TABLE OF CONTENTS

Title Page
Copyright Page
The Author
Preface
Dedication
Contents Page

Chapter I - The Anatomy and Physiology of the

Female Reproductive Tract 1
External Reproductive Organ 1
Internal Reproductive Organ 2
Vagina 2
Uterus
2
Fallopian Tubes 4
Ovaries 4
Mammary Glands 5

Chapter II - Menstrual Cycle 6

Chapter III - Ovulation, Fertilization and Implantation 9

Fertilization 9
Implantation 10
Early Human Development 11

Chapter IV - The Placenta 12

The Umbilical Cord 13
The Amnion 13
The Amniotic Fluid 14

Chapter V - The Fetus 16

Embryonic Germ Layers 16
Fetal Development 16
Fetal Circulation 17
Fetal Skull 20

Chapter VI - Normal Pregnancy 21

Physiological Changes in Pregnancy 21
Metabolic Changes in Pregnancy 25
General Metabolism 26
Nutrition in Pregnancy 27
Essential Vitamins and Minerals in Pregnancy 27
Signs of Pregnancy 28
Length of Pregnancy 33
Chapter VII - Prenatal Care 34
Prenatal visit 34
Conduct of Initial Visit 34
Estimates in Pregnancy 35
Prenatal Examination 37
Subsequent Visits 41
Danger Signals of Pregnancy 42

Chapter VIII - High – Risk Factors 43

High – Risk Factors 43
Bleeding Complications of Pregnancy 44
Abortion 45
Ectopic Pregnancy 48
H – mole 51
Placenta Previa 52
Abruptio Placenta 55
Pregnancy – Induced Hypertension 58
Coincidental Diseases of Pregnancy 61
Cardiac Disease 61
Diabetes Mellitus 63
German measles 66
Anemia 66
Sexually – Transmitted Disease 67

Chapter IX - Normal Labor 69

Premonitory Signs 69
Components of Labor Process 72
Power 72
Passenger 73
Passages 80
Person 85
Mechanism of Labor 86
Stages of Labor 89

Chapter X - Complications of Labor 93

Dystocia 93
Precipitate Labor 94
Prolapsed Umbilical Cord 95
Premature Rupture of Membranes 96
Uterine Rupture 97
Fetal Distress 97
Preterm Labor 98

Chapter XI - Immediate Care of the Newborn 100

Danger Signals in the Newborn 103
Birth Injuries 103
Chapter XII - The Normal Puerperium 105
Physiology of Puerperium 105
Objectives of Care in Puerperium 107
Promotion of Uterine Involution
Promotion of Successful Breastfeeding
Promotion of Common Discomforts of Puerperium

Chapter XIII - Complications of Puerperium 111

Postpatial Hemorrhage 111
Puerperal Sepsis 112
Mastitis 113
Postpartal Cystitis 114
Uterine Prolapse 115
Postpartal Psychosis 116

Chapter XIV - Family Planning 118

Temporary Methods 118
Oral Contraceptive Pills 118
Intrauterine Device 120
Female Barrier – Diaphragm 121
Male Barrier – Condom 121
Permanent Methods 122
Behavioral Methods 123
Natural Methods of Family Planning 123
Lactation 124
Midwife’s Role in Family Planning 125
 Chapter I

THE ANATOMY AND PHYSIOLOGY OF THE FEMALE REPODUCTIVE TRACT

The female reproductive tract is composed of external and internal organs. The
external organs of reproductive are the called VULVA or PUEDA. These include the
mons pubis, labia majora and minoira, the clitoris, hymen, vestibule, perineum, unirary
meatus, openings of Skene’s glands and the Bartholin’s glands and various vascular
structures. The internal organs of reproduction include the vagina, uterus, fallopian tubes
and the ovaies.

EXTERNAL REPRODUCTIVE ORGANS

MONS VENERIS OR MONS PUBIS – soft, rounded, fatty cushion that lies over
the symphysis pubis anteiorly. It functions to protect the symphysis pubis. After puberty,
this is covered with hair that forms the ESCUTCHEON, and which thins after
menopause.

