MATERNITY NURSING

FEMALE REPRODUCTIVE SYSTEM:

EXTERNAL STRUCTURES ( VULVA/ PUDENDUM)

A. MONS PUBIS OR MONS VENERIS

= ROUNDED, SOFT FATTY LOOSE TISSUE OVER THE SYMPHYSIS PUBIS. DARK & CURLY PUBIC
HAIR GROWTH IN TYPICAL TRIANGULAR SHAPE

B. LABIA MAJORA

= LENGTHWISE, TWO THICK FOLDS OF FATTY SKIN EXTENDING FROM THE MONS TO THE
PERINEUM THAT PROTECTS THE LABIA MINORA, URINARY MEATUS AND VAGINAL MUCOSA.

C. LABIA MINORA

= THINNER, LENGTHWISE FOLDS OF HAIRLESS SKIN, ENCIRCLING THE CLITORIS ANTERIORLY

(PREPUCE) AND UNITE POSTERIORLY ( FOURCHETTE) .HIGHLY SENSITIVE TO MANIPULATION AND
TRAUMA, THE REASON WHY IT IS OFTEN TORN DURING DELIVERY.

D. VESTIBULE

= FLATTENED SMOOTH SURFACE INSIDE THE LABIA MINORA. IT IS THE NARROW SPACE SEEN
WHEN LABIA ARE SEPARATED

E. GLANS CLITORIS

= SMALL ERECTILE STRUCTURE; CONTAINS NERVE ENDINGS, SENSITIVE TO TEMPERATURE AND

TOUCH. IT IS THE SEAT OF SEXUAL AROUSAL AND EXCITEMENT IN FEMALES. IT IS THE MOST SENSITIVE
PART OF A WOMAN’S BODY. IT IS ALSO THE STRUCTURE THAT GUIDES THE NURSE TO THE URINARY
MEATUS.

F. URETHRAL MEATUS

= THE EXTERNAL OPENING OF THE URETHRA. SLIGHTLY BEHIND AND TO THE SIDE ARE THE
OPENINGS OF THE SKENE’S GLANDS (PARAURETHRAL GLANDS); THE SECRETIONS OF WHICH HELP TO
LUBRICATE THE EXTERNAL GENITALIA

G. HYMEN .

= A TOUGH BUT ELASTIC SEMICIRCLE OF TISSUE THAT COVERS THE OPENING TO THE VAGINA.
THE REMNANT OF HYMEN IS CALLED CARUNCULAE MYRTIFORMIS.

H. VAGINAL ORIFICE / INTROITUS

 = EXTERNAL OPENING OF THE VAGINA, COVERED BY A THIN MEMBRANE ( HYMEN) IN
VIRGINS.LOCATED LATERAL TO THE VAGINAL OPENING ON BOTH SIDES ARE THE BARTHOLIN’S GLANDS
( VULVOVAGINAL GLANDS). IT LUBRICATES THE EXTERNAL VULVA DURING COITUS AND THE ALKALINE
PH OF THEIR SECRETION HELPS TO IMPROVE SPERM SURVIVAL IN THE VAGINA.

I. FOURCHETTE

= THIN FOLD OF TISSUE FORMED BY MERGING OF THE LABIA MAJORA AND LABIA MINORA
BELOW THE VAGINAL ORIFICE.

J. PERINEUM

= MUSCULAR SKIN COVERED AREA BETWEEN VAGINAL OPENING AND ANUS.

INTERNAL STRUCTURES:

A. VAGINA

HOLLOW MEMBRANOUS CANAL, 3-4 INCHES LONG,DILATABLE, CONTAINS RUGAE (WHICH PERMITS
CONSIDERABLE STRETCHING WITHOUT TEARING).

= PASSAGEWAY OF MENSTRUATION

= PASSAGEWAY OF FETUS

= ORGAN OF COPULATION

** DODERLIEN’S BACILLUS MAINTAINS THE NORMAL FLORA OF THE VAGINA, WHICH MAKES THE pH
OF VAGINA ACIDIC, DETRIMENTAL TO THE GROWTH OF PATHOLOGIC BACTERIA.

B. UTERUS

= HOLLOW, MUSCULAR PEAR SHAPED ORGAN LOCATED IN THE PELVIS, WEIGHING 50-60 g IN
A NON-PREGNAT WOMAN. HELD IN PLACE BY BROAD LIGAMENTS. ABUNDANT BLOOD SUPPLY
COMES FROM UTERINE AND OVARIAN ARTERIES.

a. ORGAN OF IMPLANTATION ( NIDATION)

AND MENSTRUATION

b. RECEIVES THE OVA FROM THE FALLOPIAN TUBE

c. FURNISH PROTECTION FOR A GROWING FETUS

DIVISIONS OF THE UTERUS

1.CERVIX

= LOWER PORTION CALLED THE NECK

 a. EXTERNAL CERVICAL OS = DISTAL OPENING TO THE VAGINA

b. CERVICAL CANAL = THE CAVITY

c. INTERNAL CERVICAL OS = OPENING TO THE UTERUS

2. FUNDUS

= UPPER PORTION WITH TRIANGULAR PART AND CAN BE PALPATED TO DETERMINE

UTERINE GROWTH DURING PREGNANCY

= MOST VASCULAR PORTION

= NORMAL IMPLANTATION SITE

3. CORPUS

= CENTRAL PART CALLED THE BODY

4.CORNUA – THE UPPER PORTION WHERE THE FALLOPIAN TUBES ARE ATTACHED.

