The document discusses the anatomy of the female pelvis and fetal skull. It begins with an overview of the female reproductive system, including the external genitalia, internal structures like the uterus and ovaries, as well as hormones produced. It then describes the bones of the pelvis, contents of the pelvic cavity, and measurements used to assess pelvic size. Finally, it covers the fetal skull, its peculiarities during birth, and importance of understanding its anatomy for assessing labor.
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
Intra Partum Cardiotocography - dr vivek patkardrvivekpatkar
Cardiotocography ( CTG )
is a procedure of graphically ( graph) recording fetal heart activity and uterine contractions ( Toco ) – both recorded in the same time scale simultaneously and continuously through uterine quiscience and contractions
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
ANATOMY OF UTERUS
ANATOMY OF OVARY
ANATOMY OF FALLOPIAN TUBES
ANATOMY OF UTERUS &ITS APPENDAGES
ANATOMY OF CERVIX
ANATOMY OF UTERUS PPT
BLOOD SUPPLY, NERVE SUPPLY, LYMPHATIC DRAINAGE
HISTOLOGY
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
Fetal skull is to some extent compressible and made mainly of thin pliable tabular (flat) bones forming
the vault. This is anchored to the rigid and incompressible bones at the base of the skull.
This was a lecture delivered during the 15th Postgraduate Course of the Jose R Reyes Memorial Medical Center- Department of Obstetrics and Gynecology on June 9, 2021. This is intended for Obstetrician-gynecologists in training and/or in practice.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
ANATOMY OF UTERUS
ANATOMY OF OVARY
ANATOMY OF FALLOPIAN TUBES
ANATOMY OF UTERUS &ITS APPENDAGES
ANATOMY OF CERVIX
ANATOMY OF UTERUS PPT
BLOOD SUPPLY, NERVE SUPPLY, LYMPHATIC DRAINAGE
HISTOLOGY
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
Fetal skull is to some extent compressible and made mainly of thin pliable tabular (flat) bones forming
the vault. This is anchored to the rigid and incompressible bones at the base of the skull.
This was a lecture delivered during the 15th Postgraduate Course of the Jose R Reyes Memorial Medical Center- Department of Obstetrics and Gynecology on June 9, 2021. This is intended for Obstetrician-gynecologists in training and/or in practice.
Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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2. Functional Anatomy of Female Pelvis
and the Fetal Skull
• 2.1.Review of the anatomy and physiology
Reproductive system
• 2.1.1.Anatomy of internal and external
genitalia
• 2.2.The female pelvis
• 2.2.1.Contents of the pelvis cavity
• 2.3.The menstrual cycle
4/6/2022 2
3. Learning Objectives
• At the end of this chapter the students will be able
to:
- Describe anatomy of the Female pelvis and Female
external genitalia
- Mention parts of fetal skull with its features.
- Differntiat organs contained in the pelivic cavity.
- Describe characteristic of menustral cycle and its
disorder
- List anatomy of female breast
- Define puberity and its featuers.
4/6/2022 3
4. 2.1.Review of the anatomy and
physiology Reproductive system
Introduction
• It is mandatory to know the anatomy and
physiology of the female reproductive
system to manage obstetric and
gynecologic problems.
4/6/2022 4
5. 2.1.1. Anatomy of internal and
external genitalia
• External female genitalia (vulva or pudendum )
• The vulva includes mons pubis, labia majora,
labia minora, clitoris, vestibule and perineum
which are all visible on external examination.
• It is bounded anteriorly by the mons pubis,
laterally by the labia majora and posteriorly by
the perineum.
4/6/2022 5
6. External genitalia
– Collectively referred to as the vulva or the pudendum
– It includes
The mons pubis (Veneris)
Labia majora
Labia minora
Clitoris
The vestibule
The fourchette
The perineum
4/6/2022 6
9. Female Reproductive Structures
• The structure of the uterus, uterine tubes, and ovaries is the basis
for understanding reproductive cycles and implantation
Uterus
• The uterus ([L.],
womb) is a thick-
walled, pear-
shaped muscular
organ.
