Antepart

um
 Menstrual Cycle

❑ Description
❑ Structures involved
1. Hypothalamus
2. Pituitary gland
3. Ovaries
4. Uterus
❑ Health education
 Menstruation

❑ FRC
❑ Episodic uterine bleeding in response to cyclic
hormonal changes
❑ Process that allows for conception and
implantation of a new life
❑ Purpose: bring an ovum to maturity and renew a
uterine tissue bed that will be responsible for its
growth should it be fertilized back
 Characteristics of 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
 Characteristics of Normal
Menstrual Cycle

❑ Amount: Difficult to estimate;

average 30-80 mL /menstrual period
❑ Signs and Symptoms: Pain, headache,
tenderness of the breasts, irritability,
nervousness, crying spells
 Characteristics of Normal
Menstrual Cycle

❑Color: Dark red

❑Odor: Similar to that of marigold

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
Menopause
❑ Occurs between 40-55 years
Structures Involved in
Menstruation
 1. Hypothalamus

❑GnRH (gonadotrophin-releasing
hormone; a.k.a. leutinizing
hormone-releasing hormone
[LHRH])
1. Hypothalamus
 2. Pituitary Gland

❑Produces growth
hormones FSH and LH
under the influence of
 2. Pituitary Gland

Follicle-Stimulating Hormone
❑ Active early in the cycle
❑ Responsible for maturation of ovum
❑ Stimulates estrogen production
 2. Pituitary Gland

Leutinizing Hormone
❑ Active at the midpoint of the cycle
❑ Responsible for ovulation and growth of uterine
lining during the second half of the menstrual cycle
❑ Stimulates progesterone production
3. Ovary
 3. Ovary

❑GH causes “trophy”

(growth) in the gonads
 4. Uterus

a. Proliferative phase
(Estrogenic/follicular/postmenstrual phase)
❑ ↑ FSH output
❑ Days 5-14 immediately after the last menstrual
flow
❑ Rapid growth and increase in the thickness of the
endometrium from 1 cell layer to approx. eightfold
 4. Uterus

b. Secretory phase
(Progestational/luteal/premenstrual phase)
❑ ↑ LH output; ↑ estrogen
❑ Days 15-28 after menstruation
❑ “Corckscrew” endometrium
❑ Increased amount of glycogen and mucin
❑ Rich, spongy velvet appearance of the endometrial
lining (vascular endometrium)
 4. Uterus

c. Ischemic phase
❑ Regression of corpus luteum
↓
❑ ↓ estrogen and progesterone
↓
❑ Degeneration of the endometrium due to
↓progesterone
↓
❑ Rupture of capillaries, minute hemorrhages, and the
endometrium sloughs off
 4. Uterus

Menstrual phase
❑ Discharge of the following from the uterus
❖ Blood from ruptured capillaries
❖ Mucin from glands
❖ Endometrial tissue fragments
❖ Unfertilized ovum
❑ Iron loss: 11 mg
❑ Average: 2-7 days
Cervical mucus and
sperm survival
 Cervical Mucus Tests

Fern test
❑ Cervical mucus and ovulation
❑ Arborization or ferning – due to crystallization
of sodium chloride in the mucus
 Cervical Mucus Tests

Spinnbarkeit test
❑ Stretching of a mucus sample between thumb and
pointing finger
 Health Education During
Menstruation

❑Moderate exercises
❑Sexual intercourse in not
contraindicated
❑Promotion of hygiene
 Health Education During
Menstruation

❑ Manage pain
❖Prostaglandin inhibitors
(Ibuprofen, Naproxen, MFA)
❖Heat application
❖Rest
❑ Iron supplement as needed
Phases of Human Sexual
Response
(Masters and Johnson)

1. Excitement
2. Plateau
3. Orgasm
4. Resolution
 1. Excitement

❑ Parasympathetic nerve stimulation

❑ Arterial dilation and venous construction at the
genital area → increased blood supply →
vasocongestion
❑ Increased muscular tension
❑ “Sex flush”
❑ Increased RR, PR and BP
 1. Excitement

