NCM 107 Care of Mother, Child & Adolescent PDF

NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE FIRST SESSION or...

NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE FIRST SESSION or "lesser lips" are the thin hairless ridges at the FEMALE REPRODUCTIVE SYSTEM entrance of the vagina, which joins behind and in front. ❖ Introduction In front they split to enclose the clitoris ❖ The ability to reproduce is one of the properties distinguishing living from non-living matter. ❖ Clitoris ❖ The more primitive the animal, the simpler the The clitoris corresponds to the penis in the male process of reproduction. In mammals, including and contains sensory nerve endings and erectile humans, the process is one of sexual tissue. reproduction, in which the male and female The clitoris is a small pea-shaped structure. It plays organs differ anatomically and physiologically, an important part in sexual excitement in females. and the new individual develops from the fusion ❖ Vestibular Glands of two different sex cells (gametes). The vestibular glands (Bartholin's glands) are ❖ The male gametes are called spermatozoa. situated one on each side near the vaginal ❖ and the female gametes are called ova. opening. They are about the size of a small pea The functions of the female reproductive system and their ducts open into the vestibule are: immediately lateral to the attachment of the formation of ova hymen. They secrete mucus that keeps the vulva reception of spermatozoa moist. provision of suitable environments for fertilization Blood supply, lymph drainage and nerve supply and fetal development Arterial supply. This is by branches from the internal parturition (childbirth) pudendal arteries that branch from the internal lactation, the production of breast milk, which iliac arteries and by external pudendal arteries provides complete nourishment for the baby in that branch from the femoral arteries. its early life. Venous drainage. This forms a large plexus which A. External Genitalia (vulva) eventually drains into the internal iliac veins. The external genitalia are known collectively Lymph drainage. This is through the superficial as the vulva, and consist of the : inguinal nodes. ❖ labia majora and Nerve supply. This is by branches from pudendal labia minora, nerves. ❖ the clitoris Perineum ❖ the vaginal orifice ➔ The perineum is a roughly triangular area ❖ the vestibule, the extending from the base of the labia minora hymen and the to the anal canal. vestibular glands ➔ It consists of connective tissue, muscle and (Bartholin's fat. It gives attachment to the muscles of the glands) pelvic floor. ❖ Labia Majora B. Internal Genitalia These are the two large folds forming the boundary ❖ vagina, uterus, of the vulva. They are composed of skin, fibrous ❖ two uterine tubes tissue and fat and contain large numbers of ❖ two ovaries. sebaceous and eccrine sweat glands. Labia majora or "greater lips" are the part around ❖ Vagina the vagina containing two glands (Bartholin's The vagina is a fibromuscular tube lined with glands) which helps lubrication during intercourse. stratified squamous epithelium At puberty, hair grows on the mons pubis and on It runs obliquely upwards and backwards at an the lateral surfaces of the labia majora. angle of about 45° between the bladder in front ❖ Labia Minora and rectum and anus behind. These are two smaller folds of skin between the In the adult, the anterior wall is about 7.5 cm long labia majora, containing numerous sebaceous and the posterior wall about 9 cm long. The and eccrine sweat glands. difference is due to the angle of insertion of the cervix through the anterior wall. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Hymen ❖ Parts of the Uterus The hymen is a thin layer of mucous For the descriptive purpose uterus can be divided membrane that partially occludes the into three distinct parts: opening of the vagina. Fundus It is normally incomplete to allow for passage Body of menstrual flow and is stretched or Cervix completely torn away by sexual intercourse, insertion of a tampon or childbirth. ❖ Structure of the Vagina The vaginal wall has three layers: an outer covering of areolar tissue, Fundus a middle layer of smooth muscle - This is the dome-shaped part of the uterus above and an inner lining of stratified squamous the openings of the uterine tubes. epithelium that forms ridges or rugae. It has no Body secretory glands but the surface is kept moist by - This is the main part. It is narrowest inferiorly at the cervical secretions. Between puberty and the internal os where it is continuous with the cervix. menopause, Cervix (neck' of the uterus) Lactobacillus acidophilus, bacteria that secrete - This protrudes through the anterior wall of the lactic acid, are normally present maintaining the vagina, opening into it at the external os. pH between 4.9 and 3.5. The acidity inhibits the growth of most other micro-organisms that may ❖ Layers of the Uterus enter the vagina from the perineum or during a. Perimetrium sexual intercourse. b. Myometrium c. Endometrium Functions of the Vagina The vagina acts as the receptacle for the penis during sexual intercourse (coitus), and provides an elastic passageway through