• Parts –
Female Reproductive Structures
• Fundus
• Body
• Cervix
4/6/2022 9
11. Uterus: Parts
1 .Fundus
• Is the part lying above the level of openings of the uterine tubes
The area where the tubes join the uterus is called cornu (uterine horn)
2. Body
• Forms 2/3 of the uterus and extends from
the tubal openings to a constricted portion
3. Cervix cylindrical inferior one third
• The most fixed the part extends between the
isthmus and the vaginal opening of the uterus
It is divided into two by the upper wall of the vaginal
A.Supravaginal part – part above the vagina
B. Vaginal part (portion vaginalis)- communicates
with the vagina through the external astium or os
4/6/2022 11
12. • The walls of the body of the uterus consist of three layers
Perimetrium -thin external layer
Myometrium- thick smooth muscle layer
Endometrium- thin internal layer
12
Uterus …
4/6/2022
13. 13
Uterus …
an outer connective tissue layer,
continuous with the ligaments, which is
adventitia in some areas, but largely a
serosa covered by mesotheliumFirmly
attached to the myometrium
Myometrium
The thick highly vascular smooth muscle
layer
Endometrium
A mucosa, the endometrium, lined by
simple columnar epithelium
has both ciliated and secretory cells, the
latter forming numerous tubular uterine
glands
Perimetrium
4/6/2022
14. 14
Endometrium
• The endometrium can be
subdivided into two zones
1. Basal layer
Adjacent to the myometrium
Contains highly cellular
lamina propria and the deep
basal ends of uterine glands
has its own blood supply and
is not sloughed off during
menstruation (remains
relatively unchanged)
2. Superficial functional layer
Contains less cellular lamina
propria
Richer in ground substance,
most of the length of the
glands
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15. 15
Endometrium
I. A thin, compact layer
consisting of densely packed,
connective tissue around the
necks of the uterine glands
II. A thick, spongy layer
composed of edematous
connective tissue containing
the dilated, tortuous uterine
glands
• During the luteal phase of the menstrual cycle, two layers of the
functional layer can be distinguished microscopically
• The functional layer undergoes
profound changes during the
menstrual cycles
– Disintegrate and are shed
during menstruation and after
parturition (delivery of a baby)
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16. Uterine tubes
• Also known as oviducts (formerly called fallopian tubes)
• It is lined with secretory epithelium for nourishment of ovum
Extent
• From the lateral angles/cornu of the uterus to uterine ends of the
ovaries
– Length = ~10 -12 cm : Diameter = ~ 1 cm
Functions of Uterine Tubes
• Carry oocytes
• Sperms (ampulla of the uterine tube )
• Conveys the cleaving zygote to the uterine cavity
The ova are propelled to the uterus along this
tube, partly by peristalsis
and partly by cilial action.
Female reproductive structures …
4/6/2022 16
18. Uterine tubes: Parts - 4
1. Infundibulum 3. Isthmus
2. Ampulla 4. Intramural
(uterine) part
Infundibulum
• Is a funnel-shaped part close to
the ovaries
• It contains the abdominal or pelvic
opening surrounded by thin irregular
finger like processes, the fimbrae
• The fimbrae catch a discharged ovum
and passes it to the tube
The largest of this fimbrae attached to
the tubal end of the ovaries is called
ovarian fimbrae (fimbrae ovarica)
Length = 1cm)
ᶲ = 3mm
4/6/2022 18
19. Ampulla
• Is the thin walled, longest part that
has a widest diameter
• It follows a slightly tortuous course
b/n infundibulum & isthmus
Isthmus
• Is the part between the widest
part, ampulla, and the uterus
• Is narrower and thicker than
the ampulla
Uterine tubes …
Length = 5cm)
ᶲ = 4mm
Length = 3cm)
ᶲ = 2 mm
Intramural part
• Is the part with in the wall of the uterus
It is the narrowest part of the tube
• Its opening into the uterine cavity
Length = 1cm)
