This power point presentation explains the female reproductive system briefly. It explains about different stages of female reproduction i.e. puberty, menarche, menstruation, pregnancy, menopause etc.

1. WORKING OF
OBG SYSTEM
Dr. Shashi Prabha Pandey
First Year MD Clinical Yoga

2. FEMALE REPRODUCTIVE SYSTEM
2

3. INTRODUCTION
• The female reproductive system consists of organs concerned with
menstruation, coitus, fertilization, pregnancy, and parturition.
• They can be divided into the following categories:
• External genitalia: Vulva
• Internal genitalia: Vagina, cervix,uterus, fallopian tubes, ovaries
• Accessory reproductive organs: A system of genital ducts: Fallopian
tubes, uterus, cervix and vagina, mammary glands.
• The female reproductive system can also be divided into the lower genital
tract (vulva and vagina) and the upper tract (cervix, uterus, fallopian
tubes, and ovaries).
3

4. 4

5. 5

6. • Puberty is the process of physical
maturation where an adolescents reach
sexual maturity and become capable of
reproduction.
• 8 to 13 in females and 9 to 14 in
males.
• Puberty is associated with emotional,
hormonal and physical changes.

7. PHYSICAL CHANGES OF
PUBERTY
Normal pubertal development is characterized by following :
• Sexual maturation
• Changes in body composition
• Rapid Skeletal growth.
Female physical changes of puberty :
• Breast development (thelarche)– First manifestation and Pubarche
• Menarche - within 2 years of the onset of breast development.
• Increase in fat mass in the later stages of puberty.
• Sexual dimorphism.
Wheeler MD. Physical changes of puberty. Endocrinol Metab Clin North Am. 1991 Mar;20(1):1-14. PMID: 2029881.
7

8. Timing of pubertal onset
• Breast budding, at 10.7 years with an SD of 1
year and the average age of menarche as 12.7
years with an SD of 1.3 years.
• Precocious puberty is defined as breast budding
younger than 2.5 SDs from the mean or younger
than 8 years of age.
• Obesity has been suggested to play a role in the
possible early onset of puberty in girls, as girls
with early onset of breast budding have higher
BMI scores than age-matched girls without
budding.
8
Tanner JM. The assessment of growth and development in children. Arch Dis Child 1952; 27:10–33

9. PHYSIOLOGY OF
PUBERTY

10. CELLULAR
• Gonadotropin-releasing hormone (GnRH) neurons of the
hypothalamus control the initiation of puberty.
• GnRH causes the release of luteinizing hormone (LH) and follicle-
stimulating hormone (FSH) from the gonadotropic cells of the anterior
pituitary gland.
• FSH and LH affect the theca and granulosa cells of the ovary.

11. FEMALE DEVELOPMENT DURING
PUBERTY
Thelarche
• Thelarche refers to breast growth, the first sign of puberty in girls.
• An increase in estrogen causes the lactiferous duct system to develop.
• Increase in progesterone causes the lobular alveoli at the ends of lactiferous
ducts to increase in number.
Pubarche
• Approximately six months after thelarche, growth of pubic hair, will occur.
• Two years after pubarche, axillary hair begins to grow- mediated by
testosterone.
Breehl L, Caban O. Physiology, Puberty. 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK534827/
11

12. Menarche
• Menarche is the female's first menstrual period, caused by an increase in FSH
and LH.
• Menarche occurs 1.5 to 3 years after thelarche at approximately 12.8 years of
age.
• The first ovulation takes place approximately 6 to 9 months after menarche.
12

13. Ovarian Development
• The rise in gonadotropins during puberty stimulates the ovary to produce
estrogen, which is responsible for thelarche, growth of reproductive organs, fat
redistribution to the hips and breasts, and bone maturation.
• Ovarian size increases from prepubertal volume (0.5 cm) to a post pubertal
volume (4.0 cm).
Uterus Size
• The uterus of a prepubertal female is tear-drop shaped. An increase in estrogen
production causes the uterus to become pear-shaped, with the uterine body
increasing in length and thickness.
Vaginal Changes
• Puberty leads to enlargement of the labia majora and labia minora. Clear to white
vaginal discharge may also be seen prior to the onset of menarche.
13

