th intercostal space. It is composed of erectile tissue and about 6mm in length. Its surface is perforated by 15-20 minutes opening of the lactiferous ducts. Montgomery’s tubercle: Within the areolar are situated about 18 sebaceous glands which become enlarged into tubercles during pregnancy. Axillary Tail of Spence: This is the part of the breast which extends up into the axilla reaching as high as the 3rd rib thus making the circular shape of the breast to be incomplete. Microscopic structure of the Breasts The breast is composed of glandular tissue gathered into about 18-20 lobes. These lobes radiate outward from the areolar and are separated from each other by fibrous connective tissue and lies next to but does not communicate with its fellow.  Each of the 18 lobes is divided by smaller partitions into numerous lobules which are made up of masses of milk secreting units known as alveoli.  Each alveolus consists of a number of milk forming cells surrounding a small duct in which they pour their secretions. The duct from the alveoli joins together to form larger ducts, these unite with ducts from other lobules until finally a larger duct known as a lactiferous tubule emerges from the entire lobe and runs towards the nipple. Ampulla: As it passes beneath the areolar, each lactiferous tubule expands and forms a dilated sac. The ampulla which serves as a reservoir for milk from here the tubule from each lobe enters the nipple and opens independently upon a surface. Myoepithelial or Breast cells:These are spider shaped contractile cells surrounding the alveoli. Fatty Tissue: The gland is stabilized in the fat of the chest wall by numerous fibrous processes. The gland tissue is covered by subcutaneous tissue and finally by the skin. Blood, Nerve & Lymphatic Supply to Breasts  Blood supply: Breasts received blood through internal mammary artery which is a branch of subclavian artery; external mammary artery which is a branch of lateral thoracic artery and the upper intercostal artery which is a branch from the aorta. Venous Return:The veins form a circular network around the nipple and drain to the internal mammary and axillary veins. Lymphatic Drainage:The lymph vessels form a plexus beneath the areolar and between the lobes of the breast. The lymphatics of the breasts communicate freely with each other. The lymph drains into the following regional nodes: Nerve Supply: The functioning of the breast is contributed by hormones as it has poor nerve supply. Some sympathetic fibres pass to it. The skin over the breast is supplied by cutaneous branches of 4th,5th and 6th thoracic nerves. Functions of Breasts The physiology of the Breast Development At puberty, the breasts enlarge and assume the adult female size and shape. This is in response to stimulation by oestrogens which mainly promote the growth and development of the lactiferous tubules and ducts and also cause a certain amount of growth of the nipples and the areolar.  Further development and enlargement of the breasts occur during pregnancy. The most important feature at this time is the hypertrophy of the alveoli in response to progesterone stimulation, preparatory to the later manufacture of milk About 3 days after delivery, milk appears in the breast as a result of stimulation by prolactin and the breasts can then be said to have reached their full development. The physiology of Lactation The process of lactation can be considered to take place in three stages: The production of milk Milk is formed as small fatty globules in the base of these cells and gradually unite to form small developments. As new globules are produced, the droplets are pushed towards the surface of the cell until finally they burst through the cell membranes and enter the lactiferous tubules.  Here, they join with droplets from other cells and eventually the terminal portions of the tubules within the alveoli become filled with milk.  The manufacturer of milk is under the control of prolactin from anterior pituitary gland. The action of this hormone is suppressed by the progesterone and oestrogen until a few days after the expulsion of the placenta. When the level of these hormones (oestrogen and progesterone) fall to allow prolactin to function.  Once lactation has been established by prolactin, growth hormone from the anterior pituitary plays some part in its maintenance. Note: The breasts require a large blood supply for the secretion of milk. The flow of milk Milk is pushed along the ducks towards the nipple by the milk which is being continually formed behind it in the alveoli. Some of the milk is stored in the ampullae underneath, the areolar until the time of the baby’s next feed. When milk is drawn off by the infant, the smooth muscle and basket cells in the wall of the duct and alveoli contact and force more milk towards the nipple. This mechanism occurs as a result of a neuro- hormonal reflex.  Thus, the stimulus of the baby’s mouth on the sensitive nipple oxytocin is liberated from the posterior pituitary gland. This hormone stimulates the muscle and basket cells to contact and therefore cause more milk to