which the baby passes during childbirth. Blood supply, lymph drainage and nerve supply Arterial supply. An arterial plexus is formed round the vagina, derived from the uterine and vaginal arteries, which are branches of the internal iliac arteries. Venous drainage. A venous plexus, situated in the muscular wall, drains into the internal iliac veins. a. Perimetrium Lymph drainage. This is through the deep and This is peritoneum, which is distributed differently superficial iliac glands. on the various surfaces of the uterus. Anteriorly it lies over the fundus and the body ❖ Uterus where it is folded on to the upper surface of the The uterus is a hollow muscular pear-shaped organ urinary bladder. that is located anteroposteriorly in the pelvic This fold of peritoneum forms the vesicouterine cavity. pouch. Posteriorly the peritoneum covers the fundus, the It lies in the pelvic cavity between the urinary body and the cervix, then it folds back on to the bladder and the rectum rectum to form the rectouterine pouch (of It is about 7.5 cm long, 5 cm wide and its walls are Douglas). about 2.5 cm thick. It weighs between 30 and 40 grams 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. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE c. Endometrium The end of each tube has fingerlike, projections Made up of the Columnar epithelial cells called fimbriae. Consist mucous secreting tubular glands The longest of these is the ovarian fimbria, which is in close association with the ovary. Blood supply, lymph drainage and nerve supply Structure of the Uterine Tubes Arterial supply. This is by the uterine arteries, The uterine tubes are covered with peritoneum branches of the internal iliac arteries. (broad ligament), Venous drainage internal illiac vein have a middle layer of smooth muscle and are Lymph drainage. Deep and superficial lymph lined with ciliated epithelium. vessels drain lymph from the uterus and the Blood and nerve supply and lymphatic drainage are as for the uterus. uterine tubes to the aortic lymph nodes and groups of nodes associated with the iliac blood Functions of the Vagina vessels. The uterine tubes propel the ovum from the ovary to the uterus by peristalsis and ciliary movement. ❖ Supporting Structures to the Uterus The secretions of the uterine tube nourish both The uterus is supported in the pelvic cavity by ovum and spermatozoa. surrounding organs, muscles of the pelvic floor and Fertilization of the ovum usually takes place in the ligaments that suspend it from the walls of the pelvis uterine tube, and the zygote is propelled into the Broad ligaments. uterus for implantation. - These are formed by a double fold of peritoneum, one on each side of the uterus. ❖ Ovaries Round ligaments. The ovaries are the female gonads (glands - These are bands of fibrous tissue between the two producing sex hormones and the ova), and they layers of broad ligament. lie in a shallow fossa on the lateral walls of the pelvis. Uterosacral ligaments. They are 2.5-3.5cm long, 2cm wide and 1cm - These originate from the posterior walls of the cervix thick. and vagina and extend backwards, one on each Each is attached to the upper part of the uterus side of the rectum, to the sacrum. by the ovarian ligament and to the back of the Transverse cervical (cardinal) ligaments. broad ligament by a broad band of tissue, the - These extend one from each side of the cervix and mesovarium. vagina to the side walls of the pelvis. Blood vessels and nerves pass to the ovary through the mesovarium Structure of the Ovaries The ovaries have two layers of tissue. Medulla. - This lies in the centre and consists of fibrous tissue, blood vessels and nerves. Cortex. - This surrounds the medulla. It has a framework of connective tissue, or stroma, covered by germinal epithelium. - It contains ovarian follicles in various stages of maturity, each of which contains an ovum. ❖ Uterine Tubes The uterine (Fallopian) tubes are about 10 cm Functions of the Vagina long and extend from the sides of the uterus The ovary is the organ in which the female between the body and the fundus. gametes are stored and develop prior to They lie in the upper free border of the broad ovulation. ligament and their trumpet-shaped lateral ends, Their maturation is controlled by the penetrate the posterior wall, opening into the hypothalamus and the anterior pituitary gland. peritoneal cavity close to the ovaries. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE ❖ Breast MALE REPRODUCTIVE SYSTEM The breasts or mammary glands are accessory glands of the female reproductive system. They exist also in the male, but in only a rudimentary form. Structure of the Breast The mammary glands or breasts consist of varying amounts of glandular tissue, responsible for milk Functions of the Male Reproductive Organ production, maturation and storage of spermatozoa delivery of spermatozoa in semen into the female reproductive tract Scrotum is a pouch of pigmented skin, fibrous and connective tissue and smooth muscle. it is divided into two compartments, each of which contains one testis, one epididymis and the testicular end of a spermatic cord. Each breast contains about 20 lobes, each of Testis which contains a number of glandular structures Also knows as testicle gonads are male called lobules, where milk is produced. reproductive glands and are the equivalent of Lobules open into lactiferous ducts, which drain the ovaries in the female. milk towards the nipple. Produces sperms Breast itself is covered in subcutaneous fat. They are about 4.5cm long, 2.5cm wide and 3cm In the lactating breast, glandular tissue thick and are suspended in the scrotum by proliferates (hyperplasia) to support milk the spermatic cords. They are surrounded by production, and recedes again after lactation three layers of tissue. stops. 