NCMA217 LEC: REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)
REPRODUCTIVE DEVELOPMENT
• Obstetric Nursing – came from the word “obstetric” means
“midwife”.
• Midwife – took care of the client during the under prandial
period, inter prandial period, post-prandial period.
Reproductive development
• Gonads – the male and female reproductive organ (para sa
lalaki – testes; sa babae – ovary, which means sex glands)
a) Sperm – produce by the testes carry the x and y
chromosomes
b) Ovaries – egg coming from the ovary they carry xx
chromosomes
(That determine of the gender/sex of the individual)
How does gender of individual develop? When the woman gets
pregnant of the 5th week of intrauterine life, there is a presence of
primitive Gonadal Tissue that has two ducts:
• Two Ducts – Mesonephric Duct & Paramesonephric Duct
- (These two ducts will be the one that will change so
that the baby will become male or female
What happened to the developing baby?
- Bet. The 7th and 8th week of pregnancy the baby/fetus will
producing or developing a primitive testis.
- Primitive Testes – capable of producing a small amount of
testosterone.
- The level of testosterone will be the one to determine if
mesonephric duct and paramesonephric duct will turn to
male or female reproductive organ.
- How? – If between 7th or 8th of pregnancy if the level of
testosterone being produce by primitive testes will became
high the mesonephric duct will turn into the male
reproductive organs, whereas paramesonephric duct will
regress. (kase ang paramesonephric duct will be the one to
turn into the female reproductive system)
• High testosterone level
- Mesonephric duct – male reproductive organs
- Paramesonephric duct – regression
• If testosterone level is not present by 10th week
- Gonadal tissues will become – ovaries – therefore,
paramesonephric duct will turn to – female
reproductive organs.
- So it is all about the testosterone but we can say that
this is already pre-determined.
Aki 1 of 8
• REMEMBER:
- OVARIES – produce egg cells, Ovum produced by the
ovaries are carrying XX chromosomes.
- TESTES – produce sperm cells. Carry X or Y
chromosome.
• Therefore, if the xx chromosomes of the sperm fertilize or if
the sperm that is carrying an xx chromosome fertilize the egg
that always carrying the xx chromosomes (pre-determined), so
the paring and the combination will be xx, therefore the
gender of the baby will be female
• But the sperm cell carrying a y chromosome and it fertilized
the egg cell that always carrying xx chromosomes the
combination will be xy, therefore the gender baby will become
boy.
• Therefore, if the combination of the chromosomes will be x
and y the primitive testes is expected to increase in production
testosterone. So, the mesonephric duct will turn into male
reproductive organ whereas, the paramesonephric duct
progresses.
• RECAP:
- If the sperm that is carrying an xx chromosome fertilize
the egg that always carrying the xx chromosomes (pre-
determined). What will happen? The level of the
testosterone by the 10th week of intrauterine life will not
increase so therefore the mesonephric duct will be the one
that will regress, and the paramesonephric duct will
develop into the female reproductive organs.
Pubertal development
- Puberty will start at the age of 9 and end the age of 17, called
pubertal period.
- Secondary sex changes begin:
• Range: 9-17 years old
• Average: 9-12 (girls); 12-14 (boys)
• Growth spurt – is earlier in girl and later in boys. A
sudden increase
 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)
Role of androgen hormone
- Female: adrenal cortex and Ovaries
• Master clock is the hypothalamus
o Hypothalamus – will trigger the adrenal cortex to
start producing the hormones
o Ovaries – will produce estrogen and progesterone
- Male: Adrenal Cortex and Testis
• Adrenal cortex – will start producing androgen and will
stimulate the testes to produce testosterone (that’s why
there will be an appearance of characteristics of male and
female secondary characteristics
Tanner’s sexual development
Female secondary sex characteristics (In order)
1. Acceleration in linear growth (growth spurt)
(Could have Broadening of the hips)
2. Increase transverse diameter of the pelvis
3. Breast development (thelarche)
4. Growth of pubic hair (adrenarche)
5. Onset of menstruation (menarche)
6. Growth of axillary hair (adrenarche) not frequently asked so
our code will be ABTAMOI
7. Ovulation
8. Increase in vaginal secretions
CBQ:
• Thelarche
• Adrenarche
• Menarche
• Ovulation
What is the earliest sign of female secondary sex characteristics?
Increase in height or Breast development?
- Increase in height (accelerated in linear growth)
Among the following which is the female secondary sign of sex
characteristics? Adrenarche, Thelarche, Menarche, Ovulation.
- Thelarche (breast development)
Ano ang unang lumalabas pubic hair or axillary hair?
- Pubic hair. Pubic hair before axillary hair.
Male secondary sex characteristics (In order)
1. Increase in weight.
2. Broadening of shoulders
3. Growth of testes.
4. Growth of face, axillary and pubic hair.
5. Voice changes- because of androgens
6. Penile growth
7. Increase in height (second to the last)
8. Spermatogenesis
NOTE:
- If a 10-year-old masturbate there is no sperm cell, seminal
fluid pa lang kase ang production ng sperm sa male last pa
nangyayari 12–14-year-old.
Male Reproductive system
- The male and female reproductive anatomy are composed of
external and internal parts.
External structures
• Penis – covered by glands skin known as prepuce.
• Scrotum –a sac of skin that hangs from the body at the front
of the pelvis bet. Legs
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• Scrotal Sac – testicles are inside of this
Why is it the testes are found inside the scrotal sac? And scrotal
sac is found outside the body?
• Because there are sperms inside the testes
• Sperm cells are heat sensitive (pag masyadong mainit
namamatay sila)
What’s temperature diff. bet. the body temp. and scrotal temp?
• 1 degree Fahrenheit
• The body temp is 1 degree Fahrenheit higher than the
scrotal temperature. (vice versa)
How long is the average length of the penis fully erect?
• Around 4 to 5 inches
• There is lesser than 4 in. or longer than 5 in.
• Urethra – tip portion of the penis
Function: dual, passageway of urine and semen
Therefore, reproduction and elimination
How long is the male urethra?
• 5 to 9 in an average of 7 dual function
• Socratal sac – does not equally level. (isa mababa, left
side)
Internal structures
1. Testes
2. Epididymis – on top of testes
3. Vas difference
4. Ampulla
5. Seminal vesicle
6. Ejaculatory duct – where the ampulla and seminal vesicle meet
connected to the urethra
7. Urethra – structure connected to this is ejaculatory duct,
prostate gland, & bulbourethral gland (cowper’s gland)
8. Corpora spongiosum – came from the word sponge
Penis – not highly mascular
How will the penis erect?
• Sexual stimulation – have blood rush, when the male person
sexually stimulated the penile arteries dilate more blood rush
towards the penis and penile veins will constrict, the blood
inside corpora spongiosum will trapped and it will absorb by it
that’s why the penis will erect. (pinkish color)
• If sexual stimulation subside the penile vein will dilate and
blood goes out of corpus spongiosum so mawawala ang
erection.
• Parasympathetic stimulation
 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)
Testes – male sex gland
- They produce testosterone
- Responsible of spermatogenesis (production of sperm in the
seminiferous tubule)
- Where is the specific site of the spermatogenesis?
- In the seminiferous tubules
- Epididymis – serving as storage room for growth and
maturation for the sperms.
- Vas Deferens/Ductus Deferens – is the conduit bet. the
seminal vesicle and epididymis or the connecting structure.
Site for male surgical sterility (vasectomy)
- Zation (vasectomy)
- (during intercourse kapag umabot ang sperm sa ampulla
sperms go out of the ampulla and the seminal vesicle will
produce seminal fluid to lubricate sperms sa ejaculatory
duct)
4 Structures Producing Seminal Fluid
1. Epididymis
2. Seminal vesicle
3. Prostate gland
4. Cowper’s gland
How many percent of the seminal fluid will epedidymis produce?
• 5% of the seminal fluid comes from epididymis
• 30% from seminal vesicle
• 60% from prostate gland – main producer of seminal fluid
the male reproductive anatomy
• 5% from cowper’s gland
During anal intercourse why is it some males ejaculate even
without masturbating?
- Because of the vibration of the prostate gland during anal
sex
• Maturation of cells in epididymis – 64 to 70 days (common
answer 64 days more than 2 months)
• Sperm Cells travels from vas deferens to ampulla – because of
the 5% of the seminal fluid produce by the epididymis
• Sperm route: Testes (produce) → epididymis (mature/storage,
5% fluid) → vas deferens (connecting struct.) → ampulla (dito
naka pila mga sperm) → seminal vesicle (already prod. 30%
seminal fluid kaya super lubricated na ung ejac. duct) →
prostate 60% and cowpers 5% at the same time produce total
of 65% seminal fluid
• Sperm Cells are alkaline in nature because of the fluids (able
to survive the acidity of vaginal canal bec. of alkaline)
• Vaginal canal is acidic
• 2 structures produced alkaline:
1) Cowper’s gland
2) Prostate gland
• During contraction of ejaculatory duct there is forceful
ejaculation so that the sperm will not stay in the acidic vaginal
canal.
• Sperm cells will reach the cervix in 90 seconds and fallopian
tube in 5 minutes
• Testes- male sex gland
• Testosterone- male sex hormones
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Vas Deferens
- the site of the male surgical sterilization (vasectomy- ligate
ligate then cut)
• sperm cells after maturation will die
• they provide nurishment
• made up of protein
• Vasectomy is permanent contraception
• After vasectomy still possible to make the wife pregnant
because may natira sa vas deferens
Nursing Teaching Plan (After vasectomize)
- Do not forget that after vasectomy that you need to wear
condom if you are going to engage sexual intercourse for
at least 2 months
- Sperm cells that located on your vas deferens are capable
of 64 days maturing causing pregnancy
- To quickly emptying the part needed to ejaculate (35 to 45
ejaculation, there is no guarantee)
- Surest method is you need to test your sperm count
- 1st result – not sure even the sperm count is zero
- 2nd result – still zero
- 2 consecutive zero sperm count results
- Vasectomy cannot stop the erection and not preventing
spermatogenesis and can still ejaculate (but seminal fluid
only no sperm)
- Vasectomy cannot protect the husband from STD
Sperm Analysis Result
• 3-5 mL - average amount of semen/ejaculation
• Per mL how many sperms are there? 20M (minimum sperm
count/mL) – 150M sperm/mL
- Oligospermia – the condition that the amount of sperm is
less than 20M per mL
- Aspermia – zero sperm cell
- Clomid – is the drug to help increase the sperm
production also helping for fertility
• 400M sperms/ejaculation- average sperm per ejaculation
• Lifespan 3-5 days or 72 hours
• pH 7-8 alkaline
• pH 4-5 acidity level of vaginal canal
• Morphology – 30% are in normal shape and size (400M ave.
sperm/ejac. And 50% viability so every ejaculation 200M are
alive)
• Motility – 50% (are activley moving)
• Viability – 50% (30% are in normal shapes, normal size)
Female Reproductive System
External structures
• Mons pubis/ Mon veneris- protects the symphysis pubis
• Labia Majora and labia minora
 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)