LABIA MAJORA – two rounded folds of adipose tissue that are pubis and merge
Into the perineum posteriorly forming the site of union called POSTEIOR
COMMISSURE. The labia majora is homologous with the scrotum of men. In children
and nulliparous women, the labia majora completely conceals and protect the labia
minora vaginal or and other underlying tissues. In the multiparous women, the labia
majora is left gaping widely. The labia majora is rich in sebaceous glands. Beneath the
skin that covers the labia majora is a mass of adipose tissue which is supplied with veins
may rapture secondary to external injury and cause hematoma.

LABIA MINORA – two flat, thinner folds of tissues within the labia majora richly
Supplied with many sebaceous follicle but with no hair follicle. The anterior ends/tissues
of the labia minora unite superiorly to form two lamellae; the lower pair fuse to form
BRENULUM OF THE CLITORIS and the upper pair unite to form the PREPUCE OF
THE CLITORIS. The posterior ends of the labia minora join together to form the
FOURCHETTE. The labia minora protects and obscure the vestibule, urinary meatus and
vaginal os.

GLANS CLITORIS – small highly erectile, cylindrical body which is protected by

Prepuce and richly supplied with nerve endings making it highly sensitive. It is
considered the principal erogenous organ of women. It is the seat of sexual arousal,
excitement and orgasm. The orimary reason why the clitoris is important in obstetrics is
because it serves as a GUIDE TO FEMALE CATHETERIZATION.

HYMEN – Thin membrane that covers the vaginal opening. Its opening, usually
erescentic or circular in shape, may be open with a pinpoint or may be wide enough to
admit a fingertip or two. Rupture of the hymen is NOT accompanied by bleeding;
occasionally though, hymenal rupture may be with slight or profuse bleeding.
 SMYTIFORM CARUNCLES – are the tissue remnants of the hymen formed is
completely occluded resulting to the retention of menstrual flow.

URINARY MEATUS – external opening of the urethra that lies 1 to 1.5 cm below
the pubic arch, appears as a vertical slit and can be distended to 4 to 5 mm in diameter
during catheterization. It leads to the SHORT FEMALE URETHARA. An important
factor to common urinary tract infections in women.

SKENE’S GLANDS PARAURETHRAL GLANDS – two palpable glands that open

onto the vestibule on either sides of the urethra but occasionally open on the posterior
wall of the urethra. These glands secrete to lubricate the vestibule and are common site
for gonococcal infection and other sexually transmitted diseases.

BARTHOLIN’S GLANDS OR VULVOVAGINAL GLANDS – two small. Palpable

glands situated between the vestibule on either side of the vaginal office. These glands
measure about 0.5 to 1 cm in diameter lie under the constrictor muscle of the vagina. The
Ducts of the glands are 1.5 to 2 cm long and open on each side of the vestibule just
outside the lateral margin of the vaginal os. The Bartholin’s glands secrete alkaline
mucus that lubricates the canal of the vagina during coitus. These glands are also
common site of cyst (Bartholin’s cyst) development, infection (Bartholinitis), and abscess
formation.

PERINEUM – area between the vagina and rectum consisting of fibro muscular
tissue. Most of the support of the perineum is provided by the pelvic and urogential
diaphragms. The pelvic diaphragms consist of the levator ani muscle plus the coccygeus
muscle posteriorly while the urogential diaphragm is comprised of the deep transverse
perineal muscles, the constrictor of the urethra, and the internal and external fascial
coverings.

VESTIBULE – almond – shapea area bounded anteriorly by the prepuce of the

alitoris, posteriorly by the functionally mature females structure of the uogential sinus,
while in the mature state, the vestibule is with six openings: the urethra, vaginal os, ducts
of the Bartholin’s glands and the ducts of paraurethral glands. In nulliparaous women, the
FOSSA NAVICULARIS, ( the space between the fouchette and the vaginal os) can be
observed; it is oftentimes obliterated with childbirth.

INTERNAL REPRODUCTIVE ORGANS

VAGINA – a musculomembranous canal extending from the vulva to the uterus. It

is between the urinary bladder (anterior) and the rectum (posterior). The anterior vaginal
wall is about 6 to 8 cm in length whereas, the posterior vaginal wall is about 7 to 10 cm
in length. The anterior wall is shorter than the posterior wall because the cervix enters the
canal along the anterior side. The vagina before menarche is smooth becoming
corrugated because of RUGAE. The nulliparous women have plenty of transverse ridges
called rugae which become obliterated after repeated vaginal birth and after menopause.
In elderly, multiparous women, the vaginal canal has scanty to no rugaetion the walls of
canal to be smooth.
The vagina is vascular. Its blood supply includes:
1. Upper third – cervicovsginal branches of the uterine arteries.
2. Middle third – inferior vesical arteries.
3. Lower third – middle hemorrhoidal and internal pudendal arteries.