LAYERS:

1.ENDOMETRIUM

= INNER LAYER, HIGHLY VASCULAR,SHEDS DURING MENSTRUATION AND FOLLOWING DELIVERY

2. MYOMETRIUM

= MIDDLE LAYER , EXPELS FETUS DURING BIRTH PROCESS THEN CONTRACTS AROUND BLOOD
VESSELS TO PREVENT HEMORRHAGE (OXYTOCIN SITE)

3. PERIMETRIUM

= OUTERMOST LAYER OF THE UTERUS; OFFERS ADDED STRENGTH AND SUPPORT TO THE
STRUCTURE

UTERINE LIGAMENTS:

1. CARDINAL LIGAMENT – LOWER PORTION OF THE BROAD LIGAMENT. IT IS THE MAIN SUPPORT
OF THE UTERUS.DAMAGE TO THIS LIGAMENT WILL RESULT TO UTERINE PROLAPSE.

2.BROAD LIGAMENT – SUPPORTS THE SIDES OF THE UTERUS & ASSISTS IN HOLDING THE UTERUS IN ITS
NORMAL ANTEVERSION AND ANTEFLEXION POSITION.

3. UTEROSACRAL LIGAMENT – CONNECTS UTERUS TO THE SACRUM

4. ANTERIOR LIGAMENT –PROVIDES SUPPORT TO THE UTERUS IN CONNECTION WITH THE BLADDER.
OVERSTRETCHING OF THIS LIGAMENT WILL LEAD TO HERNIATION OF THE BLADDER TO THE VAGINA
( CYSTOCELE).

5. POSTERIOR LIGAMENT – FORMS THE CUL-DE-SAC OF DOUGLAS. DAMAGE TO THIS LIGAMENT WILL
LEAD TO HERNIATION OF THE RECTUM TO THE VAGINA. ( RECTOCOELE)

C. FALLOPIAN TUBES / OVIDUCTS / UTERINE TUBES

= TWO SLENDER MUSCULAR TUBES WHICH ARISES FROM EACH OF THE UPPER CORNER OF THE
UTERINE BODY AND EXTEND OUTWARD. PROVIDES A PLACE FOR FERTILIZATION ( CONCEPTION,
FECUNDATION, IMPREGNATION) OF OVA BY THE SPERM.

PARTS:

1.INTERSTITIAL =( 1cm) LIES WITHIN THE UTERINE WALL. IT HAS THE SMALLEST LUMEN.

2. ISTHMUS =( 2cm) PORTION CUT OR SEALED DURING TUBAL LIGATION.

3. AMPULLA =( 5cm) LONGEST PORTION, EXACT SITE OF FERTILIZATION ( DISTAL 3 RD, OUTER 3RD)

4. INFUNDIBULUM =MOST DISTAL PORTION; RIM OF THE FUNNEL IS COVERED BY FIMBRAE

THAT HELPS GUIDE THE OVA INTO THE FALLOPIAN TUBE.

D. OVARIES

= RESPONSIBLE FOR THE PRODUCTION, MATURATION AND DISCHARGE OF OVA AND SECRETION
OF ESTROGEN AND PROGESTERONE

= ORGAN OF OVULATION

LAYERS OF THE OVARY:

1. TUNICA ALBUGINEA

- THE OUTERMOST PROTECTIVE LAYER SURROUNDED BY A SINGLE LAYER OF CUBOIDAL

EPITHELIUM.

2. CORTEX

- THE FUNCTIONAL LAYER WHICH IS THE SITE OF OVUM FORMATION & MATURATION.
IT CONTAINS THE PRIMORDIAL FOLLICLES, GRAAFIAN

FOLLICLES, CORPUS LUTEUM & CORPUS ALBICANS.

3. MEDULLA
 - LAYER WHICH CONTAINS THE BLOOD VESSELS, LYMPHATICS, NERVES & MUSCLE
FIBERS.

MALE REPRODUCTIVE SYSTEM

EXTERNAL STRUCTURES:

A. MONS PUBIS

= FIRM, CUSHION-LIKE ELEVATION OF ADIPOSE TISSUE OVER THE SYMPHYSIS PUBIS.

PATTERN OF HAIR GROWTH IS DIAMOND IN SHAPE.

MALE REPRODUCTIVE SYSTEM: ANDROLOGY

B. Penis: the male organ of copulation; a cylindrical shaft consisting of:

a. corpora cavernosa -two lateral columns of erectile tissue

b. corpus spongiosum - encases the urethra

-The glans penis, a cone-shaped expansion of the corpus spongiosum that is highly sensitive in males.

