ANATOMY AND PHYSIOLOGY

A. Female Reproductive System

The female reproductive organs are the ovaries, the uterine tubes, the uterus, the vagina, the
external genital organs, and the mammary glands. The internal reproductive organs are within
the pelvis between the urinary bladder and the rectum. The uterus and the vagina are in the
midline, with the ovaries on each side of the uterus. A group of ligaments holds the internal
reproductive organs in place. The most conspicuous of these ligaments is the broad ligament, an
extension of the peritoneum that spreads out on both sides of the uterus and attaches to the
ovaries and uterine tubes.

EXTERNAL STRUCTURES

1. Mons Veneris- The mons veneris is a pad of adipose tissue located over de symphysis
pubis, the pubic bone joint. Covered by a triangle of coarse, curly hairs, the purpose of
the mons veneris is to protect the junction of the pubic bone from trauma.

2. Labia Minora- Immediately posterior to the mons veneris spread two hair. less folds of
connective tissue, the labia minora. The labia minora vary greatly in size and shape.
Before menarche, these folds are fairly thin; by childbearing age, they increase in size
and chickness; and after menopause, they atrophy and again become much smaller.
Normally, the folds of the labia minora are pink in color; the internal surface is covered
with mucous membrane, and the external surface is covered with skin. The area is
abundant with sebaceous glands, so localized sebaceous cysts may occur here. People
who perform monthly vulvar examinations are able to detect infection or other
abnormalities of the vulva such as sebaceous cysts or herpes lesions.

3. Labia Majora- labia majora are two folds of tissue, fused anteriorly it separated
posteriorly, which are positioned lateral to the labia minora and composed of loose
connective tissue covered by epithelium and pubic hair. The labia majora serve as
 protection for the external genitalia; they shield the outlets to the urethra and vagina.
Trauma to the area, such as occurs from childbirth or rape, can lead to extensive edema
formation because of the looseness of the connective tissue base.

4. Vestibule- A flattened, smooth surface inside the labia. The openings to the bladder
(urethra) and the uterus (the vagina) both arise from his space.

5. Clitoris- The clitoris is a small (approximately 1 t0 2 cm), rounded organ of erectile tissue
at the forward junction of the labia minora. Externally, it is covered by a fold of skin, the
prepuce; is sensitive to touch and temperature; is the center of sexual arousal and orgasm.

6. Paraurethral glands- Two skene glands are located on each side of the urinary meatus;
their ducts open into the urethra.

7. Bartholin glands- Vulvovaginal glands are located on each side of the vaginal opening
with ducts that open into the proximal vagina near the labia minora and hymen.
Secretions from both of these glands help lubricate the external genitalia during coitus.

8. Fourchette- The ridge of the tissue formed by the posterior joining of the labia minora
and the labia majora. This is the structure that sometimes tears (laceration) or is cut
(episiotomy) during childbirth to enlarge the vaginal opening.

9. Hymen- tough but elastic semicircle of tissue that covers the opening to the vagina during
childhood. It is often torn during the time of first sexual intercourse.

INTERNAL STRUCTURE

1. Ovaries- The ovaries are approximately 3 cm long by 2 cm in diameter and 1.5 cm thick,
or the size and shape of almonds. They are grayish-white and appear pitted, with minute
indentations on the surface.
2. Fallopian Tube- The fallopian tubes arise from each upper corner of the uterine body and
extend outward and backward until each opens at its distal end, next to an ovary.
Fallopian tubes are approximately 10 cm long in a mature person. Their function is to
convey the ovum from the ovaries to the uterus and to provide a place for fertilization of
the ovum by sperm.

• Interstitial portion- The part of the tube that lies within the uterine wall.
This portion is only about 1cm in length; its lumen is only 1mm in
diameter.
• Isthmus- This is about 2cm and, like the interstitial tube, remains
extremely narrow. This portion of the tube is cut or sealed in a tubal
ligation, or tubal sterilization procedure.
• Ampulla- This third and is also the longest portion of the tube. It is about
5cm in length and is the portion of the tube where fertilization of an ovum
usually occurs.
• Infundibular- The most distal segment of the tube. It is about 2cm long,
funnel-shaped, and covered by fimbria (small hairs) that help guide the
ovum into the fallopian tube.

