Presentation on theme: "REPRODUCTIVE ANATOMY & PHYSIOLOGY. EARLY DEVELOPMENT Male & Female organs –produce sex cells –transport for union Sex Differentiation at 8 weeks of life."— Presentation transcript:
REPRODUCTIVE ANATOMY & PHYSIOLOGY
EARLY DEVELOPMENT Male & Female organs –produce sex cells –transport for union Sex Differentiation at 8 weeks of life –Ovary - produces oogonia at 10 weeks of fetal life; approximately 150,000 oocytes present at birth –Testes - produces spermatoza at 7-8 weeks
Layers of the Uterus Perimetrium –outer layer composed of peritoneum Myometrium –inner layer primarily in the fundus; longitudinal fibers; causes cervical effacement and power to express the baby Endometrium –innermost layer, produces endometrial milk, undergoes monthly regeneration
Figure 2–4 Structures of the uterus.
Myometrium Muscular Layer - composed of 3 distinct layers –Longitudinal fibers found mainly over the fundus; most involved with birth of fetus –Fibers interlaced with blood vessels in Figure 8 pattern; living ligature – helps stop bleeding –Circular fibers concentrated around fallopian tubes and cervical os; helps keep cervix closed
Internal Organs con. Isthmus –Joins corpus to the cervix –Site for lower C/S Cervix –Composed of fibrous connective tissue –Length 2.5 to 3 cm (~1-2) –Functions Passage of menses and sperm Produces mucus in response to cyclic hormones Frequent site for uterine cancer
Bottom of Cervix, Cells are taken from here for Pap Smear
Uterine Ligaments Think which ligaments cause pain during pregnancy Broad ligament – stabilizes uterus, covers uterus anteriorly and posteriorly Round ligament – helps keep uterus in place from the sides, pain on sides late in pregnancy Ovarian ligament – anchors lower part of ovary, helps catch ovum in fimbriae Cardinal ligament – chief uterine support, prevents uterine collapse Uterosacral ligament – support for uterus at level of the ischial spine, source of menstrual pain
Figure 2–5b Interlacing of uterine muscle layers.
Figure 2–6 Uterine ligaments.
Fallopian Tubes Functions – provide passageway for ovum into uterus, site for fertilization Fimbriae – most distal part, wavelike motion that pulls ovum into tube Ampulla – site for fertilization Isthmus - close to uterus, site for BTL
Figure 2–7 Fallopian tubes and ovaries.
Ovaries At birth, all ova are contained within immature follicles Functions 1)Ovulation 2)Produce hormones
Bony Pelvis Functions – to support and protect the internal organs of reproduction Innominate Bones –Ilium – upper prominence of hip –Ischium – under the ilium, ends in ischial tuberosity, serves as reference point for station –Pubis – (2 separate bones) front of innominate, meets other to form symphysis pubis Sacrum – 5 fused vertebrae, sacral promontory Coccyx – (Tail bone) triangular bone last on vertebral column, moves backward in childbirth (Sometimes can get fxd during childbirth)
Figure 2–8 Pelvic bones with supporting ligaments.
Pelvic Floor (Muscles) Designed to overcome force of gravity Provides stability and support for surrounding structures (Help body remain intact, until baby is ready for birth) Pelvic diaphragm – deep fascia, levator ani, and coccygeal muscles Muscles function as a whole, yet are able to move over one another – provides capacity for dilatation
Figure 2–9 Muscles of the pelvic floor. (The puborectalis, pubovaginalis, and coccygeal muscles cannot be seen from this view.)
Pelvic Division False Pelvis – portion above pelvic brim or inlet; serves to support pregnant uterus; helps direct presenting part into true pelvis True Pelvis – portion below linea terminalis; represents the bony limits of the birth canal Pelvic inlet – upper border of true pelvis Pelvic outlet – lower border of true pelvis
Figure 2–10a Female pelvis. False pelvis is shallow cavity above the inlet; true pelvis is deeper portion of cavity below the inlet.
Figure 2–10b True pelvis consists of inlet, cavity (midpelvis), and outlet.
