Aklan Polytechnic College

Kalibo, Aklan
College of Nursing

ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM

The female reproductive system is made up of the internal and external sex organs that

function in reproduction of new offspring. In humans, the female reproductive system is immature

at birth and develops to maturity at puberty to be able to produce gametes, and to carry

a foetus to full term. 

The female reproductive system provides several functions.

1. The ovaries produce the egg cells, called the ova or oocytes. The oocytes are then

transported to the fallopian tube where fertilization by a sperm may occur.

2. The fertilized egg then moves to the uterus, where the uterine lining has thickened in

response to the normal hormones of the reproductive cycle. Once in the uterus, the fertilized

egg can implant into thickened uterine lining and continue to develop. If implantation does

not take place, the uterine lining is shed as menstrual flow.

3. The female reproductive system produces female sex hormones that maintain the

reproductive cycle.

4. During menopause, the female reproductive system gradually stops making the female

hormones necessary for the reproductive cycle to work. At this point, menstrual cycles can
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become irregular and eventually stop. One year after menstrual cycles stop, the woman is

considered to be menopausal.

The main external structures of the female reproductive system include:

 Labia majora: (“large lips”) enclose and protect the other external reproductive organs.

 Labia minora: (“small lips”) They lie just inside the labia majora, and surround the

openings to the vagina and urethra. This skin is very delicate and can become easily irritated

and swollen.

 Bartholin’s glands: These glands are located next to the vaginal opening on each side and

produce a fluid (mucus) secretion.

 Clitoris: A small, sensitive protrusion. The clitoris is covered by a fold of skin. The clitoris

is very sensitive to stimulation and can become erect.

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The internal reproductive organs include:

 Vagina : The

vagina

is a

canal

that joins the cervix to the outside of the body. It also is known as the birth canal.

 Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing

fetus. The uterus is divided into two parts:

1. Cervix, which is the lower part that opens into the vagina.

2. Corpus - can easily expand to hold a developing baby. A canal through the cervix

allows sperm to enter and menstrual blood to exit.

 Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the

uterus. The ovaries produce eggs and hormones.

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 Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus.

Fertilization of an egg by a sperm normally occurs in the fallopian tubes. The fertilized egg

then moves to the uterus, where it implants to the uterine lining.

MENSTRUAL CYCLE

Menstruation is the shedding of the lining of the uterus (endometrium) accompanied by

bleeding. It occurs in approximately monthly cycles throughout a woman's reproductive life,

except during pregnancy. Menstruation starts during puberty (at menarche) and stops

permanently at menopause.

By definition, the menstrual cycle begins with the first day of bleeding, which is counted as day

1. The cycle ends just before the next menstrual period. Menstrual cycles normally range from

about 25 to 36 days. Only 10 to 15% of women have cycles that are exactly 28 days. Usually, the

cycles vary the most and the intervals between periods are longest in the years immediately after

menarche and before menopause.

Menstrual bleeding lasts 3 to 7 days, averaging 5 days. Blood loss during a cycle

usually ranges from ½ to 2½ ounces. A sanitary pad or tampon, depending on the type, can hold

up to an ounce of blood. Menstrual blood, unlike blood resulting from an injury, usually does

not clot unless the bleeding is very heavy.

The menstrual cycle is regulated by hormones. Luteinizing hormone and follicle-stimulating

hormone, which are produced by the pituitary gland, promote ovulation and stimulate the ovaries

to produce estrogen and progesterone stimulates the uterus and breasts to prepare for possible

fertilization. The cycle has three phases: follicular (before release of the egg), ovulatory (egg

release), and luteal (after egg release).

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HORMONES AND FEMALE CYCLES

The ovarian cycle is

hormonally regulated in two phases.

The follicle secretes estrogen before

the ovulation; the corpus luteum

secretes both estrogen and

progesterone after ovulation.

Hormones from the hypothalamus and

anterior pituitary control the ovarian

cycle. The ovarian cycle covers events

in the ovary; the menstrual cycle

occurs in the uterus.

