REPRODUCTIVE-DEVELOPMENT.pdf

NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT REPRODUCTIVE DEVELOPMENT REPRODUCTIVE ORGANS Main Functions: o Produce sex gametes o Transport gametes FEMALE (XX) MALE (XY) GAMETO...

NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT REPRODUCTIVE DEVELOPMENT REPRODUCTIVE ORGANS Main Functions: o Produce sex gametes o Transport gametes FEMALE (XX) MALE (XY) GAMETOGENESIS Occurs by Meiosis rather than mitosis Results in four daughter cells rather than two Reduces chromosome number by one-half PRIMARY SEX ORGANS ❖ MALE: FEMALE: SECONDARY SEX ORGANS ❖ MALE: FEMALE: NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT SECONDARY SEX CHARACTERISTICS A. Intrauterine and Extra uterine Development B. Physiology of Puberty Tanner’s Stages of Development Reproductive Cycle of the Female - Anatomy and physiology of the male Stages of Sexual Response and female reproductive systems REPRODUCTIVE ORGANS A. INTRAUTERINE DEVELOPMENT Establishment of genotypic and phenotypic sex HIGHLIGHTS: Fertilization 5 weeks 8 weeks 10 weeks 12 weeks 24 weeks 34 – 38 wks 38 – 42 wks NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT B. EXTRAUTERINE DEVELOPMENT o Birth to puberty o HIGHLIGHTS: ▪ Birth – Prepubertal age ▪ Puberty C. PHYSIOLOGY OF PUBERTY D. TANNER’S STAGES OF DEVELOPMENT MALE FEMALE NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT MALE REPRODUCTIVE SYSTEM I. EXTERNAL STRUCTURE 1. SCRUTUM a ruggaeted pouch hanging below the pendulous penis, with a medial septum dividing into two sacs, each of which contains a testes; cooling mechanism of testes; The parietal layer has the function of covering the inner aspect of the scrotal wall and the visceral layer coats the testis and epididymis. Functions: supports testis, regulates temp 2. PENIS Male organ of copulation and urination. II. INTERNAL STRUCTURES 1. TESTES 2 ovoid glands formed in the pelvic cavity Seminiferous tubules – convoluted, where sperm production occurs, surrounded by blood and lymph vessels LEYDIG”s cell – produces testosterone SERTOLLI’s cell – nourishes and protects spermatocytes RETE Testis – thin walled spaces that forms 10 – 15 efferent ducts that empty to the epididymis 2. EPIDIDYMIS 5 – 6 m long, produces 5% seminal fluid, 2 – 10 day stay before sperm is released Takes 12 – 20 days for sperm to travel out FUNCTION: provides a reservoir for maturing sperm NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT 3. VANS DEFERENS/DUCTUS DEFERENS 40 cms long, joins spermatic cord until it meets FUNCTION: rapidly squeezes sperm from storage opposite V. deferens site Expands to form terminal ampulla Site of sterilization Unites w/ seminal vesicle to form the EJACULATORY DUCT 4. SEMINAL VESICLES Secretes alkaline liquid composed of PGE, amino acids, fibrinogen and FRUCTOSE – energy source FUNCTION: produces 30% of total seminal fluid 5. PROSTATE Chestnut size, below the bladder, secretes 60% of alkaline fluid composed of Zinc, Ca, citric acid, acid phosphatase FUNCTION: fluids produced protects sperm from being immobilized 6. BULBOURETHRAL GLANDS/ COWPER’S GLANDS Secretes 5% seminal fluid that contains MUCOPROTEINS FUNCTION: ensures safe sperm passage by counteracting acid secretion of urethra. 7. URETHRA 6 – 8 inches long hollow tube lined w/mucous membrane FUNCTION: transports urine and semen, serves as exit point SPERM 1. HEAD 2. MIDSECTION 3. TAIL Produced in billions by the testes through the life cycle Composed of 2 principal components: Move at a velocity of approximately 1 – 4 mm / min through the female genital tract Primary spermatocyte divides by meiosis to form secondary spermatocytes (matures into sperm cell/spermatozoa). PHYSIOLOGY OF MALE SYSTEM 1. Sperm Analysis One of the first tests done to determine male infertility Sterile if less than 20 million sperm per ml 2. Erection Controlled by the parasympathetic nervous system Nitric oxide causes the smooth muscles to relax and the blood vessels to dilate 3. Ejaculation Controlled by the sympathetic nervous system Also called climax or orgasm SPERM COUNT: SPERM MORPHOLOGY: SPERM CONCENTRATION: PROGRESSIVE MOTILITY: NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT HORMONAL CONTROL FEMALE REPRODUCTIVE SYSTEM I. EXTERNAL PUDENDA /VULVA 1. MONS VENERIS/PUBIS Pad of adipose tissues over the symphysis pubis, covered with pubic hair FUNCTION: protects the pubic bone from trauma 2. LABIA MAJUS Made of adipose tissue, covered by connective tissues, grows hair, called the outer lip, extends from the symphysis pubis to the perineum FUNCTION: protection of the external genitalia 3. LABIA MINUS Hairless connective tissue at external surface, mucous membrane covering at internal surface, also w/ sebaceous glands FUNCTION: houses the vestibule NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT 4. CLITORAL Head Homologous to penis, located at the upper portion b/n labia minora and majora, sensitive due to the stimulation of the ISCHIOCAVERNOUS muscle surrounding it. The primary site of sexual arousal. 