Female Reproductive Female Reproductive SystemSystem

EggsEggs” are produced in the ” are produced in the ovariesovaries, , female typically has about 400,000 female typically has about 400,000 follicles/potential eggs, all formed follicles/potential eggs, all formed before birth. before birth. Only several hundred of these “eggs” Only several hundred of these “eggs” will actually ever be released during will actually ever be released during her reproductive years her reproductive years

Normally, in humans, after the onset Normally, in humans, after the onset of puberty, due to the stimulation of of puberty, due to the stimulation of follicle-stimulating hormone follicle-stimulating hormone (FSH)(FSH) one “egg” per cycle matures one “egg” per cycle matures and is released from its ovary. and is released from its ovary.

OvulationOvulation is the release of a mature “egg” is the release of a mature “egg” due to the stimulation of due to the stimulation of leutenizing leutenizing hormone (LH)hormone (LH), which then stimulates the , which then stimulates the remaining follicle cells to turn into a remaining follicle cells to turn into a corpus corpus luteumluteum which then secretes which then secretes progesteroneprogesterone to prepare the uterus for possible to prepare the uterus for possible implantation. If an egg is not fertilized and implantation. If an egg is not fertilized and does not implant, the corpus luteum does not implant, the corpus luteum disintegrates and when it stops producing disintegrates and when it stops producing progesterone, the lining of the uterus progesterone, the lining of the uterus breaks down and is shed. breaks down and is shed.

The internal genital organs form a pathway (the The internal genital organs form a pathway (the genital tract). This pathway consists of the genital tract). This pathway consists of the following:following:

Vagina (part of the birth canal), where sperm are Vagina (part of the birth canal), where sperm are deposited and from which a baby can emerge deposited and from which a baby can emerge

Uterus, where an embryo can develop into a fetus Uterus, where an embryo can develop into a fetus Fallopian tubes (oviducts), where a sperm can Fallopian tubes (oviducts), where a sperm can

fertilize an egg fertilize an egg Ovaries, which produce and release eggs Ovaries, which produce and release eggs Sperm can travel up the tract, and eggs down the Sperm can travel up the tract, and eggs down the

tract.tract.

Internal Genital OrgansInternal Genital Organs

At the beginning of the tract, just inside the At the beginning of the tract, just inside the opening of the vagina, is the hymen, a opening of the vagina, is the hymen, a mucous membrane. In virgins, the hymen mucous membrane. In virgins, the hymen usually encircles the opening like a tight usually encircles the opening like a tight ring, but it may completely cover the ring, but it may completely cover the opening. The hymen helps protect the opening. The hymen helps protect the genital tract but is not necessary for health. genital tract but is not necessary for health. It may tear at the first attempt at sexual It may tear at the first attempt at sexual intercourse, or it may be so soft and pliable intercourse, or it may be so soft and pliable that no tearing occurs. that no tearing occurs.

the hymen may also be torn during the hymen may also be torn during exercise or insertion of a tampon or exercise or insertion of a tampon or diaphragm. Tearing usually causes diaphragm. Tearing usually causes slight bleeding. In women who have slight bleeding. In women who have had intercourse, the hymen may be had intercourse, the hymen may be unnoticeable or may form small tags unnoticeable or may form small tags of tissue around the vaginal opening. of tissue around the vaginal opening.

Vagina: Vagina:

The vagina is a narrow, muscular but The vagina is a narrow, muscular but elastic organ about 4 to 5 inches long elastic organ about 4 to 5 inches long in an adult woman. It connects the in an adult woman. It connects the external genital organs to the uterus. external genital organs to the uterus. The vagina is the main female organ of The vagina is the main female organ of sexual intercourse. The penis is sexual intercourse. The penis is inserted into it. It is the passageway inserted into it. It is the passageway for sperm to the egg and for menstrual for sperm to the egg and for menstrual bleeding or a baby to the outside. bleeding or a baby to the outside.

Usually, there is no space inside the Usually, there is no space inside the vagina unless it is stretched open—vagina unless it is stretched open—for example, during an examination, for example, during an examination, sexual intercourse, or childbirth. The sexual intercourse, or childbirth. The lower third of the vagina is lower third of the vagina is surrounded by elastic muscles that surrounded by elastic muscles that control the diameter of its opening. control the diameter of its opening. These muscles contract rhythmically These muscles contract rhythmically and involuntarily during orgasm. and involuntarily during orgasm.

