MATERNAL AND CHILD HEALTH NURSING ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM Lecturer: Mark Fredderick

R. Abejo RN,MAN __________________________________________________________________________ FEMALE REPRODUCTIVE SYSTEM

I. External Genitalia (Vulva/Pudendum)

MONS PUBIS -Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair just before puberty It is where the pubic hair grows.

LABIA MAJORA -W/ hair outside but smooth inside fatty skin folds from MONS PUBIS to PERINEUM and protects the labia minora , urinary meatus & vagina

LABIA MINORA -Thin, pink, smooth, hairless, extremely sensitive to pressure, touch and temperature. The glands of labia minora lubricate the vulva. It is formed by the frenulum and the prepuce of the clitoris which is also very sensitive because it has rich nerve supply.

Covers and protects VESTIBULE

VAGINAL INTROITUS

CLITORIS
URETHRAL MEATUS

TWO GLANDS THAT LUBRICATE DURING SEX 1. SKENES GLANDS (Paraurethral Glands): lubricates the external genitalia 2. Bartholins Gland (Vulvovaginal Glands): alkaline in ph, helps improve sperm survival Doderleins Bacillus: causes the vaginal ph to be acidic, which forms lactic acid Hymen: the elastic tissue, symbolizes virginity. Thorn & bloody during forced sexual act RUGAE: thick folds of membranous stratified epitheliums on the internal wall of the vagina, capable of stretching during the birth process, to accommodate the delivery of the fetus.

-Entrance of urethra, opens approximately 1cm below clitoris

-Composed of glans & shaft that is partially covered by prepuce -GLANS is small and round and is filled w/ many nerve endings and rich blood supply -SHAFT is a cord connecting the glans to the pubic bone; w/in it is the major blood supply of clitoris

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II. Internal Genitalia

ORGAN

FUNCTIONS

STRUCTURE Divisions of the Uterus

NOTES Layers of the Uterus: 1. Endometrium: inner layer, most vascular, SHED DURING MENSTRUATION.THE NON-PREGNANT UTERUS 2. Myometrium: LARGEST PORTION EXPELS THE FETUS DURING THE BIRTH PROCESS. The part that contracts during hemorrhage. Prevents hemorrhage.

Uterus

Pear shape muscular organ which has three(3) main functions 1. receive the ova from the fallopian tube 2. provide a place for implantation of the ova 3. Nourishment for fetal growth.

I. Cervix : lowest portion , 1/3 of the total uterus External Os: where the nurse obtain the Pap Smear to the SQUAMOCOLUMNAR JUNCTION cells. This is where the cerclage is done for incompetent cervix. Namely: A. Shirodkar Barter Suture- permanent closure of the internal cervical os, until the 38th week after which is separated TREATMENT FOR INCOMPETENT CERVIX and PREVIOUS ABORTION. B. Mc Donalds or Purse String Cerclage of the external os: usually Normal spontaneous delivery will be done for the patient. II. Isthmus: shortest portion of the uterus, the portion that is cut when the fetus is delivered during cesarean birth. III. Fundus: Upper segment, this is the most vascular, the portion also where palpation is done. Also touching it by the tip of the fingers during contraction is the best method to determine the intensity of contractions during labor. Bandls Ring ( Pathological Retraction Ring): seen in Prolonged Labor or Dystocia

3. Perimetrium: Outer most layer. Aids for support & added strength.

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Fallopian tubes

Site of fertilization of the ovum with perm

4 Parts of the Fallopian tubes 1. Interstitial : lies within the uterine wall 2. Isthmus: the portion that is cut or sealed in TUBAL LIGATION ( site for sterilization) 3. Ampulla: where fertilization occurs , this is also the LONGEST portion, frequent site for ectopic pregnancy. 4. Infundibular: covered by the Fimbriae cells that help guide the ova to the Fallopian Tube. Pair of follicle containing organs on the other side of the uterus Ovaries: 4 by 2 cm in diameter, 1.5 cm thick. Responsible for the production, Maturation, and discharge of ova Secretion of estrogen and progesterone Cortex of the Ovaries; developing and graafian follicles are found here. Tube extending from the introitus to cervix

Fallopian tubes transport the ova from the ovaries to the uterus.

Ovaries

Ovulation (the release of an ovum); Steroid hormone production

The ovaries lie in the upper pelvic cavity.

Vagina

Organ for coitus; Birth canal; Conduit for menstrual flow.