❑ Women:
✓ Engorgement of the clitoris
✓ Vaginal lubrication
✓ Erection of the nipple
✓ Enlargement of the breast
✓ Labia majora flattens and spreads apart
✓ Labia minora swells
✓ Cervix and uterus pulls up
✓ “Ballooning” of the upper third of the vagina
 1. Excitement

❑ Men:
✓ Penile erection
✓ Thickening of the scrotal skin, increased
scrotal sac tension, scrotum pulled up
towards the body
✓ Nipple erection
 2. Plateau

❑ Vasocongestion peaks
❑ Increased RR, PR, BP
❑ Women:
✓ Breasts continue to swell
✓ “Orgasmic platform”
✓ Clitoris retracts into the body
✓ Uterus enlarges
✓ Darkening of the labia majora
❑ Men:
✓ Pre-ejaculatory secretion
✓ Complete erection and swelling of the glans
 3. Orgasm

❑ Rhythmic, vigorous contraction of muscles in the

pelvic area expels or dissipates blood and fluid
from the area of congestion
❑ Women:
✓ One contraction very 0.8 seconds
❑ Men:
✓ Stages:
a. Sensation of ejaculatory inevitablity
b. Ejaculation
 4. Resolution

❑ Internal and external genital organs

return to unaroused state
❑ Sex flush disappears
❑ Usually takes 15-30 minutes
❑ Refractory period
❑ Multiple orgasm
Process of
Conception
❑Ovulation
❑Fertilization
❑Implantation
1. Ovulation
❖ This is a part of the that is the process of
maturation and rupture of a graafian follicle,
with a discharge of ovum.
❖ This is the release of mature egg from the ovarian
follicle.
❖ Should occur 14 days before the next menstrual
flow is expected.
❖ Occurs approximately once a month during
reproductive years from puberty (age 11- 15) to
menopause (age 45 – 55)
❖ Ovulation is temporarily halted during
pregnancy and may be suppressed by
emotional and physical stress.
❖Usually only 1 follicle develops
fully, the other follicles recedes.
❖This one follicle release an egg
which will be fertilized.
❖The follicles that released the egg
is known as the corpus luteum.
❖ The life span of the egg after
ovulation is 12- 24 hours. This is
the optimum time for
fertilisation to occur.
43 2/24/2022
❖Fertilization must take place within
that hour or else no
fertilization will take place
after that hour.
❖However sperm that is deposited
prior to ovulation can survive in
the female reproductive tract
for 72 hours.
❖So, few days before ovulation is
also considered as fertile days.
44 2/24/2022
 Summary: When do you
ovulate?

⚫ OVULATION OCCURS APPROXIMATELY ON

THE

14TH DAY OF YOUR CYCLE (FOR

REGULARS)
⚫ AVERAGE LENGTH OF A CYCLE: _______
DAYS
⚫ SHORT CYCLE: _____ DAYS
⚫ LONG CYCLE: ______ DAYS
28 DAY CYCLE
PEAK

2O DAYS CYCLE: DAY 6

44 DAYS CYCLE: DAY 30
2. Fertilization

❑ Location
❑ Lifespan of sex cells
Sperm cell
❑ Semen: 2.5 mL/ejaculation; 50-200 million
spermatozoa/mL average of 400 million
sperm/ejaculation
❑ Mobility:
✓ Tail
✓ Uterine contractions
❑ Transport time:
✓ 80 seconds from vagina to cervix
✓ 5 minutes from vagina to fallopian tube
❑Capacitacion
—changes in the plasma membrane of the sperm
head, which reveals the sperm-binding receptor
sites, to be ready for fertilization
❑Hyaluronidase
—a proteolytic enzyme released by the spermatozoa
that acts to dissolve the layer of cells protecting
the ovum
 Factors affecting fertilization

⚫ Equal maturation of both sperm and

ovum
⚫ Ability of the sperm to reach the ovum
⚫ Ability of the sperm to penetrate the
zona pellucida and and cell membrane
and achieve fertilization
Zygote
 3. Implantation