The vagina is lined with a mucous The vagina is lined with a mucous membrane, kept moist by fluids oozing membrane, kept moist by fluids oozing from cells on its surface and by from cells on its surface and by secretions from glands in the cervix secretions from glands in the cervix (the lower part of the uterus). A small (the lower part of the uterus). A small amount of these fluids may pass to the amount of these fluids may pass to the outside as a clear or milky white outside as a clear or milky white vaginal discharge, which is normal. vaginal discharge, which is normal.

During a woman's reproductive During a woman's reproductive years, the lining of the vagina has years, the lining of the vagina has folds and wrinkles. Before puberty folds and wrinkles. Before puberty and after menopause (if the woman and after menopause (if the woman is not taking estrogen), the lining is is not taking estrogen), the lining is smooth. smooth.

Uterus and Cervix: Uterus and Cervix:

The uterus is a thick-walled, muscular, The uterus is a thick-walled, muscular, pear-shaped organ located in the pear-shaped organ located in the middle of the pelvis, behind the middle of the pelvis, behind the bladder, and in front of the rectum. bladder, and in front of the rectum. The uterus is anchored in position by The uterus is anchored in position by several ligaments. The main function several ligaments. The main function of the uterus is to sustain a developing of the uterus is to sustain a developing fetus. The uterus consists of the cervix fetus. The uterus consists of the cervix and the main body (corpus). and the main body (corpus).

The uterus is a thick-walled, muscular, The uterus is a thick-walled, muscular, pear-shaped organ located in the pear-shaped organ located in the middle of the pelvis, behind the middle of the pelvis, behind the bladder, and in front of the rectum. bladder, and in front of the rectum. The uterus is anchored in position by The uterus is anchored in position by several ligaments. The main function several ligaments. The main function of the uterus is to sustain a developing of the uterus is to sustain a developing fetus. The uterus consists of the cervix fetus. The uterus consists of the cervix and the main body (corpus). and the main body (corpus).

Sperm can enter and menstrual blood Sperm can enter and menstrual blood can exit the uterus through a channel in can exit the uterus through a channel in the cervix. The channel is usually the cervix. The channel is usually narrow, but during labor, the channel narrow, but during labor, the channel widens to let the baby through. The widens to let the baby through. The cervix is usually a good barrier against cervix is usually a good barrier against bacteria, except around the time an egg bacteria, except around the time an egg is released by the ovaries (ovulation), is released by the ovaries (ovulation), during the menstrual period, or during during the menstrual period, or during labor. labor.

The corpus of the uterus, which is The corpus of the uterus, which is highly muscular, can stretch to highly muscular, can stretch to accommodate a growing fetus. Its accommodate a growing fetus. Its muscular walls contract during labor to muscular walls contract during labor to push the baby out through the cervix push the baby out through the cervix and the vagina. During the and the vagina. During the reproductive years, the corpus is twice reproductive years, the corpus is twice as long as the cervix. After menopause, as long as the cervix. After menopause, the reverse is true. the reverse is true.

As part of a woman's reproductive As part of a woman's reproductive cycle (which usually lasts about a cycle (which usually lasts about a month), the lining of the corpus month), the lining of the corpus (endometrium) thickens. If the woman (endometrium) thickens. If the woman does not become pregnant during that does not become pregnant during that cycle, most of the endometrium is cycle, most of the endometrium is shed and bleeding occurs, resulting in shed and bleeding occurs, resulting in the menstrual period. the menstrual period.

Fallopian Tubes: Fallopian Tubes:

The two fallopian tubes, which are about 2 to The two fallopian tubes, which are about 2 to 3 inches (about 5 to 7 centimeters) long, 3 inches (about 5 to 7 centimeters) long, extend from the upper edges of the uterus extend from the upper edges of the uterus toward the ovaries. The tubes do not directly toward the ovaries. The tubes do not directly connect with the ovaries. Instead, the end of connect with the ovaries. Instead, the end of each tube flares into a funnel shape with each tube flares into a funnel shape with fingerlike extensions (fimbriae). When an egg fingerlike extensions (fimbriae). When an egg is released from an ovary, the fimbriae guide is released from an ovary, the fimbriae guide the egg into the relatively large opening of a the egg into the relatively large opening of a fallopian tube. fallopian tube.

the fallopian tubes are lined with tiny the fallopian tubes are lined with tiny hairlike projections (cilia). The cilia hairlike projections (cilia). The cilia and the muscles in the tube's wall and the muscles in the tube's wall propel an egg downward through the propel an egg downward through the tube to the uterus. The egg may be tube to the uterus. The egg may be fertilized by a sperm in the fallopian fertilized by a sperm in the fallopian tube tube