3. Uterus- The uterus is a hollow, muscular, pear-shaped organ located in the lower pelvis,
posterior part of the bladder, and anterior to the rectum. During childhood, it is about the
size of an olive the cervix is the largest portion and the uterine body is the smallest part.
At about 8 years of age, the uterus begins to enlarge. This growth is so slow; however, a
person is closer to 17 years old before the uterus reaches its adult size and changes its
proportions so that the body cavity, not the cervix, is its largest portion. With maturity, a
uterus is about 5 to 7 cm long, 5 cm wide, and, in its widest upper part, 2.5 cm deep. In a
non-pregnant state, it weighs approximately 60 g. The function of the uterus is to receive
the ovum from the fallopian tube; provide a place for implantation and nourishment;
furnish protection to a growing fetus; and, at maturity of the fetus, expel it from a
person's body. After a pregnancy, the uterus never returns to exactly its nonpregnant size
but remains approximately 9 cm long, 6 cm wide, 3 cm thick, and 80 g in weight.

4. Cervix- The cervix is the lowest portion of the uterus. It represents about one-third of the
total uterine size and is approximately 2 to 5 cm long. About half of it lies above the
vagina and half extends into the vagina. Its central cavity is termed the cervical canal.
The opening of the canal at the junction of the cervix and isthmus is the internal cervical
os the distal opening to the vagina is the external cervical os. The level of the external os
is at the level of the ischial spines (an important relationship in estimating the level of the
fetus in the birth canal at the time of birth).
• Endometrium- Inner layer of the mucus membrane. The endometrium
is the inner lining of the uterus. Each month, the endometrium thickens
and renews itself, preparing for pregnancy. If pregnancy doesn't occur,
the endometrium sheds in a process known as menstruation. If
conception takes place, the embryo implants into the endometrium.
 • Myometrium- A middle layer of muscle fibers. The myometrium is the
main component in the enlargement of the uterus during pregnancy.
The myometrium is the distinct muscular layer of the uterine wall,
which is involved in contraction during labor.
• Perimetrium- An outer layer of connective tissue. The serous layer
secretes a lubricating fluid that helps to reduce friction. The
perimetrium is also part of the peritoneum that covers some of the
organs of the pelvis.

B. ANATOMY OF THE BREAST

1. Areola- The areola is the circular dark-colored area of skin surrounding the nipple.
Areolae have glands called Montgomery’s glands that secrete a lubricating oil. This oil
protects the nipple and skin from chafing during breastfeeding.
2. Lobes: Each breast has between 15 to 20 lobes or sections. These lobes surround the
nipple like spokes on a wheel.
3. Glandular tissue (lobules): These small sections of tissue found inside lobes have tiny
bulblike glands at the end that produce milk.
4. Milk (mammary) ducts: These small tubes, or ducts, carry milk from glandular tissue
(lobules) to nipples.
5. Nipple- The nipples are very sensitive to tactile stimulation and contain smooth muscle
cells that contract, causing the nipple to become erect in response to stimulation. These
smooth muscle cells respond to stimuli such as touch, cold, and sexual arousal.
C. Male Reproductive System
The male reproductive system contains the external genitals (the penis, testes and the scrotum)
and internal parts, including the prostate gland, vas deferens and urethra. A man’s fertility and
sexual traits depend on the normal functioning of the male reproductive system, as well as
hormones released from the brain.

EXTERNAL STRUCTURES
1. Scrotum- The scrotum is a rugated, skin-covered, muscular pouch sus. rended from
the perineum. Its functions are to support the Estes and help regulate the temperature
of sperm. In very cold weather, the scrotal muscle contracts to bring the testes closer
to the body. In very hot weather, or in the presence of fever, the muscle relaxes,
allowing the testes to fall away from the body. In this way, the temperature of the
testes can remain as even as possible to promote the production and viability of
sperm.

