NCMA217 Male and Female Reproductive Anatomy PDF

NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and D...

NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL its acidity, they need alkaline. Two structures that provide MALE REPRODUCTIVE ANATOMY alkaline to the sperm: PROSTATE GLAND and COWPER’S GLAND. Composed of two structures: Internal and External Ampulla - At the end of vas/ductus deferens, connected to structures. the ejaculatory duct, that is also connected to the seminal EXTERNAL STRUCTURES vesicle. Penis and Scrotum Ejaculatory Duct - Connected to the male urethra. This is Penis - Organ of copulation/sexual intercourse for males the duct where lubricated sperms go through after the (copulation = sexual intercourse). seminal vesicle. This is the area where the ampulla and Scrotum - Newborns have darker scrotum due to not seminal vesicle meet. having fully descended testes. Male Urethra - Connected to the urinary bladder, prostate It is also darker than normal skin because scrotal gland, and Bulbourethral/Cowper’s gland. It is 5-9 inches temperature is 1 deg. Fahrenheit LOWER than body in length, and average of 7 inches. temperature as sperms are heat-sensitive. Functions of the urethra: DUAL, for elimination of urine INTERNAL STRUCTURES and reproduction. Prepuce - Skin covering an uncircumcised penis. Can build up more Smegma. Smegma is a build up composed of sweat and urine (might to cervical cancer when pushed through the cervix). Note: If the male is highly stimulated, it is possible for him to leak a clear fluid prior to ejaculation. This is called pre-cum or pre-ejaculatory fluid. PRE-CUM may cause pregnancy. Note: Withdrawal is not a good method of contraception. This is called COITUS INTERRUPTUS, commonly called “pulling out” or “pull-out”, and is only 80% effective with a 20% failure rate. IT IS THE #1 cause of teenage pregnancy. Note: The ejaculatory duct contracts during the peak of Testes - Male gonad/sex gland (gonad = sex gland). the orgasm during intercourse. This propels the semen Functions of the testes: Spermatogenesis (sperm (forceful ejaculation in the urethra). This force is needed production, which happens in the seminiferous tubules of to push the semen through the acidic vaginal canal for the testes) and Testosterone production. survival of the sperms. What do you call the cells inside the testes that nourish the Note: The sperms’ goal is to enter the first part of the sperm? Laydig’s cells; gives glucose and fructose. uterus, which is the CERVIX. The cervical canal is Vas/Ductus Deferens - pathway of sperm from the non-acidic, hence, this is a safe area for the sperm. Weak epididymis to the ampulla. ejaculation would result in higher sperm death in the Epididymis - On top of the testes, connected to the vaginal canal due to prolonged exposure to its acidity. seminal vesicle via vas/ductus deferens. Storage for Note: The penis is not highly muscular. It is composed growth and maturation of sperm. more of ligaments. It will take how many days for the sperms to grow in the The ligaments being the following: Epididymis? 64 (or 2 months minimum) to 75 days. 1. Corpora Cavernosa - it is harder, more during erection. Seminal Fluid - provides the lubrication of sperm. 2. Corpus Spongiosum - in the middle and inside of it, the Structures that produce this fluid (with % of how one urethra is located. The end of it is called Glans Penis, structure produces): which is highly sensitive to stimulation. 1. Epididymis - 5% Note: Erection is due to blood rush. When the male is 2. Seminal Vesicle - 30% sexually stimulated, blood rushes to the Corpora 3. Prostate Gland - 60% (main producer of seminal fluid) Cavernosa and Corpus Spongiosum. 4. Cowper’s Gland - 5% Note: Average length of a fully erect penis is 4 to 5 Note: The vaginal canal is acidic. For the sperms to survive inches. Size matters in terms of the survival of sperm as a NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 1  NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL lengthy penis can easily reach the cervix. The ejaculation stimulates ovulation but may cause both ovaries to force can also compensate for the survival of sperm. ovulate leading to multiple ovulation. Multiple ovulation Note: The sperms must reach the uterus through the might lead to fraternal twins (dizygotic, meaning two cervix in 90 minutes, and reach the fallopian tubes in 5 separate zygotes) or multiple pregnancy (e.g. having minutes. Octuplets). Note: Penis curvature/posture is influenced by its VASECTOMY placement in the underwear or having a lengthy penis The ligation or cutting of the vas deferens to effect even if it’s flaccid. sterilization. NORMAL SPERM ANALYSIS RESULT This is permanent. It can be reversed, but it is not mL of semen /ejaculation: 3-5 mL recommended due to narrowing of the vas deferens due sperm count /mL: 20 million (minimum or at least) to 150 to scarring of the cut. million He can not impregnate, but gives no protection from STD. sperm count /ejaculation: 400 million All penile functions will remain, only a change in semen Lifespan after ejaculation in the fallopian tubes: 3-5 days characteristic can be observed as sperm can no longer / 72 hrs travel out of the epididymis. pH: 7-8 (alkaline) FEMALE REPRODUCTIVE ANATOMY Morphology: 30% (shape and size, normal or defective) Composed of two structures: Internal and External Motility: 50% (actively moving sperm) structures. Viability: 50% (survivability) EXTERNAL STRUCTURES Note: Morphology, Motility, and Viability APPEAR in the board exams. Note: SPERM MORPHOLOGY 1. Gynosperm - big-headed and long-tailed, slow-moving, higher alkaline thus more acid-resistant. 