female reproductive

7/18/2019 Female Reproductive

http://slidepdf.com/reader/full/female-reproductive-56d75405dfdeb 1/87

Female reproductive system



Event of oogenesis



Physiological Stages

Neonatal period: birth---4 weeks

Childhood: 4 weeks----12 years

Puberty: 12 years---18 years Sexual aturation: 18 year---!" year

Perienopause: decline o# o$arian #unction

%4" years&----1 year postenopause Postenopause:



'enstruation

'enstruation

cyclic endoetriu sheds and bleeds due to cyclico$ulation

'ense1( )ndoetriu is sloughed %progesterone withdrawal&

2( Nonclotting enstrual blood ainly coes #roartery %*!+&

,( nter$al: 24-,! days %28 days&( duration: 2-. days( the#irst day o# enstrual bleeding is consideredy by day1

4( Shedding: ,"-!" l



Central reproducti$e horones

/ypothalaus-Pituitary-0$ary%/-P-0 axis&




Neuroendocrine regulation

1( onadotropin-releasing horonen3/

1& cheical structure

%pro&lu-/is-rp-Ser-yr-ly-5eu-6rg-Pro-ly-N/2

2& Synthesi7e and transport

nerve cells

hypothalamus

portal vein

pitutary

anterior lobe




,& 3egulation o# n3/

/ypothalas

n3/

Pituitary

S/ 5/

0$ary

)P




2( onadotropins

1& Coposition %glycoprotein&

ollicle stiulating horoneS/

5uteini7ing horone5/

2& Synthesi7e and transport

Gonadotroph(pulse)

Bloodcirculation

ovary




,( Prolactin %P35&

3egulated by the prolactin inhibiting #actor %P&



he 0$arian cycle

unction o# o$ary

1( 3eproduction

de$elopent and aturation o# #ollicle9 o$ulation

2( )ndocrine

estrogens progesterone testosterone



he 0$arian cycle

Cyclic changes o# o$ary

1( he de$elopent and aturation o# #ollicle

1& Priordial #ollicle: be#ore eiosis

2& Preantral #ollicle: 7ona pellucida granulosa cells %S/receptor&

,& 6ntral #ollicle: granulosa cells %5/ receptor& )

4& 'ature #ollicle: )P

heca externa theca interna granulosa #ollicular antruound radiate coronal

!& ollicular phase: day 1 to #ollicle ature %14 days&



he 0$arian cycle



he 0$arian cycle

2( 0$ulation

1& irst eiosis copleted→

collagen decoposed→

oocyte o$ulated

2&

3egulationa& 5/;S/ peak

)2 (

ature #ollicle) →

n3/ %hypothalaus&→

5/;S/ peak %positi$e #eedback&

b& P cooperation5/ < P %#ollicle luteini7ed be#ore o$ulation&

<positi$e #eedback



he 0$arian cycle

,( Corpus luteu

1& #ollicle luteini7ed a#ter o$ulation: luteal cells

2& 5/ → =) → corpus heorrhagicu

,& 3egression

non #ertili7ed < corpus albicans

4& 5uteal phase

0$ulation to day 1



he 0$arian cycle

sex horones secreted by o$ary

1( Coposition

)strogen progesterone testosterone

2( Cheical structure

Steroid horone

,( Synthesis

Cholesterol<pregnenolone<androstenedione<testosterone<estradiol

>! or >4 pathway o# estrogen production



he 0$arian cycle

4( 'etabolis: li$er

!( Cyclic change o# ) and P in o$ary

1& )strogen

a& )%day *& < ) peak %pre-o$ulate& < )? < ) %1

day a#ter o$ulate& <) peak %day *-8& < )?

b& theca interna cells %5/ receptor& < testosterone

c& ranulosa %S/ receptor& < estrogen



he 0$arian cycle

2& Progesterone

P

%a#ter o$ulation&→

P peak %day *-8&→

P↓

granulosa

progesterone

LH



Ovarian responses



he 0$arian cycle

/-P-0 axis

1( Positi$e #eedback

Sex horones %)& < n3/ or 5/;S/

) peak %@2""pg;l& < 5/;S/ peak < o$ulation

2( Negati$e #eedback

Sex horones %)& < n3/ or 5/;S/↓

ollicular phase: ) < S/↓5uteal phase: )P < 5/;S/

↓

%#oration&

)↓P↓ < 5/;S/%regression&



The endometral cycle

Proli#erati$e phase

1( )

%itogen&→

stroa thickens and glands

becoe elongated→

proli#erati$e endoetriu

2( Auration: 2 weeks

,( hickness: "(! → !



he endoetral cycle

Secretory phase

1( P %di##erentiation& → secretory endoetriu

2( eatures

stroa becoes loose and edeatousblood $essels entering the endoetriu becoe thickened

and twisted

glands becoe tortuous and contain secretory aterial

within the luina,( Auration: 2 weeks

4( hickness: !-.