1. Tunica vaginalis - is a closed peritoneal sac surrounding the front and sides of the testis and Nipples extends upwards over the spermatic cord This is a small conical eminence at the centre 2. Tunica albuginea - is the tough fibrous layer of of the breast surrounded by a pigmented connective tissue that surrounds the corpora area, the areola. cavernosa of the penis On the surface of the areola are numerous 3. Tunica vasculosa - is the inner-most of the three sebaceous glands (Montgomery's tubercles), layers that form the capsule of the testis. It consists of which lubricate the nipple during lactation. a vascular plexus and loose connective tissue. Blood supply, lymph drainage and nerve supply Arterial supply. The breasts are supplied with blood from the thoracic branches of the axillary arteries and from the internal mammary and intercostal arteries. Venous drainage. This is formed by an anastomotic circle round the base of the nipple from which branches carry the venous blood to the circumference, and end in the axillary and mammary veins. Lymph drainage. This is mainly into the superficial axillary lymph vessels and nodes. Nerve supply. The breasts are supplied by Structure In each testis are 200-300 lobules and branches from the 4th, 5th and 6th thoracic within each lobule are 1-4 convoluted loops of nerves. germinal epithelial cells called seminiferous tubules. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE DUCT SYSTEM ❖ Urethra tube that carries urine from the bladder to Vas Deferens outside of the body Transports mature sperm to the urethra also carries sperm out of the body Epididymis 19-20 cm long Sperm mature in epididymis Prostatic urethra Membranous urethra ❖ Spermatic Cord Penile urethra The spermatic cords suspend the testes in the Two sphincter by scrotum. Each cord contains a testicular artery, testicular veins, lymphatics Seminal Vesicle is a 5 cm long tube that joins with the deferent duct to forms the common ejaculatory duct. Attached to vas deferens Produces a sugar rich fluid that provides energy to sperm 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 100 million spermatozoa per mL. If not ejaculated, 50. sperm gradually lose their fertility after several Makes fluid months and are reabsorbed by the epididymis. FUNCTIONS The prostate gland secretes a thin, milky fluid that makes up about 30% of the volume of semen, and gives it its milky appearance. It contains a clotting enzyme, which thickens the semen in the vagina, increasing the likelihood of semen being retained close to the cervix. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE SPERMATOGENESIS AND OOGENESIS ❖ Spermiogenesis ❖ is the metamorphosis of spherical spermatids ❖ Spermatogenesis into elongated spermatozoa. No further mitosis or meiosis occurs ❖ occurs in the seminiferous tubules that form the ❖ during spermiogenesis, the acrosome forms, the bulk of each testis flagellar apparatus forms, and most excess ❖ the process begins at puberty and constantly cytoplasm (the residual body) is separated and throughout a man’s life left in the Sertoli cell. ❖ the process of spermatogenesis begins with ❖ spermatozoa are released into the lumen of the mitosis of the diploid spermatogonia seminiferous tubule ❖ How long does it take for one production ❖ Role of Sertoli Cell in Spermatogenesis cycle, from spermatogonia to sperm, to take ❖ secrete signaling molecules that promote sperm place?" production ❖ 64 days ❖ has also been called the "mother" or "nurse" cell ❖ Three phases of spermatogenesis ❖ form blood-testis barrier ❖ provide factors necessary for the successful ❖ Spermatocytogenesis progression of spermatogonia (germ cells) into ❖ Meiosis spermatozoa (sperm) ❖ Spermiogenesis ❖ 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 ❖ hormones such as testosterone, FSH and luteinizing hormone (LH) are known to influence the germ cell fate. ❖ FSH, by its ability to stimulate Sertoli cell mitosis during testicular development, can influence the spermatogenic capacity of the adult testis ❖ both FSH and testosterone exert synergistic actions on germ cells, but testosterone has a specific action on the later stages of spermatid ❖ Spermatocytogenesis (Mitosis) maturation. ❖ germ cells (spermatogonium) divide mitotically to replace themselves and to produce cells that ❖ OOGENESIS begin differentiation ❖ Gametogenesis in females is called ❖ Meiosis oogenesis. ❖ cells in prophase of the first meiotic division are ❖ The process begins with the ovarian stem primary spermatocytes cells, or oogonia ❖ Oogonia are formed during fetal ❖ primary spermatocytes go through the first development, and divide via mitosis meiotic division and become secondary spermatocytes ❖ the cells quickly proceed through this stage and complete the second meiotic division ❖ meiosis is the process by which the diploid number of chromosomes present in spermatogonia (the germ cells) is reduced to the haploid number present in mature spermatozoa ❖ the products of the second meiotic division are called spermatids BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE STEPS of OOGENESIS Follicular development (stepwise) 1. Oogonia are formed during fetal 1. Each primary oocyte is surrounded by follicular development, and divide via mitosis cells and is called as Primordial follicle. 