2. Testes- The testes are two ovoid glands, 2 to 3 cm wide, that reg in the scrotum. Each
testis is encased by a protective white fibrous capsule and is composed of a number of
lobules. Each lobule contains interstitial cells (Leydig cells) that produce testosterone
and a seminiferous tubule that produces spermatozoa.
 3. Penis- penis shaft. The urethra passes through these layers of tissue, allowing the
penis to serve as both the outlet for the male urinary and reproductive tracts. With
sexual excitement, nitric oxide is released from the endothelium of blood vessels.
This causes dilatation and an increase in blood flow to the arteries of the penis
(engorgement).

INTERNAL STRUCTURE

1. Epididymis- The seminiferous tubule of each testis leads to a tightly coiled It is about
8 in (18 to 2 structures, it is lined wit tube, the epididymis, which is responsible for
conducting sperm from the tubule to the vas deferens, the next step in the passage to
the outside. Because each epididymis is so tightly coiled, its length is extremely
deceptive; it is over 20 ft long. Some sperm are stored in the epididymis, and a part of
the alkaline fluid (semen, or seminal fluid that contains a basic sugar and protein) that
will surround sperm at maturity is produced by the cells lining the epididymis.

2. Vas Deferens (Ductus Deferens)- The vas deferens is an additional hollow tube
surrounded by arteries and veins and protected by a thick fibrous coating. Altogether,
these structures are referred to as the spermatic cord. It carries sperm from the
epididymis through the inguinal into the abdominal cavity, where it ends at the
seminal vesicles and the ejaculatory ducts below the bladder. Sperm complete
maturation as they pass through the vas deferens. They are still not mobile at this
point, however, probably because of the fairly acidic medium of semen.
 3. Seminal Vesicles- The seminal vesicles are two convoluted pouches that lie along the
lower portion of the bladder and empty into the urethra by ejaculatory ducts. These
glands secrete a viscous alkaline liquid with high sugar, protein, and prostaglandin
content. Sperm become increasingly motile because this added fluid surrounds them
with a more favorable pH environment.

4. Prostate Gland- The prostate is a chestnut-sized gland that lies just below the bladder
and allows the urethra to pass through the center of it, like the hole in a doughnut.
The gland's purpose is to secrete a thin, alkaline fluid, which, when added to the
secretion from the seminal vesicles, further protects sperm by increasing the naturally
low pH level of the urethra.

5. Bulbourethral Glands- Two bulbourethral, or Cowper, glands lie beside the prostate
gland and empty by short ducts into the urethra. They supply one more source of
alkaline fluid to help ensure the safe passage of spermatozoa. Semen, therefore, is
derived from the prostate gland (60%), the seminal vesicles (30%), the epididymis
(5%), and the bulbourethral glands (5%).

6. Urethra- The urethra is a hollow tube leading from the base of the bladder, which,
after passing through the prostate gland, continues to the outside through the shaft and
glans of the penis. It is about 8in (18 to 20cm). Like other urinary structures, it is
lined with mucous membranes.

D. PHYSIOLOGICAL CHANGES DURING PREGNANCY

1. Reproductive System
• By 12 weeks of pregnancy, the enlarging uterus may cause the woman’s
abdomen to protrude slightly. The uterus continues to enlarge throughout
pregnancy. The enlarging uterus extends to the level of the navel by 20 weeks
and to the lower edge of the rib cage by 36 weeks. The amount of normal
vaginal discharge, which is clear or whitish, commonly increases. This
increase is usually normal. However, if the discharge has an unusual color or
smell or is accompanied by vaginal itching and burning, a woman should see
her doctor. Such symptoms may indicate a vaginal infection. Some vaginal
infections, such as trichomoniasis (a protozoan infection) and candidiasis (a
yeast infection), are common during pregnancy and can be treated.
a. Cervix- Increase in cell numbers due to estrogen
o Secretes a thick, sticky mucus that forms a plug in the cervix
(operculum).
o Goodell’s sign- softening of the cervix.
o Chadwick’s sign- the purplish-blue color of the cervix and vagina due
to increased vascularity noted at 8 weeks. Ph level- 4-5 (lactobacillus
acidophilus)
 b. Ovaries- Follicles do not mature. Ovulation does not occur. The Corpus luteum
produces progesterone and estrogen for about 12 weeks.
c. Vagina- Increase in vaginal secretions called leukorrhea
o Increased levels of glycogen in cells may enhance the growth of
organisms such as Trichomonas vaginalis or Candida albicans.
o Increase in vascularity change in violet color (Chadwick’s sign)
o pH of vagina changes from normally acidic to alkaline (due to
increased levels of estrogen).
2. Breast
a. Enlargement - Going up a cup size or two is normal when pregnant, especially
during the first pregnancy. This growth can begin early on in pregnancy and continue
throughout. Rapid growth can cause the breasts to feel itchy as the skin stretches.
The breasts may also continue to increase in size after birth during nursing.