ᶲ = 1 mm
4/6/2022 19
20. The female reproductive structures ….
A. Estrogen (sex hormone)
secreted from Graffian follicle
responsible for 20 female sex characters
B. Progesterone (pregnancy hormone)
secreted from corpus luteum after
ovulation for some time
responsible for maintenance of pregnancy by increase the thickness
and vascularity of uterine endometrium 20
Ovaries
• Are female sex glands
• lie in the side wall of the
pelvis (in the ovarian fossa)
• Produce oocytes
• Secretes two hormones:
4/6/2022
21. 2.2.The Bony Pelvis
• The Bony Pelvis
– composed of four bones
• Sacrum & coccyx
• Two innominate bones (ilium, ischium, & pubis)
– False (greater) & True (lesser) pelvis
• By the pelvic brim
– True pelvis
• Divided into three planes
1. Pelvic inlet
2. Mid pelvis
3. Pelvic outlet
4/6/2022 21
31. Average & Critical Limit Values for Pelvic
Measurements by X-ray Pelvimetry
DIAMETER
AVERAGE
VALUE
CRITICAL
LIMIT[*]
Pelvic inlet
Anteroposterior
(cm)
12.5 10.0
Transverse (cm) 13.0 12.0
Pelvic midcavity
Anteroposterior
(cm)
11.5 10.0
Transverse (cm) 10.5 9.5
4/6/2022 31
32. Pelvic Shapes
• The Caldwell-Moloy classification
– based on measurement of the greatest transverse
diameter of the inlet & its division into anterior &
posterior segments.
• The character of the posterior segment determines the type of
pelvis, and
• The character of the anterior segment determines the tendency
– Four pelvis types
1. Gynecoid
2. Anthropoid
3. Android
4. Platypelloid
4/6/2022 32
37. Estimation of Pelvic Capacity
1. X-Ray Pelvimetry
§ Limited value in the Mx of labor with a cephalic
presentation
2. CT Scanning
3. MRI
4. Clinical pelvimetry
4/6/2022 37
38. Clinical Pelvimetry
• Clinical pelvimetry
– is currently the only method of assessing the
shape & dimensions of the bony pelvis in labor
– involves the assessment of the pelvic inlet,
mid pelvis, & pelvic outlet.
4/6/2022 38
39. Pelvic Inlet
1. Diagonal conjugate
• > 12cms - adequate pelvic inlet for a normal size fetus
• OC = DC - 1.5 to 2cms
• OC < 10cms or DC < 12cms - contraction
2. Sacral promontory
• Easily reachable or prominent - contraction
3. Head fit test
4/6/2022 39
40. How to measure the Diagonal Conjugate
• Patient placed in dorsal position
• Examining fingers
– Mobilize in upward direction following the anterior
sacral curvature
• So as to reach the promontory the elbow & wrist are to be
depressed sufficiently
• The point at which the bone recedes from the fingers is the
sacral promontory
– Mobilize under the symphysis pubis & place a mark on
the index finger
– Remove fingers & measure the distance between the
marking & tip of the middle finger
4/6/2022 40
46. Pelvic outlet
• Inter tuberous diameter
• Estimated by placing a fist on the perineum to measure the
distance between the ischial tuberosities
• < 8cms - contraction
• Subpubic arch
– Adequate if it accommodates the palmar aspect of two fingers
• Subpubic angle
– Adequate if it roughly corresponds to the fully abducted thumb &
index finger
– Narrow - if it roughly corresponds to the fully abducted middle & index
finger
4/6/2022 46
50. Pelvic floor Or Pelvic diaphragm
• The pelvic floor or diaphragm is a muscular
floor that demarcates the pelvic cavity and
perineum.
