NCM 107 Care of Mother, Child & Adolescent Female Reproductive System PDF

NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE FIRST SESSION ❖ Labia Minora FEMALE REPRODUCTIVE S...

NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE FIRST SESSION ❖ Labia Minora FEMALE REPRODUCTIVE SYSTEM These are two smaller folds of skin between the labia majora, containing numerous ❖ Introduction sebaceous and eccrine sweat glands. ❖ The ability to reproduce is one of the or "lesser lips" are the thin hairless ridges at the properties distinguishing living from non- entrance of the vagina, which joins behind living matter. and in front. ❖ The more primitive the animal, the simpler In front they split to enclose the clitoris the process of reproduction. In mammals, ❖ Clitoris including humans, the process is one of The clitoris corresponds to the penis in the sexual reproduction, in which the male and male and contains sensory nerve endings and female organs differ anatomically and erectile tissue. physiologically, and the new individual The clitoris is a small pea-shaped structure. It develops from the fusion of two different sex plays an important part in sexual excitement cells (gametes). in females. ❖ The male gametes are called spermatozoa. ❖ and the female gametes are called ova. ❖ Vestibular Glands The functions of the female reproductive system The vestibular glands (Bartholin's glands) are are: situated one on each side near the vaginal formation of ova opening. They are about the size of a small reception of spermatozoa pea and their ducts open into the vestibule provision of suitable environments for immediately lateral to the attachment of the fertilization and fetal development hymen. They secrete mucus that keeps the parturition (childbirth) vulva moist. lactation, the production of breast milk, Blood supply, lymph drainage and nerve supply which provides complete nourishment for Arterial supply. This is by branches from the the baby in its early life. internal pudendal arteries that branch from A. External Genitalia (vulva) the internal iliac arteries and by external The external genitalia are known pudendal arteries that branch from the collectively as the vulva, and consist of the : femoral arteries. ❖ labia majora and labia minora, Venous drainage. This forms a large plexus ❖ the clitoris which eventually drains into the internal iliac ❖ the vaginal orifice veins. ❖ the vestibule, the hymen and the Lymph drainage. This is through the vestibular glands (Bartholin's glands) superficial inguinal nodes. ❖ Labia Majora Nerve supply. This is by branches from These are the two large folds forming the pudendal nerves. boundary of the vulva. They are composed of Perineum skin, fibrous tissue and fat and contain large ➔ The perineum is a roughly triangular area numbers of sebaceous and eccrine sweat extending from the base of the labia glands. minora to the anal canal. Labia majora or "greater lips" are the part ➔ It consists of connective tissue, muscle around the vagina containing two glands and fat. It gives attachment to the (Bartholin's glands) which helps lubrication muscles of the pelvic floor. during intercourse. At puberty, hair grows on the mons pubis and on the lateral surfaces of the labia majora. BSN 2104_A.Y. 2024-2025 0 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE B. Internal Genitalia provides an elastic passageway through which ❖ vagina, uterus, the baby passes during childbirth. ❖ two uterine tubes Blood supply, lymph drainage and nerve supply ❖ two ovaries. Arterial supply. An arterial plexus is formed ❖ Vagina round the vagina, derived from the uterine The vagina is a fibromuscular tube lined with and vaginal arteries, which are branches of stratified squamous epithelium the internal iliac arteries. It runs obliquely upwards and backwards at Venous drainage. A venous plexus, situated in an angle of about 45° between the bladder the muscular wall, drains into the internal iliac in front and rectum and anus behind. veins. In the adult, the anterior wall is about 7.5 cm Lymph drainage. This is through the deep and long and the posterior wall about 9 cm long. superficial iliac glands. The difference is due to the angle of insertion of the cervix through the anterior wall. ❖ Uterus The uterus is a hollow muscular pear-shaped organ that is located anteroposteriorly in the Hymen pelvic cavity. The hymen is a thin layer of mucous It lies in the pelvic cavity between the urinary membrane that partially occludes the bladder and the rectum opening of the vagina. It is about 7.5 cm long, 5 cm wide and its walls It is normally incomplete to allow for are about 2.5 cm thick. passage of menstrual flow and is It weighs between 30 and 40 grams stretched or completely torn away by sexual intercourse, insertion of a tampon or childbirth. ❖ Parts of the Uterus For the descriptive purpose uterus can be ❖ Structure of the Vagina divided into three distinct parts: The vaginal wall has three layers: Fundus an outer covering of areolar tissue, Body a middle layer of smooth muscle Cervix and an inner lining of stratified squamous epithelium that forms ridges or rugae. It has no Fundus secretory glands but the surface is kept moist by - This is the dome-shaped part of the uterus cervical secretions. Between puberty and the above the openings of the uterine tubes. menopause, Body Lactobacillus acidophilus, bacteria that - This is the main part. It is narrowest inferiorly at secrete lactic acid, are normally present the internal os where it is continuous with the maintaining the pH between 4.9 and 3.5. The cervix. acidity inhibits the growth of most other micro- Cervix (neck' of the uterus) organisms that may enter the vagina from the - This protrudes through the anterior wall of the perineum or during sexual intercourse. vagina, opening into it at the external os. Functions of the Vagina ❖ Layers of the Uterus The vagina acts as the receptacle for the a. Perimetrium penis during sexual intercourse (coitus), and b. Myometrium c. Endometrium BSN 2104_A.Y. 2024-2025 1  NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE ❖ Supporting Structures to the Uterus The uterus is supported in the pelvic cavity by surrounding organs, muscles of the pelvic floor and ligaments that suspend it from the walls of the pelvis Broad ligaments. - These are formed by a double fold of peritoneum, one on each side of the uterus. Round ligaments. - These are bands of fibrous tissue between the two layers of broad ligament. a. Perimetrium Uterosacral ligaments. This is peritoneum, which is distributed - These originate from the posterior walls of the differently on the various surfaces of the cervix and vagina and extend backwards, one uterus. on each side of the rectum, to the sacrum. Anteriorly it lies over the fundus and the body Transverse cervical (cardinal) ligaments. where it is folded on to the upper surface of - These extend one from each side of the cervix the urinary bladder. and vagina to the side walls of the pelvis. This fold of peritoneum forms the vesicouterine pouch. Posteriorly the peritoneum covers the fundus, the body and the cervix, then it folds back on to the rectum to form the rectouterine pouch (of Douglas). b. Myometrium. This is the thickest layer of tissue in the uterine wall. It is a mass of smooth muscle fibres interlaced with areolar tissue, blood vessels and nerves. c. Endometrium Made up of the Columnar epithelial cells ❖ Uterine Tubes Consist mucous secreting tubular glands The uterine (Fallopian) tubes are about 10 Blood supply, lymph drainage and nerve cm long and extend from the sides of the uterus between the body and the fundus. supply They lie in the upper free border of the broad Arterial supply. This is by the uterine arteries, ligament and their trumpet-shaped lateral branches of the internal iliac arteries. ends, Venous drainage internal illiac vein penetrate the posterior wall, opening into Lymph drainage. Deep and superficial lymph the peritoneal cavity close to the ovaries. vessels drain lymph from the uterus and the peritoneal cavity close to the ovaries. uterine tubes to the aortic lymph nodes and The end of each tube has fingerlike, groups of nodes associated with the iliac projections called fimbriae. blood vessels. The longest of these is the ovarian fimbria, which is in close association with the ovary. BSN 2104_A.Y. 2024-2025 2  NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Structure of the Uterine Tubes Functions of the Ovaries The uterine tubes are covered with The ovary is the organ in which the female peritoneum (broad ligament), gametes are stored and develop prior to have a middle layer of smooth muscle and ovulation. are lined with ciliated epithelium. Their maturation is controlled by the Blood and nerve supply and lymphatic hypothalamus and the anterior pituitary drainage are as for the uterus. gland. Functions of the uterine tubes ❖ Breast The uterine tubes propel the ovum from the The breasts or mammary glands are ovary to the uterus by peristalsis and ciliary accessory glands of the female reproductive movement. system. The secretions of the uterine tube nourish They exist also in the male, but in only a both ovum and spermatozoa. rudimentary form. Fertilization of the ovum usually takes place in the uterine tube, and the zygote is Structure of the Mammary Glands propelled into the uterus for implantation. The mammary glands or breasts consist of varying amounts of glandular tissue, ❖ Ovaries responsible for milk The ovaries are the female gonads (glands producing sex hormones and the ova), and they lie in a shallow fossa on the lateral walls of the pelvis. They are 2.5-3.5cm long, 2cm wide and 1cm thick. Each is attached to the upper part of the uterus by the ovarian ligament and to the back of the broad ligament by a broad band of tissue, the mesovarium. Blood vessels and nerves pass to the ovary through the mesovarium Each breast contains about 20 lobes, each of which contains a number of glandular Structure of the Ovaries structures called lobules, where milk is The ovaries have two layers of tissue. produced. Medulla. Lobules open into lactiferous ducts, which - This lies in the centre and consists of fibrous drain milk towards the nipple. tissue, blood vessels and nerves. Breast itself is covered in subcutaneous fat. Cortex. In the lactating breast, glandular tissue - This surrounds the medulla. It has a framework proliferates (hyperplasia) to support milk of connective tissue, or stroma, covered by production, and recedes again after germinal epithelium. lactation stops. - It contains ovarian follicles in various stages of maturity, each of which contains an ovum. Nipples This is a small conical eminence at the centre of the breast surrounded by a pigmented area, the areola. On the surface of the areola are numerous sebaceous glands (Montgomery's tubercles), which lubricate the nipple during lactation. BSN 2104_A.Y. 2024-2025 3 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Blood supply, lymph drainage and nerve supply the spermatic cords. They are surrounded by Arterial supply. The breasts are supplied with three layers of tissue blood from the thoracic branches of the axillary arteries and from the internal 1. Tunica vaginalis - is a closed peritoneal sac mammary and intercostal arteries. surrounding the front and sides of the testis and extends upwards over the spermatic cord. Venous drainage. This is formed by an anastomotic circle round the base of the 2. Tunica albuginea - is the tough fibrous layer of nipple from which branches carry the venous connective tissue that surrounds the corpora blood to cavernosa of the penis the circumference, and end in the axillary and mammary veins. 3. Tunica vasculosa - is the inner-most of the Lymph drainage. This is mainly into the three layers that form the capsule of the testis. It consists of a vascular plexus and loose superficial axillary lymph vessels and nodes. Nerve supply. The breasts are supplied by connective tissue. branches from the 4th, 5th and 6th thoracic nerves. MALE REPRODUCTIVE SYSTEM Structure In each testis are 200-300 lobules and within each lobule are 1-4 convoluted loops of germinal epithelial cells called seminiferous tubules. DUCT SYSTEM Functions of the Male Reproductive Organ production, maturation and storage of Vas Deferens spermatozoa Transports mature sperm to the urethra delivery of spermatozoa in semen into the Epididymis female reproductive tract Sperm mature in epididymis Scrotum is a pouch of pigmented skin, fibrous and connective tissue and smooth muscle. ❖ Spermatic Cord it is divided into two compartments, each of The spermatic cords suspend the testes in which contains one testis, one epididymis the scrotum. Each cord contains a and the testicular end of a spermatic cord. testicular artery, testicular veins, lymphatics Testis Seminal Vesicle Also knows as testicle gonads are male is a 5 cm long tube that joins with the reproductive glands and are the equivalent deferent duct to forms the common of the ovaries in the female. ejaculatory duct. Produces sperm Attached to vas deferens They are about 4.5cm long, 2.5cm wide and Produces a sugar rich fluid that provides 3cm thick and are suspended in the scrotum energy to sperm by BSN 2104_A.Y. 2024-2025 4 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE FUNCTIONS The seminal vesicles contract and expel their stored contents, seminal fluid, during ejaculation. Seminal fluid, which forms 60% of the volume of semen. ❖ Ejaculatory Duct The ejaculatory ducts are two tubes about 2 cm long, each formed by the union of the duct from a seminal vesicle and a deferent duct. They pass through the prostate gland and join the prostatic urethra, carrying seminal fluid and spermatozoa to the urethra Prostate Gland The gland weighs about 8 g in youth, but progressively enlarges (hypertrophies) with age and is likely to weigh about 40 g by the age of 50. Makes fluid FUNCTIONS The prostate gland secretes a thin, milky fluid that makes up about 30% of the volume of 100 million spermatozoa per mL. If not semen, and gives it its milky appearance. It ejaculated, sperm gradually lose their fertility contains a clotting enzyme, which thickens after several months and are reabsorbed by the semen in the vagina, increasing the the epididymis. likelihood of semen being retained close to the cervix. ❖ Urethra tube that carries urine from the bladder to outside of the body also carries sperm out of the body 19-20 cm long Prostatic urethra Membranous urethra Penile urethra Two sphincter by BSN 2104_A.Y. 2024-2025 5 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE SPERMATOGENESIS AND OOGENESIS ❖ the products of the second meiotic division are called spermatids ❖ Spermatogenesis ❖ Spermiogenesis ❖ occurs in the seminiferous tubules that form the bulk of each testis ❖ is the metamorphosis of spherical spermatids into elongated spermatozoa. ❖ the process begins at puberty and No further mitosis or meiosis occurs constantly throughout