14. Growth Spurt
• The growth spurt results from interactions between sex steroids
(estrogen/testosterone), growth hormone. The rise in sex steroids leads to an
increase in growth hormone levels, which causes an increase in Insulin like
Growth Factor-1.
• IGF-1 causes somatic growth via its metabolic actions (e.g., increases
trabecular bone growth).
Adrenarche
• Adrenarche refers to the increased secretion of adrenal androgen precursors
dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS),
and androstenedione from the adrenal zona reticularis.
• It occurs prior to puberty in children around the ages of 6-8 years. The
eventual result of adrenarche is pubarche, increased oiliness of hair and skin,
and acne.
14

15. UTERUS
• It lies in the pelvic cavity, in between the rectum and urinary
bladder.
• Uterus is a hollow muscular organ with a thick wall. It has a
central cavity, which opens into vagina through cervix.
• Virgin uterus is pyriform in shape and is flattened
anteroposteriorly. It measures about 7.5 cm in length, 5 cm in
breadth at its upper part and about 2.5 cm in thickness.
• Uterus is divided into three portions:
1. Fundus (above the entrance points of fallopian tubes)
2. Body (between fundus and isthmus)
3. Cervix (below isthmus).
15

16. 16

17. Structure of uterus
• Uterus is made up of three layers:
1. Serous or outer layer : Serous or outer layer is the covering of
uterus derived from peritoneum.
2. Myometrium or middle muscular layer : Thickest layer, It expands
during pregnancy to hold the growing baby. It contracts during labor to
push the baby out.
3. Endometrium or inner mucus layer : This is the inner lining. It's
shed during a menstrual period. Endometrium has minute orifices,
through which tubular follicles of endometrium open.
17
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=34&ContentID=17114-1

18. 18

19. CHANGES IN UTERUS IN DIFFERENT PHASES OF
SEXUAL LIFE.
• Before menstruation, uterus is enlarged, becomes more vascular. The
endometrium thickens with more blood supply. This layer is
desquamated during menstruation and reformed after menstrual
period.
• With pregnancy progression, the uterus leaves the pelvis and ascends
to the abdominal cavity
• Uterus increases in size till the 38 weeks after that the fundus level
starts to descend preparing for delivery.
• Its weight increases from 50g to 1200g at 40 weeks and stretches to
accommodate the fetus size, which is associated with an increase in
the thickness and length of the fundus.
19

20. CERVIX
• Cervix is the lower constricted part of uterus.
• It is divided into two portions:
1. Upper supra vaginal portion
• It communicates with body of uterus through internal os (orifice)
of cervix.
2. Lower vaginal portion, which
• It projects into the anterior wall of the vagina and it
communicates with vagina through external os of cervix.
20

21. VAGINA
• The vagina is an elastic, muscular canal with a soft, flexible
lining that provides lubrication and sensation.
• The vulva and labia form the entrance, and the cervix of the
uterus protrudes into the vagina, forming the interior end.
• The hymen is a thin membrane of tissue that surrounds and
narrows the vaginal opening. It may be absent, torn or ruptured
by sexual activity or by an kind of physical exercise.
21

22. MENSTRUATION
22

23. MENSTRUAL CYCLE
• Menstrual cycle is defined as cyclic events that take place in a
rhythmic fashion during the reproductive period of a woman’s
life.
• Menstrual cycle starts at the age of 12 to 15 years, which marks
the onset of puberty.
• The commencement of menstrual cycle is called menarche.
• Menstrual cycle ceases at the age of 45 to 50 years.
Permanent cessation of menstrual cycle in old age is called
menopause.
• Menstruation is a visible manifestation of cyclic physiologic
uterine bleeding due to shedding of endometrium.
23