What is cord prolapse? Cord prolapse is an obstetrical emergency whereby the cord lies in the front of the presenting part with the membranes ruptured. It requires the expertise of an experienced midwife or obstetrician to save the baby’s life. During this period, the midwife should allay the woman’s anxiety and ensure that he or she provides woman-centered care devoid of disrespect and abuse. Proper information regarding what is happening should be provided to her and her support person or partner. Risk factors for umbilical cord prolapse Diagnosis A loop of cord may be visible below or beside the presenting part. It can be felt on vaginal examination. It may also be on the Os as in high head. Cord prolapse is diagnosed when membranes are ruptured.  General management of cord prolapse Immediate care Relieve pressure on the cord  by: Specific management of cord prolapse This depends on the stage of labour at which the diagnosis was made.  First stage: Fetus still alive – delivery not immenient or woman cannot deliver by vagina, Caesarean section is the treatment of choice. Second stage: Encourage mother to push with contractions. Perform episiotomy. If cephalic presentation, assist labour with vaccum or forceps. Community: Fetus is still alive – transfer to hospital immediately. Relieve pressure on cord by placing mother in left lateral position and buttocks elevated.  Inform consultant: prepare for emergency Caesarean section on arrival. Complications of cord prolapse Poorly managed umbilical cord prolapse is associated with dangers such as fetal hypoxia and death due to cord compression especially in premature and low birth weight babies. However, there are no specific ways of preventing cord prolapse. Pregnant women are usually advised to attend antenatal care regularly and utilize facility-based delivery where there are skilled and qualified birth attendants. Bottom line Umbilical cord prolapse is an emergency situation that needs obstetric interventions to save the life of the baby. When this condition occurs in the community, the midwife should carefully transfer to hospital where proper care will be provided. Again, midwife should avoid performing artificial rupture of membranes (ARM) in pregnant women diagnosed with polyhydramnios in order to minimize the risk of the cord prolapse due to the rushing of the liquor amnii. The midwife should also endeavour to provide respectful and evidence-based care to the woman as well as involve her in decision pertaining her care.

What is Cervix? Cervix otherwise called uteri cervix or “neck of the uterus” refers to a cylindrically shaped fibromuscular structure that connects the uterus to the vagina. Strawberry cervix occurs there is cervical trichomoniasis characterized by bloody sightings over the vagina and cervix.   Position: It forms the lower one-thirds  of the uterus. It is situated in the true pelvis and enters the vagina at right angles.  Shape: It is cylindrical in shape, while its cavity is spindle or cylindrical shaped and slightly fuse-form. Size: It is approximately 2.5cm in length and 1.3cm thick. Gross structure Macroscopically, the cervix is divided into:  The supra-vaginal part: This part  lies above and outside the vagina. It’s also called ectocervix.  The infra-vaginal part: This is the portion lying with the vagina and is otherwise known as endocervix.  The transformation zone(TZ) is where there is overlap  between the endocervix and ectocervix and remains the commonest site for cervical cancer. The widest part of the cervix lies in the centre with a constriction above where it communicates with the body of the uterus known as the internal os and a constriction below where it communicates with the vagina called the external os. Microscopic structure The cervix unlike the body of uterus contains less muscular but more elastic tissues just like the body of the uterus it has three layers (within outwards) Endometrium: This refers to Inner lining of ciliated epithelium containing racemose glands. It is arranged in folds giving a tree- like appearance termed “arbor vitae”   The myometrium: The cervical muscle fibres are arranged into two (2) fibres as follows:  Perimetrium: This covers that part of the cervix which lies anteriorly