NCM 107 (WEEK 2 PART 1)
The endometrium is the
2nd week Topics
3. CARE OF THE MOTHER AND THE
FETUS DURING PERINATAL PERIOD
✓ Menstrual cycle
✓ Pregnancy
✓ Fetal development
✓ Embryonic and Fetal features
✓ Feto-placental circulation
✓ PRE-NATAL CARE
2 Physiologic Process of the Female
Reproductive Cycle
1. Menstrual cycle
2. Gestation (Pregnancy) and Lactation
- It is other term of pregnancy
The menstrual cycle
- Refers to the regular changes in the
activities of the ovaries and
endometrium that make reproduction
possible.
inner layer tissue of the uterus and
subjective to hormonal changes and
sheds of during menstruation
What is menstruation?
- Female reproductive cycle wherein
periodic uterine bleeding occurs in
response to cyclic hormonal changes
- Its purpose it to bring an ovum to
maturity; renew a uterine bed for the
growth of a fertilized ovum. Which
allows conception and implantation of
a baby.
3 organs involve during menstruation
Hypothalamus – it is a small region of the
brain located at base near in the pituitary
gland, it is responsible in the release of
luteinizing hormone or releasing hormone.
Pituitary gland – small bean shape gland
located at the base of brain, it is the
responsible in the production of luteinizing
hormone and follicle stimulating hormone.
Ovaries – are two glands located in the
pelvic cavity anterior to the rectum
posterior to the bladder and it is
responsible in the release of female sex
hormone such as estrogen and
progesterone.
these 3 organs are responsible in the
release of hormones that regulates the
menstrual cycle
 4 Main Hormones Menarche – which refers to the first onset of
the menstrual period, usually occurs during
1. Luteinizing hormones (LH)
early adolescence as part of puberty. After
- LH is important because it stimulates
menarche menstruation usually occurs on
the ovarian follicle in the ovary to
monthly basis, it poses during pregnancy until
produce the female sex hormone
the woman reaches menopause. Where in the
- An increase in the level of the
ovarian function decreases and menstruation
luteinizing hormone causes the
diminishes or ceases.
ovarian follicle to tear and release
immature oocyte or egg from the
ovary.
- This process of release of mature
ovum is noun as “ovulation”

2. Follicle Stimulating Hormone (FSH)

- It stimulates the growth of ovarian
follicles in the ovary.
- It stimulates the follicles to mature.

3. Progesterone
- Progesterone helps thicken the lining
of the uterus to prepare for a fertilize
egg.
- It supports pregnancy
4. Estrogen
- is the primary female sex hormone, it
is responsible for the development and
regulation of the female reproductive
system and female secondary sexual
characteristics.
The menstrual cycle is consist of
interconnected and synchronized processes
Two interconnected processes
1. ovarian cycle
- development of follicle (egg cell or
ovum) and ovulation
2. Uterine cycle
- Which focuses on the way of the
endometrium thickens and shed of in
response to the ovarian activity.
The monthly menstrual cycle can vary
duration from 20-35 days, but the average
cycle is 28 days. Each menstrual cycle begins
on the first day of menstruation and it referred
to as day 1 of menstruation. In ovulation or the
release mature ovum from the ovaries occurs
10-14 days before the first day of menstruation
or 14 days before the next cycle.
For an average 28 days’ cycle, this means that
there are usually 14 days leading up to
ovulation and we call it as the “pre-ovulatory
phase”, and 14 days after ovulation is called
“post-ovulatory phase”. During these two
phases the endometrium undergo several
changes.
For the ovary the two weeks leading to
ovulation is called “follicular phase” which
corresponds to the menstrual and proliferative
phases of the endometrium, and the two weeks
following ovulation is called “Luteal phase”
which corresponds to the “secretory phase” of
the endometrium.
PRE-OVULATORY PERIOD
Follicular Phase
- Start in the first day of menstruation
up to 14 days of the 1-month cycle.
The menstrual cycle is controlled by the
hypothalamus and the pituitary gland, the
hypothalamus is responsible in the release of
gonadotrophin releasing hormone or the
luteinizing hormone releasing hormone. This
hormone is usually release after puberty, the
gonadotrophin releasing hormone or the
luteinizing hormone releasing hormone
stimulate the pituitary gland to release the
follicles stimulating hormone and the
luteinizing hormone.