The vagina is devoid of glands of any special nerve. It is acidic in reaction after
puberty because of the action of Doderlei’s bacilli (vaginal pH: 4.0 TO 6.0)
The functions of the vaginal include.
1. Female organ of copulation.
2. Excretory canal of the uterus through which uterine
secretions and menstrual flow escape.
3. Soft birth canal in labor.

UTERUS – hollow, pear-shaped, muscular organ partially covered by peritoneum

(serosa) with cavity lined by the endometrium. It is located in the pelvic cavity between
the bladder anteriorly and the rectum posteriorly.
The uterine length varies. Before puberty, the length is from 2.5 to 3.5 cm; in
adult nulliparous women, it is from 6 to 8 cm; and in multiparous women from 9 to 10
cm. A nonpregnant uterus weighs approximately 60gm and 1000gm in pregnancy.

The uterus has three layers:

1. Perimetrium – outer serosal layer; continuous with the broad ligaments on
the sides of uterus.
2. Myometrium – the living ligatures which control bleeding during the third
stage of labor; responds to the stimulation by oxytoxic drugs; the middle
layer.
3. Endometrium – inner mucosal lining; undergoes constant changes in respond
to levels of estrogen and progesterone during the menstrual cycle; becomes
DECIDUA in pregnancy.

The great bulk of the uterus (except cervix) is comprised of muscle. The uterus
has the following PARTS:

1. FUNDUS – convex upper part between the insertion of the fallopian tubes; the
MOST CONTRACTILE portion of the uterus.
2. CORPUS OR BODY – upper, larger triangular portions; houses and nourishes the
Growing fetus.
3. CORNUA – point from which the oviducts of the fallopian tubes emerge.
4. ISTHMUS – constricted area immediately above the cervix, distends in
pregnancy; significant in obstetrics because it forms the LOWER UTERINE
SEGMENT in pregnancy and labor.
5. CERVIX – lower, smaller, cylindrical specialized portion; with anterior os, the
internal os, that leads to the uterine cavity; and a posterior of the cervix D
 (PORT OR VAGINALIS). A 2.5 cm cervical canal connects the external f
os.

The cervix has glands that secrete thick, tenacious secretions of the
cervical canal.. Occlusion of these glands can result to retention cyst called
NABOTHAN CYST/FOLLICE.
The Cervix is predominantly collagenous tissues and elastic tissues with
blood vessels. Only about 10% of the cervix is of smooth muscles. In incomplete
cervix, the proportion of smooth muscles is notably greater.

The uterus is a partially mobile organ with the body free to move in the
Anteroposterio Plane. It lies in a position almost horizontal when a nonpregnant woman
stands erect. It leans FORWADS and this position is known as ANTEVERSION; and it
bends FORWARDS ON ITSELF producing ANTEFLEXION, with the fundus resting on
the bladder. The normal anteversion and anaflexion of the uterus prevents uterine
prolapse.

The uterus is maintained in position by four pairs of ligaments and indirectly by

The pelvic floor. The BROAD ligaments extend from the lateral margins of the uterus to
the pelvic walls thereby dividing the pelvic cavity into anterior and posterior
compartments. The CARDINAL ligaments o the TRANSVERSE CERVICAL
LIGAMENT or MACKENRODT LIGAMENTS is the densest portion of the base of the
broad ligament which is thickened and strengthened to form the MOST IMPORTANT
UTERINE SUPPORT. Damage of the transverse cervical ligaments incurred during labor
will cause the uterus to sag downwards.

The round ligaments arise at the cornua of the uterus, in front of and below the
insertion of the fallopian tube and is inserted into the labium majus. It holds the uterus in
ANTEVERSION. In pregnancy, the ROUND LIGAMENTS hypertrophy and increase
markedly in length and width.