2. Androsperm - small-headed and long-tailed, fast-moving, lower alkaline thus weaker to acidity. Note: The “maraming labasan” is not more on the sperms, but more on the seminal fluid. Therefore, ejaculation is stronger because sperm is more lubricated. Note: Lesser seminal fluid leads to a stinging sensation in the male urethra because of friction. If your seminal fluid is less, considering that the #1 producer of the fluid is the PROSTATE GLAND, you must get checked as this means of Collectively this is called the vulva. having problems with the prostate gland. What do you call the space inside the Labia minora? Note: PROSTATE CANCER is the #1 common cancer VESTIBULE. among males. * Females develop Smegma in the Vestibule. This may Note: Viagra increases blood supply and libido, it must be enter the vaginal canal. used with utmost caution (or with physician’s clearance) as How many obvious openings can you see in the it also increases contractility of the heart or induces vestibule? palpitation. 1. Urethral meatus - first opening going to the urinary PROBLEMS REGARDING SPERM COUNT bladder. Oligospermia - low sperm count, sperm count is less than 2. Vaginal opening/orifice - opening going to the vaginal 20 million per mL. It is the #1 cause of male infertility, canal. meanwhile, aging for females leads to anovulation. What do you call the gland that lubricates the urethra? Criterias taken in consideration: SKENE’S GLAND. 1. Sperm count What do you call the pair of glands that lubricate the 2. Motility vaginal canal? BARTHOLIN’S GLANDS. Aspermia - No presence/absence of sperm. What do you call the area where the Labia majora and Note: CLOMID or Clomiphene Citrate is a fertility drug. In Labia minora meet? FOURCHETTE. males, it increases sperm production. In females, it NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 2  NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL What do you call the area between the fourchette and 3. Retroverted position - During pregnancy (normal). anus? PERINEUM. 4. Retroflexion position - abnormal positioning. Counterpart of LABIA to the male is SCROTUM. Note: If a non-pregnant uterus is anteflexed, it protrudes Counterpart of the VAGINA is the PENIS. towards the urinary bladder and it is called CYSTOCELE. Counterpart of the CLITORIS is the GLANS PENIS. Cystoceles experience urinary frequency and sometimes INTERNAL STRUCTURES feel pain during urination (dysuria). Note: If a non-pregnant uterus is retroflexed, the uterus protrudes to the rectal wall and it is called RECTOCELE. Rectoceles experience difficulty in defecation and sometimes pain. TAKE NOTE OF THIS BOARD EXAM QUESTION: When will the uterus assume the retroverted position? What trimester of pregnancy? ANSWER: AT THE SECOND TRIMESTER OF PREGNANCY. * If the woman is pregnant in the first trimester, her uterus is still anteverted but her uterus is already enlarging. Moreover, the uterus already compresses the urinary bladder, leading to urinary frequency. In the second trimester, the urinary frequency will be gone because of the uterus’ new positioning. Urinary frequency The female reproductive internal structures are composed will appear again on the third trimester of pregnancy of the following: The vaginal canal, the uterus, the because both the uterus and the baby are full-term sized. fallopian tubes, and the ovaries. Vaginal canal is rugated. POC = products of conception. Doderlein Bacilli - Normal flora of the vaginal canal that Note: The uterus aids in labor and delivery by promoting produces lactic acid. It keeps the vaginal canal acidic. UTERINE CONTRACTION. Uterus - Suspended between the urinary bladder in front The myometrium is the thickest layer. and the rectum at the back. (Size shown in the picture is of TAKE NOTE OF THIS BOARD EXAM QUESTION: What is the a non-pregnant uterus). site of implantation? POSSIBLE POSITIONS OF THE UTERUS: ANSWER: Up to the endometrium only, at the upper 1. Anteverted position - Slightly leaning forward (normal). uterine segment, at the upper posterior of the uterus. 2. Anteflexion position - Sharply leaning forward. * The site of implantation is the site of placental NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 3  NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL development. Uterine arteries are abundant at the back of In palpating for uterine contractions, how are you going to the uterus. place your hand on the abdomen of the laboring client? Sa paglabas ng baby, is the placenta separating itself from PUT THE SURFACE OF YOUR FINGERS UPWARD OVER THE the uterus? YES, because the placenta is superficially AREA OF THE THICK MYOMETRIUM IN THE FUNDUS. attached to the endometrium. * We do this because the surface of our fingers are more PLACENTA ACCRETA - When the placenta is attached to sensitive to sensations and the thick myometrium in the the myometrium, it becomes a part of the uterus. This can fundus is the site of strong uterine contractions. be determined when the baby is out, but the placenta shows no sign of separation minutes after. The only management for this is hysterectomy. PLACENTA PREVIA - The condition where the placenta is attached at the lower uterine segment. This obstructs the birth canal. Painless on the third trimester of pregnancy and shows a soft abdomen. The mother bleeds regardless of having no uterine contraction because the weight of the baby is compressing the placenta. Photo from the lecture video discussion of sir Vasquez. 2 GROUPS OF DRUGS THAT STIMULATE THE CONTRACTION AND PREVENT THE CONTRACTION: 1. Oxytocic - Stimulant, stimulates contraction (e.g. Syntocinon, Pitocin, Oxytocin, Methergine). 2. Tocolytic - Prevent, relieve contraction (e.g. Duvadilan, Dactil OB, Yutopar, Bricanyl or Terbutaline, Magnesium Sulfate). Syntocinon and Pitocin are given via IV incorporation. To remember easily, from TOP to BOTTOM: FunCorIsCerv. Oxytocin is given IM, one minute after the baby is out. Dividing the uterus crosswise, you will have 2 SEGMENTS: Methergine is given IM after the placenta is out. It is no The UPPER UTERINE SEGMENT and the LOWER UTERINE longer given nowadays. It is given if there is postpartum SEGMENT (the vaginal canal is excluded from the uterine atony. segment). Oxytocin stimulates rhythmic uterine contraction Where is the thickest layer of the myometrium? (contract-relax-contract-relax). The placenta can still be IN THE FUNDUS, which is in the upper uterine segment. delivered. * STRONG/POWERFUL UTERINE CONTRACTIONS originate Methergine stimulates sustained uterine contraction here, while the mild contractions originate from the lower (continuous, tuloy-tuloy). portion. TAKE NOTE OF THIS BOARD EXAM QUESTION: If the blood Why is it that strong contractions are coming from the vessels of the pregnant woman constrict, will that increase fundus? her BP? So that the fundus uterus CAN PUSH THE BABY DOWN. ANSWER: YES. If the strong uterine contractions originate from the * You have to check her BP before administering fundus, how are you going to monitor the uterine Syntocinon, Pitocin, and Oxytocin. At a BP reading of contraction? 