Reproductive Biology PDF

 Reproductive biology Prepared by Dr. Hala Nouh Ibrahim Obstetric & Gynecologic Nursing Department OBJECTIVES: qIdentify component of internal and external female genitalia qExplain Structure and function of internal and external genital tract of female genitalia...

 Reproductive biology Prepared by Dr. Hala Nouh Ibrahim Obstetric & Gynecologic Nursing Department OBJECTIVES: qIdentify component of internal and external female genitalia qExplain Structure and function of internal and external genital tract of female genitalia qDefine menstrual cycle. qDiscuss nursing role during menstrual cycle qDefine Reproductive health qIdentify women's reproductive health needs.  Female reproductive system composed of: 1.Bony pelvis 2. Soft tissue.  BONY PELVIS 1.Bony pelvis is composed of: Ø Two innominate bones. Ø Sacrum. Ø Coccyx. Each innominate bone is formed by the fusion of three bones, ileum, ischium & pubis.  Soft tissue of reproductive system A) External female reproductive organs. B) Internal female reproductive organs.  EXTERNAL ORGANS A-The vulva refers to those parts that are outwardly visible which includes: 1. Mons pubis 2. Labia majora 3. Labia minora 4. Clitoris 5. The vestibule: (Urethral opening &Vaginal opening) B-Perineum External organs  1-Mons pubis – Also called Mons veneris, The triangular mound of fatty tissue that covers the pubic bone. – During adolescence sex hormones trigger the growth of pubic hair on the Mons pubis – Hair varies in coarseness, curliness, amount, color and thickness – The function of Mons pubis is to protect the pelvic bones, especially during sexual intercourse.  2-Labia Majora ( Outer& greater lips): – These are two rounded, fleshy folds of fat and areolar tissue that extend from the mons pubis to the perineum – They have a darker pigmentation – They Are covered with hair and sebaceous glands – Tend to be smooth and moist – The chief function of is to protect the structure lying between them.  3-Labia Minora ( Inner& lesser lips): – These are paired of erectile tissue folds that darkens and swells during sexual arousal – Located inside the labia majora – They are more sensitive and responsive to touch than the labia majora  4-Clitoris: – At the apex of labia minora is a hooded body composed of erectile tissue called clitoris. – It is very rich in blood and nerve supplies and allows the women to experience sexual pleasure & orgasm during sexual stimulation.  5-The vestibule: This is the area enclosed by the labia minora in which are situated the openings of the urethera, parauretheral (skene's ) glands, vaginal opening or introitus and bartholin's glands. It is boat shape. *The Urethral orifice: § This orifice lies 2.5cm posterior to the clitoris. its long is 4cmc on either side lie the openings of skene‘s ducts, two small blind-ended tubules 0.5 cm long running within the uretheral wall. § Their secretions lubricate the vaginal vestibule to facilitate sexual intercourse. *The vaginal orifice: § This is also known as introitus of the vagina and occupies the posterior two thirds of the vestibule. § The orifice is partially closed by the hymen, a thin elastic membrane that tears during sexual intercourse or during the birth of the first child. § The hymen is a vascular & it varies in shape from woman to woman. *Bartholin’s glands (vulvovaginal glands): § There are two small glands that open on the either side of the vaginal orifice and lies in the posterior part of the labia majora. § These glands secrete mucus that is clear and thick mucus with an alkaline pH that enhances the viability and motility of the sperm deposited in the vaginal vestibule.  5-Perineum – The muscle and tissue located between the vaginal opening and anal canal – It supports and surrounds the lower parts of the urinary and digestive tracts – The perineum contains an abundance of nerve endings that make it sensitive to touch – An episiotomy is an incision of the perineum used during childbirth for widening the vaginal opening.  INTERNAL ORGANS – Vagina – Cervix – Uterus – Fallopian Tubes – Ovaries  INTERNAL ORGANS VAGINA – The vagina connects the cervix to the external genitals – It is located between the bladder and rectum – Its length: (Anterior wall is 8-9 cm &Posterior wall is 10 -11 cm) Its functions: – As a passageway for the menstrual flow – For uterine secretions to pass down through the introitus – As the birth canal during labor – With the help of two Bartholin‘s glands becomes lubricated during sexual intercourse Internal organs  Cervix: – The cervix connects the uterus to the vagina – The cervical opening to the vagina is small – This acts as a safety precaution against foreign bodies entering the uterus – During childbirth, the cervix dilates to accommodate the passage of the fetus – This dilation is a sign that labor has begun  UTERUS – Commonly referred to as the womb – A pear shaped organ about the size of a clenched fist – It is made up of the endometrium, myometrium and perimetrium – Consists of blood-enriched tissue that sloughs off each month during menstrual cycle – The powerful muscles of the uterus expand to accommodate a growing fetus and push it through the birth canal – Size: 7.5 long, 5cm wide, 2.5cm thick and weight about 60gms. Measurement of uterus  Divisions of uterus: The cervix: Forms the lower third of the uterus. The isthmus: Is the narrowed construction about 7mm thick lying between body of uterus and cervix. The corpus or body: Forms the upper two thirds of the uterus and is that portion of organ lying above the cervix. The cornua: Are the areas of uterus where fallopian tubes are inserted the lumen of this tubes opens into the uterine cavity. The fundus: It‘s the portion lies above and between the cornuae. The cavity: Is a triangular hollow shape in the center of the uterus. The wall of the uterus normally lie in opposition.  