The uterosacral ligaments extend backwards from the side of the isthmus and
attached to the sacrum. By pulling the cervix backwards, it helps maintain uterine
anteversion. These ligaments form the lateral boundaries of the cul-de-sac of Douglas and
help retain the body of the uterus in its usual anterior position by traction exerted
posteriorly on the cervix.

BLOOD SUPPLY of the uterus is derived principally from the uterine and ovarian
arteries. The uterine blood supply increase in pregnancy and decrease during puerperium.

The LYMPHATIC drainage from the uterus is abundant and accounts for the
successful outcome of uterine infections. Though the endometrium is abundantly
 supplied with lymphatic, the lymphatic vessels are confinced primarily to the uterine
basal layer.

The main NEVE SUPPLY to the uterus is considered from the pelvic automatic
system, sympathetic, but principally from the sympathetic nervous system.

The FUNCTIONS OF THE UTERUS include:

1. Organ of menstruation
2. Site of implantation and organ of pregnancy or gestation: it houses and nourishes
the growing fetus
3. Propels the products of conception into the vaginal canal during labor.

FALLOPIAN TUBES OVIDUCTS – two muscular canals about 8-14 cm length

(average: 11cm) extending from the uterine cornua to a site near the ovaries and are
developed in the upper fold of the broad ligaments. Each tube is covered by peritoneum
and the lumen is lined by ciliated mucous membrane which produces a current of lymph
that facilitates the movement of ovum along the tube. The tubal musculature contacts
constantly fastest during ovum transport and weakest during pregnancy.

THE PARTS OF THE OVIDUCTS include:

1. INTERNAL Portion – lumen 1mm in diameter, embedded within the uterine

muscular wall and proceeds upward and outward from the uterine cavity.
2. ISTHMUS – narrow portion adjoining the uterus; site that continues into the
widen AMPULLA (widest portion – 5 to 8mm).
3. AMPULLA – wider portion (outer third of the tube); site the longer projection,
The FIMBRIA IOVARICA reaches the ovary.

The tubes have the same three coats as the uterus. The mucosal and peritoneal
linings of the tubes are in direct contact allowing spread of infection from tubes to
peritoneum. The tubal musculature’s rhythmic movements vary with hormonal changes
of the menstrual cycle.

The fallopian tubes 8-14cm tubes functions as the SITE OF NORMAL

FERTILIZATION, and the ducts through which ova travel from the ovaries to uterus
(facilitated by tubal peristalsis).

OVARIES – two almond – shaped organ situated in the upper part of the pelvic
cavity on the posterior surface of the broad ligaments to which they are attached by the
MESOVARIUM; length – 2.5 to 5cm; breath – 1.5 to 3cm; thickness – 0.6 to 1.5 cm.
The ovaries are smooth; dull-white surface glisten several small follicles. More
corrugated in older women and marked convoluted in elderly women.
 PARTS OF THE OVARIES are the CORTEX – the layer that contains the ova and
the graafian follicles; the more important portion; and the MEDULLA – the inner or
central portion composed of loose connective tissue continuous with the mesovarium.
The TUNICA ALBUGINEA is the outer most portion of the cortex which is dull and
white and from which surface arises the germinal epithelium waldlayer.

THE FUNCTIONS OF THE OVARIES include:

1. OOGENESIS – the process of the developing a mature ovum in the

graafian follicle.
2. Ovulation – monthly expulsion or release of the mature ovum from the
graafian follicle into the pelvic cavity.
3. Endocrine function – secretion of female hormones ESTROGEN and
PROGESTERONE; maturing follicle secrete estrogen while corpus
luteum secretes estrogen and progesterone, primarily progesterone.

ANALOGOUS STRUCTURE AND PROCESS

FEMALE Male

# Sex organ : ovary Sex organ : testes

# Germ cell / gamete; ova Germ cell / gamete; sperm
# Process of producing ova; Oogenesis Process of producing sperm;
Spermatogenisis
Sex chromosomes; XY
# Sex chromosomes: XX Nocturnal emission
# Menstruation Glans penis
# Glans clitoris Scrotum
# Labia majora Vas deferens
# Fallopian tubes Bulbourethral glands
# Vulvovaginal glands (Cowper’s)
(Bartholin’s) Prostate glands
# Paraurethral glands
( Skene’s)
# Vagina Penis

