reviewer Flashcards
Puberty: initiated when the hypothalamus releases __________
Gonadotropin-releasing hormone(GnRH)
The release of Gonadotropin-releasing hormone(GnRH) triggers anterior pituitary to release _____and ____ which initiate the production of androgen and estrogen
FSH
LH
Male around ______ & Female around ______
12-14yrs old
9-12 yrs old
Are a group of hormones that play a role in male traits and reproductive activity. Both present in male and female. It is responsible for muscular development, physical growth, and increase in sebaceous gland secretions
Androgens
Androgens are produced by the ______, and the _______
adrenal cortex
testes or ovaries
In male, specific function of androgen is further development of _____, _______ , ______, _____, and _______. Also for the appearance of _____, _____, and ______, _______ enlargement , maturation of ________, and closure of growth in ______
testes scrotum penis prostate seminal vesicles pubic axillary facial hair laryngeal enlargement spermatozoa long bones
In female, ________ influences enlargement of labia majora and clitoris, formation of axillary and pubic hair termed as _______
testosterone
adrenarche
Estrogen is triggered at puberty of ____
FSH
Estrogen contains 3 compounds _____,
(Estrone or E1, Estradiol or E2, Estriol or E3)
Influences development of uterus, fallopian tubes and vagina; female fat distribution, hair patterns, breast development, and closure of long bones
Estrogen
Beginning of breast development
Thelarche
First menstrual period
Menarche
Arrange the typical pubertal changes of female in order. Onset of Menstruation Growth of pubic hair Growth of axillary hair Vaginal Secretions Growth of Spurt Breast Development Increase in the transverse diameter of the pelvis
5 4 6 7 1 3 2
Arrange the typical pubertal changes of male in order Penile growth Growth of face, axillary, and pubic hair Voice changes Increase in weight Growth of testes Spermatogenesis (production of sperm) Increase in height
5 3 4 1 2 7 6
Study of female reproductive organs
Gynecology
Study of male reproductive organs
Andrology
Rugated, skin-covered, muscular pouch suspended from the perineum. Support the testes and to help regulate the temperature of sperm
Scrotum
Two ovoid glands, 2 to 3 cm wide, that lie in the scrotum
Testes
Each testis is encased by a protective white fibrous capsule and is composed of several lobules, with each lobule containing _________ and a ________
interstitial cells (Leydig’s cells) seminiferous tubule
Are responsible for production of testosterone
Leydig’s cells
Responsible for release of androgen-binding protein which promotes sperm formation
FSH
LH responsible for release of _________
testosterone
Usually, the ______ is slightly larger and suspended slightly lower than the other
left testis
Penis
-composed of three cylindrical masses of _________ in the penis shaft: two termed the ________ , and a third termed the _________
erectile tissue
corpus cavernosa
corpus spongiosum
Is released by endothelium during sexual excitement which results in dilation of blood vessels and increase blood flow.
Nitric Oxide
Outlet for both the urinary and the reproductive tract
Penis
When the Nitric oxide is released, the _________ at the base of the penis then contracts, trapping both venous and arterial blood
ischiocavernosus muscle
Penile erection is stimulated by __________
parasympathetic nerve innervations
Bulging,sensitive ridge of tissue at the distal end of penis which is protected by Prepuce(retractable casing of skin)
Glans
Tightly coiled tube. Responsible for conducting sperm from the tubule to the vas deferens
Epididymis
Epididymis is ___ long
-Over 20ft long
Some sperm are stored in the epididymis, and a portion of the______ that will surround sperm at maturity
alkaline fluid
Semen, or seminal fluid that contains a ______ and _____, a form of protein
basic sugar
mucin
Is produced by the cells lining the epididymis
Semen or seminal fluid
It takes at least ______for them to travel the length of the epididymis and a total of _____ for them to reach maturity
12 to 20 days
64 days
Absence of sperm
aspermia
<20 million sperm/mL
oligospermia
Hollow tube surrounded by arteries and veins and protected by a thick fibrous coating
Vas deferense (Ductus deferens)
Vas deferens carries sperm from the epididymis through the _______ into the abdominal cavity, where it ends at the seminal vesicles and the ejaculatory ducts
inguinal canal
Sperm mature as they pass through the _______
vas deferens
The blood vessels and vas deferens together are referred to as the __________
spermatic cord
Sperm are still not mobile at this point (as they pass through the vas deferens, however, probably because of the _____________ produced at this level
fairly acidic medium of the semen
Varicosity of the internal spermatic vein
varicocele
Severing of the vas deferens to prevent passage of sperm
Vasectomy
Two convoluted pouches that lie along the lower portion of the posterior surface of the bladder and empty into the urethra by way of the ejaculatory ducts
Seminal Vesicles
Seminal Vesicles secrete a viscous alkaline liquid that has a ______, _____, and _______
high sugar
protein
prostaglandin content
Sperm become increasingly motile with this added fluid, because it surrounds them with nutrients and a more favorable pH
Secreted viscous alkaline liquid of seminal vesicle
The two _______ pass through the prostate gland and join the seminal vesicles to the urethra
Ejaculatory ducts
- chestnut-sized gland that lies just below the bladder
- The urethra passes through the center of it, like the hole in a doughnut
- secretes a thin, alkaline fluid
- alkaline fluid further protects sperm from being immobilized by the naturally low pH level of the urethra
Prostate Gland
- Cowper’s glands
- lie beside the prostate gland and empty via short ducts into the urethra
- secrete an alkaline fluid that helps counteract the acid secretion of the urethra and ensure the safe passage of spermatozoa
Bulbourethral glands
Semen, therefore, is derived from the ______ (60%), the ______ (30%), the ______ (5%), and the _______ (5%).
