1.
Female Reproductive System

2.
<ul><li>Eggs ” are produced in the ovaries , female typically has about 400,000 follicles/potential eggs, all formed before birth. Only several hundred of these “eggs” will actually ever be released during her reproductive years </li></ul>

3.
<ul><li>Normally, in humans, after the onset of puberty, due to the stimulation of follicle-stimulating hormone (FSH) one “egg” per cycle matures and is released from its ovary. </li></ul>

4.
<ul><li>Ovulation is the release of a mature “egg” due to the stimulation of leutenizing hormone (LH) , which then stimulates the remaining follicle cells to turn into a corpus luteum which then secretes progesterone to prepare the uterus for possible implantation. If an egg is not fertilized and does not implant, the corpus luteum disintegrates and when it stops producing progesterone, the lining of the uterus breaks down and is shed. </li></ul>

5.
<ul><li>The internal genital organs form a pathway (the genital tract). This pathway consists of the following: </li></ul><ul><li>Vagina (part of the birth canal), where sperm are deposited and from which a baby can emerge </li></ul><ul><li>Uterus, where an embryo can develop into a fetus </li></ul><ul><li>Fallopian tubes (oviducts), where a sperm can fertilize an egg </li></ul><ul><li>Ovaries, which produce and release eggs </li></ul><ul><li>Sperm can travel up the tract, and eggs down the tract. </li></ul>Internal Genital Organs

7.
<ul><li>At the beginning of the tract, just inside the opening of the vagina, is the hymen, a mucous membrane. In virgins, the hymen usually encircles the opening like a tight ring, but it may completely cover the opening. The hymen helps protect the genital tract but is not necessary for health. It may tear at the first attempt at sexual intercourse, or it may be so soft and pliable that no tearing occurs. </li></ul>

8.
<ul><li>the hymen may also be torn during exercise or insertion of a tampon or diaphragm. Tearing usually causes slight bleeding. In women who have had intercourse, the hymen may be unnoticeable or may form small tags of tissue around the vaginal opening. </li></ul>

9.
Vagina: <ul><li>The vagina is a narrow, muscular but elastic organ about 4 to 5 inches long in an adult woman. It connects the external genital organs to the uterus. The vagina is the main female organ of sexual intercourse. The penis is inserted into it. It is the passageway for sperm to the egg and for menstrual bleeding or a baby to the outside. </li></ul>

10.
<ul><li>Usually, there is no space inside the vagina unless it is stretched open—for example, during an examination, sexual intercourse, or childbirth. The lower third of the vagina is surrounded by elastic muscles that control the diameter of its opening. These muscles contract rhythmically and involuntarily during orgasm. </li></ul>

11.
<ul><li>The vagina is lined with a mucous membrane, kept moist by fluids oozing from cells on its surface and by secretions from glands in the cervix (the lower part of the uterus). A small amount of these fluids may pass to the outside as a clear or milky white vaginal discharge, which is normal. </li></ul>

12.
<ul><li>During a woman's reproductive years, the lining of the vagina has folds and wrinkles. Before puberty and after menopause (if the woman is not taking estrogen), the lining is smooth. </li></ul>

13.
Uterus and Cervix: <ul><li>The uterus is a thick-walled, muscular, pear-shaped organ located in the middle of the pelvis, behind the bladder, and in front of the rectum. The uterus is anchored in position by several ligaments. The main function of the uterus is to sustain a developing fetus. The uterus consists of the cervix and the main body (corpus). </li></ul>

14.
<ul><li>The uterus is a thick-walled, muscular, pear-shaped organ located in the middle of the pelvis, behind the bladder, and in front of the rectum. The uterus is anchored in position by several ligaments. The main function of the uterus is to sustain a developing fetus. The uterus consists of the cervix and the main body (corpus). </li></ul>

15.
<ul><li>Sperm can enter and menstrual blood can exit the uterus through a channel in the cervix. The channel is usually narrow, but during labor, the channel widens to let the baby through. The cervix is usually a good barrier against bacteria, except around the time an egg is released by the ovaries (ovulation), during the menstrual period, or during labor. </li></ul>

16.
<ul><li>The corpus of the uterus, which is highly muscular, can stretch to accommodate a growing fetus. Its muscular walls contract during labor to push the baby out through the cervix and the vagina. During the reproductive years, the corpus is twice as long as the cervix. After menopause, the reverse is true. </li></ul>

17.
<ul><li>As part of a woman's reproductive cycle (which usually lasts about a month), the lining of the corpus (endometrium) thickens. If the woman does not become pregnant during that cycle, most of the endometrium is shed and bleeding occurs, resulting in the menstrual period. </li></ul>

18.
Fallopian Tubes: <ul><li>The two fallopian tubes, which are about 2 to 3 inches (about 5 to 7 centimeters) long, extend from the upper edges of the uterus toward the ovaries. The tubes do not directly connect with the ovaries. Instead, the end of each tube flares into a funnel shape with fingerlike extensions (fimbriae). When an egg is released from an ovary, the fimbriae guide the egg into the relatively large opening of a fallopian tube. </li></ul>

