Anatomy and Physiology

Ovary

Female organ that produces reproductive cells called eggs, or ova. In

humans they are oblong, flattened, ductless glands, about 3.8 cm (about 1.5

in) long, on either side of the uterus, to which they are connected by the

Fallopian tubes. Each ovary is composed of two portions: an external, or

cortical, portion, and a deep, medullary portion. The cortical portion in the

adult contains an enormous number of follicles, or sacs, varying in size.

called Graafian follicles, they contain the ova, the female reproductive cells.

The interior of the ovary is distinctly divided into an outer cortex, where the

germ cells develop, and a central medulla occupied by the major arteries

and veins. Each egg cell develops in its own fluid-filled follicle and is released

by ovulation. The ovary is supplied with an ovarian artery, ovarian veins, and

ovarian nerves, which travel through the suspensory ligament.

 The ovary is held in place by the ovarian, suspensory, and broad

ligaments as well as a peritoneal fold called the mesovarium. The ovary

secretes hormones that, together with secretions from the pituitary gland,

contribute to secondary female sexual characteristics and also regulate

menstruation. The union of the male sperm cell with the ovum results in

fertilization. The ovary may be the site of several disease conditions. It can

be the site of acute and chronic inflammation; this may arise from injuries

during labor, operations in the pelvic area, or gonorrheal infection spreading

from the vagina. The ovary also may be the site of neoplasms (tumors) of

several varieties. Some are fluidic enlargements of one or more Graafian

follicles and may attain an enormous size; these are known as ovarian cysts.

Other growths, of a solid nature, are known as dermoid cysts. These

enlargements, usually benign, occasionally prove to be cancerous.

Ovary Releasing an Ovum

The ovary is the female organ that produces the reproductive cells called eggs, or ova. This
false-color electron micrograph shows the release of a mature ovum at ovulation. The ovum
(red) is surrounded by cells and liquid from the ruptured ovarian follicle.
Fallopian Tube

One of two ducts in female leading from the ovaries to the upper part of

the uterus. They are also known as oviducts. In the human female the

fallopian tubes are about 2 cm (about 0.75 in) thick and 10 to 13 cm (4 to 5

in) long. As the ovum leaves the ovary it passes into the mouth of the

adjoining fallopian tube and is propelled toward the uterus by hairlike

projections called cilia on the inner surface of the tube. If the ovum is

fertilized inside the tube, where most fertilization takes place, it usually

implants in the uterus.

Uterus

Usually called womb, flattened, pear-shaped, hollow organ in the pelvis of

the human female and most other mammals. In pregnancy, it is the organ

that holds the unborn developing child. The uterus consists of a body, a base

or fundus, a neck or cervix, and a mouth. Suspended in the pelvis, it lies with

the base directed upward and forward and the cervix directed slightly

backward. It is connected to the vagina by the cervix. On either side of the

uterus lies an ovary. Eggs produced by the ovaries reach the uterus through

the fallopian tubes. In the unimpregnated condition the uterus is about 7.6

cm (about 3 in) in length, 5 cm (2 in) in breadth, and 2.5 cm (1 in) in

thickness. In pregnancy the fertilized egg implants itself in the lining of the

uterus, where it grows to maturity; the walls of the uterus are elastic and

stretch during pregnancy to hold the developing child. The uterus body
consists of a firm outer coat of muscle, known as the myometrium, and an

inner lining of soft, glandular material, known as the endometrium, that

thickens with blood during ovulation, preparatory to receiving a fertilized

ovum. If fertilization does not occur, this lining breaks down in menstruation.

`Females

also have external

organs collectively called the vulva (which means "covering"). Located

between the legs, the outer parts of the vulva cover the opening to a narrow

canal called the vagina. The fleshy area located just above the top of the

vaginal opening is called the mons pubis. A thin sheet of tissue called the

hymen partially covers the opening of the vagina. Two pairs of skin flaps,

the labia (which means "lips") surround the vaginal opening. The clitoris,

which is located toward the front of the vulva where the folds of the labia

join, is a small cylindrical structure similar to the male penis; it also contains
erectile tissue. Inside the labia are openings to the urethra (the canal that

carries urine from the bladder to the exterior of the body) and vagina. The

outer labia and the mons pubis are covered by pubic hair in the sexually

mature female.

