Unit

1
Basics of Reproduction

Anatomy and Physiology of Female Reproductive System

Female external genitalia
The vulva refers to those parts that are outwardly visible
The vulva includes:
Mons pubis
Labia majora
Labia minora
Clitoris
Urethral opening
Vaginal opening
Perineum

Internal genitalia
The internal genitalia consists of the:
Vagina
Cervix
Uterus
Fallopian Tubes
Ovaries

Gynecoid Pelvis and Fetal Skull
Bony pelvis is a bony canal through which the fetus must pass through during the
process of labor.
If the canal is of average shape and dimension, the baby of normal size will negotiate
with it without difficulty.
Types of bones in pelvis
Two innominate bones
Ilium
Ischium
Pubis
One sacrum
One coccyx

Fetal skull
The skull is formed of the face, the vault & the base
The bones that form the skull are: two frontal bones, two parietal bones, two temporal
bones wings of the sphenoid & occipital bone
 The bones of the face & base are heavy & fused
The bones of the vault are 2 frontal ,2 parietal & occipital
The bones of the vault are not joined thus changes in the shape of the fetal head during
labor can occur due to molding

Fetal skull definitions
Bregma Anterior fontanelle
Brow lies between bregma and root of the nose
Face lies between root of the nose & suborbital ridges
Occiput boney prominence behind post fontanelle
Vertex diamond shaped area between ant & post fontanelles & parietal eminences

Fetal skull fontanelles
Anterior fontanelle (bregma)
diamond shaped space between
coronal & sagittal suture 3 * 3 cm ,
ossifies at 18 m
Posterior fontanelle (lambda)
triangle shaped space between sagittal
& lambdoid suture

Moulding of the head
Occurs with descent of the fetal head into the pelvis to reduce the head circumference
Frontal bones slip under parietal bones
Parietal bones override each other
Parietal bones slip under the occipital bone

Degree of moulding
Assessed vaginally
0 suture lines are separate
+1 suture lines meet
+2 suture lines overlap but can be reduced by gentle digital pressure
+3 overlap irreducible

Menstrual Cycle
Key terms and definitions
Menarche: Age at onset of menstruation (a woman's first menstruation)
Primary amenorrhea: Absence of menstruation despite signs of puberty
Secondary amenorrhea: Absence of menstruation for 3-6 months in a woman who
previously menstruated
Dysfunctional uterine bleeding: Irregular bleeding due to anovulation or anovulatory
cycle
Oligomenorrhea: Menstrual interval greater than 35 days
 Menorrhagia: Regular menstrual intervals, excessive flow and duration
Metrorrhagia: Irregular menstrual intervals, excessive flow and duration
Anovulation/anovulatory: Menstrual cycle without ovulation
Mittleschmertz: Pain with ovulation
Molimina: Symptoms preceding menses
Dysmenorrhea: Menstrual cramping/pain
Menopause: end of a woman's reproductive phase, commonly occurs between ages
45 and 55

Menstruation
Rhythmical series of physiological changes that occur in fertile women.
Under the control of the endocrine system
Menarche, the onset of menstruation signals the bodily changes that transform a
female body
Average age is 12.8 yrs
Amount of bleeding varies from woman to woman (appx. 30 -50 ml)
Expulsion of blood clots
The duration of flow is 2-7 days
Blood color can vary from bright red to dark maroon
Usually occurs every 25 to 32 days
Women can experience fluid retention, cramping, mood swings, weight gain, breast
tenderness, diarrhea, and constipation

Physiological changes during menstrual cycle
It can be observed at three different levels:
neuroendocrine level
ovaries
uterus

Menstrual cycle
Menstrual cycle can be divided into 3 phases:
menstrual phase
proliferative / follicular (estrogen) phase
secretory / luteal phase (progesterone) phase