140/90 and above, you are NOT allowed to administer the UTERINE CONTRACTIONS CAN BE MONITORED drugs. Notify the doctor. ACCORDING TO: TAKE NOTE OF THIS BOARD EXAM QUESTION: In the part 1. Interval of the mother, if Syntocinon, Pitocin, and Oxytocin cause 2. Intensity vasoconstriction, what will happen? Can that lead more to 3. Duration diuresis or water intoxication? 4. Frequency ANSWER: It will lead to WATER INTOXICATION. * To do this, you need to palpate the abdomen of the * Because of the vasoconstriction, it hampers blood pregnant woman. circulation. NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 4  NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL How will Tocolytic drugs relieve uterine contraction? They Increment - Start are categorized as SMOOTH MUSCLE RELAXANT. The Acme - Peak myometrium uterus is a smooth muscle. Decrement - End Bricanyl or Terbutaline act as smooth muscle relaxant AND Duration - Time from beginning to end (increment to BRONCHODILATOR. decrement). TAKE NOTE OF THIS BOARD EXAM QUESTION: A client is Interval - From the first or previous decrement to the next experiencing a threatened abortion. The doctor asked you inclement (decrement to increment or end to beginning). to administer ½ Amp of Terbutaline SC Stat. The client asks Frequency - From the first or previous inclement to the you why you are going to give her that. What is your next inclement (increment to increment or beginning to answer? beginning). CHOICES: A. This will relax the smooth muscles of your uterus. B. This will cause bronchodilation. C. Both A and B. D. None of the above. ANSWER: A. * The case is a THREATENED ABORTION. There are no respiratory problems mentioned, therefore, you will not include the function of Terbutaline as a bronchodilator upon answering the client. You will only answer what is pertinent to the client. If the doctor can no longer save the pregnancy, all products of conception must go out. Because if something Fallopian tubes are tubular organs. These are ciliated. remains inside, the uterus relaxes and the woman bleeds. Depth of the vaginal canal is 3-4 inches, same as the With this, what drug should you administer? OXYTOCIC length of fallopian tubes. DRUG. PARTS OF THE FALLOPIAN TUBES: * If the client is experiencing threatened abortion but the pregnancy can still be saved, administer TOCOLYTIC DRUG. If cannot be saved, OXY. If it can be saved, TOCO. ABRUPTIO PLACENTA - Premature, sudden and abrupt separation of the placenta from the uterus. This makes the abdomen board-like. If the woman experiences this, prepare TOCO (specifically Magnesium Sulfate). If a pregnant woman is experiencing preterm labor that cannot be stopped anymore, prepare OXY. What drug is contraindicated in the presence of fetal distress? OXY. At the end of the infundibulum, you have the fimbriae. * Oxytocic drugs cause vasoconstriction, there will be The narrowest is the Interstitial, middle is Isthmus, widest uteroplacental deficiency in the baby and the woman can is Ampulla. experience uteroplacental insufficiency. Hence, the more The fimbriae has an opening so that the fallopian tubes the baby experiences hypoxia that leads to distress. can catch the egg released from the ovary going to the THREE PARTS OF UTERINE CONTRACTION ampulla. Common site of fertilization is Ampulla. The most dangerous site of implantation is in the Interstitial. Lifespan of OVUM in the Ampulla: 1 to 2 days (48 hours is maximum). Fertilization is the beginning of pregnancy. Level of Estrogen increases during pregnancy, but the Photo from https://slideplayer.com/slide/14381296/. level of Progesterone increases more. NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 5  NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL Hormone of PRegnancy, PRevents contraction, and support. The most important ligament because it provides PROvides nourishment: Progesterone. stability to the uterus. Hormone that causes Palmar Erythema and Epistaxis in 4. Pelvic floor ligament - Provides lower support. pregnant women: Estrogen. TAKE NOTE OF THIS BOARD EXAM QUESTION: What Hormone that causes Poor GI motility in pregnant women: ligament allows the uterus to assume the position from Progesterone. anteverted to retroverted? Hormone that Enlarges the uterus, Encourages ANSWER: Round ligament. contraction: Estrogen. Since Estrogen encourages contraction, which is high, and Progesterone prevents contraction, which is higher, is the uterus of the pregnant woman contracting or not during pregnancy? CONTRACTING. PAINLESS. IRREGULAR. Called Braxton Hicks contractions. Note: Once fertilization occurs, the fertilized egg stays in the fallopian tubes for 3-4 days. In that span, Estrogen is increasing. Therefore, the fallopian tubes contract and its cilia propels the fertilized egg inward, and will take another 3-4 days of traveling to reach the uterine cavity and implant on the endometrium. Chadwick sign - bluish/purplish discoloration of the Note: Implantation will happen 7-10 days after vaginal mucosa. fertilization. Once implantation occurs, the more the Goodell sign - softening of the cervix thanks to Estrogen. Progesterone increases, thus preventing uterine Hegar sign - on the isthmus, softening of the lower uterine contraction. segment. How soft is a non-pregnant cervix? As soft as the tip of your nose. How is the cervix during early pregnancy? As soft as the ear lobule/earlobe. How soft is the cervix during late pregnancy? As soft as the lips. Whose labor and delivery is longer? Primigravida or Multigravida? PRIMIGRAVIDA. * DURATION OF LABOR AND DELIVERY 1. PRIMI - 12 to 16 hours average of 14 hours. 