OB I session one.ppt
- 1. OBSTETRICS I Diriba Wakjira ( BSc,MSc in maternity health)
- 2. Session 1 External and internal female reproductive organ 1/18/2024 2
- 3. Session outline:- External female reproductive organ Internal female reproductive organ Ovarian hormone and their functions Ovarian cycle Uterine cycle 1/18/2024 3
- 4. Session objective At end of this session, students will be able to:- Explain effect of ovarian hormone on female reproductive organs. Discuss how menus trial cycle happened. List function of external and internal reproductive organ. Explain events that occur during ovarian cycle and uterine cycle. 1/18/2024 4
- 5. Definition The reproductive organs in female are those which are concerned with copulation fertilization growth and development of the fetus and its subsequent exit to the outer world. 5 1/18/2024
- 6. Female reproductive organs broadly classified as External genitalia Internal genitalia and Accessory reproductive organs 6 1/18/2024
- 7. External genitalia/pudendum/vulva The vulva or pudendum includes all the visible external genital organs in the perineum It consists of the mons pubis, labia majora, labia minora, hymen, clitoris, vestibule, urethra and glands (Skene’s glands, Bartholin’s glands and vestibular bulbs) It bounded by:- Anteriorly by mons pubis Posteriorly by the rectum Laterally by the genitocrural fold. The vulvar area is covered by keratinized stratified squamous epithelium. 7 1/18/2024
- 8. External organ….. Mons pubis It is Pad of subcutaneous fatty tissue found in front of pubis Covered by inverted triangle shape hair in adult L.majora: It is elevation of skin and subcutaneous tissue which bounded vulva on each side It is continuous and join medially to form the posterior Commissure in front of the anus. Analogous to the male scrotum 8 1/18/2024
- 9. External organ….. 9 L.Minora It is a thin folds of skin, devoid of fat, on either side just within the labia majora. Upper portion of L.minora covers clitoris and form prepuce in front and frenulum behind of clitoris The lower portion of the labia minora fuses across the midline to form a fold of skin known as fourchette. The labia minora are homologous to the penile urethra and part of the skin of penis in males. 1/18/2024
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- 12. External organ…. Clitoris It is a small cylindrical erectile body, measuring about 1.5–2 cm situated in the most anterior part of vulva. It is homologues to male penis The glans is covered by squamous epithelium and is richly supplied with nerves. Extremely sensitive and highly vascular and plays a role in the orgasm of sexual inter course The vessels of the clitoris are connected with the vestibular bulb and are liable to be injured during 12 1/18/2024
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- 14. External organ….. Vestibule It is a triangular space bounded anteriorly by the clitoris, posteriorly by the fourchette and on either side by labia minora. There are four openings into the vestibule. urethral opening Vaginal orifice Opening of Bartholin's ducts Opening of skene’s gland 14 1/18/2024
- 15. Bartholin’s gland Are two small glands situated beneath the vestibule on either side of the vaginal opening posterior to it. During sexual excitement varying amounts of lubricating mucoid material are secreted by these glands. Correspond to the bulbo-urethral glands in the male. They are oval, about the size of a pea and are on either side of the vagina. Often they are site of infection forming an abscess. 1/18/2024 15
- 16. Skene’s duct (glands) are small glands located on the anterior wall of the vagina near the urethra. Are to be homologous to the male prostate gland Function : During sexual arousal, these glands may release fluid through small ducts that open into the urethra or near the opening of the urethra. This fluid is sometimes referred to as female ejaculate. 1/18/2024 16
- 17. Hymen Marks the division between the internal and external organs. It is a thin fold of mucous membranes situated at the orifice of the vagina. It may be entirely absent, or may form a complete septum across the lower end of the vagina. It has no clinical function but used as symbol of virginity in many society. 1/18/2024 17
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- 20. Internal organs…Vagina Is a muscular canal in the female reproductive system that extends from the vulva to the cervix. Is a flexible, muscular tube that varies in length and width among individuals. The average length of the vagina is typically reported to be around 7 to 8 centimeters at rest. Functions: o It is female organs of copulations; receives the penis and the ejected sperm during sexual inter course o Provides an exit for the fetus during delivery 20 1/18/2024
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- 22. Internal organ…. Uterus: A hollow muscular organ situated in the cavity of true pelvis. Function: It is the organ of menstruation During pregnancy receives the fertilized ovum and retains, nourishes it until it expels the products of conception at the time of labour 22 1/18/2024