24. • Menstruation is caused by the reduction of estrogens and
progesterone, especially progesterone, at the end of the
monthly ovarian cycle.
• The first effect is decreased stimulation of the endometrium,
followed by involution of the endometrium to about 65% of its
previous thickness.
• During the 24 hours preceding the onset of menstruation, the
tortuous blood vessels become vasospastic due to the release
of a vasoconstrictor prostaglandins.
24

25. CHANGES DURING MENSTRUAL CYCLE
1. Ovarian changes
2. Uterine changes
3. Vaginal changes
4. Changes in cervix
25

26. OVARIAN CHANGES DURING MENSTRUAL CYCLE
• A. Follicular phase
• B. Luteal phase.
• Ovulation occurs in between these two phases.
FOLLICULAR PHASE
• 5th to 14th day of cycle.
• Maturation of ovum and development of ovarian follicles.
26

27. FOLLICULAR PHASE
• At the beginning of menstrual cycle, levels of FSH rise cause the
stimulation of few ovarian follicles.
• As follicles mature they compete with each other for dominance.
• The first follicle that becomes fully mature begins to produce large
amounts of estrogen.
• Estrogen inhibits the growth of the other competing follicles.
• The Follicle that reaches full maturity during this process is called
Graafian follicle (the oocyte develops within this).
• The Graafian follicle continues to secrete increasing amounts of
estrogen which leads to endometrial thickening, thinning of the
cervical mucus to allow easier passage of sperm.
27

28. 28

29. OVULATION
• Ovulation is the process by which
the graafian follicle ruptures with
consequent discharge of ovum into
the abdominal cavity.
• It is influenced by LH.
• Ovulation occurs on 14th day of
menstrual cycle in a normal cycle of
28 days.
• The ovum enters the fallopian tube.
29

30. • As estrogen levels rise, they eventually surpass a threshold
level, at which point they conversely stimulate LH production,
resulting in a spike in LH levels around day 12.
• The high amounts of LH cause the membrane of the
Graafian follicle to become thinner.
• Within 24-48 hours of the LH surge, the
follicle ruptures releasing a secondary oocyte.
• The secondary oocyte quickly matures into an ootid and then
into a mature ovum.
• The mature ovum is then released into the peritoneal space and
is taken into the fallopian tube via fimbriae.
30

31. LUTEAL PHASE
• Once ovulation has occurred LH and FSH stimulate the
remaining Graafian follicle to develop into the corpus luteum, hence
called luteal phase.
• The corpus luteum then begins to produce the hormone progesterone.
Increased levels of progesterone result in:
• The endometrium becoming receptive to implantation.
• Negative feedback causing decreased LH and FSH (both needed to
maintain the corpus luteum)
• As the levels of FSH and LH fall, the corpus luteum degenerates.
• Degeneration of the corpus luteum results in loss of progesterone
production.
• The subsequent falling level of progesterone triggers menstruation and
the entire cycle begins again.
31

32. Presentation title 32

33. • If an ovum is fertilized it produces human chorionic gonadotropin
(hCG) which is similar in function to LH.
• hCG prevents degeneration of the corpus luteum (resulting in the
continued production of progesterone).
• Continued production of progesterone prevents menstruation.
• The placenta eventually takes over the role of the corpus luteum (from 8
weeks gestation).
33

34. THE UTERINE CHANGES
During each menstrual cycle, along with ovarian changes, uterine
changes also occur simultaneously. Uterine changes occur in
three phases:
1. Menstrual phase
2. Proliferative phase
3. Secretory phase
34

35. MENSTRUAL PHASE
• At the end of the luteal phase, the corpus luteum degenerates (if
no implantation occurs).
• The loss of the corpus luteum results in decreased progesterone
production.
• The decreasing levels of progesterone cause the spiral
arteries in the functional endometrium to contract.
• The loss of blood supply causes the functional endometrium to
become ischemic and necrotic.
• As a result, the functional endometrium is shed and exits
through the vagina as menstruation.
Presentation title 35