19.
<ul><li>the fallopian tubes are lined with tiny hairlike projections (cilia). The cilia and the muscles in the tube's wall propel an egg downward through the tube to the uterus. The egg may be fertilized by a sperm in the fallopian tube </li></ul>

20.
Ovaries: <ul><li>The ovaries are usually pearl-colored, oblong, and about the size of a walnut. They are attached to the uterus by ligaments. In addition to producing female sex hormones (estrogen and progesterone) and male sex hormones, the ovaries produce and release eggs. The developing egg cells (oocytes) are contained in fluid-filled cavities (follicles) in the wall of the ovaries. Each follicle contains one oocyte. </li></ul>

21.
Menstruation <ul><li>Menstruation is the shedding of the uterine lining ( endometrium ). </li></ul><ul><li>Eumenorrhea denotes normal, regular menstruation that lasts for a few days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal). [2] The average blood loss during menstruation is 35 millilitres with 10-80 mL considered normal; [3] many females also notice shedding of the endometrium lining that appears as tissue mixed with the </li></ul>

22.
<ul><li>Because of this blood loss, premenopausal women have higher dietary requirements for iron to prevent iron deficiency . Many women experience uterine cramps, also referred to as dysmenorrhea , during this time, caused largely by the contractions of the uterine muscle as it expels the endometrial blood from the woman's body. A vast industry has grown to provide drugs to aid in these cramps, as well as sanitary products to help manage menses. </li></ul>

23.
<ul><li>Menstruation is the term given to the periodic discharge of blood, tissue, fluid and mucus from the reproductive organs of sexually mature females. The flow usually lasts from 3 - 6 days each month and is caused by a sudden reduction in the hormones estrogen and progesterone. </li></ul>

24.
<ul><li>It is hormones that govern this process. Hormones are a chemical substance, produced by an organ, gland or special cells, that is carried through the bloodstream to regulate the activity of certain organs. </li></ul>

25.
<ul><li>It is the balance and interplay between these hormones which regulate the specific events that make up the menstrual cycle. </li></ul><ul><li>Factors like nutrition, stress, exercise, and belief systems can all influence how the hormones work and what we experience during our cycles. </li></ul>

26.
Hormones start to do their thing at the onset of puberty, and various types of hormones are involved <ul><li>These hormones are: Estrogen 1) Promotes the development and maintenance of female reproductive structures (especially the endometrial lining of the uterus), 2) Assists in the control of fluid and electrolyte balance within the body. 3) Prepares the follicle for the release of an egg. Estrogen also has many other functions. </li></ul>

27.
Progesterone: <ul><li>Secreted at ovulation, helps to prepare the endometrium (womb lining) for the implantation of an egg, prepares mammary galnds for milk production. Primarily concerned with the procreation and survival of the fetus. </li></ul>

28.
FSH Follicle Stimulating Hormone: <ul><li>Stimulates the follicles (a follicle is a balloon shaped structure which is filled with fluid and contains an egg, follicles are found in the ovaries) to ripen several eggs. At the same time the ovaries release oestrogen. </li></ul>

29.
LH Lutenising hormone: <ul><li>Further develops the follicles, triggers ovualtion and stimulates production of other hormones necessary for the post ovulatory stage of the menstrual cycle. The secretion of hormones is a complex affair.Various parts of the body become involved in a myriad of chemical transactions. </li></ul>

30.
<ul><li>Often the hormones within the menstrual cycle have other functions to play in a womans body as well, for example progesterone increases libido, is a natural diuretic and aids in the process of building new bone to name just a few, therefore maintaining hormonal health is essential to all levels of a womans well being. </li></ul>

31.
<ul><li>We need to remember that these hormones are usually only present in small amounts and that it is the relationship between the levels of the hormones that is critical. When the balance is upset, any number of menstrual irregularities can occur. </li></ul>

32.
MENSTRUATION CHARACTERISTICS <ul><li>Length of menstrual cycle- first day of the last menstrual bleeding to the first day of the next menstruation. </li></ul><ul><li>Average Menstrual cycle – 28 days </li></ul><ul><li>Average Flow -4-7 days </li></ul><ul><li>Dysmenorrhea-abdominal and lower back pain </li></ul>

33.
<ul><li>Premenstrual Syndrome-HA, Bloating, heaviness in lower abdomen and legs, breast tenderness and swelling, food cravings, depression , irritability. </li></ul>

34.
Physiology of Menstruation <ul><li>Proliferative Phase – (estrogenic, luteal, postmenstrual) </li></ul><ul><li>- the time between the ending of menses and ovulation </li></ul><ul><li>Secretory Phase – ( progestational, luteal, premenstrual) </li></ul><ul><li> - time between ovulation and the next menses </li></ul><ul><li>3. Ischemic Phase - bleeding </li></ul>