prostate gland
seminal vesicles
epididymis
bulbourethral glands
Hollow tube leading from the base of the bladder, which, after passing through the prostate gland, continues to the outside through the shaft and glans of the penis
Urethra
Urethra is approximately _______ long
8 in (18 to 20 cm)
Urethra is lined with ____________
mucous membrane
Female External Structures- Female external genitalia. _____ which means covering
Vulva
- pad of adipose tissure over the symphysis pubis
- covered by a triangle of coarse, curly hairs
- protects the junction of pubic bone from trauma
Mons Veneris
- posterior to the mons veneris
- two hairless folds of connective tissue
- firm and full in childbearing age and atrophies on menopause
- normally pink in color
- internal surface is covered with mucous membrane and the external surface with skin
- abundant with sebaceous glands
Labia Minora
- two folds of adipose tissue covered by loose connective tissue and epithelium
- lateral to the labia minora
- covered with pubic hair
- serve as protection for the external genitalia and distal urethra and vagina
- fused ______ but separated ______
Labia Majora
anteriorly
posteriorly
- flattened, smooth surface inside the labia
- urethra and vagina both arises on this organ
Vestibule
- small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of the labia minora
- covered by prepuce
- sensitive to touch and temperature and is the center for sexual arousal and orgasm
- rich in arterial blood supply
Clitoris
- lateral to the urinary meatus, one on each side
- their ducts open into the urethra
- help to lubricate the external genitalia during coitus
- the alkaline pH of their secretions helps to improve sperm survival in the vagina
Skene’s glands (paraurethral glands)
- lateral to the vaginal opening on both sides
- their ducts open into the distal vagina
- help to lubricate the external genitalia during coitus
- the alkaline pH of their secretions helps to improve sperm survival in the vagina
Bartholin’s glands (vulvovaginal glands)
- ridge of tissue formed by the posterior joining of the two labia minora and the labia majora
- sometimes cut (episiotomy) during childbirth to enlarge the vaginal opening
Fourchette
- posterior to fourchette
- easily stretched during childbirth to allow for enlargement of the vagina and passage of the fetal head
- Kegel’s exercise makes this organ flexible
Perineal muscle or the Perineal body
- tough but elastic semicircle of tissue that covers the opening to the vagina in childhood
- often torn during the first time of sexual intercourse
Hymen
Complete hymen that does not allow for passage of menstrual blood from the vagina or for sexual relations until it is surgically incised
Imperforate hymen
The blood supply of the external genitalia is mainly from the pudendal artery and a portion of the inferior rectus artery.
Vulvar Blood Supply
Venous return is through the ___________
pudendal vein
The anterior portion of the vulva derives its nerve supply from the ______ and ________ The posterior portions of the vulva and vagina are supplied by the _________.
ilioinguinal genitofemoral nerves (L1 level). pudendal nerve (S3 level)
- approximately 4 cm long by 2 cm in diameter and approximately 1.5 cm thick, or the size and shape of almond
- grayish white and appear pitted, or with minute indentations on the surface
- located close to and on both sides of the uterus in the lower abdomen
Ovaries
Ovaries produce, mature, and discharge _______
ova (the egg cells)
- produce estrogen and progesterone and initiate and regulate menstrual cycles
- necessary for maturation and maintenance of secondary sex characteristics in females
- held suspended and in close contact with the ends of the fallopian tubes by three strong supporting ligaments attached to the uterus or the pelvic wall
- not covered by the peritoneum
ovaries
Principal divisions of ovaries:
- Protective layer of surface _______
- _________ , where the immature (primordial) oocytes mature into ova and large amounts of estrogen and progesterone are produced
- _________, which contains the nerves, blood vessels, lymphatic tissue, and some smooth muscle tissue
epithelium
Cortex
Central medulla
Division of Gametes (Reproductive cells)
- At birth, each ovary contains approximately _______________, which formed during 5 mos of intrauterine life
- __________ differ in other body cells in the number of chromosomes which contains only half the usual number of chromosomes
- oocytes divide in _________ by mitosis which halt until puberty when meiosis occurs
- in male, meiosis(reduction division) occurs just before the ________, while in female, in occurs just _________
2 million immature ova reproductive cells intrauterine life spermatozoa mature before ovulation
Maturation of Oocytes
- Each oocyte lies in the ovary surrounded by a protective sac, or thin layer of cells, called a _________
- 5 and 7 million ova form in ____. The majority never develop beyond the primitive state and actually atrophy, so that by birth only 2 million are present.
