FERTILIZATION

ASSISTED REPRODUCTIVE
TECHNIQUE

• If ovulation, sperm production, or

sperm mobility problems cannot be
corrected, assisted reproductive
strategies are available
• ARTIFICIAL INSEMINATION
- is the instillation of sperm into the
female reproductive tract to aid
conception.
- the sperm can be instilled into the
cervix (intracervical insemination)
or into the uterus (intrauterine
insemination).
• To prepare for artificial insemination, a
woman must record her BBT, assess her
cervical mucus, or use an ovulation
predictor kit to predict her likely day of
ovulation.
• On the day after ovulation, the selected
sperm are delivered to her cervix using a
device similar to a cervical cap or
diaphragm, or they are injected directly
into the uterus using a flexible catheter.
• IN VITRO FERTILIZATION
in IVF, one or more mature oocytes
are removed from a woman’s ovary
by laparoscopy and fertilized by
exposure to sperm under laboratory
conditions outside the woman’s body.
• About 40 hours after fertilization, the
laboratory-grown fertilized ova are
inserted into the woman’s uterus,
where ideally one or more of them will
implant and grow.
• GAMETE INTRAFALLOPIAN
TRANSFER
- in GIFT procedures, ova are
obtain from ovaries exactly as in IVF.
- instead of waiting for fertilization
to occur in the laboratory, however,
both ova and sperm are instilled
within a matter of hours, using a
laparoscopic technique, into the open
end of a patent fallopian tube.
GIFT is a procedure in which eggs and sperm are placed
in the fallopian tube via laparoscopy.
Fertilization may then take place in the fallopian tube.
• Fertilization then occurs in the tube,
and the zygote moves to the uterus
for implantation.
• The procedure is contraindicated if
the woman’s fallopian tubes are
blocked, because this could lead to
ectopic (tubal) pregnancy.
• ZYGOTE INTRAFALLOPIAN
TRANSFER
- ZIFT involves oocyte retrieval by
transvaginal, ultrasound-guided
aspiration, followed by culture and
insemination of the oocytes in the
laboratory.
• Within 24 hours, the fertilized eggs
are transferred by laparoscopic
technique into the end of a waiting
fallopian tube.
• ZIFT differs from GIFT in that
fertilization takes place outside the
body, allowing health care providers
to be certain that fertilization has
occurred before the growing structure
is reintroduced.
• A woman must have one functioning
fallopian tube for the technique to be
successful, because the zygotes are
implanted into the fimbriated end of a
tube rather than into the uterus
• SURROGATE EMBRYO TRANSFER
- is an assisted reproductive
technique for a woman who does not
ovulate.
- the process involves use of an
oocyte that has been donated by a
friend or relative or provided by an
anonymous donor.
• At the time of ovulation, the donor’s
ovum is removed by a transvaginal,
ultrasound-guided procedure.
• The oocyte is then fertilized by the
recipient woman’s male partner’s
sperm (or donor sperm) and placed in
the recipient woman’s uterus by
embryonic transfer.
 FERTILIZATION
• Also referred to as conception,
impregnation, or fecundation.
• Is the union of an ovum and a
spermatozoon.
• This usually occurs in the outer
third of a fallopian tube.
• Usually only one ovum reaches
maturity each month. Once it is
released, fertilization must occur
fairly quickly because an ovum is
capable of fertilization for only
24 hours (48 hours at the most)
.
• After that time, it atrophies and
becomes nonfunctional. Because
the functional life of a
spermatozoon is about 48 hours,
possibly as long as 72 hours, the
total critical time span during
which sexual relations must
occur for fertilization to be
successful is about 72 hours (48
hours before ovulation plus 24
hours afterward).
• At the time of ovulation,
there is a reduction in the
viscosity (thickness) of the
cervical mucus, which makes
it easier for spermatozoa to
penetrate it.
• Sperm transport is so efficient
close to ovulation that
spermatozoa deposited in the
vagina during intercourse
generally reach the cervix within
80 seconds and the outer end of
a fallopian tube within 5 minutes
after deposition. This is the
reason why douching is not an
effective contraceptive measure.
• Spermatozoa move by means of
their flagella (tails) and uterine
contractions through the cervix
and the body of the uterus and
into the fallopian tubes, toward
the waiting ovum.
• Immediately after penetration of
the ovum, the chromosomal
material of the ovum and
spermatozoon fuse. The resulting
structure is called a zygote.
• From the fertilized ovum
(zygote) the future child and also
the accessory structures needed
for support during intrauterine
life are all formed (e.g.,
placenta, fetal membranes,
amniotic fluid, umbilical cord).
 IMPLANTATION