35.
MATERNAL ADAPTATION TO PREGNANCY <ul><li>Terms used to denote Fetal Growth </li></ul><ul><li>Ovum - From ovulation to fertilization </li></ul><ul><li>Zygote - From fertilization to implantation </li></ul><ul><li>Embryo - From implantation to 5-8 weeks </li></ul><ul><li>Fetus - From 5-8 weeks until term </li></ul><ul><li>Conceptus - Developing embryo or fetus and placental structures throughout pregnancy. </li></ul>

36.
<ul><li>TIMETABLE FOR PHYSIOLOGIC CHANGES OF PREGNANCY </li></ul><ul><li>BODY OCCURRENCE </li></ul><ul><li>__________________________________________________________________ </li></ul><ul><li>Location of Change 1st trimester 2nd trimester 3rd trimester </li></ul><ul><li>Cardiovascular Blood volume increasing-----------------------------------------------------------------  </li></ul><ul><li>Pseudoanemia BP slightly decreased BP returns to pre </li></ul><ul><li>pregnancy levels </li></ul><ul><li>Clotting factors increasing--------------------------------------------------------------  </li></ul><ul><li>Ovarian Corpus luteum active Corpus luteum fading </li></ul><ul><li>Uterine Increased growth--------------------------------------------------------------------------  </li></ul><ul><li>Placenta forming estrogen and progesterone---  </li></ul><ul><li>Cervix Softening progressive---------------------------------------------------------  ”Ripe” </li></ul><ul><li>Vaginal White discharge present-------------------Increasing--------------------------------  </li></ul><ul><li>Musculoskeletal Progressive cartilage softening---------------------  </li></ul>

37.
TERMINOLOGIES <ul><li>Gestation: pregnancy </li></ul><ul><li>Embryo : Conception up to 10 th week.AOG(8 TH week post conception) </li></ul><ul><li>Fetus: 10 TH Wk up to delivery </li></ul><ul><li>Viability: Capability of the fetus to survive, accepted at 24wks </li></ul>

38.
<ul><li>Gravida: A Woman who is or has been pregnant regardless of the outcome </li></ul><ul><li>Nulligravida: A woman who is not been pregnant regardless of the outcome. </li></ul><ul><li>Primigravida: Woman pregnant for the first time. </li></ul><ul><li>Multigravida:Woman who has been pregnant more than once. </li></ul><ul><li>Para: refers to past pregnancy that has reached viability </li></ul><ul><li>Nullipara: Woman who has never completed pregnancy up to the age of viability </li></ul>

39.
<ul><ul><ul><ul><ul><li>Nullipara : Woman who has never completed pregnancy up to the age of viability </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Primipara: Woman who has completed one pregnancy up to the edge of viability regardless of the outcome. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Multipara : Woman who has completed 2 or more pregnancy to the age of viability </li></ul></ul></ul></ul></ul>

40.
OBSTETRIC HISTORY <ul><li>T: TERM >37 wks AOG </li></ul><ul><li>P: preterm 24 wks<37WKS AOG </li></ul><ul><li>A: abortion <24 WKS AOG,including molar pregnancy </li></ul><ul><li>L: living Children </li></ul>

41.
Manifestation of Pregnancy <ul><li>Presumptive : Signs and Symptoms that suggest but do not prove pregnancy </li></ul><ul><li>Cessation of menses </li></ul><ul><li>Breast Changes </li></ul><ul><li>enlargement </li></ul><ul><li>Tingling of breast </li></ul><ul><li>Increased sensitivity to touch </li></ul><ul><li>Darkening of nipples and areola </li></ul>

42.
<ul><li>Skin Changes </li></ul><ul><li>-Chloasma </li></ul><ul><li>-Linea nigra </li></ul><ul><li>-Abdominal striae </li></ul><ul><li>Nausea and Vomiting </li></ul><ul><li>Frequency and Urination </li></ul><ul><li>Goodells sign – softening of the cervix </li></ul><ul><li>fatique </li></ul>

43.
PROBABLE SIGNS <ul><li>Strong indicators of pregnancy, maybe detected about the 12 th week </li></ul><ul><li>Enlargement of the abdomen -12 weeks </li></ul><ul><li>Chadwick’s Sign </li></ul><ul><li>Hegar’s Sign </li></ul><ul><li>Braxton hicks Contraction </li></ul><ul><li>Ballotment </li></ul>

44.
<ul><li>Palpation of Fetal Outline </li></ul><ul><li>Quickening(16-20 WKS) </li></ul><ul><li>Positive Pregnancy Test –as early as 8-10 days after conception </li></ul>

45.
Positive Signs <ul><li>Fetal heart tones (FHT) </li></ul><ul><li>Fetal movement felt by the examiner </li></ul><ul><li>Qutlining of the fetal body </li></ul><ul><li>Sonographic Evidence </li></ul>