36. PROLIFERATIVE PHASE
• Proliferative phase extends from 5th to 14th day of menstruation
and it corresponds to the follicular phase of ovarian cycle.
• During this phase, endometrium is exposed to increasing levels
of estrogen as a result of FSH and LH stimulating its production.
• Estrogen stimulates repair and growth of the functional
endometrial layer allowing recovery from the recent
menstruation (increasing endometrial thickness, vascularity and
the number of secretory glands).
• The endometrium reaches the thickness of 3 to 4 mm at the end
of proliferative phase.
36

37. SECRETORY PHASE
• The secretory phase begins once ovulation has occurred.
• It extends between 15th and 28th day of the menstrual cycle,
i.e. between the day of ovulation and the day when
menstruation of next cycle commences.
• This phase is driven by progesterone produced by the corpus
luteum and results in the secretion of various substances by
the endometrial glands, making the uterus a more welcoming
environment for an embryo to implant.
37

38. 38

39. REGULATION OF MENSTRUAL CYCLE
• The menstrual cycle is orchestrated by the endocrine system
through interaction of the hypothalamus, pituitary and gonads (
hypothalamo-pituitary-ovarian axis).
• Hormones involved in the regulation of menstrual cycle are:
1. Hypothalamic hormone: GnRH
2. Anterior pituitary hormones: FSH and LH
3. Ovarian hormones: Estrogen and progesterone.
• HYPOTHALAMO-PITUITARY GONADALAXIS
• HYPOTHALAMO-PITUITARY GONADALAXIS
39

40. The hypothalamus secretes GnRH.
GnRH travels down to the
anterior pituitary gland and binds to
receptors on the gland.
LH and FSH travel in the
bloodstream to the ovaries.
This promotes the release
of LH (luteinizing hormone)
and FSH (follicle-stimulating
hormone).

41. When LH and FSH bind to
the ovaries they stimulate the
production of estrogen,
progesterone and inhibin
Estrogen helps to regulate the
menstrual cycle
Inhibin causes inhibition of
activin which is responsible
for stimulating GnRH
production
FSH stimulates the
development of ovarian
follicles, follicle most sensitive
to FSH becoms Graafian
follicle
LH causes the Graafian follicle
to change into the corpus
luteum, which begins to
produce progesterone
Progesterone stimulates the
endometrium to become
receptive to the implantation
of a fertilized ovum.

42. Increasing levels
of oestrogen, progesterone and inhibin have
a negative feedback effect on
the pituitary and hypothalamus
This leads to the decreased
production of GnRH, LH and FSH.
If female becomes pregnant, GnRH, FSH
and LH remain inhibited, causing
menstruation to cease.
This, in turn, results in decreased
production of oestrogen and inhibin.

43. 43

44. APPLIED PHYSIOLOGY
MENSTRUAL SYMPTOMS
These symptoms are due to hormonal withdrawal, leading to cramps in
uterine muscle before or during menstruation.
1. Abdominal pain
2. Dysmenorrhea
3. Headache
4. Occasional nausea and vomiting
5. Irritability
6. Depression
7. Migraine
44

45. PREMENSTRUAL SYNDROME
• Premenstrual syndrome (PMS) is the symptom of stress that appears before the
onset of menstruation.
It lasts for about 4 to 5 days prior to menstruation.
Symptoms appear due to salt and water retention caused by estrogen.
Symptoms :
1. Mood swings, anxiety, irritability
2. Emotional instability
3. Headache
4. Depression
5. Constipation
6. Abdominal cramping
7. Bloating (abdominal swelling).
45

46. ABNORMAL MENSTRUATION
46
AMENORRHEA
Absence of
menstruation
HYPOMENORRHEA
Decreased
menstrual
bleeding
MENORRHAGIA
Excess
menstrual
bleeding
OLIGOMENORRHEA
Decreased
frequency of
menstrual
bleeding
METRORRHAGIA
Uterine
bleeding in
between
menstruations.