• Clitoris- sit of sexual excitement for female. Homologous part Internal structures
of glans penis of the male.
• Vestibule – pear-shaped space. 2 obvious opening found in
here: urethral meatus and vaginal orifice (for vaginal opening)
• Female urethra – 2-3 inches; Male- 5-9 average of 7. That is
why female is prone to UTI. Have single function for
elimination only passage of urine
• For correct catheterization we can see the clitoris
• Fourchette – where labia minora and majora meet
• Perineum- fourchette to anus
• Paraurethral gland (skene’s) – lubricates the urethra
• Bartholin’s gland – lubricates the vagina
• Down the fourchette and perineum this is the site of
episiotomy. D- vaginal canal
• Episiotomy – the cutting of the perineum of the woman to C- uterus
provide wider space to delivery and prevent laceration. Has 2 A- ovary
types: midline and mediolateral episiotomy. B- fallopian tubes
• Mediolateral episiotomy- is better than midline. Uterus
- Size 3”x2”x1”- 3 in long 2 in wide and 1 in thick.
• If you have laceration and there is total communication bet.
- Weight: 50-60 grams, but in pregnancy it can weight
The vaginal canal and the rectum that can lead to infection
minimum of 500 gram
because of fecal contamination
- Shape: pear shaped hollow organ, during non-pregnant state it
• When will the doctor perform the cut? During contraction or
is empty so if the woman is not pregnant and something is
between contraction? Is there an anesthesia? No, because it
inside the uterus then it is no longer hollow it becomes
has a natural anesthesia, the doctor will cut during the peak of
abnormal like myoma or endometriosis.
the uterine contraction, because when there is strong uterine
- Location: suspended between the urinary bladder anteriorly
contraction during the acme, because one contraction is
and the rectum posteriorly. Located at the back of the bladder
composed of three parts: relaxation, contraction, relaxation
and in front of the rectum.
A - Position:
• Anteflexion- fundus of
uterus is leaning sharply
I D
forward and it is abnormal
I- ncrement (start), A- cme (peak), D- ecrement (end)
because it can compress to
• The doctor will not do the cut during the increment and
much of urinary bladder and
decrement. The doctor will do the cut during acme because
other organs in front of it.
during this time the peak of the uterine contraction, the head
• Anteverted/ anteversion
of the baby is already pressuring the perineum of the woman.
(non-pregnant)- normal
If the head of the baby is pressuring the perinium of the
position, fundus of uterus is
woman the nerve ending will not be able to transmit pain
leaning forward
impulses so nagiging numb ung lugar. In cutting it should be
perfect timing. • Retroverted/ retroversion
(pregnant)
• Retroflexion
• Flexion- means abnormal