• Its strength is inforced by its associated
condesed pelvic fascia, therefore, it is
important for pelvic organs protection.
4/6/2022 50
51. Functions: -
• It supports the weight of the abdominal and
pelvic organs
• The muscles are responssible for the voluntary
control of micturation, defication and play an
important part in sexual intercourse.
• It infulences the passive movement of the
fetus through the birth canal and relaxes to
allow its exit from the pelvis.
4/6/2022 51
52. The main important muscels of pelivic
floor are:
• Levater ani muscles are arising from the lateral
pelveic wall and decussate in the midline
between the urethra, the Vagina and rectum.
• It contains pubococcygeous muscle, ileo
coccygeus and pubo rectalis.
• Pubococygeous muscle is constructed in such
away that it can expand enough for child bith and
contract the pelvis supported
4/6/2022 52
53. 2.2.1. Contents of the pelvis cavity
Pelvic Viscera
• include the:
• urinary bladder and parts of the ureters
• the reproductive system
• the distal part of the alimentary tract (rectum).
• Although the sigmoid colon and parts of the small bowel
extend into the pelvic cavity, they are abdominal rather
than pelvic viscera.
• The sigmoid colon is continuous with the rectum anterior
to S3 vertebra.
55. The Fetal Skull
• The fetal head is the most difficult part to deliver
whether it comes first or last.
• It is large in comparison with the ture pelvis
and some adptation between skull and pelvis must
take place during labour.
• An understanding of the landmarks and
measurements of the fetal skull enables to
recognize normal presentation and positions and
to facilitate delivery with the least possible trauma
to mother and child.
4/6/2022 55
57. Peculiarities of the Fetal Skull
• The fetal skull anatomy and dimensions are very
important parameters in labor outcome
• This is because the fetal skull is proportionally the
largest and least pliable structure of the fetal
anatomy
• Labor obstruction usually occurs at the level of
the fetal skull
• Clear understanding of fetal skull anatomy and
identification of important landmarks is
important in assessment of labor progress and
diagnosis of abnormalities of labor
57
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58. Bones of the Vault
• There are five main bones in the vault of the fetal
skull.
A. The occipital bone lies at the back of the head
and forms
the region of the occiput.
B. The two parietal bones lie on either side of the
skull.
C. The two frontal bones from the forehead or
sinciput.
4/6/2022 58
59. Peculiarities of the Fetal Skull- Landmarks
Fontanels Sutures
•Anterior fontanel (Bregma) - rhomboid
shape space at the junction of the two
parietal and frontal bones . Not readily
felt during vaginal exam in a well flexed
vertex. But easily felt in a brow and face
presentation. Differentiated from the
posterior fontanel by its four angles
•Posterior fontanel- a triangular space at
the junction of the occipital and two
parietal bones. Has three angles. Useful as
the anatomical landmark as the
denominator of fetal position in vertex
presentations. Easily felt in vertex
presentations.
•Saggital suture- opening between the
two parietal bones. Its central positioning
is used to diagnose fetal asynclitism. Also
used as the landmark for locating the
fontanelles.
•Lambdoid sutures- opening between the
two parietal bones and the occipital bone
posteriorly.
•Coronal sutures- opening between the
parietal bones and the frontal bone
anteriorly.
•Other non-significant sutures as well.
•Significance of these openings is believed
to be the provision of pliability of the fetal
skull allowing for growth of the fetal and
childhood brain.
59
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61. Important fetal skull diameters
Diameter Measurement landmarks Term
fetus
Fetal presentation
Biparietal
diameter
Between the two parietal
eminences
9.5cms Largest transverse diameter of
the fetal skull in all cephalic
presentations
Sub-occipito
bregmatic
Lowest point of occipital bone
to the middle of anterior
fontanel
9.5cms Vertex presentation
Sub-mento
bregmatic
Just behind the mentum to
the center of anterior fontanel
9 cms Face presentation
Mento-
vertical
Mentum to the highest point
of the vertex
13.5
cms
Brow presentation
The BPD is the transverse diameter in all the cephalic presentations including vertex, face
and brow as it is the largest transverse diameter of the fetal skull.