a man’s life ❖ during spermiogenesis, the acrosome forms, ❖ the process of spermatogenesis begins with the flagellar apparatus forms, and most mitosis of the diploid spermatogonia excess cytoplasm (the residual body) is ❖ How long does it take for one production separated and left in the Sertoli cell. cycle, from spermatogonia to sperm, to take ❖ spermatozoa are released into the lumen of place?" the seminiferous tubule ❖ 64 days ❖ Role of Sertoli Cell in Spermatogenesis ❖ Three phases of spermatogenesis ❖ secrete signaling molecules that promote ❖ Spermatocytogenesis sperm production ❖ Meiosis ❖ has also been called the "mother" or "nurse" ❖ Spermiogenesis cell ❖ form blood-testis barrier ❖ provide factors necessary for the successful progression of spermatogonia (germ cells) into spermatozoa (sperm) ❖ helps in development and maturation of sperm cells ❖ provide protection to germ cells. ❖ have receptors for follicle stimulating hormone (FSH) and testosterone which are the main hormonal regulators of spermatogenesis ❖ Hormones involved in Spermatogenesis ❖ Spermatocytogenesis (Mitosis) ❖ hormones such as testosterone, FSH and ❖ germ cells (spermatogonium) divide luteinizing hormone (LH) are known to influence the germ cell fate. mitotically to replace themselves and to ❖ FSH, by its ability to stimulate Sertoli cell produce cells that begin differentiation mitosis during testicular development, can ❖ Meiosis influence the spermatogenic capacity of the adult testis ❖ cells in prophase of the first meiotic division ❖ both FSH and testosterone exert synergistic are primary spermatocytes actions on germ cells, but testosterone has ❖ primary spermatocytes go through the first a specific action on the later stages of meiotic division and become secondary spermatid maturation. spermatocytes ❖ OOGENESIS ❖ the cells quickly proceed through this stage ❖ Gametogenesis in females is called and complete the second meiotic division oogenesis. ❖ meiosis is the process by which the diploid ❖ The process begins with the ovarian stem number of chromosomes present in cells, or oogonia spermatogonia (the germ cells) is reduced ❖ Oogonia are formed during fetal to the haploid number present in mature development, and divide via mitosis spermatozoa BSN 2104_A.Y. 2024-2025 6 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE STEPS of OOGENESIS 1. Oogonia are formed during fetal Follicular development (stepwise) development, and divide via mitosis 1. Each primary oocyte is surrounded by 2. Oogonia produce primary oocytes in follicular cells and is called as Primordial the fetal ovary prior to birth. follicle. 3. These primary oocytes are then arrested in this stage of meiosis I 2. At puberty, the primordial follicle start 4. Meiosis-I resumes at puberty and growing under influence of FSH and LH and continuing until the woman is near developed into primary follicle. menopause. 3. As the primary follicle grow, the follicular cell 5. After Meiosis-I, two cells are produce: surrounding to primary oocyte start growing, Secondary oocyte and first polar body and that newly growing cells are called as 6. This cell division does not result in two granulosa cells. identical cells. Instead, the cytoplasm is divided unequally, and one daughter 4. The glycoprotein layer is start developing cell is much larger than the other. between granulosa cell and primary oocyte 7. This larger cell (the secondary oocyte), that layer is called as zona pellucida. eventually leaves the ovary during ovulation. 5. As the follicle grow, the theca cells (also 8. If fertilization occurs, then Meiosis of a called as theca externa) are developed that secondary oocyte is completed. ie encircle the granulosa cells. At this stage Meiosis II then resumes, producing one granulosa cells start secreting follicular fluid haploid ovum that fertilization by a which develop the cavity called as antrum. (haploid) sperm and produce diploid 6. When antrum is developed in follicle, the (two cell) zygote. follicle is termed as secondary follicle. 9. If fertilization does not occur, the secondary 7. Theca cells work with the granulosa cells to oocyte fails to complete the 2nd meiotic produce estrogens. division, and degenerates in about 24 hours after ovulation 8. Follicles in which the antrum has become large and fully formed are considered tertiary FOLLICULAR DEVELOPMENT follicles 9. Once the follicle is mature, it ruptures and releases the oocyte. Cells remaining in the follicle then develop into the corpus luteum. BSN 2104_A.Y. 2024-2025 7 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE FERTILIZATION and IMPLANTATION APPROXIMATION OF GAMETES The ovum immediately following ovulation is ANATOMY OF SPERM picked up by the tubal fimbriae which partly envelope the ovary, specially at the time of ovulation. The pick up action might be muscular or by a kind of suction by ciliary action or by a positive chemotaxis exerted by the tubular secretion ANATOMY OF OVA The ovum is rapidly transported to the ampullary part. Fertilised lifespan of oocytes ranges from 12 to 24 hours whereas that of sperm is 48 to 72 hours. Out of hundreds of millions of sperms deposited in the vagina at single ejaculation. Only thousands of capacitated spermatozoa enter the uterine tube while only 300-500 reach the ovum. The tubal transport is facilitated by muscular contraction and aspiration action of the uterine tube. CONTACT AND FUSION OF THE GAMETES Fertilization Complete dissolution of the cells of the corona is the process of fusion of the spermatozoon with radiata occurs by the chemical action of the the mature ovum. It begins with sperm and egg HYALURONIDASE liberated from the Acrosomal collision and ends with the production of a cap of the hundreds of sperm present at the site. mononucleated single cell called ZYGOTE. Penetration of Zona pellucida is facilitated by Almost always fertilization occurs in Hyaluronidase from the acrosomal cap. AMPULLARY portion of fallopian tubes. Soon after the Sperm fusion, penetration of other sperm is prevented by ZONA REACTION and COLEMA BLOCK. PROCESS OF FERTILIZATION BSN 2104_A.Y. 2024-2025 8 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE WHEN DOES LIFE BEGIN ? IMPLANTATION/NIDATION/ NESTING Implantation occurs in the endometrium of the anterior or posterior wall of the body near the fundus on the 6th day which corresponds to the 20th day of regular menstrual cycle. IMPLANTATION occurs through four stages: A) Apposition B) Adhesion C) Penetration D) Invasion The implantation process is completed by the 10th or 11th day. This type of deeper penetration of human blastocyst is called IMPLANTATION. - Every human cell has 46 chromosomes Now the blastocyst is covered on all sides by (Chr) except the sperm and the egg the endometrium (DECIDUA). which have 23 each. At conception they become a unique human with 46 Chr. The Blastocyst begins to collapse - Sex of the child is determined by the pattern of sex chromosome supplied by the SPERMATOZOON. If the SPERMATOZOON contains 'X' Chromosome a female embryo (46 XX). If it contains 'Y' Chromosomes a Male embryo (46 XY) is formed. MORULA After the zygote formation, a typical mitotic Day 15 - division of the segmentation nucleus occurs The primitive streak can be seen on the left side of producing two BLASTOMERES. this The two cells stage is reached approximately Day17 - 30 hours after "FERTILIZATION". The primitive streak can still be seen, and the The blastomeres continue to divide by binary opposite end of