MATERNAL AND CHILD NURSING

ANTEPARTUM/ PREGNANCY
REPRODUCTIVE SYSTEM
MODULE 1.1

REPRODUCTIVE DEVELOPMENT
Reproductive development begins at the moment of conception and continues through life.

INTRAUTERINE DEVELOPMENT
Gonad – the body organ that produces cells for reproduction (ovary in female, testis in males)
5 weeks of IUL – mesonephric(wolfian) and paramesonephric (mullerian) ducts are formed
7-8 weeks – in chromosomal males, gonadal tissue begins formation of testosterone.
Mesonephric Ducts develops into male reproductive organ and the
Paramesonephric Duct regresses
10 weeks – if testosterone is not present, paramesonephric duct becomes dominant and
develops to female reproductive organs. Formed Ovaries produces
oocytes (the cells that will develop into eggs throughout the woman’s
mature years.
12 eeks - external genitals begins to develop
– if testosterone is halted during 12 weeks, male could be born with female-
appearing genitalia. This is termed
as AMBIGUOUS GENITALIA

- If a pregnant woman is prescribed with testosterone or with metabolic

abnormality, she produces a high level of testosterone, a chromosomal
female could be born with male-appearing genitalia.

PUBERTY DEVELOPMENT
PUBERTY - is the stage of life at which secondary sex changes begins.

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Role of Androgen Hormone
• Responsible for muscle development, physical growth,
• Increase in sebaceous gland that causes acne to adolescents
• Primary Androgenic Hormone in Male
• Testosterone – low until puberty (12 to 14 y/o)
• Responsible for changes in testes, scrotum, penis, prostate, seminal vesicles,
appearance of pubic hair, laryngeal enlargement, maturation of spermatozoa,
• closing of growth plates in long bone termed as Adrenarche

For females:
• Enlargement of labia majora and clitoris
• Formation of axillary and pubic hair
For male, produced by adrenal cortex and testes
For females, by the adrenal cortex and ovaries

Role of Estrogen

• During puberty of females FSH is triggered to excrete high level of Estrogen Hormone
• Influences the development of the uterus, fallopian tubes and vagina
• Fat distribution
• Hair patterns
• Breast development

• Thelarche - the beginning of breast development usually 1 to 2 years before

menstruation

Secondary Sex Changes

Sequential order of pubertal sex changes:

For girls:
• Growth spurt
• Increase in the transverse diameter of the pelvis
• Breast Development
• Growth of pubic hair
• Onset of menstruation
 Menarche – the first menstrual period

 average age 12.4 y/o

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  may occur as early as 9 or as late as 17 years.
 Irregular menstrual period is normal in 1 to 2 years of 1st menstruation.
 Normalizes when ovulation starts.
• Growth of axillary hair
• Vaginal secretions

For boys:
• Increase in weight
• Growth of testes
• Growth of face, axillarry and pubic hair
• Voice Changes
• Penile growth
• Increase in height
• Spermatogenesis (production of sperm)

External Male Reproductive System

1. Scrotum
• Rugated, skin-covered muscular pouched
• Support the testes
• Helps to regulate the temperature of the sperm
o In cold weather, the scrotal muscles contracts to bring the testes to the body

o Vice versa in hot weather. Fall away from the body to maintain temp of testes for
production and viability of sperm.

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 2. Testes
• Two ovoid glands, 2 to 3 cm wide
Contains number of lobules
1. Interstitial cells(Leydig cells)
 Produces testosterone
2. Seminiferous tubule
 Produces spermatozoa
• Descends into the scrotal Sac at 34 to 38 wks from the pelvic cavity

3. Penis
• Consist of three cylindrical masses of erectile tissue in the shaft
• Urethra passes serves as outlet for urinary and reproductive tracts
• Glans - Distal end of the organ is a bulging
Sensitive ridge of tissue