MAMARY GLANDS OR BREASTS – the necessary organs of reproduction

1. Location – under skin, over the pectoralis major muscles.

2. composition – each mature mammary gland is made up of 15-25 lobeses
(average:20) with each lobe divided into tubules consisting of alveoli and
 secreting cells, the acinar cells (milk – producing cells); excretory ducts leads
from each lobe to the opening of the nipple. The nipple is composed of
erectile tissue and muscle fibers which have a sphincter – like action in
controlling the flow of milk. The Areola, loose pigmented area of the skin
surrounding the nipple.
3. size – varies depending on the amount of adispose tissue rather than on the
amount of successful breast – feeding. THELARCHE is the ONESET OF
RAPID INCREASE IN BREAST SIZE due to estrogen production rises.
4. Function – milk secretion, lactation
5. Maternal Reflexes in breastfeeding.

a. PROLACTIN REFLEX OR MILK SECRETION REFLEX

High levels of estrogen and progesterone induce alveolar and duct
growth as well as stimulation of milk secretion. In pregnancy, milk
secretion is not stimulated because of low prolactin as a result of high
estrogen level. Placental delivery decreases level of estrogen which in
turn stimulated the anterior pituitary gland (APG) to increase prolactin
secretion. HIGH PROLACTIN level stimulates the alveoli,
particularly the acini cells, to secrete milk which is then stored in the
breast tubules.

b. “LETDOWN REFLEX” (DRAUGHT REFLEX) – oxytocin – induced

The act of sucking the breast stimulates the flow of milk. This free
flowing of milk is called “letdown reflex. The initial letdown
reflex is brought about by sucking, but the succeeding letdown
reflexes are affected by maternal emotions. And since negative
emotions like worry and anxiety can impair “letdown reflex”, this
is considered the MOST IMPORTANT REFLEX to successful
breastfeeding.

c. MILK EJECTION REFLEX – controls the expulsive pf milk from

the breast tubules; also under influence of oxytocin
 CHAPTER II

THE MENSTRUAL CYCLE

The menstrual cycle is a series of monthly rhythmic in the ovaries affecting the
tissue structure of the endometrium directly by the ovarian hormones, estrogen and
progesterone and indirectly by the hypothalamus and anterior pituitary gonadotropic
hormones.

THE FOUR PHASES OF THE MENSTRUAL CYCLE

A. MENSTRUAL PHASE: from days 1-4

This is characterized by number living of the uterus by the vaginal bleedings as
the super ficial uterine endometrium is shed along with blood from the capillaries and the
unfertilized ovum.
This is TERMINAL PHASE of the cycle. Although the terminal phase, the first
day of bleeding is considered to be the FIRST DAY of the menstrual cycle simplify
calculation of the day of starting pills administration.

B. REGENEATIVE PHASE: day 3 after end of menstruation

This phase is characterized by reformation of the endometrium.

C. PROLIFERATIVE PHASE: 5 -14 days

By the 5th day, the epithelial surface of the endometrium has been restored.
During this early proliferative phase, the endometrium is thin, less than 2 mm is depth. In
the late proliferative phase, the endometrium is thicker.
The “dating” of the endometrium during the proliferative phase is not possible –
the follicular phase of the ovarian cycle varies in length among women.

ESTROGEN is the hormone responsible for the proliferative phase of the

menstrual cycle.

D. SECRETORY PHASE: LUTEAL PHASE, 15 – 28 days

In this phase, the endometrium is thick, velvety, soft and vascular as the
endometrial capillaries get distended with blood. In this phase, endometrium is being
prepared for the reception of the fertilized ovum.
The luteal phase (also called postovulatory phase). Is constant in duration: 12-14
days.

During the secretory phase, three layers of the endometrium are well defined:
1. Basal layer: adjacent to the myometrium. This zona basalis develops into a new
Endometrium
 2. Spongy layer or zona spongiosum: the middle layer.
3. Compact zone: the superficial layer.

PROGESTERONE is the hormone responsible for the secretory phase of the menstrual
cycle
The PREMENTRUAL PHASE of the menstrual cycle is the 2 to 3 days before
menstruation when there is a decline in the secretion of both estrogen and progesterone
because of the regression of the YELLOW BODY – the CORPUS LUTEUM. During this
phase glands & arteries collapse.