❑ Contact between the growing sperm-ovum

structure and the uterine endometrium, occurring
approx. 8-10 days after fertilization
❑ Migration from the fallopian tube to the body
of the uterus for lasts 3-4 days
❑ Usually happens at the upper portion, anterior
surface of the endometrium
Cleavage
Morula
Blastocyst
Embryo
Auxiliary Structures
of Embryo and Fetus
❑Placenta
✓Decidua
✓Chorionic villi
❑Umbilical cord
❑Amniotic membrane
❑Amniotic fluid
 1. Decidua

a. Decidua basalis
✓ Where nidation of the fertilized
ovum takes place
✓ Portion where the trophoblast cells
are establishing communication
with the maternal blood vessels
b. Decidua capsularis
❖Encapsulates the embryo

c. Decidua vera/ decidua parietalis

 2. Chorionic villi

❑ Appears 11th-12th day after implantation

❑ Arises from trophoblast cells

 Layers

a. Syncytiotrophoblast (syncytial layer)

❑ Outer layer
❑ Instrumental in the production of
somatomammotropin, hPl, estrogen, progesterone
b. Cytotrophoblast (Langhan’s layer)
❑ Inner layer
❑ Function: protect the growing embryo and fetus from
certain infectious agents such as spirochete
 3. Placenta

cotyledon

❑ Metabolic function
❑ Transfer function

✓ Gas exchange
✓ Nutrient transfer
✓ Waste removal
✓ Antibody transfer
✓ Transfer of maternal hormones
❑ Endocrine function
✓ hCG—sustains luteum until 6-8 weeks
✓ Progesterone—continuation of the pregnancy
⚫ Causes secretory changes in the
endometrium
⚫ Growth and thickening of the deciduas
⚫ Reduces uterine muscle contraction
⚫ Acts with estrogen and other hormones to
cause growth of the breast and secretion of
milk
✓ Testosterone if fetus is male
✓ Estrogen—causes enlargement of the uterus,
breast and growth of the ductal system of the
breast and enlargement of the external genitalia
✓ hPL—produced at about 6th week; promotes
normal nutrition and normal growth of the fetus
and maternal breast development for lactation
✓ Others: human chorionic thyrotropin and human
chorionic adrenocorticotropin
❑ Selective osmosis
✓ No direct exchange of maternal and fetal blood
✓ Oxygen and nutrients are transported through
the cell layers of the chorionic villi to the villi
capillaries
✓ Most drugs can cross the placental barrier
including nicotine and alcohol
❑ Minute breaks allows occasional crossing of fetal
cells and AFP
 4. Umbilical cord
❑ Formed from fetal membranes and provides a
circulatory pathway that connects the embryo to
the placenta
❑ Length: 53 cm (21 in); thickness: about 2 cm (¾
in)
❑ Transport oxygen and nutrients to the fetus
from the placenta and to return waste products
from fetus to the placenta
❑ 2 arteries (carries deoxygenated blood away from
the fetus)
❑ 1 vein (carries fresh oxygenated and nutrient-rich
blood from the placenta to the fetus)
AVA

❑ Wharton’s jelly
 5. Amniotic Membrane

a. Chorion
❑ Outermost and continuous with the surface of the
umbilical cord
❑ Supports the sac that contains the amniotic fluid
b. Amnion
❑ Supports and produces amniotic fluid
❑ Produces a phospholipid that initiates the production of
prostaglandin → uterine contractio → labor
 6. Amniotic Fluid

❑ Sources:
✓ Fetal urine
✓ Fluid transported from the maternal blood across the
amnion
❑ pH: 7.2
❑ Normal amount: 500-1500 mL
❑ Composition:
✓ Epithelial cells
✓ Leukocytes
✓ Urates
✓ Organic and inorganic salts
✓ Water
✓ Enzymes
✓ Hormones
✓ Lanugo
✓ Vernix caseosa
❑ Protects the fetus thru:
✓ Cushioning against impacts to the
maternal abdomen
✓ Providing stable temperature
✓ Prevents cord compression
✓ Helps in delivery process
❑ Promotes normal development thru:
✓ Allowing symmetric development
✓ Prevents the membranes from adhering to
the developing parts
✓ Allows buoyancy and room for fetal
movement
Fetal
Circulation
 Activity

❑ Read the notes on fetal circulation and

accomplish the following:
✓ Trace the path of fetal circulation from the placenta
through the fetal body and back to the placenta.
Present it in a diagrammatic scheme.
✓ Trace the path of blood circulation among a person
with
▪ Patent ductus arteriusus
▪ Patent foramen ovale