• Or contact between the

growing structure and the
uterine endometrium, occurs
approximately 8 to 10 days
after fertilization.
• Once fertilization is complete,
the zygote migrates over the
next 3 to 4 days toward the body
of the uterus, aided by the
currents initiated by the
muscular contractions of the
fallopian tube.
• During this time, mitotic cell
division, or cleavage, begins.
• By the time the zygote reaches
the body of the uterus, it
consists of 16 to 50 cells. At this
stage, because of its bumpy
outward appearance, it is termed
a morula.
• The morula continues to multiply
as it floats free in the uterine
cavity for 3 to 4 more days.
Large cells tend to collect at the
periphery of the ball, leaving a
fluid space surrounding an inner
cell mass. At this stage the
structure is termed a
blastocyst. It is the structure
that attaches to the uterine
endometrium.
• The cells in the outer ring are known
as trophoblast cells. They are the
part of the structure that will later
form the placenta and membranes.
• The inner cell mass (embryoblast
cells) is the portion of the structure
that will form the embryo.
 Pre-embryonic stage
• When the zygote implants in the
decidua, approximately 8 to 10
days after fertilization, the
structure is referred to as an
embryo.
• After implantation, the embryo
undergoes rapid growth and
differentiation.
• Establishment of embryonic
membranes and development of
tissues and organs from the
three primary germ layers of the
embryo occurs:
- ectoderm
- mesoderm
- endoderm
 Embryonic stage

• This stage begins during the third

week after conception and continues
until the embryo reaches a crown-to-
rump length of 3 cm at about the
eight week. At this time, the embryo
is referred to as a fetus.
• During this stage, differentiation of
tissues into organs and development
of main external features occur.
 EMBRYONIC AND FETAL
STRUCTURES
I.DECIDUA
The endometrium becomes the
decidua following conception and
implantation.
It will protect and nourish the
developing embryo.
 Decidua has three separate
areas:
• Decidua basalis
- the part of the
endometrium that lies directly
under the embryo (or the portion
where the trophoblast cells are
establishing communication with
maternal blood vessels).
• Decidua capsularis
- the portion of the
endometrium that stretches or
encapsulates the surface of the
trophoblast.
• Decidua vera
- the remaining portion of the
uterine lining.
II. CHORIONIC VILLI
Once implantation is
achieved, the trophoblastic layer
of the cells of the blastocyst
begin to mature rapidly.
 As early as the 11th or 12th
day, miniature villi, or probing
“fingers,” termed chorionic villi,
reach out from the single layer
of the cells into the uterine
endometrium.
III. PLACENTA
• Develops by the third month
• Dependent upon maternal
circulation
• Provides for exchange of
nutrients and waste products
between fetus and mother
 Mechanism by which nutrients cross
the placenta

a) Diffusion
when there is a greater
concentration of a substance on
one side of a semipermeable
membrane than on the other,
substances of the correct
molecular weight cross the
membrane from the area of
higher concentration to the area
of lower concentration.
b) Facilitated diffusion
to ensure that the fetus
receives enough concentrations
of necessary growth substances,
some substances cross the
placenta more rapidly or more
easily without the expenditure of
energy than would occur if only
simple diffusion were operating.
A carrier moves the substance
into and through the membrane.
c) Active transport
this process requires energy
and action of an enzyme to
facilitate transport
d) Pinocytocis
absorption by the cellular
membrane of microdroplets of
plasma and dissolved
substances.
unfortunately, viruses that
then infect the fetus can also
cross in this manner.
• Produces hormones to maintain
pregnancy and assumes full
responsibility for the production
of these hormones by the 12th
week of gestation
> estrogen
> progesterone
> human chorionic gonadotropin
> human placental lactogen
• Large particles such as bacteria
cannot pass through the
placenta
• In addition to nutrients, drugs,
antibodies, and viruses can pass
through the placenta.
• In the third trimester, transfer of
maternal immunoglobulin
provides fetus passive immunity
to certain diseases for the first
few months after birth.
• IV. MEMBRANES AND AMNIOTIC
FLUID