FALLOPIAN TUBES – Serve as a pathway for the ovum to the uterus – Are the site of fertilization by the male sperm – Often referred to as the oviducts or uterine tubes – Fertilized egg takes approximately 6 to 10 days to travel through the fallopian tube to implant in the uterine lining – It consists of 4 parts : Interstitial part: Lies within the wall of the uterus and is 2.5cm in length. Isthmus : Is also 2.5cm in length. It is the narrowest portion of the tube and acts as reservoir for spermatozoa because the temperature is lower there than in the rest of the tube. Ampulla :Is the widened lateral area of the tube where fertilization normally occurs. It is 5cm in length. Infundibulum (2 cm): trumpet shaped outer end opens into the peritoneal cavity by the tubal ostium.  OVARIES – The female gonads or sex glands – They develop and expel an ovum each month – A woman is born with approximately 400,000 immature eggs called follicles – During a lifetime a woman release 400 to 500 fully matured eggs for fertilization – The follicles in the ovaries produce the female sex hormones, progesterone and estrogen – These hormones prepare the uterus for implantation of the fertilized egg.  Menstrual cycle Definition: Menarche:, the onset of menstruation signals the bodily changes that transform a female body Menstrual cycle: Cyclic changes in the endometrium caused by estrogen and progesterone § Average age is 12.8 § Amount of bleeding varies from woman to woman § Expulsion of blood clots § Blood color can vary from bright red to dark maroon § Usually occurs every 25 to 32 days § Women can experience fluid retention, cramping, mood swings, weight gain, breast tenderness, diarrhea, and constipation  Menstrual cycle: control by hormones It is a hypothalamus pituitary ovarian axis hypothalamus releases GnRH that stimulates pituitary pituitary produces: 1-Follicle-stimulating hormone (FSH): Ovum maturation in follicles inside ovaries Estrogen production in ovaries 2-Luteinizing hormone (LH): Stimulates release of mature ovum Stimulates development of corpus luteum, the progesterone- secreting part of the follicle that remains after egg is released. Negative feedback mechanism –Each hormone is secreted until the organ it acts upon is stimulated then that organ secretes a hormone that reduces secretion of the first hormone.  Component of female reproductive cycle 1. Menstrual cycle 2. Ovarian cycle – Menstrual cycle Cyclic changes in the endometrium caused by estrogen and progesterone  Menstrual cycle 1-Menstrual Phase – Starts with 1st day of menstrual cycle – Lasts for 4-5 days – Functional layer of uterine wall is sloughed off and discarded with the menstrual flow – Blood discharge from vagina is combined with small pieces of endometrial tissue – Cyclic changes of the Endometrium – Decidua functional is: 2/3 superficial, proliferate and shed each cycle Decidua basalis: deepest region, source of endometrial regeneration after each menses  Menstrual cycle 2-Proliferative phase – Is a phase of repair and proliferation – Lasts for 9 days – Controlled by estrogen secreted by follicles – 2-3 mm increase in thickness of endometrium – The glands increase in number and length and the spiral arteries elongate – Glandular epithelium secrete glycogen rich material – Endometrium thickens under the influence of estrogen and progesterone  Menstrual cycle 3-Secretory Phase It begins with ovulation and end with menstruation Spiral arteries grow into the superficial layer Arteries become increasingly coiled Large venous network develops If Fertilization Occurs Fertilized ovum implants in endometrium on about 6th day of this phase HCG hormone secreted by syncytiotrophoblast keeps the corpus luteum secreting estrogen and progesterone If Fertilization Doesn’t Occur No HCG Corpus luteum degenerates Estrogen and progesterone levels fall Secretory endometrium enters an ischemic phase Menstruation occurs  Component of female reproductive cycle Ischemic Phase q Decreased levels of estrogen & progesterone q Stoppage of glandular secretion q Loss of interstitial fluid q Marked shrinking of endometrium q Spiral arteries become constricted q Venous stasis & Ischemic necrosis q Rupture of damaged vessel wall q Blood seeps into the surrounding connective tissues q 2 days before menses: dramatic increases in PMN migrate from vascular system q Lasting about 13 days  Ovulation It occurs around mid-cycle about 14 days in a 28 day menstrual cycle Ovarian follicle undergoes sudden growth spurt (burst) under the influence of FSH & LH These hormones prepare endometrium for implantation of Fertilized Ovum (Blastocyst)  2-OVARIAN CYCLE FSH and LH produce cyclic changes in ovaries. 