Measurements represent the averages form a term fetus.
61
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66. Fetal molding and types
• Fetal molding refers to the process of overlap of fetal skull
bones on each other at the location of certain sutures
usually due to the pressure against the birth canal during
labor
• Molding allows for a reduction in fetal skull diameters by
upto 6mms to 1 cms which can be significant enough to
allow progress to delivery in cases of cephalo-pelvic
disproportion
• Excessive molding can also lead to trauma
• Assessment of molding is one of the parameters used to
diagnose cephalo-pelvic disproportion
• Two types of molding- parieto-parietal (PP) and occipito-
parietal (OP)
66
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67. Degrees of fetal skull molding during labor
Degree Description Significance
0 Skull bones separate from each other No abnormality
+ 1 Skull bones approximate each other but do
not overlap
No abnormality
+ 2 Skull bones overlap but can be separated by
the examining hand
Can indicate obstruction if
in early labor or at high
station
+ 3 Skull bones overlap and cannot be separated
by the examining finger
Indicator of obstruction
67
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72. Caput Succedaneum
• Caput succedaneum is the development of
edema on the fetal skull due to the pressure
of the cervix impeding venous outflow from
the scalp
• It usually recedes hours after delivery
• In cases of obstructed labor caput can grow to
excessive sizes and become one of the
indicators of obstruction
72
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74. Puberty
• Puberty - the age of sexual maturation
• ThIs is the stage of life at which secondary sexual
characterstics appear.
• Girls begin dramatic development and maturation of
reproductive organs at approximately age 12 to
13 years, Although the mechanism that initiates this
dramatic change is not well understood, the hypothalamus
under the direction of the centeral nerveous system may
initiate or regulate mechanism set to “turn on” gonadal
functioning at this age.
4/6/2022 74
75. • There is a wide variation in the times that
adolescents move through developmental stages;
however the sequential order is fairly constant.
• In girls pubertal changes typically occur in
the order of:
- Marked physical growth
- Increase in the transvers diameter of the pelvis
- Breast development
- Growth of pubic and axillary hair
- Vaginal secretion /Menarche
4/6/2022 75
76. 2.3.The menstrual cycle
• A menstrual cycle (also termed a female reproductive cycle)
can be defined as periodic uterine bleeding in response to
cyclic hormonal changes or a serioes of changes that occur
on the ovary, uterus, and cervix in response to hormonal
change.
• The average age at which menarche (the first
menustral period) occurs at the average age of 12.8 years.
• This may occur as early as age 9 or as late as age 17 years.
• The purpose of a menstrual cycle is to bring an ovum to
maturity and renew a uterine tissue bed that will be
responsive to its growth should it be fertilized.
4/6/2022 76
77. • The average age of onset of menstrual cycles
is 21 to 35 days.
• The accepted average length is 28 days.The
length of the average menstrual flow is 1-9
days and the average
length is 5 days.
• Amount of flow is from spotting to 80 ml on
average.
4/6/2022 77
78. • Four body structures that are involved in the
normal physiology of the menstrual cycle are:
- The hypothalamus
- The pituitary gland
- The ovaries and
- The uterus.
- Cervix
4/6/2022 78
79. • For a menstrual cycle to be complete, all four structures must
contribute their part, in activity from any part will result in an
incomplete or ineffective cycle.
• Some women have symptoms of anxiety, fatigue, abdominal
bloating, headache, appetite disturbance, irritability and
depression in pre-manustural period.
• Some women may experience abdominal pain during ovulation
and the release of accompanying prostaglandins.
• Some even notice irritation when a drop or two of follicular fiuid
or blood spills in to the abdominal cavity.
• This pain, called mitlelschmerz may range from a few sharp
cramps to several hours of discomfort.