b. Dark areola- The areolas are the colored circles around the nipples. Over the
course of the second and third trimesters, the areolas often become larger and
darker. Darkening areolas are likely to result from hormonal changes. Often, the
areola returns to its pregnancy color after breastfeeding, but it sometimes remains
a shade or two darker than it was originally.

c. Bumps- Pregnancy causes small, painless bumps to appear on the areolas.

These are oil-producing glands called Montgomery’s tubercles, and they lubricate
the breasts and promote easier breastfeeding.

d. Lumps- Lumpy breasts affect some individuals during pregnancy. Usually,

these lumps are not a cause for concern. They are often either galactoceles, which
are clogged milk ducts or fibroadenomas, which are benign breast tumors.

e. Stretch marks- Rapid tissue growth causes the skin to stretch, which may lead
to striae gravidarum or stretch marks. Research indicates that pregnant people
develop stretch marks on their bodies, most commonly on the breasts, stomach,
and thighs. These red lines typically occur in months 6 and 7 of pregnancy but can
also appear before or after this time.

c. Milk production- After delivery, or sometimes before, the breasts produce small
amounts of colostrum. This fluid helps boost the baby’s immune system.
Newborn babies have very small stomachs and only require modest amounts of
colostrum to meet their nutritional needs. Over the next few days, the breasts
begin to produce milk instead of colostrum. Breast milk production typically
starts between 5 days and after delivery.

3. Integumentary System
 a. Melasma- Blotchy, a brownish pigment that may appear on the skin of the
forehead and cheeks.
b. Linea Nigra- A dark line commonly appears down the middle of the abdomen.
These changes may occur because the placenta produces a hormone that
stimulates melanocytes, the cells that make a dark brown skin pigment (melanin).
c. Palmar erythema- As early as the second month of pregnancy, the insides of
your hands and the bottoms of your feet may itch and take on a darker or reddish
hue. This redness and itchiness of the palms is called palmar erythema
d. Spider Nevi- A spider nevus is a collection of small, dilated arterioles (blood
vessels) clustered very close to the surface of the skin. The cluster of vessels is
web-like, with a central spot and radiating vessels. Spider nevi (plural) can be
caused by injuries, sun exposure, hormonal changes, or liver disease, but often the
cause is unknown. For most people, the nevi are not a medical concern. In some
cases, they cause discomfort.

4. Gastrointestinal System
- As pregnancy progresses, pressure from the enlarging uterus on the rectum and
the lower part of the intestine may cause constipation. Constipation may be
worsened because the high level of progesterone during pregnancy slows the
automatic waves of muscular contractions in the intestine, which normally move
food along. Eating a high-fiber diet, drinking plenty of fluids, and exercising
regularly can help prevent constipation. Pica, a craving for strange foods or
nonfoods (such as starch or clay), may develop.
o Nausea and Vomiting “morning sickness”
o Occurs in the first trimester
o Causes:
Increased HCG levels
Increased estrogen and progesterone levels
Decreased maternal glucose levels as glucose are utilized by the fetus
o Hyperemesis gravidarum- excessive vomiting in pregnancy persisting
beyond 3 months.