-Erection is stimulated by parasympathetic nerve

C. Scrotum: a pouch hanging below the penis that contains the testes.

INTERNAL STRUCTURES:

A. TESTES

= TWO OVOID SHAPED BODY THAT LIE INSIDE THE SCROTUM

= ENCASED BY A PROTECTIVE WHITE FIBROUS CAPSULE AND COMPRISES A NUMBER OF LOBULES

= EACH LOBULE CONTAINS INTERSTITIAL

CELLS ( LEYDIG’S CELLS) AND SEMINIFEROUS TUBULES

= SEMINIFEROUS TUBULES PRODUCE SPERMATOZOA

= LEYDIG’S CELLS PRODUCE THE HORMONE TESTOSTERONE

FUNCTIONS OF THE TESTES:

1. SPERMATOGENESIS

= PROCESS BY WHICH THE SPERMATOCYTES ARE DEVELOPED INTO MATURE SPERMATOZOA

2. HORMONE PRODUCTION

a. TESTOSTERONE = AN ANDROGEN OR MUSCULINIZING HORMONE RESPONSIBLE FOR

** GROWTH & DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS

b. FSH = FOLLICLE STIMULATING HORMONE

= CAUSES RAPID SPERM PRODUCTION BY THE TUBULE (SPERMATOGENESIS)

c. ICSH – INTERSTITIAL CELL STIMULATING HORMONE( LH)

= STIMULATES LEYDIG’S CELLS TO INCREASE TESTOSTERONE PRODUCTION

B. Internal Structures

1. Epididymis: serves as reservoir for sperm storage and maturation. Approximately 20 ft. it takes 12-20
days for the sperm to travel the length of Epididymis.

A total of 60 days before they reach maturity.

(“Treatment= 2 months”).

Aspermia - (absence of sperm)

Oligospermia- if < 20 million sperm/ ml

2. Vas deferens: a duct extending from epididymis to the ejaculatory duct and seminal vesicle, providing
a passageway for sperm. (sperm mature).

Varicocele- varicosity of internal spermatic cord

Vasectomy (male birth control)

3. Seminal vesicle: are two convoluted pouches that lie along the lower portion of the bladder and
empty into the urethra by the way of ejaculatory ducts

4. Ejaculatory duct: the canal formed by the union of the vas deferens and the excretory duct of the
seminal vesicle, which enters the urethra at the prostate gland.
5. Prostate Gland: located just below the urinary bladder. Secretes alkaline and most of the seminal
fluid.

6. Bulbourethral glands or Cowper’s Gland: adds alkaline fluid to the semen. Counterpart of the
Bartholin’s glands in females.

7. Urethra: the passageway for both urine and semen, extending from the bladder to the urethral
meatus. (8 inches in long)

SEMEN:

• Is a thick whitish fluid ejaculated by the male during orgasm, contains spermatozoa
and fructose-rich nutrients.

• During ejaculation, semen receives contributions of fluid from

Prostate gland (60%)

Seminal vesicle (30%)

Epididymis ( 5%)

Bulbourethral gland (5%)

• Average pH = 7.5

• The average amount of semen released during ejaculation is 2.5 -5 ml. Sperms can
live within the female genital tract for about 24 to 72 hours.

• (50-400 million of sperms /ejaculation-

• 90 seconds- cervix

• 5 mins.- end of fallopian tube

• If the sperm count reaches 20 million, the rate is considered infertile.

 In the male, spermatogenesis occurs in the:

a. Vas deferens c. Epididymis

b. Prostate gland d. Testes

HOMOLOGUE STRUCTURE

 Female Male
  Glans Clitoris Glans penis

 Labia majora Scrotum

 Vagina Penis

 Ovaries Testes

 Fallopian tubes Vas deferens

 Skene’s glands Prostate glands

 Bartholin’s glands Cowper’s glands

 Ovum Spermatozoa

REPRODUCTIVE AND SEXUAL HEALTH

PUBERTAL DEVELOPMENT:

Puberty =is the stage of life at which the secondary sex changes; stage when the reproductive organs
become functional.

Girls- age 9 to12 years

Theory: must reach a critical weight of approx. 95lbs (43kgs)

Boys- age 12 to 14 years

The role of Androgen- hormones responsible for :

1. Muscular development

2. Physical growth

3. Increase sebaceous gland secretion (acne)

In girls, testosterone influences the development of

labia majora, clitoris, and axillary & pubic hair latter termed as (adrenarche)

SEQUENTIAL ORDER OF PUBERTAL CHANGES IN GIRLS:( GIBGOGVA)

1. GROWTH SPURT

2. INCREASE IN THE TRANSVERSE DIAMETER OF THE PELVIS

 3. BREAST DEVELOPMENT(THELARCHE)

4. GROWTH OF PUBIC HAIR

5. ONSET OF MENSTRUATION(MENARCHE)

6. GROWTH OF AXILLARY HAIR(ADRENARCHE)

7. VAGINAL SECRETIONS

SEQUENTIAL ORDER OF PUBERTAL CHANGES IN BOYS:

