Anatomy and Physiology

The female reproductive system (or female genital system) contains two main parts: the uterus, which
hosts the developing fetus, produces vaginal and uterine secretions, and passes the male's sperm through
to the fallopian tubes; and the ovaries, which produce the female's egg cells. These parts are internal; the
vagina meets the external organs at the vulva, which includes the labia, clitoris and urethra. The vagina
is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the Fallopian
tubes. At certain intervals, the ovaries release an ovum, which passes through the Fallopian tube into the
uterus.

If, in this transit, it meets with sperm, the sperm penetrate and merge with the egg, fertilizing it. The
fertilization usually occurs in the oviducts, but can happen in the uterus itself. The zygote then implants
itself in the wall of the uterus, where it begins the processes of embryogenesis and morphogenesis.
When developed enough to survive outside the womb, the cervix dilates and contractions of the uterus
propel the fetus through the birth canal, which is the vagina.

The ova are larger than sperm and are generally all created by birth. Approximately every month, a
process of oogenesis matures one ovum to be sent down the Fallopian tube attached to its ovary in
anticipation of fertilization. If not fertilized, this egg is flushed out of the system
Internal Structures
A female's internal reproductive organs are the vagina, uterus, fallopian tubes, cervix and ovary

Vagina

The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female
mammals, or to the cloaca in female birds and some reptiles. Female insects and other invertebrates also
have a vagina, which is the terminal part of the oviduct.

The vagina is the place where semen from the male is deposited into the female's body at the climax of
sexual intercourse, commonly known as ejaculation. Around the vagina, pubic hair protects the vagina
from infection and is a sign of puberty. The vagina is mostly used for sexual intercourse.

Cervix

The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is
cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately
half its length is visible; the remainder lies above the vagina beyond view!

Uterus

The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into
the vagina; the other is connected on both sides to the fallopian tubes.

The uterus is a pear-shaped muscular organ. Its major function is to accept a fertilized ovum which
becomes implanted into the endometrium, and derives nourishment from blood vessels which develop
exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates
until childbirth. If the egg does not embed in the wall of the uterus, a woman begins menstruation and
the egg is flushed away.

Oviducts

The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals
into the uterus.

On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter
the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner
lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube,
then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of
pregnancy.

Ovaries

The ovaries are the place inside the female body where ova or eggs are produced. The process by which
the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the
length of a menstrual cycle.

After ovulation, the ovum is captured by the oviduct, after traveling down the oviduct to the uterus,
occasionally being fertilized on its way by an incoming sperm, leading to pregnancy and the eventual
birth of a new human being.

The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell
travel.

External Structures

The external components include the labia, clitoris and urethra.

The function of the external female reproductive structures (the genital) is twofold: To enable sperm to
enter the body and to protect the internal genital organs from infectious organisms. The main external
structures of the female reproductive system include:

 Labia majora: The labia majora enclose and protect the other external reproductive organs.
Literally translated as "large lips," the labia majora are relatively large and fleshy, and are
comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands.
After puberty, the labia majora are covered with hair.
 Labia minora: Literally translated as "small lips," the labia minora can be very small or up to 2
inches wide. They lie just inside the labia majora, and surround the openings to the vagina (the
canal that joins the lower part of the uterus to the outside of the body) and urethra (the tube that
carries urine from the bladder to the outside of the body).
 Bartholin’s glands: These glands are located next to the vaginal opening and produce a fluid
(mucus) secretion.
 Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that is
comparable to the penis in males. The clitoris is covered by a fold of skin, called the prepuce,
which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very
sensitive to stimulation and can become erect.

Cesarean section

A Caesarian section (or Cesarean section in American English), also known as C-section or Caesar, is a surgical
procedure in which incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to
deliver one or more babies. It is usually performed when a vaginal delivery would put the baby's or mother's life
or health at risk, although in recent times it has been also performed upon request for childbirths that could
otherwise have been natural.[1][2][3] The World Health Organization (WHO) recommends that the rate of
Caesarean sections should not exceed 15% in any country.

There are several types of Caesarean section (CS). An important distinction lies in the type of incision
(longitudinal or latitudinal) made on the uterus, apart from the incision on the skin.

 The classical Caesarean section involves a midline longitudinal incision which allows a larger space to
deliver the baby. However, it is rarely performed today as it is more prone to complications.
 The lower uterine segment section is the procedure most commonly used today; it involves a transverse
cut just above the edge of the bladder and results in less blood loss and is easier to repair.
 An emergency Caesarean section is a Caesarean performed once labour has commenced.
 A crash Caesarean section is a Caesarean performed in an obstetric emergency, where complications of
pregnancy onset suddenly during the process of labour, and swift action is required to prevent the
deaths of mother, child(ren) or both.
 A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This
may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus.
 Traditionally other forms of Caesarean section have been used, such as extraperitoneal Caesarean
section or Porro Caesarean section.
 a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is
performed through the old scar.

In many hospitals, especially in Argentina, the United States, United Kingdom, Canada, Norway,
Sweden, Australia, and New Zealand the mother's birth partner is encouraged to attend the surgery to
support the mother and share the experience. The anaesthetist will usually lower the drape temporarily
as the child is delivered so the parents can see their newborn.