5. Respiratory System
o Increased tidal volume
o Upward displacement of the diaphragm
o Shortness of breath
o Chest crowding
o Slight hyperventilation
o Congestion or stuffiness of the nasopharynx

6. Musculoskeletal
 o Relaxation of the pelvic joints results in the classic “waddling” gait
seen in pregnancy
o Physiologic lordosis (“pride of pregnancy”)
o Curvature of the lumbar spine increases to compensate for the weight
of the gravid uterus.
o Results in low back pain

7. Endocrine System
o Increased basal metabolic rate
o Average weight gain is 3 to 5 pounds in the first trimester and 12 to 15
pounds in each of the following trimesters.
o The increase in total weight is 22-25 lbs.
o Water retention occurs during pregnancy due to increased sex
hormones and decreased serum protein.
o Increased production of prolactin
o Increased estrogen levels
o Increased cortisol levels

8. Immune System
- immunologic competency during pregnancy decreases, probably to prevent a
pregnant person's body from rejecting the fetus as if it were a transplanted organ.
Immunoglobulin G (IgG) production is particularly decreased, which can make a
pregnant person more prone to infection during pregnancy. A simultaneous
increase in the white blood cell count may help to counteract this decrease in the
IgG response.

E. MENSTRUAL CYCLE
A menstrual cycle (the chromosomal female reproduction cycle) is episodic uterine bleeding in
response to cyclic hormonal changes. The purpose of a menstrual cycle is to bring an ovum to
maturity and renew a uterine tissue bed that will be necessary for the ovum's growth should it be
fertilized. Because menarche may occur as early as 9 years of age, it is good to include health
teaching information on menstruation t both school-aged children and their parents as early as
fourth grade as part of routine care. The length of menstrual cycles differs from person to person,
but the average length is 28 days from the beginning of one menstrual flow to the beginning of
the next, is not unusual for cycles to be as short as 23 days or as long as 35 days. The length of
the average menstrual flow (termed menses) is 4 to 6 days, although menses may be as short as 2
days or as long as 2 days (Ledger, 2018).

Characteristics Description
Beginning (Menarche) The average age at onset, 12.4 years; average
range 9-17 years
Interval between cycles Average, 28 days; cycles of 23-35 days not
unusual
Duration of menstrual flow Average flow, 4-6 days; range 2-9 days not
abnormal
Amount of menstrual flow Difficult to average estimated 30-80ml per
menstrual period; saturating a pad or tampon
in less than 1 hour is heavy bleeding
Color of menstrual flow Dark red; a combination of blood, mucus, and
endometrial cells
Odor Similar to marigolds
Dysmenorrhea Painful menstruation
Menorrhagia Heavy menstrual flow
Amenorrhea Absence of menstruation
Menopause Cessation of menstrual flow (40-45 years old)

F. OVULATION
Ovulation is a part of your menstrual cycle. It occurs when an egg is released from your ovary.
When the egg is released, it may or may not be fertilized by sperm. If fertilized, the egg may
travel to the uterus and implant to develop into a pregnancy. If left unfertilized, the egg
disintegrates and the uterine lining is shed during your period.

G. FERTILIZATION AND IMPLANTATION

Fertilization is the natural life process, which is carried out by the fusion of both male and female
gametes, which results in the formation of a zygote. In humans, the process of fertilization takes
place in the fallopian tube. During this process, semen comprising thousands of sperms are
inseminated into the female vagina during coitus. The sperms move towards the uterus and reach
the opening of the fallopian tube. only a few sperm will succeed in reaching the opening of the
fallopian tube. The secondary oocyte is released from the matured Graafian follicle of the ovary
and enters the fallopian tube, where it is fertilized within 24 hours, after which it is released from
the ovary. Though surrounded by several sperms, the oocyte is fertilized by a single sperm.
During meiosis II, the sperm enters the secondary oocyte and completes meiosis. After this, the
secondary oocyte is known as the egg. Both sperm and egg can show their vitality only for a
limited period. Sperm is alive for 48-72 hours in a female reproductive system, whereas the egg
can be fertilized for 24 hours before it is released.

H. CAPACITATION
Capacitation, generally speaking, is the change sperm undergo in the female reproductive tract
that enables them to penetrate and fertilize an egg. This step is a biochemical event; the sperm
moves normally and looks mature prior to capacitation. It is important to note that once the
sperm reaches the egg, it does not mean that it is capable of fertilizing it immediately. In order to
fertilize the egg, the sperm must undergo the process of capacitation in the reproductive tract
where a number of enzymes and signaling molecules are involved. This process can take around
10 hours, which means that the fertilization time is approximately 24 hours. Capacitation causes
a series of changes in sperm’s biochemical composition and structure such that they develop
increased motility and are prepared for interactions with the egg (or oocyte) at fertilization.
Essentially, the sperm becomes able to break through the membrane (known as the zona
pellucida) that surrounds the egg. Once sperm is able to traverse the zona pellucida, it can begin
the process of fertilizing the egg.

