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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
Every month one of these will be stimulate
to develop and will be released.

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.

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

Ovarian steroid hormones are produced

and released under the action of FSH and

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

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.


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


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.


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

The embryo organogenesis is complex

and a variety of agents may cause

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.

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.

Umbilical cord has 2 arteries which carry

poorly oxygenated blood to the placenta,

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

Maternal physiology during pregnancy:

Physiological anemia of pregnancy;

The cardiac output increases by 40% until 30
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

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)

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,

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.

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


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.