The FSH and the LH controls the maturation
of the primary oocytes, once the primary
oocytes mature, it secretes estrogen. This
estrogen will accelerate or increases the
maturation of the primary oocyte and when the
estrogen level increases or as its thick level it
will release the mature ovum causing
ovulation.
On the 15th to the 28th day after ovulation the
follicle will become “corpus luteum”. Corpus
luteum (mature follicle) is a mass of cells
which is responsible for the production of
“progesterone.” Progesterone is the one that
thickens the lining of the uterus and increases
its vascularity in preparation for fertilization,
so this is the luteal phase of menstruation
cycle. However, when fertilization does not
occur the progesterone level increases and
suppresses the growth of the corpus luteum
until it degenerates after a week.
Since the corpus luteum degenerate, it is
expected that the progesterone level will also
drop causing the endometrial lining to shed
off, which results to menstruation.
Once the mature ovum, the sperm of the egg
cell meets at the upper or the distal portion of
the fallopian tube they unite in to one. The
union of the sperm and the egg cell is called
“fertilization” about 5 days later the zygote
implant in the uterine endometrium.
The human chorionic gonadotrophin which is
secreted by the chorionic villi in the
endometrium of a pregnant women stimulates
that corpus luteum to secrete estrogen and
progesterone until the placenta takes over.
Chorionic villi – this are buds that develop
from the chorion in order to give a maximum
area of contact with the maternal blood. It is
from the chorion that the placenta develops.
Once the mature ovum fertilize it undergo
mitotic division to form what we called
blastocyst or embryo. Generally, the baby
will be called an embryo from conception until
the 8th week of development. After the 8 week
the baby will be called fetus until it is born.
The blastocyst will implant into the uterus and
implantation of the fertilize ovum called
“implantation or NIDATION”, once the
fertilize ovum is implanted the woman is
considered “pregnant”.
Characteristics of Normal Menstrual Period
- Menarche – average onset 12-13
years
- Interval between cycle – average 28
dates; 23-35 days
- Duration – average 2-7 days; range 1-
9 days
- Amount – average 30-80 ml
– Heavy bleeding saturates
pad in < 1 hour
- Color – dark red; with blood; mucus;
and endometrial cells
FACTS
- Lifespan of a sperm = 48-72 hours
- Critical period is 72 hours
* 48 hours before and 24 hours after
ovulation
Parts of sperm
- Normal amount of semen: 3-5cc
- Number of sperms: 120-150M/cc/E
- Mature ovum may be fertilized for 12-
24 hours after ovulation
- Sperms are capable of fertilizing even
for 3-4 days after ejaculation
- Zygote stays in FT for 3-4 days
Gestation and Lactation
- Gestation is other term for pregnancy
Pregnancy – is a state of being pregnant
- It is a PERIOD when a woman carries
one or more offspring inside her
womb.
Terms related to pregnancy
Obstetric History
TPAL OR FPAL
✓ T/F – number of full-term infants (>37
weeks’ age of gestation)
✓ P – number of preterm infants (<37
weeks of gestation)
✓ A – number of abortions
✓ L – number of children living
✓ Gravida (G) – we write gravida by
using the capital letter G, this refers to
a pregnant woman
- Refers the number of pregnancies the
woman who has had regardless of the
outcome of pregnancy
✓ Nulligravida – a woman who has
never been pregnant
✓ Primigravida – a woman pregnant for
the first time
✓ Multigravida – a woman who has had
two or more pregnancies (even the
baby got laglag)
✓ Para (P) – the number of pregnancies
that reach the age of viability
Viability – it is ability of fetus to live in
the extra uterine life.
Age of viability – 24- 28 weeks
What is the age of variability?
- The age of variability is 28 weeks or 6
months
✓ Nullipara – a woman who has never
delivered a fetus that reached the age
of viability
✓ Primipara – a woman who has
completed one pregnancy to viability
✓ Multipara – a woman who has
completed two or more pregnancies
to the viability
✓ Term infant – and infant born between
38 – 42 weeks of gestation (AOG)
✓ Post term – an infant born after 42
weeks AOG
✓ Preterm – an infant born before 38
weeks AOG
Difference signs and symptoms of
pregnancy
The signs and symptoms of pregnancy are
divided into 3
1. Presumptive sign (Baka buntis)
 What are the different presumptive signs
of pregnancy?