The female internal organs are the vagina, uterus, fallopian tubes, and

ovaries. The vagina is a 3- to 6-inch-long tubular structure that extends from

the vaginal opening to the uterus. It has muscular walls lined with mucous

membrane, and it serves as the female organ of copulation (sexual

intercourse) as well as the birth canal. It connects with the uterus, or womb,

which houses the fetus during pregnancy. About 3 inches long and 2 inches

wide and shaped like an inverted pear, the uterus is a muscular, expandable

organ with thick walls At the lower part of the uterus is the cervix, which

opens into the vagina. At the upper part, the fallopian tubes connect the

uterus with the ovaries, two oval-shaped organs that lie to the right and left

of the uterus. They produce, store, and release eggs through the fallopian

tubes into the uterus. The ovaries also produce the hormones estrogen and

progesterone. Also part of the reproductive system are the breasts.

Mammary glands inside the breasts secrete milk after childbirth.

Normal Physiology

The organs of sexual reproduction are the gonads, which are the

ovaries in females and the testes in males. Females produce female

gametes, or eggs; males produce male gametes, or sperm. Sexual

reproduction is the fertilization of a female gamete by a male gamete. When

a female is born, each of her ovaries has hundreds of thousands of eggs, but

they remain dormant until her first menstrual cycle, which occurs during

puberty. At this time, during adolescence, the pituitary gland secretes

hormones that stimulate the ovaries to produce female sex hormones,

including estrogen, which helps the female develop into a sexually mature

woman. Also at this time, females begin releasing eggs as part of a monthly

period called the menstrual cycle. Approximately once a month, during

ovulation, an ovary discharges a tiny egg that reaches the uterus through

one of the fallopian tubes. Unless fertilized by a sperm while in the fallopian

tube, the egg dries up and is expelled about 2 weeks later from the uterus

during menstruation. Blood and tissues from the inner lining of the uterus

combine to form the menstrual flow, which usually lasts from 3 to 5 days.
 If a female and male have sexual intercourse within several days of

ovulation, fertilization can occur. When the male ejaculates, about one tenth

of an ounce of semen is deposited into the vagina. Between 200 and 300

million sperm are in this small amount of semen, and they "swim" up from

the vagina through the cervix and uterus to meet the egg in the fallopian

tube. It takes only one sperm to fertilize the egg. About a week after the

sperm fertilizes the egg, the fertilized egg has become a multicelled

blastocyst, a pinhead-sized hollow ball with fluid inside, now housed in the

uterus. The blastocyst burrows itself into the lining of the uterus, called the

endometrium. Estrogen causes the endometrium to thicken and become rich

with blood, and progesterone, another hormone released by the ovaries,

maintains the thickness of the endometrium so that the blastocyst can

attach to the uterus and absorb nutrients from it. This process is called

implantation.

As cells from the blastocyst take in nourishment, the embryonic stage

of development begins. The inner cells form a flattened circular shape called

the embryonic disk, which will develop into a baby. The outer cells become

thin membranes that form around the baby. The embryonic cells multiply

thousands of times, move to new positions, and eventually become the

embryo. After approximately 8 weeks, the embryo is about the size of an

adult's thumb, but all of its parts - the brain and nerves, the heart and blood,

the stomach and intestines, and the muscles and skin - have formed. During

the fetal stage, which lasts from 9 weeks after fertilization to birth,
development continues as cells multiply, move, and differentiate. The fetus

floats in amniotic fluid inside the amniotic sac. Its oxygen and nourishment

come from the mother's blood via the placenta, a disk-like structure that

adheres to the inner lining of the uterus and is connected to the umbilical

cord. The umbilical cord attaches the embryo at its navel to the mother's

uterus. The umbilical arteries in the cord carry blood from the fetus to the

placenta, and an umbilical vein returns blood from the placenta to the fetus.

The amniotic fluid and membrane cushion the fetus against bumps and jolts

to the mother's body.