Fibromuscular lined with membrane

organ mucus

III. THE PELVIS

A. Structures 1. Two Os Coxae or Innominate Bones- it is made up of: a. Ilium- is the upper, extended part which has a curved upper border called Iliac Crest. b. Ischium- is the under part which when sitting, the body rests on the ischial tuberosities and an important landmark is the ischial spines. c. Pubis- is the front part that joins to form an articulation of the pelvis called the Symphysis Pubis. 2. Sacrum- a wedge-shaped that forms the back part of the pelvis that consists of 5 fused vertebrae, the first having a prominent upper margin called the Sacral Promontory; it articulates with the ilium and sacroiliac joint. 3. Coccyx- is the lowest part of the spine with a degree of movement between the sacrum and coccyx which is made possible by the third articulation of the pelvis called Sacrococcygeal joint which allows room for delivery of the fetal head B. Divisions 1. False Pelvis- the superior half formed by the ilia offers landmarks for pelvic measurements; it supports the growing uterus during pregnancy and directs the fetus into the true pelvis near the end of gestation. 2. True Pelvis- the inferior half formed by the pubes in front, the ilia and the ischia on the sides and the sacrum and coccyx behind; it is made up of three parts: a. Inlet- the entrance way to the true pelvis wherein its transverse diameter is wider than its anteroposterior diameter, thus Transverse diameter = 13.5 cm Antero-posterior diameter = 11 cm Right and left oblique diameter = 12.75 cm b. Cavity- the space between the inlet and outlet c. Outlet- the inferior portion of the pelvis bounded in the back by the coccyx, on the sides by the ischial tuberosities and in front by the inferior aspect of the symphysis pubis and the pubic arch; its anteroposterior diameter is wider than its transverse diameter

C. Types 1. Gynecoid- normal female pelvis where inlet is well rounded forward and back; it is most ideal for childbirth. 2. Anthropoid- transverse diameter is narrow, AP diameter is larger than normal. 3. Platypelloid- inlet is oval, AP diameter is shallow. 4. Android- male pelvis where inlet has a narrow, shallow posterior portion and pointed anterior portion

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D.

Types of Pelvic Ligaments 1. Round: remain lax during non-pregnancy & become HYPERTROPHIED & elongated during pregnancy. 2. Cardinal: chief uterine supports 3. Broad ligaments: drapes over the fallopian tubes, uterus & ovaries

D. Measurements 1. External- suggestive only of pelvic size a. Intercristal- distance between the middle points of the iliac crests with an average= 28 cm. b. Interspinous- distance between the anterosuperior iliac spines with an average= 25 cm. c. Intertrochanteric- distance between the trochanters of the femur with an average= 31 cm. d. External Conjugate or Baudelocques- the distance between the anterior aspect of the symphysis pubis and depression below L5 with an average= 18-20 cm.

2.

Internal- gives the actual diameter of the inlet and outlet a. Diagonal Conjugate- distance between the sacral promontory and inferior margin of the symphysis pubis with an average= 12.5 cm. b. True Conjugate or Conjugata Vera- distance between the anterior surface of the sacral promontory and the superior margin of the symphysis pubis; it is very important measurement because it is the diameter of the pelvic inlet with an average=10.5-11 cm. c. Bi-ischial diameter or Tuberischii- transverse diameter of the pelvic outlet and measured at the level of the anus with an average= 11 cm.

MALE REPRODUCTIVE SYSTEM

External Features: 2 Erectile Tissues in the penis: a. Corpus cavernosa b. corpus spongiosum Internal Features: Epididymis: totals 20 ft. WHERE SPERMS ARE STORED Vas / Ductus Deferens: carries the sperm to the inguinal canal Seminal Gland / Vesicle: Secretes SEMEN Prostrate Gland: secretes SEMEN also. Cowpers Gland/ Bulbo-urethral: secretes also semen SEMEN sources: 1. Prostrate gland : 60% 2. Seminal vesicles : 30% 3. Epididymis : 5% 4. Cowpers : 5%

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Accessory Structures

Mammary Gland III. Mammary Glands

MAMMARY GLANDS -2 mammary glands located on each side of chest wall -Each breast 15-20 lobes containing clusters of ALVEOLI

ACINI -Saclike end of the glandular system -Lined both w/ epithelial cells that secrete colostrum( which is rich in IgA) & milk & w/ muscles that expel milk

DUCTULES -Exit alveoli & join to form larger canals LACTIFEROUS DUCTS -During lactation, milk flows to the alveoli and then thru the duct system further going to the balloon like storage sacs called LACTIFEROUS SINUSES

NIPPLES -Sinuses merge into openings on nipple

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Female Reproductive Hormones HORMONES

Follicle Stimulating Hormone *Stimulates Graafian follicle to mature and resulting in increase levels of estrogen

Lutenizing Hormone -When follicle is ripe and mature, triggers follicular rupture and release of ovum -Peaks at 16-18 hours before ovulation. -stimulates ovulation & development of corpus luteum