and posteriorly above the vagina i.e. supravaginal portion with the exception of that area lying in contact with the base of the bladder. Blood, Nerve & Lymphatic supply Anatomical surroundings The cervix is surrounded by    Functions Changes during pregnancy During pregnancy, the cervical glands produce mucus which forms a plug of operculum that fills the cervical canal and helps to prevent infection of the genital tract. Towards the end of the pregnancy,it feels very much softer and the internal os begins to dilate. This is known as ” cervical ripening”. Changes during labour When labour begins, the muscular fibre surrounding the internal os are drawn upwards by the retracted upper uterine segment and it is shortened as it arranges to form part of the lower uterine segment. This is called cervical effacement(taking up of the cervix).  Collectively, these physiological processes result in dilatation and subsequent delivery.  Changes during puerperium Following delivery, it begins to close and return to its pregravid state. The internal and external os and canal between them must have reformed.  The external os is however, never completely closed but becomes a slit-like aperture which can admit a tip of finger. This is known as “multip’s os”. Hence, the cervix of a parous woman appears larger than that of a nulliparous woman. Postnatal period examination usually carried out 6 weeks after delivery helps to review the status of the mother  during the period of recuperation to detect any deviation such as subinvolution, postpartum infection, puerperal psychosis or mastitis. Note that postmenopausal women have thinner cervix than that of those within reproductive age. Cervical disorders Healthy cervix is a key factor in maintaining a healthy pregnancy. However, sometimes, a disruption in its structure or function resulting disorders such as: Cervicitis: Cervicitis refers to the cervical inflammation which is usually caused by infections such as chlamydia, gonorrhea  and herpes simplex. Its clinic features are vaginal discharge and  postcoital bleeding.   However, gonococcal and chlamydial cervicitis are often characterized with cervical oedema, mucopurulent discharge and cervical friability.  While ulcerative lesions(multiple small vesicular lesions) point at Herpes simplex viral infection.  Treatment for  infectious cervicitis involves administration of antibiotics for 7 days therapeutic regimen as well as sticking to safer sex practices.  Cervical incompetence: This is usually diagnosed during pregnancy when the cervix begins to dilate earlier, predisposing to premature labour and delivery.  Its causes may include surgical procedures on the cervix such as dilatation and curettage(D&C).  The incompetency is treated with cervical cerclage.   Cervical cancer/myomas: This occurs when there is cancerous growth on the cervix. It accounts for 6% of all leiomyomas which is often caused by infection of  the human papillomavirus (HPV). The HPV also causes  genital and cervical warts. Its clinical manifestations are feeling of mechanical pressure, urinary urgency, dysuria, dyspareunia, urethral and ureteral obstruction, obstruction of the cervix, menorrhagia and dysmenorrhea.  Diagnosis of cervical cancer is through pelvic examination and ultrasonography. While its treatment includes chemotherapy, radiation and surgery. Postcoital bleeding: This refers to bleeding after sexual intercourse and its causes may include benign or malignant etiology found on the cervix or other genital area such as cervical intraepithelial neoplasia (CIN) and invasive cancer, vaginal, or endometrial cancer.  If you are experiencing bleeding after sex, kindly meet a doctor (gynecologist) for a colposcopic examination and prompt attention.  Cervical Polyps/ Endocervical Polyps: These are abnormal small growths often painless and  harmless found on the cervix which can result in vaginal bleeding. The cervical polyps are diagnosed during pelvic examination and the patient may report postcoital, intermenstrual and/or postmenopausal bleeding.  Where necessary, treatment involves simple surgery that can be performed in the office. Cervical Ectropion This is otherwise known as cervical ectopy or erosion and it refers to a condition where there is eversion of the endocervix exposing the  columnar epithelium to the vaginal wall. Adolescents and pregnant women including those taking estrogen-containing contraceptives are far more likely to have ectropion.  Its clinical features are vaginal discharge and postcoital bleeding(especially in pregnant women).  Treatment is not needed unless there is excessive mucus discharge or troubling spotting. Cryotherapy or electrocautery is used for treating symptomatic ectropion. Other cervical disorders are: Nabothian cysts (mucinous retention cysts or epithelial cysts) cervical dysplasia/cervical intraepithelial neoplasia (CIN), cockscomb cervix, cervical collar, and clear cell adenocarcinoma(CCA).  Tofort Recommendation Cervix is a spindle-shaped organ that links the uterus to the vagina. It remains