When will the uterus assume the retroverted position?

• The uterus assumes the retroverted position during the 2nd
trimester/ 4-6 months.
• Note: 1st tri. 1-3 mos, 2nd tri. 4-6 mos, 3rd tri. 7-9 mos
The woman is 2 ½ mos pregnant is the uterus already enlarging?
• Yes, and its position is anteverted and can compress the
bladder so discomfort of pregnancy experienced by
pregnant woman is urinary frequency and this will
disappear in 2nd trimester beginning 4th month because the
uterus assume the retroverted position
In the 3rd mos. of trimester, she experiences urinary frequency
why?
• Because the baby is so big

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 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)
- Functions of the uterus:
1. Site of implantation. (endometrium)
2. Houses and nourishes the products of conception.
3. Aids in labor and delivery (by promoting uterine
contraction)
4. Organ of menstruation (where menstrual discharge
originate. Vaginal canal is only passageway of menstrual
discharge)
- Aids in delivery because it is composed of three layers:
Perimetrium- outermost layer, Myometrium- middle and
Endometrium- inner most layer and the site of implantation.
o Myometrium - Highly muscular layer and considered as
thickest layer. Source origin of uterine contraction.
o The uterus composed of 4 parts:
1. Fundus – upper most triangular portion
2. Corpus – the working you find the uterine cavity. Body of
uterus
3. Isthmus – lower segment/part
4. Cervix (collar) – mouth/opening of uterus.
Upper uterine segment
F during pregnancy turns
C (thickened)
I (widening/opening)
C vaginal canal
Lower uterine segment
o The thickest layer of the myometrium located in the fundus.
- Because that is the site of uterine contraction.
- The strongest uterine contraction.
- When the fundus contracts it gives the baby a downward
push.
o The uterine contraction here are not that strong.
- If the uterine contraction here is strong, the baby cannot
go out the baby will have a hard time going out.
- NOTE: site of implantation? Uterus, what specific part?
Endometrium.
o The ideal site of implantation is Upper uterine segment –
posterior.
- Not in the lower because the site of implantation is the
site of placental development. Ibigsabihin kung saan nag
plant dun din mag grow ang placenta.
- If the implantation happened in lower, called placenta
previa. The placenta obstructs the birth canal and lead to
bleeding.
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- Posterior because uterine arteries are located at the
posterior. Rich in nourishment, nutrient supply and
oxygen supply.
o The implantation should only happen in endometrium.
- It should not reach in myometrium.
- If the implantation invaded the myometrium, in the future
the placenta is attach up to myometrium.
- After the baby goes out, the placenta goes out next. The
placenta separate itself from endometrium. Meaning, the
placenta is superficially implanted on the endometrium.
- If implantation goes deeper/ invasive, the placenta is
attached permanently on the myometrium (because during
delivery the baby goes out and after that the placenta goes
out next and it separates itself from endometrium meaning
placenta is superficially implanted in the endometrium but
if the implantation goes deeper invasive implantation the
placenta is attached permanently and it is called placenta
accrete
- If there’s placenta accrete, the placenta will not go out,
because the placenta becomes part of the uterus. When the
baby went out, but the placenta cannot detach itself from
the uterus, the women bleed to death. (Management:
removal of uterus called hysterectomy)
Cervix
• Internal OS – during
pregnancy it effaces
(thinning)
• Cervical canal –
into operculum
• External OS – during
pregnancy it dilates
Location: above
- During delivery we measure internal os by percentage. What
is the full cervical effacement? 100%, how about dilatation?
Centimeters, what is the full dilatation? 10 cm.
- During pregnancy, the level of estrogen is high.
- When the level of estrogen is high, it makes the cervix soft.
And softening of cervix is known as Goodell’s sign.
- Three probable signs of pregnancy can be found in the
vagina, cervix and isthmus:
1. Chadwick sign – purplish or blueish discoloration of
vaginal mucosa
2. Goodell’s sign – softening of cervix
3. Hegar’s sign – softening of cervix
Hegar’s sign
Goodell’s sign
Chadwick sign
 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)

