Reproductive Anatomy and Physiology PDF

Reproductive Anatomy and Physiology Copyright © 2016, © 2012, © 2009 by Pearson Education, Inc. All Rights Reserved  Learning Outcomes 1. Identify the structures and functions of the female reproductive system...

Reproductive Anatomy and Physiology Copyright © 2016, © 2012, © 2009 by Pearson Education, Inc. All Rights Reserved  Learning Outcomes 1. Identify the structures and functions of the female reproductive system. 2. Discuss the significance of specific female reproductive structures during pregnancy and childbirth.  Learning Outcomes 4. Summarize the actions of the hormones that affect reproductive functioning. 5. Identify the phases of the ovarian cycle and the changes that occur in each phase.  Learning Outcomes 6. Describe the phases of the uterine (menstrual) cycle, their dominant hormones, and the changes that occur in each phase. 7. Identify common menstrual disorders  Female Reproductive System  External genitals  Internal genitals  Accessory organs of breasts  Structure of bony pelvis External Genitals  External Genitals  Vulva includes:  Mons pubis  Labia majora and minora  Clitoris  Urethral meatus  Vaginal orifice  Vestibule  Perineal body Figure 9–2 Female external genitals, longitudinal view.  External Genitals  Mons pubis  Subcutaneous fatty tissue at lowest portion of anterior abdominal wall, over the pubic bone  Covered with pubic hair & loaded with nerve endings  Labia majora  Either side of the vulvar cleft  Chief function to protect structures between Stratified squamous epithelium  External Genitals  Labia minora  Skin within labia majora that converge near the anus  Form fourchette  Clitoris  Located between labia minora  Erectile tissue with prepuce, or clitoral hood  Primary erogenous organ of women  External Genitals  Urethral meatus and paraurethral glands  1–2.5 cm beneath clitoris  Difficult to visualize  Skene glands on 2 sides of the opening  Vaginal vestibule: area bw labia minora & has 2 opennings: uterthral & vagina  Introitus  Hymen  Vulvovaginal (Bartholin) glands  External Genitals  Perineal body  Wedge-shaped mass of fibromuscular tissue between vagina and anus  Perineum is superficial area  Site of episiotomy or lacerations during childbirth Internal Genital Organs  Internal Genital Organs Vagina Uterus Fallopian tubes Ovaries Female Internal Reproductive Organs  Vagina  A stretchable canal, 10 cm long, run from the vestibule to cervix  Muscular, membranous tube  Walls covered with rugae  allows enlargement of vagina during delivery  Normally acidic during reproductive life Female Internal Reproductive Organs  Vagina  Functions  Passageway for sperm during coitus, fetus during birth  Passage for menstrual blood flow  Protect against trauma from sexual intercourse and infection from pathogenic organisms Female Internal Reproductive Organs  Uterus – Hollow, thick-walled muscular pear- shaped – Centered in pelvic cavity, behind bladder & in front of rectum – Leans forward: called anteversion – Two major parts – corpus and cervix – Mature size 6–8 cm long Figure 9–3 Female internal reproductive organs. Female Internal Reproductive Organs Uterus Female Internal Reproductive Organs  Uterus  Isthmus  Lower uterine segment  Portion of uterus between internal cervical os, endometrial cavity  Site for CS incision Female Internal Reproductive Organs  Uterus  Uterine corpus  Upper triangular portion  Serosal layer (perimetrium)  Muscular layer (myometrium)  Mucosal layer (endometrium): ciliated epithelium, change thickness during cycle  Monthly renewal from menarche to menopause in absence of pregnancy  Basal & functional layer Figure 9–4 Structures of the uterus. Female Internal Reproductive Organs  Uterus  Uterine corpus  Cervix  Internal os  Opens to uterus  External os  Opens to vagina  Female Internal Reproductive Organs  Uterus  Uterine corpus  Cervix  Function  Lubrication of vagina  Acts as bacteriostatic agent  Provides alkaline environment Female Internal Reproductive Organs Uterine ligaments – Broad: folds of peritoneum, draped over fallopian tubes like a curtain – Round: maintain anteverted position of uterus – Ovarian: support ovaries – Cardinal: supports cx to lateral wall – Infundibulopelvic: supports ovaries – Uterosacral: supports cx to sacrum Figure 9–7 Uterine ligaments.  