I. LACTATION
Lactation is the process of making human milk. Human milk is secreted through the mammary
glands, which are located in the breasts. Lactation is hormonally driven and occurs naturally in
people who are pregnant. Lactation begins as early as a few weeks into the second trimester of
your pregnancy. As estrogen and progesterone levels rise, your body prepares for lactation by
increasing the number of milk ducts in your breasts, and those milk ducts will transport milk
from the alveoli to your nipples. About midway through pregnancy, your body creates colostrum,
which is the baby’s first milk.

• Lactogenesis I- - Milk synthesis process begins on the 5th-6th month.

Colostrum is secreted.
• Lactogenesis II- Triggered by the delivery of the placenta. Progesterone
decreases and prolactin is no longer inhibited.
• Lactogenesis III- Day 10 until weaning. Called the mature milk
• Lactogenesis IV- occurs after weaning. The breast returns to its pre-lactation

J. Maternal Circulation
Maternal circulation or Uteroplacental circulation is mostly developed after the end of the first
trimester. The maternal blood enters the placenta through the basal plate endometrial arteries
(spiral arteries), traversing into the intervillous spaces, and flows around the villi. The maternal
blood perfusing around the villi exchanges nutrients and oxygen with fetal blood and drains back
through the placenta intervillous space into the venous openings in the basal plate, to return into
the maternal systemic circulation through uterine veins. The flow of maternal blood into the
placenta is propelled by maternal arterial pressure because of the low-resistance nature of
uteroplacental vessels, which adapt and accommodate the massive increase in uterine perfusion
during the rest of the course of pregnancy

K. Fetal Circulation

The fetal circulatory system uses 3 shunts. These are small passages that direct blood that needs
to be oxygenated. The purpose of these shunts is to bypass the lungs and liver. That's because
these organs will not work fully until after birth. The shunt that bypasses the lungs is called the
foramen ovale. This shunt moves blood from the right atrium of the heart to the left atrium. The
ductus arteriosus moves blood from the pulmonary artery to the aorta.
Oxygen and nutrients from the mother's blood are sent across the placenta to the fetus. The
enriched blood flows through the umbilical cord to the liver and splits into 3 branches. The blood
then reaches the inferior vena cava. This is a major vein connected to the heart. Most of this
blood is sent through the ductus venosus. This is also a shunt that lets highly oxygenated blood
bypass the liver to the inferior vena cava and then to the right atrium of the heart. A small
amount of this blood goes straight to the liver to give it the oxygen and nutrients it needs.

Waste products from the fetal blood are transferred back across the placenta to the mother's
blood.

L. FETAL GROWTH
Age of Gestation Fetal growth and Development
End of the 4th Gestational Week ✓ The length of the embryo is 0.75cm; its
weight is 400mg
✓ The spinal cord is formed and fused at the
midpoint.
✓ The head is large in proportion and
represents about one-third of the entire
structure.
✓ The rudimentary heart appears as a
prominent bulge on the anterior surface.
✓ Arms and legs are bud-like structures;
rudimentary eyes, ears, and nose are
discernable.

End of Eight Gestational Week
✓ The length of the fetus is about 2.5cm
(11in); its weight is about 20g
✓ Organogenesis is complete
✓ The heart, with a septum and valves, beats
rhythmically.
✓ Spontaneous movements are possible,
although they are usually too faint to be felt
by the mother.
✓ Some reflexes, such as Babinski effect, are
present.
✓ Bone ossification centers begins to form.