1. INCREASE IN WEIGHT

2. GROWTH OF TESTES

3. GROWTH OF FACE, AXILLARY & PUBIC HAIR

4. VOICE CHANGES

5. PENILE GROWTH

6. INCREASE IN HEIGHT

7. SPERMATOGENESIS

MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE

= EPISODIC UTERINE BLEEDING IN RESPONSE TO HORMONAL CHANGES

= PERIODIC SERIES OF CHANGES THAT RECUR IN THE UTERUS AND ASSOCIATED ORGANS BEGINNING AT
PUBERTY AND ENDING AT MENOPAUSE

= TAKEN FROM THE FIRST DAY OF MENSTRUATION TO THE FIRST DAY OF THE NEXT MENSTRUATION

MENSTRUATION = PERIODIC, SLOUGHING OFF OF THE ENDOMETRIUM WHICH OCCURS EVERY 28 DAYS
BUT COULD BE ANYWHERE FROM 25 TO 35 DAYS & LASTS FOR 3-5 DAYS.

Characteristic of Menstrual Blood:

1. Does not appear to clot

2. Dark red as that of venous blood

3. Offensiveness ( Fleshy stale odor)

4. MENOPAUSE = PERMANENT CESSATION OF MENSTRUAL CYCLES THAT OCCURS BETWEEN 40 &

55 Y/O

5. = THE POINT AT WHICH NO FUNCTIONING OOCYTES REMAIN IN THE OVARIES

 FUNCTIONS OF MENSTRUATION:

1. OVULATION – release of an oocyte from an ovary

2. PREPARATION FOR FERTILIZATION

3. PREPARATION FOR IMPLANTATION

ABNORMALITIES OF MENSTRUATION:

1. AMENORRHEA = TEMPORARY ABSENCE OF MENSTRUAL FLOW

2. DYSMENORRHEA = PAINFUL MENSTRUATION

3. OLIGOMENORRHEA = MARKEDLY DIMINISHED MENSTRUATION

4. POLYMENORRHEA = TOO FREQUENT MENSTRUATION OCCURING AT INTERVALS OF LESS

THAN THREE WEEKS

5. MENORRHAGIA = EXCESSIVE MENSTRUAL BLEEDING

6. METRORRHAGIA = BLEEDING BETWEEN PERIODS; INTERCYCLIC BLEEDING

7. HYPOMENORRHEA = ABNORMALLY SHORT MENSTRUATION

8. HYPERMENORRHEA = ABNORMALLY LONG MENSTRUATION

BODY STUCTURES INVOLVED IN MENSTRUATION;

1. HYPOTHALAMUS

2. ANTERIOR PITUITARY GLAND

3. OVARIES

4. UTERUS

PITUITARY HORMONES WHICH REGULATE MENSTRUAL CYCLIC ACTIVITIES:

1. FOLLICLE STIMULATING HORMONE ( FSH)

2. LUTEINIZING HORMONE ( LH )

OVARIAN HORMONES WHICH REGULATE MENSTRUAL CYCLE ACTIVITIES:

1. ESTROGEN

2. PROGESTERONE
The uterine cycle

Consists of 3 phases

1. Menstrual phase

2. Proliferative phase

3. Secretory phase

Uterine Cycle: Menstrual phase

 Day 1- day 5

 First day of bleeding is the first day of cycle

 Stratum functionale (compactum and spongiosum) is shed

 Around 60 ml average!

Uterine cycle: proliferative Phase

 Day 5- day 14

 Epithelial cells of functionale multiply and form glands

 Due to the influence of estrogen

Uterine cycle: Secretory phase

 Day 15- day 28

 Endometrium becomes thicker and glands secrete nutrients

 Uterus is prepared for implantation

 Due to progesterone

 If no fertilizationà constriction vesselsà menstruation

OVARIAN cycle

Consists of three phases

1. Pre-ovulatory : follicular phase

2. Ovulatory phase

3. Post-ovulatory : Luteal phase

Ovarian Cycle; preovulatory/follicular

 Variable in length: day 6- day 13

 Dominant follicle matures and becomes graafian follicle with primary oocyte

 FSH increases initially then decreases because of estrogen increase

Ovarian cycle:
Ovulatory phase

 Day 14

 Rupture of the graafian follicle releasing the secondary oocyte

 Due to the LH surge

 MITTELSCHMERZ- pain during rupture of follicle

OVARIAN cycle:
Post-ovulatory: luteal phase

 Day 15- day 28

 MOST CONSTANT 14 days after ovulation

 Corpus luteum secretes Progesterone

 If no fertilization, corpus luteum will become corpus albicans then degenerate

 Decreased estrogen and progesterone

Hormonal cycle

1. Menstrual phase

 Decreased Estrogen, decreased progesterone, decreased FSH and decreased LH

2. Proliferative/ Pre-ovulatory phase

 Increased FSH and Estrogen in small amounts

3. Ovulatory phase

 Increased FSH, Increased LH (surge) Increased Estrogen

4. Post ovulatory/luteal Phase

 Increased Estrogen, increased progesterone, decreased FSH and LH

  Which phase of the menstrual cycle is characterized by a surge in luteinizing hormone (*LH)?