Indications

Caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. Not
all of the listed conditions represent a mandatory indication, and in many cases the obstetrician must use
discretion to decide whether a caesarean is necessary. Some indications for caesarean delivery are:

Complications of labor and factors impeding vaginal delivery such as

 prolonged labor or a failure to progress (dystocia)

 fetal distress
 cord prolapse
 uterine rupture
 placental problems (placenta praevia, placental abruption or placenta accreta)
 abnormal presentation (breech or transverse positions)
 failed labor induction
 failed instrumental delivery (by forceps or ventouse. Sometimes a 'trial of forceps/ventouse' is tried out
- This means a forceps/ventouse delivery is attempted, and if the forceps/ventouse delivery is
unsuccessful, it will be switched to a caesarean section.
 overly large baby (macrosomia)
 umbilical cord abnormalities (vasa previa, multi-lobate including bi-lobate and succenturiate-lobed
placentas, velamentous insertion)
 contracted pelvis

Other complications of pregnancy, preexisting conditions and concomitant disease such as

 pre-eclampsia
 hypertension [15]
 multiple births
 precious (High Risk) Fetus
 HIV infection of the mother
 Sexually transmitted infections such as genital herpes (which can be passed on to the baby if the baby is
born vaginally, but can usually be treated in with medication and do not require a Caesarean section)
 previous Caesarean section (though this is controversial – see discussion below)
 prior problems with the healing of the perineum (from previous childbirth or Crohn's Disease)

Description

Regional anesthesia, either a spinal or epidural, is the preferred method of pain relief during a c-section.
The benefits of regional anesthesia include allowing the mother to be awake during the surgery,
avoiding the risks of general anesthesia, and allowing early contact between mother and child. Spinal
anesthesia involves inserting a needle into a region between the vertebrae of the lower back and
injecting numbing medications. An epidural is similar to a spinal except that a catheter is inserted so that
numbing medications may be administered continuously. Some women experience a drop in blood
pressure when a regional anesthetic is administered; this can be countered with fluids and/or
medications.

In some instances, use of general anesthesia may be indicated. General anesthesia can be more rapidly
administered in the case of an emergency (e.g., severe fetal distress). If the mother has a coagulation
disorder that would be complicated by a drop in blood pressure (a risk with regional anesthesia), general
anesthesia is an alternative. A major drawback of general anesthesia is that the procedure carries with it
certain risks such as pulmonary aspiration and failed intubation. The baby may also be affected by the
anesthetics since they cross the placenta; this effect is generally mild if delivery occurs within 10
minutes after anesthesia is administered.
Once the patient has received anesthesia, the abdomen is washed with an antibacterial solution and a
portion of the pubic hair may be shaved. The first incision opens the abdomen. Infrequently, it will be
vertical from just below the navel to the top of the pubic bone or, more commonly, it will be a horizontal
incision across and above the pubic bone (informally called a "bikini cut").

The second incision opens the uterus. In most cases, a transverse incision is made. This is the favored type
because it heals well and makes it possible for a woman to attempt a vaginal delivery in the future. The classical
incision is vertical. Because it provides a larger opening than a low transverse incision, it is used in the most
critical situations such as placenta previa. However, the classic incision causes more bleeding, a greater risk of
abdominal infection, and a weaker scar.

To remove a baby by cesarean section, an incision is made into the abdomen, usually just above the pubic
hairline (A). The uterus is located and divided (B), allowing for delivery of the baby (C). After all the contents
of the uterus are removed, the uterus is repaired, and the rest of the layers of the abdominal wall are closed
(D).

Once the uterus is opened, the amniotic sac is ruptured and the baby is delivered. The time from the
initial incision to birth is typically five minutes. The umbilical cord is clamped and cut, and the newborn
is evaluated. The placenta is removed from the mother, and her uterus and abdomen are stitched closed
(surgical staples may be used instead in closing the outermost layer of the abdominal incision). From
birth through suturing may take 30–40 minutes; the entire surgical procedure may be performed in less
than one hour.

Diagnosis/Preparation

There are several ways that obstetricians and other doctors diagnose conditions that may make a c-
section necessary. Ultrasound testing reveals the positions of the baby and the placenta and may be used
to estimate the baby's size and gestational age. Fetal heart monitors, in use since the 1970s, transmit any
signals of fetal distress. Oxygen deprivation may be determined by checking the amniotic fluid for
meconium (feces); a lack of oxygen may cause an unborn baby to defecate. Oxygen deprivation may
also be determined by testing the pH of a blood sample taken from the baby's scalp; a pH of 7.25 or
higher is normal, between 7.2 and 7.25 is suspicious, and below 7.2 is a sign of trouble.

When a c-section becomes necessary, the mother is prepped for surgery. A catheter is inserted into her
bladder and an intravenous (IV) line is inserted into her arm. Leads for monitoring the mother's heart
rate, rhythm, and blood pressure are attached. In the operating room , the mother is given anesthesia,
usually a regional anesthetic (epidural or spinal), making her numb from below her breasts to her toes.
In some cases, a general anesthetic will be administered. Surgical drapes are placed over the body,
except the head; these drapes block the direct view of the procedure.

Aftercare

A woman who undergoes a c-section requires both the care given to any new mother and the care given
to any patient recovering from major surgery. She should be offered pain medication that does not
interfere with breastfeeding. She should be encouraged to get out of bed and walk around eight to 24
hours after surgery to stimulate circulation (thus avoiding the formation of blood clots) and bowel
movement. She should limit climbing stairs to once a day, and avoid lifting anything heavier than the
baby. She should nap as often as the baby sleeps, and arrange for help with the housework, meals, and
care of other children. She may resume driving after two weeks, although some doctors recommend
waiting for six weeks, the typical recovery period from major surgery.