Change o# 0ther genital organs

Cer$ix

endocer$ical glands %)

&< ucus%thinclear watery& <

axial %o$ulation&

endocer$ical glands %P

&< ucus%thick opaBuetenacious&

Vagina

=aginal ucosa %) )

< thickening and secretorychanges

=aginal ucosa %P

& < secrete↓



Pregnancy

1. Fertilization

2. Placenta development,

nutrition3. Hormonal changes duringpregnancy



Fertilization



The sperm passes through the corona radiata, the outermost cell layer of the egg.

The sperm breaks through the ona pellucida.

This occurs !ith the aid of several enymes possessed by the sperm that break

do!n the proteins of the ona pellucida, the most important one being acrosin.

"hen the sperm penetrates the ona pellucida, the #crosome reaction occurs. This

makes the egg impermeable to any other sperms and prevents fertiliation by more

than one sperm.

The cell membranes of the egg and sperm fuse together.

The female egg, also called a secondary oocyte at this stage, completes its second

meiotic division. This results in a mature ovum.

The sperm$s tail and mitochondria degenerate !ith the formation of the male pronucleus.

The male and female pronuclei fuse to form a ne! nucleus that is a combination of

the genetic material from both the sperm and egg.



Fertilization

Fertilization inthe ampulle o"the F#.

$ Prostaglandins$ O%ytocin

Ectopic(extrauterine)gravidity



Fertilization

#ransport intothe uterus & 3&5 days

$ 'ontractiono" the F#isthmus$ (ela%ation &progesteron



Fertilization

)mplantation5&* days a"ter"ertilization

$ Proteolyticenzymes o"thetropho!lastcells



Placenta



Placenta development

$ +arly nutrition o" the em!ryo & invasion o"tropho!lastic cells into the decidua$ Progesteron produced !y ' & stimulates decidualcells to concentrate glycogen, proteins and lipids



Placenta works as aphysiological A-V shunt



Placenta - oxygentransport$

-imilarities !eten placenta and lungs$O%ygen transport & simple di"usion

ungs

$ pO2 in alveoli…………………………..100mmHg

$ pO2 in the venous blood……………40mmHg

$ dO2 in (pressure gradient)…………60mmHg

Placenta/

$ pO2 in placental sinuses00005mmHg$ pO2 in "etal um!ilical vein0003mmHg

$ dO2 in pressure gradient0002mmHg

ow is a su!cient oxygenation o" the "etuspossi#le$



Placenta - oxygentransport

%& Fetal hemoglo#in

'& igher #

concentration in the"etal !lood5 more than in adults

& ou#le *ohr e+ect & Hb can carry moreoygen in lo! p"O2 than

in high p"O2



Placenta - ,'.

nutritients. wasteproducts transport$ ,' gradient & 2&3 mmHg, !ut e%treme solu!ility

diuses 2times "aster than o%ygen

$ "acilitated diusion "or glucose

high glucose need in 3dr trimester$ "ree diusion o" "atty acids

$ diusion o" aste products !ased on concentrationgradient

$ drugs crossing placental !arier & teratogens/$ #alidomide, 'ar!amazepine, 'oumarins,

#etracycline0

$ 6lcohol, nicotine, heroin, cocaine, caeine$ &



ormonal

,hanges uringPregnancy

l h



ormonal changes

,0

,1

uman ,horionic0onadotropin

$ prevent involutionpregesterone, estrogen

$eect on the testes o"male "etus & developmento" se% organsuman ,horionic1omatomammotropin

$ eect on latation$groth hormone eects

$decreases insulinsensitivity & more glucose

"or the "etus

l h



ormonal changes

Progesterone

Estrogens

$ development o"decidual cells

$ decreases uteruscontractility

$ preparation "or thelactation

$ enlargement o" uterus

$ !reasts development

$ rela%ation o" ligments

$ estriol level & indicatoro"

vitality o" the "etus



Progesterone and ,ortisolmeta#olism

Placenta

l h



ormonal changes

Placenta 2other

'(H 6'#H aldosteronecortisol

edema

insulin resistaH'7

H' thyrotropinhyperthyroidism

hypertensio

gestationaldia#etes

yperparathyroidism'alcium demands



ther

Physiological,hanges

, di l h



,ardiovascular changes

,ardiac output (,)$ 3 &5 a!ove normal

$ placental circulation$ increased meta!olism$ s8in & thermoregulation

$ renal circulation

$ decreases in last 9 ee8s uterus compressesvena cava

$ incr. 3 more during la!or

$ eart rate H( increases up to :;min$ *lood pressure <P drops, peri"eral resistancedecreases