Amenorrhea - refers to the absence of
menstruation
Breast changes – what are the
possible breast changes that may occur
during pregnancy?
- Breast tenderness
- Enlargement of the breast
- Changes in the color of areola in the
nipple
Urinary frequency
Quickening - is the first fatal
movement felt by mother
Nausea and vomiting
Easy fatigability
Chadwicks sign – is the bluish
discoloration of the vagina and usually
it can be visualized with the use of
vaginal speculum.
Skin changes – what are those
different skin changes that may occur
during pregnancy?
- Linea nigra
- Striae gravidarum
- Melisma
- Skin discoloration or
hyperpigmentation of neck and armpit
Linea nigra – is a physiological form of hyper
pigmentation commonly seen in the first
trimester of pregnancy, it is a dart vertical line
that trans down the middle of abdomen and it
can be one of the earliest indicators of
pregnancy, it is also known as the pregnancy
line.
Striae gravidarum – this are stretchmarks
cause by the over stretching of the skin in the
abdomen
Melasma – it is also term as the mask of
pregnancy; it is a common pigmentation
disorder that causes brown or grey patches on
the skin primarily on the face. The most
common areas part of the melisma to appear
on the face includes the bridge of the nose,
forehead and the cheeks
Hyperpigmentation of the neck and armpit
– this hyperpigmentation of the neck and
armpit as well as the melasma would just fade
away, it will just disappear 6 moths to 1 year
after the delivery of the baby and sometimes it
will take at least more than a year before it
totally disappears.
2. Probable signs (most probably
buntis)
What are the probable signs of pregnancy?
Hegar’s sign – is softening of cervix
and it is felt during internal
examination.
Uterine growth or enlargement of the
abdomen
Ballottement – is rebound felt by the
examiner when the finger is push
sharply against the uterus to detect the
presence or position of the fetus.
Goodell’s sign – refers to the
softening of the cervix
Uterine soufflé – is soft, blowing
sound heard using a stethoscope or
adapter usually the second trimester of
pregnancy or between 13 to 28 weeks’
age of gestation, this sound is heard
most clearly in the lower part of the
uterus and synchronous with the pulse
of the mother.
Braxton Hick’s contraction – this
refers to painless uterine contractions
Positive pregnancy test – why is it
that positive pregnancy test is not a
positive sign of pregnancy?
- Because it is possible have a positive
pregnancy test even if the woman is
not technically pregnant, this is called
false positive. It is sometimes cause
by a chemical pregnancy.
 - Chemical pregnancy occurs if the
fertilize ovum known as an embryo is
enabled to implant or grow or maybe
the woman may have hydatidiform
mole or H mole or what we call molar
pregnancy.
- H mole – is the growth of an abnormal
fertilize egg or an overgrowth of tissue
from the placenta. Women with H
mole appears to be pregnant, but the
uterus enlarges much more rapidly
than a normal pregnancy and because
of the excessive production of the
human chorionic gonadotrophin
hormone they have a positive
pregnancy test result.
3. Absolute/positive signs
What are positive/ absolute signs of
pregnancy?
FHT (fetal heart tone) – are the
heartbeat of the baby which can be
heard through the use of the
stethoscope or doppler during the last
week of third month age of gestation.
The normal FHT is 120-160 beats per
minute.
Funic (umblical cord) soufflé/suffle
– it is a sharp whistling sound at is
synchronous with the pulse of the
fetus and usually heard with the use of
stethoscope of Doppler during the
second trimester of pregnancy or
between 13 -28 weeks age of gestation
and the mother will feel the fetal
movement and there is a positive x-
ray/ultrasound result
Fetal movement
X-ray/ultrasound
Pregnancies divided into 3 trimesters
Trimesters of pregnancy
First Trimester:
• 1st – 12th (critical time) or 1-3 months
gestation
• Rapid fetal cell differentiation
• Maternal physical changes start
What are those maternal physical changes?
- Uterine enlargement
- Chadwicks sign
- Hegar’s sign
At this stage the woman should refrain from
taking drugs or medication without doctors’
advice or prescription and to avoid strenuous
activities for it will affect the development of
the fetus which may result to physical or
mental abnormality or even abortion.