Ovaries: Ovaries:

The ovaries are usually pearl-colored, oblong, The ovaries are usually pearl-colored, oblong, and about the size of a walnut. They are and about the size of a walnut. They are attached to the uterus by ligaments. In attached to the uterus by ligaments. In addition to producing female sex hormones addition to producing female sex hormones (estrogen and progesterone) and male sex (estrogen and progesterone) and male sex hormones, the ovaries produce and release hormones, the ovaries produce and release eggs. The developing egg cells (oocytes) are eggs. The developing egg cells (oocytes) are contained in fluid-filled cavities (follicles) in contained in fluid-filled cavities (follicles) in the wall of the ovaries. Each follicle contains the wall of the ovaries. Each follicle contains one oocyte. one oocyte.

MenstruationMenstruation

Menstruation is the shedding of the Menstruation is the shedding of the uterine lining (uterine lining (endometriumendometrium).).

EumenorrheaEumenorrhea denotes normal, regular denotes normal, regular menstruation that lasts for a few days menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal).[2] The 7 days is considered normal).[2] The average blood loss during menstruation is average blood loss during menstruation is 35 millilitres with 10-80 mL considered 35 millilitres with 10-80 mL considered normal;[3] many females also notice normal;[3] many females also notice shedding of the endometrium lining that shedding of the endometrium lining that appears as tissue mixed with the appears as tissue mixed with the

Because of this blood loss, premenopausal Because of this blood loss, premenopausal women have higher dietary requirements women have higher dietary requirements for iron to prevent iron deficiency. Many for iron to prevent iron deficiency. Many women experience uterine cramps, also women experience uterine cramps, also referred to as dysmenorrhea, during this referred to as dysmenorrhea, during this time, caused largely by the contractions of time, caused largely by the contractions of the uterine muscle as it expels the the uterine muscle as it expels the endometrial blood from the woman's body. endometrial blood from the woman's body. A vast industry has grown to provide drugs A vast industry has grown to provide drugs to aid in these cramps, as well as sanitary to aid in these cramps, as well as sanitary products to help manage menses. products to help manage menses.

Menstruation is the term given to Menstruation is the term given to the periodic discharge of blood, the periodic discharge of blood, tissue, fluid and mucus from the tissue, fluid and mucus from the reproductive organs of sexually reproductive organs of sexually mature females. The flow usually mature females. The flow usually lasts from 3 - 6 days each month lasts from 3 - 6 days each month and is caused by a sudden and is caused by a sudden reduction in the hormones reduction in the hormones estrogen and progesterone.estrogen and progesterone.

It is hormones that govern this It is hormones that govern this process.process.  Hormones are a chemical  Hormones are a chemical substance, produced by an organ, substance, produced by an organ, gland or special cells, that is carried gland or special cells, that is carried through the bloodstream to regulate through the bloodstream to regulate the activity of certain organs. the activity of certain organs.

It is the balance and interplay It is the balance and interplay between these hormones which between these hormones which regulate the specific events that regulate the specific events that make up the menstrual cycle.make up the menstrual cycle.

Factors like nutrition, stress, exercise, Factors like nutrition, stress, exercise, and belief systems can all influence and belief systems can all influence how the hormones work and what we how the hormones work and what we experience during our cycles. experience during our cycles.

Hormones start to do their thing at the onset of Hormones start to do their thing at the onset of puberty, and various types of puberty, and various types of hormoneshormones are are

involvedinvolved These hormones are:These hormones are:

EstrogenEstrogen1) Promotes the development and maintenance 1) Promotes the development and maintenance of female reproductive structures (especially of female reproductive structures (especially the endometrial lining of the uterus), the endometrial lining of the uterus), 2) Assists in the control of fluid and electrolyte 2) Assists in the control of fluid and electrolyte balance within the body.balance within the body.3) Prepares the follicle for the release of an egg.3) Prepares the follicle for the release of an egg.Estrogen also has many other functions.Estrogen also has many other functions.

Progesterone:Progesterone:

Secreted at ovulation, helps to Secreted at ovulation, helps to prepare the endometrium (womb prepare the endometrium (womb lining) for the implantation of an egg, lining) for the implantation of an egg, prepares mammary galnds for milk prepares mammary galnds for milk production. Primarily concerned with production. Primarily concerned with the procreation and survival of the the procreation and survival of the fetus. fetus.