- By age ____, only approximately 500,000 are present in each ovary
- by ____, there are approximately 300,000; and
- by ____, none are left (all have either matured or atrophied). “The point at which no functioning oocytes remain in the ovaries” is one definition of menopause
primordial follicle utero 7 years 22 years menopause
- 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
- Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum by sperm
- smooth, hollow tunnel
- composed of mucous membrane with cilia, connective tissue and muscular layer(circular)
Fallopian Tubes
The mucus in fallopian tube contains _____, ______, and _____ which help in nourishment of the ovum
water
protein
salt
Four parts of a fallopian tube:
proximal to uterine wall, 1 cm in length and its lumen is about 1mm in diameter
Interstitial portion
Four parts of a fallopian tube:
extremely narrow, 2 cm in length, cut or sealed in tubal ligation
Isthmus
Four parts of a fallopian tube:
longest portion approx 5cm and this is where fertilization occurs
Ampulla
Four parts of a fallopian tube:
most distal, approx 2cm and is funnel shaped, the rim is covered by fimbria(small hairs) which help to guide ovum to fallopian tube
Infundibular
- hollow, muscular, pear-shaped organ
- located in the lower pelvis, posterios to the urinary bladder, and anterior to the rectum
- size of an olive in childhood
- receives ovum from the fallopian tube, and site of implantation and nourishment, protection, and maturity of a growing fetus, and expel it from the woman’s body
Uterus
Uterus begins to increase at ________ up to _______
8yrs of age
17 yrs of age
Uterus us approx ____ long, ____ wide in upper part and ____ deep. ___ in nonpregnant state
In a woman who has a borne child, it is approx ___ long, ____ wide, ____ thick, and ____ in weight
5-7cm
5cm
2.5cm
60g
9cm
6cm
3cm
80g
Uterus is consist of _____, ____ and _____
body, isthmus, and cervix
Uppermost and forms bulk of the organ.
Enlarges during pregnancy
Body
Portion between the points of attachment of fallopian tubes. Can be palpated to determine uterine growth, measure contraction
Fundus
Short segment between the body and cervix, 1-2mm in length, enlarges during pregnancy, and most commonly cut during cesarean birth
Isthmus
Lowest portion, approx 1/3 of uterus size, approx 2-5cm long
-approx half of it lies above the vagine, and half of it extends into the vagina
Cervix
Central cavity
- cervical canal
Opening of the canal at junction of cervix & isthmus
Internal cervical os
Opening of the canal at junction of distal opening to vagina, the level of ischial spines
External cervical os
Uterine and Cervical Coats
- Important for menstrual function
- shed when pregnancy does not occur as menstrual flow
Endometrium
Endometrium is formed by two layers of cells, ______ (not influenced by hormone) and inner _______(influenced by estrogen and progesterone)
basal layer
glandular layer
Mucous lining of the cervix, affected by hormones
- secretes mucus to lubricate surface for sperm passing through cervix
- when estrogen is at its peak, about ____ mucus is produced per day
Endocervix
700mL
The mucus secreted by the endocervix is ______
alkaline
Endocervix becomes plugged during ________ to keep ascending infections
pregnancy
Are not lined with mucous membrane but with stratified squamous epithelium and location for obtaining Papanicolaou smear
Lower surface of cervix
- muscle layer
- composed of fibers arranged in longitudinal, transverse, and oblique directions
- provides extreme strength to the organ
Myometrium
Adds strength and support to the organ
Perineum-
Uterine blood supply
-large descending abdominal aorta divides to two _____, main divisions of these are the _______
iliac arteries
hypogastric arteries
Uterine nerve supply
The uterus is supplied by both ______ and _______
efferent (motor)
afferent (sensory) nerves
The efferent nerves that supply the uterus arise from the ___ through ____
T5
T10 spinal ganglia
The afferent nerves join the ______and enter the spinal column at ___and ____
hypogastric plexus
T11 T12
Uterine deviations (shape and position) Oddly shaped “horns” in junction of the fallopian tubes
Bicornuate uterus
Uterine deviations (shape and position) Fundus is tipped forward
Anteversion
Uterine deviations (shape and position) Fundus is tipped back
Retroversion
Uterine deviations (shape and position) Body of uterus is bent sharply forward at junction with cervix
Anteflexion
Uterine deviations (shape and position) Body of uterus is bent sharply back just above the cervix
Retroflexion
Suspended in the pelvic cavity by several ligaments that also help support the bladder and is further supported by a combination of fascia and muscle
Uterine support
herniated bladder in anterior wall of vagina
Cystocele
herniated rectum in posterior wall of vagina
Rectocele
The anterior wall of the vagina is about _____ and posterior wall is around _____
7-6cm
8-9cm
The vagina has both sympathetic and parasympathetic nerve innervations originating at the _____ to _______
S1
S3 levels
The mucus produced by the vaginal lining has a rich _____ which is broken down by the lactose-fermenting bacteria that frequent the vagina (Döderlein’s bacillus), and lactic acid is formed
glycogen content
Recesses at the side of the cervix. Anterior, posterior(place for pooling of semen), and lateral sides
Fornix
Breasts or mammary glands are located __________ and extends well into the axilla
anterior to the pectoral muscle
Milk glands of the breasts are divided by connective tissue partitions into approximately ______.
20 lobes
All of the glands in each lobe produce milk by ________ and deliver it to the nipple via a ________
acinar cells
lactiferous duct
A _____ is composed of smooth muscle that is capable of erection on manual or sucking stimulation
nipple
Acts to constrict milk gland cells and push milk forward into the ducts that lead to the nipple
Oxytocin
Areola: darkly pigmentation around nipples which contains many sebaceous glands, called ________
Montgomery’s tubercles
Although not a part of the female reproductive system but of the skeletal system, it is a very important body part of pregnant women.