• It is typically felt on either side of the abdomen (near an ovary)
and may be accompanied by scant vaginal spotting.
4/6/2022 79
80. Ovulation
80
Defination
• A process in which secondary oocyte is released from the ovary.
Time of Ovulation:
• 14 days before the next menstruation (for woman with regular 28 days cycle)
• Around midcycle, the ovarian follicle,
under the influence of FSH and LH,
undergoes a sudden growth spurt,
producing a cystic swelling or bulge
on the surface of the ovary.
A small avascular spot, the stigma, soon
appears on this swelling.
• Before release (ovulation), the
secondary oocyte and some cells of
the cumulus oophorus detach from
the interior of the distended follicle.
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81. Surface bulge
Stigma
1. High level of
estrogen to -
hypothalamus &
Ant.pituitary
LH. surge
Ovary
Ovulation occurs
81
Ovulation
• Ovulation is triggered by a surge of LH production
– Usually follows the LH peak by 12 to 24 hours.
– The LH surge, elicited by
the high estrogen level in
the blood, also appears
to cause the stigma to
balloon out, forming a
vesicle
• The stigma soon
ruptures, expelling the
secondary oocyte with
the follicular fluid
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82. 1.High level of
estrogen to -
hypothalamus &
Ant.pituitary
LH. surge
Ovary
Ovulation occurs
82
Ovulation …
• The expelled secondary
oocyte is surrounded by the
zona pellucida and one or
more layers of follicular cells,
which are radially arranged
as the corona radiata,
forming the oocyte-cumulus
complex.
• The LH surge also seems to
induce resumption of the first
meiotic division of the primary
oocyte
• Hence, mature ovarian follicles
contain secondary oocytes
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83. • Middle pain and Ovulation
A variable amount of abdominal pain,
mittelschmerz (German, mittel, mid + schmerz,
pain), accompanies ovulation in some women
In these cases, ovulation results in slight bleeding
into the peritoneal cavity, which results in sudden
constant pain in the lower abdomen
Mittelschmerz or Middle pain may be used as a
symptom of ovulation
Ovulation…
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84. C. Corpus Luteum (CL)
84
• Causing the endometrial glands
to secrete and prepare the
endometrium for implantation
of the blastocyst
• Shortly after ovulation,
Under LH influence, the walls
of the ovarian follicle and
theca folliculi collapse and
are thrown into folds they
develop into a glandular
structure, the corpus luteum
• CL produces progestron and
estrogen
Progesteron-is important for
endometrial thickening
• It is a collapsed wall of ovarian follicle and theca cells
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85. Types of corpus luteum 1. corpus luteum of pregnancy
2. corpus luteum of menstruation
85
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86. • If fertilization occurs
– CL becomes enlarges to form corpus luteum of pregnancy
(corpus graviditatis) and continues its hormone production
– Its degeneration is prevented by human chorionic
gonadotropin, a hormone secreted by the syncytiotrophoblast
of the blastocyst
• The corpus luteum of pregnancy remains functionally
active throughout the first 20 weeks of pregnancy
– By this time, the placenta has assumed the production of
progesterone necessary for the maintenance of pregnancy
• If fertilization doesn’t occur
– The corpus luteum degenerates 10 to 12 days after ovulation
• It is then called a corpus luteum of menstruation i.e white
scar tissue in the ovary (corpus albicans) and its hormone
production level decreases 3-86
Corpus luteum(CL) …
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87. Duration of ovarian cycle
Ovarian cycle persist
• Throughout the
reproductive life of
women and terminate
at menopause
No ovarian cycle
• During pregnancy
• At menopause
– Menopause, the permanent
cessation of menstruation,
usually between the ages of
48 and 55.
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88. Phases of menstrual cycle
• Proliterative phase: - Immediately following a
menstrual flow (occurring the first 4 or 5 days of a
cycle), the endometrium, or lining of the uterus is very
thin, only approximately one cell
layer in depth.