a. Proliferative c. Ischemic

b.menstruation d. Secretory

SIGNS OF OVULATION

1. MITTLESCMERZ = A CERTAIN DEGREE OF PAIN FELT AT THE LOWER LEFT OR RIGHT ILIAC

2. CERVICAL MUCUS METHOD OR BILLING’S METHOD = CHANGES IN CERVICAL MUCUS SECRETIONS TO

CLEAR, ELASTIC & WATERY ( MOST RELIABLE SIGN).

3. SPINNBARKHEIT TEST = TEST FOR ELASTICITY OF CERVICAL MUCUS

4. Spinnbarkheit – does not indicate the exact time of ovulation but signals that a woman is nearing
ovulation. This sign is characterized by cervical mucus that is thin, watery and transparent, abundant
and highly stretchable. When dried and viewed under the microscope, the mucus reveals a fern
pattern. The fern pattern is due to elevated levels of sodium chloride.

5.Increase in Basal Body Temperature

6. MOOD CHANGES

7. BREAST CHANGES AND ENLARGEMENT AND NIPPLES BECOME ERECT

8. INCREASED LIBIDO

9. ( +) FERNING

FUNCTIONS OF ESTROGEN:

1. ASSISTS WITH THE MATURATION OF THE PRIMARY FOLLICLE

2. CAUSES PROLIFERATION OF THE ENDOMETRIUM

3. RESPONSIBLE FOR THE DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS ( BREAST

DEVELOPMENT)

4. INHIBITS FSH PRODUCTION

5. INCREASES CONTRACTIONS OF THE MYOMETRIUM

6. INCREASE CONTRACTIONS OF THE FALLOPIAN TUBES

7. INCREASES QUANTITY AND PH OF CERVICAL MUCUS CAUSING IT TO BECOME THIN & WATERY & CAN
BE STRETCHED TO A DISTANCE OF 10-13CM ( SPINBARKHEIT TEST OF ELASTICITY)

8. STIMULATES UTERINE CONTRACTIONS

 FUNCTIONS OF PROGESTERONE:

1. INCREASES BBT( THERMOGENIC EFFECT)

2. PREPARES THE ENDOMETRIUM FOR IMPLANTATION BY INCREASING GLYCOGEN, ARTERIAL BLOOD,

SECRETORY GLANDS, AMINO ACIDS AND WATER.

3. MAINTAINS PREGNACY BY INHIBITING UTERINE CONTRACTIONS

4. INHIBITS THE PRODUCTION OF LH

5. INCREASES ENDOMETRIAL TORTUOSITY

REPRODUCTIVE HORMONES

1. FOLLICLE STIMULATING HORMONE (FSH)

= STIMULATES THE DEVELOPMENT OF GRAAFIAN FOLLICLE & THE OVUM

= MAKES THE OVUM MATURE

2. LUTEINIZING HORMONE ( LH)

= STIMULATES OVULATION AND DEVELOPMENT OF CORPUS LUTEUM

SEXUAL RESPONSE CYCLE

1. EXCITEMENT PHASE = OCCURS WITH PHYSICAL, PSYCHOLOGICAL ( SIGHT, SOUND, EMOTION

OR THOUGHT) STIMULATION THAT CAUSES PARASYMPATHETIC NERVE STIMULATION

= VAGINAL LUBRICATION OCCURS, ARTERIAL DILATION & VENOUS CONSTRICTION IN THE GENITAL
AREA, OVERALL MUSCLE TENSION INCREASES. IN MEN, ERECTION INCREASES, CR,RR,BP INCREASES

2. PLATEAU PHASE = NIPPLES BECOME FURTHER ENGORGED. IN MEN, VASOCONGESTION LEADS TO

FULL DISTENTION OF THE PENIS, FLUSHING OCCURS, BREATHING BECOMES DEEPER, CR,RR & BP
INCREASE MARKEDLY

3. ORGASMIC PHASE = SHORTEST STAGE IN THE SEXUAL RESPONSE CYCLE, STRONG MUSCULAR
CONTRACTIONS BOTH VOLUNTARY & INVOLUNTARY IN MANY PARTS OF THE BODY, RR,CR DOUBLES
AND BP INCREASING AS MUCH AS 1/3 ABOVE NORMAL.

4. RESOLUTION PHASE = GENERALLY TAKES APPROXIMATELY 30 MINUTES FOR BOTH MEN & WOMEN ,
GENERAL MUSCLE RELAXATION OCCURS, EXTERNAL & INTERNAL ORGANS TO UNAROUSED STATE.