Pelvis
A. Structure of Pelvis
Two os coxae/innominate bones made up of:
Ilium
Ischium
Pubes
Upper extended part; curved upper border is the _______.
Ilium
iliac crest
Under part; when sitting, the body rests on the ischial tuberosities; ______are important landmarks.
Ischium
ischial spines
Front part; join to form an articulation of the pelvis called the ________
Pubes
symphysis pubis.
Wedge-shaped, forms the back part of the pelvis. Consists of 5 fused vertebrae, the first having a prominent upper margin called the __________
Sacrum
sacral promontory.
Lowest part of the spine;
Coccyx
Degree of movement between sacrum and coccyx made possible by the third articulation of the pelvis called _________ which allows room for delivery of the fetal head.
sacroccygeal joint
B. Divisions – set apart by the _______, an imaginary line from the sacral promontory to the ilia on both sides to the superior portion of the symphysis pubis.
linea terminalis
Superior half formed by the ilia. Offers landmarks for pelvic measurements; supports the growing uterus during pregnancy; and directs the fetus into the true pelvis near the end of gestation.
False pelvis
Inferior half formed by the pubes in front, the iliac and the Ischia on the sides and the sacrum and coccyx behind.
True pelvis
The true pelvis is made up of three parts:
Inlet
Cavity
Outlet
Entranceway to the true pelvis. Its transverse diameter is wider than its anterosposteior diameter.
Inlet
The measurements of inlet
Transverse diameter = .
Anteroposterior diameter (AP) = .
Right and left oblique diameter = .
13.5 cm
11 cm
12.75 cm
Space between the inlet and the outlet. Contains the bladder and the rectum, with the uterus between them in an anteflexed position towards the bladder.
Cavity
Inferior portion of the pelvis, bounded on the back by the coccyx, on the sides by the ischial tuberosities and in front by the inferior aspect of the symphysis pubis and the pubic arch. Its _____ diameter is wider than its _______.
Outlet
AP
transverse diameter
“normal” female pelvis. Inlet is well rounded forward and back. Most ideal for childbirth.
Gynecoid
transverse diameter is narrow, AP diameter is lager than normal.
Anthropoid
inlet is oval, AP diameter is shallow
Platypelloid
“male” pelvis. Intel has a narrow, shallow posterior portion and pointed anterior portion.
Android
Distance between the middle points of the iliac crests. Average = ____.
Intercristal diameter
28 cm
Distance between the anterosuperior iliac spines. Average = _____.
Interspinous diameter
25 cm
Distance between the trochanters of the
femur. Average = _____
Intertrochanteric diameter
31 cm
Distance between the anterior aspect of the symphysis pubis and depression below L5. Average = ______
External conjugate/Baudelocque’s diameter
18-20cm
Suggestive only of pelvic size:
External
Give the actual diameters of the inlet and outlet
Internal
Distance between the sacral promontory and inferior margin of the symphysis pubis. Average = _____
Important measurement because it is the diameter of the pelvic inlet.
Average = ________.
Diagonal conjugate
- 5 cm.
- 5 – 11 cm
Transverse diameter of the pelvic outlet. Is measured at the level of the anus. Average = ____.
Bi-ischial diameter/tuberischii
11 cm
Episodic uterine bleeding in response to cyclic hormonal changes
Menstruation
Temporary cessation of menstrual flow.
Amenorrhea
Markedly diminished menstrual flow, nearing amenorrhea
Oligomenorrhea
Excessive bleeding during regular menstruation.
Menorrhagia
Bleeding at completely irregular intervals.
Metrorhagia
Frequent menstruation occurring at intervals of less than 3 weeks.
Polymenorrhea
Markedly diminished menstrual flow.
Oligomenorrhea
Physiology of Menstruation
Four body structures are involved in the physiology of the menstrual cycle: the _______, the ______, the _____, and the ______.
hypothalamus
pituitary gland
ovaries
uterus
Hormones which regulate cyclic activites - ____ and ____
FSH and LH
Effects of _____ in the body
-Inhibits production of FSH
estrogen
Effects of ______ in the body
-Inhibits production of LH
progesterone
-Stimulates growth of the ductile structures of the breasts.
estrogen
-Causes hypertrophy of the myometrium
estrogen
Effects of ______ in the body
-Increases body temperature after ovulation. Just before ovulation basal body temperature decreases slightly (because of low ______ level in the blood) and then increases slightly a day after ovulation (because of the presence of ________)
progesterone
Effects of ______ in the body
- Increases endomentrial tortuosity
- Increases endometrial secretions
- Inhibits uterine motility
progesterone
Effects of ______ in the body
-Increases quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of ____cm. (Spinnbarkheit test of ovulation).
estrogen
10-13
Effects of ______ in the body
-Decreases muscle tone of gastrointestinal and urinary tracts
progesterone
Effects of ______ in the body
-Increases musculoskeletal motility
progesterone
Effects of ______ in the body
-Facilitates transport of the fertilized ovum through the Fallopian tubes
progesterone
Effects of ______ in the body
- Decreases renal threshold of lactose and dextrose
- Increases fibrinogen levels; decreases hemoglobin and hematocrit
progesterone
Sequential steps of the menstrual cycle
1. On the third day of the menstrual cycle, serum _____ is at its lowest. This low level serves as the stimulus for the hypothalamus to produce the ______.
estrogen level
Follicle-Stimulating Hormone Releasing Factor (FSHRF)
Sequential steps of the menstrual cycle
2. FSHRF is the one responsible for stimulating the _______ to produce the first of two hormones which regulate cyclic activities, the Follicle-Stimulating Hormone (FSH).