- GS and HS are the same thanks to estrogen because during Uterine Blood Supply
pregnancy the level of estrogen increases causes to increase DECENDING AORTA
vascularity (means temporary capillaries are building up that ↓
increases fluid supply that’s why it becomes soft) on the 2 ILIAC ARTERIES
isthmus and cervix. ↓
How soft is non pregnant cervix? HYPOGASTRIC ARTERIES
- as soft as tip of the noses ↓
How soft is Early pregnancy cervix? UTERINE ARTERIES
- Earlobe - Most of the uterine arteries are found at the back of the uterus
How soft is late pregnancy cervix? so the most ideal site of implantation is the upper posterior.
- lips Uterine Nerve Supply
Why is there a need to cervix soften?
- To be able to allow the cervix to efface and dilates.
Kailangan lumambot para numipis ang internal os at mag
open ang external os.
Operculum
- Thickened cervical mucus - Uterus nerves
- When the cervical mucus thickened it acts as a seal that a) Afferent sensory – from thoracic #11 to #12
protects the mother and the baby against the ascending b) Efferent motor – from t5 to t10
infection. CBQ:
- Protection against m.o are acidity of vaginal canal and - Epidural Anesthesia – stops pain of uterine contraction at t11
operculum and t12 without stopping uterine contraction. For painless
- Dislodge during through labor (bloody show) delivery.
- Supporting Ligament Structures of Uterus • Because the motor nerves that will allow the motor nerves
• Broad Ligament – it keeps the fallopian tube and uterus in to contract is t5 to t10, sensory from t11 to t12.
place. • Kaya if woman receives epidural anesthesia the woman
• Round ligament – upper support, pair of ligament will continue uterine contraction because epidural
attached to the fundus. anesthesia affects at t11 and t12 but not affecting the
• Cardinal ligament – middle support (important, it is vital) nerves t5- t10 so she will contiue uterine contraction but
• Uterosacral ligament/pelvic floor ligament – lower not feeling the pain.
support Vagina
What ligament allows the uterus to assume the retroverted position - Length – 3 to 4 inc
during pregnancy? - Rogaeted – skin folds, stretching
• Round ligament. During 2nd trimester the round ligament - Function – organ of intercourse; passageway of menstrual
is contracting so fundus is going up retroverted position. discharge; birth canal
What is the most important ligament during pregnancy because it - Environment; Acidic – douderline bacillus this produces lactic
provides stability to the uterus? acid
• Cardinal ligament. It will not be called cardinal if it is not - pH – 4 to 5
important. Fundus and isthmus is not stable. Middle part - During IE the fingers are inserted to vaginal canal
is usually stable and not becoming soft so what is the - Vagina can accommodate a bigger and longer size of penis,
ligament attached? Cardinal. because it has rogae
- During sexual intercourse the cervix moves little upward and
the rogae is stretched
Fallopian Tubes
- Pair of tubular organs
- Also called oviduct, because it is the passage way of ovum
once it is fertilized
- Length 3-4 inc
- Ciliated (may cilia)
• Parts
1. Interstitial – dangerous of ectopic preganancy bec. it is
narrowest and connected to the uterus so bleeding is
profuse
2. Isthmus – site of tubal ligation. The doc. Will fold
fallopian tube.

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 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)

3. Ampulla – fertilization happens and common site of - Pro (for) gesterone (gestation)- hormone of preganancy,
ectopic pregnancy (pregnanacy outside the uterus) and provides nourishment for the baby and hormone that prevents
meeting place/mating place, widest part. contraction.
4. Infundibullum- comprises fimbrae - Estrogen- hormone that encourages contraction and hormone
that enlarges the uterus.
Ovaries
- Female gonad that produce estrogen and progesterone
- 3 Division
1) Surface epithelium
2) Cortex – maturation of oocytes
3) Medulla
- During the pregnancy ovaries are not active because placenta
will be the one will provide the estrogen and progesterone.
- If fallopian tubes is divided into 3 equal parts it is called:
ampulla- outer most third, isthmus- middle third and Breast: Mammary Glands
interstisial- inner most third (narrowest and goes to 3 layers of - The breast lies in the pectoralis muscle
uterus) Internal structures of the breast
- Fimbrae- farthest part of the infundibullum, to cath the egg
cell. When the follicle of the ovary releases an egg cell the
fimbrae catch the egg cell. The egg cell will then go to
ampulla to wait for the arrival of the sperm.