47. ANOVULATORY CYCLE
• Ovulation does not occur.
• The menstrual bleeding occurs.
• It is common during puberty and few years before menopause.
• If it occurs very often during childbearing years, it leads to infertility.
CAUSES
1. Hormonal imbalance
2. Prolonged strenuous exercise program
3. Eating disorders
4. Hypothalamic dysfunctions
5. Tumors in pituitary gland, ovary or adrenal gland
6. Long-term use of drugs like steroidal oral contraceptives.
47

48. 48

49. 49
Due to aging reduction in
no. of ovarian follicles and
granulosa cells
occur which are the
primary producers of
estrogen and inhibin.
With the lack of inhibition
from estrogen and inhibin
on gonadotropins, follicle-
stimulating
hormone (FSH) and
luteinizing hormone (LH)
production increases.
The decline in estrogen
levels disrupts the
hypothalamic-pituitary-
ovarian axis.
Failure of endometrial
development.
Irregular menstruation and
stoppage of
menstrual cycle
altogether.
Peacock K, Ketvertis KM. Menopause. [Updated 2022 Aug 11] Publishing; 2022 Jan

50. PHASES OF MENOPAUSE
• The phases of menopause is usually broken down into four categories:-
1.PRE-MENOPAUSE:
• Pre-menopause is the time prior to menopause. The occurrence of menopause
before the age of 40 years.
2.PERI MENOPAUSE:
• A period of women's life characterized by the physiological changes associated
with the end of reproduction capacity and terminating with the completion of
menopause also called climacteric.
3.MENOPAUSAL PHASE:
• It is the end of menstruation. The age of menopause ranges between 45-55 years,
average being 50 years.
4.POST-MENOPAUSAL :
• It is defined formally as the time after which a women has experienced 12
consecutive month of amenorrhea..
50

51. PHYSIOLOGICAL CHANGES
• The lack of estrogen and progesterone causes many changes in women's physiology.
INCREASED CHOLESTEROL LEVEL IN THE BLOOD:
• Increase in the level of cholesterol and lipids in the blood is common. This lead to
gradual rise in the risk of heart disease and stroke after menopause.
OSTEOPOROSIS:
• Calcium loss from the bone is increased in the first five years after the onset of
menopause, resulting in a loss of bone density.
• The calcium moves out of the bones, leaving them weak and liable to fracture at the
smallest stress.
51

52. URINARY SYSTEM
As the estrogen level decreases after menopause, the tissue lining
the urethra and the bladder become drier, thinner and less elastic.
This can lead to increased frequency of passing urine as well as
an increased tendency to develop UTI.
52

53. CHANGES IN GENITAL ORGANS
UTERUS
• The uterus become small and fibrotic due to atrophy of the muscles after the
menopause.
• The cervix become smaller and appears to flush with vagina. In older women the
cervix may be impossible to identify separately from vagina.
• The vaginal and cervical discharge decreases in amount and later disappear
completely
OVARIES
• The ovaries become smaller in appearance.
VAGINA
• The vaginal mucous membrane becomes thin and loses its rugosity after the
menopause.
• Decreased secretion makes vagina dry. Sexual intercourse become painful and
difficult due to pain from the dryness.
53

54. CHANGES IN VASOMOTOR SYSTEM 54
HOT FLASHES
• Women in menopause gets a sudden feeling of warmth and flushing that starts in
the face and quickly spread all over the neck and upper body.
• Can occur at any time of the day or night. The hot flashes are often associated
with profuse sweating.
NIGHT SWEAT
• Night sweat are closely related to hot flashes . Both usually occur simultaneously.
Sweat can occur any time of the day or night, they are more common at night.
• It wakes women up from the sleep. The sudden waking up from sleep can cause
palpitation and sometimes panic attacks.

