Birth Terms

Birth rates-The number of live births per 1000 people Infant mortality-The number of deaths of infants under 1

year of age per 1000 live births Neonatal Mortality-The number of deaths of infants less than 28 days old per 1000 live births Fetal Death-Death inutero at 20 weeks or greater of gestation. Perinatal mortality-neonatal death and fetal death combined per 1000 live births Maternal mortality-The number of maternal deaths from any cause during the cycle of pregnancy up to 42 days following birth per 100,000 live births

The Normal Female Reproductive System (NFRS)

External Organs (vulva)

All visible structures from the pubis to perineum

Mons pubis Labia majora Labia minora Clitoris Vestibular glands Vaginal vestibule Vaginal orifice Urethral opening

NFRS
Internal Organs
Vagina
Uterus Fallopian tubes Ovaries

NFRS
Vagina-Muscular membranous tube connecting external

genitalia with the uterus. 3 functions 1-serve as passage for sperm for conception and fetus at birth 2-provide passage for menstrual flow from uterine endometrium to outside the body 3-to protect against trauma from sexual intercourse and infection from pathogenic organisms

NFRS

During reproductive life an acidic vaginal environment is normal-Ph is 4-5. Before puberty and after menopause it is 7.5 The uterine cervix extends into the upper portion of the anterior wall of the vagina creating the vaginal fornix (in a space called the vaginal vault)

NFRS
The Uterus-hollow, muscular,

thick-walled organ-located between the base of the bladder and the rectum above the vagina
Supported by four pairs of

Divided into 2 major

portions:
Upper: corpus Smooth muscle layer the myometrium Dome shaped top of corpus is the fundus
Fallopian tubes enter here

ligaments: Cardinal Uterosacral Round Broad (single ant. & post. ligaments also assist with support)

Lower: cervix

NFRS
Uterus continued
The Corpus: made up of three layers: 1. perimetrium

Serosal-peritoneum 2. myometrium-continuous with muscle layers of Fallopian tubes and vagina Muscular 3 layers of involuntary smooth muscle 3. endometrium-inner lining of the uterus

NFRS
Outer layer over the fundus-longitudinal muscles causing cervical effacement & expel fetus
Thick middle layer interlacing muscle fibers in figure 8 patterns surround large blood vessels. Their contractions produce a tourniquet-like action on vessel to stop bleeding p birth

Inner muscle layer is circular fibers that form sphincters at fallopian tube attachment sites and internal os. Work to keep uterine content inside during pregnancy.

NFRS
The cervix-the narrow neck of the uterus. Made of fibrous connective tissue and elastic tissue. Meets the body of the uterus at the internal os. Descends about 2.5 cm (the cervical canal) to connect with the vaginal cervix at the external os. Cervical canal is lined with columnar ciliated epithelium containing mucus-secreting glands. MOST CERVICAL CANCER begins at this squamocolumnar junction (the transformation zone).

NFRS
Cervical mucus has 3 functions: 1. lubricate vaginal canal 2. act as a protector against bacteria 3. to provide an alkaline environment for sperm (in the acid vagina)

NFRS
Fallopian Tubes

(also known as uterine tubes and oviducts)

4 sections:

Interstitial or uterine portion is the shortest and narrowest. This portion is located completely within the uterus.

Isthmus-straight, narrow, sight of tubal ligation, thick muscle wall Ampulla-curved, outer 2/3rds, highly folded wall, fertilization usually here, ends at fimbria Fimbria-funnel-shaped enlargement with many projections reaching out to the ovary

8-3.5 cm long Link peritoneal cavity with uterus and vagina Fallopian tubes have 3 functions: 1. transport the ovum from the ovary to the uterus 2. provide a site for fertilization 3. Serve as a warm, moist , nourishing environment for the ovum or zygote 3 parts:

interstitial

Isthmus Ampulla Fimbria

NFRS
Ovaries-left and right almond

shaped structures located just below the pelvic brim. Size varies among women and with the stage of the menstrual cycle as well as onset of puberty and menopause. About 3 cm long bu 1 cm wide. About 400 ova are ovulated during a womans ovulatory life span
Primary functions:

Primary source of the estrogens

(chx. contributing to femaleness) and progesterone the hormone of pregnancy

Further in-depth discussion on

hormones later on

Species maintenance but much more-hormonal maintenance as well

NFRS
Breasts-mammary glands-accessories of the reproductive system-

highly specialized sebaceous glands

Composed of glandular, fibrous, & adipose tissue. The glandular tissue is arranged in a series of 15-24 lobes separated by fibrous and adipose tissue. Each lobe is made up of several lobules composed of many alveoli clustered around tiny ducts. The lining of the ducts secretes the components of milk. The ducts from several lobules merge to form the larger lactiferous ducts and join to form lactiferous sinuses which serve as reservoirs for milk collection and open on the surface of the nipple