2. MULTI - 6 to 8 hours, average of 7 hours. Ovaries - Oogenesis. PAP SMEAR Papanicolaou smear. Identifies abnormal cervical cells, which must be done yearly. TIMES TO GET TESTED: 1. When a female reaches 21 years old. 2. Or 1 year after becoming sexually active. Samples for the test are gathered from the endocervical canal where the walls are swabbed. PAP SMEAR RESULTS CLASS: Class I - Absence of atypical cells (AC). LIGAMENTS OF THE UTERUS: Class II - (+) of AC but not suggestive of malignancy. 1. Broad ligament - Keeps the uterus and fallopian tubes Class III - Suggestive of malignancy. in place. Class IV - Strongly suggestive of malignancy. 2. Round ligament - Provides upper support. Class V - Conclusive of malignancy. 3. Cardinal ligament - Middle side, provides middle NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 6  NCMA217 LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY WEEK 1 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: EDGARDO III T. BALAIS I BSN 2-Y1-4 I OLFU - VAL Note: Sometimes in the board exams, there are only 4 classifications where Class V becomes Class IV. MALE - FEMALE COUNTERPARTS 1. Penis - Vagina: Organs of copulation. 2. Glans Penis - Glans Clitoris: Sites of sexual excitement. 3. Scrotum - Labia 4. Vas Deferens - Fallopian Tubes: Surgical sites of ligation. 5. Testes - Ovaries: Gonads. 6. Testosterone - Estrogen and Progesterone: Sex hormones. 7. Sperm - Ovum/Egg: Sex cells/gametes. NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 1: MALE AND FEMALE REPRODUCTIVE ANATOMY 7  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL Upper and Lower Portion of the Areola BREAST ○ The upper portion of the areola is much more visible compared to the lower portion of the The female breast is also known as the mammary gland. areola. Mammary gland - milk production ○ This is because the lower lip and the tongue are BREAST ANATOMY on the lower areola. The tongue covers entirely PROLACTIN the lower areola. Stimulates the breast to produce milk. ○ The upper lip is only up to the top portion of the Secreted by the anterior pituitary gland. nipple. This is because of the principle of OXYTOCIN breastfeeding that the chin of the baby must touch the lower portion of the breast. Causes the let-down reflex of the breast. ○ This results in the tongue covering the entire Secreted by the posterior pituitary gland. lower areola and the upper lip only partially COOPER’S LIGAMENT covering the upper areola, consequently The ligament that lifts the weight of the breast. squeezing the areola when the baby sucks Also keeps the firmness of the breast. during breastfeeding, making the flow of the The moment you get pregnant and start feeding your milk strong. baby, it will result in the sagging of the breast. ○ You need to wear a support bra after breastfeeding your baby. During breastfeeding, the chin of the baby must touch the breast of the mother to avoid stretching of the cooper’s ligament. Do not be too lazy to carry the head of the baby during breastfeeding! This will result in sagging of the breast. LOBES OF THE BREAST Site of milk production, which is where the acinar cells can be found. MAMMARY GLANDS AND MILK EJECTION REFLEX ACINAR/ACINI CELLS Cells found inside the lobes of the breast responsible for milk production. LACTIFEROUS DUCTS Connected to the lobes of the breast. AMPULLA/LACTIFEROUS SINUSES Found at the end of the lactiferous duct, which is connected to the nipple opening. Most are located under the areola. Each breast consists of 15-20 lobes. PATHWAY OF THE PRODUCED MILK INSIDE THE BREAST Each lobe has acini cells. 1. Production of milk happens inside the lobes of the breast How will the mother produce the milk? because of the acinar cells. ○ At the end of the pregnancy, the anterior 2. Once the milk is produced and released, it will flow pituitary gland becomes active and releases through the lactiferous ducts. prolactin. 3. Unreleased breast milk that passes through the lactiferous ○ Once the prolactin is produced, the acinar cells duct will be stored in the ampulla. will become active, and they begin to produce 4. The milk will then be released once the baby sucks the the milk. areola of the mother during breastfeeding. ○ Once the baby is delivered, the baby will begin For proper latching, the baby must suck both the sucking the nipple of the mother. areola and the nipple. NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 1  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL ○ The sucking action will stimulate the posterior pituitary gland to release oxytocin. ○ The release of oxytocin will stimulate the milk gland cells to contract. ○ During contraction, the milk will flow through the lactiferous duct, which will then be stored in the lactiferous sinuses/ampulla. ○ Therefore, the milk is now expressed in the nipple. When the newborn baby sucks the nipple of the mother, there will be a release of oxytocin. What is the advantage the mother gets when she is breastfeeding? ○ There will be uterine contraction. This will promote the start of involution. This prevents postpartum bleeding. This will also prevent the formation of blood clots. BOUNDARIES OF THE TRUE PELVIS ○ Kapag nag-cocontract, lumalabas ang lochia. Lumalabas ang blood, lalabas din ang lochia Anterior Posterior Lateral therefore, walang blood clot formation. Ano ang problema kapag nagka-blood clot formation? Inlet Superior Sacral Ilium Pubis Prominence ○ Pasalamat ka kapag may lumabas sa vagina na discharge within 2-3 days. Cavity _ _ _ ○ Kapag lumampas na ang 3 days na wala lumalabas na discharge, this will lead to Outlet Inferior Pubis Coccyx Ischial Spines infection. Superior Pubis SELF BREAST EXAMINATION ○ Buto na nasa ibabaw ng symphisis pubis. Kailan