THE BREASTS

FUNCTIONS:

1. LACTATION
2. MILK SECRETION/ EJECTION

STRUCTURES:

1. LOBES = CONSISTS OF 15-20 LOBES WHICH ARE SUBDIVIDED INTO LOBULES OR ACINAR CELLS
( RESPONSIBLE FOR MILK PRODUCTION)

2. 2. LACTIFEROUS DUCTS = MILK RESERVOIR – WHICH OPEN TO THE NIPPLE.

3. 3. AREOLA = DARK PIGMENTED PART AROUND THE NIPPLE

4. 4. MONTGOMERY TUBERCLE = SECRETES FATTY SUBSTANCE TO LUBRICATE NIPPLES

5. 5. NIPPLE = ELEVATED PART OF THE BREASTS CONTAINING 15-20 OPENINGS FROM THE
LACTIFEROUS DUCTS

6. 6. COOPER’S LIGAMENT = PROVIDES SUPPORT TO THE MAMMARY GLAND WHILE IT PERMITS

MOBILITY ON THE CHEST WALL

PHYSIOLOGY OF MILK PRODUCTION

** THE PRODUCTION OF BREAST MILK IS NOT ACHIEVED DURING PREGNACY BECAUSE OF THE
PREDOMINANCE OF ESTROGEN & PROGESTERONE.

** IMMEDIATELY AFTER THE DELIVERY OF THE PLACENTA, THERE IS MARKED DECREASE OF BOTH
ESTROGEN & PROGESTERONE W/C SERVES AS A STIMULUS FOR THE APG TO PRODUCE PROLACTIN.

** PROLACTIN ACTS ON THE ACINI CELLS TO STIMULATE PRODUCTION OF MILK & STORED IN THE
LACTIFEROUS DUCTS.

** AS THE INFANT SUCKS, THE PPG IS STIMULATED TO RELEASE THE HORMONE OXYTOCIN CAUSING
THE COLLECTING SINUSES OF THE MAMMARY GLANDS TO CONTRACT, FORCING MILK FORWARD
THROUGH THE NIPPLES CALLED “LET DOWN REFLEX” OR “MILK EJECTION REFLEX”.

PREGNANEDIOL – DRUG THAT SUPRESSES MILK FORMATION.

** IN A BREAST FEEDING MOTHER,WHEN AN INFANT SUCKS,NERVE IMPULSES TRAVEL FROM NIPPLE TO

THE HYPOTHALAMUS TO STIMULATE PRODUCTION OF PROLACTIN.

** 3-4 DAYS AFTER DELIVERY,A THIN, WATERY FLUID COMPOSED OF PROTEIN, SUGAR, FAT, WATER,
MINERALS, VITAMINS AND MATERNAL ANTIBODIES IS PRODUCED CALLED COLOSTRUM.

SPERM CELL:

** SPERMATOZOA DEPOSITED IN THE VAGINA REACHES THE WAITING EGG IN THE FALLOPIAN TUBE IN
ABOUT 5 MINUTES
** THE FUNCTIONAL LIFE OF SPERMATOZOA IS 48-72 HRS (3 DAYS) BUT CAN STAY ALIVE IN THE VAGINA
FOR 5 -7 DAYS.

** ONLY ONE SPERMATOZOON IS ABLE TO PENETRATE THE CELL MEMBRANE OF THE OVUM
AFTERWHICH CELL MEMBRANE BECOMES IMPERVIOUS TO OTHER SPERMATOZOA.

** REPRODUCTIVE CELLS, DURING GAMETOGENESIS DIVIDE BY MEIOSIS ( HAPLOID NUMBER OF

DAUGHTER CELLS)

** ( THE REST OF THE BODY CELLS HAVE 46 CHROMOSOMES)

** SPERMS THEREFORE CONTAIN ONLY 23 CHROMOSOMES = 22 AUTOSOMES & 1 X SEX

CHROMOSOME OR 1 Y SEX CHROMOSOME.

** THE UNION OF AN X CARRYING SPERM (GYNOSPERM) & A MATURE OVUM RESULTS IN A BABY GIRL
(XX)

** THE UNION OF A Y CARRYING SPERM(ANDROSPERM) & A MATURE OVUM RESULTS IN A BABY BOY
(XY)

** ONLY FATHERS CAN DETERMINE THE SEX OF THEIR CHILDREN

** SEX OF A CHILD IS DETERMINED AT THE TIME OF FERTILIZATION

 An anxious woman who missed her period went to the clinic for consult; she tells you that she
wants to have a boy this time because she already has 9 girls. And she asks you what will she
do? Your appropriate response would be, that the sex of the fetus is determined by :

a. The X chromosome of the father

b. Either a or c

c. The Y chromosomes of the father

d. The mother chromosomes

A. FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION)

= IT IS THE UNION OF A MATURED EGG AND A SPERM & THE PRODUCT IS CALLED A CONCEPTUS
OR ZYGOTE.