THE REPRODUCTIVE HORMONES INFLUENCE MENTRUAL CYCLE

A. Follicle – stimulating hormone (FSH)

This is secreted by the anterior pituity gland (AGP). It promotes the
development of the primordial follicles (immature follicle) into graafian follicles
(mature follicles which contain high levels of estrogen.

B. Luteinizing hormone (LH)

This is secreted by the AGP. It stimulates ovulation and development of the
corpus luteum which is responsible for high level of progesterone.

C. Estrogen
This is an ovarian secretion. It is responsible for the development of the
secondary sex characteristics, or “genital growth”. It stimulates the thickening of the
endometrium. Thus it is responsible for the PROLIFERATIVE PHASE of the
menstrual cycle.

D. PROGESTERONE
This hormone is secreted by the ovaries and in particular by the corpus
luteum. It is responsible for the SECRETORY PHASE of the menstrual cycle.
PROGESTERONE is the hormone responsible for the secretory phase of the menstrual
cycle
The PREMENTRUAL PHASE of the menstrual cycle is the 2 to 3 days before
menstruation when there is a decline in the secretion of both estrogen and progesterone
because of the regression of the YELLOW BODY – the CORPUS LUTEUM. During this
phase glands & arteries collapse.

THE REPRODUCTIVE HORMONES INFLUENCE MENTRUAL CYCLE

A. Follicle – stimulating hormone (FSH)

This is secreted by the anterior pituity gland (AGP). It promotes the
development of the primordial follicles (immature follicle) into graafian follicles
(mature follicles which contain high levels of estrogen.

B. Luteinizing hormone (LH)

This is secreted by the AGP. It stimulates ovulation and development of the
corpus luteum which is responsible for high level of progesterone.
 C. Estrogen
This is an ovarian secretion. It is responsible for the development of the
secondary sex characteristics, or “genital growth”. It stimulates the thickening of the
endometrium. Thus it is responsible for the PROLIFERATIVE PHASE of the
menstrual cycle.

D. PROGESTERONE
This hormone is secreted by the ovaries and in particular by the corpus
luteum. It is responsible for the SECRETORY PHASE of the menstrual cycle.

MENSTRUATION

Menstruation is the periodic discharge of blood, mucus and cellular debris from
the uterine mucosa and occurs at regular, cyclic and predictable intervals from
menarche to menopause except during PREGNANCY and LACTATION.

A. DURATION: The duration of menstruation is variable but usually it is 4 to 6 days.

B. AMOUNT: The amount of menstrual flow is about 25 – 60ml which is equivalent
to about 0.4-1.mg of iron for every menstruation.
C. CHARACTERISTICS: INCOAGULABLE blood, because the blood, coagulated
as it was shed, is quickly fibrinolytic activity.
D. MENARCHE: This is the FIRST MENSTRUATION. The average time for the
first menstruation is between 12 to 13 years. It may be as early as 10 years and as
late 16 years.
Menarche is one sign of puberty (entire transitional stage between
childhood and sexual maturity) and is indicative of the completion of the
physiology event of puberty which is the RELEASE OF THE OVUM.
The first menses are an ovulatory, infertile and irregular.
Menstruation is considered parturition of failed fertility. In ovulatory women,
progesterone “withdrawal” is the one that leads to the onset of menstruation.

MENOPAUSE: The charge of life or climacteic period.

The menopausal period is the CESSATION OF MENSES, or the end of
reproductive period. It occurs between 45 and 59 years in 50% of women. In rare
instances, it occurs as early as 35 years and as late as 55 years.
This period as generally extending over a period of two years. During this period,
the woman may have the following signs:
1. Scanty and irregular menses
2. Hot flushes, one of the most common disturbances
3. Tendency to obesity
4. Palpitation
5. Depression and anxiety
6. Insomnia
7. Anorexia
8. Irritability and tension
9. Slight hypertension and headache
 10. Vague feeling of illness

ESTROGEN preparations may be prescribed by the doctor for decreasing menopausal

symptoms.