Menstrual cycles vary from between 15 and 31 days. The first day of the cycle is the

first day of blood flow (day 0) known as menstruation. During menstruation, the uterine lining is

broken down and shed as menstrual flow. FSH and LH are secreted on day 0, beginning both the

menstrual cycle and the ovarian cycle. Both FSH and LH stimulate the maturation of a single

follicle in one of the ovaries and the secretion of estrogen. Rising levels of estrogen in the blood

trigger secretion of LH, which stimulates follicle maturation and ovulation (day 14, or mid

cycle). LH stimulates the remaining follicle cells to form the corpus luteum, which produces both

estrogen and progesterone.

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Estrogen and progesterone stimulate the development of the endometrium and

preparation of the uterine lining for implantation of a zygote. If pregnancy does not occur, the

drop in FSH and LH causes the corpus luteum to disintegrate. The drop in hormones also causes

the sloughing off of the inner lining of the uterus by a series of muscle contractions of the uterus.

FERTILIZATION AND PREGNANCY

If a female and male have sex within several days of the female's ovulation (egg

release), fertilization can occur. When the male ejaculates (which is when semen leaves a

man's penis), between 0.05 and 0.2 fluid ounces (1.5 to 6.0 milliliters) of semen is deposited

into the vagina. Between 75 and 900 million sperm are in this small amount of semen, and they

"swim" up from the vagina through the cervix and uterus to meet the egg in the fallopian tube.

It takes only one sperm to fertilize the egg.

About a week after the sperm fertilizes the egg, the fertilized egg (zygote) has become a

multi- celled blastocyst .A blastocyst is about the size of a pinhead, and it's a hollow ball of

cells with fluid inside. The blastocyst burrows itself into the lining of the uterus, called the

endometrium The hormone estrogen causes the endometrium to become thick and rich with

blood. Progesterone, another hormone released by the ovaries, keeps the endometrium thick

with blood so that the blastocyst can attach to the uterus and absorb nutrients from it. This

process is called implantation.

As cells from the blastocyst take in nourishment, another stage of development, the

embryonic stage, begins. The inner cells form a flattened circular shape called the embryonic

disk, which will develop into a baby. The outer cells become thin membranes that form around

the baby. The cells multiply thousands of times and move to new positions to eventually
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become the embryo. After approximately 8 weeks, the embryo is about the size of an adult's

thumb, but almost all of its parts — the brain and nerves, the heart and blood, the stomach and

intestines, and the muscles and skin — have formed.

During the fetal stage, which lasts from 9 weeks after fertilization to birth, development

continues as cells multiply, move, and change. The fetusfloats in amniotic fluid inside the

amniotic sac. The fetus receives oxygen and nourishment from the mother's blood via the

placenta, a disk- like structure that sticks to the inner lining of the uterus and connects to the

fetus via the umbilical cord. The amniotic fluid and membrane cushion the fetus against bumps

and jolts to the mother's body.

Pregnancy lasts an average of 280 days — about 9 months. When the baby is ready for

birth, its head presses on the cervix, which begins to relax and widen to get ready for the baby to

pass into and through the vagina. The mucus that has formed a plug in the cervix loosens, and

with amniotic fluid, comes out through the vagina when the mother's water breaks.

When the contractions of labor begin, the walls of the uterus contract as they are stimulated by

the pituitary hormone oxytocin (pronounced: ahk-see-toh-sin). The contractions cause the cervix

to widen and begin to open. After several hours of this widening, the cervix is dilated (opened)

enough for the baby to come through. The baby is pushed out of the uterus, through the cervix,

and along the birth canal. The baby's head usually comes first; the umbilical cord comes out with

the baby and is cut after the baby is delivered.

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The last stage of the birth process involves the delivery of the placenta, which is now called the

afterbirth. After it has separated from the inner lining of the uterus, contractions of the uterus

push it out, along with its membranes and fluids.

THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM

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The renin-angiotensin-aldosterone system (RAAS) plays an important role in

regulating blood volume and systemic vascular resistance, which together influence cardiac

output and arterial pressure. As the name implies, there are three important components to this

system: 1) renin, 2) angiotensin, and 3) aldosterone. Renin, which is primarily released by the

kidneys, stimulates the formation of angiotensin in blood and tissues, which in turn stimulates

the release of aldosterone from the adrenal cortex.

