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Maternity Chapter 4

Vocabulary and concepts

vulva include all structures visible externally from the pubis to the perineum: the mons pubis, the labia majora, the labia minora, the clitoris, the vestibular glands, the vaginal vestibule, the vaginal orifice, and the urethral opening.
mons pubis a fatty pad that lies over the anterior surface of the symphysis pubis.
vaginal vestibule an almond-shaped area enclosed by the labia minora that contains openings to the urethra, Skene glands, vagina, and Bartholin glands.
perineum a skin-covered muscular area that covers the pelvic structures.
Four pairs of ligaments support the uterus: the cardinal, the uterosacral, the round, and the broad.
The uterus is divided into two major parts an upper triangular portion called the corpus and a lower cylindric portion called the cervix
fundus the dome-shaped top of the uterus and is the site at which the uterine tubes enter the uterus.
The isthmus (lower uterine segment) is a short, constricted portion that separates the corpus from the cervix.
functions of the uterus: reception, implantation, retention, and nutrition of the fertilized ovum and later of the fetus during pregnancy, and for expulsion of the fetus during childbirth. It also is responsible for cyclic menstruation.
The uterine wall comprises three layers: the endometrium, the myometrium, and part of the peritoneum (membrane that covers the abdominal wall).
endometrium layers: The endometrium is a highly vascular lining made up of three layers, the outer two of which are shed during menstruation.
myometrium The myometrium is made up of layers of smooth muscles that extend in three different directions (longitudinal, transverse, and oblique) (Fig. 4-3).
outer layer of the myometrium > longitudinal: assist in expelling fetus, and found on the outside of the myometrium
middle layer of the myometrium > middle layer has all three types of fiber that assist in ligating blood vessels after childbirth and control blood loss.
inner layer of the myometrium circular fibers of the inner myometrial layer are around the site where the uterine tubes enter the uterus and around the internal cervical os (opening). >>They help keep the openings close when needed
The cervix is made up of mostly... fibrous connective tissues and elastic tissue, making it possible for the cervix to stretch during vaginal childbirth.
How does the cervix feel? The cervix feels firm (like the end of a nose) with a dimple in the center, which marks the external os.
squamocolumnar junction where the two types of cells meet, is usually located just inside the cervical os. >> also called the transformation juction >> the most common site for neoplastic changes >> cells from this site are scraped for the Pap test
uterine tubes are supported by broad ligaments.
Four sections of the uterine tubes: the -interstitial- portion is closest to the uterus; the -isthmus- and the -ampulla- are the middle portions; and the -infundibulum- is closest to the ovary.
Where is the ovum fertilized? The ovum is usually fertilized by the sperm in the ampulla portion of one of the tubes.
Estrogen, progesterone, and androgen are the hormones produced by what? The ovaries.
The bony pelvis serves three primary purposes: protection of the pelvic structures, accommodation of the growing fetus during pregnancy, and anchorage of the pelvic support structures.
Once ovulation begins in puberty, what hormone levels increases? Progesterone
The pelvis is divided into two parts: the false pelvis and the true pelvis
false pelvis: The false pelvis is the upper portion above the pelvic brim or inlet.
true pelvis: The true pelvis is the lower, curved bony canal, which includes the inlet, the cavity, and the outlet through which the fetus passes during vaginal birth.
Pelvic ossification is complete at what age? 20.
location of the breast between the 2nd and 6th ribs
Estrogen effect on the breast--> Estrogen stimulates growth of the breast by inducing fat deposition in the breasts,and growth of the extensive ductile system. Estrogen also increases the vascularity of breast tissue.
Full development of the breast: After the end of the first pregnancy or in the early period of lactation.
When do the breasts grow the least? The physiologic alterations in breast size and activity reach their minimal level about --5 to 7 days after menstruation stops--.
When should women do a breast-self examination? (best time) --5 to 7 days after menstruation stops--.
FEMALE REPRODUCTIVE PHYSICAL ASSESSMENT ACROSS THE LIFE CYCLE Refer to pg. 66 table 4-1 for details Growth of reproductive organs complete by age 20, except for the breast. Postmenopausal organs include smaller ovaries and uterus.
menarche First menstruation.
Menstruation the periodic uterine bleeding that begins approximately 14 days after ovulation. --1st day of bleeding is day one, followed by about 5 days of menstrual flow
Hypothalamic-Pituitary Cycle Follicular phase and luteal phase (half-half) FSH makes estrogen until ovulation After ovulation, LH takes over
Ovarian Cycle estrogen levels increase before ovulation, and decrease afterward. LH surge after ovulation, and decrease at menstruation.
Endometrial Cycle (4 phases) The four phases of the endometrial cycle are (1) the menstrual phase, (2) the proliferative phase, (3) the secretory phase, and (4) the ischemic phase
what occurs during the menstrual phase of Endometrial Cycle? shedding of the endometrium
what occurs during the proliferative phase of Endometrial Cycle? The endometrial surface is completely restored in approximately 4 days, or slightly before bleeding ceases. From this point on, an eight- to tenfold thickening occurs, with a leveling off of growth at ovulation. (estrogen is responsible for this)
Secretory phase of the endometrial cycle The secretory phase extends from the day of ovulation to about 3 days before the next menstrual period. >> Progesterone is produced and endometrial wall is ready to possibly support a fertilized ovum
Cervical Mucus consistency before and after ovulation Very thick Discourages entry of the little guys (sperm)
Cervical Mucus consistency during ovulation cervical mucus is thin and clear. It looks, feels, and stretches like egg white.
Menstrual blood and prostaglanding levels: Menstrual blood is a potent prostaglandin source.
climacteric transitional phase during which ovarian function and hormone production decline.
Menopause Last menstrual period
Perimenopause period preceding menopause that lasts about 4 years. During this time, ovarian function declines. Ova slowly diminish, and menstrual cycles may be anovulatory, resulting in irregular bleeding. Bleeding stops at decline of estrogen.
Sexual Response divided into four phases: excitement phase, plateau phase, orgasmic phase, and resolution phase.
Created by: ekm