End of 16th Gestational Week
End of 20th Gestational Week
✓ Tooth buds are present
✓ Sex is distinguishable on outward
appearance
✓ Urine secretion begins but may not be
evident in amniotic fluid.
✓ The heartbeat is audible through Doppler
technology.
✓ The length of the fetus is 10cm to 17cm;
weight is 55 to 120g
✓ Fetal heart sounds are audible by an
ordinary stethoscope
✓ Lanugo is well-formed
✓ Both the liver and the pancreas are
functioning
✓ The fetus actively swallows amniotic
fluid, demonstrate is present in amniotic
fluid.
✓ Sex can be determined by ultrasound.
✓ The length of the fetus is 25cm; weight is
223g
✓ Spontaneous fetal movements can be
sensed by the mother
✓ Antibody production is possible
✓ Hair, including eyebrow, forms on the
head, vernix caseosa begins to cover the
skin
✓ Meconium is present in the upper intestine
✓ Brown fat, a special fat that aids in
temperature regulation, begins to form
behind the kidneys, sternum, and posterior
neck.
✓ Passive antibody transfer from the
pregnant person to fetus begins
✓ Definite sleeping and activity patterns are
distinguishable as the fetus develops
biorhythms that will guide sleep/wake
patterns throughout life.
End of 24th Gestational Week (Second ✓ The length of the fetus is 28cm to 36cm;
Trimester) weight is 55og
✓ Meconium is present as far as the rectum
✓ Active production of lung surfactant
begins
✓ Eyelids, previously infused since the 12th
week, now open; pupils react to light
✓ Hearing can be demonstrated by response
to sudden sounds
✓ When fetuses reach 24 weeks, or 500 to
600g, they have achieved a practical low-
end age of viability if they are cared for
after birth in a modern intensive care
nursery

End of 28th Gestational Week ✓ The length of the fetus is 35 to 38cm;

weight is 1200g
✓ Lung alveoli are almost mature; surfactant
can be demonstrated in amniotic fluid
✓ Testes begins to descend into the scrotal
sac from the lower abdominal cavity
✓ The blood vessels of the retina are formed
but thin and extremely susceptible to
damage from high oxygen concentrations
(an important consideration when caring
for preterm infants who need oxygen)

End of 32nd Gestational Week ✓ The length of the fetus is 38 to 43cm;

weight is 100g
✓ Subcutaneous fat begins to be deposited
(the former stringy, “little old man”
appearance is lost)
✓ Fetus responds by the movement to sound
outside the pregnant person’s body
✓ An active Moro reflex is present
✓ Iron stores, which provide iron for the
time during which the neonate will ingest
breast milk after birth, are beginning to be
built.
End of 36th Gestational Week
End of the 40th Gestational Week (Third
Trimester)
✓ The length of the fetus is 42 to 48cm;
weight is 1,800 to 2,700g (5 to 66 lbs.)
✓ Body stores of glycogen, iron,
carbohydrate, and calcium are deposited
✓ Additional amounts of subcutaneous fats
are deposited
✓ Sole of the foot has only one or two
crisscross creases compared with a full
crisscross pattern evident at term
✓ Amount of lanugo begins to diminish
✓ Most fetuses turn into a vertex (head
down) presentation during this month
✓ The length of the fetus is 48 to 52cm
(crown to tump, 35 to 37 cm); weight is
3,000g (7 to 7.5 lbs)
✓ Fetus kicks actively. Sometimes hard
enough to cause pregnant person
considerable discomfort
✓ Fetal hemoglobin begins its conversion to
adult hemoglobin
✓ Vernix caseosa start to decrease after the
infant reaches 37 weeks gestation and may
be more apparent in the creases than the
covering of the body as infant approaches
40 weeks or more gestational age.
✓ Fingernails extend over the fingertips
✓ Creases on the sole of the feet cover at
least two-thirds of the surface
 M. PHYSIOLOGY DIAGRAM

Primary follicle in ovary

containing immature ovum

Follicle stimulating hormone

from the anterior pituitary gland

Follicle matures

Secretes Corpus Ovulation: Ovum is

progesterone luteum released
(and estrogen) formed in
which support ovary
any subsequent
pregnancy
Ovum fertilized

Ovum not
Secrets human Embeds in uterine fertilized
chorionic wall
Gonadotrophin

Menstruation
Pregnancy

New cycle
begins
 REFERENCES

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