1. Menstrual phase
Endometrium becomes very thin, but due to low estrogen levels, hypophysis secretes
more FSH
FSH stimulates secretion of estrogen, and estrogen serves as proliferation signal to
the endometrial basal layer
2. Follicular phase
Due to the rise of follicle stimulating hormone (FSH) during the first days of the cycle,
several ovarian follicles are stimulated
 Follicles compete with each other for dominance
The follicle that reaches maturity is called a Graafian follicle
As they mature, the follicles secrete increasing amounts of estrogen, which thickens
the new functional layer of endometrium in the uterus
Estrogen also stimulates crypts in the cervix to produce fertile cervical mucus
At the end of this phase ovulation occurs
Ovulation
During the follicular phase, estrogen suppresses production of luteinizing hormone
(LH) from the pituitary gland
When the ovum has nearly matured, levels of estrogen reach a threshold above which
they stimulate production of LH (positive feedback loop)
The release of LH matures the ovum and weakens the wall of the follicle in the ovary,
causing the fully developed follicle to release its secondary oocyte
After being released from the ovary, the ovum is swept into the fallopian tube

3. Luteal phase
Corpus luteum: solid body formed in an ovary after the ovum has been released into
the fallopian tube
Produces significant amounts of progesterone, which plays a vital role in making the
endometrium receptive to implantation of the blastocyst
High levels of E and P suppress production of FSH and LH that the corpus luteum needs
to maintain itself
Falling levels of progesterone trigger menstruation and the beginning of the next cycle

Embryology
Stages of development
Pregnancy is estimated to last an average of 10 lunar months: 40 weeks or 280 days. This
period of 280 days is calculated from the beginning of the last menstrual period to the time of
birth. The fertilization age or post conception age of the fetus is calculated to be about 2 weeks
less or 266 days (38 weeks).

Human development follows three stages:
Pre-Embryonic Stage: The first 14 days after conception referred to as the pre-embryonic
period are characterized by rapid cellular multiplication and differentiation, establishment of
embryonic membranes, and development of the primary germ layers.
Embryonic stage: The stage of the embryo starts on day 15th (beginning of the 3rd week after
conception or fertilization) and continuous until approximately 8 weeks or until the embryo
reaches a crown to rump length of 3 cm. This length is usually reached about 56 days after
fertilization. During the embryonic stage tissue differentiates into essential organs, and the
main external features develop, the embryo is most vulnerable to teratogens during this
period.
Fetal Stage: By the end of the eighth week the embryo is sufficiently developed to be called
a fetus. Every organ system and external structure that will be found in the full term newborn
 is present. The remainder of gestation is devoted to refining structures and perfecting
function.

Events before fertilization:
Gametogenesis: The process involved in the maturation of the two highly specialized
cells, spermatozoon in male & ovum in female before they unite to form zygote is called
gametogenesis. It involves 2 process.
Oogenesis: Process by which female gametes or Ova are produced.
Spermatogenesis: The process involved in the development of spermatids from the
primordial male germ cells and their differentiation into spermatozoa is called
spermatogenesis.
Gametes must have haploid no. of chromosomes so that when the gamete and male gamete
unite to form zygote, the normal human diploid no. of chromosomes (46) is reestablished.
Meiosis: It is the process by which gametes are formed. It occurs during gametogenesis and
consists of two cell divisions which produce a gamete with 23 chromosomes (22 chromosomes
and 1 sex chromosome) the haploid no. of chromosomes.

Process of Fertilization: Fertilization is a process by which a sperm fuses with an ovum to form a
new diploid cell or zygote.
Fertilization takes place in the ampulta (outer third) of the fallopian tube. Sperm
undergoes to processes before fertilization 1. CAPACITATION
2. ACROSOMAL REACTION.
Capacitation is the removal of the plasma membrane which exposes the acrosomal
covering of the sperm head. The acrosomal reaction is the deposit of hyaluronidase in the Corona
radiata which allows the sperm head to penetrate the ovum.
When each gamete contributes an X chromosome the resulting zygote is female. When
the Ovum contribute the X chromosome and sperm contributes a Y, male zygote formed.

Accomplishing fertilization
The oocyte is viable for 12 to 24 hours
Sperm is viable 24 to 72 hours
For fertilization to occur, coitus must occur no more than:
Three days before ovulation
24 hours after ovulation
Fertilization when a sperm fuses with an egg to form a zygote

Sperm transport and capacitation
Fates of ejaculated sperm
Leak out of the vagina immediately after deposition
Destroyed by the acidic vaginal environment
Fail to make it through the cervix
Dispersed in the uterine cavity or destroyed by phagocytic leukocytes
Reach the uterine tubes
Sperm must undergo capacitation before they can penetrate the oocyte
Blocks to polyspermy
Only one sperm is allowed to penetrate the oocyte
Two mechanisms ensure monospermy
Fast block to polyspermy membrane depolarization prevents sperm from fusing with
the oocyte membrane
Slow block to polyspermy zonal inhibiting proteins (ZIPs):
Destroy sperm receptors
Cause sperm already bound to receptors to detach