Renin is a proteolytic enzyme that is released into the circulation primarily by the kidneys. Its

release is stimulated by:

1. sympathetic nerve activation (acting via β1-adrenoceptors)

2. renal artery hypotension (caused by systemic hypotension or renal artery stenosis)

3. decreased sodium delivery to the distal tubules of the kidney.

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Juxtaglomerular (JG) cells associated

with the afferent arteriole entering the

renal glomerulus are the primary site of

renin storage and release in the body. A

reduction in afferent arteriole pressure

causes the release of renin from the JG

cells, whereas increased pressure inhibits

renin release. Beta1-adrenoceptors

located on the JG cells respond to

sympathetic nerve stimulation by releasing renin. Specialized cells (macula densa) of distal

tubules lie adjacent to the JG cells of the afferent arteriole. The macula densa senses the amount

of sodium and chloride ion in the tubular fluid. When NaCl is elevated in the tubular fluid, renin

release is inhibited. In contrast, a reduction in tubular NaCl stimulates renin release by the JG

cells. There is evidence that prostaglandins (PGE2and PGI2) stimulate renin release in response

to reduced NaCl transport across the macula densa. When afferent arteriole pressure is reduced,

glomerular filtration decreases, and this reduces NaCl in the distal tubule. This serves as an

important mechanism contributing to the release of renin when there is afferent arteriole

hypotension.
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When renin is released into the blood, it acts upon a circulating substrate, angiotensinogen, that

undergoes proteolytic cleavage to form the decapeptide angiotensin I. Vascular endothelium,

particularly in the lungs, has an enzyme,angiotensin converting enzyme (ACE), that cleaves off

two amino acids to form the octapeptide, angiotensin II (AII), although many other tissues in the

body (heart, brain, vascular) also can form AII.

AII has several very important functions:

• Constricts resistance vessels (via AII [AT1] receptors) thereby increasing systemic

vascular resistance and arterial pressure

• Acts on the adrenal cortex to release aldosterone, which in turn acts on the kidneys to

increase sodium and fluid retention

• Stimulates the release of vasopressin (antidiuretic hormone, ADH) from the posterior

pituitary, which increases fluid retention by the kidneys

• Stimulates thirst centers within the brain

• Facilitates norepinephrine release from sympathetic nerveendings and inhibits

norepinephrine re-uptake by nerve endings, thereby enhancing sympathetic adrenergic function

• Stimulates cardiac hypertrophy and vascular hypertrophy

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The renin-angiotensin-aldosterone pathway is regulated not only by the

mechanisms that stimulate renin release, but it is also modulated by natriuretic peptides (ANP

and BNP) released by the heart. These natriuretic peptides acts as an important counter-

regulatory system.

Therapeutic manipulation of this pathway is very important in treating hypertension

and heart failure. ACE inhibitors, AII receptor blockers and aldosterone receptor blockers, for

example, are used to decrease arterial pressure, ventricular afterload, blood volume and hence

ventricular preload, as well as inhibit and reverse cardiac and vascular hypertrophy.
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THE CARDIOVASCULAR SYSTEM

The cardiovascular system consists of the pump and vessels that distribute blood to all

areas of the body. This system allows for the delivery of needed substances to the cells of the

body as well as for the removal of wastes.

Heart is a muscular hollow organ often called the pump of the body. It is located in the

mediastinal cavity (between the lungs), behind the sternum and above the diaphragm.

3 LAYERS OF THE HEART

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ENDOCARDIUM a smooth layer of cells that lines the inside of the heart. This allow

for smooth flow of the blood.

MYOCARDIUM the muscular middle layer, also the thickest layer .

PERICARDIUM the double layered membrane or sac that covers the outside of the

heart.

SEPTUM OF THE HEART a muscular wall that separates the heart into right and left

sides of the heart.

Interatrial septum - The upper part of the septum.

Interventricular septumthe lower part of septum.

THE HEART IS DIVIDED INTO 4 PARTS 4 CHAMBERS

Atrium - 2 upper chamber

Ventricles - 2 lower chambers

Right atrium - receives blood as it returns from the body cells.

Right ventricle - receives blood from the right atrium then pushes the blood into the pulmonary

artery, which carries it to the lungs for oxygen.

Left atrium - receives oxygenated blood from the lungs.