$ +'7 changes$ "unctionalmurmurs

$ heart sounds

l i h



ematologic changes

$ plasma volume increases 5$ erythropoesis (<' increases 25$ decreased #. hematocrite

$ )ron re=uirements increases signi>cantly$ 3ron suplements needed

4 i h



4espiratory changes

$ o%ygen consumption increases$ 2 a!ove normal

$ Progesterone increasessensitivity

"or 'O2 in respiratory

centre

$ 7roing uterus

$ Fre=uency

increases$ inute ventilation

increases 5

$ p'O2 decreases

slightly

5 i t



5rinary system

$ 7lomerulat >ltration rate and renal plasma?o increases

up to 3 & 5

$ )ncreased rea!sorption o" ions and ater & placental steroids & aldosterone

$ -light increase o" urine "ormation

$ Postural changes aect renal "unctions& upright position& supine position& lateral osition durin slee



Preeclampsia. Eclampsia

$ Preeclampsia - pregnancy induced hypertension6 proteinuria

$ )ncresing <P since 2th ee8 & hypertension

$ -alt and ater retention & edema "ormation$ (<F and 7F( decreases

$ e%tensive secretion o" placental hormones @$ insuAcient !lood supply to placenta & ischemia

& increased resistance& #BF al"a, cyto8ines @

$Eclampsia & vascular spasms, chronic seizures, coma



7utrition and

2eta#olism



2aternal weight gain

Fetus 8 kg

2othe 9 kg



2aternal-Fetal

2eta#olism$ 25 & 3 e%tra 8cal;day should !e ingested & 95 "etal meta!olism, 15 stored in maternal

"at

$ +%tra protein inta8e & 3g;day$ +nd o" pregnancy & "etal glucose need 5mg;8g;minmother 2,5mg;8g;min

$ ' phases o" pregnancy/%st - ':th week - mother;s ana#olic phase/

& ana!olic meta!olism o" the mother& =uite small nutrition demands o" the

conceptus'% - <: week (esp& last trimester)/

& high meta!olic demands o" the "etus-



2aternal-Fetal

2eta#olism2other;s ana#olic phase/& normal or increased sensitivity to insulin& loer plasmatic glucose level& lipogeneses, glycogen stores increases

& groth o" !reasts, uterus,eight gain

,ata#olic phase (accelerated starvation)/& maternal insuln resistance

& increased transport o" nutritients troughplacental mem!rane

& lipolysis

$ 3nsulin resistance caused #y ,1. cortisol androwth hormone



1pecial nutrition need in

pregnancy$ High protein diet, higher energy upta8e

$ )ron supplements & 3mg "errous sul"ate

$ < & vitamins & erythropoesis

$ Folic acid "olate & reduces ris8 o" neural tu!e de"ects

$ Citamin D3 E 'a supplements

$ <e"ore parturition & vitamin prevention o"intracranial !leedingduring the la!or



Parturition

<irth o" the !a!y

<oth <iological and -ocial +vent

+%pected Day o" Delivery

G 2 days 39 ee8s a"ter "ertilizationG 29 days 4 ee8s a"ter last menstrual

period

• Onset o" a!or not completely understood

!ut e do 8no itIs a!out/1. echanical Factors psst this means muscles

2. Hormonal Factors oh yes there are moreJJ

3t= >ik 2 th



3t=s >ike a 2arathon/?he *ody Prepares

#raining/ >tness o" momand "etus are importantduring la!or remem!erhypo%ia !adJ

-tretching/ igaments

rela% esp. pu!ic symphisisma8ing more room inpelvic !rim

Practice ma8es per"ect/<ra%ton&Hic8s 'ontractions

give the top myometriuma or8out, stretch the!ottom muscles and helpdilate the cervi%

@our Favorite/



@our Favorite/ormones

Fetal Hormones High +strogen vs.