Pregnancy lasts an average of 266 days. When the baby is ready for

birth, its head presses on the cervix, which begins to relax and widen to get

ready for the baby to pass into and through the vagina, which has enlarged
to become the birth canal. The mucus that has formed a plug in the cervix

loosens, and with amniotic fluid, comes out through the vagina when the

mother's "water" breaks. When contractions begin, the uterine walls contract

as they are stimulated by the pituitary hormone oxytocin. The contractions

cause the cervix to widen and begin to open. After several hours of this

widening, the cervix is dilated (opened) enough for the baby to come

through. The baby is pushed out of the uterus, through the cervix, and along

the birth canal. The baby's head usually comes first; the umbilical cord

comes out with the baby and is cut after the baby is delivered.

The last stage of the birth process involves the delivery of the

placenta, which is now called the afterbirth. It has separated from the inner

lining of the uterus, and through further contractions of the uterus it is

expelled with its membranes and fluids.

Menstrual Cycle

A menstrual cycle (also termed a female reproductive cycle) can be

defined as episodic uterine bleeding in response to a cyclic hormonal

changes. It is the process that allows for conception and implantation of a

new life. The purpose of a menstrual cycle is to bring an ovum to maturity

and renew a uterine tissue bed that will be responsible for its growth

should it be fertilized. Menarche, the first menstrual period in girls, may

occur as early as age 8- 9 or as late as 17 and still be within normal limits.

Because menarche may occur as early as age 9 years, it is good to include

health teaching information on menstruation to both girls and their parents

as early as 4th grade as part of routine care. It is a poor introduction to

sexuality and womanhood for a girl to begin menstruation unwarned and

unprepared for the important internal function it represents.

The length of menstrual cycle differs from woman to woman, but the

accepted average length is 28 days (from the beginning of one menstrual

flow to the beginning of the next). However, it is not unusual for cycles to be

as short as 23 days or as long as 35 days. The length of the average

menstrual flow is (termed menses) is 2 to 7 days although women may have

periods as short as 1 day or as long as 9 days.

Because there is such variation in length, frequency, and amount of

menstrual flow and such variation in the onset of menarche, many women

have questions about what is considered normal. Contact with health care
personnel during the yearly health examination or pre- natal visit is often the

first opportunity some women have to ask question they have had for some

time.

Phases of Menstrual Cycle

1. Proliferative Phase

Immediately after a menstrual flow (occurring the first 4 or 5 days of a

cycle), the endometrium, or lining of the uterus, is very thin, only

approximately one cell layer in depth. As the ovary begins to produce

estrogen (in follicular fluid,under the direction of the pituitary FSH), the

endometrium begins to proliferate. This growth is very rapid and increase

the thickness of the endometrium approximately eightfold. This increase

continues for the first half of the menstrual cycle (from approximately day 5

to 14). This half of menstrual cycle is termed interchangeably the

proliferative, estrogenic, follicular or post menstrual phase.

2. Secretory Phase

After ovulation, the formation of progesterone in the corpus luteum

(under the direction of the LH) causes the glands of the uterine endometrium

to become corkscrew or twisted in appearance and dilated with quantities

of glycogen and mucin, an elementary sugar and protein. The capillaries of

the endometrium increase in amount until the lining takes on the

appearance of rich, spongy velvet. This second phase of menstrual cycle is

termed the progestational, luteal, premenstrual, or secretary phase.

3. Ischemic Phase

If fertilization does not occur. The corpus luteum in the ovary begins to

regrets after 8 to 10 days. As it regresses, the production of progesterone

and estrogen decreases. With the withdrawal of progesterone stimulation,

the endometrium of the uterus begins to degenerate (approximately day 24

or 25 of the cycle). The capillaries rupture, with minute hemorrhages, and

the endometrium sloughs off.

4. Menses: Final Phase of Menstrual Cycle

The following products are discharged from the uterus as the

menstrual flow or menses: blood from ruptured capillaries; mucin from the

glands, fragments of edometrial tissues, microscopic, atrophied and

unfertilized ovum.

Menses is actually the end of an arbitrarily defined menstrual cycle. Because

it is the only external marker of the cycle, however, the first day of

menstrual flow is used to mark the beginning day of a new menstrual cycle.

Contrary to common belief, menstrual flow contains only approximately 30 to

80 ml of bloods, it may seem more because of the accompanying mucus and

endometrial shreds. The iron loss during menstrual flow is approximately 11

mg, this is enough that many woman need to take daily iron supplement to

prevent iron depletion during their menstruating years.