the embryo is starting to fold up. division through the 4,6,8 cell stage until a cluster Day 19- of cells is formed and is called MORULA, The neural tube is seen along with somites on either resembling MULBERRY. side of it. By the 4th day it forms to 16-64 cell stage. BLASTOCYST While the morula remains free in the uterine cavity on the 4th and 5th day. The fluid passes through the canaliculi of the zona pellucida which separates the cells of morula and is now termed as BLASTOCYST. Somites - zipper-like motion of the neural tube closing Zona Hatching is the next step so that together, three pairs of small bumps form on either trophectoderm cells interact with endometrial side of the closure. they will form the skeleton and the major muscles of the body. 38 pairs of somites will line cells and implantation occurs. the neural tube within 2 weeks. the neural tube should close BLASTOCYST- when zygote divides to 32 cells. neural tube defect if it doesn’t close folic acid is needed to prevent this BSN 2104_A.Y. 2024-2025 9 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE DAY 22 and DAY 24: 10 WEEKS OF EMBRYO The embryo is about 1 to 1¼ inches long (the head is about half the length) and weighs less than ½ ounce. The beginnings of all key body parts are present, but they are not completed. Structures that will form eyes, ears, arms and legs can be seen. * Skeletons are present. Muscles and skeletons are DAY 26: developing and the nervous system becomes more responsive. 12 WEEKS OF EMBRYO The fetus is about 2½ inches long and weighs about ½ ounce. Fingers and toes are distinct and have nails. Hair begins to develop, but won't be seen until later in the pregnancy. The fetus begins small, random movements, too slight to be felt. The fetal heartbeat can be detected with a heart monitor. All major external body features have appeared. 4 WEEKS EMBRYO Muscles continue to develop. After the cluster of cells attaches 14 WEEKS OF EMBRYO to the womb it is called an embryo. The fetus is about 3½ inches long and weighs about 1½ The embryo is between 1/100 ounces. and 4/100 inch long at this time. The fetus begins to swallow, The embryo continues rapid the kidneys make urine, and growth. blood begins to form in the bone marrow. 8 WEEKS OF EMBRYO Joints and muscles allow full body movement. The embryo is about ½ inch long. There are eyelids and the The heart now has four nose is developing a bridge. chambers. External genitals are developing. Fingers and toes begin to form. Reflex activities begin as the brain and nervous system develop. Cells begin to form the eyes, ears, jaws, lungs, stomach, intestines and liver. BSN 2104_A.Y. 2024-2025 10 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE 18 WEEKS OF EMBRYO 24 WEEKS OF EMBRYO The fetus is about 5½ The fetus is about 8¼ inches long inches long and weighs and weighs about 1¼ pounds. about 7 ounces. Bones of the ears harden making The skin is pink and sound conduction possible. The transparent and the ears fetus hears the mother's sounds are clearly visible. such as breathing, heartbeat and All the body and facial voice. features are now The first layers of fat are beginning recognizable. to form. The fetus can grasp and move its mouth. This is the beginning of substantial Nails begin to grow. weight gain for the fetus. The fetus has begun to kick. Some women feel this Lungs continue developing movement. 25 WEEKS OF EMBRYO - approximately 68% of babies born survive. Babies 20 WEEKS OF EMBRYO born at this age require intensive care and usually The fetus is about 6¼ inches have life-long disabilities and chronic health long and weighs about 11½ conditions. ounces. 26 WEEKS OF EMBRYO All organs and structures are The fetus is about 9 inches formed long and weighs about 2 Skin is wrinkled and pink to pounds. reddish in The fetus can respond to color - thin and close to the sound from both inside and blood vessels. outside the womb. Protective skin coating, (VERNIX) begins to Reflex movements develop. continue to develop and Respiratory movements occur - lungs have not body movements are developed enough to permit survival outside the stronger. uterus. Lungs continue to develop. By this time, mothers usually feel the fetus moving. The fetus now wakes and sleeps. At this time an ultrasound can often identify the sex The skin is slightly wrinkled. of the fetus. *vernix=protecive skin coating. 22 WEEKS OF EMBRYO 27 WEEKS OF EMBRYO - approximately 87% of babies born survive. Babies The fetus is about 7½ born at this age require intensive care and have an inches long weighs increased risk of developmental delays and chronic about 1 pound. health conditions. It has fingerprints and some head and body 28 WEEKS OF EMBRYO hair. The fetus is about 10 It may suck its thumb inches long and and is more active. weighs about 2 The brain is growing pounds, 3 ounces. very rapidly. Mouth and lips show The fetal heartbeat can be easily heard. more sensitivity. The kidneys start to work. The eyes are partially open and 23 WEEKS OF EMBRYO can perceive light. approximately 31% of babies born survive. More than 90% of Babies born at this age require intensive care babies born at this age and usually have lifelong disabilities and WILL SURVIVE. chronic health conditions. Some survivors have developmental delays and chronic health conditions. BSN 2104_A.Y. 2024-2025 11 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE 30 WEEKS OF EMBRYO 38 WEEKS OF EMBRYO The fetus is about 13½ to 14 The fetus is about 10½ inches long inches long and weighs and weighs about 3 pounds. about 6½ pounds. The lungs that are capable of Lungs are usually mature. breathing air, although medical The fetus can grasp firmly. help may be needed. The fetus turns toward light sources. The fetus can open and close its Almost all babies born at eyes, suck its thumb, cry and this age will survive. respond to sound. The skin is smooth. Rhythmic breathing and body temperature are now controlled by the brain. 40 WEEKS OF EMBRYO Most babies born at this age WILL SURVIVE The fetus is about 18 to 20 inches long and may weigh 32 WEEKS OF EMBRYO about 7½ pounds. At the time of birth, a baby The fetus is about 11 inches has more than 70 reflex long and weighs about 3 behaviors, which are pounds, 12 ounces. automatic behaviors The connections between necessary for survival. the nerve cells in the brain The baby is full-term and increase. ready to be born. Fetal development now centers on growth. CRITICAL PERIODS OF HUMAN DEVELOPMENT Almost all babies born at this age will survive. 34 WEEKS OF EMBRYO CThe fetus is about 12 inches long and weighs about 4 1⁄2 pounds. Ears begin to hold shape. Eyes open during alert times and close during sleep. Almost all babies born at this age will survive. 