a) two membranes protect and

support the embryo
 1. Amnion
- encloses the amniotic cavity
- forms a fluid-filled sac that
surrounds the embryo and later
the fetus
2. Chorion
- outer membrane
- becomes vascularized and
forms the fetal part of the
placenta
 b) Amniotic fluid
- is contained within the
amnion
- at term, the amount ranges
from 800 to 1200 ml.
- surrounds, cushions, and
protects the fetus and allows for
fetal movement.
 - maintains the body temperature
of the fetus
- consists largely of fetal urine,
and is therefore a measure of fetal
kidney function
- the fetus drinks, swallows and
urinates the amniotic fluid and
breathes the amniotic fluid into its
lungs
• V. UMBILICAL CORD
- is formed from the fetal
membranes and provides a
circulatory pathway that
connects the embryo to the
chorionic villi of the placenta.
 - its function is to transport
oxygen and nutrients to the
fetus from the placenta and to
return the waste products from
the fetus to the placenta.
 - it is about 53 cm (21 in) in
length at term and about 2 cm
(3/4 in) thick
 - contains two arteries (
carrying blood from the fetus
back to the placental villi), and
one vein ( carrying blood from
the placental villi to the fetus).
 STAGES OF FETAL
DEVELOPMENT
• Day 1: Conception
The egg and the
sperm each
containing 23
chromosomes,
unite to form one
cell with 46
chromosomes. The
newly fertilized egg
is known as the
zygote
• Day 2 to week 2
The blastocyst
travels down the
fallopian tube and
implants in the
uterus. It is
composed of an
embryonic disk,
which will develop
into an embryo
after implantation,
and two cavities,
an amniotic cavity
and yolk sac
• Week 2-8
The germ layers of the embryonic
disk develop into the principle organ
systems. By the eight week the
embryo is 23millimeters long.
All organs and structural feature are
in place and the fetus resembles a
very small newborn child.
At week 5 heart beginning to beat
8 Weeks Gestation
All essential organs have
begun to form.
Elbows and toes are visible.
The fingers have grown to
the first joint.
Facial features — the eyes,
nose, lips, and tongue —
continue to develop.
• The outer ears begin to take shape.
• Organs begin to be controlled by the brain.
• The length is about 1/2 to 3/4 inch.
• 10 Weeks Gestation
The unborn child is now
called a fetus, rather than
an embryo.
The head is half the
length of the body.
The arms and legs are
long and thin.
The hands can make a fist
with fingers.
Red blood cells are
produced.
The length is about 1 1/4
to 1 3/4 inches.
• 12 Weeks Gestation
• The neck is present and the
face well formed.
• The eyelids close and will
reopen at about 24 weeks.
• Tooth buds appear.
• The arms and legs move.
• All body parts and organs are
present.
• The fibers that carry pain to
the brain are developed;
however, it is unknown if the
unborn child is able to
experience sensations such
as pain.
• Definitive signs of male and
female gender are present.
• A heartbeat can be heard with
electronic devices.
• The length is about 2 to 3
inches.
• Some reflexes, such as babinski
reflex, are present
14 Weeks Gestation
The skin is almost
transparent.
The mouth makes sucking
motions.
Amniotic fluid is
swallowed.
Sweat glands develop.
The liver and pancreas
are starting to work.
The length is about 3 to 4
inches.
• 16 Weeks Gestation
• Swallowing and chest
movements are clearly
present.
• Movement may be felt by the
mother.
• The head and body become
proportional.
• The neck takes shape.
• The weight is about five
ounces.
• The length is about 4 to 5
inches
• Fetal heart sounds are audible
with an ordinary stethoscope
• Lanugo ( fine, downy hair on the
back and arms of newborn,
which apparently serves as a
source of insulation for body
heat) is well formed
• Sex can be determined by
ultrasonography
• 18 Weeks Gestation
• The arms and legs begin to
punch and kick.
• The fingernails are well
formed.
• The unborn child can suck its
thumb.
• Taste buds are present.
• Male or female gender is
evident.
• A protective waxy coating is
present on the skin.
• The length is about 5 to 6
inches.
• 20 Weeks
Gestation
• Some experts have
concluded that the
unborn child is
probably able to feel
pain.
• The skin becomes less
transparent as fat
begins to deposit.
• Eyebrows and lashes
appear.
• Breathing-like movements become