Figure 8–5a Manual measurement of inlet and outlet. Estimation of the diagonal conjugate, which extends from the lower border of the symphysis pubis to the sacral promontory.
Figure 8–5b Estimation of the anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of the sacrum.
Pelvic Measurements Helps figure whether babys head can fit. Diagonal conjugate – extends from the subpubic angle to the middle of the sacral promontory; can be measured manually (with hand) during a pelvic exam –Take and substract 1.5cm to get Obstetric conjugate. Obstetric conjugate – extends from the middle of the sacral promontory to 1 cm below the pubic crest (Cannot be reached/measured manually) Conjugate vera – extends from the middle of the sacral promontory to the pubic crest
Figure 2–11 Pelvic planes: coronal section and diameters of the bony pelvis.
Figure 8–5 c & d Methods that may be used to check the manual estimation of anteroposterior measurements. C D
Figure 8–6 Use of a closed fist to measure the outlet. Most examiners know the distance between their first and last proximal knuckles. If they do not, they can use a measuring device.
Pelvic Types Gynecoid – most common female, adequate Android – most common male, not adequate Anthropoid – usually adequate Platypelloid – usually not adequate
Figure 15–1 Comparison of Caldwell-Moloy pelvic types.
Female Sex Hormones Estrogen –Maturation of secondary sex characteristics –Secreted by the maturation of ovarian follicles –Cause proliferation of endometrial mucosa –Causes increase in size and weight; closure of long bones –Increases myometrial and fallopian tube contractility –Increases uterine sensitivity to oxytocin –Maintains bone density –Inhibits FSH production and stimulates LH production –May increase libido
Female Sex Hormones con. Progesterone keeps everything quiet; maintains pregnancy –LH stimulates corpus luteum to secrete progesterone –Decreases motility and contractility of uterus –Proliferates vaginal epithelium –Causes cervix to secrete thick viscous mucus Anti-sperm –Prepares breast tissue for lactation –Thermogenic heat producing check temp to determine ovulation –Hormone of Pregnancy
Female Sex Hormones con. Prostaglandins –Produces by the endometrium lining of the uterus –Differentiated by Roman letters and numbers or Greek numbers –Essential for ovulation (help egg be expelled from the ovary) –Causes expulsion of the ovum –Produces progesterone withdrawal –Facilitates tissue digestion to cause endometrial shedding
Neurohormonal Basis of the Female Reproductive Cycle Causes menses cycle to occur Controlled by an interaction between the nervous and endocrine systems and their target tissues – hypothalamus, anterior pituitary, and ovaries
NEUROHORMONAL BASIS OF THE FRC CNS --- HYPOTHALMUS RELEASES ----GnRF (FSHRH & LHRH) ------CAUSES ANTERIOR PITUITARY TO RELEASE FSH & LH -- -- STIMULATES GONADS TO SECRETE HORMONES (ESTROGEN & PROGESTERONE) In males, LH induces secretion of testosterone. In females, LH working w/ FSH stimulate follicle growth in ovary to secrete estrogen.
Ovarian Cycle Be able to know which cycle the woman is in 1 st Part- Follicular Phase (Follicles- where the immature eggs are contained) –Starts with day 1 menses; 1-14 days; may vary –multiple follicles are maturing; one is selected; when mature, called a graafian follicle; surrounded by fluid …and becomes a cyst on the ovary. –Comes close to surface of ovary, forms a blister, ovum pushed out of the follicle near the fimbria (ovulation) –Pain at mid-cycle Mittelschmerz (may see blood spotting) –Pulled into fallopian tube and travels to ampulla where fertilization can occur
Ovarian Cycle con. 2 nd Part- Luteal Phase –Begins with ovulation (the second half of ovarian cycle) –Corpus luteum develops from the ruptured follicle –If fertilized, the ovum implants into endometrium –Ovum secretes HCG to maintain corpus luteum; the corpus luteum secretes progesterone and estrogen (cause you have to have high levels of H to maintain preg) –If no fertilization, degenerates in about a week and becomes the corpus albicans –Estrogen and Progesterone decrease which stimulates FSH and LH to be released which will start whole cycle over again. –14 days after ovulation, menses begins (this remains constant) A person can then predict ovulation.