- 24. Relations Anteriorly in front of the uterus lie the utero - vesical pouch and the bladder. Posterior behind the uterus are the recto-uterine pouch of Douglas and the rectum. Lateral : Laterally :The broad ligaments, the fallopian tubes and the ovaries. Superior: above the uterus lies the intestine. Inferior: below the uterus is the vagina 1/18/2024 24
- 25. Uterus Position Situated in the cavity of true pelvis, behind the bladder and in front of the rectum. Leans forward => ante version Bends for wards on itself => ante flexion When the woman is standing, this results in an almost horizontal position with the fundus resting 25 1/18/2024
- 26. Uterus ….structure The non-pregnant uterus is a hollow, muscular, pear shaped organ. Size = 7.5cm long, 5cm wide and 2.5cm in depth, each wall being 1.25cm thick. The cervix measures 2.5cm in all directions, and forms the lower one third of the uterus. The uterus of non-pregnant woman weighs 60gms. 1/18/2024 26
- 28. Structures of uterus….muscles The uterus is made up of a very strong muscle called the myometrium, consisting of three muscle fibers /layers: Outer longitudinal (up and down) fibers - contracts the uterus. Middle oblique fibers (criss -cross)-controls bleeding in the third stage of labour. Inner circular fibers - involved in stretching during labour. The myometrium is lined from outside by perimetrium and inside with a layer of mucous membrane - the endometrium 28 1/18/2024
- 30. Uterus…supportive ligaments The transverse cervical ligaments (cardinal or Macknrodts ligament) The utero - sacral ligament The pubo - cervical ligament The broad ligament The round ligament The ovarian ligament. 30 1/18/2024
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- 32. Uterus…supportive ligaments The transverse cervical ligaments Is located on each side of the cervix and provides support to the uterus. Play a crucial role in maintaining the position and stability of the uterus within the pelvis. They also have a role in limiting excessive movement of the uterus and preventing it from prolapsing or descending into the vaginal canal. The utero - sacral ligament They are paired ligaments that extend from the posterior aspect of the uterus to the sacrum, a triangular bone at the base of the spine. 1/18/2024 32
- 33. Uterus…supportive ligaments The pubo - cervical ligament pass forwards from the cervix, under the bladder, to the pubic bone The broad ligaments Located on each side of the uterus and extends from the lateral surfaces of the uterus to the sidewalls of the pelvis. plays a crucial role in providing support and stability to the pelvic organs. It helps to maintain the position of the uterus, fallopian tubes, and ovaries within the pelvic 1/18/2024 33
- 34. Uterus…supportive ligaments The round ligament arises from the upper part of the uterus and travels through the inguinal canal to reach the labia majora. It passes through the inguinal canal, a passage in the lower abdominal wall, and attaches to the connective tissue of the labia majora (outer lips of the vulva). helps to maintain the anteverted position of the uterus. 1/18/2024 34
- 35. Uterus… Parts of the uterus The fundus, body and cervix. The other parts include the cornua, cavity and the isthmus are located in these major areas. The fundus: is the top and widest part, between the insertions of the fallopian tubes The body (corpus): makes up the upper two- thirds of the uterus and is the greatest part. 35 1/18/2024
- 36. Parts of uterus: The cervix or neck The cervix is a canal with constrictions at the upper and lower ends respectively forming an internal and external cervical os. The Cavity Is the potential space between the anterior and posterior wall with in the body. Has three openings, two of the top communicating with the fallopian tubes and one at the bottom leading through cervix into the vagina 36 1/18/2024
- 37. Parts of uterus: Cornua: are the upper outer angles of the uterus where the fallopian tubes join. The isthmus is the narrow area between the cavity and the cervix which is 7mm in length. It enlarges during pregnancy to form the lower uterine segment 37 1/18/2024
- 38. FALLOPIAN TUBES Are two trumpet shaped, thin, flexible, muscular tubes extending from the cornua and measures 11cms. Have two openings, one into the uterine cavity and the other into the peritoneal cavity. 38 1/18/2024
- 39. Function Propel the ovum towards the uterus, receive the spermatozoa as they travel up wards and provide a site for fertilization Supplies the fertilized ovum with nutrition during its continued journey to the uterus. 39 1/18/2024
- 40. Parts of the fallopian tubes:- The interstitial portion: 1.25cm long and lies with in the wall of the uterus. Its lumen is 1mm in width. The isthmus: another narrow part which extends for 2.5cm from the uterus. The ampulla: is wider portion of the fallopian tube where fertilization takes place and is 5 cm long. The infundibullum: is the funnel shaped fringed end which is composed of many processes known as fimbrae 40 1/18/2024
