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REPRODUCTIVE

PHYSIOLOGY AND
ANATOMY

PUBERTY
At 5 months of intrauterine life there are 7x

106 follicles in female fetus ovaries.


When puberty starts, at around 11 years of
age, in the ovaries are only about 250000
follicles.
Every month one of these will be stimulate
to develop and will be released.

PUBERTY
The ovary produce oestradiol, which in

childhood has a negative feed-back effect


on hypothalamus and pituitary gland.
At puberty, the sensitivity of these to
oestradiol will decrease and menarche will
occur few years after puberty.
Later, the endocrine system becomes
sufficiently coordinated to produce
ovulation each month.

MENSTRUAL CYCLE
The hypothalamus regulating hormones

orchestrate the activities of anterior


pituitary gland LHRH/LRH, CRH, GNRH,
TRH, somatostatin, PIF.
LRH regulates the secretion of LH and
FSH from anterior pituitary gland.
PIF controls the releasing of prolactin from
same gland

MENSTRUAL CYCLE
Ovarian steroid hormones are produced

and released under the action of FSH and


LH.
When the graafian follicle is enlarged,
increased amounts of oestradiol are
produced.
After the midcycle surge of LH, ovulation
occurs and the follicle is converted in
corpus luteum which produces
progesterone.

MENSTRUAL CYCLE
The increasing amount of oestradiol

produced by graafian follicle cause a


negative feedback to the hypothalamus,
inhibiting release of LHRH and therefore
also of FSH.
However, a positive feedback loop is
triggered to the anterior pituitary which
produce a surge of FSH and LH,
appearing ovulation.

MENSTRUAL CYCLE

Oestradiol and progesteron secretion decrease


after fading of corpus luteum, FSH increase
again and a new cycle begin.
Oestradiol stimulates growth of endometrium in
the first part of cycle.
In the second part of cycle, under the
progesterone influence, endometrial gland
become tortuous and convoluted, being a
secretory pattern after a proliferative one.
When they both decrease, the menstruation
starts.

CONCEPTION

The oocyte released by the graafian follicle at


the moment of ovulation is swept into the lumen
of fallopian tube by fimbriae.
Ciliated cells waft the egg to tubal ampulla,
where fertilization occurs.
Sperm is constantly produced, by a process of
maturation that takes 70-80 days, number of
spermatozoa at one ejaculation is huge, around
60-120 x 106 /ml.

CONCEPTION

The nuclei of both egg and sperm contain each


23 chromosomes. They fuse and in 30 hours
first cell division occurs, producing 2 cells, each
with 46 chromosomes.
After 6 days the fertilized egg gets to uterine
cavity, being fixed in endometrium.
It produces human chorionic gonadotrophin
hormone, which can be detect at 10 days after
fertilization.

PREGNANCY
The embryo organogenesis is complex

and a variety of agents may cause


malformation.
By 12 weeks of gestation organogenesis
is largely complete and the emphasis then
is on growth of the fetus and maturation of
its organ functions.

PREGNANCY
Placenta has a cardinal role in fetal growth

and assure the metabolic exchange for


the fetus. It consists of 2 layers:
cytotrophoblast and syncytiotrophoblast.
Cytotrophoblast invades deeply into the
spiral arteries, which are maternal vessels
supplying blood to the intervillous space.

PREGNANCY
Umbilical cord has 2 arteries which carry

poorly oxygenated blood to the placenta,


and 1 vein which brings good oxygenated
blood.
Foramen ovale (between atria) and ductus
arteriosus (between pulmonary artery and
aorta) are open during intruterine life.

PREGNANCY
Maternal physiology during pregnancy:

Physiological anemia of pregnancy;


The cardiac output increases by 40% until 30
weeks;
Renal blood flow and the glomerular filtration
rate increase;
Hyperventilation lowers the partial pressure of
carbon dioxide in maternal blood;
Constipation, urinary tract infection are
frequent.

PARTURITION
Labour is preceded by softening, dilatation

and effacement of the cervix. BraxtonHicks contractions are painless and are
not uncommon.
Usually, the fetal lie is longitudinal and the
presentation is cephalic.
Lies: longitudinal, oblique, transvers.
Presentation: vertex, face, brow, shoulder,
breech (frank, complete)

PARTURITION
Position: relation between the

denominator (occiput or sacrum) and the


maternal pelvis (right, left)
Stages of labour:

Complete dilatation of the cervix;


Delivery of the baby;
Delivery of the placenta;
Postpartum, lactation (oestrogen, prolactin,
oxytocin)

PELVIC ANATOMY
Ovaries are pale glands normally found on

the lateral pelvic wall. Ovarian arteries


arise from aorta and the veins accompany
the arteries.
The uterus is a muscular organ with a
shape of inverted pear, the upper part-the
corpus and the lower part- the cervix. It is
supported by a number of ligaments and
the muscles of the pelvic floor.

PELVIC ANATOMY
The fallopian tubes are very rare sites of

primary cancer, but may become involved


by spread from other structures.
The vagina can be involved in uterovaginal prolapse because its anatomical
position.

THE MENOPAUSE

Represents the cessation of menstruation and is


the counterpart of menarche, as the climacteric
is the counterpart of puberty.
Occurs around age of 51 and results from the
depletion of oocytes in the ovaries.
Oestradiol becomes low with no response from
LH and FSH.
GNRH levels reach a maximum in 2 years after
menopause and then decrease slowly.