Internal Male Reproductive System

1. Epididymis
• Tightly coiled tube approx. 20 ft.
• Responsible for conducting sperm from the tubule to the vas deferens
• 12 to 20 days for the sperm to travel
• Aspermia - absence of sperm
• Oligospermia (fewer than 20 millions sperm per ml.
• Long length affects the response to therapy…usually after 2 months
2. Vas Deferens(Ductus Deferens)
• Also referred to as spermatic cord
• Hollow tube surrounded by areteries and veins
• Carries sperm from the epididymis through the inguinal canal into the
abdominal cavity

3. Seminal Vesicles
4. Prostate Gland
5. Bulbouretheral Glands
6. Seminal Vesicles

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 REVIEW OF THE FEMALE REPRODUCTIVE ANATOMY

Female External Organs

1. Mons veneris –
The purpose of the mons veneris is to protect the junction of the pubic bone (symphysis) from
trauma.

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 The mons veneris is a pad of adipose tissue located over the symphysis pubis, the pubic bone
joint. It is covered by a triangle of coarse, curly hairs.

2. Labia majora – two folds of adipose tissue covered by loose connective tissue and epithelium
that are positioned lateral to the labia minora.
• fused anteriorly but separated posteriorly.
• protection for the external genitalia and the distal urethra and vagina.
• Covered by pubic hair

3. Labia minora –
• posterior to the mons veneris spread two hairless pink folds of connective tissue
• the internal surface is covered with mucous membrane
• the external surface is covered with skin.

4. Vestibule -
• the flattened, smooth surface inside the
labia.
• The openings to the bladder (the
urethra) and the uterus (the vagina)
both arise from the vestibule.

5. Clitoris – small erectile tissue

The clitoris is a small (approximately 1 to 2
cm), rounded organ of erectile tissue at
the forward junction of the labia minora. It
is covered by a fold of skin, the
prepuce.The clitoris is sensitive to touch
and temperature and is the center of sexual arousal and orgasm in a woman. Arterial
blood supply for the clitoris is plentiful. When the ischio-cavernosus muscle surrounding
it contracts with sexual arousal, the venous outflow for the clitoris is blocked, leading to
clitoral erection.

6. Hymen – thin membrane at opening of vagina

• tough but elastic semicircle of tissue that covers the opening to the vagina in
childhood.
a. Imperforate Hymen – This is the situation where the
hymen does completely cover the opening to the vagina. This
condition usually goes undiagnosed until a girl enters puberty
and her first period and the blood cannot flow out.

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 b. Septate Hymen – This is when one hymen is split into two
openings over the vagina. This condition also does not stop
menstrual blood flow, but can block the use of tampons in virginal
females.

c. Microperforate Hymen – the hymen almost completely closes

off the vaginal opening. Menstrual blood is able-to flow out, but a
virginal female may not be able to use tampons

7. Urinary meatus – opening of urethra

8. Skene’s glands (paraurethral glands)

• located just lateral to the urinary meatus, one on each side.

9. Bartholin’s glands (vulvovaginal glands)

• located just lateral to the vaginal opening on both sides. Their ducts open into the
distal vagina.
• two pea sized compound racemose glands .
• producer of alkaline secretions that enhances sperm motility, viability.

10. Fourchette -
• the ridge of tissue formed by the posterior joining of the two labia minora and the
labia majora.
This is the structure that is sometimes cut (episiotomy) during childbirth to enlarge the vaginal
opening.
Posterior to the fourchette is the perineal muscle or the perineal body. Because this is a
muscular area, it is easily stretched during childbirth to allow for enlargement of the vagina
and passage of the fetal head. Many exercises suggested for pregnancy (such as Kegel’s,
squatting, and tailor-sitting) are aimed at making the perineal muscle more flexible to allow
easier expansion during birth without tearing of this tissue.

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 INTERNAL FEMALE REPRODUCTIVE STRUCTURES

Female Internal Structures

1. Ovaries
 The ovaries are approximately 4 cm long by 2
cm in diameter and approximately 1.5 cm
thick, or the size and shape of almonds.
 grayish white and appear pitted, or with
minute indentations on the surface.
 The function is to produce, mature, and
discharge ova (the egg cells).
 located close to and on both sides of the
uterus in the lower abdomen

2. Fallopian Tubes
 The fallopian tubes arise from each upper corner of the uterine body and extend outward
and backward until each opens at its distal end, next to an ovary.
 approximately 10 cm long in a mature woman.
 a smooth, hollow tunnel
Function:
To convey the ovum from the ovaries to the uterus and to provide a place for
fertilization of the ovum by sperm.