QUESTIONS:
- Site of fertilization? Fallopian tube, specific part? Ampulla
- Functions: site of sterilization and transports ovum to the
uterus.
- Pomeruy Procedure – cutting of fallopian tube
- Modified Pomeruy – no cutting the fallopian tube
- The doctor will do the tubal lateral ligation during
menstruation because it is a sign that the woman is not
pregnant.
- When is the best time will the woman undergo tubal ligation?
– 1st day after the last menstrual period or during mens.
Choose the day closest to the day that the woman is
menstruating.
- For example the woman had sex the sperms enter vaginal
canal → uterine cavity → 2 fallopian tubes → tapos wala pa
ung egg cell dahil hindi pa siya nag ovulate, eh ung life span
ng sperm ay 72 hrs/3 days maximum of 5 days so tatambay
muna siya sa ampulla → nag ovulate na ung egg cell → Lobes of the breast- are connected to the lactiferous ducts
mature egg cell ika-catch sya ng fimbrae → it will enter Lactiferous sinuses/Ampulla of the breast- dulo ng lactiferous duct,
ampulla → there will be fertilization. storage room for the milk
- Once its fertilize the egg it stays on the fallopian tube for 3-4 From: Lobes → lactiferous ducts → Lactiferous sinuses/Ampulla
days, during w/c the level of estrogen is increasing and → opening of lactiferous
progesterone is increasing more because the woman is already What hormone stimulates the breast to produce milk?
pregnant. - Prolactin – it produces by the pituitary gland. (Anterior
- When level of estrogen is increasing it encourages contraction and posterior)
in the fallopian tube nag kakaroon ng wave like motion. Inner - Prolactin – from anterior pituitary gland; Oxytocin – from
portion of the fallopian tube is ciliated so as the fallopian tube Posterior pituitary gland.
is contracting the cilia are moving so the fertilized egg is also - Oxytocin causes uterine contraction.
moving inward for another 3-4 days if it moves outward it will - Prolactin stimulates acinar cells (found inside lobes that
cause high risk of ectopic pregnancy. can produce milk)
- After fertilization the implantation will happen 6 to 8 days or How will the mother breast feed the baby after delivery?
average of 7 days (1 week) and maximum of 10 days - Because of the action of the prolactin and oxytocin.
- 7 to 10 days implantation will occur in upper segment in - Prolactin stimulates the production of milk by acini cells
posterior uterus in the endometrium inside the lobes
- Milk ejection reflex or let down reflex of the milk we
need oxytocin, coming from the posterior pituitary gland.

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 NCMA217 LEC: WEEK 1 – REPRODUCTIVE DEVELOPMENT (SIR VASQUEZ)

Mammary glands and milk ejection reflex

- Cells responsible for producing the milk is the acini cells that
is found in the lobe that contains 15-20 each breast.
- How milk ejection happens? When the newborn baby sucks
the nipple of mother, it sends signal to the posterior pituitary
gland to release oxytocin.
- Once oxytocin release, it will cause the contraction of milk
gland cells and acini cells will release milk.
- Then, the milk flows into lactiferous ducts, it will be stored in
the lactiferous sinus.
- Because sucking action of the baby, the milk is expressed in
the nipple.
- Is there any advantage when posterior pituitary gland during
breast feeding releases oxytocin – the advantage will be
contraction of the uterus during the post-partum period. Then,
the uterus remains firm and contracted, it stops or prevents
post-partum bleeding.
- The normal consistency of the uterus after delivery must be
firm and contracted. Because if the uterus is relaxing, the
woman bleeds.

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 NCMA217 LEC: PELVIS (SIR VASQUEZ)
PELVIS True pelvis
- Supports and protects the reproductive and other pelvic organs.
- Bony ring structure
- Inside the pelvic cavity there is female internal reproductive
system including the part of the renal system the bladder and
the digestive system, the rectum and the anus.
- 2 divisions:
1) False pelvis – simula sa symphysis pubis pataas (support
growing uterus)
2) True pelvis – simula sa symphysis pubis pababa (serves as
the birth canal) 1. Inlet
2. Cavity
3. Outlet

4 types of pelvis

Ischial tuberosity- called sitting bones, the ones carrying our body
1. Gynecoid
weight when we are sitting
- True female pelvis because this is the most rounded type
Ischial spine/ sipit-sipitan- katapat ng coccyx
of pelvis.
- It can easily support pregnancy and delivery. Anterior Posterior Lateral
2. Anthropoid Sacral
Inlet Superior pubis Ileum
- Can also support pregnancy and delivery. prominence
3. Android Cavity - - -
- Male pelvis – heart or triangular shape Ischial
4. Platypelloid Outlet Inferior pubis Coccyx
spines
- The anterior and posterior diameter is short. - If u get the distance from superior pubis to sacral prominence
- Flat pelvis it is anterior-posterior diameter of the inlet
- Cannot support pregnancy and delivery - If u get the distance from inferior pubis to coccyx it is
anterior-posterior diameter of the outlet
- If u get the distance between the 2 ileums, then transverse
diameter
- If u get the measurement between the 2 ischial spines then,
transverse diameter of outlet and inlet kase may diameters ang
pelvis

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 NCMA217 LEC: WEEK 1 – PELVIS (SIR VASQUEZ)

Diameter of the pelvis EXAMPLE:

Anterior- 1. The head is located at the negative 2 station, so the baby is
Transverse Oblique
Posterior located 2 cm above ischial spine.
2. If the head is located at the positive 3 station the baby is
Inlet 11 cm 13 cm 12 cm located 3 cm below ischial spine.
Cavity 12 cm 12 cm 12 cm 3. The head is located 2 cm above the ischial spine, is the head
already engage? Not yet but there is ballottement since the
Outlet 13 cm 11 cm 12 cm
head is not yet engage the baby can still bounce and the baby
is floating
4. When the head is already engaged in station zero it is no
longer floating w/out ballottement.
5. When the head goes down to positive 5 the head is always
engaged.
6. You performed IE upon inserting your finger you are able to
feel/palpate the ischial spine, but the head is not yet there the
head is located at the negative station.
7. Upon inserting your finger, you feel the head w/out feeling/
palpating ischial spine the head is located at the positive
station
- All oblique and cavity are 12 8. Upon inserting your finger, you feel the head along the ischial
- Inlet- transverse is bigger and AP dia. is smaller spine then that is station zero.
- Outlet- transverse is smaller and AP dia. is bigger • Crowning – when the head reaches positive 4 and 5. The
• The baby needs to rotate while passing the birth canal. – 6 head of the baby is being encircle already by the vaginal
mechanism labor. D-FIRE-ER-E opening.
1) Decent Fetal skull – Pelvis relationship
2) Flexion - The fetal skull is the most important part of the fetal body
3) Internal rotation during the labor and delivery because:
4) Extension
• The most frequent presenting part. (Because the most
5) External rotation
common fetal presentation is cephalic presentation)
6) Expulsion
• Largest part of the fetal body. (Since it is the largest that’s
• Ischial spines – landmark for the station zero. (Station zero is
the part of the body that can have a problem of not
landmark of engagement – means the head is already between
passing through the birth canal kase malaki)
the ischial spines naka sipit ang head kaya tinawag na sipit-
• Least compressible. (When head passed birth canal the
sipitan)
head is compressed and that is called molding)
• If the fetus still inside of the uterus of mother, there is
amniotic fluid. The fetus bouncing in the amniotic fluid. Fetal skull
• Ballottement – the bouncing of the baby in the amniotic fluid. 3 main bones:
1) Frontal bones
2) Parietal bones
Station zero 3) Occipital bones
(-) Not Engaged Sutures:
- Cranial joints, like space
1) Frontal suture - between 2 frontal bones
(+) Engaged 2) Coronal suture - between 2 parietal and 2 frontal
3) Sagittal suture - between 2 parietal bones
4) Lambdoidal suture - between 2 parietal and 1
occipital
• Engagement is when the head of the baby reaches at least Fontanels:
minimum of station zero or if the head of the baby is already 1) Anterior fontanel – diamond space (closes within 12-18
reaching the two ischial spine mos.)
• If the head of the baby is already engaged 2) Posterior fontanel – triangular space (closes within 2-3
• Station zero- is the level of the ischial spine mos.)
• Above station zero is negative 1, negative 2 etc.
• Below station zero is positive 1, positive 2 etc.
• 1 station = 1 cm.