1-Follicular phase the primordial follicles start to grow under the effect of FSH. Only one reaches the maturity and called Graafian follicle. the grown follicle secrete steroidal 2-Ovulatory phase Ovulation is outward expulsion of a mature ovum from a ruptured Graafian follicle. Where it is picked up by the fimbirial end of the tube. It occurs about 14 th day of menstrual cycle  OVARIAN CYCLE 3-luteal phase: qRuptured Graafian follicle are termed corpus luteum qIt secretes Progesterone and little estrogen qThese hormones prepare endometrium for implantation of Fertilized Ovum (Blastocyst) qIf the oocyte is fertilized the corpus luteum enlarges & remains active for first 20 weeks of pregnancy qIf the oocyte is not fertilized the corpus luteum degenerates in 10-12 days  Nursing role during menstrual cycle: (health teaching about the following items): 1- Sanitary pads and tampons: 1. Wash hands before and after giving self perineal care. 2. Washing or wiping the perineum should be always done from front to back. 3. Reduce use of tampons by substitute sanitary pads part of the time especially at night. 4. Apply perineal pad snugly enough so it won't slide back and forth with her movements. 5. Do not touch the side of the perineal pad that will come in contact with the perineum. 6. Frequently take warm bath to maintain personal hygiene.  Nursing role during menstrual cycle: (health teaching about the following items): 2-Diet: 1. Decrease intake of caffeine (tea, coffee, coals, chocolate) to reduce anxiety. 2. Decrease intake of simple sugars. 3. Decrease intake of salty food to reduce fluid retention. 4. Eat six small meals a day to prevent hypoglycemia. 5. Increase fluid intake. 6. Avoid alcohol which aggravates depression.  Nursing role during menstrual cycle: (health teaching about the following items): 3-Nutritional self-care: 1. Vitamin B complex neutralizes the excessive amounts of estrogen produced by the ovaries thus reduce nervousness that sometimes occur premenstrual. It is present in lean meats, whole grains, and dark green leafy vegetables. 2. Vitamin B6 can relive the heavy bloated puffy feeling that is often experienced before the period. 3. Vitamin E is a mild prostaglandin inhibitor similar to aspirin but without the side effects. It improves circulation; reduce muscular spasm and pain by reducing the uterus need for O2. It is present the yeast, wheat germ. 4. Iron is needed to prevent depletion of the female iron stores. 5. Calcium may also provide relief from menstrual symptoms, it is present in yogurt and cheese.  Nursing role during menstrual cycle: (health teaching about the following items): 4-Exercise: 1. Daily exercise can prevent cramps, relieves constipation. 2. Deep breathing brings more O2 to the blood which relaxes the uterus. 3. Aerobic activities as jogging or walking alleviate irritability and tension. 5-Heat and massage: 1. Using any form of warm application may be beneficial during painful periods. 2. Massage can also sooth aching muscles, promote relaxation and blood flow.  Reproductive health Definition q Reproductive health is a status of complete physical, mental and social wellbeing and not merely the absence of disease or disability in all matters relating to the reproductive system and to its function and processes. q Being able to choose when to get pregnant, apart from being health issue, greatly influences population growth, and environmental conditions. q Increasing contraceptive choices and access leads to fewer unsafe abortions- arguably the most easily avoidable cause of maternal death. q Life-saving care for complications from abortion is an excellent opportunity to provide contraception, avoiding another unwanted pregnancy. q Reducing pregnancy-related deaths and illness in mothers increases newborn and child survival, and improves productivity. q Reducing maternal deaths depends on a functioning death system. q Strengthening the system to improve maternal health benefits in many other areas of death.  Basic elements of reproductive health: Ø Employment of women. Ø Woman's nutrition. Ø Care of adolescent. Ø Safe sexual behavior. Ø Safe motherhood. Ø Widely available family planning services. Ø Elimination of unsafe abortion. Ø Prevention of unwanted pregnancy. Ø Prevention and management of infertility. Ø Male involvement. Ø Prevention and treatment of malignancies and post menopausal care. Ø Women's and men's reproductive health needs  Women's reproductive health needs are: A continuum from sexual health. Prevention and management of infertility. Fertility by choice, not by chance. Pre-conceptional care. Keeping labour normal. Pregnancy and child birth, postnatal care. In addition, it covers menopausal and postmenopausal health care.  Women's reproductive health needs include: – Sexuality. – Protection against sexually transmitted infectious. – Infertility prevention and management and fertility regulation. – Protection against prostatic hypertrophy and prostatic cancer is another concern  Reproductive health rights: 1. Right to be free from all forms of discrimination. 2. Right to life, liberty and security. 3. Right to marry and found a family. 4. Right to education and information. 5. Right to benefit from scientific progress. 6. The right of sexual equality. 7. Right to health and health care. 8. The Egyptian women work law. 9. Right of adolescents to meet their needs.