ginagawa ang self breast examination? ○ Bounds the inlet anteriorly. ○ You conduct self breast examination after Inferior Pubis menstruation (5-7 days). Para hindi ganun ○ Buto na nasa ilalim ng symphisis pubis. kasakit. ○ The anterior boundary of the outlet. PELVIS Sacral Prominence ○ Prominent bone inside the cavity. Supports and protects the reproductive and other pelvis ○ Bounds the inlet posteriorly. organs. Ilium The reproductive organs can be found in the pelvic cavity. ○ Magkabilang buto sa gilid. ○ Bounds the inlet transversely. Coccyx ○ Buto sa dulo ng sacrum. ○ Posterior boundary ng outlet. Ischial Spines ○ Dalawang sungay sa likod ng acetabulum. ○ Tagalog: Sipit-sipitan Dito naiipit yung presenting part (head, buttocks, shoulder) ng baby TWO DIVISIONS ○ Kapag naipit ang ulo ng baby between the ischial spines, ano ang condition ni baby? TRUE PELVIS Engaged/Engagement - When your Inlet - yung lining ng butas baby's head moves into your pelvis in Cavity - yung pinakabutas preparation for birth. Outlet - sa may bandang baba Acetabulum ○ Located sa ibabaw ng ischial tuberosity. This serves as the birth canal. FALSE PELVIS NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 2  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL Which supports the growing uterus? ○ Masyadong narrow ang anterior-posterior ○ False Pelvis - ang size ng non-pregnant uterus ay (AP)diameter 3 inches long, 2 inches wide at 1 inch thick. What are the two types of pelvis that can support The uterus enlarges because of the pregnancy, labor, and delivery? hormone estrogen. ○ GYNECOID and ANTHROPOID Habang lumalaki ang uterus during DIAMETER OF THE PELVIS pregnancy, ang sumasalo sa kanya ay ang ilium which is a part of the false Anterior-Posterior Transverse Oblique pelvis. Inlet 11 cm 13 cm 12 cm Cavity 12 cm 12 cm 12 cm Outlet 13 cm 11 cm 12 cm What part of the pelvis guides the baby toward the birth canal? ○ False Pelvis - kasi ang false pelvis ay parang funnel. When the upper part of the fundus is contracting, the fundus is pushing the baby down. Tandaan palagi yung pinakamalaki at pinakamaliit. The false pelvis acts as a funnel. It ○ Inlet - pinakamalaking diamter yung tranverse guides the baby towards the true (13 cm) then pinakamaliit yung pelvis. anterior-posterior (11 cm). Ang true pelvis ay ang birth canal. ○ Outlet (baliktad lang) - pinakamalaking Mula sa inlet pataas, yung ang ilium, which is the false diameter yung anterior-posterior (13 cm) then pelvis. pinakamaliit yung transverse (11 cm). 4 TYPES OF PELVIS ○ Cavity - 12 cm lahat ng diameter. ○ Oblique - 12 cm lahat ng parts ng true pelvis. Kapag i-draw-drawing, iba-iba ang shapes ng mga parts kasi magkakaiba ang sukat nila. Gynecoid ○ True female pelvis ○ Well rounded Android ○ True male pelvis ○ Heart-shaped and triangular Anthropoid Since varied ang shapes ng mga parte ng true pelvis ○ Oblong because of their different diameters, is there a need for Platypelloid the fetus to rotate while passing the birth canal? ○ Flat pelvis ○ Yes. The head is trying to look for an area where it will fit. NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 3  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL What do you call that rotation of the baby while passing Diamond - Anterior Fontanelle the birth canal? ➔ Bigger ○ The 6 Mechanisms of Labor and Delivery ➔ Will take 12-18 months to (D-FIRE-ERE) close Descent ➔ Formed because of the Flexion frontal bones and parietal Internal Rotation bones Extension ➔ Sutures: frontal, coronal, External Rotation/Restitution sagittal Expulsion Triangle - Posterior Fontanelle FETAL SKULL-PELVIS RELATIONSHIP ➔ Smaller ➔ Will close first after delivery The fetal skull is the most important part because: ➔ Will take 2-3 months to close ○ Most frequent presenting part ➔ Formed because of the Kasi ang pinaka-common na presentation ay cephalic. occipital bone and parietal bones The most frequent presenting part is the head. ➔ Sutures: sagittal and lamboidal ○ Largest part of the fetal body ○ Least compressible Hindi mo siya mapapaliit nang husto, hindi kagaya ng buttocks. Ang fetal skull ay magkakaroon lamang ng some degree of molding. REGIONS OF THE FETAL SKULL Face ○ Biggest Brow/Sinciput FETAL SKULL ○ Big THREE MAIN BONES Vertex ○ Small Frontal Bones (2) Occiput Parietal Bones (2) ○ Smallest Occipital Bone (1) FOUR SUTURES If you fuse the bones together, ang mafo-form mo ay joint. Ano ang tawag sa cranial joint? ○ Suture 4 Sutures of the Fetal Skill ○ Frontal Suture - bet. 2 frontal ○ Coronal Suture - bet. 2 frontal and parietal ○ Sagittal Suture - bet. 2 parietal ○ Lamboidal Suture - bet 2. parietal and 1 occipital What regions of the fetal skull should enter the first inlet TWO FONTANELLES and goes out of the outlet first? If you connect the different sutures, anong shape ang ○ To fit, the most ideal is the vertex (small) and the nabuo? occiput (smallest) ○ Diamond and Triangle ○ Ang tawag diyan ay fontanelle. NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 4  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL It doesn’t mean to say that if the baby is in cephalic FETAL LIE presentation, labor and delivery will be normal. It depends Relationship of the long axis of the uterus and the long on the presenting part (the specific region of the fetal skull axis of the fetus. that will go out/present first). ○ Two regions best to be presented first: vertex and occiput. Subocciput Bregmatic (SOB) ○ If the presenting part is the occiput. ○ The most common diameter presented. ○ 9.5 cm ○ Will fit in the inlet, cavity, and outlet: Because of the diameter of the inlet (11 cm), cavity (12 cm), Longitudinal - axis of the uterus and the baby is parallel and outlet (13 cm). ○ Cephalic Mento-Vertical Diameter (MVD) ○ Breech ○ If the presenting part is the face. Mas appropriate na terminology na ginagamit sa labor ○ For the face, our landmark in the chin. room during communication ang fetal presentation kasi Mento = mental (chin) mas accurate ito kaysa sa fetal lie. ○ 13.5 cm - will not fit