Progesterone

Prostaglandins O%ytocin (ela%in 6ll com!ine "or a

PO-)#)C+ "eed!ac8loop

n @our 2ark 0et 1et



n @our 2ark. 0et 1et.0o ?he nset o" >a#or

Fetal Hypothalmus secretes 'orticotropin(eleasing Hormone near term hich stimulatesthe

Fetal 6nterior Pituitary to secrete

adrenocorticotropin hormone 6'#H 6'#H stimulates "etal adrenal corte% to produce

cortisol 'ortisol stimulates secretion o" estrogen "rom

placenta, inhi!ition o" P synthesis &K uterinecontractions &K stimulates o%ytocin &K hyp

Fetuses ith adrenal hypoplasia are o"ten post&date and la!or is slo to start

Estrogen and



Estrogen andProgesterone

$ Progesteroneinhi!itscontracti!ility

$ +strogen increasescontracti!ility

$ 6t *th month,estrogen stillincreasing !utprogesteronedrops o slightly

$ High +strogen/Progesterone ratioe%cites uterus

xytocin/ B?he ormone



xytocin/ ?he ormoneo" >oveC -2ichel dent

Peptide hormone created in hypothalmus Once +/P stimulating contraction,

hypothalmus signaled to send o%ytocin toposterior pituitary

+ and Prostaglandin increase sensitivity o"o%ytocin receptors

-timulates uterine contraction and !reasts 6dministered to stimulate la!or as pitocin Fun Fact/ hormone involved in orgasmJJ



?wo 2ore

Prostagladins (elease stimulated

!y estrogen ando%ytocin

6lso stimulateso%ytocin E loop

Promotes uterine

contractions

(ela%in

Peptide hormoneproduced !y the

corpus luteum ooses ligaments

-o"tens cervi%

)ncreases L o"o%ytocin receptors



?hree 1tages o" >a#or

Dilation and+acement

Descent and

+%pulsion +%pulsion o"

Placenta



1tage ne/ ilation

)ntermittentcontractions M 1minutes

'ervi% dilating andthinning

6verage 12 hoursprimigravidas, *hours "ormultigravidas

Vertex and ?ransverse



Vertex and ?ransversePositions

Certe% position headdon is Nnormal

terus contractspushing the occiput

!one to put pressureon cervi% to dilate

#ransverse lie is orstcase scenario ith

shoulder as presentingpart



*reech Presentation



1tage ?wo/ Expulsion

<egins hen cervi%"ully dilated 1cm

'ontractions arestrongest at top o"uterus pushing"etus donard

6verage 5 minutesprima, 2 min multi ead ,rowing

,an @ou ?ell the



,an @ou ?ell thei+erence$

ost - hospitals encourage omen to deliver insupine position

Physiologically orst position !ecause or8sagainst gravity, compresses !lood vesselsendangering !a!y and increases chance o" 3rdand 4th degree tears ith episiotomy

Dorking ard



Dorking ard2om and *a#y

Pain "rom contractions comes >rst "romhypo%ia to uterine muscles and then "romstretching and straining

'ontractions intermittent !ecause !a!yIs!lood supply compromised and "etal H(drops ith every contraction, thus hypo%iacan occur esp hen too much pit is given

<a!y is an active participant in !irthpushing and negotiating !ony structure toget through !irth canal

?his >ittle 0uy is All ?uckered u



1tage / Placenta

terus contracts reducingarea o" attachment

-eparation o" placentaresults in !leed and clotting

Placenta e%pelled (epresents stage hen

hemorrhage can occur Pitocin administered to aid

uterine contraction

anual +%traction i" retained asts a!out 15 minutes

4ecovery ?ime



4ecovery ?ime

%ontraction of uterus result in

constriction of spiral arteries&!hat !as their role again'(

)other * Father * +aby+onding Time intense periodof hormone release prolactin,serotonin, dopamine, thehappy hormones

-n first hour of life, babies cancra!l and self*attach to breast

ho!ever babies that aredrugged are almost al!ays toodisoriented to do so

appy 2om *reast"eeding

3" All Else Fails



3" All Else Fails,esarean 1ection

)ndications/G 'ord Prolapse

G #ranverse ie

G Fetal Distress

GPlacenta PreviaG Placenta 6!ruption

G NFailure to Progress

G C<6'/ ris8 o" uterinerupture

G 'ephlo&PelvicDisproportion



Darning/ 2idwi"e



Darning/ 2idwi"e1peaking

- '&section rate 25&3 QHO says K1 unnecessary )nterventions such as

epidurals, ithholding "oodand ater, supine position

increase chance o" '&section Hospital settings induce

an%iety, release o"adrenaline, la!or -#OP-

Feminist criti=ue/ uch o"language used to descri!e!irth is very unempoeringie "ailure to progess,stu!!orn uterus

If we hope to create

i l t ld



a non-violent world

where respect and kindness

replace fear and hatred

We must begin

with how we treat each other

at the beginning of life.

For that is where

our deepest patterns are set.

From these roots

grow fear and alienation

~or love and trust.

~Suzanne Arms

If we want to create a less violent world, we

must begin with birth

h k "



?hank you "or

attention

female reproductive

Documents