Maternal 1 Side-notes: Menstruation
fallopian tubes
Menstruation
⁃ 30 to 60cc of blood
⁃ Bring ovum to maturity
⁃ Renew uterine tissue bed
⁃ Conception and implantation of new
life
⁃ Average length: 28 days
⁃ From beginning of one menstrual
flow to beginning of next
⁃ Color: dark red
⁃ Mucus and endometrial cells
Menstruation Process:
1. Hypothalamus
2. GnRH (AKA: Luteinizing hormone-
releasing hormone)
3. Anterior pituitary gland
4. Release of Hormones
FSH- ovum maturation
LH- ovulation and growth of uterine lining
5. Ovary
⁃ follicular fluid with high degree of
estrogen (mainly estradiol)
⁃ Small ovum= graafian follicle
⁃ LH = prostaglandin = graafian follicle
ruptures
⁃ Ovum set free = OVULATION
⁃ Ovum proceed to end of fallopian
tube
6. Uterus
⁃ uterine changes result of stimulation
from hormones of ovaries
Estrogen Effects
⁃ blocks FSH
⁃ Hypertrophy and hyperplasia of
myometrium
⁃ Growth of breast
⁃ Increase cervical mucus
(spinnbarkeit test of dilation): 10-13cm
⁃ Regulate fluid and electrolytes
⁃ Protein synthesis
⁃ Lowers cholesterol level
Progesterone Effects
⁃ blocks LH
⁃ Transport fertilized ovum into
⁃ Fluid retention
⁃ Decreased Hgb and Hct levels
⁃ Increased basal body temperature
⁃ Corpus luteum
⁃ Endometrium implantation
⁃ Lactation
⁃ Decrease GI motility
⁃ Permeability of kidney (lactose and
dextrose)
⁃ Mood swings
3rd Day of Cycle
⁃ serum estrogen at lowest level
Follicle Stimulating Hormone Releasing Factor
(FSHRF)
⁃ hypothalamus
⁃ In response to decrease serum
estrogen level
⁃ FSH = anterior pituitary gland
Primordial follicle
⁃ immature oocyte
⁃ Stimulate by FSH to grow
⁃ Estrogen to be produced inside
Graafian Follicle
⁃ contains high amounts of estrogen
⁃ estrogen inside cause uterine cells
to grow rapidly (8 fold thickness)
⁃ Result: Proliferative or Follicular
Phase
13th Day of Cycle
⁃ Serum progesterone at lowest level
Luteinizing Hormone Releasing Factor (LHRF)
⁃ In response to decrease
progesterone
⁃ anterior pituitary = LH
LH
⁃ stimulate ovary to produce
progesterone
Note:
⁃ Estrogen and progesterone push
new mature ovum to surface of ovary until 14th day
⁃ GF rupture= mature ovum=
ovulation
Ovulation
⁃ GF high in progesterone
⁃ Progesterone = corpus luteum
(yellowish appearance)
Progesterone
⁃ uterine endothelium to corkscrew or
twisted in appearance
⁃ HORMONE OF PREGNANCY
⁃ Prevents uterine contraction
Estrogen
⁃ Hormone of menstrual cycle
Trophoblast
⁃ fertilized ovum
⁃ Finger-like projections around
blastocyst
⁃ Implants on surface of uterus
Note:
⁃ Ovulation 2 weeks before next
menstruation
⁃ 14 days prior to 1st day of next
menstrual cycle
⁃ Menstrual cycle from day 1 to next
day 1 of next cycle
Fertilization
⁃ conception and impregnation
⁃ Union of ovum and spermatozoon
⁃ Ampulla of fallopian tube
⁃ One ovum will reach maturity
Mature Ovum
⁃ lifespan: 24-48hrs
⁃ Atrophies and non-functional
⁃ With ring of mucopolysaccharide
fluid and circle of cells
72hrs
⁃ critical time for fertilization to be
successful
Zona Pellucida-mucopolysaccharide fluid and
Corona Radiata Circle of Cells
⁃ Increase bulk of ovum
⁃ Protective buffer against injury
Fimbriae (WALIS)
⁃ propelled ovum to fallopian tube
90 seconds
⁃ Spermatozoa to reach cervix
5 minutes
⁃ Spermatozoa to reach outer
fallopian tube
Capacitation
⁃ Final process of sperm for
fertilization
⁃ As sperm move towards ovum
⁃ Change plasma membrane of head
of sperm
⁃ Reveals sperm binding receptor
sites
Hyaluronidase
⁃ Proteolytic enzyme from sperm
⁃ Dissolves layer of cells protecting
ovum
⁃ Sperm penetration to ovum
⁃ Dissolves corona cells
Zygote (46 chromosomes)
⁃ fusions of spermatozoon and ovum
⁃ Sperm: 23 chromosomes
⁃ Ovum: 23 chromosomes
⁃ 22 autosomes and 1 sex
chromosomes
Implantation
⁃ Complete fertilization
⁃ Zygote migrate to body of uterus
⁃ Mitotic cell division (cleavage
begins)
⁃ 8-10 days after fertilization
Mitotic Cell Division
⁃ 1st cleavage at 24hrs
⁃ Cleavage division 1x q 22hrs
⁃ Zygote 16 to 50 cells (Morula Stage)
Blastocyst
⁃ Morula stage (bumpy outward
appearance)
⁃ Morus= mulberry
⁃ Large cells collection
⁃ Attaches to uterine endometrium
⁃ Inside cell
⁃ Invades endometrium to receive
nourishment
 ⁃ Later become EMBRYO ⁃ Ovulation to fertilization
2. Zygote
Trophoblast ⁃ Fertilization to implantation
⁃ cells outer ring 3. Embryo
⁃ Outside cell ⁃ Implantation to 5-8 weeks
⁃ Produces proteolytic enzymes that 4. Fetus
dissolves any tissue ⁃ 5-8 weeks to Term
⁃ Later become PLACENTA
Conceptus
Events of Implantation: ⁃ developing embryo/ fetus and
Implantation placenta throughout pregnancy
⁃ contact of zygote and uterine
endometrium Gametes
⁃ sperm and egg cells
1. Apposition
⁃ zygote brushes against uterine Human Chorionic Gonadotropin (HcG)
endometrium ⁃ stimulates estrogen and
⁃ 2nd phase of menstrual cycle progesterone
⁃ Trophoblast tissue and early
2. Adhesion embryos
⁃ attaches to surface of endometrium ⁃ Stimulate corpus luteum to produce
progesterone to maintain pregnancy
3. Invasion
⁃ Settles down into soft folds

Note:
⁃ Zygote implanted = EMBRYO

Time of Ovulation (regular cycle)

⁃ Subtract 16 from number of days in
cycle then add 4

Signs and Symptoms of Ovulation

1. Mittlelschermz
⁃ Abdominal tenderness
⁃ Left or right illiac regions
⁃ Peritoneal irritation from blood
coming out from graafian follicle

2. Spinnbarkeit
⁃ Vaginal secretion clear and
transparent

3. Change vaginal mucus

4. Goodel’s sign
5. Mood changes
6. Breast tenderness
7. Increase progesterone
8. Change basal body temperature

Anterpartal Period:
1. Ovum