• Secratory phase- What occurs in the next half of in a
menstrual cycle depends on whether the released
ovum meets and is fertilized by spermatozoa.
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89. • If fertilization does not occur, the corpus luteum in the
ovary begins to regress after 8 to 10 days.
• As it regresses, the production of progesterone and
oestrogen decreases.
• With the withdrawal of progesterone stimulation, the
endometrium of the uterus begins to degenerate (at
approximately day 24 or day 25 of the cycle).
• The capillaries rupture, with minute hemorrhage, the
endometrium sloughs off, and menustration
starts.
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91. • The monthly changes in the internal layer of the uterus
constitute the endometrial/uterine cycle, commonly
referred to as the menstrual cycle or period
– The later is because -menstruation (flow of blood from the uterus) is
an obvious event
• Is the time during which the oocyte matures, is ovulated, and
enters the uterine tube
• The hormones produced by the ovarian follicles and corpus
luteum (estrogen and progesterone) produce cyclic changes
– The endometrium is a "mirror" of the ovarian cycle because it
responds in a consistent manner to the fluctuating concentrations of
gonadotropic and ovarian hormones
• The average menstrual cycle is 28 days (In 90%, +5)
• Day 1 of the cycle designated as the day on which menstrual flow
begins
Menstrual (Endometrial) Cycle
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92. Phases of menstrual cycle
92
Menstrual
Phase.
Proliferative
phase
Luteal Phase
4 to 5 days
9 days
14/13 days
• Changes in the estrogen and progesterone levels cause cyclic
changes of the endometrium
• The menstrual
cycle is a
continuous process
divided into three
main phases
Each phase
gradually passes
into the next one
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94. Phases of menstrual cycle
94
• The functional layer of the uterine wall is sloughed off and
discarded with the menstrual flow-menses (monthly bleeding)
– The blood discharged through the vagina is combined with small pieces of
endometrial tissue.
Blood + part of endometrium
• After menstruation, the eroded endometrium is thin
1.Menstrual phase
• Usually lasts 4-5 day
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95. Phases of menstrual cycle ….
2. Proliferative Phase
95
• The proliferative (follicular, estrogenic) phase ~ 9 days
– Coincides with growth of ovarian follicles and is
controlled by estrogen secreted by these follicles.
• Early during this phase, the surface epithelium reforms and covers
the endometrium (it is a phase of repair)
• The glands increase in number and length, and the spiral arteries
elongate
• There is a two- to three fold increase in the thickness of the
endometrium and in its water content
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96. 96
3. Luteal (secretory, progesterone) phase
• Lasting approx.13 days, coincides with functioning, and growth of
corpus luteum
• The progesterone produced by the corpus luteum stimulates the
glandular epithelium to secrete a glycogen-rich material.
Direct arteriovenous anastomoses are prominent features of this stage
Phases of menstrual cycle ….
• Because of the influence of progesterone
and estrogen from the corpus luteum -
increased fluid in the connective tissue
– The endometrium thickens
• As the spiral arteries grow into the
superficial compact layer, they become
increasingly coiled
– The glands become wide, tortuous, and saccular
– The venous network becomes complex and large
lacunae (venous spaces) develop.
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97. What happen to emdometrial cycle if;
Fertilization does not occur
Fertilization occurs
• Cleavage of the zygote and blastogenesis
(formation of blastocyst) occur
The blastocyst begins to implant on approximately the
sixth day of the luteal phase (day 20 of a 28-day cycle)
• The corpus luteum degenerates
Estrogen and progesterone levels fall …. and
The secretory endometrium enters an ischemic phase … then
Menstruation occurs
• Human chorionic gonadotropin, keeps the corpus
luteum secreting estrogens and progesterone
The luteal phase continues and menstruation
does not occur
FSH
LH
0 7 14 21 28 days
Proliferative
phase
Secretory phase
Menstrual &
recovery
phase
98. Pregnancy Phase
• If pregnancy occurs, the menstrual cycles cease and the
endometrium passes into a pregnancy phase.