Anterior Pituitary Gland (APG)
Sequential steps of the menstrual cycle
3. FSH, in turn, will stimulate the growth of an ________ inside a primordial follicle by stimulating production of _____ by the ovary.
immature oocytes
estrogen
Sequential steps of the menstrual cycle
3. Once estrogen is produced, the primordial follicle is now termed as ______, therefore, is the structure which contains high amounts of estrogen).
Graafian follicle (The Graafian follicle)
4.________ will cause the cells in the uterine endothelium to proliferate (grow very rapidly), thereby increasing its thickness to about eightfold. This particular phase in the uterine cycle, therefore, is called _______.
Estrogen in the Graafian follicle
proliferative phase
In view of the change from primordial to Graafian follicle, it is also called _____. Because of the predominance of estrogen, it is also called the _______. And since it comes right after the menstrual period, it is also called ________. And it is also called the ________.
follicular phase
estrogenic phase
postmenstrual phase
pre-ovulatory phase
- On the ____ of the menstrual cycle, there is now a very low level of _______ in the blood. This low serum level is the stimulus for the Hypothalamus to produce the _________
13th day
progesterone
Luteinzing Hormone Releasing Factor (LHRF).
- LHRF is responsible for stimulating the APG to produce the second hormone which regulates cyclic activity, the ________.
Luteininzing Hormone (LH)
- The LH, in turn, is responsible for stimulating the ovary to produce the second hormone produced by the ovaries, _______.
progesterone
- The increased amounts of both estrogen and progesterone push the _________ to the surface of the ovary until, on the following day (the 14 th day of the menstrual cycle)
new mature ovum
On the following day (the 14 th day of the menstrual cycle), the Graafian follicle ruptures and releases the mature ovum, a process called _______.
ovulation
- Once ovulation has taken place, the Graafian follicle, because it now contains increasing amounts of ______, giving it its yellowish appearance, is termed ______.
progesterone
Corpus Luteum
The structure which contains high amounts of progesterone is the
Corpus Luteum
- Progesterone causes the glands of the uterine endothelium to become corkscrew or twisted in appearance because of the increasing amount of ___________.
capillaries
________, therefore, is said to be the hormone designed to promote pregnancy because it makes the uterus nutritionally abundant with blood in order for the fertilized zygote to survive should conception take place, that is why this phase in the uterine cycle is what we call __________.
Progesterone
progestational phase
Progestational phase in the uterine cycle is also called _________ because it secretes the most important hormone in pregnancy.
secretory phase
In view of the change from Graafian follicle to corpus Luteum, it is called ______ . Because it occurs just after ovulation, it is also called the_______. And, it is also called the _____
luteal phase
post-ovulatory phase
pre-menstrual phase.
- Up until the _____ of the menstrual cycle, if the mature ovum is not fertilized by a sperm, the amounts of hormones in the corpus Luteum will start to decrease.
24 th day
The corpus Luteum turning white is now called the _______ and in 3-4 days, the thickened lining of the uterus produced by _____ starts to degenerate and slough off and capillaries rupture. And thus begins another _____.
corpus albicans
estrogen
menstrual period
When the ovary releases the mature ovum on the day of ovulation, sometimes a certain degree of pain in either the _______ is felt by the woman. This sensation is normal and termed ______.
right or left lower quadrants
mittelschmerz
The first 14 days of the menstrual cycle is a very ______ period. The last 14 days of the menstrual cycle is a ____ period
variable
fixed
Exactly _____ after ovulation, menstruation will occur (unless a pregnancy has taken place) because the ______ has only this length of life span .
2 weeks
corpus Luteum
In a 28-day cycle, ovulation takes place on the 14th day. In a 32-day cycle, ovulation takes place on the 18 thday. In a 26-day cycle, ovulation takes place on the 12 th day (Subtract ____ from the cycle).
14 days
Menstruation does not occur during pregnancy because _____ does not decrease in amount. Corpus ______continues to produce progesterone until the placenta takes over production of hormones by the_______of pregnancy.
progesterone
Luteum
8 th week
Menstruation can occur even _____ (as in women taking oral contraceptives). Ovulation can likewise occur even ______
without ovulation without menstruation (as in lactating mothers).
Sexual Response Cycle
Occurs with physical and psychological stimulation
Excitement
Excitement
- Vaginal _____ and ______ of genitalia
- Penile erection due to ______
lubrication
vasocongestion
vasocongestion
Before orgasm
- In woman, ______ is draw on forward and retracts under ______, ______ becomes congested and increased ____ elevation
- Formation of orgasmic platform due to prominent _____
- Generalized ______, ______, ______, ______ in the late plateau phase.
- __________ with live spermatozoa
Plateau clirotis clitoral prepuce lower part of the vagina nipple vasocongestion
muscle tension
hyperventilation
increased BP
tachycardia
Pre-ejaculatory phase
When body suddenly discharges accumulated sexual tension
shortest stage in sexual cycle
intense pleasure affecting the body
-vigorous contraction of muscles in the _____ and ____ from the area of congestion
- ______ in woman
-In men, contractions project semen into the ______ followed by ________ contractions
Orgasm pelvic area expels blood fluid 8-15 contractions (one every 0.8sec) proximal urethra three to seven propulsive ejaculatory
External and internal genitalia return to an unaroused state
Resolution
Only in males; the period during which no amount of stimulation can cause another erection. Not manifested in females because females are multi- orgasmic. This phase lengthens with age.