Figure 2–14 Various stages of development of the ovarian follicles.
Endometrial Cycle- 4 Phases 1) Menstruation –Cyclic uterine bleeding in response to hormones changes; begins 14 days after ovulation –Partial shedding of the endometrium –Discharge made up of blood, fluid, cervical and vaginal secretions, bacteria, leukocytes and cellular debris; dark red, distinctive odor –Menarche- onset of menstruation; age 9-16 –Cycle lengths vary 21- 36 days; illness, fatigue, stress, anxiety, vigorous exercise can alter cycle
Endometrial Cycle con. 2) Proliferative –Endometrium increases 6-8 fold, estrogen incr/peaks, cervical mucus becomes thin (to allow sperm to pass), BBT drops at ovulation then increases (Progesterone levels incr) 3) Secretory –Estrogen decreases, progesterone dominates, vascularity of uterus increases, glands begin to secrete endometrial milk for fertilized ovum 4) Ischemic –If no fertilization, corpus luteum begins to degenerate; estrogen and progesterone levels fall; leads to tissue necrosis and small blood vessels rupture, arteries constrict decreasing blood supply to endometrium; tissue pale, menses begins
Figure 2–13 Female reproductive cycle: interrelationships of hormones with the four phases of the uterine cycle and the two phases of the ovarian cycle in an ideal 28- day cycle.
Physical and Psychological Changes of Pregnancy
Three Pregnancy Periods Antepartum- from conception to the onset of labor Intrapartum- from the onset of labor to the first 1-4 hours after delivery of newborn and placenta Postpartum- refers to the 6 weeks after delivery of the newborn and placenta.
Pregnancy Nine months of pregnancy are divided into three trimesters, each are three months long. All systems of a womans body are altered in some way during pregnancy.
Changes of the Reproductive System Uterus - increases in capacity and size; requires one-sixth of maternal blood flow. Braxton Hicks - irregular contractions, usually painless, felt throughout pregnancy, can be confused with true labor later in pregnancy Ovaries – stop ovulation; corpus luteum continues to produce hormones until 6-8 weeks
Change in the Reproductive System Cervix - secretes mucus that forms a plug –Goodells sign - softening of the cervix –Chadwicks sign - bluish color of the cervix during pregnancy Vagina - mucosa thickens and connective tissue relaxes; pH acidic favors yeast
Changes in the Reproductive System cont Breasts - increase in size and number of glands Colostrum - thin yellow secretion high in protein and immune properties
Changes in the Cardiovascular System Cardiac output - increases 30-40% Pulse – increases 10-15 bpm BP - decreases in the 1st and 2nd trimesters; 3rd trimester increases to pre-pregnant levels Vena cava syndrome – (Caution!) uterus compresses the vena cava S/S: pallor, dizziness and clammy skin
Figure 7–1 Vena caval syndrome. The gravid uterus compresses the vena cava when the woman is supine. This reduces the blood flow returning to the heart and may cause maternal hypotension. Caution for Vena cava syndrome!!! Keep head elevated or turn to one side.
Cardiovascular System cont Blood (More volume, but blood is diluted) –volume increases 45% –RBCs increase 18 to 30% –Plasma volume increases 50% Physiologic anemia – more diluted
Changes in the Respiratory System Growing uterus elevates the diaphragm Increased 0 2 needs Increased air volume exchange Nasal stuffiness and epistaxis from increased estrogen
Changes of the Musculoskeletal System Teeth/gums – bleeding gums; oral hygiene important to prevent preterm labor Relaxation of the pelvic joints – Waddling gait Physiologic lordosis - lumbar spinal curvature increases compensating for weight of uterus Diastasis recti - separation of the rectus abdominal muscle
Figure 7–3 Postural changes during pregnancy. Note the increasing lordosis of the lumbosacral spine and the increasing curvature of the thoracic area.