Completion of meiosis II and fertilization
Upon entry of sperm, the secondary oocyte:
Completes meiosis II
Casts out the second polar body
The ovum nucleus swells, and the two nuclei approach each other
When fully swollen, the two nuclei are called pronuclei
Fertilization when the pronuclei come together

Pre- embryonic stage
Zygote enters a period of rapid mitotic division called cleavage during which it divides into 2
cells, 4 cells, 8 cells & so on. These cells are called Blastomeres. The Blastomeres will eventually
form a solid ball of 12 16 cells called the morula.
The inner solid mass of cells is called Blastocyst. The outer layer of cells that surround the cavity
and have replaced the zona pellucida is the trophoblast. Eventually the trophoblast develops into
one of the embryonic membrane called the Chorion. The Blastocyst develops into a double layer
of cells called the embryonic disk from which embryo will develop and the other embryonic
membrane called the Amnion will develop.
Implantation
The most frequent site of attachment is the upper part of the post. Uterine wall between
day 7 & 9 after fertilization, the zona pellucida disappears and blastocyst implants itself by
burrowing into the uterine lining and penetrating down toward maternal capillaries. After
implantation endometrium is called decidua.
The portion of the Decidua that covers the blastocyst is called the decidua capsularis. The
portion under implanted blastocyst is decidua basalis and portion that lines the rest of the uterine
cavity is decidua vera. Maternal part of the placenta develops from decidua basalis. The chorionic
villi in contact with decidua form fetal portion of the placenta.
Begins six to seven days after ovulation when the trophoblasts adhere to a properly prepared
endometrium
The trophoblasts then proliferate and form two distinct layers
Cytotrophoblast cells of the inner layer that retain their cell boundaries
Syncytiotrophoblast cells in the outer layer that lose their plasma membranes and
invade the endometrium
The implanted blastocyst is covered over by endometrial cells
Implantation is completed by the fourteenth day after ovulation
 Viability of the corpus luteum is maintained by human chorionic gonadotropin (hCG) secreted
by the trophoblasts
hCG prompts the corpus luteum to continue to secrete progesterone and estrogen
Chorion developed from trophoblasts after implantation, continues this hormonal stimulus
Between the second and third month, the placenta:
Assumes the role of progesterone and estrogen production
Is providing nutrients and removing wastes
Cellular differentiation
Primary Germ layers:
After day 10 14 of conception blastocyst differentiates into primary germ layers
Ectoderm, Endoderm & Mesoderm. All tissues organs and organ systems will develop from the
primary germ cell layers.
Embryonic Membrane: Embryonic membranes begin to form at the implantation site.
The first membrane to form is Chorion, that encircles the amnion, embryo and yolk sac. It has
finger like projections called Chorionic villi. Amnion the second membrane originates from the
ectoderm it is thin protective membrane that contains amniotic fluid. The space between
amniotic membrane and embryo is the amniotic cavity. This cavity surrounds the embryo and
yolk sac.
Primary germ layers
Serve as primitive tissues from which all body organs will derive
Ectoderm forms structures of the nervous system and skin epidermis
Endoderm forms epithelial linings of the digestive, respiratory, and urogenital systems
Mesoderm forms all other tissues
Endoderm and ectoderm are securely joined and are considered epithelia

Amniotic fluid
functions as a cushion to protect against injury. At 20 weeks it is 350 ml. after 20 weeks it
is 700 1000 ml. The amniotic fluid volume is constantly changing as the fluid moves back and
forth across the placental membrane. Fetus excretes urine in amniotic fluid. It swallow up to 600
ml. of fluid every 24 hrs. amniotic fluid is slightly alkaline and contains albumin, urea, uric acid,
creatinine, lecithine, bilirubin, fat, fructose, leukocytes, proteins, enzymes & lanugo. There could
be oligohydramnios and polyhydramnious.
Abnormalities of fetal urine production can result in changes in amniotic fluid volume.
Major mechanism by which amniotic fluid is removed in the last half of pregnancy:
1 fetal swallowing 2. Transmembranous pathway 3. Intramembranous
pathway
Functions:
Fluid acts as a cushion.
Allows for fetal movement.
Prevents the embryo/ fetus from adhering to surrounding tissues.
Protects from infection.
Helps to maintain an even temperature.


