III.

Anatomy and Physiology

Vagina

The vagina is a muscular, hollow

tube that extends from the vaginal
opening to the cervix of the uterus. It is
situated between the urinary bladder and
wall allows the vagina to expand and
contract. The muscular walls are lined
with mucous membranes, which keep it
protected and moist. A thin sheet of
tissue with one or more holes in it, called the hymen, partially covers the opening
of the vagina. The vagina receives sperm during sexual intercourse from the
penis. The sperm that survive the acidic condition of the vagina continue on
through to the fallopian tubes where fertilization may occur. The vagina is made
up of three layers, an inner mucosal layer; middle muscular is layer, and an outer
fibrous layer. The inner layer is made of vaginal rugae that stretch and allow
penetration to occur. These also help with stimulation of the penis. The middle
layer has glands that secrete acidic mucus (pH of around 4.0.) that keeps
bacterial growth down. The outer muscular layer is especially important with
delivery of a fetus and placenta.

Purposes of the Vagina

•Receives a males erect penis and semen during sexual intercourse.

•Pathway through a woman's body for the baby to take during childbirth.
•Provides the route for the menstrual blood (menses) from the uterus, to leave
the body.
•May hold forms of birth control, such as a diaphragm, FemCap, Nuva Ring, or
female condom.
 The cervix (from Latin
"neck") is the lower, narrow
portion of the uterus where
it joins with the top end of
the vagina. Where they
join together forms an
almost 90 degree curve. It
is cylindrical or conical in
shape and protrudes through the
upper anterior vaginal wall. Approximately
half its length is visible with appropriate medical equipment; the remainder lies
above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of
the uterus".During menstruation, the cervix stretches open slightly to allow the
endometrium to be shed. This stretching is believed to be part of the cramping
pain that many women experience. Evidence for this is given by the fact that
some women's cramps subside or disappear after their first vaginal birth because
the cervical opening has widened. The portion projecting into the vagina is
referred to as the portio vaginalis or ectocervix.

. On average, the ectocervix is three cm long and two and a half cm wide. It has
a convex, elliptical surface and is divided into anterior and posterior lips. The
ectocervix's opening is called the external os. The size and shape of the external
os and the ectocervix varies widely with age, hormonal state, and whether the
woman has had a vaginal birth. In women who have not had a vaginal birth the
external os appears as a small, circular opening. In women who have had a
vaginal birth, the ectocervix appears bulkier and the external os appears wider,
more slit-like and gaping. The passageway between the external os and the
uterine cavity is referred to as the endocervical canal.

. It varies widely in length and width, along with the cervix overall. Flattened
anterior to posterior, the endocervical canal measures seven to eight mm at its
widest in reproductive-aged women. The endocervical canal terminates at the
internal os which is the opening of the cervix inside the uterine cavity. During
childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter
to allow the child to pass through. During orgasm, the cervix convulses and the
external os dilates.
 The uterus is shaped like an
upside-down pear, with a thick lining and
muscular walls. Located near the floor of
the pelvic cavity, it is hollow to allow a
blastocyte, or fertilized egg, to implant and
grow. It also allows for the inner lining of
the uterus to build up until a fertilized egg
is implanted, or it is sloughed off during
menses. The uterus contains some of the
strongest muscles in the female body.
These muscles are able to expand and contract to accommodate a growing fetus
and then help push the baby out during labor. These muscles also contract
rhythmically during an orgasm in a wave like action. It is thought that this is to
help push or guide the sperm up the uterus to the fallopian tubes where
fertilization may be possible.The uterus is only about three inches long and two
inches wide, but during pregnancy it changes rapidly and dramatically. The top
rim of the uterus is called the fundus and is a landmark for many doctors to track
the progress of a pregnancy. The uterine cavity refers to the fundus of the uterus
and the body of the uterus. Helping support the uterus are ligaments that attach
from the body of the uterus to the pelvic wall and abdominal wall. During
pregnancy the ligaments prolapse due to the growing uterus, but retract after
childbirth. In some cases after menopause, they may lose elasticity and uterine
prolapse may occur. This can be fixed with surgery. Some problems of the uterus
include uterine fibroids, pelvic pain (including endometriosis, adenomyosis),
pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and
cancer. It is only after all alternative options have been considered that surgery is
recommended in these cases. This surgery is called hysterectomy. Hysterectomy
is the removal of the uterus, and may include the removal of one or both of the
ovaries. Once performed it is irreversible. After a hysterectomy, many women
begin a form of alternate hormone therapy due to the lack of ovaries and
hormone production. At the upper corners of the uterus are the fallopian tubes.