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 NCMA217 LEC: WEEK 1 – PELVIS (SIR VASQUEZ)

Fetal Lie
- Relationship of the long axis of the uterus and long axis of the
fetus.

Attitudes: • Longitudinal lie - if the axis of uterus and baby is parallel to

1) Flexion - yuko each other. Two types: Cephalic and breech
2) Extension - tinggala • Transverse lie
4 regions of the fetal skull: • In actual area presentation is the commonly used term because
1) Face - biggest it is direct.
2) Brow/ sinciput - big
3) Vertex - small
4) Occiput – smallest
EXAMPLE:
- If the head is:
• fully flexed the presenting part is occiput
• Partially flexed the presenting part is vertex
• Partially extended the presenting part is brow
• Fully extended the presenting part is face
Occiput and vertex - 2 ideal presenting part, kase maliit sila

Fetal presentation

1) Cephalic – headfirst
2) Breech – buttocks first
3) Transverse- shoulder first
• All babies that are in cephalic presentation will be delivered
normally? No, it depends.
• If the presenting part in the vagina is the face of the baby
delikado un because as the uterus is contracting the uterus is
pushing the baby down and the head further extend is face that
can cause fracture of the cervical bone
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 NCMA217 LEC: MENSTRUATION (SIR VASQUEZ)
MENSTRUATION Menstruation Ovulation Menstruation
- A periodic cyclic discharge of blood coming from the uterus.
- A periodic, cyclic, regular, monthly discharge of blood coming Day 1 Day 14 Day 28
from the uterus.
Day 1-5 safe & (-5) (+3)
- Uterus - organ of menstruation Day 18-28 safe
Day 6- 8 Days 9 to 17
- Average blood loss during menstrual period – 30 to 80 cc, an
average of 60 cc.
Example: 5 days of menstruation
- 60 cc = ¼ cup.
o Days 1-5 = menstrual period is safe
- Iron loss (12- 29 mg) o Deduct 5 days from the day of ovulation 14-5 = 9
- If the woman is heavily having menstrual period, pwede siya o Add 3 days from the day of ovulation 14+3 =17
mamutla/ pallor. o Day 9-17 fertile window, the woman is considered fertile
Menstrual period VS Menstrual Cycle
o The woman is considered safe to have sex if she doesn’t
- Menstrual period are the days where in the woman is
want to get pregnant beyond the window so less than 9
menstruating and the average length of the menstrual period is and above 17
three to five days, maximum of seven days. o Specifically, the woman is safe to have sex from day 1 to
- Menstrual cycle, starts from the first day of period to the first day 8 but days 1 to 5 have menstrual period. Therefore,
day of next period (regla to regla), average of 28 days/cycle
day 6- 8 and during menstrual period is safe.
- Ranges from 23-35days; maximum of 40 days. o Day 18 – 28 is also safe
- Occurs during puberty, 9-17 y/o average of 12 y/o. o Day 9 – 17 fertile days, not safe
- First onset of menstrual cycle is menarche Recap:
- Menstrual cycle can be regular or irregular.
1st half of the cycle 2nd half of the cycle 28 DAYS CYCLE
1 2 3 4 5 6 7 8 9 10
Menstruation Ovulation Menstruation 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28
Day 1 Day 14 Day 28 5 days explanation:
Day 30 1 2 3 4 5
Day 1 Day 16

Day 1 Day 11 Day 25 9 10 11 12 13 14

• Ovulation - the day that the one of the 2 ovaries of the woman
is releasing a mature egg cell.
• The woman is fertile when the one of her 2 ovaries is releasing
egg cell.
• If the woman is fertile and she had sex there is a possibility
that the egg will be fertilized by the sperm and get pregnant.
• How are we going to compute for the day of ovulation?
- From the end of the cycle, minus 14.
- 28 – 14 = 14 – she will be ovulating on day 14.
- This is only done by regular
• Hormone estrogen is high on the first half of the cycle.
• Hormone progesterone is high on the second half of the cycle.
• The length of the cycle affects the day of the cycle? Yes
• The day of ovulation is based on the cycle
• If the length of the cycle is changing every month, then the
day of your ovulation every month is also changing, then you
are not regular.
Fertile window
- These are the days the woman is considered fertile.
- If you want to get pregnant have sex during the fertile window.
- If you don’t want to get pregnant have sex outside the window.
28 Days Cycle Legend:
• Red - menstruation (safe)
• Green – safe days
• Orange - fertile window (not safe)
• Violet- ovulation day
• Blue- sex days
1) If the woman is a 28-day cycle, she will ovulate on day 14,
granted that the menstrual period of the woman is 1-5 days.
2) From the day of ovulation minus 5 (14-5 =9) & from the day
of ovulation plus 3 (14+3 =17) so days 9-17 she is fertile.
3) Therefore days 1-8 she is safe but if she wants to engage in sex
beyond menstrual period, she is safe from days 6-8 and from
day 18-28.
- Q: Is she ovulating at day 9? A: No, because day 14 is the
ovulation day
1) Day 9 is 5 days before ovulation, means that if you have sex
on day 9 sperm enters the vagina → cervix (w/in 90 sec) →
uterine cavity → fallopian tube (reached w/in 5 min) and;
2) Starting from day 9 the sperm is waiting in the ampulla of the
fallopian tube for the arrival of the egg for 5 days (kase diba
ang life span ng sperm is 3-5 days so 5 days siyang mag
hihintay sa ampulla) and the egg will arrive on the 5th day at
exactly day 14 (ovulation day) in the ampulla of the fallopian
tube therefore she will get pregnant even if the sex was 5 days
ago.