Important principles that can diminish intensity of menopausal symptoms include:

1. Adequate sleep
2. Good nourishing food
3. Fresh air
4. Reassurance
5. Sympathetic understanding

RELATED TERMINOLOGIES
1. DYSMENORHEA: painful menstruation
2. MENORRHAGIA/HEPRMENORRHEA: excessive menstruation
3. METRORRHAGIA: abnormal bleeding between menses
4. POLYMENORHEA: too frequent menstruation
5. HYPOMENORRHEA: scanty menstrual flow

CHAPTER III

OVULATION, FERTILIZATION AND IMPLANTATION

Ovulation is the CARDINAL, FUNCTION of the ovary. It is the charge of a mature egg
cell by the graafian follicle of the ovary repeated every month from menarche to
menopause (about 35 years), except in pregnancy, lactation or when there are insufficient
numbers of follicle in the ovary. Normally, only one ovary ovulates each month.

A. TIME: ( ) Ovulation usually occurs in the middle of the menstrual cycle o generally,
about 12 to 14 days the next menstruation
B. ESTIMATING DAY OF OVULATION: In a regular 28 – days cycle, ovulation
occurs on the 14th day, whereas in regular 30-days cycle, ovulation on the 16th day of
the cycle.

28 30
- 14 -14
_________ _________
 14 16

C. SIGNS OF OVULATION

1. Tenderness of the breasts

2. Mittelsohsmerz: left or right lower quadrant pain corresponding to the rupture of the
graafian follicle.
3. Slight rise in basal body temperature (BBT) which is preceded a slight drop (0.3ْ C-
0.6ْ C). This rise in temperature is because of the hormone (PROGESTERONE).
4. Spinnbarkheit test is positive. In this test, the cervical mucus can be stretched to a
distance of 10 to 13cm. Characteristic of fertile cervical mucus are:
a. Clear c. Stringy
b. Stretchable d. Slippery or lubricative

FERTILIZATION

Fertilization is the union of mature egg cell (ovum) and mature sperm cell.

At the time of fertilization, the female gamete o egg cell has 23 chromosomes: 22
autosomes and an X sex chromosomes. The male gamete also has 23 chromosomes: 22
autosomes and a sex chromosomes which can either be an X or Y chromosomes. A
combination of XX chromosomes gives rise to a female baby, whereas a combination of
XY sex chromosomes gives rise to a male baby. It is therefore the sex chromosomes of
the father and not that of the mother that determines the male sex of the baby.
The fertilized ovum is termed ZYGOTE. The zygote has a total of 46
chromosomes: 22 pairs of autosomes and a pair of sex chromosomes. The zygote then
cell-divides by the process of MITOSIS to form blastomere, morula, blastocyst or
tropoblast.
Fertilization is also called impregnation, conception. The best site for fertilization
is the AMPULLA of the fallopian tube the outer third of the fallopian tube.

HOW FERTILIZATION OCCURS

During circulation, sperm are deposited in the vagina. An average of 3-5 ml semen is
released with approximately 70 120 million of sperm per ml are deposited in the vaginal
canal.
The movement of the sperm caused by the flagellar action is believed to maintain
the sperm in suspension and to facilitate transport.
The sperm must be in the genital tract 4 to 6 hours before they are able to
penetrate the ZONA PELLUCIDA. This period of time is needed as the enzyme
HYALURONIDASE, needed to dissolve the cement substance (hyaluronic acid) that
holds the cells that cover the ovum, is activated sperms may be in the ampulla as early as
5 minutes after circulation.
As soon as the sperm penetrates the zona pellucida entry sperms in inhibited.
Sperm penetration initiates a series of mitotic cell division called CLEAVAGE.
Cleavage produces a solid ball of cell without such increase in the size of the whole unit.
This mass of cells is called a MORULA and its individual cells called BLASTOMERES.
 Over the next 3 to 4 days of development, reorganization o morula follows. It is
also in the blastocyst stage when the group of cells enters the uterine cavity.
The outer layer of the blastocyst is termed FROPHOBLAST. This stage is
responsible for implantation.

IMPLANTATION

The embedding of the ovum in the uterus is called implantation. It is also called
NIDATION.

A. TIME: six to nine days (average: 7days)after fertilization.

B. SITE: Uterus or the upper third of the uterus/upper, fundal portion.
Abnormal sites may be fallopian tube resulting to ectopic pregnancy; or lower
Uterine segment, causing placenta previa.
C. BLASTOCYST: Driving force in implantation. It is invasive, aggressive force
responsible for implantation (specially, its outer layer, the trophoblast).