NFRS
The nipple is composed of erectile tissue which

becomes more rigid and prominent during pregnancy, lactation, sexual stimulation

The surrounding areola secretes a fatty substance

during lactation thought to lubricate the skin

 CYCLES

1. The Endometrial Cycle

There are 4 phases in this cycle
1-The Menstrual Phase. Shedding of the spongy and compact layers, basal layer always retained. Edometrial surface completely restored. Day 1-4 or 5 Symptoms: Cramping, bleeding: 30-60 cc bleeding is WNL 2-The proliferative phase-rapid growth. 8-10 fold thickening of the endometrium. Endometrial lining is enhanced to receive fertilized zygote if conception occurs. Lining is nutrient rich. Depends on estrogen stimulation from the ovarian follicles. Days 4/5 to ovulation

The Endometrial Cycle

Symptoms: May experience some sensation of

uterine puffiness. At the time of ovulation may experience Mittelschmerz-pain with ovulation (amount of estrogens is greatest in this phase) 3-Secretory Phase-Larger amounts of progesterone are produced. Endometrium is edematous, swollen, vascular, functional, able to sustain a growing embryo. Ovulation to 3 days prior to next menses. If fertilization does not occur the corpus luteum which has been secreting estrogen and progesterone will regress. This loss of estrogen and progesterone will cause the spiral arteries to spasm bringing about the ischemic phase.

The Endometrial Cycle Continued

Symptoms: Gradually heavy, puffy. Traditional PMS symptoms occur 3-5 days before 1st day of menses (see also the hypothalamic pituitary cycle) (amount of progesterone is greatest in this phase) 4-Ischemic Phase-Within the endometrium the blood supply is blocked, the functional endometrial layer is separated from the basal layer and sloughing is initiated or Day 1 has started of the next cycle. Symptoms: Same as above

2. The Ovarian Cycle

Immature graafian follicles containing immature ova Begin to mature with the influence of estrogen and the release of FSH When LH is released (pre-ovulation) a single follicle is selected and allowed to mature This oocyte matures, is ovulated, and the now empty follicle transforms into the corpus luteum.

The Ovarian Cycle

After ovulation estrogen levels decrease, the luteal phase

begins and ends at menstruation. This is a 13-15 day cycle. During this time the corpus luteum reaches a peak of activity 8 days after ovulation secreting estrogen and progesterone. If fertilization occurred if no fertilization Implantation now no implantation, corpus luteum regression, estrogen and progesterone withdraw, endometrium sheds

3. The Hypothalamic-Pituitary Cycle

(note when this cycle begins)
When the blood levels of estrogen and progesterone

decrease toward the end of the menstrual cycle this stimulates hypothalamus to secrete GnRH; which stimulates anterior pituitary secretion of FSH; which stimulates development of ovarian graafian follicles and their own production of estrogen

Hypothalamic-Pituitary Cycle
Now estrogen levels will slowly decrease and the
GnRH will trigger the anterior pituitary to release LH. This combination of LH surge and a lower estrogen peak happen about 24 to 36 hours before the ovum is pushed out of the graafian follicle in the ovary. This means the LH surge is on day 12-13 of the 28 day cycle.
If fertilization and implantation do not occur, the

corpus luteum becomes non functional, the estrogen and progesterone levels drop, menstruation occurs and the hypothalamus begins again the cycle of stimulating GnRH

Estrogens
Hormones that associate with

femaleness Effects are due to 3 primary estrogens: estrone, B-estradiol, estriol. #1 is B-estradiol

Estrogens control: Breast development Widening of the hips Deposits of fat tissue in buttocks and mons pubis Maturation of ovarian follicles Endometrial mucosa to develop following menses Maturation of ovarian follicles Amount is greatest in the proliferative phase Causes the uterus to increase in size and weight Uterine sensitivity to oxytocin increases Myometrial contractility increases Inhibits FSH production Stimulates LH production Many other effects on hormones

Progesterone

Secreted by the corpus luteum, greatest amount produced in the secretory phase

Decreases uterine motility and

contractility-preparing the uterus for implantation after fertilization Causes the uterine endometrium to increase its supply of glycogen, arterial blood, secretory glands, amino acids, water. Causes vaginal epithelium to proliferate Causes cervical mucus to thicken Breasts begin changes for lactation Body temperature change of 0.5-1.0 F which occurs with ovulation is due to progesterone.