Placenta
It is the means of metabolic and nutrient exchange between the embryonic and maternal
circulation. Placental development and circulation does not begin until the third week of
embryonic development. Expansion of placenta continues until about 20 weeks when it covers
about half the inside of the uterus. After 20 weeks it becomes thicker but not wider. At 40 weeks
placenta is about 15-20 cm. in diameter and 2.5 to 3 cm. in thickness it weighs approximately 400
to 600 grams.
The placenta also secretes other hormones human placental lactogen, human chorionic
thyrotropin, and relaxin
Placenta has two parts:
Maternal Portion.
Fetal Portion: It consists of chorionic villi and their circulation. Fetal surface of placenta is
covered by amnion.
Development of Placenta
Development of Placenta begins with chorionic villi. Trophoblast cells of the chorionic villi
form spaces in the tissues of the decidua basalis. Syncytium is in direct contact with maternal
blood in the intervillous space. It is the functional layer of placenta and secretes placental
hormones of pregnancy. Septa divides the mature placenta into 15 20 segments called
cotyledons. In each cotyledon the branching villi form a highly complex vascular system that
allows exchange of gases and nutrients. In the fully developed placenta, fetal blood in the villi
and maternal blood in the intervillous spaces are separated by 3-4 thin layer of tissues.
Placental Circulation:
By the 4th week placenta has begun to function as a means of metabolic exchange
between embryo and mother by 14 weeks placenta is a discrete organ. In the fully developed
placentas umbilical cord, fetal blood flows through the 2 umbilical arteries to the capillaries of
the villi and O2 rich blood flows back through the umbilical vein to the fetus. The pressure in the
arteries forces the blood into intervillous spaces and bathes the numerous small villi in
oxygenated blood.
Placental functions:
Main functions of Placenta are:
Transfer of nutrients and waste products between the mother and fetus. It includes
(i) respiratory (ii) Excretory (iii) Nutritive.
Produces or metabolizes the hormones and enzymes necessary to maintain the
pregnancy.
Barrier Function
Immunological function
Mechanisms involved in the transfer of substances across the placenta are (i) simple
diffusion (ii) facilitated diffusion (iii) active transfer (iv) pinocytosis (v) leakage.

Umbilical cord
As the placenta is developing, the umbilical cord is also being formed from the amnion
the body stalk which attaches the embryo to the yolk sac, contains blood vessels that extent into
the chorionic villi. As the body stalk elongates to become the umbilical cord, the vessels in the
cord decrease to one large vein and 2 small arteries. At term the average cord is 2 cm. across and
about 55 cm. long.

Fetal circulatory system
The Cardio vascular system is the first organ system to function in the developing human.
By the end of the embryonic stage the heart is developmentally complete. Oxygen rich blood
from the placenta flowed rapidly through the umbilical vein into the fetal abdomen. When the
umbilical vein reaches the liver, it divide into 2 branches, 1 circulates some oxygenated blood to
the liver.
Most of the blood passes through the ductus venosus into the inferior venacava there it
mixes with the deoxygenated blood from the fetal legs and abdomen on its way to the right
atrium. Most of this blood passes straight through the right atrium and through the foramen
ovale, an opening into the left atrium there it mixes with the small amount of blood returning
deoxygenated from the fetal lungs through the pulmonary veins.
The blood flows into the left ventricle and is squeezed out into the aorta, where the
arteries supplying the heart, head, neck & arms receive the major part of the oxygen rich blood.
Deoxygenated blood returning from the head and arms enters the right atrium through
the superior venacava. This blood is directly downward into the right ventricle, where it is
squeezed into the pulmonary artery. A small amount of blood circulate to the resistant lung tissue
but the majority follows the path with less resistance through the ductus arteriosus into the
aorta, distal to the point of exit of the arteries supplying head and arms with oxygenated blood.
The oxygen poor blood flows through the abdominal aorta into the internal iliac arteries, where
the umbilical arteries direct most of it back to the umbilical cord to the placenta. The blood
remaining in iliac arteries flows through the fetal abdomen and legs ultimately returning through
the inferior venacava to the heart.