5. Urethral meatus Small opening of the urethra located between the clitoris and the vaginal orifice for the purpose of urination. 6. Skene’s glands Small mucus-secreting glands that open into the posterior wall of the urinary meatus and lubricate the vagina. 7. Hymen A membranous tissue ringing the vaginal introitus. II. PUDENDA /VULVA 8. FOURCHETTE Lower portion b/n minora and majora 9. PERINEUM The area of tissue between the anus and vagina 10. Vestibule Boat like depression middle of labia, contains vaginal opening, urethral meatus, skene’s glands or paraurethral glands and Bartholin’s glands or paravaginal glands 11. BARTHOLIN’S GLANDS Mucus-secreting glands located on either side of the vaginal orifice. III. BREAST Breasts/ mammary glands – supported by Cooper’s ligaments, contains 20 lobules – milk glands divided by connective tissues, empty externally via the lactiferous duct ACINAR cells – in each lobule produces milk Nipple – w/ 20 openings, surrounded by areola Montgomery’s tubercles – sebaceous glands causing roughness in the areola Blood supply – thoracic branches of the axillary artery and intercostal artery The Female Internal Reproductive Structures NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT A. VAGINA female organ of copulation; passageway of menstruation & fetus 3 – 4inches or 8 – 10 cm long, dilated canal Rugae – permits stretching without tearing B. UTERUS Organ of menstruation, is a hollow, thick-walled muscular organ. It varies in size, shape and weight Size: 1x2x3, 6-8 cms long, WEIGHT: NONPREGNANT 40-70 g; PREGNANT - 1,000 g Shape: nonpregnant—pear shaped; pregnant—ovoid shaped Divisions: **Three layers: a. Cervix 1. Perimetrium (outer layer) b. Corpus 2. Myometrium (middle layer) c. Fundus 3. Endometrium (inner layer) SEGMENTS OF THE UTERUS CERVIX Lowest portion connecting to vagina, 2 – 5 cms long, 1/3 total uterine size, alkalinic environment, contains mucus secreting glands that works as lubricant, bacteriostat, alkalizing agent o INTERNAL OS – junction of cervix and isthmus o EXTERNAL OS – opening to the vagina, basis for level of ischial spines ISTHMUS portion b/n internal os and corpus, 6mm above the internal os, joins corpus to cervix, becomes the lower uterine segment during pregnancy, site for LSCS FUNDUS – uppermost part of the uterus, palpable abdominally during pregnancy CORPUS – point of insertion of fallopian tubes, shortens during advances pregnancy and labor C. UTERINE LIGAMENTS 1. Upper segment: BROAD l – keeps uterus centrally placed, provides stability w/in pelvic cavity ROUND l – arise from sides of the uterus. During labor, steadies uterus, pulling downward and forward so fetal presenting part is moved to cervix 2. Middle segment CARDINAL/ McKENRODT’S/ TRANSVERSE l – suspends uterus, arise from sides of pelvic walls, prevents uterine prolapse UTEROSACRAL l – contains sensory fibers that cause dysmennorhea PUBOCERVICAL l - 3. Lower Segment PUBOCOCCYGEAL l, ILIOCOCCYGEAL , PUBOCERVICAL, PUBOVAGINALIS – all support muscular floor Blood supply – uterine and azygous artery ⚬ Nerve supply : T5 – T10 – efferent nerves, T11 – T12 – afferent nerves D. FALLOPIAN TUBES 2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the ampulla to the uterus. 4 SIGNIFICANT SEGMENTS 1. Infundibulum – distal part of FT, trumpet or funnel shaped, swollen at ovulation 2. Ampulla – outer 3rd or 2nd half; site of fertilization 3. Isthmus – site of sterilization or tubal ligation 4. Interstitial – site of ectopic pregnancy (most dangerous E. OVARIES 2 female sex gonads, almond shaped, 6 – 10 gms each, located below the pelvic brim No peritoneal covering thus eruption and easy spread of cancer cells FUNCTIONS: Ovulation, Production of hormones – Estrogen that maintains secondary sex char and PROGESTERONE which increases uterine vegetation LAYERS: tunica albuginea – outermost cortex – contains ova, follicle medulla – surrounded by cortex, contains nerve, blood and lymphatic vessels NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT F. PELVIS Three Primary Purposes: 1. Its bony cavity forms a protective cradle for pelvic structures. 