In women who are going through menopauses, menses may typically be a

few days of spotting before a heavy flow or heavy flow followed by a few

days of spotting, because progesterone withdrawal is more sluggish or tends

to “staircase” rather than withdraw.

Teachings About Menstrual Health

Exercise

 It’s good to continue moderate exercise during menses because it

increases abdominal tone. Sustained excessive exercise, such as

professional athletes maintain, can cause amenorrhea.

Sexual Relations

 Not contraindicated during menses (the male should wear a condom to

prevent exposure to body fluid). Heightened or decrease sexual arousal may

be noticed during menses. Orgasm may increase menstrual flow.

Activities of Daily Living

 Nothing is contraindicated (many people believed incorrectly that things

like washing hair are harmful).
Pain Relief

 Any mild analgesic is helpful. Prostaglandin inhibitors such as ibuprofen

(Motrin) are specific for menstrual pain. Applying local heat may also be

helpful

Rest

 More rest may be helpful if dysmenorrhea interferes with sleep at night.

Nutrition.

 Many women may need iron supplementation to replace iron lost in

menses. Eating pickles or cold food does not cause dysmenorrhea.

Stages of Fetal Development

In just 38 weeks, a fertilized egg matures from a single cell carrying all

the necessary genetic material to a fully developed fetus ready to born. Fetal

growth and development is typically divided into three periods. Pre-

embryonic (First 2 weeks beginning with fertilization); embryonic (from 3

weeks through 8), and fetal (from week 8 through birth).

Ovum From ovulation to fertilization

 Zygote  From fertilization to implantation
Embryo  From implantation to 5 – 8 weeks
Fetus  From 5 – 8 weeks until term
Conceptus Developing embryo or fetus and

 placental structures throughout

pregnancy

Milestones of Fetal Growth and Development

The life of the fetus is generally measured from the time of ovulation or

fertilization (ovulation age), but the length of pregnancy is generally

measured from the first day of the last menstrual period (gestational age).

Because ovulation and fertilization take place about 2 weeks after the last

menstrual period, the ovulation age of the fetus is always 2 weeks less than

the length of the pregnancy or the gestational age.

Both ovulation and gestational age are also sometimes measured in lunar

months

(4 - week periods) or in trimesters (3- month. Period) rather than in weeks. In

lunar months, a pregnancy is 10 months (40 weeks or 280 days) long; a fetus

grows in utero 9.5 lunar months or three full trimesters (38 weeks or 266

days)

End of 4 Gestation Weeks

At the end of the 4th week gestation, the human embryo is rapidly growing

formation of cells but does not resemble a human being yet.

• Length: 0.75 to 1 cm.

 • Weight: 400 mg.

• The spinal cord is formed and fused at the midpoint.

• Lateral wings that will form the body are folded forward to fuse at the

midline.

• Head folds forwards, becoming prominent, comprising about one third

of the entire structure.

• The back is bend so the head almost touches the tip of the tail.

• The rudimentary heart appears as a prominent budge on the anterior

surface.

• Arms and legs are bud like structures.

• Rudimentary eyes, ears and nose are discernible.

End of 8 Gestation Weeks

• Length: 2.5 cm (1cm).

• Weight: 20 g.

• Organogenesis is complete.

• The heart, with a septum and values, is beating rhythmically.

• Facial features are definitely discernible.

• Extremities have developed.

• External genitalia are present, but sex is not distinguished by simple

observation.

• Primitive tail regressing.

• Abdomen appears large as the fetal intestine is growing rapidly.

• Sonogram shows gestational sac, diagnostic of pregnancy.

End of 12 Gestation Weeks (First Trimester)

• Length: 7 to 8 cm.

• Weight: 45 g.

• Nail beds are forming on fingers toes.

• Spontaneous movements are possible, although usually too faint to be

felt by the mother.

• Some reflexes, such as Babinski reflex are present.

• Bone ossification centers are forming.

• Tooth buds are present.

• Sex is distinguishable by outward appearance.

• Kidney secretion has begun, although urine may not be evident in

amniotic fluid.

• Heart beat is available by a Doppler

End of 16 Gestation Weeks

• Length: 10 to 17 cm.

• Weight: 55 to 120 g.