FSH Follicle Stimulating FSH Follicle Stimulating Hormone:Hormone:

Stimulates the follicles (a follicle is a Stimulates the follicles (a follicle is a balloon shaped structure which is balloon shaped structure which is filled with fluid and contains an egg, filled with fluid and contains an egg, follicles are found in the ovaries) to follicles are found in the ovaries) to ripen several eggs. At the same time ripen several eggs. At the same time the ovaries release oestrogen. the ovaries release oestrogen.

LH Lutenising hormone:LH Lutenising hormone:

Further develops the follicles, triggers Further develops the follicles, triggers ovualtion and stimulates production of ovualtion and stimulates production of other hormones necessary for the post other hormones necessary for the post ovulatory stage of the menstrual cycle. ovulatory stage of the menstrual cycle.

The secretion of hormones is a The secretion of hormones is a complex affair.Various parts of the complex affair.Various parts of the body become involved in a myriad of body become involved in a myriad of chemical transactions. chemical transactions.

Often the hormones within the menstrual Often the hormones within the menstrual cycle have other functions to play in a cycle have other functions to play in a womans body as well, for example womans body as well, for example progesterone increases libido, is a progesterone increases libido, is a natural diuretic and aids in the process natural diuretic and aids in the process of building new bone to name just a few, of building new bone to name just a few, therefore maintaining hormonal health is therefore maintaining hormonal health is essential to all levels of a womans well essential to all levels of a womans well being. being.

We need to remember that these We need to remember that these hormones are usually only present in hormones are usually only present in small amounts and that it is thesmall amounts and that it is the relationship between the levels of relationship between the levels of the hormones that is critical.the hormones that is critical. When When the balance is upset, any number of the balance is upset, any number of menstrual irregularities can occur.menstrual irregularities can occur.

MENSTRUATION MENSTRUATION CHARACTERISTICSCHARACTERISTICS

Length of menstrual cycle- first day Length of menstrual cycle- first day of the last menstrual bleeding to the of the last menstrual bleeding to the first day of the next menstruation.first day of the next menstruation.

Average Menstrual cycle – 28 daysAverage Menstrual cycle – 28 days Average Flow -4-7 daysAverage Flow -4-7 days Dysmenorrhea-abdominal and lower Dysmenorrhea-abdominal and lower

back painback pain

Premenstrual Syndrome-HA, Premenstrual Syndrome-HA, Bloating, heaviness in lower Bloating, heaviness in lower abdomen and legs, breast abdomen and legs, breast tenderness and swelling, food tenderness and swelling, food cravings, depression , irritability.cravings, depression , irritability.

Physiology of Physiology of MenstruationMenstruation

Proliferative Phase –Proliferative Phase –(estrogenic, (estrogenic, luteal, postmenstrual)luteal, postmenstrual)

- the time between the ending of menses - the time between the ending of menses and ovulationand ovulation

Secretory Phase – Secretory Phase – ( progestational, ( progestational, luteal, premenstrual)luteal, premenstrual)

- time between ovulation and the - time between ovulation and the next mensesnext menses

3. Ischemic Phase3. Ischemic Phase - bleeding - bleeding

MATERNAL ADAPTATION TO MATERNAL ADAPTATION TO PREGNANCYPREGNANCY

Terms used to denote Fetal GrowthTerms used to denote Fetal Growth OvumOvum - - From ovulation to fertilizationFrom ovulation to fertilization Zygote Zygote - - From fertilization to implantationFrom fertilization to implantation Embryo Embryo - - From implantation to 5-8 weeksFrom implantation to 5-8 weeks FetusFetus - - From 5-8 weeks until termFrom 5-8 weeks until term Conceptus - Conceptus - Developing embryo or fetus and Developing embryo or fetus and

placental structures throughout pregnancy. placental structures throughout pregnancy.

TIMETABLE FOR PHYSIOLOGIC CHANGES OF PREGNANCYTIMETABLE FOR PHYSIOLOGIC CHANGES OF PREGNANCY BODY OCCURRENCEBODY OCCURRENCE ____________________________________________________________________________________________________________________________________ Location of ChangeLocation of Change 1st trimester1st trimester 2nd trimester2nd trimester