regular and are detected by
ultrasound, but the lungs have not
developed enough to permit survival if
birth occurs.
• The unborn child turns its entire body
side to side and front to back.
• The length is about 6 to 7 inches.
• Antibody production is possible
• Meconium is present in the upper
intestine
• Vernix caseosa, which serves as a
protective skin covering during
intrauterine life, begins to form
• 22 Weeks Gestation
• Rapid brain growth continues.
• The eyebrows and eyelashes
are well formed.
• The eyes are fully functional
and capable of movement.
• The vocal cords are active.
• Reflexes are present.
• There is little chance for
survival outside the uterus.
• The weight is about one
pound.
• The length is about 7 to 8
inches.
• 24 Weeks Gestation
• Unique footprints and
fingerprints are present.
• Outside sounds can be
heard.
• Actions such as hiccuping,
squinting, smiling, and
frowning may be seen
through ultrasound.
• The lungs have developed
such that some premature
babies may survive.
• Surviving premature babies may have
severe disabilities and require long-term
intensive care.
• The weight is about 1 to 1 1/2 pounds.
• The length is about 8 to 9 inches.
• 26 Weeks Gestation
• The central nervous system
is developed enough to
control some body functions.
• The eyelids open, close and
can perceive light.
• The lungs have further
matured and breathing is
possible.
• The unborn child exercises
muscles by kicking and
stretching.
• The weight is about 1 1/2 to 2 pounds.
• The length is about 9 to 10 inches.
• 28 Weeks Gestation
• Brain-wave patterns resemble
those of a full term baby.
• Another person can hear a
heartbeat by listening to the
pregnant woman’s abdomen.
• There is a good chance of
survival if birth occurs at this
stage of development.
• The weight is about 2 to 2 1/4
pounds.
• The length is about 10 to 13
inches.
30 Weeks Gestation
The central nervous system
has increased control over
body functions.
Rhythmic breathing
movements occur.
The lungs are not fully mature.
The bones are fully developed,
but still soft and pliable.
The weight is about 2 1/2 to 3
pounds.
The length is about 15 to 16
inches.
• 32 Weeks Gestation
• The lungs are still developing.
• Body temperature is partially
under control.
• The skin is thicker, with more
color.
• The connections between the
nerve cells in the brain have
increased.
• There is a good chance of
long-term survival and the risk
of long-term disability is low.
• The weight is about 3 to 3 3/4 pounds.
• The length is about 16 to 17 inches.
• 34 Weeks Gestation
•The ears have begun to
hold shape.
•The eyes open during
alert times and close
during sleep.
•There is a very good
chance of survival with
a low chance for long-
term disability.
• The weight is about 4 to 4 1/2 pounds.
• The length is about 17 to 18 inches.
• 36 Weeks Gestation
• Fine hair begins to
disappear.
• Body fat has
increased.
• The fingernails reach
the end of the
fingertips.
• The chance of
survival is excellent,
but the newborn may
require special
medical care.
• The weight is about 5 to 6 pounds.
• The length is about 16 to 19 inches.
• 38 Weeks Gestation
• A newborn is considered
full-term at 38 weeks.
• The fingernails extend
beyond the fingertips.
• Small breast buds are
present on both sexes.
• The unborn child can grasp
firmly.
• The unborn child turns
toward a light source.
• The average weight is greater than 6
pounds.
• The length is about 19 to 21 inches.
• Week Thirty-Nine
• The lanugo has mostly disappeared, but
you'll probably find a bit on her
shoulders, arms and legs and in those
protected little bodily creases. It will
vanish completely on its own in time.
• His lungs are maturing and surfactant
production is increasing and fully
prepared to take on the outside world!
• His body continues laying on the fat stores
that will help regulate his body temperature
after birth. In addition to normal fat, he is
accumulating a special "brown" fat in the nape
of his neck, between his shoulders and around
organs. Brown fat cells are important for
thermogenesis (generating heat) during his
first weeks.
• Your infant's weight is around 7.3 pounds
(3288gm) and length is 19.9 inches (50.7cm).
•Week Forty
•Much of the vernix has vanished but you will
notice traces on her body.