2. Its architecture is of special importance in accommodating a growing fetus throughout pregnancy and during the birth process. 3. Its strength provides stable anchorage for the attachment of supportive muscles, fascia, and ligaments. Four Bones: a. Two innominate bones divided into three parts o Ilium: the flaring portion o Ischium: lower part below the hip joint o Pubis: the anterior portion b. Sacrum - posterior wall; pelvic portion of the spinal column c. Coccyx - tail end of the sacrum Types of Pelvic Shapes o Gynecoid. Female type: Ovoid or rounded in all directions o Android. Male type: Heart-shaped with narrow pubic arch o Anthropoid. Resembles ape pelvis: Oval-shaped inlet o Platypelloid. Wide but flat: may still allow vaginal delivery Pelvic Divisions a. False Pelvis Shallow upper portion of the pelvis; supports uterus during late pregnanc b. Linea terminalis Plane dividing the upper or false pelvis from the lower or true pelvis c. True pelvis Consists of the: a) pelvic inlet b) pelvic cavity c) pelvic outlet Measurement of the true pelvis influences the conduct and progress of labor and delivery Anteroposterior diameter includes: 1. Diagonal conjugate 2. Anatomic conjugate 3. Obstetrical conjugate REPRODUCTIVE CYCLE NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT HORMONAL INFLUENCE THE OVARIAN CYCLE 1. Follicular Phase: 2. LUTEAL PHASE: THE UTERINE CYCLE Pre-ovulatory stage Post-ovulatory stage a. Menses a. Secretory b. Proliferative b. Ischemic 1. MENSTRUAL PHASE 3. SECRETORY PHASE 2. PROLIFERATIVE PHAS 4. ISCHEMIC PHASE NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT THE MENSTRUAL CYCLE PURPOSE: Bring an ___________ to maturity and renew uterine tissue ready for _______________________. AVERAGE LENGTH: _______ days (beginning of one menstrual flow to the beginning of the next) maybe as short as _______ days or as long as ________ days. AVERAGE LENGTH OF MENSTRUAL FLOW: ______ to ______days. Maybe as short as ____ days or as long as _____days. OVULATION This is the release of mature egg from the ovarian follicle. CERVICAL MUCUS 1. Fern Test Increased estrogen = cm Forms fernlike pattern or ferning 2. SPINBARKEIT TEST Increased estrogen = Stretchability 3. Mittleschmerz 4. Mittlestain HEALTH EDUCATION DURING MENSTRUATION Moderate exercises Prostaglandin inhibitors (Ibuprofen, Naproxen, MFA) Sexual intercourse in not contraindicated Heat application Promotion of hygiene Rest Manage pain Iron supplement as needed Other stages of a woman’s reproductive cycle: POST MENOPAUSAL period MENOPAUSAL period MENOPAUSAL permanent cessation of menses, around 45 – 55 y/o, end of ability to conceive, sudden ESTROGEN decrease – mood swings occur, osteoporosis, amenorrhea state. NORMAL MENSTRUAL CYCLE Menarche: Average onset: 11-13 y/o; Average range: 9-17 y/o Interval: Average: 28 days; normal range: 23-35 days Duration: Average: 2-7 days; normal range: 1-9 days Amount: Difficult to estimate; average 30-80 mL/menstrual period Signs and Symptoms: Pain, headache, tenderness of the breasts, irritability, nervousness, crying spells Color: Dark red Odor: Similar to that of marigold NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 3: REPRODUCTIVE DEVELOPMENT MENARCHE As early as 8-9 years old and as late as 17 years old Dysmenorrhea—painful menstruation Menorrhagia—abnormally heavy menstrual flow Metrorrhagia—bleeding between menstrual period Amenorrhea – absence of menses NURSING MANAGEMENT a. Assessment 1. Biographical Data – age, name, 2. Menstrual History - Menarche Interval Duration Amount Signs and symptoms 3. Estimating fertile and non fertile days: OGINOKNAUSE formula – used if cycle is REGULAR 4. Obstetric History GTPALM G : Gravida (Number of pregnancies) T : Term (37wks and above P : Preterm (20wks to 36 6/7) A : Abortion (below 20 weeks L : Living children M : Multiple pregnancy G/P G : Number of pregnancies P : Para (Number of deliveries after 20wks HUMAN FERTILITY A. Joint Fertility Involves the united and equal contribution of the male and female in the decision and ability to have a child. B. Male Fertility A man is fertile every day of his life starting from puberty. Most sperm survive no more than 24 hours in the female reproductive tract Male fertility ends at death C. Female Fertility A woman is fertile from the onset of her first menses; This signals her readiness to bear a child An egg is released at ovulation, which occurs once during each menstrual cycle The ovum may survive no longer than 24 hours after its release at ovulation Female fertility ends at menopause