Left ventricle - receives blood from the left atrium and pushes blood into the aorta so it can be

carried to the body cell.

HEART VALVES- one way valves in the chamber of the heart keep flowing in the right

direction.
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TRICUSPID VALVE

 Is located between the right atrium and ventricle.

 It closes when the right ventricle contracts and pushes the blood to the lungs.

 This prevents blood flowing backward into the right atrium.

 PULMONARY VALVE 

 The Pulmonary valve is located between the right ventricle and pulmonary artery, a blood

vessel that carries blood to the lungs.

 It encloses when the right ventricle has finished contracting and pushing blood into the

pulmonary artery.

 It prevents blood from flowing back into the right ventricle.

MITRAL VALVE

 Located between the left atrium and left ventricle.

 It closes when the left ventricle is contracting and pushing blood into the aorta so it can

be carried to the body.

 It prevents blood from flowing back into the left atrium.

AORTIC VALVE

 Located between the left ventricle and the aorta, the largest artery in the body.

 It closes when the left ventricle is finished contracting and pushing blood into the

aorta.
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 It prevents blood from flowing back into the left ventricle.

BLOOD VESSELS

 Blood leaving the heart is carried throughout the body in blood vessel. The heart

and the blood vessels form a closed system for the flow of blood.

THREE MAIN TYPES OF BLOOD VESSELS

 1) ARTERIES - Carry blood away from the heart.

AORTA - Is the largest artery in the body. It receives blood from left ventricle of the heart. It

immediately begins branching into smaller arteries.

Arterioles- are the smallest branches of the arteries and they join with capillaries.

2) CAPILLARIES

 Connect arterioles with venules, the smallest veins.

 They have thin walls that contain only one layer of cells and allow oxygen and

nutrients to pass through to the cells.

 At the same time, carbon dioxide and metabolic products from the cells enter the

capillaries.

3) VEINS

 Blood vessels that carry blood to the heart.

 Veins are thinner than arteries and have less muscle tone. Most veins contain valves

that keep the blood from flowing in a backward direction.

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Venules are the smallest branches of veins, they connect with capillaries, then venules join

together and become larger vessels called veins.

Superior and inferior vena cava are the two largest veins.

Superior vena cava - brings blood from the upper part of the body.

Inferior vena cava - brings blood from the lower part of the body. Both vena cava drain into the

right atrium.
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Kalibo, Aklan
College of Nursing

The blood that flows through the fetus is actually more complicated than after the baby is

born (normal heart). This is because the mother (the placenta) is doing the work that the baby's

lungs will do after birth. The placenta accepts the blood without oxygen from the fetus through

blood vessels that leave the fetus through the umbilical cord (umbilical arteries, there are two of

them). When blood goes through the placenta it picks up oxygen.

The oxygen rich blood then returns to the fetus via the third vessel in the umbilical cord

(umbilical vein). The oxygen rich blood that enters the fetus passes through the fetal liver and

enters the right side of the heart.

The oxygen rich blood goes through one of the two extra connections in the fetal heart

that will close after the baby is born. The hole between the top two heart chambers (right and left

atrium) is called a patent foramen ovale (PFO). This hole allows the oxygen rich blood to go

from the right atrium to left atrium and then to the left ventricle and out the aorta. As a result the

blood with the most oxygen gets to the brain. Blood coming back from the fetus's body also

enters the right atrium, but the fetus is able to send this oxygen poor blood from the right atrium

to the right ventricle (the chamber that normally pumpspumps blood to the lungs).

Most of the blood that leaves the right ventricle in the fetus bypasses the lungs through

the second of the two extra fetal connections known as the ductus arteriosus. The ductus

arteriosus sends the oxygen poor blood to the organs in the lower half of the fetal body. This also

allows for the oxygen poor blood to leave the fetus through the umbilical arteries and get back to

the placenta to pick up oxygen. Since the patent foramen ovale and ductus arteriosus are normal
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findings in the fetus, it is impossible to predict whether or not these connections will close

normally afterbirth in a normal fetal heart. These two bypass pathways in the fetal circulation

make it possible for most fetuses to survive pregnancy even when there are complex heart

problems and not be affected until after birth when these pathways begin to close.