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 NCMA217 LEC: WEEK 1 – MENSTRUATION (SIR VASQUEZ)

3) Note the sperm lives for 3-5 days that is why you have to Menstruation Ovulation Menstruation
subtract 5 and add 3 is derived from the life span of the
ovum/egg cell. It is only 1-2 days or actually average of 24 hrs. Day 1 --------- Day 38
or 1 day, maximum of 48 hrs. or 2 days. Plus 3 kase they
added 1 day. 1-5 MP (1-2 safe) 3-27 FW 28-38 safe
4) If you don’t want to get pregnant have sex more than 5 days - Day 5 still menstruating and day 3 ovulation day- they are
before ovulation: day 8 paatras. overlapping

Another Example: 4 days of menstruation 38 DAYS CYCLE

o Fertile window: 19-27 1 2 3 4 5 6 7 8 9 10
o Safe days: 1-18 and 28-38 11 12 13 14 15 16 17 18 19 20
o Ovulation day: 24 21 22 23 24 25 26 27 28 29 30
31 32 33 34 35 36 37 38
38 DAYS CYCLE
1 2 3 4 5 6 7 8 9 10 38 Days Cycle for Irregular Legend:
11 12 13 14 15 16 17 18 19 20
• Red - menstruation (safe)
21 22 23 24 25 26 27 28 29 30
31 32 33 34 35 36 37 38 • Green – safe days
• Orange - fertile window (not safe)
38 Days Cycle Legend: • NO ovulation day
• Red - menstruation (safe) 4 Important Structures
• Green – safe days - That regulate/control the menstrual cycle
• Orange - fertile window (not safe) - Hypothalamus gland that starts menstrual cycle →
• Violet- ovulation day hypothalamus stimulates what gland? anterior pituitary gland
• For irregular there is computation but it is not highly → APG stimulates what organ? ovaries → ovaries affect what
recommended because from the very beginning the woman is organ? uterus.
irregular. 1. Hypothalamus
• To know if you are regular or not you have to: Producing:
 Monitor your menstrual cycle for at least 6 mos. - GnRH or Gonadotropic Releasing Hormone
 For regulars your menstrual cycle should be fixed to Types of GnRH:
specific no. of days. o FSHRF or Follicle Stimulating Hormone Releasing Factor
- Ex. Your cycle is 30-day cycle so dapat every following o LHRF or Luteinizing Hormone Releasing Factor
month 30 days pa din siya. 2. Anterior pituitary gland
- Although naiba nung April ng 28 hindi pa din siya
Producing:
considered as irregular, ask ur self if you are stressed that
- FSH or Follicle Stimulating Hormone
time because it can alter mens. cycle.
- LH or Luteinizing Hormone
Type Jan Feb March April May June 3. Ovaries
Regular 30 30 30 30 30 30 Producing:
Regular 30 30 30 28 30 30 - Estrogen- dominant on the 1st half of cycle
Irregular 28 25 28 30 33 26 - Progesterone- dominant on the 2nd half of cycle
4. Uterus
 For irregular, you must also monitor your menstrual cycle
at least 6 months. Dominant on the Structures Dominant on the
- You have to identify the month that has longest cycle and 1st half of cycle 2nd half of cycle
the shortest cycle. FSHRF Hypothalamus LHRF
- You have to deduct 11 days from the longest cycle then, FSH APG LH
- Deduct 18 days from the shortest cycle. Estrogen Ovaries Progesterone
- We cannot identify exactly the ovulation day but we will
know the fertile window.
4 Dates in the Menstrual Cycle
1. ↓ 3rd day - the level of estrogen in the blood of the woman is
Example for irregular:
very low.
a) (May) Longest cycle – 38 – 11 = 27 days
↑ Considered as the cycle because it is the longest o Days 1-5, she is menstruating at the beginning
b) (Aug.) Shortest cycle – 21 – 18 = 3 days menstrual cycle.
2. ↑ 13th day - the level of estrogen in the blood of the woman is
very high

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 NCMA217 LEC: WEEK 1 – MENSTRUATION (SIR VASQUEZ)