2. Oogonia produce primary oocytes in the 2. At puberty, the primordial follicle start growing fetal ovary prior to birth. under influence of FSH and LH and developed into 3. These primary oocytes are then arrested in primary follicle. this stage of meiosis I 3. As the primary follicle grow, the follicular cell 4. Meiosis-I resumes at puberty and continuing surrounding to primary oocyte start growing, and until the woman is near menopause. that newly growing cells are called as granulosa 5. After Meiosis-I, two cells are produce: cells. Secondary oocyte and first polar body 4. The glycoprotein layer is start developing 6. This cell division does not result in two between granulosa cell and primary oocyte that identical cells. Instead, the cytoplasm is layer is called as zona pellucida. divided unequally, and one daughter cell is 5. As the follicle grow, the theca cells (also called as much larger than the other. theca externa) are developed that encircle the 7. This larger cell (the secondary oocyte), granulosa cells. At this stage granulosa cells start eventually leaves the ovary during ovulation. secreting follicular fluid which develop the cavity 8. If fertilization occurs, then Meiosis of a called as antrum. secondary oocyte is completed. ie Meiosis II 6. When antrum is developed in follicle, the follicle is then resumes, producing one haploid ovum termed as secondary follicle. that fertilization by a (haploid) sperm and 7. Theca cells work with the granulosa cells to produce diploid (two cell) zygote. produce estrogens. 9. 9. If fertilization does not occur, the 8. Follicles in which the antrum has become large secondary oocyte fails to complete the 2nd and fully formed are considered tertiary follicles meiotic division, and degenerates in about 9. Once the follicle is mature, it ruptures and releases 24 hours after ovulation the oocyte. Cells remaining in the follicle then develop into the corpus luteum. FERTILIZATION and IMPLANTATION ANATOMY OF SPERM FOLLICULAR DEVELOPMENT ANATOMY OF OVA BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Fertilization PROCESS OF FERTILIZATION is the process of fusion of the spermatozoon with the mature ovum. It begins with sperm and egg collision and ends with the production of a mononucleated single cell called ZYGOTE. Almost always fertilization occurs in AMPULLARY portion of fallopian tubes. WHEN DOES LIFE BEGIN ? APPROXIMATION OF GAMETES The ovum immediately following ovulation is 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 The ovum is rapidly transported to the ampullary part. Fertilised lifespan of oocytes ranges from 12 to 24 - Every human cell has 46 chromosomes (Chr) hours whereas that of sperm is 48 to 72 hours. except the sperm and the egg which have 23 Out of hundreds of millions of sperms deposited in each. At conception they become a unique the vagina at single ejaculation. human with 46 Chr. 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 division of the segmentation nucleus occurs producing two BLASTOMERES. The two cells stage is reached approximately 30 Only thousands of capacitated spermatozoa enter hours after "FERTILIZATION". the uterine tube while only 300-500 reach the ovum. The blastomeres continue to divide by binary The tubal transport is facilitated by muscular division through the 4,6,8 cell stage until a cluster of contraction and aspiration action of the uterine tube. cells is formed and is called MORULA, resembling CONTACT AND FUSION OF THE GAMETES MULBERRY. Complete dissolution of the cells of the corona By the 4th day it forms to 16-64 cell stage. radiata occurs by the chemical action of the HYALURONIDASE liberated from the Acrosomal cap BLASTOCYST of the hundreds of sperm present at the site. While the morula remains free in the uterine cavity Penetration of Zona pellucida is facilitated by on the 4th and 5th day. Hyaluronidase from the acrosomal cap. The fluid passes through the canaliculi of the zona Soon after the Sperm fusion, penetration of other pellucida which separates the cells of morula and is sperm is prevented by ZONA REACTION and COLEMA now termed as BLASTOCYST. BLOCK. Zona Hatching is the next step so that trophectoderm cells interact with endometrial cells and implantation occurs. BLASTOCYST- when zygote divides to 32 cells. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE IMPLANTATION/NIDATION/ NESTING DAY 22 and DAY 24: 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 * Skeletons are present. The implantation process is completed by the 10th or 11th day. DAY 26: This type of deeper penetration of human blastocyst is called IMPLANTATION. Now the blastocyst is covered on all sides by the endometrium (DECIDUA). The Blastocyst begins to collapse 4 WEEKS EMBRYO After the cluster of cells attaches to the womb it is called an embryo. The embryo is between 1/100 and 4/100 inch long at this time. The embryo continues rapid growth. Day 15 - The primitive streak can be seen on the left side of this Day17 - The primitive streak can still be seen, and the opposite end of the embryo is starting to fold up. Day 19- The neural tube is seen along with somites on either side of it. 8 WEEKS OF EMBRYO The embryo is about ½ inch long. The heart now has four chambers. Fingers and toes begin to form. Reflex activities begin as the brain and nervous system Somites - zipper-like motion of the neural tube closing develop. together, three pairs of small bumps form on either side of the closure. they will form the skeleton and the Cells begin to form the eyes, major muscles of the body. 38 pairs of somites will line ears, jaws, lungs, stomach, intestines and liver. the neural tube within 2 weeks. the neural tube should close neural tube defect if it doesn’t close folic acid is needed to prevent this BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE 10 WEEKS OF EMBRYO 18 WEEKS OF EMBRYO The embryo is about 1 to 1¼ The fetus is about 5½ inches long (the head is about inches long and weighs half the length) and weighs less about 7 ounces. than ½ ounce. The skin is pink and The beginnings of all key body transparent and the ears are parts are present, but they are clearly visible. not completed. All the body and facial Structures that will form eyes, features are now ears, arms and legs can be recognizable. seen. The fetus can grasp and Muscles and skeletons are move its mouth. developing and the nervous Nails begin to grow. system becomes more The fetus has begun to kick. Some women feel this responsive. movement. 12 WEEKS OF EMBRYO 20 WEEKS OF EMBRYO The fetus is about 2½ The fetus is about 6¼ inches inches long and weighs long and weighs about 11½ about ½ ounce. ounces. Fingers and toes are All organs and structures are distinct and have nails. formed Hair begins to Skin is wrinkled and pink to develop, but won't be reddish in seen until later in the color - thin and close to the pregnancy. blood vessels. The fetus begins Protective skin coating, (VERNIX) begins to small, random develop. movements, too slight to be felt. Respiratory movements occur - lungs have not The fetal heartbeat can be detected with a heart developed enough to permit survival outside the monitor. uterus. All major external body features have appeared. By this time, mothers usually feel the fetus moving. Muscles continue to develop. At this time an ultrasound can often identify the sex of the fetus. 14 WEEKS OF EMBRYO 22 WEEKS OF EMBRYO The fetus is about 3½ inches long and weighs about 1½ The fetus is about 7½ ounces. inches long weighs The fetus begins to swallow, about 1 pound. the kidneys make urine, and It has fingerprints and blood begins to form in the some head and body bone marrow. hair. Joints and muscles allow full It may suck its thumb body movement. and is more active. There are eyelids and the The brain is growing nose is developing a bridge. very rapidly. External genitals are The fetal heartbeat can be easily heard. developing. The kidneys start to work. 23 WEEKS OF EMBRYO approximately 31% of babies born survive. Babies born at this age require intensive care and usually have lifelong disabilities and chronic health conditions. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE 24 WEEKS OF EMBRYO 30 WEEKS OF EMBRYO The fetus is about 8¼ inches long The fetus is about 10½ inches long and weighs about 1¼ pounds. and weighs about 3 pounds. Bones of the ears harden making The lungs that are capable of sound conduction possible. The fetus breathing air, although medical help hears the mother's sounds such as may be needed. breathing, heartbeat and voice. The fetus can open and close its The first layers of fat are beginning eyes, suck its thumb, cry and respond to form. to sound. This is the beginning of substantial The skin is smooth. weight gain for the fetus. Rhythmic breathing and body temperature are now Lungs continue developing controlled by the brain. Most babies born at this age WILL SURVIVE 25 WEEKS OF EMBRYO 32 WEEKS OF EMBRYO - approximately 68% of babies born survive. Babies born at this age require intensive care and usually The fetus is about 11 inches have life-long disabilities and chronic health long and weighs about 3 conditions. pounds, 12 ounces. The connections between 26 WEEKS OF EMBRYO the nerve cells in the brain increase. The fetus is about 9 inches Fetal development now long and weighs about 2 centers on growth. pounds. The fetus can respond to Almost all babies born at this sound from both inside and age will survive. outside the womb. Reflex movements continue 34 WEEKS OF EMBRYO to develop and body movements are The fetus is about 12 inches long stronger. and weighs about 4 1⁄2 pounds. Lungs continue to develop. Ears begin to hold shape. The fetus now wakes and sleeps. Eyes open during alert times and The skin is slightly wrinkled. close during sleep. *vernix=protecive skin coating. Almost all babies born at this age will survive. 