•15% of your child's body is fat. Since he hasn't
learned to shiver yet, these fat stores will help
regulate his temperature.
•Approximately 60 - 75 percent is water!
•Your baby's chest sticks out, almost as if he's
ready to strut proudly over his accomplishment!
•His lungs will continue developing until birth.
They are manufacturing large quantities of
surfactant which works to keep the air sacs open.
• She continues to grow; her hair and nails
longer as well. You may need to trim those
fingernails soon after birth or protect her face
from scratches with mittens.
• Small breast buds are present on both sexes.
• The baby now weighs 7.6 pounds (3462gm)
and is 20.2 inches (51.2cm) long.
• Congratulations! Any day now you will be
cradling your son or daughter! Cherish the
moments and learn all you can about this new
personality in your life. They go by all too fast!
 Determination of
estimated birth date
It is impossible to
predict the day an infant
will be born with a high
degree of accuracy.
Traditionally, this date
has been referred to as the
estimated date of
confinement (EDC).
The average length of
pregnancy is 280 days (40
weeks, 10 lunar months, or
9 calendar months), as
calculated from the first
day of the menstrual period
(LMP).
 To estimate the age of
gestation:
NAGELE’S RULE
- is the standard method used
to predict the length of a
pregnancy.
- to calculate the date of
birth by this rule:
• count backward 3 calendar
months from the first day of
the LMP and add 7 days.
WAYS TO DATE THE PREGNANCY IF
LMP IS UNKNOWN
McDonald’s rule
- determines age of
gestation by measuring from
the fundus to the symphysis
pubis (in cm.); is equal to
the week of gestation
between the 20th and 31st
weeks of pregnancy.
Bartholomew’s rule
- estimates AOG by the
relative position of the uterus
in the abdominal cavity.
• By the 3rd lunar month, the
fundus is palpable slightly
above the symphysis pubis.
• On the 5th lunar month, the
fundus is at the level of the
umbilicus.
• On the 9th lunar month, the
fundus is below the xiphoid
process
Haase’s rule
- determines the length of
the fetus in centimeters.
• During the first half of
pregnancy, square the
number of the month
• During the second half of
pregnancy, multiply the
month by 5
Johnson’s rule
- estimates the weight of the
fetus in grams.
• Formula:
fundic height in cm.- n x k
“k” is a constant, it is
always 155
“n” is – 12 (if fetus is
engaged)
- 11 (if fetus is not
yet engaged)
Patient with meningocele
Px with Turner’s syndrome
Child with trisomy 13-15
Polydactyly
Children with Down’s Syndrome
Children with “fetal alcohol
syndrome”
Siamese Twins
Development of dizygotic twins
Monozygotic twins
Removal of amniotic fluid for
amniocentesis
 ♀ External Genitalia
• labia majora
• Labia minora
• Clitoris
• Vestibule
• Hymen
• Greater vestibular glands
 ♀ Internal Organs
• Vagina
• Uterus
• Fallopian tube
• ovaries
 Breast or Mammary glands
• Consists of about 20 lobes of glandular
tissue
• Lactiferous ducts converge toward the
center of the breast where they form
dilatations or reservoir for milk
• For lactation—active only during
pregnancy and after birth of a baby when
they produce milk
Anatomy of the breast
 ♂ Reproductive organs
• 2 testes } in the scrotum
• 2 epididymides }
• 2 vas deferens (deferent ducts)
• 2 spermatic cords
• 2 seminal vesicles
• 2 ejaculatory ducts
• 1 prostate gland
• 1 penis
 Perimetrium
• Consists of peritoneum,
which is distributed
differently on the various
surfaces of the uterus
 Myometrium
• Thickest layer of tissue in
the uterine wall
• Consists of a mass of
smooth muscle fibers
interlaced with areolar
tissue, blood vessels and
nerves
 Endometrium
• Contains a large number of mucus-
secreting tubular glands
• The thickness of this layer varies
during menstrual cycle
• Upper 2/3 of the cervical canal is
lined with mucous membrane. The
lower 3rd is lined with squamous
epithelium, continuous with that of
the vagina
Follicle Stimulating Hormone
(FSH)
• Stimulates the seminiferous
tubules of the testes to
produce male germ cells, the
spermatozoa
• Promotes maturation of ovarian
follicles & secretion of
estrogen, leading to ovulation
Luteinizing hormone (LH)
• Stimulates synthesis and
secretion of testosterone
• Stimulates the development of
corpus luteum and the
secretion of progesterone
 Menarche

