Obstetrics Female Reproductive Organ External Structures Mons Pubis- is a fatty pad that lies over the anterior surface of the symphysis pubis covered with curly hair (puberty) Labia Majora- are two rounded folds of fatty tissue covered with skin that extend downward and backward from the mons pubis
Cardinal Round Uterosacral Broad
4 pairs of ligaments that support the Uterus Uterus
Corpus
isthmus
Cervix
Uterine walls *Endometrium-shed during menstruation
Labia Minora- are two flat, reddishfolds of tissue visible whenthe labia majora are separated
*Myometrium-Extends longitudinal, transverse, oblique
Prepuce- hoodlike covering of the clitoris formed by fusing of labia minora
Longitudinal Fibers- mostly found in the fundus and this arrangement assist in expelling the fetus duringbirth process Middle layer-has fibers that form a figure 8 and this arrangement assist in constricting blod vessels after childbirth and control blood loss. Circular Fibers- help keep the cervix closed during pregnancy and prevent menstrual blood from flowing back into the uterine tubes during menstruation. *Peritoneum
Frenulum- fold tissue under the clitoris Fourchette – a thin flat tissue, junction of two labia minora underneath the vaginal opening at midline. Clitoris- is located underneath the prepuce composed of erectile tissue with numerous sensory nerve endings. Viginal Vistibule- is an “almond-shaped” area enclosed by the labia minora that contains opening to the urethra, Skene glands, Vagina, and Bartholin Glands. Urethra-2.5 cm below the clitoris Skene Glands- are located on each side of the urethra and produce mucus, which aids in lubrication of the vagina.
Cul-de-sac of Douglas - deep pouch, or recess posterior to the cervix and formed by the posterior ligament.
Hymen- a connective tissue membrane, surrounds the vaginal opening.
Fundus- dome shaped, top of the uterus, site where the uterine tubes enter the uterus.
Bartholin glands- lie under the constrictor muscles of the vagina and are located posteriorly on the sides of the vaginal opening, also secreting mucus during sexual arousalto lubricate the vaginal introitus
Isthmus-(lower uterine segment) separate the Corpus and the Cervix
Perineum- found between the fourchette and the anus, a skin covered muscular area tha t covers the pelvic structure. Pelvic organs are supported by mucles and ligaments to for a sling.
Internal Structures Vagina - is a fibromuscular, collapsible tubular structure that extends from the vulva to the uterus and lies between the bladder and the rectum. - serves as a passageway for menstrual flow, copulation and birthcanal Rugae- allow the vagina to expad during childbirth Estrogen Deprivation= after childbirth, during lactation, and menopause causes dryness and thinnes of the vaginal walls and smoothing of the rugae. pH 4-5 acidic vaginal secretion. Fornices- pockets (anterior, posterior & lateral) palpation area Uterus- is a muscular organ shaped like and upsidedown pear that sits midline in the pelvic cavitybetween the bladder and the rectum above the vagina. - serves for reception, implantation, retention, and nutrition of ther fertilized ovumand later the fetus during pregnancy and expulsion of the fetus during childbirth,
also for cyclic menstruation.
Cervix- made mostly with fibrous connective tissue and elastic tissue, making it possible for the cervix to stretch during vaginal childbirth Internal OS- the opening between the uterine cavity and the canal that connects the uterine cavity to the vagina 9 endocervical canal Enternal OS- narrowed opening between the endocervix and the vagina, a small circular opening in women who have never been pregnant. Fells like the nose with a dimple on the center. Outer Cervix- covered with a layer os squamos epithelium. Mucosa of the cerviacal canal- coverd with columnar epithelium and contains numerous glans that secrete mucus in response to ovarian hormones. Squamocolumnar junction (transformation jxn)- where two types of cells meet is usually located just inside th cervical os. - Common site os neoplastic changes and site for Pap Smear. Fallopian tube- attach to the utertine fundus supported by braod ligaments (8-14 cm in leght) - provide a passage between the ovaries and the uterus for the passage of the ovum. Ovaries- are two almond-shaped organs located on each side of the uterine tubes
- for ovulation and production of Estrogen, Progesterone, and Androgen. PCPS/07-2409