- 41. Ovaries Are two small endocrine glands and female gonads which are situated in the upper part of the pelvic cavity one on either side of the uterus Function Produce ova and the hormones estrogen and progesterone. Are attached to the back of the broad ligament with in the peritoneal cavity Size 41 1/18/2024
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- 43. Female reproductive cycles Definition: The female reproductive cycle refers to the series of changes that occur in a woman's reproductive system, typically over a monthly period. The two main cycles involved in female reproduction are the uterine cycle and the ovarian cycle. 43 1/18/2024
- 44. • Start at puberty. • Normally continues until the menopause. • Reproductive cycles depend upon activities & coordination of: 1. Hypothalamus, 2. Pituitary gland, 3. Ovaries, 4. Uterus, 5. Uterine tubes, 6. Vagina and 7. Mammary OVARIAN AND UTERINE CYCLES
- 45. GnRH • Gonadotrophin- releasing hormone (GnRH) is synthesized by neurosecretory cells in the Hypothalamus. • Carried to the Pituitary gland (anterior lobe). • It stimulates the pituitary to release Two Hormones that act on Ovaries (FSH & LH)
- 46. OVARIAN CYCLE • The ovarian cycle is under the control of the Pituitary Gland. • It is divided into 3 phases: (FOL) • 1- Follicular, (FSH) • 2- Ovulatory, (LH). • 3- Luteal. (LH). • The ovarian cortex contains hundreds of thousands of primordial follicles (400,000 t0 500,000). • Each consists of one primary oocyte encircled by single layer of flat follicular Early development of ovarian follicle is induced by FSH. The simple flat follicular cells become cuboidal, then columnar then forming many layers around the oocyte forming primary follicle. FSH
- 47. FSH • Follicle- Stimulating Hormone . • FUNCTIONS: • 1- It stimulates the ovarian primary follicles to develop and become mature. • 2- Production of Estrogen by the follicular cells. OVARIAN CYCLE Follicular Phase
- 48. • The follicle becomes enlarged until it gets maturity. • It produces swelling on the surface of the ovary. • Early development of ovarian follicle is induced by FSH. • Final stages of maturation require LH. • LH. causes ovulation (rupture These Growing follicles produce estrogen which regulates the development and functions of the reproductive organs. Ovulatory Phase LH
- 49. LH • Luteinizing Hormone. • FUNCTIONS: • 1- It serves as the trigger for ovulation. • 2- Stimulates the mature follicles to produce Estrogen. • 3-Stimulates corpus luteum to produce Progesterone. 2 1 3 Ovulatory Phase
- 50. Corpus Luteum • The remaining of the ruptured follicle is now called corpus luteum. • It secretes Progesterone and small amount of Estrogen. • These 2 hormones stimulate endometrial glands to secrete and prepare endometrium for implantation of fertilized Ovum (Blastocyst). • If the oocyte is fertilized the Corpus Luteum enlarges and remains till the 4th month of pregnancy. • If the oocyte is not fertilized the corpus luteum involutes and degenerates in 10-12 Luteal Phase
- 51. Uterine or Menstrual Cycle • Cyclic changes in the endometrium of the uterus caused by estrogen & progesterone. • Average menstrual cycle is 28 days. • Day One is the day when menstrual blood flow begins. • It varies by several days in normal women. • Ranges between 23 and 35 days in 90% of women. • It sometimes varies in
- 52. Phases of Menstrual Cycle 1. Menstrual Phase 2. Proliferative or Follicular Phase 3. Luteal Phase 4. Ischemic Phase
- 53. Menstrual Phase • Starts with 1st day of menstrual cycle. • Lasts for 4-5 days. • Functional layer of the endometrium is sloughed off and discarded with the menstrual flow. • Blood discharge from vagina is combined with small pieces of endometrial tissue.
- 54. Proliferative Phase • Is a phase of repair and proliferation. • Lasts for 9 days. • Coincides with growth of ovarian follicle (Follicular Phase). • So it is controlled by Estrogen secreted by the follicular cells. • Thickness of the endometrium is increased into 2-3 folds. • The glands increase in number and length and the
- 55. Luteal Phase • Is a Secretory or Progesterone phase. • Lasts about 13 days. • Coincides with the formation, growth and functioning of the Corpus Luteum. • Glandular epithelium secretes glycogen rich material. • Endometrium thickens under the influence of estrogen and progesterone.
- 56. Luteal Phase • Spiral arteries grow into the superficial layer. • Arteries become increasingly coiled. • Large venous network develops. • Direct arterio- venous anastomoses are the prominent features.
- 57. Ischemic Phase • Degeneration of corpus luteum leads to decrease the levels of estrogen & progesterone. • Loss of interstitial fluid. • Marked shrinking of endometrium. • Spiral arteries become constricted. • Venous stasis & Ischemic necrosis. • Rupture of damaged vessel wall. • Loss of 20-80 ml of blood • Entire compact layer and most of the spongy layer of endometrium is discarded.
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