• Occurs during puberty from 10-

14 y/o
• Menstrual cycle and ovulation
begin
• Marks the beginning of child-
bearing period
 Menstrual Cycle
• Average length is 28 days
• Menstrual phase—usually lasts about 4
days
• Proliferative phase—about 10 days
• Secretory phase—about 14 days
 Menses (Day 1 to Day 4 or 5)
• In response to the declining progesterone
levels, the endometrial lining of the uterus
sloughs off, resulting in menses followed
by repair of the endometrium
 Proliferative phase
• From day 4 or 5 until ovulation on about
day 14
• Estrogen causes endometrial cells of the
uterus to divide
• Endometrium of the uterus thickens and
tubelike glands form
• Estrogen causes the uterus to be more
sensitive to progesterone by ↑ing the # of
progesterone receptors in the uterine
tissues
 Ovulation (about Day 14)
• Endometrium contnues to divide in
response to estrogen
 Secretory phase
• About day 14-18
• Endometrial cells enlarge and the layer
thickens
• If fertilization doesn’t occur, the corpus
luteum degenerates after about day 25
and pogesterone levels decline which
cause the endometrium to degenerate
 Menses
• Day 1-5 of the next menstrual cycle
• Endometrial lining sloughs off, and the
cycle continues
 Menopause (Climacteric)
• 45-55 y/o
• Marking the end of the child-bearing
period
• Disturbance of the normal sleep pattern
• Shrinkage of the breast
• Axillary & pubic hair becomes sparse
• Atrophy of sex organ
• Irritability or mood changes
• Gradual thinning of the skin
 Menopause (Climacteric)
• Prone to osteoporosis
• Prone to cardiovascular disorders
Sexual Behavior and Sexual Act
• Erection—the first major component
of the male sexual act
--parasymphatetic action potentials
from the sacral region of the spinal
cord cause arteries that supply blood
to the erectile tissues to dilate
• Ejaculation—is the forceful expulsion
of the secretions that have
accumulated in the urethra to the
exterior
 Physiological Changes in sexual
activity
• Excitement or arousal—occurs in
response to sexual stimulation either
due to touch (reflexogenic) or
imagination (psychogenic) in both
male & female
• Plateau—high level of sexual arousal
that precedes the threshold levels
required to trigger orgasm
 Physiological Changes in sexual
activity
• Orgasm—believed to be a cortical
experience; seems to be mainly
dependent upon intactness of sensation
associated with muscles of ejaculation
--supreme pleasure followed by a feeling
of well-being and satiation
--a mild stimulation to a sensation of
ecstacy so overwhelming that awoman
momentarily loses consciousness
 Physiological Changes in sexual
activity
• Resolution—return to pre-arousal state
over a period of 5-15 min
♀ EXCITEMENT
♀ PLATEAU
♀ ORGASM
♀ RESOLUTION
♂ EXCITEMENT
♂ PLATEAU
♂ ORGASM
♂ RESOLUTION
Human Embryo 35 days after
fertilization
Embryo 50 days of development
Fetus at 3 mos of development
 Leopold’s maneuver
• To diagnose fetal presentation and
position of the fetus
a. Palpation of the upper pole
b. Determining the side of the small parts
c. Palpation of the lower pole
d. Is the prominence of the presenting
part on the side opposite the small parts,
as with the vertex presentation? Or is it on
the same side, as with face presentation?
Leopold’s maneuver
 Estimation of descent of fetal head into the
pelvis. Station 0 is diagnosed when the fetal
vertex has reached the level of the ischial
spines
Various vertex presentations
Various vertex presentations
Various vertex presentations
 Labor and Delivery
• Full Term
--40 weeks (280 days) after last menstrual
period
--38 weeks (266 days) after fertilization
--weight = 3,000-3,500 grams
--height = 50 cm
 Labor and Delivery
• Post-term—anything after 40 weeks
• Pre-term—anything below 38 weeks
• LGA—large for gestational age—above
ideal wt & ht; caused by diabetes
• SGA—small for gestational age-below
ideal wt & ht; caused by malnutrition,
smoking and alcohol
 Labor and Delivery
• Gravida—a woman who is or has been
pregnant, irrespective of the pregnancy
outcome
• Primigravida—first pregnancy
• Multigravida—successive pregnancies
• Nulligravida—a woman who is not now
and never has been pregnant
Vulva and Hymen of a virgin
Vulva and Hymen of a woman who
has sexual intercourse
Vulva and Hymen of a multiparous
woman
 Labor and Delivery
• Obstetric history includes:
GP (F-P-A-L)
Gravidity, Parity (number of full term
infants—number of preterm infants—
number of abortions—number of children
currently living)
 Labor and Delivery
• Example:
G9 P7 (6-1-2-6)
Interpretation:
9 pregnancies, 7 viable pregnancies (6
full term infants—1 preterm infant—2
abortions—6 living children)
 Clinical course of labor
• Lightening—due to the ff:
a. Well formed lower uterine segment
b. Descent of fetal head to pelvic inlet
c. Reduction in amniotic fluid
• False labor—irregularity in occurrence,
short duration, confined to lower abdomen
and groin
 Clinical course of labor
• Show—a yellowish mucus discharge
• True labor—begins in the fundus then
radiates to lower uterus
--regular contractions
--gradually diminishing interval
--increasing duration (30-45 sec)
--increasing intensity
 Labor pains
• Theories:
--hypoxia of contracting myometrium
--compression of nerve ganglia in the
cervix and the uterus
--stretching of the cervix during dilatation
--stretching of overlying peritoneum
 Three stages of labor (Parturition)