27 WEEKS OF EMBRYO 36 WEEKS OF EMBRYO - approximately 87% of babies born survive. Babies born at this age require intensive care and have an The fetus is about 12 to 13 inches increased risk of developmental delays and chronic long and weighs about 5½ to 6 health conditions. pounds. Scalp hair is silky and lies against 28 WEEKS OF EMBRYO the head. Muscle tone has developed and The fetus is about 10 the fetus can turn and lift its head inches long and Almost all babies born at this age weighs about 2 will survive. pounds, 3 ounces. Mouth and lips show 38 WEEKS OF EMBRYO more sensitivity. The eyes are The fetus is about 13½ to 14 inches partially open and long and weighs about 6½ pounds. can perceive light. Lungs are usually mature. More than 90% of The fetus can grasp firmly. babies born at this age The fetus turns toward light WILL SURVIVE. sources. Some survivors have developmental delays and Almost all babies born at this age chronic health conditions. will survive. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE 40 WEEKS OF EMBRYO The fetus is about 18 to 20 inches long and may weigh about 7½ pounds. At the time of birth, a baby has more than 70 reflex behaviors, which are automatic behaviors necessary for survival. The baby is full-term and ready to be born. CRITICAL PERIODS OF HUMAN DEVELOPMENT MENSTRUAL CYCLE ❖ MENSTRUATION Periodic discharge of blood and cellular debris from the female genital tract is termed menstruation. Cyclical changes occurring from one menstruation to the next comprises a menstrual cycle. The duration of the menstrual cycle is about 28 ± 4 days. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE ❖ Phases of Menstruation Weakened wall of follicle 1.) Proliferative phase Degeneration of stigma ± swelling of follicle 2.) Secretory phase Rupture of follicle—) expulsion of ovum 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. ❖ SECRETORY PHASE (luteal phase) This phase lasts for about 14 days. It starts after ovulation and extends up to the next menstrual phase. Endometrium thickens up to 6 mm. Glands become bigger, tortuous and filled with secretions. Stromal cells proliferate, spiral arteries become ❖ OTHER CHANGES more coiled and dilated. BREAST This is caused due to the action of progesterone VAGINA CERVIX and estrogen on uterine endometrium. BODY FLUIDS ❖ Accelerated Growth of Follicle BASAL BODY TEMPERATURE More of estrogen is secreted into the follicle. Stimulates granulosa cells to form increased -------------------END OF LECTURE—------------------- 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. ❖ LH Surge and Ovulation LH surge Release of follicular steroid hormone Release of proteolytic enzyme and prostaglandin Release of plasma into the follicle BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE SECOND SESSION ❖ Without sufficient levels of FSH and LH, the DISORDERS OF MENSTRUATION ovaries do not produce or release eggs (ovulation), and the menstrual cycle is ❖ Sexual Developmental Sequence disrupted, leading to amenorrhea (absence of menstruation). ❖ Female (HPTAMO) Height, Pelvic Broadening, Thelarche, Adrenarche, Menarche and ❖ Reason for having amenorrhea during Ovulation childhood and menopause ❖ Male (ITAVPIS) Increase in weight, Testicular Childhood growth, Adrenarche, Voice change, Penile Absence of menses is due to the immaturity of the growth, Increase in height and reproductive system and low hormone levels, SpermatogenesisMalT preventing the onset of the menstrual cycle. ❖ Physiology of Menstruation Menopause Hypothalamus, GnRH, Anterior Pituitary Gland, FSH Menstruation ceases due to the depletion of ovarian and LH, Ovaries, Estrogen and Progesterone follicles and a significant decline in hormone production, marking the end of reproductive ❖ Homologous Structures capability. are body parts in different species that have a similar structure or origin but may serve different functions. ❖ Onset of MENARCHE ❖ 12 years old Menstrual Irregularities refer to any changes or deviations from the normal CLASSIFICATION OF AMENORRHEA menstrual cycle, which typically ranges from 21 to 35 1. Primary amenorrhoea (menstrual cycles never days, with menstruation lasting about 3 to 7 days. starting) may be caused by developmental problems These irregularities can include variations in cycle such as, the length, flow, and symptoms. Congenital Absence of the Uterus- Müllerian ❖ Amenorrhea Agenesis (Mayer-Rokitansky-Küster-Hauser ❖ absence of menstrual period in a woman of Syndrome) reproductive age ❖ This condition occurs when the Müllerian ducts, ❖ Physiological states of amenorrhoea are seen, which develop into the female reproductive most commonly, during pregnancy and tract, do not form properly during fetal lactation (breastfeeding), the latter also forming development. As a result, the uterus, cervix, and the basis of a form of contraception known as upper part of the vagina may be absent or the lactational amenorrhoea method. underdeveloped. ❖ Outside of the reproductive years there is ❖ Individuals with this condition have normal absence of menses during childhood