Changes of the Gastrointestinal System 1 st trimester – Incr HCG causes N/V Increased progesterone levels – causes decreased peristalsis reflux and constipation (Fiber and fluids important) Hemorrhoids - constipation and increased pressure on blood vessels in the rectum
Changes of the Renal System Urinary frequency Glomerular filtration - increases 50% Glycosuria – more prone to develop gestational diabetes.
Changes in the Integumentary System Increased pigmentation - areola, nipples and vulva Chloasma - mask of pregnancy Linea nigra - darkly pigmented line from umbilicus to the pubic area Striae gravidarum - stretch marks Sweat and sebaceous gland activity increases
Changes in the Endocrine System Metabolism - increases Weight gain – Norm 3 to 5 pounds 1st trimester; 1 pound/week 2 nd and 3rd trimesters. (Avg 25-35lb incr throughout preg) Water retention - increased sex hormones and decreased serum protein
Endocrine System cont Hormones –Human chorionic gonadotropin (hCG)- Present only during preg, causes the N/V –Human placental lactogen (hPL)- Maintainance of preg; is an insulin antagonist; it promotes lipolysis. –Estrogen- incr growth of uterus and stimulates the breast for lactation. –Progesterone keeps uterus quiet maintains the endometrium, decreased uterine contractility, and causes relaxation of smooth muscle. –Relaxin- decreases uterine contractility, contributes to the softening of the cervix –Postaglandins- some contract, some relax
Signs and Symptoms of Pregnancy 3 categories: presumptive, probable and positive. –1) Presumptive – woman reports Amenorrhea Nausea and vomiting Fatigue Urinary frequency Breast changes- tender/darker Quickening- From feeling the baby move Define: Quickening- the process of showing signs of life. Define: Presumptive- signs of pregnancy, ex: morning sickness
Signs and Symptoms of Pregnancy 2) Probable - Noted by examiner –Goodells sign - softening of cervix –Chadwicks sign - bluish color, cervix, vagina –Hegars sign - softening of lower uterine segment –Enlarged abdomen –Pigmentation changes –Stretch marks –Ballottement- A method of diagnosing pregnancy, in which the uterus is pushed with a finger to feel whether a fetus moves away and returns again. –Positive pregnancy test –Palpation of fetal outline
Figure 7–4 Hegars sign, a softening of the isthmus of the uterus, can be determined by the examiner during a vaginal examination.
Signs and Symptoms of Pregnancy 3) Positive Noted by examiner - only caused by pregnancy Fetal heartbeat Fetal movement palpable by the examiner Visualization of the fetus by ultrasound
Psychological Response of the Expectant Family to Pregnancy Turning point in a familys life Role changes Financial changes Fear and anxiety Developmental tasks for mom and dad Cultural values and beliefs
Maternal Reactions and Responses to Pregnancy 1st Trimester –Feelings of disbelief and ambivalence –Baby does not seem real –Focuses on herself and pregnancy –May experience early s/s of pregnancy –Introspective –Mood swings –Fantasize about miscarriage (Many women fear miscarriage, usually w/in the 1 st trimester)
Maternal Reactions and Responses to Pregnancy 2 nd Trimester –Quickening - baby a real separate person. –Mom excited about pregnancy –Helps plan her future and childs future –Experiences body image changes –Concern about partners support
Maternal Reactions and Responses to Pregnancy 3rd Trimester –Pride in pregnancy –Anxious about labor –Concern about babys health –Surge of energy close to delivery date
Rubins Maternal Tasks What mom wants Ensuring safe passage for fetus Seeking acceptance of fetus by others Assumption of mother role Learning to give of oneself on behalf of ones child
Paternal Psychological Responses to Pregnancy of Partner Pride in pregnancy– virility ; Manly character; The ability to procreate Ambivalence- a state in which one experiences conflicting feelings (Ambi- both) Ex: concerns about readiness Stress Concerns and fears Couvades- may experience certain rituals during the fatherhood transition. Also may experience certain pregnancy s/s felt by partner such as nausea, cravings and weight gain.
Other Family Members Reaction Sibling rivalry –Threat –Regression –Preparation –Include Grandparents –Increase support –Childrearing practices