• Uterine contractions to cervix dilatation

upto 10cm
• Cervical dilatation to expulsion of the fetus
• Delivery of placenta
1st Stage: cervix dilate & rupture of
amniotic sac
2nd stage: fetus is expelled from the
uterus
3rd stage: delivery of placenta
 Types of delivery
• Normal spontaneous delivery (NSD)
• Cesarian section
• Breech delivery—feet first
– Frank Breech—most common, buttocks first
– Breech primigravida pregnancy—always
cesarian section
Pajot’s manuever for forceps
delivery of the fetal head.
Cardinal mov’ts of labor in NSD
• Engagement—biparietal diameter of fetal
head traverses the pelvis
• Descent
• Flexion
• Internal rotation
• Extension
• External rotation
• Expulsion
Engagement and flexion of head
Internal Rotation
Delivery by extension of the head
External rotation
Delivery of Anterior Shoulder
Delivery of the posterior shoulder
 Causes of Preterm Labor
• Spontaneous rupture of membranes
• Amniotic fluid infection
• Anomalies of conception
• Previous preterm delivery of abortion
• Over distended uterus
• Fetal death
• Cervix incompetence
• Uterine anomalies
• Faulty placentation
• Maternal diseases
 Conditions associated with
prolonged pregnancy
• Anencephaly
• Fetal adrenal hypoplasia
• Absence of fetal pituitary gland
• Extrauterine pregnancy