55. PREGNANCY
• Pregnancy is the state of carrying a
developing embryo or fetus.
• The human gestational period is 39 weeks
or 280 days and is divided into trimesters.
• Known as gestational period.
Anderson J, Ghaffarian KR. Early Pregnancy Diagnosis.
55

56. FERTILISATION
56

57. • Fertilization is defined as the union of two gametes. Also known as
conception.
• During fertilization, sperm and egg fuse to form a diploid zygote to initiate
prenatal development.
• Movement of the sperm through uterus is facilitated by the anti-peristaltic
contractions of uterine muscles. Uterine contractions are induced by oxytocin.
• Takes place in outer third of the fallopian tube.
• Zygote- Initial name for fertilized ovum
• Embryo- Name of product of conception from second through 8 week of
pregnancy
• Fetus- Name of product of conception from 9" week through duration of
gestational period.
• In mammals, fertilization involves multiple ordered steps, including the
acrosome reaction, zona pellucida penetration, sperm–egg attachment, and
57

58. Presentation title 58

59. 59
Sperm enters the ovum by penetrating the multiple layers of
granulosa cells known as corona radiata present around the ovum.
Secondary oocyte stage, divides
into a matured ovum. Nucleus
of matured ovum becomes
female pronucleus with 23
chromosomes.
23 chromosomes of the sperm and 23 chromosomes of ovum
arrange themselves to reform the 23 pairs of chromosomes in the
fertilized ovum.
Head of sperm swells and
becomes male pronucleus.
23 chromosomes.

60. IMPLANTATION
60

61. • Implantation is the process by which the fertilized ovum called zygote
attaches in the endometrial lining of uterus.
• Zygote takes 3 to 5 days to reach the uterine cavity from fallopian tube.
• It takes about 1 week for implantation after the day of fertilization.
• Before implantation, during the stay in the uterine cavity the zygote
receives its nutrition from the secretions of endometrium, known as uterine
milk.
• Before implantation, zygote develops into morula which is a 12-15 celled
stage.
• Morula is covered with spherical trophoblasts cells which
secrete proteolytic enzymes over the surface of endometrium to digest it.
• Morula moves through the digested part of endometrium and implants
itself.
61

62. DEVEOPMENT OF PLACENTA
• When implantation occurs, there is further increase in the thickness of endometrium
because of continuous secretion of progesterone from corpus luteum.
• At this stage, the endometrial stromal cells are called decidual cells and the endometrium
at the implanted area is called decidua.
• The trophoblastic cells of morula develop into cords, which are attached with decidual
portion of endometrium. Blood capillaries grow into these cords from the blood vessels of
the newly formed embryo.
• At about 16th day of fertilization, heart of embryo starts pumping the blood into the
trophoblastic cords.
• Blood sinusoids develop around the trophoblastic cords. These sinusoids receive blood
from the mother.
62

63. MATERNAL CHANGES DURING PREGNANCY
STRUCTURAL CHANGES
Ovaries
• Ovulation does not occur as the secretion of FSH and LH from
anterior pituitary is inhibited.
• Corpus luteum secretes large quantity of progesterone and little
estrogen, for maintaining the pregnancy.
• Corpus luteum degenerates after 3 months and placenta
takes over the formation of progesterone and estrogen.
Uterus
• From almost zero volume, uterus reaches about 5 to 7 liters at the
end of pregnancy.
63

64. 64
State Shape
Non- pregnant Pyriform
12 weeks Globular
28 weeks Ovoid
Beyond 36
Weeks
Spherical
SHAPE OF THE UTERUS
Weight increases from 50g to 1200 g.

65. VAGINA
• Vagina increases in size and its color changes to violet due to
increased blood supply. There is deposition of glycogen in the
epithelial cells.
CERVIX
• The number of glands, blood supply and mucus secretion
increase.
• The tough cervix becomes soft and it is closed by mucus plug.
MAMMARY GLANDS
• Size of the mammary glands increases because of development
of new ducts and alveoli, deposition of fat and increased
vascularization.
• Pigmentation of nipple and areola occurs. 65

66. METABOLIC CHANGES
• Increased metabolic rate due to increased secretion of thyroxin
and cortisol.
• Blood glucose level increases leading to glucosuria.
• Ketosis might develops either due to less food or more vomiting.
• There is deposition of about 3 to 4 kg of fat in the maternal body. It
also increases the blood cholesterol.
• Estrogen and progesterone lead to the retention of sodium and
water.
66