Refractory phase
Abstinence from sexual activity
Celibacy
Self-stimulation for erotic pleasure
Masturbation
Use of visual materials such as magazines or photographs for sexual arousals
Erotic stimulation
Sexual arousal resulting from the use of certain objects or situations
Fetishism
An individual who dresses to take on the role of the opposite sex
Transvestism
Obtaining sexual arousal by looking at other’s person’s body
Voyeurism
Involves inflicting pain (sadism) or receiveing pain (masochism)
Sadomasochism
Revealing one’s genitals in public
Exhibitionism
Individuals who are interested in sexual encounters with children
Pedophiles
PREGNANCY AND PRENATAL CARE
Definition: the union of the sperm and the mature ovum in the outer third or outer half of the Fallopian tube.
I. FERTILIZATION
Fertilization
General considerations
1. Normal amount of semen per ejaculation = ______
3-5 cc. = 1 teaspoon.
Fertilization
2. Number of sperms in an ejaculate = _____
120-150 million/cc
Fertilization
3. Mature ovum is capable of being fertilized for_______ after ovulation. Sperms are capable of fertilizing even for _____ after ejaculation.
12-24 hours
3-4 days
Fertilization
4. Normal life span of sperms = ______
7 days
Fertilization
5. Sperms, once deposited in the vagina, will generally reach the cervix within _____ after deposition.
90 seconds
Fertilization
6. Reproductive cells, during ______, divide by meiosis (haploid umber of daughter cells); therefore, they contain only 23 chromosomes (the rest of the body cells contain 46 chromosomes).
gametogenosis
Sperms have 22 autosomes and 1 X sex chromosome or 1 Y sex chromosome. The union of an X-carrying sperm and mature ovum results in a ______; the union of a Y-carrying sperm and a mature ovum results in a _____. Important: Only _____, therefore, determine the sex of their children.
baby girl (XX) baby boy (XY) fathers
II. IMPLANTATION
- Implementation after fertilization, the fertilization ovum or zygote stays in the ______ for 3 days, during which time rapid cell division (mitosis) is taking place.
Fallopian tube
II. IMPLANTATION
The developing cells are now called ______ and when there are already about 16 blastomeres, it is now termed a ____.
blastomere
morula
In this morula for, it will start to ravel (by ciliary action and peristaltic contractions of the Fallopian tube) to the
_____ where it will stay for another 3-4 days.
uterus
When there is already a cavity formed in the morula, it is now called a _____.
blastocyst
Fingerlike projections, called ______ (Table 4), form around the blastocyst
trophoblasts
Are the ones which will implant high on the anterior or posterior surface of the uterus. Thus, implantation, also called ______, takes place about a week after fertilization.
trophoblasts
nidation
II. IMPLANTATION
General Considerations:
1. Once implantation has taken place, the uterine endothelium is now termed _____.
decidua
- Occasionally, a small amount of vaginal spotting appears with implantation because capillaries are ruptured by the _________ = implantation bleeding. Implication: this should not be mistaken for the Last Menstrual Period (LMP)
implanting trophoblasts
III. STAGES OF HUMAN PRENATAL DEVELOPMENT
A. First 12-14 days = _____
B. From 15th day up to the 8th week = ____
C. From 8th week up to the time of birth = _____
D. Developing embryo or fetus and placental structures throughout pregnancy- _____
zygote
embryo
fetus
Conceptus
III. STAGES OF HUMAN PRENATAL DEVELOPMENT
The inner layer.
Cytotrophoblast
III. STAGES OF HUMAN PRENATAL DEVELOPMENT
The outer layer containing fingerlike projections called chorionic villi
Syncytiotrophoblast
Chorionic villi which differentiate into:
Langhan’s layer
Syncytial layer
believed to protect the fetus against Treponema Pallidum (etiologic agent of syphilis). Present only during the _________ of pregnancy.
Langhan’s layer
second trimester
gives rise to the fetal membranes:
Syncytial layer
Syncytial layer gives rise to the fetal membranes:
Amnion
Chorion
Inner membrane which gives rise to
Umbilical cord/funis
Amniotic fluid
Amnion
Contains two arteries and one vein, which are supported by the Wharton’s jelly.
Umbilical cord/funis
- Clear, albuminous fluid in which the baby floats.
- Begins to form at _______.
- Approximates water in specific gravity ______and is neutral to slightly alkaline _____ Note: the higher the pH, the more alkaline; the lower the pH, the more acidic
Amniotic fluid
11-15 weeks gestation
(1.007-1.025)
(pH = 7.0-7.25).
-Near term is clear, colorless, containing little white specks of vernix caseosa and other solid particles.
Amniotic fluid
Amniotic fluid is produced at a rate of ____ in 24 hours and fetus swallows it at an equally rapid rate.
500 ml
By the 4th lunar month, _____ is added to the amount of amniotic fluid.
urine
Amniotic fluid, therefore, is derived chiefly from _________ and ________.
maternal serum
fetal urine
Is the excessive accumulation of amniotic fluid — the fluid that surrounds the baby in the uterus during pregnancy.