Female Internal Reproductive Organs  Fallopian tubes: 2 tubes, each has 3 parts:  Isthmus: narrow part, 2.5 cm from uterus  Ampulla: dilated portion, 5 cm.  Fimbria: funnel-shaped end, has fimbriae (finger-like) at the end  Functions  Transport ovum to uterus  Site for fertilization  Nourishing environment for ovum/zygote Figure 9–8 Fallopian tube and ovaries. Female Internal Reproductive Organs  Ovaries: Female sex glands, oval, almond- shaped, 3 cm long, 1.5 cm wide, 1 cm thick  Attached to the back of broad ligaments  Three layers  Tunica albuginea: surface of ovary  Cortex: functioning part of the ovary, contains ovarian follicles  Medulla: supporting part Female Internal Reproductive Organs  Ovaries Female Internal Reproductive Organs  Function of ovaries:  Store and develop follicles  Secrete hormones  Estrogen  Progesterone Bony Pelvis  Bony Pelvis  Function – Support and protect the pelvic contents – Form the relatively fixed axis of the birth passage  Bony structure – four bones – Innominate (two side bones) – Sacrum – Coccyx Figure 9–12 Pelvic planes: coronal section and diameters of the bony pelvis.  Bony Pelvis  Bony structure: Resembles bowl – Four bones  Innominate (two side bones): hip bones 1) Ilium 2) Ischium Ischial spines Strongest bone 3) Pubis Symphysis pubis The 3 bones joined into a depression called acetabulum  Bony Pelvis  Bony structure – Four bones  Sacrum – Sacral promontory  Coccyx  Bony Pelvis  Pelvic floor: The soft tissue that fill the pelvic outlet – Musculature to overcome force of gravity – Pelvic diaphragm  Dilatation during birth  For return to pre-pregnancy condition after birth  Deep fascia, levator ani, coccygeal muscles Table 9–1 Muscles of the Pelvic Floor Figure 9–10 Muscles of the pelvic floor. (The puborectalis, pubovaginalis, and coccygeal muscles cannot be seen from this view.)  Bony Pelvis  Pelvic division  False pelvis: – All of the bony pelvis ABOVE pelvic brim – It supports enlarged uterus & directs fetal part into true pelvis – This is not important in obstetric  Bony Pelvis  Pelvic division – True pelvis: all of pelvis BELOW pelvic brim. Very important!  Pelvic inlet – Diagonal conjugate: extends from the subpubic angle to the middle of sacral promontory & typically = 12.5 cm. Can be measured manually – Obstetric conjugate: The shortest APD between sacral promontory & symphysis pubis through which the head should pass. V. important & cannot be measured. (widest is 11 cm) Bony Pelvis  Bony Pelvis Adequacy of the pelvis to achieve vaginal delivery Adequacy means N > 10 cm Olds’ Maternal-Newborn Nursing & Women's Health Across the Lifespan, Tenth Edition Michele Davidson | Marcia London | Bony Pelvis  Pelvic inlet – Conjugate vera: from middle of sacral promontory to the pubic crest. – Transverse diameter Bony Pelvis  Bony Pelvis  Pelvic division – True pelvis  Pelvic cavity  Pelvic outlet – Determined by assessing pelvic diameter Bi-ischial or intertuberous – Outlet dystocia may require use of forceps, or cesarean birth Bony Pelvis  Pelvic types – Gynecoid – Android – Anthropoid – Platypelloid Bony Pelvis Figure 9–13 Comparison of Caldwell-Moloy pelvic types.  Gynaecoid pelvis  It is the normal female type.  Inlet is slightly rounded to transverse oval.  Sacrum is wide with average concavity and inclination.  Side walls are straight with blunt ischial spines.  Subpubic angle is 90-100o.  shape, best chances for normal vaginal delivery  Anthropoid pelvis  Long oval shape.  All anteroposterior diameters are long.  All transverse diameters are short.  Sacrum is long and narrow.  Subpubic angle is narrow (