67. CHANGES IN PHYSIOLOGICAL SYSTEMS
1.CARDIOVASCULAR SYSTEM
Pre-eclampsia
• Preeclampsia is a multisystem disorder of unknown etiology
characterized by development of hypertension to the extent of
140/90 mm of hg or more with proteinuria induced by pregnancy
after the 20thweek in a previously normotensive woman.
• It encompasses 2% to 8% of pregnancy-related complications,
greater than 50,000 maternal deaths, and over 500,000 fetal
deaths worldwide.
• Early diagnosis and prompt management are crucial.
International society for study of hypertension in pregnancy, 1998
67

68. Causes of pre-eclampsia
• Release of vasoconstrictor substances from placenta.
• Hypersecretion of adrenal hormones and other hormones, which cause
vasoconstriction.
• Development of autoimmune processes induced by the presence of placenta or
fetus.
Symptoms associated with hypertension
• Decreased blood flow to kidney and thickening of glomerular capillary membrane,
leading to reduction in GFR and urinary output
• Retention of sodium and water
• Decreased urinary output along with retention of sodium and water results in
edema
• Excretion of proteins through urine.
Karrar SA, Hong PL. Preeclampsia. [Updated 2022 Jun 9].
68

69. Eclampsia
• Eclampsia is a severe complication of preeclampsia and poses both a risk to
the mother and fetus.
• Characterized by severe vascular spasm, uncontrolled hypertension and
convulsive muscular contractions.
• It occurs just before, during or immediately after delivery. It leads to death, if
timely treatment is not given.
Features of eclampsia
1. Spasm of blood vessels
2. Very severe hypertension
3. Renal failure, liver failure, heart failure
4. Convulsions
5. Coma.
Magley M, Hinson MR. Eclampsia. [Updated 2022 Feb 16].
69
Treatment for eclampsia
• Treatment should be
immediate.
• It includes administration of
quick acting vasodilator drugs
or termination of pregnancy.

70. PARTURITION
• Parturition is the expulsion or delivery of the fetus from the
mother’s body at the end of the pregnancy.
• Series of events that take place in the genital organs in an effort to
expel the viable products of conception (fetus, placenta and the
membranes) out of the womb through the vagina into the outer
world is called Parturition or Labor.
• Labor is characterized by the presence of regular uterine
contractions with effacement and dilatation of the cervix and fetal
descent.
• Delivery is the expulsion or extraction of a viable fetus out of the
womb. It is not synonymous with labor; delivery can take place
without labor as in cesarean section.
70

71. BRAXTON HICKS CONTRACTIONS
• Braxton Hicks contractions are the weak, irregular, short and usually
painless uterine contractions, which start after 6th week of
pregnancy.
• These contractions do not induce cervical dilatation but may cause
softening of cervix. Braxton Hicks contractions help the uterus
practice for upcoming labor. Sometimes may cause discomfort.
• Triggered by 1. Touching the abdomen 2.Fetal movement 3.
Physical activity 4. Sexual intercourse 5. Dehydration.
• While nearing the time of delivery, the Braxton Hicks contractions
become intense and are called false labor contractions. The false
labor contractions are believed to help cervical dilatation.
• It is found more in primigravidae than in parous women.
71

72. • Painful uterine contractions
at regular intervals
• Frequency of contractions
increase gradually
• Associated with “show”
• Progressive effacement
and dilatation of the cervix
• Descent of the presenting
part
• Not relieved by enema or
sedatives.
72
TRUE LABOR PAIN FALSE LABOR PAIN
• Dull in nature
• Confined to lower abdomen
and groin
• Not associated with
hardening of the uterus
• Progressive effacement
and dilatation of the cervix
• Usually relieved by enema
or sedative.
• Absence of other
features of labor pain.