• Fetal heart sounds are audible with an ordinary stethoscope.

• Lanugo (fine, downy hair on the back and arms of newborns,

apparently serving as a source of insulation for body heart) is well

formed.

• Liver and pancreas are functioning.

 • Fetus actively swallows amniotic fluid, demonstrating an intact but

uncoordinated swallowing reflex, urine is present in amniotic fluid.

• Sex can be determined by ultrasound.

End of 20 Gestation weeks

• Length: 25 cm.

• Weight: 223 g.

• The mother can sense spontaneous fetal movements.

• Antibody production is possible.

• Hair forms, extending to include eyebrows and hair on the head.

• Meconium is present in the upper intestine.

• Brown fat, a special fat that will aid in temperature regulation at birth,

begins to be formed behind the kidneys, sternum and posterior neck.

• Fetal heart beat is strong – enough to be audible

• Vernix caseosa, a cream cheese -like substance produced by the

sebaceous gland that serves as a protective skin covering intrauterine

life, begins to form.

• Definite sleeping and activity patterns are distinguishable (the fetus

has developed biorhythms that will guide sleep /wake patterns

throughout life).

End of 24 Gestation Weeks (Second Trimester)

• Length: 28- 36 cm.

• Weight: 550 g.
 • Passive antibody transfer from mother to fetus probably begins as

early as 20th

week of gestation, certainly by the 24th week of gestation. Infants born

before antibody transfer has taken place have natural immunity and need

more than the usual protection against infectious disease in the newborn

period until the infant’s own store pf immunoglobulins can build up.

• Meconium is present as far as the rectum.

• Active production of lung surfactant begins.

• Eyebrows and eyelashes are well defined.

• Eyelids, previously fused since the 12th week, are now open.

• Pupils are capable of reacting to light.

• When fetuses reach 24 weeks or 601 g, they have achieved a practical

low- end age of viability if they are cared for after birth in a modern

intensive care facility.

• Hearing can be demonstrated by response to sudden sound.

End of 28 Gestation Weeks

• Length: 35 to 38 cm.

• Weight: 1,200 g.

• Lung alveoli begin to mature, and surfactant can be demonstrated in

amniotic fluid.

• Testes begin to descend into the scrotal sac from the lower abdominal

cavity.
 • The blood vessels of the retina are extremely susceptible to damage

from high oxygen concentrations (an important consideration when

caring for preterm infants who need oxygen).

• The eyes open.

End of 32 Gestations Weeks

• Length: 38-43 cm.

• Weight: 1,600 g.

• Subcutaneous fat begins to be deposited (the former is stringy “ Little

old man” appearance is lost).

• Fetus is aware of sounds outsides the mothers body.

• Active Moro reflex is present.

• Birth position (vertex or breech) may be assumed.

• Iron stores that provide iron for the time during which the neonate will

ingest only milk after the birth are beginning to be developed.

• Finger nails grow to reach the end of the fingertips.

End of 36 Gestation weeks

• Length: 42 to 49 cm.

• Weight: 1,900 to 2,700 g (5 – 6 lbs).

• Body stores of glycogen, iron, carbohydrate and calcium are

augmented.

• Additional amounts of subcutaneous fat are deposited.

 • Sole of the foot has only one or two crisscross crisscross creases

compared with the full crisscross pattern that will be evident at term.

• Amount of lanugo begins to diminish.

• Most babies turn into vertex or head – down presentation during this

month.

End of 40 gestation Weeks (Third Trimester)

• Length: 48 to 52 cm (crown to rump, 35 to 37 cm).

• Weight: 3,000g (7 – 7.5 lbs).

• Fetus kicks actively, hard enough to cause the mother considerable

discomfort.

• Fetal hemoglobin begins its conversion to adult hemoglobin. The

conversion is so rapid that, at birth about 20% hemoglobin will be adult

in character.

• Vernix caseosa is fully formed.

• Fingernails extend over the fingertips.

• Creases on the soles of the feet cover at least two thirds of the surface.

In primiparas (women having their first baby), the fetus often sinks

into the birth canal during these last 2 weeks, giving the mother a

feeling that her load is being lightened. This event is termed lightening. It

is the fetal announcement that the third trimester of pregnancy has

ended and birth is at hand.