Polyhydramnios
Implication: a case of polyhydramnios (=more than ________ of amniotic fluid) stems from the inability of the fetus to swallow amniotic rapidly, as in tracheoesophageal fistula;
1500 ml
- Amniotic fluid less than 500 ml
- is due to the inability of the kidneys to add urine to the amniotic fluid, as in congenital renal anomaly.
Oligohydramnios
Amniotic fluid also known as __________,
bag of water (BOW)
Amniotic fluid serves the following purposes:
Protestion
Diagnosis
Shields the fetus against blows or pressures on the mother’s abdomen; against sudden changes in temperature because liquid changes temperature more slowly than air; and from infections
Protestion
As in amniocentesis; meconium-stained amniotic fluid means fetal distress
Diagnosis
Aids in descent of the fetus during active labor
Amniotic fluid
Is a procedure in which amniotic fluid is removed from the uterus for testing or treatment
amniocentesis
meconium-stained amniotic fluid means ________
fetal distress
Together with the deciduas basalis, gives rise to the placenta, which starts to form at 8th week gestation.
Chorion
Chorion develops into ____________ call cotyledons.
15-20 subdivisions
Respiratory system – exchange of gases takes place in the _______, not in the fetal lungs
Placenta
Renal system – waste products are being excreted through the ________
placenta
In pregnancy: it is the ______ which detoxifies the fetal waste products
mother’s liver
Gastrointestinal system nutrients pass to the fetus via the placenta by ________ through the placental tissues
diffusion
Placenta serves the following purposes:
Circulatory system – __________ is established by selective osmosis
feto-placental circulation
Placenta serves the following purposes:
Endocrine system – it produces the following important hormones (before 8 weeks gestation, the _________ is the one producing these hormones):
corpus luteum
Placenta serves the following purposes:
“orders” the corpus luteum to keep on producing estrogen and progesterone, that is why menstruation does not take place during pregnancy.
Human chorionic gonadotropin (HCG)
– promotes growth of mammary glands necessary for lactation. Also has growth-stimulating properties
Human placental lactogen (HPL) or human chorionic somatomammotropin
– promotes growth of mammary glands necessary for lactation. Also has growth-stimulating properties
Human placental lactogen (HPL) or human chorionic somatomammotropin
Serves the following purposes:
Estrogen and Progesterone
Protective barrier – inhibits the passage of same bacteria and large molecules
Placenta
FETAL DEVELOPMENT
First Lunar Month
1. Germ layers differentiat by the _______: (in cases of multiple congenital anomalies, the structures that will be affected are those that arise out of the same germ layer).
2nd week
FETAL DEVELOPMENT
– develops into the lining of the GIT, the respiratory tract, tonsils, thyroid (for basal metabolism), parathyroid (for calcium metabolism), thymus gland (for development of immunity), bladder and urethra
Endoderm
FETAL DEVELOPMENT
– forms into the supporting structures of the body (connective tissues, cartilagem muscles and tendons); heart, circulatory system, blood cells, reproductive system, kidneys and ureters
Mesoderm
FETAL DEVELOPMENT
- responsible for the formation of the nervous system, the skin, hair and nails, and the mucous membrane of the anus and mouth.
Ectoderm
Fetal Development
2. _____________ appear by the second week.
Fetal membranes (amnion and chorion)
Fetal Development
3. ___________ very rapidly develops by the 3rd week. (Dizziness is said to be the earliest sign of pregnancy because as the fetal brain rapidly develops, _______ stores of the mother are depleted, thus causing hypoglycemia in the latter).
Nervous system
glucose
Fetal development
4. Fetal heart begins to form as early as the __________
16th day of life
“When does the fetal heart begin to beat?”, the answer is ________.
first lunar month
But to the question, “When can fetal heart tones to first heard?” the answer is __________
fifth month
Fetal Development
5. The ________ and __________ exist as a single tube until the 3rd week of life when they start to separate.
digestive
respiratory tracts
Fetal Development
Second Lunar Month
1. All vital organs are formed by the _______; placenta develops fully
8th week
Fetal development
2. Are formed by the 8th week. (To the question, “When is sex determined?” the answer is “At the time of conception”).
Sex organs (ovaries and testes)
Fetal Development
3. __________ are formed in the instestines by the 5th – 8th week.
Meconium (first stools)
Fetal development
Third Lunar Month
1. Kidneys are able to function – urine is formed by the ______.
12th week
What month in Fetal development does this happen Buds of milk teeth form
Third lunar Month
What month in Fetal development does the beginning bone ossification
Third Lunar Month
What month in Fetal development does the
fetus swallows amniotic fluid
Third Lunar Month
What month in Fetal development does the
Feto-placental circulation is established by selective osmosis; no direct exchange between fetal and maternal blood.
Third Lunar Month
What month in Fetal development does the Lanugo appears
.
Fourth Lunar Month
What month in Fetal development does the Buds of permanent teeth form.