=IT OCCURS AT THE DISTAL 3RD OF THE FALLOPIAN TUBE – THE AMPULLA

TWO CHANGES THAT TAKE PLACE IN THE SPERM AS IT REACHES THE OVUM
1. CAPACITATION – REMOVAL OF THE PROTECTIVE COATING OF THE SPERM

2. ACROSOME REACTION = PERFORATION OF THE HEAD AND RELEASE OF ENZYMES

( HYALURONIDASE) THEREBY DISSOLVING THE COVERING OF THE OVUM ( ZONA PELLUCIDA & CORONA
RADIATA.)

ZYGOTE:

- IS THE FIRST CELL FORMED FROM THE FERTILIZATION OF SPERM & OVUM.

- IT CONTAINS 46 CHROMOSOMES: 44 AUTOSOMES & EITHER XX CHROMOSOMES IF THE

OFFSPRING IS A FEMALE, OR XY CHROMOSOME, IF THE OFFSPRING IS A MALE.

- IT JOURNEYS FROM THE FALLOPIAN TUBE TO THE UTERUS FOR 3-5 DAYS

- 16 HOURS AFTER FERTILIZATION, IT UNDERGOES ITS FIRST CELL DIVISION ,” BLASTOMERE”

- WHEN THERE ARE ALREADY 16 OR MORE BLASTOMERES, THE ZYGOTE IS TERMED

“MORULA”( MORUS – MULBERRY)

- WHEN IT REACHES THE UTERUS IT IS TRANSFORMED INTO A “BLASTOCYST” – A BALL LIKE

STRUCTURE COMPOSED OF AN INNER CELL MASS , CALLED EMBRYONIC DISC OR BLASTOCELE & AN
OUTER LAYER OF RAPIDLY DEVELOPING CELLS CALLED TROPHOBLASTS OR TROPHODERM.

THE TROPHOBLASTS SECRETES A HORMONE CALLED “ HUMAN CHORIONIC GONADOTROPIN “ OR HCG

NECESSARY IN PROLONGING THE LIFE OF THE CORPUS LUTEUM.

- THE BLASTOCELE OR EMBRYONIC DISC GIVES RISE TO THE THREE PRIMARY GERM LAYERS:
ECTODERM, MESODERM, ENDODERM.

 Pregnancy tests analyze for the level of HCG hormone. The purpose of this hormone is to:

A. Ensure HPL production

B. Permit the uterus to increase in size

C. Prolong the life of the corpus luteum

D. Ensure oxygen transport to the placenta

PRIMARY GERM LAYERS (BLASTOCELE)

TISSUE LAYER BODY PORTIONS FORMED

ECTODERM NERVOUS SYSTEM, SKIN, HAIR

( OUTER LAYER) NAILS, SENSE ORGANS, MUCUS

MEMBRANES OF NOSE & MOUTH

MESODERM CONNECTIVE TISSUE, BONES,

( MIDDLE LAYER) CARTILAGE, MUSCLES,

TENDONS, KIDNEYS, URETERS,

REPRODUCTIVE SYSTEM, HEART,

CIRCULATORY SYSTEM, BLOOD

CELLS

ENDODERM / ENTODERM LINING OF THE GI TRACT, ( INNER LAYER)

RESPIRATORY TRACT,

TONSILS, PARATHYROID,

THYROID, THYMUS GLANDS,

BLADDER, URETHRA

TROPHOBLASTS OR THE OUTER CELLS:

AT ABOUT 3 WEEKS, THE TROPHOBLAST CELLS DIFFERENTIATE INTO TWO DISTINCT LAYERS:

1.CYTOTROPHOBLAST OR LANGHAN’S LAYER:

- INNER LAYER THAT PROTECTS THE FETUS AGAINST SYPHILIS UNTIL THE 2 ND TRIMESTER.

2. SYNCYTIOTROPHOBLAST OR SYNCYTIAL LAYER:

- OUTER LAYER THAT PRODUCES THE HORMONES HUMAN CHORIONIC GONADOTROPIN

(HCG),HUMAN PLACENTAL LACTOGEN (HPL). ESTROGEN & PROGESTERONE.

IMPLANTATION/NIDATION

- THE BLASTOCYST REMAINS FREE FLOATING IN THE UTERINE CAVITY FOR 3-5 DAYS & IMPLANTS
IN THE ENDOMETRIUM 6-7 DAYS AFTER FERTILIZATION.
 - AS IT ATTACHES ITSELF TO THE WALL OF THE UTERUS, ITS TROPHOBLAST CELLS RELEASE
ENZYMES ALLOWING IT TO BURROW DEEP INTO THE ENDOMETRIUM RESULTING IN RUPTURE OF
VESSELS & BLEEDING AT THE IMPLANTATION SITE. “ IMPLANTATION BLEEDING”.

DECIDUA:

- AFTER IMPLANTATION, THE ENDOMETRIUM IS NOW REFERRED TO AS THE DECIDUA.