There are two fallopian tubes, also called the uterine tubes or the oviducts. Each
fallopian tube attaches to a side of the uterus and connects to an ovary. They are
positioned between the ligaments that support the uterus. The fallopian tubes are
about four inches long and about as wide as a piece of spaghetti. Within each
tube is a tiny passageway no wider than a sewing needle. At the other end of
each fallopian tube is a fringed area that looks like a funnel. This fringed area,
called the infundibulum, lies close to the ovary, but is not attached. The ovaries
alternately release an egg. When an ovary does ovulate, or release an egg, it is
swept into the lumen of the fallopian tube by the frimbriae. Once the egg is in the
fallopian tube, tiny hairs in the tube's lining help push it down the narrow
passageway toward the uterus. The oocyte, or developing egg cell, takes four to
five days totravel down the length of the fallopian tube. If enough sperm are
ejaculated during sexual intercourse and there is an oocyte in the fallopian tube,
fertilization will occur. After fertilization occurs, the zygote, or fertilized egg, will
continue down to the uterus and implant itself in the uterine wall where it will
grow and develop.If a zygote doesn't move down to the uterus and implants itself
in the fallopian tube, it is called a ectopic or tubal pregnancy. If this occurs, the
pregnancy will need to be terminated to prevent permanent damage to the
fallopian tube, possible hemorrhage and possible death of the mother.

Mammary glands are the organs that

produce milk for the sustenance of a baby.
These exocrine glands are enlarged and
modified sweat glands. The basic components
of the mammary gland are the Alveoli (hollow
cavities, a few millimetres large) lined with
milk-secreting epithelial cells and surrounded
by myoepithelial cells. These alveoli join up to
form groups known as lobules, and each lobule
has a lactiferous duct that drains into openings
in the nipple. The myoepithelialcells can
contract, similar to muscle cells, and thereby
push the milk from the alveoli through the lactiferous ducts towards the nipple,
where it collects in widenings (sinuses) of the ducts. A suckling baby essentially
squeezes the milk out of these sinuses. The development of mammary glands is
controlled by hormones. The mammary glands exist in both sexes, but they are
rudimentary until puberty when - in response to ovarian hormones - they begin to
develop in the female. Estrogen promotes formation, while testosterone inhibits
it. At the time of birth, the baby has lactiferous ducts but no alveoli. Little
branching occurs before puberty when ovarian estrogens stimulate branching
differentiation of the ducts into spherical masses of cells that will become alveoli.
True secretory alveoli only develop in pregnancy, where rising levels of estrogen
and progesterone cause further branching and differentiation of the duct cells,
together with an increase in adipose tissue and a richer blood flow. Colostrum is
secreted in late pregnancy and for the first few days after giving birth. True milk
secretion (lactation) begins a few days later due to a reduction in circulating
progesterone and the presence of the hormone prolactin. The suckling of the
baby causes the release of the hormone oxytocin which stimulates contraction of
the myoepithelial cells. The cells of mammary glands can easily be induced to
grow and multiply by hormones. If this growth runs out of control, cancer results.
Almost all instances of breast cancer originate in the lobules or ducts of the
mammary glands.
IV. Pathophysiology
Release of FSH by
the anterior pituitary gland

Development of the
graafian follicle

Production of estrogen
(thickening of the endometrium)

Release of the
luteinizing hormone

Ovulation
(release of mature ovum from the graafian follicle)

Ovum travels into the

fallopian tube

Fertilization
(union of the ovumand sperm in the ampulla)

Zygote travels from the

fallopian tube to the uterus

Implantation

Development of the
fetus/embryo & placental structure
until full term

PRELIMINARY SIGNS OF LABOR

Lightening Braxton Hicks Contraction Ripening of the cervix

(descent of the fetal (false labor) (Goodell’s Sign the cervix
wherein head into the pelvis) >begin and remain irregular feels softer like earlobe.
>pain disappears with
Ambulation
 >do not increase in duration
And intensity
>do not achieve cervical
Dilatation

TRUE LABOR

Uterine Contractions SHOW Rupture of Membranes

>increase in duration (pink-tinge of blood, a (rupture of the amniotic sac)
and intensity mixture of blood and fluid)
>1st felt at the back
&radiates to the abdomen
>pain is not relieved no
matter what the activity
>achieve cervical dilatation.