and after ovaries and external genitalia, so they menopause. experience normal development of secondary ❖ Why does LACTATION affect amenorrhea? sexual characteristics like breast development. Lactation affects the absence of menstruation However, the through a process called lactational amenorrhea. ❖ absence of the uterus means there is no site for This natural suppression of the menstrual cycle during menstrual blood to form and be expelled, breastfeeding is primarily driven by hormonal resulting in primary amenorrhea. changes that occur to support milk production. Failure of the Ovary to Receive or Maintain Egg Prolactin Cells- Gonadal Dysgenesis (Premature Ovarian ❖ is a hormone produced by the pituitary gland that stimulates milk production in the mammary Insufficiency) glands. ❖ In these conditions, the ovaries fail to develop properly or cannot maintain the egg cells. Without ❖ Elevated levels of prolactin during functional ovaries, there is insufficient production of breastfeeding suppress the release of the hormones needed to stimulate the development gonadotropin-releasing hormone (GnRH) from of the uterine lining and initiate the menstrual cycle, the hypothalamus. GnRH is necessary for the resulting in primary amenorrhea. stimulation of the pituitary gland to produce follicle-stimulating hormone (FSH) and art It is defined as an absence of secondary sexual luteinizing hormone (LH), which are crucial for characteristics by age 14 with no menarche or normal the ovarian cycle and ovulation. secondary sexual characteristics but no menarche by 16 years of age. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE SECONDARY AMENORRHEA (menstrual cycles Stress. ceasing) is often caused by hormonal disturbances Mental stress can temporarily alter the functioning of from the hypothalamus and the pituitary gland, from your hypothalamus - an area of your brain that premature menopause or intrauterine scar formation. controls the hormones that regulate your menstrual cycle. It is defined as the absence of menses for three months in a woman with previously Ovulation and menstruation may stop as a result. normal menstruation or nine months for Regular menstrual periods usually resume after your women with a history of oligomenorrhea. stress decreases. ❖ Pregnancy is the most common cause of 5. Hormonal imbalance secondary amenorrhea, although problems Many types of medical problems can cause with hormones also can cause secondary hormonal imbalance, including: amenorrhea. Polycystic ovary syndrome (PCOS). ❖ Common medical treatments for secondary amenorrhea include: Birth control pills or other PCOS causes relatively high and sustained levels of types of hormonal medication. hormones, rather than the fluctuating levels seen in the normal menstrual cycle. Causes and Risk Factors Thyroid malfunction. An overactive thyroid gland 1. Natural Amenorrhea (hyperthyroidism) or underactive thyroid During the normal course of life, women may (hypothyroidism) gland can cause menstrual experience amenorrhea for natural reasons, such as: irregularities, including amenorrhea. Pregnancy Breast-feeding Pituitary tumor. A noncancerous (benign) tumor in Menopause your pituitary gland can interfere with the hormonal 2. Contraceptives regulation of menstruation. Some women who take birth control pills may Premature menopause. Menopause usually begins not have periods. Even after stopping oral around age 50. But, for some women, the ovarian contraceptives, it may take some time before regular supply of eggs diminishes before age 40, and ovulation and menstruation return. Contraceptives menstruation stops congenital absence of the uterus, that are injected or implanted also may cause failure of the ovary to receive or maintain egg cells. amenorrhea, as can some types of intrauterine devices. 6. Structural Problems 3. Medications Problems with the sexual organs themselves Certain medication can cause menstrual also can cause amenorrhea. Examples include: periods to stop, including some types of: Antipsychotics ❖ Uterine Scarring Cancer chemotherapy Asherman's syndrome, a condition in which scar Antidepressants tissue builds up in the lining of the uterus. Usually Blood pressure drugs occurs due to the trauma that happens in the Allergy medication uterine lining. Uterine scarring prevents the normal 4. Lifestyle factor buildup and shedding of the uterine lining. Sometimes lifestyle factors contribute to Scarring can also cause infertility, the adhesion amenorrhea, for instance: may block the sperm from reaching the egg or Low body weight. Excessively low body weight prevent the embryo from implanting in the uterine - about 10 percent under hormonal functions in your wall. body, potentially halting ovulation. Women who Uterine scarring can sometimes occur after: have eating disorder, such as anorexia or bulimia, ○ dilation and curettage (D&C) a procedure often stop having periods because of these after miscarriage, to avoid possible retained abnormal hormonal changes. placental fragments. Excessive exercise. Women who participate ○ cesarean section can lead to in activities that require rigorous training, such as adhesions/scarring. ballet, may find their menstrual cycles interrupted. ○ treatment for uterine fibroids (Myomectomy – Several factors combine to contribute to the loss of surgery for the removal of fibroids). periods in athletes, including low body fat, stress and high energy expenditure. BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Infection can be a possible cause of Asherman's ❖ Lack of Reproductive Organs Syndrome (e.g. severe infection of the uterus such Sometimes problems arise during fetal as endometritis - inflammation of the uterine development (embryogenesis) that lead to a lining/endometrium.) girl being born without some major part of her Radiation treatment for cancer can also damage reproductive system, such as her uterus, cervix or the endometrium and it will lead to scar. vagina. Because her reproductive system didn't develop normally, she can't have menstrual Symptoms of Asherman’s Syndrome: cycles. 1. Reduce or no menstruation at all (or had amenorrhea/hypomenorrhea) Cases of Congenital Anomalies with Regards to *Scar Tissue may prevent the normal shedding of Female Reproductive System the endometrium that will result to lighter period Mullerian duct anomalies or abnormally low bleeding (hypomenorrhea) - happens because of abnormalities in the development of the mullerian duct during 2. Recurrent miscarriage embryogenesis. *Scarred uterine lining may not be able to support - The affected parts are the uterus, cervix and the embryo upper 2/3 of the vagina 3. Pelvic Pain *Women may experience pain, especially if there is cryptomenorrhea - the menstrual blood is trapped inside the uterus. How do we detect Asherman’s Syndrome? Transvaginal Ultrasound - a common imaging procedure used to diagnose conditions affecting the reproductive organs and monitoring the pregnancy. Helps to detect the irregularities in the uterine cavity. Hysteroscopy - definite method in which we are going to diagnose asherman's syndrome. A small Vaginal agenesis (mayer-rokitansky-kuster-hauser camera would be inserted to the uterus through syndrome) the cervix, allowing the doctor to see what the - Absence of vagina/ no vagina/ extent of the adhesion is. underdevelopment of the uterus/ not fully Hysterosalpingography (HSG) - an X-ray test with develop a contrast dye/contrast media that is injected to - There is normal ovarian function, but the the uterus, to see or outline the shape of the reproductive tracts structures is underdeveloped uterus, and detect if there are blockage or - can be repaired through surgical repair adhesions - women with this condition typically present with MRI - in some cases, this is also possible to primary amenorrhea (absence of menstruation) visualize the uterine abnormalities. and may require surgical intervention for the vagina to be functional. Treatment: Ovarian agenesis hysteroscopic surgery - removal of adhesions via - This condition has either complete absence or hysteroscopy, during the procedure the surgeon underdeveloped 1 or both ovaries will cut and remove the scar tissue under direct - need hormonal replacement therapy vision guided by the camera. After the (necessary to develop secondary sexual operation, the patient needs a temporary characteristics in menstrual function) Intrauterine Device (IUD) or balloon catheter to be placed in the uterus to prevent the walls of Hymenal anomalies the uterus from sticking together again as they - hymen is the partial covering of the vaginal heal. orifice, depending on the variation, the Hormonal Therapy e.g. estrogen therapy for the hymen can be completely incorporate endometrium to generate and reduce the (covers the entire opening of the vagina or likelihood of adhesion reformation partially) Antibiotic - to prevent or if an infection is suspected as a cause of complication BSN 2104_A.Y. 2024-2025 NCM 107 FIRST SEM CARE OF MOTHER, CHILD & ADOLESCENT LECTURE Types of Hymen - parous introitus - annular - imperforate - microperforate - septate Complex Congenital Syndrome - e.g. androgen insensitivity syndrome an individual with XY chromosome have typical female phenotype lack of response to androgen ❖ Structural Abnormalities of the Vagina An obstruction of the vagina may prevent visible menstrual bleeding. A membrane or wall may be present in the vagina that blocks the outflow of blood from the uterus and cervix. Signs and symptoms: The main sign of amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as: Milky nipple discharge - Happens because of the increase level of Prolactin and underlying health conditions. - Galactorrhea production of milk discharge from the nipple. - Medications that can cause high levels of Prolactin (Ex. Antipsychotic/ Antidepressant/ Antihypertensive) - Problems with Hormonal Imbalance and other endocrine imbalances can contribute - Excessive nipple stimulation may lead to galactorrhea - Pathological conditions such as breast cancer affecting the ducts which causes discharge Hair loss - Hormonal disorder such as PCOS - Cancer drugs - Hair loss and amenorrhea associated with hormonal imbalances and other health conditions - Because of stress Headache Vision changes Excess facial hair - Because of excessive level of male hormone which is androgen Pelvic pain Асnе Vaginal dryness Night sweats BSN 2104_A.Y. 2024-2025