36 WEEKS OF EMBRYO MENSTRUAL CYCLE The fetus is about 12 to 13 inches ❖ MENSTRUATION long and weighs about 5½ to 6 pounds. Periodic discharge of blood and cellular debris Scalp hair is silky and lies from the female genital tract is termed against the head. menstruation. Muscle tone has developed and the fetus can turn and lift its head Cyclical changes occurring from one Almost all babies born at this age menstruation to the next comprises a menstrual will survive. cycle. The duration of the menstrual cycle is about 28 ± 4 days BSN 2104_A.Y. 2024-2025 12 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE ❖ Phases of Menstruation 1.) Proliferative phase 2.) Secretory phase 3.) Menstrual phase ❖ MENSTRUAL PHASE It lasts for about 3 — 5 days. If the ovum is not fertilized, corpus luteum regresses from the 24th day of the cycle. This causes a decrease in estrogen and progesterone levels. It results in shrinkage of endometrium, coiling and spasm of arteries leading to focal necrosis of the endometrium. The necrosed endometrium is shed along with blood and other secretions. ❖ PROLIFERATIVE PHASE (follicular phase) This proliferation occurs under the influence of estrogen. There is growth of simple tubular glands and blood vessels. Endometrium increases in thickness to about 3- 5mm. The endometrial glands produce a thick mucus. At the end of the proliferative phase, ovulation occurs. ❖ Accelerated Growth of Follicle More of estrogen is secreted into the follicle. Stimulates granulosa cells to form increased number of FSH receptors This makes granulosa cells more sensitive to FSH. FSH and estrogen promote LH receptors on granulosa cell leading to rapid increase in follicular secretion. Estrogen and LH cause proliferation of thecal cells and increase their secretion. BSN 2104_A.Y. 2024-2025 13 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE ❖ LH Surge and Ovulation LH surge Release of follicular steroid hormone Release of proteolytic enzyme and prostaglandin Release of plasma into the follicle Weakened wall of follicle Degeneration of stigma ± swelling of follicle Rupture of follicle—) expulsion of ovum ❖ SECRETORY PHASE (luteal phase) This phase lasts for about 14 days. ❖ OTHER CHANGES It starts after ovulation and extends up to the BREAST next menstrual phase. VAGINA CERVIX Endometrium thickens up to 6 mm. BODY FLUIDS Glands become bigger, tortuous and filled BASAL BODY TEMPERATURE with secretions. Stromal cells proliferate, spiral arteries become -------------------END OF LECTURE—------------------- more coiled and dilated. This is caused due to the action of progesterone and estrogen on uterine endometrium. BSN 2104_A.Y. 2024-2025 14 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE SECOND SESSION ❖ Why does LACTATION affect amenorrhea? DISORDERS OF MENSTRUATION Lactation affects the absence of menstruation through a process called lactational ❖ Sexual Developmental Sequence amenorrhea. This natural suppression of the menstrual cycle during breastfeeding is primarily ❖ Female (HPTAMO) Height, Pelvic driven by hormonal changes that occur to Broadening, Thelarche, Adrenarche, support milk production. Menarche and Ovulation Prolactin ❖ Male (ITAVPIS) Increase in weight, Testicular ❖ is a hormone produced by the pituitary growth, Adrenarche, Voice change, Penile gland that stimulates milk production in the mammary glands. growth, Increase in height and ❖ Elevated levels of prolactin during Spermatogenesis breastfeeding suppress the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. GnRH is ❖ Physiology of Menstruation necessary for the stimulation of the Hypothalamus, GnRH, Anterior Pituitary Gland, pituitary gland to produce follicle- FSH and LH, Ovaries, Estrogen and Progesterone stimulating hormone (FSH) and art luteinizing hormone (LH), which are crucial for the ovarian cycle and ❖ Homologous Structures ovulation. are body parts in different species that have a ❖ Without sufficient levels of FSH and LH, the ovaries do not produce or release eggs similar structure or origin but may serve different (ovulation), and the menstrual cycle is functions. disrupted, leading to amenorrhea (absence of menstruation). Menstrual Irregularities ❖ Reason for having amenorrhea during refer to any changes or deviations from the childhood and menopause normal menstrual cycle, which typically ranges from 21 to 35 days, with menstruation lasting Childhood about 3 to 7 days. These irregularities can Absence of menses is due to the immaturity of include variations in cycle length, flow, and the reproductive system and low hormone symptoms. levels, preventing the onset of the menstrual cycle. ❖ Amenorrhea Menopause Menstruation ceases due to the depletion of ❖ absence of menstrual period in a woman of ovarian follicles and a significant decline in reproductive age hormone production, marking the end of ❖ Physiological states of amenorrhoea are reproductive capability. seen, most commonly, during pregnancy ❖ Onset of MENARCHE and lactation (breastfeeding), the latter also forming the basis of a form of contraception ❖ 12 years old known as the lactational amenorrhoea CLASSIFICATION OF AMENORRHEA method. 1. Primary amenorrhoea (menstrual cycles never ❖ Outside of the reproductive years there is starting) may be caused by developmental absence of menses during childhood and problems such as, the after menopause. BSN 2104_A.Y. 2024-2025 15 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Congenital Absence of the Uterus- Müllerian ❖ Pregnancy is the most common cause of Agenesis (Mayer-Rokitansky-Küster-Hauser secondary amenorrhea, although Syndrome) problems with hormones also can cause secondary amenorrhea. ❖ This condition occurs when the Müllerian ducts, which develop into the female ❖ Common medical treatments for reproductive tract, do not form properly secondary amenorrhea include: Birth during fetal development. As a result, the control pills or other types of hormonal uterus, cervix, and upper part of the medication. vagina may be absent or underdeveloped. ❖ Individuals with this condition have Causes and risk factors normal ovaries and external genitalia, so 1. Natural Amenorrhea they experience normal development of secondary sexual characteristics like During the normal course of life, women breast development. However, the may experience amenorrhea for natural reasons, such as: ❖ absence of the uterus means there is no site for menstrual blood to form and be Pregnancy expelled, resulting in primary Breast-feeding amenorrhea. Menopause Failure of the Ovary to Receive or Maintain Egg Cells- Gonadal Dysgenesis (Premature Ovarian 2. Contraceptives Insufficiency) Some women who take birth control pills ❖ In these conditions, the ovaries fail to may not have periods. Even after stopping oral develop properly or cannot maintain the contraceptives, it may take some time before egg cells. Without functional ovaries, regular ovulation and menstruation return. there is insufficient production of the Contraceptives that are injected or implanted hormones needed to stimulate the also may cause amenorrhea, as can some types development of the uterine lining and of intrauterine devices. initiate the menstrual cycle, resulting in primary amenorrhea. 