Estrogen -Produce from ovaries, adrenal cortex, and placenta -Assists in maturation of Graafian follicle -Stimulates thickening of endometrium. Other functions a. Contracts smooth muscles Inhibits the secretion of FSH b. Responsible for the increase vaginal secretion in the vagina (LEUKORRHEA) c. Thickens the endometrium d. SUPPRESSES THE FSH & Prolactin e. Responsible for the devt of 2ndary sex characteristics in females f. Stimulates uterine contractions & smuscular peristalsis of the fallopian tubes for the passage of the ovum to the uterus. g. Mildly increases Na & water reabsorption h. Stimulates LH secretion & responsible for the production of cervical mucus associated in ferning & spinnbarkeit

Progesterone *Produce from corpus luteum, placenta -Secretes thick/viscous cervical secretions. A. Preparation of the uterus to receive a fertilized ovum B. Decrease uterine motility/ contractility during pregnancy C. Increases basal metabolism D. Enhances placental growth E. Stimulates the devt of acini cells in the breast(major cells for breast milk) Increase the endometriums supply of glycogen, oxygen & amino acids for maintaining pregnancy

LUTENIZING HORMONE AND ESTROGEN peak immediately before ovulation Most women ovulate two weeks before the beginning of the next period. Other Reproductive Hormones 1. Lactogenic Hormone (Prolactin) -Stimulates lactation 2. Melanocyte Stimulating Hormone -Responsible for the linea nigra & chloasma in pregnancy -Secreted by the anterior pituitary hormone MELANOTROPIN -Will end on the 2nd month of pregnancy 3. Human Chorionic Gonadotropin -Increases in nausea and vomiting Responsible for Hyperemesis Gravidarum

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MENSTRUATION Menarche: 1st menstrual period, usually age 12, but may begin as early as 9. Menopause: cessation of menstrual cycle that occurs normally from 40 & 55 y.o. Menstrual Cycle: 1. Menstrual Phase ( 1 14 days) -Corpus luteum dies. -Progesterone & Estrogen vanishes- triggers/stimulate the production of FSH. -Endometrium degenerated/ sheds- menstruation occurs. Sexual intercourse during menstruation is not harmful. 2. Proliferative Phase- Estrogen Phase ( 6 14 days) Graafian Follicle: Estrogen Anterior Pituitary Gland secretes FSH stimulates the development of the Graafian follicle (secretes Estrogen) suppresses FSH & stimulates LH LH stimulates ovulation Increase Estrogen kills/decreases FSH 3. Secretory Phase (15 to 21 days) Progesterone Phase (Corpus Luteum: Progesterone) Other Books it is called: Luteal Phase After Ovulation-----release of mature ovum from the Graafian follicle----Graafian Follicles die and replaced by Corpus Luteum-----secretes progesterone Functions of Progesterone: 4. Pre-Menstrual Phase (22 days to 28 days) -If fertilization does not occur, corpus luteum begins to die -Progesterone & Estrogen decreases -Endometrium degenerates -Menstruation stops during pregnancy because there is decrease secretion of hormones by the ovary.

OVARIAN CYCLE (ACORDING TO HORMONAL ACTIVITY) 0 7 14

OVULATION

21
CORPUS LUTEUM

28
LUTEAL REGRESSION

DEVELOPING FOLLICLES

FOLLICULAR PHASE Ovarian follicles mature under influence of FSH and estrogen LH surge causes ovulation

LUTEAL PHASE -mittelshmerz -cervical changes -increase BBT

ENDOMETRIAL/UTERINE CYCLE (Described by varying thickness of the endometrium)

MENSTRUAL PHASE -Menstruation -Decrease estrogen -Decrease progesterone PROLEFERATIVE PHASE -Hypothalamus secretes FSH -APG (anterior pituitary gland) secretes FSH -Maturation of Graafian follicle -Increased estrogen -Hypothalamus stops FSH & starts LH -APG stops FSH & starts LH secretion SECRETORY PHASE -Formation of corpus luteum -Increase progesterone -NO FERTILIZATION; corpus luteum degenerates 10 days after ovulation -WITH FERTILIZATION; concepts produces HCG that sustains life corpus luteum; progesterone level is maintained at high level -Progesterone level decreases -Corpus albicans Sloughing off of endometrial lining PREMENSTRUAL PHASE -endometrium degenerates

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Menstrual Cycle

Menstrual Disorders Dysmenorrhea - PrimaryNo known cause - SecondaryMay be caused by tumor/inflammatory conditions Premenstrual Syndrome Amenorrhea Menorrhagia Metrorrhagia - Irregular bleeding in between periods

-Edema of Primary-Excessive or lower Never prolonged extremities menstruated; bleeding - Abdominal structural/congenit bloating al abnormality - Weight gain Secondary - Headache Cessation of -Breast menstruation tenderness - Depression - Crying - Loss of concentrati on

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