in the true pelvis ○ Kapag fetal lie kasi tas longitudinal, it can pertain ATTITUDES OF THE FETAL SKULL to two, which are cephalic and breech. How can we be able to get the face as the presenting FETAL STATIONS part? Or how can we get the occiput to be the presenting part? ○ It depends on the attitudes. It is the degree of flexion and extension of the fetal head. What is the presenting part if the head is… ○ Hyper-extend: Face ○ Partially Extended: Brow/Sinciput ○ Partially Flexed: Vertex ○ Fully Flexed: Occiput If the presenting part is the face, and deeply engaged (sad-sad sa inlet at may uterine contraction), how will the doctor? ○ CS/C-Section/Cesarean Section ○ Kapag pinilit parin sa normal delivery, If the head or the presenting part is along the ischial magkakaroon ng cervical fracture. spines, the station is 0. The station 0 is the start of FETAL PRESENTATIONS engagement. Cephalic If the head is located above the station 0, the station is ○ Most ideal negative. Therefore, the head is not engaged. ○ It does not mean to say that if the baby is in this If the head goes down below station 0, the station is presentation, the baby is delivered normally. It positive. Therefore, the head is engaged. depends on the presenting part. Rule: 1 station = 1cm Breech ○ The baby is in the -2 station. The presenting part Transverse is located 2 cm above the ischial spine. ○ The baby is in the +3 station. The presenting part is located 3 cm below the ischial spine. The head is located 2 cm above the ischial spine (-2 station), and the cervix is 5 cm dilated and fully effaced. Additionally, the bag is ruptured. What possible problem/complication is expected to happen? ○ Umbilical Cord Prolapse NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 5  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL If the head of the baby is 2 cm above FETAL POSITION the ischial spine, the head is not Fetal Position engaged. Thus, there is a presence of ○ The relationship of the maternal pelvic quadrant space between the head and the to the fetal landmark. ischial spine. The cervix is dilated, and the bag of Occiput = ulo water is ruptured. When the bag of Mento = chin/face water is ruptured, the umbilical cord Sacro = buttock can go with the amniotic fluid. Umbilical Cord Prolapse happens when the umbilical cord slips down in front of the baby after the waters have broken. If the mother is experiencing cord prolapse, what are the DONTs in cord prolapse? ○ Do not expose the cord to room air. Do not allow the cord to dry. How are you going to prevent the cord from drying out? ➔ Wet OS = sterile gauze with 1. Occiput Anterior (OA) NSS 2. Occiput Posterior (OP) ○ Do not allow the cord to go out further. 3. Right Occiput Posterior (ROP) ○ Do not put back the cord. Do not re-insert. 4. Right Occiput Anterior (ROA) Why? 5. Right Occiput Transverse (ROT) ➔ The cord is already exposed. 6. Left Occiput Posterior (LOP) Hence, it is contaminated. It 7. Left Occiput Anterior (LOA) can lead to infection (later 8. Left Occiput Transverse (LOT) problem). 9. Mento Anterior (MA) ➔ Pushing the cord back can 10. Mento Posterior (MP) allow it to kink. It will result 11. Right Mento Posterior (RMP) in a low oxygen supply for 12. Right Mento Anterior (RMA) the baby. It can also result in 13. Right Mento Transverse (RMT) possible fetal distress 14. Left Mento Posterior (LMP) (immediate problem). 15. Left Mento Antetior (LMA) What is the position to prevent the cord from going out 16. Left Mento Transverse (LMT) further during cord prolapse? 17. Sacro Anterior (SA) ○ Knee-chest/Genupectoral Position 18. Sacro Posterior (SP) ○ Dorsal Recumbent Position (w/ pillow under the 19. Right Sacro Posterior (RSP) buttocks) 20. Right Sacro Anterior (RSA) ○ Trendelenburg Position 21. Right Sacro Transverse (RST) NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 6  NCMA217 LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: CHARLZ YUNEL ELLIAZ EMIL M. DILLENA, SN I BSN 2-Y1-4 I OLFU - VAL 22. Left Sacro Posterior (LSP) Therefore, if the baby is in the Left 23. Left Sacro Anterior (LSA) Occiput Anterior Position, you 24. Left Sacro Transverse (LST) auscultate at the Left Lower Quadrant. ○ Right Occiput Anterior (ROP) More back pain and prone to laceration: LOP, ROP, OP Look at the middle letter (O - cephalic) Ideal position: LOA, ROA, OA Kapag cephalic, sa lower quadrant ang pag-auscultate. Kapag nag-aauscultate ng baby ay sa back. Since the occiput is already at the back, just bring down “R.” Therefore, if the baby is in the Right Occiput Posterior Position, you auscultate at the Right Lower Quadrant. ○ Occiput Anterior (OA) Look at the middle letter (O - cephalic) Kapag cephalic, sa lower quadrant ang pag-auscultate. Walang left or walang right, so nasa mid (M). Therefore, if the baby is in the Occiput Anterior, you auscultate at the Mid-lower Quadrant (gitna ng abdomen sa baba). ○ Left Mento Posterior (LMP) Look at the middle letter (M - cephalic) Kapag cephalic, sa lower quadrant ang pag-auscultate. The mentum is in the chest, but you need to auscultate at the back which is at the opposite of “L” = “R” Therefore, if the baby is in the Left Mento Posterior, you auscultate ay the Right Lower Quadrant. REMEMBER: Kapag M, i-opposite yung given side. Kapag O, kopyahin lang yung given side. ○ Left Sacro Anterior (LSA) Look at the middle letter (S - breech) Kapag breech, sa upper quadrant ang AUSCULTATION SITE FOR FETAL HEART pag-auscultate. TECHNIQUE Kapag nag-aauscultate ng baby ay sa ○ Left Occiput Anterior (LOA) back. Since the sacro is already at the Look at the middle letter (O - cephalic) back, just bring down “L.” Kapag cephalic, sa lower quadrant ang Therefore, if the baby is in the Left pag-auscultate. Sacro Anterior Position, you Kapag nag-aauscultate ng baby ay sa auscultate at the Left Upper back. Since the occiput is already at Quadrant. the back, just bring down “L.” NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.1: BREAST, PELVIS, AND FETAL SKULL 7  NCMA217 LESSON 2.2: MENSTRUATION WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y1-4 I OLFU - VAL 2nd half of the cycle. MENSTRUATION Dominated by the hormones progesterone Monthly periodic, cyclic discharge of blood coming from DAY OF OVULATION the uterus because the uterus is the organ of The day of ovulation is based on the cycle menstruation. LENGTH OF THE CYCLE Normal blood loss: 30-80cc The length of the cycle affects the day of ovulation 60cc is equivalent to ¼ cup WHEN WILL OVULATION OCCUR? Iron loss: 12-29 mg/less than 30mg Iron loss during normal menstrual period: less than 30mg. For the nurse to accurately determine the ovulation, she/he must deduct 2 weeks from end of the cycle MENSTRUATION PERIOD VS. MENSTRUAL CYCLE Adding 14 days from beginning of the cycle is only MENSTRUAL PERIOD applicable if the cycle is only 28 days Days of the woman is menstruating Ovulation will happen 2 weeks before the menstruation Usual length of period is 3-5 days; maximum of 7 days. PAANO MO MASASABI KUNG ANG CYCLE NG BABAE AY REGULAR MENSTRUAL PERIOD OR IRREGULAR? Starts from the first day of the period to the first of the The length of the cycle is constant in 6 months next period of the next cycle. The number of days of your cycle is consistent Average menstrual cycle is 28 days/cycle. NO. 1 CRITERIA OR QUESTION THAT YOU’RE GOING TO ASK YOUR Normal range: 23-35; maximum of 40 CLIENT ABOUT STANDARD DAYS METHOD WHETHER HE IS The menarche usually occurs during the stage of puberty IRREGULAR OR REGULAR Puberty starts at 9 and ends with 17. If the client is irregular, ask the client how long is her Usually, nagme-menarche ang babae at the average of 12 cycle? years old. How to compute the fertile window? DO NOT FORGET!! ○ From the day of ovulation, you deduct 5 days, ○ Menarche is not the first sign of female from the day of ovulation you add 3 days secondary sex development Kailan safe ang client makipagtalik? Outside the fertile THELARCHE - breast development window. Nauuna ang accelerated linear growth kaysa thelarche DOES THE CLIENT OVULATING ON DAY 9? ACCELERATED LINEAR GROWTH - known as growth spurt. Followed by broadening of the hips EXAMPLE: ○ UNA SA BABAE; M—-------------------------O—------------------------M Increase in height 1-7 14 28 Broadening of the hips (day of menstruation) DAY 9-17 (day of next cycle) TAMO (thelarche, adrenarche, (fertile window) menarche, and ovulation) NO ADRENARCHE - appearance of pubic hair, axillary hair The ovulation of the client is on 14 MENARCHE - onset of menstruation Day 9 is 5 days before ovulation and day 17 is three days OVULATION after ovulation Ovulation is only one day WHEN WILL THE WOMAN OVULATE? The 5 days is the life span of the sperm while the +3 is the The woman ovulates in the middle of the cycle. lifespan of the egg Deduct 14 on the next period of the next cycle. The minus DIFFERENT GLANDS THAT CONTROL MENSTRUAL CYCLE 14 is constant If the woman cycle is 32 days, the woman will ovulate in Structural and hormonal control of the menstrual cycle 18 days. FOUR STRUCTURES THAT CONTROL MENSTRUAL CYCLE FROM MENSTRUAL TO OVULATION Hypothalamus The 1st half of the cycle. Anterior pituitary gland Dominated by the hormones estrogen ovaries The number of days of period may be different. Uterus OVULATION TO MENSTRUATION WHAT GLAND STARTS THE MENSTRUAL CYCLE? NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.2: MENSTRUATION 1  NCMA217 LESSON 2.2: MENSTRUATION WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y1-4 I OLFU - VAL Hypothalamus myometrium that will cause proliferation of the Hypothalamus stimulates the anterior pituitary gland myometrial tissues and endometrial tissues. APG stimulates ovaries GRAAFIAN FOLLICLE Ovaries affect the uterus Is a follicle that contains high HYPOTHALAMUS levels of estrogen and you can find the maturing egg Is a gland therefore collectively producing GNRH (gonadotropin-releasing hormones) cells in the graafian follicle. ○ TWO TYPES OF GNRH: IF THERE IS THICKENING, IS THE UTERUS SLIGHTLY ENLARGING? FSHRF (follicle stimulating hormone releasing factor) ○ YES DO WE NEED ESTROGEN DURING PREGNANCY? LHRF (luteinizing hormone releasing factor) ○ Yes because we need the uterus to enlarge to accommodate the growing baby ANTERIOR PITUITARY GLAND HOW WILL THE OVARIES STOP PRODUCING ESTROGEN Producing FSH (follicle stimulating hormone) and LH SO THAT IT CAN START PRODUCING PROGESTERONE? (luteinizing hormone) ○ Feedback mechanism will happen; graafian OVARIES follicle have high estrogen and it will give Producing estrogen and progesterone feedback effect mechanism to anterior pituitary FOUR DATES OF THE MENSTRUAL CYCLE gland; once the FSH production inhibit, the ovary won’t produce estrogen anymore and by 3rd day of the menstrual cycle that time, on the 13th day, progesterone will be ○ What happened to the woman during the 3rd the lowest day? She is menstruating ○ The level of estrogen is low 2ND HALF 13th day of the menstrual cycle 13th - low progesterone ○ The level of estrogen is high Low level of progesterone will stimulate the hypothalamus 13th day of the menstrual cycle Hypothalamus will release LHRF, stimulating the APG to ○ The level of progesterone is low release LH; LH will stimulate the ovary to release the 14th day of the menstrual cycle progesterone and progesterone will stimulate the uterus ○ The level of progesterone is high Once the LH will go higher, it will cause the ovulation REMEMBER!!! LH will stimulate the ovary then the ovary will produce ○ 3rd, 13th, 13th, 14th; low, high, low, high; progesterone. Progesterone will convert the graafian estrogen, progesterone follicle into corpus luteum. The lifespan of corpus luteum 1ST HALF is 14 days or 2 weeks Progesterone will affect the uterus then the uterus will 3rd - low estrogen undergo increased vascularity of the endometrium. The Low level of estrogen on the 3rd day of the cycle will blood supply will be high, the oxygen is high, water supply stimulate the hypothalamus to start the cycle. is high and the amino acid will also be high. HOW? ○ INCREASE VASCULARITY - dadami and ○ Hypothalamus will release FSHRF, stimulating temporary capillary sa endometrium. the APG to release the FSH; FSH will stimulates DID THE PROGESTERONE MAKE THE ENDOMETRIUM the ovaries to release the estrogen and estrogen HIGHLY NOURISHED OR POORLY NOURISHED? will affect the uterus ○ Highly nourished EFFECT: WHAT HORMONE PROVIDE NOURISHMENT TO THE BABY ○ Once FSH is released, it will cause the DURING PREGNANCY? maturation of the egg cell or ovum. Second ○ Progesterone effect of FSH, once FSH stimulates the ovary, the ovary wil produce estrogen; estrogen will convert the follicle into GF (graafian follicle); estrogen will affect the uterus therefore there will be thickening of endometrium and 2 THING WILL HAPPEN ONCE THE MOTHER WILL OVULATE Normally she will menstruate NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.2: MENSTRUATION 2  NCMA217 LESSON 2.2: MENSTRUATION WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y1-4 I OLFU - VAL ○ The reason why she’s menstruating: she did not REMEMBER!! get pregnant ○ FEG HAOU LPC She will not menstruate H ○ No. 1 cause if she’s not menstruating: she may F A L be pregnant E O P BAKIT BA NAGU-UNDERGO NG MENSTRUAL CYCLE G U C BUWAN-BUWAN? STRUCTURES: You are undergoing the menstrual cycle monthly because ○ HAOU GC (hypothalamus, anterior pituitary your uterus is being prepared for pregnancy every month. gland, ovaries, uterus, graafian follicle, and corpus luteum) The reason why you are menstruating is because you are not getting pregnant. HORMONES: ○ LP FE (luteinizing hormone, progesterone, DURING POSITIVE FERTILIZATION, DO WE NEED ESTROGEN ON follicle stimulating hormone, and estrogen) THE BEGINNING OF PREGNANCY? FAMILY PLANNING YES Progesterone also needed Use of range of methods to fertility regulation in order to: Corpus luteum life will extend up to 2 months ○ Avoid unwanted pregnancy After 2 months, lalabas ang placenta (endorsement time) ○ Bring unwanted births/pregnancy ○ Regulate the number of children born WHAT STRUCTURES MAINTAIN ON THE EARLY MONTHS OF ○ Regulate intervals between pregnancies/birth PREGNANCY? spacing Corpus luteum ○ Control time at which birth occurs WHAT IS THE NO. 1 HORMONE PRODUCED BY THE PLACENTA? 2 COMPONENTS Progesterone Planning pregnancy ○ Preventing uterine contraction, providing Preventing pregnancy nourishment to the baby PLANNING THE PREGNANCY Placenta only last longer up to 9 months of pregnancy After 9 months, the placenta begins one of theories of Proper nutrition and exercise labor: placental aging theory/placental degeneration ○ Vitamin she must be able to take during theory pregnancy to prevent spina bifida: amino acid ○ Recommended amount of folic acid intake IF THE PLACENTA IS AGING, WHAT WILL HAPPEN TO THE ABILITY during pregnancy: 400mcg OF PLACENTA TO PRODUCE PROGESTERONE? Lifestyle changes: The level of progesterone will go low that is preventing ○ REMEMBER!! contraction which may cause no more hormone Smoking can cause SGA baby preventing contractions Alcohol can cause cognitive You’ll start to have increased uterine contraction. impaired-baby Your braxton hicks which is painless and irregular will start Medical history taking and check up is important being regular and painful and then eventually you will Genetic counseling undergo labor and delivery. PREVENTING PREGNANCY TWO THEORIES OF LABOR Contraceptive methods are used Placental aging theory Always remember that there is always a possibility for the Progesterone deprivation theory method of contraception to fail thus pregnancy may occur PAANO NAMAN MAGRE-REGLA? METHODS OF CONTRACEPTION If there is no fertilization, the life of corpus luteum will not NATURAL extend because there is no pregnancy to support ○ SDM/calendar In 2 weeks, the corpus luteum will degenerate ○ CMT / Billings Test / Creighton’s Method / Estrogen will go down first, next is the progesterone. Spinnbarkeit Method The uterus will contract and the temporary capillaries will ○ Basal body temp rupture and the lining of temporary endometrium will ○ abstinence slack off giving menstrual discharge. ○ 2-day method NCMA217: CARE OF THE MOTHER, CHILD, AND ADOLESCENT LESSON 2.2: MENSTRUATION 3  NCMA217 LESSON 2.2: MENSTRUATION WEEK 2 I SECOND YEAR, FIRST SEMESTER - PRELIMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS PPT and Discussed by: PROF. FRANCIS A. VASQUEZ, MAN, RN Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y1-4 I OLFU - VAL ○ Lactational amenorrhea method/LAM Loss of self control - difficult ○ Symptothermal method to maintain ARTIFICIAL ○ STRICT ABSTINENCE ○ Barrier, chemical, hormonal, surgical No any form of sexual contact NATURAL METHOD LAM Abstinence ○ Use of this method requires regular and full time breastfeeding Lactation amenorrhea method (LAM) Coitus interruptus (withdrawal) ○ Effective during the first 6 months post partum Fertility awareness method (FAM) ○ No ovulation and no menstruation ○ Calendar method, cervical mucus test ○ Not effective after 6 months ○ After 6 months, woman may ovulate but ○ Basal body temperature test and symptothermal method without menstruation 2-day method ○ How will LAM prevent pregnancy? If the woman is breastfeeding the BARRIER METHOD baby, the level of estrogen will remain condom - male and female high; hypothalamus will not produce Cervical cap FSHRF, APG will not produce FSH, no Diaphragm egg cells will mature, therefore no IUD-intrauterine device ovum will be release during ovulation HORMONAL METHODS ○ Is it okay for a post partum woman who is using Oral pills - combined oral contraceptives (COCP), progestin the LAM to take pills? only pill (POP) or mini pill Yes ○ COCP - estrogen and progesterone ○ What pills? ○ POP - progesterone COCP and POP Injectable - depo provera and lunelle ○ What hormone is contraindicated in ○ Progesterone base breastfeeding? Patch - ortho evra Estrogen ○ Progesterone base Implants - norplant and implanon ○ Progesterone base —----------------------------- TO BE CONTINUED—----------------------------- Vaginal ring ○ Estrogen base STERILIZAT