LAYERS:

1. DECIDUA BASALIS –LAYER WHERE IMPLANTATION TAKES PLACE. IT WILL LATER ON FORM THE
MATERNAL SIDE OF THE PLACENTA.

2. DECIDUA CAPSULARIS – LAYER WHICH ENCLOSES, ENVELOPES THE BLASTOCYST & BECOMES
THE BAG OF WATER.

3. . DECIDUA VERA – NO FUNCTION IN PREGNANCY

** DECIDUA PARIETALIS – LOCATED UNDER THE DECIDUA BASALIS.

MEMBRANES:

1. CHORION – TOGETHER WITH THE DECIDUA BASALIS BECOMES THE PLACENTA.

2. AMNION – SMOOTH, THIN, TOUGH & TRANSLUCENT MEMBRANE DIRECTLY ENCLOSING THE FETUS &
THE AMNIOTIC FLUID. IT IS CONTINUOUS WITH THE UMBILICAL CORD & COVER THE FETAL SURFACE OF
THE PLACENTA & UMBILICAL CORD.

AMNIOTIC FLUID:

- 500 ML TO 1200 ML AT TERM; AVERAGE 1000 ML

- 99% WATER & 1% SOLID PARTICLES CONTAINING ALBUMIN, UREA, URIC ACID, CREATININE,
LECITHIN, SPHINGOMYELIN, BILIRUBIN & VERNIX CASEOSA.

- SHOULD BE CLEAR, COLORLESS TO STRAW COLORED WITH TINY SPECKS OF VERNIX CASEOSA.

- AMNIOTIC FLUID VOLUME INCREASES DURING PREGNANCY & PEAKS APPROXIMATELY 2

WEEKS BEFORE EDC

AMNIOTIC FLUID

 fetus contributes to the fluid through urine excretion and absorbs from it by swallowing

 Hydramnios or polydydaramnios (> 2000 ml)

  Oligohydramnios (< 500) ml indicate an abnormal process

ABNORMAL AMNIOTIC COLORS:

1. GREEN TINGES OR MECONIUM STAINED – SIGNIFIES FETAL DISTRESS

2. GOLD OR YELLOW – SIGNIFIES HEMOLYTIC DISEASE SUCH AS Rh OR ABO INCOMPATIBILITY

3. GRAY – INDICATES INFECTION

4. PINK – SIGNIFIES BLEEDING

FUNCTIONS OF AMNIOTIC FLUID:

1. PROTECTS THE FETUS FROM TRAUMA

2. ALLOWS FREEDOM OF MOVEMENT WHICH PERMITS SYMMETRICAL GROWTH & DEVELOPMENT

3.MAINTAINS A CONSTANT TEMPERATURE.

4. SOURCE OF ORAL FLUID INTRAUTERINE.

5. AIDS IN DIAGNOSIS OF MATERNAL & FETAL COMPLICATIONS.

6. AIDS IN FETAL DESCENT DURING LABOR BY PROVIDING LUBRICATION IN THE BIRTH CANAL.

 A patient asks the nurse about the amniotic fluid volume during pregnancy. Which statement by
the nurse conveys correct information?

a.. “ Amniotic fluid volume increases until birth”

b. “ Amniotic fluid volume fluctuates throughout pregnancy”

c. “ Amniotic fluid volume remains constant throughout pregnancy”

d. “ Amniotic fluid volume decreases near term

 Which of the following amount of amniotic fluid is normal at full term,

 a. 800-1200 ml
  b. 300-400 ml

 c. 2 00-300 ml

 d. 1000-2000 ml

UMBILICAL CORD / FUNIS

- formed from the chorion and the amnion

- STRUCTURE THAT CONNECTS THE FETUS TO THE PLACENTA. MAIN FUNCTION IS TO CARRY O2
& NUTRIENTS FROM THE PLACENTA TO THE FETUS & RETURN THE UNOXYGENATED BLOOD & FETAL
WASTE PRODUCTS TO THE PLACENTA.

- 50 -55 CMS LONG. APPEARS DULL WHITE,MOIST & COVERED BY AMNION.

- COMPOSED OF 2 ARTERIES & 1 VEIN ( AVA)

- IF ONLY TWO BLOOD VESSELS, SUSPECT RENAL ANOMALIES.

** WHARTON’S JELLY – GELATINOUS SUBSTANCE THAT COVERS THE UMBILICAL CORD TO PREVENT
TRAUMA TO THE CORD.

CORD INSERTION:

* CENTRAL INSERTION – NORMALLY, THE CORD IS INSERTED AT THE CENTER OF THE FETAL
SURFACE OF THE PLACENTA.

* LATERAL INSERTION – WHEN THE CORD IS INSERTED AWAY FROM THE CENTER OF THE
PLACENTA BUT NOT AT ITS EDGES.

* VELAMENTOUS INSERTION – WHEN THE CORD IS INSERTED IN THE MEMBRANES ABOUT 5 TO

10 CM AWAY FROM THE EDGE OF THE PLACENTA.

* BATTLEDORE INSERTION – WHEN THE CORD IS INSERTED AT THE EDGE OF THE PLACENTA

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