3. Medications It is defined as an absence of secondary sexual Certain medication can cause menstrual characteristics by age 14 with no menarche or periods to stop, including some types of: normal secondary sexual characteristics but no Antipsychotics menarche by 16 years of age. Cancer chemotherapy SECONDARY AMENORRHEA (menstrual cycles ceasing) is often caused by hormonal Antidepressants disturbances from the hypothalamus and the pituitary gland, from premature menopause or Blood pressure drugs intrauterine scar formation. Allergy medication It is defined as the absence of menses for three months in a woman with previously 4. Lifestyle factor normal menstruation or nine months for Sometimes lifestyle factors contribute to women with a history of oligomenorrhea. amenorrhea, for instance: BSN 2104_A.Y. 2024-2025 16 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Low body weight. Excessively low body weight 6. Structural Problems - about 10 percent under hormonal functions in your body, potentially halting ovulation. Women Problems with the sexual organs who have eating disorder, such as anorexia or themselves also can cause amenorrhea. bulimia, often stop having periods because of Examples include: these abnormal hormonal changes. ❖ Uterine Scarring Excessive exercise. Women who participate in Asherman's syndrome, a condition in which activities that require rigorous training, such as scar tissue builds up in the lining of the uterus. ballet, may find their menstrual cycles Usually occurs due to the trauma that interrupted. Several factors combine to happens in the uterine lining. Uterine scarring contribute to the loss of periods in athletes, prevents the normal buildup and shedding of including low body fat, stress and high energy the uterine lining. expenditure. Scarring can also cause infertility, the Stress adhesion may block the sperm from reaching the egg or prevent the embryo Mental stress can temporarily alter the from implanting in the uterine wall. functioning of your hypothalamus - an area of your brain that controls the hormones that Uterine scarring can sometimes occur after: regulate your menstrual cycle. ○ dilation and curettage (D&C) a Ovulation and menstruation may stop as a result. procedure after miscarriage, to avoid Regular menstrual periods usually resume after possible retained placental fragments. your stress decreases. ○ cesarean section can lead to 5. Hormonal imbalance adhesions/scarring. Many types of medical problems can cause ○ treatment for uterine fibroids hormonal imbalance, including: (Myomectomy – surgery for the removal Polycystic ovary syndrome (PCOS). of fibroids). PCOS causes relatively high and sustained Infection can be a possible cause of levels of hormones, rather than the fluctuating Asherman's Syndrome (e.g. severe infection levels seen in the normal menstrual cycle. of the uterus such as endometritis - inflammation of the uterine Thyroid malfunction. An overactive thyroid lining/endometrium.) gland (hyperthyroidism) or underactive thyroid (hypothyroidism) gland can cause menstrual Radiation treatment for cancer can also irregularities, including amenorrhea. damage the endometrium and it will lead to scar. Pituitary tumor. A noncancerous (benign) tumor in your pituitary gland can interfere with the Symptoms of Asherman’s Syndrome: hormonal regulation of menstruation. 1. Reduce or no menstruation at all (or had amenorrhea/hypomenorrhea) Premature menopause. Menopause usually *Scar Tissue may prevent the normal begins around age 50. But, for some women, the shedding of the endometrium that will result ovarian supply of eggs diminishes before age 40, to lighter period or abnormally low bleeding and menstruation stops.congenital absence of (hypomenorrhea) the uterus, failure of the ovary to receive or maintain egg cells. BSN 2104_A.Y. 2024-2025 17 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE 2. Recurrent miscarriage Hormonal Therapy e.g. estrogen therapy for *Scarred uterine lining may not be able to the endometrium to generate and reduce support the embryo the likelihood of adhesion reformation 3. Pelvic Pain Antibiotic - to prevent or if an infection is *Women may experience pain, especially if suspected as a cause of complication there is cryptomenorrhea - the menstrual blood is trapped inside the uterus. ❖ Lack of Reproductive Organs How do we detect Asherman’s Syndrome? Sometimes problems arise during fetal development (embryogenesis) that lead to Transvaginal Ultrasound - a common a girl being born without some major imaging procedure used to diagnose part of her reproductive system, such as her conditions affecting the reproductive organs uterus, cervix or vagina. Because her and monitoring the pregnancy. Helps to reproductive system didn't develop detect the irregularities in the uterine cavity. normally, she can't have menstrual cycles. Hysteroscopy - definite method in which we are going to diagnose asherman's syndrome. A small camera would be Cases of Congenital Anomalies with Regards to inserted to the uterus through the cervix, Female Reproductive System allowing the doctor to see what the extent Mullerian duct anomalies of the adhesion is. - happens because of abnormalities in the Hysterosalpingography (HSG) - an X-ray test development of the mullerian duct during with a contrast dye/contrast media that is embryogenesis. injected to the uterus, to see or outline the shape of the uterus, and detect if there are - The affected parts are the uterus, cervix blockage or adhesions and upper 2/3 of the vagina MRI - in some cases, this is also possible to visualize the uterine abnormalities. Treatment: hysteroscopic surgery - removal of adhesions via hysteroscopy, during the procedure the surgeon will cut and remove the scar tissue under direct vision guided by the camera. After the operation, the patient needs a temporary Vaginal agenesis (mayer-rokitansky- Intrauterine Device (IUD) or balloon catheter kuster-hauser syndrome) to be placed in the uterus to prevent the - Absence of vagina/ no vagina/ walls of the uterus from sticking together underdevelopment of the uterus/ not fully again as they heal. develop BSN 2104_A.Y. 2024-2025 18 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE - There is normal ovarian function, but the Depending on the cause of amenorrhea, you reproductive tracts structures is might experience other signs or symptoms along underdeveloped with the absence of periods, such as: - can be repaired through surgical repair - women with this condition typically present Milky nipple discharge with primary amenorrhea (absence of - Happens because of the increase level of menstruation) and may require surgical Prolactin and underlying health conditions. intervention for the vagina to be functional. - Galactorrhea production of milk discharge Ovarian agenesis from the nipple. - This condition has either complete absence or underdeveloped 1 or both ovaries - Medications that can cause high levels of - need hormonal replacement therapy Prolactin (Ex. Antipsychotic/ Antidepressant/ (necessary to develop secondary sexual Antihypertensive) characteristics in menstrual function) - Problems with Hormonal Imbalance and Hymenal anomalies other endocrine imbalances can contribute - hymen is the partial covering of the vaginal orifice, depending on the - Excessive nipple stimulation may lead to variation, the hymen can be completely galactorrhea incorporate (covers the entire opening of - Pathological conditions such as breast the vagina or partially) cancer affecting the ducts which causes Types of Hymen discharge - parous introitus Hair loss - annular - imperforate - Hormonal disorder such as PCOS - microperforate - septate - Cancer drugs Complex Congenital Syndrome - Hair loss and amenorrhea associated with - e.g. androgen insensitivity syndrome an hormonal imbalances and other health individual with XY chromosome have typical conditions female phenotype lack of response to - Because of stress androgen Headache Vision changes ❖ Structural Abnormalities of the Vagina Excess facial hair An obstruction of the vagina may prevent visible menstrual bleeding. A membrane or wall may - Because of excessive level of male be present in the vagina that blocks the outflow hormone which is androgen of blood from the uterus and cervix. Pelvic pain Асnе Signs and symptoms: Vaginal dryness The main sign of amenorrhea tis the absence of menstrual periods. Night sweats BSN 2104_A.Y. 2024-2025 19 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE ❖ Diagnostic Evaluation Before administering oral contraceptives, History collection withdrawal bleeding is induced with an Physical examination injection of progesterone or oral Blood tests may be performed to administration of 5-10 mg of determine the levels of hormones medroxyprogesterone (provera) for 10 secreted by the pituitary gland (FSH, LH, days. TSH and prolactin) and the ovaries Some pituitary and hypothalamic tumors (estrogen) may require surgery and in some cases, Ultrasonography of the pelvis may be radiation therapy. performed to assess the abnormalities of Women with intrauterine adhesions the genital tract or to look for polycystic require dissolution of the scar tissue. ovaries. CT Scan or MRI of the head may be PREMENSTRUAL SYNDROME (PMS) performed to exclude pituitary and Introduction: hypothalamic causes of amenorrhea. It refers to physical and emotional symptoms that occur in the one to two If the above tests are inconclusive, weeks before a woman’s period. additional tests may be performed Symptoms often vary between women including: and resolve around the start of bleeding. Thyroid function tests Determination of prolactin levels COMMON SYMPTOMS are present for Hysterosalpingogram (x-ray test) which around six days such: examine the uterus acne, tender breasts, bloating, Hysteroscopy feeling tired, irritability and mood chances. ❖ Management PREMENSTRUAL DYSPHORIC DISORDER DOPAMINE AGONISTS (PMDD) -such as bromocriptine (Parlodel) or more severe form of PMS that has pergolide (Permax), are effective in greater psychological symptoms. treating hyperprolactinemia. In most women, treatment with dopamine CAUSES AND RISK FACTORS: agonists medications restores normal exactly what causes premenstrual syndrome ovarian endocrine function and is unknown, but several factors may ovulation. contribute to the condition: HORMONE REPLACEMENT THERAPY CYCLIC CHANGES IN HORMONES- - consisting of an estrogen and progestin signs and symptoms of premenstrual can be used for women in whom syndrome change with hormonal estrogen deficiency remains because fluctuations and disappear with ovarian function cannot be restored. pregnancy and menopause. METFORMIN (GLUCOPHAGE) CHEMICAL CHANGES IN THE BRAIN- -is a drug that has been successfully used Fluctuations of serotonin, a brain in women with polycystic ovary syndrome chemical( neurotransmitter) that is to induce evaluation. thought to play a crucial role in mood In some cases, oral contraceptives may states, could trigger PMS symptoms. be prescribed to restore the menstrual Insufficient amounts of serotonin may cycle and to provide estrogen contribute to premenstrual replacement to women with amenorrhea depression, as well as to fatigue, food who do not wish to become pregnant. cravings and sleep problems. BSN 2104_A.Y. 2024-2025 20 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE CLINICAL MANIFESTATIONS: Hormonal contraceptives. Emotional and behavioral symptoms: These prescription medications stop tension or anxiety ovulation, which may bring relief from PMS depressed mood symptoms crying spells Modify diet: mood swings & irritability or anger Eat smaller, more-frequent meals to reduce appetite changes and food cravings bloating and the sensation of fullness. trouble falling asleep(insomnia) Limit salt and salty foods to reduce bloating social withdrawal and fluid retention. poor concentration Choose foods high in complex carbohydrates, Physical signs and symptoms such as fruits, vegetables and whole grains. Joint or muscle pain Choose foods rich in calcium. If you can't Headache tolerate dairy products or aren't getting Fatigue adequate calcium in your diet, a daily calcium Weight gain related to fluid retention supplement may help. Abdominal bloating Avoid caffeine and alcohol. Breast tenderness Incorporate exercise into regular routine Acne Engage in at least 30 minutes of brisk walking, Constipation or diarrhea cycling, swimming or other aerobic activity most Diagnostic evaluation: days of the week. Regular daily exercise can There are no unique physical findings or help improve your overall health and alleviate laboratory tests to positively diagnose certain symptoms, such as fatigue and a premenstrual syndrome. depressed mood. Management: Reduce stress Antidepressants. : Get plenty of sleep. - Selective serotonin reuptake inhibitors (SSRIs) Practice progressive muscle relaxation or — which include fluoxetine (Prozac, deep-breathing exercises to help reduce Sarafem), paroxetine (Paxil, Pexeva), headaches, anxiety or trouble sleeping sertraline (insomnia). - (Zoloft) and others - have been successful in Try yoga or massage to relax and relieve stress. reducing mood symptoms. - SSRIs are the first line treatment for severe Record symptoms for a few months PMS or PMDD. These drugs are generally Keep a record to identify the triggers and taken daily. But for some. women withPMS, timing of your symptoms. This will allow you to use of antidepressants may be limited to the intervene with strategies that may help to lessen two weeks before menstruation begins. them. Nonsteroidal - Anti-inflammatory drugs (NSAIDs). Taken MENORRHAGIA before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or Introduction: It is the most common type of naproxen (Aleve, Naprosyn, others) can abnormal uterine bleeding characterized by ease cramping and breast discomfort. heavy and prolonged menstrual bleeding. In Diuretics. some cases, bleeding may be so severe and - When exercise and limiting salt intake aren't daily activities become interrupted. enough to reduce the weight gain, swelling and bloating of PMS, taking water pills A normal menstrual cycle 21-35 days in duration, (diuretics) can help your body shed excess with bleeding lasting an average of 5 days and fluid through your kidneys. Spironolactone total blood flow between 25 and blood of (Aldactone) is a diuretic that can help ease greater than 80 ml or lasting longer than 7 days some of the symptoms of PMS. constitutes menorrhagia. BSN 2104_A.Y. 2024-2025 21 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Causes and Risk Factors Inherited bleeding disorders. Some blood coagulation disorders such as von Willebrand's Hormone imbalance. In a normal menstrual cycle, a balance between the hormones disease, a condition in which an important estrogen and progesterone regulates the blood- clotting factor is deficient or impaired buildup of the lining of the uterus can cause abnormal menstrual bleeding. (endometrium), which is shed during Medications menstruation. If a hormone imbalance occurs, Including Certain drugs, anti-inflammatory the endometrium develops in excess and medications and anticoagulants, can eventually sheds by way of heavy menstrual contribute to heavy or prolonged menstrual bleeding. bleeding. Dysfunction of the ovaries. If ovaries don't release an egg (ovulate) during a menstrual Other medical conditions cycle (anovulation), your body doesn't produce Several other medical conditions, including the hormone progesterone, as it would during a pelvic inflammatory disease (PID), thyroid normal menstrual cycle. This leads to hormone problems, endometriosis, and liver or kidney imbalance and may result in menorrhagia. disease, may be associated with menorrhagia. Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your Clinical Manifestations: childbearing years. Uterine fibroids may cause Soaking through one or more sanitary pads heavier than normal or prolonged menstrual or tampons every hour for several bleeding. consecutive hours Polyps. Small, benign growths on the lining of Needing to use double sanitary protection to the uterus (uterine polyps) may cause heavy or control your menstrual flow prolonged menstrual bleeding. Polyps of the Needing to wake up to change sanitary uterus most commonly occur in women of protection during the night reproductive age as the result of high hormone Bleeding for longer than a week levels. Passing blood clots with menstrual flow for more than one day Adenomyosis. This condition occurs when Restricting daily activities due to heavy glands from the endometrium become menstrual flow embedded in the uterine muscle, often causing Symptoms of anemia, such as tiredness, heavy bleeding and painful menses. fatigue or shortness of breath. Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal Diagnostic evaluation intrauterine device for birth control. When an IUD History collection is the cause of excessive menstrual bleeding, Physical examination may need to remove it. Blood test. A sample of your blood may be evaluated for iron deficiency (anemia) and Pregnancy complications. A single, heavy, late other conditions, such as thyroid disorders or period may be due to a miscarriage. If bleeding blood-clotting abnormalities. occurs at the usual time of menstruation, Pap test. In this test, cells from your cervix are however, miscarriage is unlikely to be the cause. collected and tested for infection, An ectopic pregnancy implantation of a inflammation or changes that may be fertilized egg within the fallopian tube instead of cancerous or may lead to cancer. the uterus menorrhagia. also may cause Endometrial biopsy. Your doctor may take a Cancer. Rarely, uterine cancer, ovarian sample of tissue from the inside of your uterus cancer and cervical cancer can cause to be examined by a pathologist. excessive menstrual bleeding. BSN 2104_A.Y. 2024-2025 22 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Ultrasound scan. This imaging method uses cervix and then scrapes or suctions tissue sound waves to produce images of your from the lining of your uterus to reduce uterus, ovaries and pelvis. menstrual bleeding. Although this procedure Based on the results of your initial tests, doctor is common and often treats acute or active may recommend further testing, including: bleeding successfully, you may need Sonohysterogram. During this test, a fluid is additional D&C procedures if menorrhagia injected through a tube into your uterus by recurs. way of your vagina and cervix. Your doctor Uterine artery embolization. For women then uses ultrasound to look for problems in the whose menorrhagia is caused by fibroids, the lining of your uterus. goal of this procedure is to shrink any fibroids Hysteroscopy. This exam involves inserting a in the uterus by blocking the uterine arteries tiny camera through your vagina and cervix and cutting off their blood supply. into your uterus, which allows your doctor to Focused ultrasound ablation. Similar to see the inside of your uterus. uterine artery embolization, focused ultrasound ablation treats bleeding caused Management by fibroids by shrinking the fibroids. This lron supplements. If you also have anemia, procedure uses ultrasound waves to destroy your doctor may recommend that you take the fibroid tissue. There are no incisions iron supplements regularly. If your iron levels required for this procedure. are low but you're not yet anemic, you may Myomectomy. This procedure involves be started on iron supplements rather than surgical removal of uterine fibroids. waiting until you become anemic. Depending on the size, number and location Nonsteroidal anti-inflammatory drugs of the fibroids, surgeon may choose to (NSAIDs). NSAIDs, such as ibuprofen (Advil, perform the myomectomy using open Motrin IB, others) or naproxen (Aleve), help abdominal surgery, through several small reduce menstrual blood loss. NSAIDs have incisions (laparoscopically), or through the the added benefit of relieving painful vagina and cervix (hysteroscopically). menstrual cramps (dysmenorrhea). Endometrial ablation. Using a variety of Tranexamic acid. Tranexamic acid (Lysteda) techniques, doctor permanently destroys the helps reduce menstrual blood loss and only lining of your uterus (endometrium). After needs to be taken at the time of the endometrial ablation, most women have bleeding. much lighter periods. Oral contraceptives. Aside from providing Endometrial resection. This surgical birth control, oral contraceptives can help procedure uses an electrosurgical wire loop regulate menstrual cycles and reduce to remove the lining of the uterus. Both episodes of excessive or prolonged endometrial ablation and endometrial menstrual bleeding. resection benefit women who have very Oral progesterone. When taken for 10 or heavy menstrual bleeding. Pregnancy isn't more days of each menstrual cycle, the recommended after this procedure. hormone progesterone can help correct Hysterectomy. Hysterectomy — Surgery to hormone imbalance and reduce remove your uterus and cervix — is a menorrhagia. permanent procedure that causes sterility The hormonal IUD (Mirena). This intrauterine and ends menstrual periods. Hysterectomy is device releases a type of progestin called performed under anesthesia and requires levonorgestrel, which makes the uterine hospitalization. Additional removal of the lining thin and decreases menstrual blood ovaries (bilateral oophorectomy) may cause flow and cramping. premature menopause. Dilation and curettage (D&C). In this procedure, your doctor opens (dilates) your —-------- END OF LECTURE/ PPT —--------- BSN 2104_A.Y. 2024-2025 23 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE THIRD SESSION ANNA’S RULE THE ANTEPARTUM PERIOD GRAVIDA identify the first day of the last menstrual - a woman who is or has been pregnant period (LMP) - total number of pregnancies a woman add 9 months (usual time for a baby to had grow) PARA add 7 days (babies are usually late a - the number of pregnancies that week) reached viability (20 weeks) SIGNS OF PREGNANCY PRIMIGRAVIDA PRESUMPTIVE SIGNS - a woman who is pregnant for the first - those that suggest but do not positively time indicate pregnancy (subjective signs) PRIMIPARA - woman who has delivered one viable PROBABLE SIGNS fetus - strong indicators of pregnancy MULTIGRAVIDA - short of confirmation (objective signs). - a pregnant woman who has been - two or more are highly suggestive of pregnant before pregnancy MULTIPARA - detected at about 12th week - a woman who has delivered more than one viable fetus POSITIVE SIGNS NULLIGRAVIDA - absolute confirmation of pregnancy - woman who has never been pregnant NULLIPARA PRESUMPTIVE SIGNS OF PREGNANCY - a woman who has not carried a fetus to Amenorrhea: absence of menstruation viability Nausea/vomiting: due to metabolic and hormonal changes Breast changes: enlargement, tingling, increases sensation to touch, darkening of nipples and areola Urinary frequency: due to pressure on bladder from uterine enlargement Fatigue: due to increase metabolism Quickening: fluttering sensation when fetus moves (16-20 weeks gestation) PROBABLE SIGNS OF PREGNANCY Pigmentation changes: Calculating the Date of Delivery NAEGELE’S RULE identify the first day of the last menstrual period (LMP) subtract three months from this date linea nigra add seven days BSN 2104_A.Y. 2024-2025 24 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE HYDATIDIFORM MOLE(MOLAR PREGNANCY) Benign proliferating growth of the