• With the termination of pregnancy, the ovarian and
menstrual cycles resume after a variable period (usually 6 to
10 weeks if the woman is not breast-feeding her baby).
• If pregnancy does not occur, the cycles normally continue
until menopause
Ischemic Phase
• The ischemic phase occurs when the oocyte is not
fertilized.
• Ischemia (reduced blood supply) occurs as the spiral
arteries constrict, giving the endometrium a pale
appearance
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99. How do hormonal contraceptives work????
• Diagram depicts positive and negative
feedback loops seen with the
hypothalamic-pituitary-ovarian axis.
Pulsatile release of gonadotropin-
releasing hormone (GnRH) leads to
release of luteinizing hormone (LH)
and follicle-stimulating hormone
(FSH) from the anterior pituitary.
• Effects of LH and FSH result in follicle
maturation, ovulation, and
production of the sex steroid
hormones (estrogen, progesterone,
and testosterone).
• Rising serum levels of these
hormones exert negative feedback
inhibition on GnRH and gonadotropin
release.
• Sex-steroid hormones vary in their
effects on the endometrium and
myometrium as discussed in the text.
• Inhibin, produced in the ovary, has a
negative effect on gonadotropin
release.
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101. The Female Breast Anatomy
• The female breasts
The female breasts, also known as the mammary glands, are
accessory orgns of reproduction.
• Size The size varies with each individual and with the stage of
development as well as with age. It is not uncommon for one breast
to be little or larger than the other.
• Alveoli: Containing the milk- secreting cells.
• Lactifierous tubules: small ducts which connect the alveoli.
• Lactifierous duct: a central duct into which the tubules run.
• Amplulla: the widened-out portion of the duct where milk is
stored. The ampullae lie under the areola.
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102. 4/6/2022 102
Female Reproductive System
• Mammary Glands
• Each mammary gland is made up or 15-25 lobes that
radiate around the nipple
• Each lobule is connected by lactiferous ducts that open
into the nipples (gets milk to nipple)
• Lobes contain
– Alveolar Glands produce milk during lactation
• Lobes are separated by connective tissue and fat
• There are suspensory ligaments in the connective
tissue that attach the breasts to the pectoral muscles
of the chest.
107. Review Questions
1. . List the main femal gentail orgns that are important in the
process of reproduction.
2. Mention the main pelvic land mark that are important in
obstatrics during pregnancy and labour process.
3. What are the obstratrical importancy of fontanalles and sutures in
the process of labour mangment.
4. - Describe anatomy of the Female pelvis and Female
external genitalia
5. Mention parts of fetal skull with its features.
6. Differntiat organs contained in the pelivic cavity.
7. Describe characteristic of menustral cycle and its disorder
8. List anatomy of female breast
9. Define puberity and its featuers.
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108. Reference:-
1. Atlas of human anatomy Williams
2. Essentials of obstetrics and gynecology – Haker/Moore
3. Brie human anatomy- part 2-Maseresha A buhay
4. Williams gynecology and
5. Williams obstetrics 24th edition
6. current obstetric and gynecology -9th edition
7. Clinical practice for midwifery guide line and women’s
2006 – 2009
8. Bennett. (1993): Myles Text Book of Midwives, 12th
edition. Great Britain.
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The blood vessels supplying the endometrium are of special significance in the periodic sloughing of the functional layer during menses. Arcuate arteries in the middle layers of the myometrium send two sets of smaller arteries to the endometrium (Figures 22–14 and 22–16): straight arteries, which supply only the basal layer, and long, progesterone-sensitive spiral arteries, which extend farther and bring blood throughout the functional layer. Spiral arteries branch with numerous arterioles supplying a rich capillary bed that includes many dilated, thin-walled vessels called vascular lacunae