73. Presentation title 73

74. STAGES OF PARTURITION
Parturition occurs in three stages:
First stage:
• It starts from the onset of true labor pain and ends with full dilatation of the
cervix.
• Its average duration is 12 hours in primigravidae and 6 hours in multiparae.
Second Stage :
• It has two phases—
(1) The propulsive phase—starts from full dilatation up to the descent of the
presenting part to the pelvic floor.
(2) The expulsive phase is distinguished by maternal bearing down efforts and
ends with delivery of the baby.
• Its average duration is 2 hours in primigravidae and 30 minutes in multiparae.
74

75. Third Stage :
• It begins after expulsion of the fetus and ends with
expulsion of the placenta and membranes.
• Its average duration is about 15 minutes in both
primigravidae and multiparae.
Fourth Stage :
• It is the stage of observation for at least 1 hour after
expulsion of the afterbirths.
• During this period maternal vitals, uterine retraction
and any vaginal bleeding are monitored.
• Baby is examined. These are done to ensure that
both the mother and baby are well.
75

76. MAMMARY
GLANDS
AND
LACTATION
76

77. 77

78. 78

79. • During first half of pregnancy, the duct system develops further with
appearance of many new alveoli. No milk is secreted by the gland now.
• During the second half, there is enormous growth of glandular tissues and the
development is completed for the production of milk just before the end of
gestation period.
79

80. ROLE OF HORMONES IN GROWTH OF MAMMARY GLANDS
• Estrogen causes growth and branching of duct system.. Estrogen
is also responsible for the accumulation of fat in breasts.
• Progesterone- Progesterone stimulates the development of
glandular tissues.
• Prolactin is necessary for milk secretion. It helps in growth of
mammary glands during pregnancy. Prolactin secretion starts
increasing from 5th month of pregnancy. At that time, it acts directly
on the mammary glands and causes proliferation of epithelial cells
of alveoli.
• Growth hormone, thyroxine and cortisol enhance the overall
growth and development of mammary glands in all stages.
80

81. LACTATION
• The physiological basis of lactation is divided into four phases:
(a) Preparation of breasts (mammogenesis)
(b) Synthesis and secretion from the breast alveoli (lactogenesis)
(c)Milk ejection (Galactokinesis)
(d) Maintenance of lactation (galactopoiesis).
81

82. 1. MAMMOGENESIS:
• In pregnancy there is remarkable growth of both ductal and lobuloalveolar
systems.
• An intact nerve supply is not essential for the growth of mammary glands during
pregnancy.
2. LACTOGENESIS:
• The alveolar cells secrete milk.
• Prolactin is responsible for lactogenesis.
• During pregnancy, large quantity of prolactin is secreted. But the activity of this
hormone is suppressed by estrogen and progesterone secreted by placenta.
Because of this, lactation is prevented during pregnancy.
• After the delivery and expulsion of placenta, there is sudden loss of estrogen and
progesterone. Now, the prolactin is free to exert its action on breasts and to
promote lactogenesis.
• Prolactin, insulin, growth hormone and glucocorticoids are the important
hormones in this stage.
82

83. 3. GALACTOKINESIS :
• Milk ejection is the discharge of milk from mammary gland. It depends
upon suckling exerted by the baby and on contractile mechanism in breast,
which expels milk from alveoli into the ducts.
4.GALACTOPOIESIS:
• Prolactin is the most important galactopoietic hormone.
• For maintenance of effective and continuous lactation, frequency of suckling
(>8/24 hours) is essential.
• Distension of the alveoli by retained milk is due to failure of suckling. This causes
decrease in milk secretion by the alveolar epithelium.
83

84. 84

85. MILK PRODUCTION
• A healthy mother will produce about 500–800
mL of milk a day.
• This requires about 700 Kcal/day for the
mother, which must be made up from diet or
from her body store.
• For this purpose a store of about 5 kg of fat
during pregnancy is essential to make up any
nutritional deficit during lactation.
85

86. REFERENCES
• Medicine 438's Reproductive
Physiology
• Dutta's-Textbook Of Obstetrics and
Gynecology
• Essentials of medical physiology-K-
Sembulingam
86

87. 87