Description of Fallopian tubes The Fallopian tubes are muscular canals extending from the cornua of the uterus and opening into the peritoneal cavity near the ovaries.  It helps to move released or fertilized eggs to the uterus for implantation. Blocked fallopian tubes is one of the causes of infertility in women. Fallopian tubes are also called oviducts, uterine tubes or salpignx, which are conduits through which spermatozoa pass through to fertilize the ovum at the ampullary portion of the tube.  Each tube measures 10cm in length and 6mm in diameter and is enveloped in the upper poles of the broad ligament. The tubes have a lumen which communicate with the uterine cavity medially and opens into the peritoneal cavity laterally. Gross structure of the Fallopian tubes Each tube is described in 4 parts The Interstitial part:This is the narrowest part of the tube measuring 1.23cm in length and lying within the thickness of the uterine wall. It’s lumen measures 1 mm in diameter. The Isthmus: This is a narrow portion of the tube, extending for about 2.5cm laterally from the uterine walls. The Ampulla: This is much wider than the Isthmus, extending for about 5 cm from the Isthmus towards the side wall of the pelvis. Fertilization of the ovum takes place in the . The Infundibulum: This is the last of the tube which measures 2.5m & turns backwards and downwards. It is funnel shaped and composed of numerous finger- like processes/ projections called the fimbriae which surrounds the tubal orifice. One fimbra is attached to the ovary and is known as “the fimbria ovarica” and is the longest of all. Microscopic structure of Fallopian tubes Each  uterine tube has  three layers:  The Endometrial layer: This is an inner lining of mucous membrane thrown into complicated folds known as the plicae. The folds are designed to slow down the passage of the ovum to the uterus .  Note that the mucous membranes in the cervix are arranged in tree-like structure known as arbo vitae. The plicae are more developed in the ampullary part of the ovidicts. Many of the cells of the lining are made of cubical epithelium and are ciliated.  The non-ciliated cells are called goblet cells and  they secrete mucus into lumen of the tube shortly before menstruation. Beneath the inner lining is a layer of vascular connective tissue. The Muscular layer: The muscle coat consist of  two layers: (a) an inner circular layer which surrounds the mucous layer and (b) an outer layer of longitudinal smooth muscles.  The peritoneal layer: This is an outer covering of peritoneum which is absent along the inferior surface of the tube between the layers of broad ligament. Anatomic surroundings Blood, Nerve & Lymphatic supply to Oviducts  Functions of Fallopian tubes  Disorders of Oviducts

Description of Non-pregnant or non-gravid uterus Uterus is a pear-shaped, hollow muscular organ which receives the insertion of two oviducts into its upper and outer angle.  The uterus provides an environment for nourishment, growth and development of fetus during pregnancy till delivery. Position: The uterus is located within the true pelvis above the vagina behind the bladder and in front of rectum in an anteverted and anteflexed manner.  Size: Measures 7.5cm long, 5cm wide, 2.5cm depth and 1.25cm thick in each wall. The uterus weighs about 60g. Gross structure  The uterus is discribed in two parts which are the body and the cervix.  The body is the upper two-thirds of the uterus and this in turn consists of the following parts: (a) Fundus: this is the broad rounded upper portion above the insertion of the tubes.  (b) Cavity: it is the hollow ‘D’ shaped area which has its base above and apex below and measures 5cm. Due to the flatness of the uterus, the anterior and posterior walls are in apposition.  (c) Cornua(horn): This is the lateral angle of the uterine body where fallopian tubes insert.  (d) Isthmus: This is the constricted or narrowed part which joins the body to the neck. Isthmus measures 7mm in length and is selected immediately above the internal is. Its function is to expand during the 2nd trimester of pregnancy to form lower uterine segment. Cervix: This is the neck of the uterus. Cervix is spindled shaped portion of the uterus, which is described in two parts: the supravaginal  and the intravaginal portions. Macroscopic Structure  The walls of the uterus are mainly composed of plain muscle cells called the myometrium. The uterine cavity is lined by mucous membranes known as the endometrium and  the peritoneum that covers the body the body of the uterus is known as perimetrium. Endometrium: This is the inner linning of the mucous membrane. The coporal endometrium undergoes series of changes from puberty to menopause(i.e. its appearance varies with each day of menstrual cycle). During menstruation, it is shed as far as the basal layer.  The cervical endometrium are of poor quality and do not undego any changes. The cervical endometrium is thrown into folds called arbo vitae (fern-like appearance) Myometrium:  This is the plain muscular layer which forms the second middle coat of of the uterus. It forms ⅞th of the thickness of the uterine walls and its fibres are arranged in three patterns: The Perimetrium The outer part of peritoneum covers only the upper part of the uterus. It is reflected posteriorly to the rectum — forming the pouch of Douglas and also anteriorly to the bladder —forming the utero-vesical pouch.  Control of haemorrhage(action of living ligatures) During third stage of labour, the oblique fibres which are arranged in the figure of ‘8’ patterns contract rhythmically. When these fibres contract, they ligate the arteries that pass via them thereby arresting bleeding. In addition, the contractions of the oblique fibres result in occlusion of the blood vessels. When the vessels are ligated, the fibrins form at the cut- end of the vessels and clot forms which occlude the vessels — making the escape of blood to be controlled. That is haemostasis mechanism.  Anatomic relationships Anteriorly: bladder, utero-vesical pouch, coils of intestines Posteriorly: rectum and pouch of Douglas Superiorly: coils of intestines Inferiorly: vagina and the base of bladder Laterally: Fallopian tubes, ovaries and broad ligaments  Supports of the uterus  The uterus is maintained or held in its position by 6 pairs of ligaments and individually by the pelvic floor muscles.  The supporting ligaments are: Blood, Nerve & Lymphatic Supply to Uterus Uterine Functions Changes that occurs in the uterus during pregnancy  Position: By 12th weeks of pregnancy, the uterus rises out of the pelvis to become an abdominal organ.  It is more vertical than anteverted and anteflexed.  Shape: As the uterus is increasing in size, its shape becomes modified. At the onset of pregnancy, it’s pear-shaped.  But by the end of third month, it becomes globular. Between 12th and 36th weeks, it becomes ovoid as the fetus grows longer. By the end of the third month, the isthmus widens out to form the lower uterine segment. Size: As the pregnancy advances, the uterus with 60g weight and  7.5cm long, 5cm wide and 2.5cm thick becomes 30cm long, 23cm wide and 20cm thick and weighs 900-1000g. The Isthmus increases from 7mm to 25mm in length. Changes in myoctyes(uterine muscle cells) The uterine muscle growth during pregnancy occurs in two ways which are: Hypertrophy: The actual muscle cells enlarge, increasing ten times in length and five times in width.  Hyperplasia: New muscle cells appear and grow along side of the pre-existing muscle cells.  Other changes occurring during pregnancy are: Physiology of uterus during pregnancy The uterus does not only enlarge remarkably to accommodate the growing fetus but also relaxes in order not to expel the fetus before term(uterus is intrinsically contractile). The growth and relaxation of uterine muscles are due to the hormones, oestrogen and progesterone respectively, both from corpus luteum and later from the placenta.  The uterus, however, is not completely relaxed. This is  because from 8th weeks onwards, periodic waves of contractions pass via the uterus. This lasts only for one minute and reoccur at  5-10 minutes intervals.  They are painless and women are unaware of their presence. These uterine contractions are known as “Braxton Hicks contractions”, “false labour” or “practice contraction” because they are simply preparing uterus for the role it would play during labour.  Towards the end of pregnancy, the contractions become stronger and more frequent and are responsible for taking up of the cervix(effacement) during the last month of pregnancy.  They increase during labour and become true labour contractions, and the woman then experiences discomfort or pain.  The bottom line  The uterus otherwise known as womb, is a pear-shaped muscular organ of the female reproductive system which is suitated  between the bladder anteriorly and the rectum posteriorly. It houses and nourishes fertilized egg (zygote) till