3. ↓ 13th day - the level of progesterone in the blood of the - That high level of the estrogen will send signal to the
woman is very low. APG to temporarily stop producing FSH.
4. ↑ 14th day - the level of progesterone in the blood of the - Effect: If the FSH stop producing, then ovary will no
woman is very high. longer produce estrogen. (may stock na sya ng estrogen sa
graafian follicle)
3rd day  E 13th day  P Second half of the Cycle (P)
1) That’s why on the 13th day of the menstrual cycle the level of
Hypothalamus progesterone is very low stimulating the hypothalamus to
FSHRF LHRF release LHRF.
2) LFRH stimulates the APG to release LH.
Anterior pituitary gland 3) LH stimulates the ovary to release progesterone. Then,
FSH LH 4) Progesterone will affect the uterus.
Mat. oocyctes Triggers ovulation
- When the level of LH is high, LH triggers ovulation.
13th ↑ Ovaries - The high level of progesterone will convert graafian
Estrogen Progesterone follicle into corpus luteum. (Corpus luteum -yellowish)
Graafian follicle Graafian follicle - Progesterone will stimulate uterus, there will be
Uterus increased vascularity on endometrium
Corpus luteum
- Increase vascularity – building up of temporary capillary.
Thickening of myo and endo ↑vascularity on endo
- Progesterone builds up temporary capillaries on
First half of the Cycle (E) endometrium.
1) Particularly days 1-5, on the 3rd day of menstrual period the - The blood supply will be high when there’s a build-up of
level of estrogen in the blood of the woman is already very temporary capillary.
low because she is menstruating. - If the blood supply in endometrium will become high, it
2) That low level of the estrogen of woman stimulates the increased supply of O2, H20, Glucose, Amino Acid.
hypothalamus to start a new cycle. - Progesterone made the endometrium highly nourished.
3) Estrogen stimulate hypothalamus to release FSHRF
4) FSHRF stimulates the APG to release FSH.
5) FSH stimulates the ovary to release estrogen. Then,
6) Estrogen will affect the uterus.
- Once APG release, FSH – will develop egg cells. It will
cause the maturation of oocytes (1st effect). (Oocyte –
immature egg cells)
- (2nd effect of FSH) FSH stimulates ovaries to release
estrogen so once estrogens is release, it converts the
follicle of the ovary into graafian follicle.
- Follicle is the compartment in the ovary where you can
find the egg cells and becomes graafian follicle. Estrogen Pathway of woman getting pregnant
is the hormone that is very high in the graafian follicle.
Menstruation Ovulation Menstruation
- The effect of the estrogen on the uterus is thickening of
myometrium and endometrium. Corpus luteum (2 weeks life span)
Day 1 Day 14
- Myometrium is also thickening – the uterus will slightly
enlarge during menstrual cycle because of the hormone
She is fertile and she had
estrogen. sexual intercourse
2 months CL is aging
- If the woman gets pregnant the level of estrogen is high
that is why estrogen enlarges the uterus.
Positive fertilization
- Hindi sabay pinoproduce ng ovary ang estrogen and (beginning of pregnancy)
Placenta
progesterone. Isa isa lang.
- Estrogen partner niya si FSH. Progesterone is LH
9th month – aging
How ovaries produce progesterone?
- Estro is low on 3rd day and high on 13th day so on the 13th
Increase uterine
day the level of estro is high and pro is low. Since the 13th Labor Low progesterone
contraction
day the level of estrogen is already very high, there will
be a feedback effect. - Kaya minus 14 kase 14 days ang life span ng CL

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 NCMA217 LEC: WEEK 1 – MENSTRUATION (SIR VASQUEZ)

- Corpus luteum came from graafian follicle, GF produce To simplify

estrogen. CL combines estrogen with progesterone. But
progesterone is higher during pregnancy.
- 2 hormones produced by CL is estrogen and progesterone.
- Estrogen is high (encourage contraction) but progesterone is
higher (prevent contraction) and we need these 2 hormones in
pregnancy.
- The reason why the woman will not menstruate when she gets
pregnant because lifespan of CL after fertilization, extends
from 2 weeks to 2 months. Since nag extend menstruation
missed.
- On the 2nd month, corpus luteum is aging/degenerating.
- On the 2nd month of pregnancy, the placenta will develop. And
the placenta produces estrogen and progesterone, but the
progesterone is higher than estrogen.
- The lifespan of placenta (inunan) is 9 months.
- When the placenta reaches the 9th month of pregnancy,
placenta is considered aging. (Progesterone – preventing
contraction) then,
- The ability of the placenta to produce progesterone, will begin
to decrease. Therefore, it will increase uterine contraction.
Then the woman enters the labor.
Pathway of woman menstruation
Menstruation Ovulation Menstruation
Corpus luteum (2 weeks)
Day 1 Day 14 Day 28
No sexual intercourse
No fertilization decreased E and P
increase uterine
contraction
temporary capillaries
Menstrual discharge
rupture
- She did not engage in sexual intercourse, or she engaged in
sexual intercourse but protected. That’s why there’s no
fertilization.
- If there is no fertilization, there is no pregnancy to support. So,
CL will not extend life span from 2 weeks to 2mos. So, within
2 weeks the corpus luteum is degenerating.
- If the corpus luteum is degenerating, the level of estrogen and
progesterone will begin to decrease.
- If the estrogen and progesterone decrease, the uterine
contraction will increase.
- The temporary capillaries will begin to rupture – giving you
menstrual discharge.
F H L
A
E O P
G U C
- Legend: green- structure, yellow- hormones
- FEG- HAOU- LPC
- If hormones contain “RF” releasing factor it came from
hypothalamus walang “RF” from APG
- If the questions are about structures look at the middle
- If the question is about the hormones look at the outside.
QUESTIONS:
1. What gland that starts menstrual cycle? Hypothalamus
2. Hypothalamus stimulates? APG
3. APG stimulates? Ovary
4. Ovary affects? Uterus
5. Hormone high in the graafian follicle? Estrogen
6. Hormone high in the CL? Progesterone
7. What gland stimulate ovary to produce estrogen and
progesterone? APG
8. What hormone will stimulate the ovary to produce
estrogen? FSH
9. What hormone will stimulate the ovary to produce
progesterone coming from what gland? APG, under the
regulation of hypothalamus gland
10. What hormone will stimulate APG to produce LH? LHRF
coming from hypothalamus
11. What day the level of estrogen is highest? 13th
12. What day the level of progesterone is lowest? 13th
13. What day the level of progesterone is highest? 14th
14. What day the level of estrogen is lowest in the blood of
the woman? 3rd day because she is menstruating
15. What hormones trigger ovulation? LH

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