3rd trimester3rd trimester Cardiovascular Cardiovascular Blood volume Blood volume

increasing-----------------------------------------------------------------increasing----------------------------------------------------------------- Pseudoanemia BP slightly decreasedPseudoanemia BP slightly decreased BP returns to pre BP returns to pre pregnancy levelspregnancy levels Clotting factors Clotting factors

increasing--------------------------------------------------------------increasing-------------------------------------------------------------- OvarianOvarian Corpus luteum active Corpus luteum Corpus luteum active Corpus luteum

fadingfading UterineUterine Increased Increased

growth--------------------------------------------------------------------------growth-------------------------------------------------------------------------- Placenta Placenta

forming estrogen and progesterone---forming estrogen and progesterone--- CervixCervix Softening Softening

progressive---------------------------------------------------------progressive---------------------------------------------------------”Ripe””Ripe” VaginalVaginal White discharge present-------------------White discharge present-------------------

Increasing--------------------------------Increasing-------------------------------- MusculoskeletalMusculoskeletal Progressive Progressive

cartilage softening---------------------cartilage softening---------------------

TERMINOLOGIESTERMINOLOGIES

Gestation: pregnancyGestation: pregnancy Embryo : Conception up to 10Embryo : Conception up to 10thth

week.AOG(8week.AOG(8THTH week post conception) week post conception) Fetus: 10Fetus: 10THTH Wk up to delivery Wk up to delivery Viability: Capability of the fetus to Viability: Capability of the fetus to

survive, accepted at 24wkssurvive, accepted at 24wks

Gravida: A Woman who is or has been pregnant Gravida: A Woman who is or has been pregnant regardless of the outcomeregardless of the outcome

Nulligravida: A woman who is not been pregnant Nulligravida: A woman who is not been pregnant regardless of the outcome.regardless of the outcome.

Primigravida: Woman pregnant for the first time.Primigravida: Woman pregnant for the first time. Multigravida:Woman who has been pregnant Multigravida:Woman who has been pregnant

more than once.more than once. Para: refers to past pregnancy that has reached Para: refers to past pregnancy that has reached

viabilityviability Nullipara: Woman who has never completed Nullipara: Woman who has never completed

pregnancy up to the age of viabilitypregnancy up to the age of viability

Nullipara : Woman who has never Nullipara : Woman who has never completed pregnancy up to the age completed pregnancy up to the age of viabilityof viability

Primipara: Woman who has Primipara: Woman who has completed one pregnancy up to the completed one pregnancy up to the edge of viability regardless of the edge of viability regardless of the outcome.outcome.

Multipara : Woman who has Multipara : Woman who has completed 2 or more pregnancy to completed 2 or more pregnancy to the age of viabilitythe age of viability

OBSTETRIC HISTORYOBSTETRIC HISTORY

T: TERM >37 wks AOGT: TERM >37 wks AOG P: preterm 24 wks<37WKS AOGP: preterm 24 wks<37WKS AOG A: abortion <24 WKS AOG,including A: abortion <24 WKS AOG,including

molar pregnancymolar pregnancy L: living ChildrenL: living Children

Manifestation of PregnancyManifestation of Pregnancy

Presumptive : Signs and Symptoms that Presumptive : Signs and Symptoms that suggest but do not prove pregnancysuggest but do not prove pregnancy

Cessation of mensesCessation of menses Breast ChangesBreast Changes enlargementenlargement Tingling of breastTingling of breast Increased sensitivity to touchIncreased sensitivity to touch Darkening of nipples and areolaDarkening of nipples and areola

Skin ChangesSkin Changes -Chloasma-Chloasma -Linea nigra-Linea nigra -Abdominal striae-Abdominal striae Nausea and VomitingNausea and Vomiting Frequency and UrinationFrequency and Urination Goodells sign – softening of the cervixGoodells sign – softening of the cervix fatiquefatique

PROBABLE SIGNSPROBABLE SIGNS

Strong indicators of pregnancy, maybe Strong indicators of pregnancy, maybe detected about the 12detected about the 12thth week week

- Enlargement of the abdomen -12 Enlargement of the abdomen -12 weeksweeks

- Chadwick’s SignChadwick’s Sign- Hegar’s SignHegar’s Sign- Braxton hicks ContractionBraxton hicks Contraction- BallotmentBallotment

Palpation of Fetal OutlinePalpation of Fetal Outline Quickening(16-20 WKS)Quickening(16-20 WKS) Positive Pregnancy Test –as early as Positive Pregnancy Test –as early as

8-10 days after conception8-10 days after conception

Positive SignsPositive Signs

Fetal heart tones (FHT)Fetal heart tones (FHT) Fetal movement felt by the Fetal movement felt by the

examinerexaminer Qutlining of the fetal bodyQutlining of the fetal body Sonographic EvidenceSonographic Evidence