Fourth Lunar Month
What month in Fetal development does the Heart beats maybe audible with fetoscope
Fourth Lunar Month
What month in Fetal development does the Vernix caseosa appears
Fifth Lunar Month
What month in Fetal development does the Lanugo covers entire body
Fifth Lunar Month
What month in Fetal development does the
Quickening (fetal movements) felt
Fifth Lunar Month
What month in Fetal development does the
Fetal heart beats very audible
Fifth Lunar Month
What month in Fetal development does the Skin markedly wrinkled
Sixth Lunar Month
What month in Fetal development does the Attains proportions of fullterm baby
Sixth Lunar Month
What month in Fetal development does the
alveoli begin to form (28th weeks of gestation is said to be the lower limit of prematurity because if baby is delivered at this time, will cry and breathe but usually dies)
Seventh Lunar Month
What month in Fetal development does the Fetus is viable
Eighth Lunar Month
What month in Fetal development does the Lanugo begins to disappear
Eight Lunar Month
What month in Fetal development does the Nails extend to ends of fingers
Eight Lunar Month
What month in Fetal development does the
Subcutaneous fat deposition begins
Eight Lunar Month
What month in Fetal development does the Lanugo and vernix disappear
Ninth Lunar Month
What month in Fetal development does the Amniotic fluid volume somewhat decreases
Ninth Lunar Month
What month in Fetal development does the – all characteristics of the normal newborn
Tenth Lunar Month
FOCUS OF FETAL DEVELOPMENT
Period of organogenesis
First trimester –
Period of continued fetal growth and development; rapid increase in fetal length
Second trimester
Period of most rapid growth and development because of rapid deposition of subcutaneous fat
Third trimester
NORMAL ADAPTATIONS IN PREGNANCY
A. Systemic Changes
1. Circulatory/Cardiovascular
- Beginning the end of the first trimester there is a
Gradual increase of about ________ reaching its peak during the 6th month.
30% - 50% in the total cardiac volume,
The increase in the total cardiac volume causes a drop in _________ and _________ since the increase is only in the plasma volume = physiologic anemia of pregnancy.
hemoglobin
hematocrit values
Consequences of increased total cardiac volume are:
Easily fatigability and shortness of breath because of _____
increased workload of the heart
Consequences of increased total cardiac volume are:
Slight hypertrophy of the heart, causing it to be displaced to the ____, ______________
left
resulting in torsion on the great vessels (the aorta and pulmonary artery).
Consequences of increased total cardiac volume are:
Systolic murmurs are common due to _____________
lowered blood viscosity
Consequences of increased total cardiac volume are:
Nosebleeds may occur because of ___________ as pregnancy progresses.
marked congestion of the nasopharynx
Circulatory/Cardiovascular
Palpitations are due to:
____________ stimulation during the first half of pregnancy
Sympathetic nervous system
Circulatory/Cardiovascular
Palpitations are due to:
Increased pressure of uterus against the diaphragm during __________
Second half of pregnancy
Circulatory/Cardiovascular
- Because of poor circulation resulting from pressure of the gravid uterus on the ____________:
• __________ occurs. Management legs above hip level. Important: Edema of the lower extremities is normal during pregnancy; it is not a sign of toxemia
• _________ can also occur. Management:
o Use/wear support hose or elastic stockings to promote venous flow, thus preventing stasis in lower extremities
o Apply elastic bandage – start at the distal end of the extremity and work toward the trunk to avoid congestion and impaired circulation in the distal part; do not wrap toes so as to be able to determine adequacy of circulation (Principle behind bandaging: blod flow through tissues is decreased by applying excessive pressure on blood vessels)
o Avoid use of constricting garters, e.g., knee-high socks
blood vessels of the lower extremities
Edema of the lower extremities
Varicosities of the lower extremities
Important: ______________ is normal during pregnancy; it is not a sign of toxemia
Edema of the lower extremities
Management of varicosities of the lower extremities:
o Use/wear _____________ to promote venous flow, thus preventing stasis in lower extremities
o Apply ______ – start at the distal end of the extremity and work toward the trunk to avoid congestion and impaired circulation in the distal part; do not wrap ____ so as to be able to determine adequacy of circulation
o Avoid use of _______, e.g., knee-high sock
support hose or elastic stockings
elastic bandage
toes
constricting garters
Principle behind bandaging: blood flow through tissues is decreased by _______________)
applying excessive pressure on blood vessels
Circulatory/Cardiovascular
- Because of poor circulation in the blood vessels of the genitalia due to the pressure of the gravid uterus, ________ and ______ can occur.
varicosities of the vulva
rectum
Circulatory/Cardiovascular
Management: _______ with hips elevated on pillow and _________.
side-lying position
modified knee-chest position
Circulatory/Cardiovascular
- There is increased level of circulating _______, that is why pregnant women are normally safeguarded against undue bleeding. However, this also predisposes them to formation of ___________.
fibrogen blood clots (thrombi)
The implication is that pregnant women should not be massaged since __________ and cause ________.
blood clots can be released
thromboembolism
NORMAL ADAPTATIONS IN PREGNANCY
A. Systemic Changes
2. Gastrointestinal changes
- Morning sickness – nausea and vomiting during the first trimester is due to increased ___________. It may also be due to increased ______ or even to ______.
human chorionic gonadotropin (HCG)
acidity
emotional factors
Management morning sickness: Eat ____or ____ 30 minutes before arising in the morning (or ___, ________, _____ and _____ in the diet).
dry toast crackers dry high carbohydrate low fat low spices
Excessive nausea and vomiting which persists beyond 3 months; results in dehydration, starvation and acidosis.
Hyperemesis gravidarum