Parts of the Fallopian Tube:

1. Interstitial

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 • is that part of the tube that lies within the uterine wall.
• about 1 cm in length; the lumen of the tube is only 1 mm in diameter
2. Isthmus
• approximately 2 cm in length
• extremely narrow
• the next distal portion.
• the portion of the tube that is cut
or sealed in a tubal ligation, or
tubal sterilization
•
3. Ampulla
• the longest portion of the tube
• approximately 5 cm in length.
• It is in this portion that fertilization of an ovum usually occurs.
4. Infundibular
• the most distal segment of the tube.
• approximately 2 cm long and is funnel shaped.
5. Fimbria
• the small hairs that covers the rim of the funnel
• helps to guide the ovum into the fallopian tube..

3. Vagina –

4. Cervix – cone-shaped neck of the uterus that protrudes into the vagina

5. OVARY
• Ovulation is the most important function of
the ovary
• Production of the female hormone
• Situated retroperitoneally

• Contained in the OVARIAN FOSSA

• In times of abdominal new growth in the
ovary – these are always detected late due
to anatomical location

• Example:
 Ovarian carcinoma
 Ovarian malignancy
Not easily palpable

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 6. UTERUS
• Changes occurring during pregnancy
• Endometrium lining during pregnancy
becomes deciduas (lining of the pregnant
uterus)
• Endometrium is the lining of the NON-
PREGNANT UTERUS

There are three (3) types of DECIDUA

a. Decidua Basalis
• Decidua immediately beneath the implantation of the blastocyst
b. Decidua Capsularis
• Decidua covering the blastocyst
c. Decidua Vera
• This is the remaining portion of the decidua
• Decidua that is not Basalis nor Capsularis

Clinical significance

• Desidua Basalis
 Most important among the deciduas
 Limits invasion of CHORIONIC VILLI into the MYOMETRIUM
 Placenta will not be delivered spontaneously if basalis is NOT WELL DEVELOPED
 This will result into a condition known as PLACENTA ACCRETA

• Placenta Accreta
 Presence of faulty attachment of the chorionic villi of the placenta into the myometrium
 The main problem in Placenta Accreta is HEMORRHAGE
Placenta

 Therefore, the decidua basalis should be well developed

The Female Pelvis

Structure of pelvis

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• Two hip bones (right and left
innominate: Sacrum, coccyx).

1. False pelvis – upper portion above brim,

supportive structure for uterus during
last half of pregnancy.

2.True pelvis – below brim; pelvic inlet,

midplane, pelvic outlet. Fetus passes
through during birth

Four Types of Pelvis:

1.Gynecoid Pelvis
• Inlet is round
• Wide
• This is the typical FEMALE PELVIS
• Most favorable for normal
spontaneous delivery
2. Android Pelvis
• Wide
• HEART-SHAPED
• This is the typical MALE PELVIS
3. Anthropoid Pelvis
• Wide
• Narrow
• This is the typical APE PELVIS

4. Platypelloid Pelvis
• Opposite of Anthropoid Pelvis
• Wide
• Narrow

DIAMETERS OF THE PELVIS

Sagittal section
Obstetric Conjugate
 A conjugate that CANNOT BE MEASURED CLINICALLY
 Distance from posterior surface of symphysis pubis up to the most prominent
portion of sacral promontory
o Subtract 1.5 – 2.0 cm from diagonal conjugate
o Therefore, Obstetric Conjugate (OC) is equal to Diagonal Conjugate (DC) minus 1.5 to
2.0 centimeters.
o In equation form:
 OC = DC – 1.5 or 2.0 cm

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Diagonal Conjugate
• Distance from anterior surface of symphysis pubis and the inferior margin of symphysis pubis up
to the most prominent area of the sacrum
• Only conjugate that can be measured clinically
• Normal value is 11.5 cm to 12.5 cm. or greater is adequate size, evaluated by examiner

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