Breast - paired mammary glands loc. @ 2nd and 6th ribs - lies over the pectoralis major b/w strnum and midmaxillary line -attatced to the muscles by a connective tissue called Fascia. Tail of Spence- extension to the axilla Serratus anterior muscle-where the lowest third of the breast overlies Estrogen stimulates growth of the breast and increases vascularity of breast tissue Progesterone- Increase of this hormone @ pubety causes maturation of mammary gland tissue specifically lobules and acinar structures. Fat deposition- during adolescence may contribute to increase in size. 15-20 lobes- each breast is made of.. Lobules- division of lobes, cluster of acini Acinus – a sac-like terminal part of a compound gland emptying through a narrow lumen or duct. Acini- lined lined with epithelial cells that secrete colostrun abd milk. Myoepitheilium- expels milk from acini by cxn Mamary papilla- “single nipple” surrounded by areola. Contains 15-20 openings of lactiferous ducts Areola- rough looking due to sebaceous glands, Montgomery tubercles directly beneath the skin that secrete substance believed to lubricate the nipples. Lactiferous sinuses/ampullae – formed when ducts converge and dilate which servers a milk reservoir. Cooper’s Ligaments- provide support to the mammary glands while permitting their mobility on the chest wall. Menstruation Puberty- transitional stage between childhood and sexual maturity. 8-11y/o secretions of small amounst of estrogen is visible. Menarche- “first menstruation.” Menstrual Cycle Menstruation is a periodic uterine bleeding that begins approx. 14 days of ovulation. -Adequate prodxn of estrogen is needed for regular menstruation. -It is a complex interplay of events that occur simultaneously in the endometrium, hypothalamus, ovaries and the pituitary glands. - prepares the uterus for pregnancy. -28 day cycle (some may vary) -ave. 5days (ranges 3-6days) -ave. 50ml (20-80ml) of blood Factors: physical emotional environmental Hypothalamus-pituitary cycle Occurs when there is no fertilization and implantation and levels of progesterone and estrogen decline, menstruation occurs and the hypothalamus is once again stimulated to secrete GnRH Gonadotropin Releasing Hormone (GnRH) -it stimulates the pituitary secretion of foliicle-stimulating hormone (FSH) FSH- stimulates the development of ovarian graafian follicles and their prodxn of estrogen Luteinizing Hormone (LH)- from pituitary gland triggered by decrease of estrogen level and Hypothalamin GnRH - for expulsion of the ovum from the graafian follicle by approx. 24-36hrs. - peaks @ 13-14day of a 28-day cycle. Corpus luteum- regresses if fertilization and implantation does not occur by the time of ovulation period.
Ovarian Cycle Primutive graafian folliclescontains immature oocytes(primordial ova) 1-30 follicles begin to mature before ovulationin each ovaryunder the influence of FSH and estrogen Preovulatory LH surge- affect the selected follicle. Follicular Phase- - oocytes mature, ovulation occurs and the empty follicles begins its transformation in to the corpus luteum. Midcycle bleeding exp. By 10% of women where in there is sufficient bleeding Luteal Phase (Postovulatory phase)- begins immediately after the ovulation and ends with the start of menstruation. It requires 13, 14, 15 days. Corpus letuem – reaches its peak of fxnal activity 8 days after ovulation, secreting both estrogen and progesterone * with no implantation in the endometrium it regresses, steroids level drop, and menstruation occurs. Endometrial Cycle 4 faces 1) Menstrual phase- periodic vasoconstriction in the upper layers of the endometrium occurs to shed fxnal 2/3 of the endometrium. Basalis- the remaining glandular remnant or stromal cells 2) Proliferative phase – rapid growth lasting fr. 5 th day to the time of ovulation. -Endometrial surface is completely restored in approx. 4days or slight bere bleeding ceases -8fold to 10fold thickening occurs with leveling off of growth at ovulation. - depends on estrogen stimulation derived from ovarian follicles. 3) Secretory Phase - extends from the day of ovulation to approx. 3days before the next menstrual period *-after ovulation larger amount of progesterone is produced. -endometrium thickens and becomes luxuriant of blood and glandular secretions, a suitable protective and nutritive bed for a fertilized ovum. Implantation- 7-10days after ovulation 4) Ischemic Phase – the blood supply to the fxnal endometrium is blocked and necrosis develops. Other Cyclic Changes Spinnbarkeit- stretchable quality Mittelschmerz- localized abdominal pain. Climacteric- is a transitional phase during which ovarian fxn and prdxn of hormone decline. Menopause- refers to the final menstruation with an ave. of 51.4y/o (35-60 y/o) Perimenopause- ovarian fxn declines, ova slowly diminish and menstrual cycles are an ovulatory, resulting in irregular bleeding; ovary stops producing estrogen and eventually menses no longer occurs.
PCPS/07-2409