What is abortion?
It is an expulsion of an embryo or fetus which
can be intentional or unintentional.
• 10 days after conception, HCG
(human chorionic gonadotropin) can
be detected in the pregnancy test
HCG – it is a hormone normally produce by
the placenta and it is important in the early
stages of pregnancy because it helps determine
whether the woman is pregnant or not.
Second Trimester:
• 13th – 28th or 4 to 6 months AOG
• Uterine and fetal size increase
substantially and other physical
changes occurs.
What are those physical changes?
- Weight gain
- Breast changes (breast tenderness,
enlargement of the breast, changes the
color of the nipple and the areola,
pigment changes, increase waistline
due to the uterine growth, and
abdominal striations)
- By week 20, the woman feels
quickening
- Quickening is the first fetal
movement.
Third Trimester
 • 29th to 40th week or 7th to 9th month - Nails beds: forming on fingers and
AOG toes
• The woman experiences Braxton - Spontaneous movements are possible
Hicks contractions - Tome reflexes present
- Braxton Hicks contraction is the - Tooth buds: present
painless uterine contraction, and this - Bone ossification
can be a sign of false labor. - Tooth buds: present
• Increasing uterine size may displace - Sex: distinguishable by outward
pelvic and intestinal structures, appearance
causing indigestion, protrusion of the - Kidney secretion:
umbilicus, shortness of breath, - Heartbeat: audible through Doppler
haemorrhoids and insomnia.
16th week
• The patient’s center of gravity changes
(may cause backaches) - Length: 10-17 cm
- Weight: 55-120g
- Fetal heart sounds: audible
Stages of fetal development - Lanugo: well-formed
3 stages of fetal development - Liver and pancreas: functioning
- Pre embryonic period (Two - Fetus actively swallows amniotic fluid
fertilization which is 3 weeks) - Sex: can be determined by
- Embryonic period (3 to 7 week) ultrasonography
- Fetal period (8 weeks until birth) 20th week
- Length: 25cm
Milesstones of fetal development - Weight: 223g
End of 4th gestational week - Fetal movement can be felt by the
movement
- Length: 0.75 – 1cm - Antibody production
- Weight: 400mg - Hair: head and eyebrows
- Head - Meconium: present in the upper
- Heart intestines
- Arms and legs - Brown fat: kidneys, sternum and
- Eyes, ears and nose posterior neck
8th week - Vernix caseosa
- Sleeping and activity patterns:
- Length: 2.5cm (1inch) distinguishable
- Weight: 20g
- Organogenesis: complete 24th week
- Heart: beating rhythmically - Length: 28 – 36cm
- Facial features - Weight: 550g
- Arms and legs: developed - Passive antibody
- External genitalia: present but sex is - Meconium: present
not distinguishable - Active production of lung surfactant
- Abdomen: appears large (fetal - Eyebrows and eyelashes: well defined
intestine is growing rapidly) - Eyelids: open
- Sonogram shows a gestational sac - Pupils: react to light
- Viable
12th week
- Hearing: responds to sudden sound
- Length: 7-8 cm
- Weight: 45g 28th week
 - Length: 35 – 38cm - What are the endocrine functions of
- Weight: 1200g the decidua?
- Lung alveoli: begin to mature o Endocrine functions:
- Testes: begin to descend into the a. Secretes prolactin
scrotal sac (responsible in the
- Blood vessels of retina secretion of breastmilk)
32nd week Prolactin – as it names implies
a hormone that promotes
- Length: 38 – 43cm
lactation of breast milk
- Weight:1600g
production
- Subcutaneous fat: begin to be
deposited b. Secretes relaxin (reduce
- Responds by movement to sound the uterine contraction)
active Moro reflex
Relaxin – relaxes the body’s
- Fingernails: grow to reach the end of
muscle, joints and ligament, it
fingertips
has a great effect on the joints
36th week of the pelvis allowing then to
stretch during delivery, it also
- Length: 42 – 48 cm
softens and lengthens the
- Weight: 1800 – 2700g (5-6lb)
cervix and helps relax the
- Body stores (glycogen, iron,
smooth muscles in the uterus
carbohydrate and calcium
- additional amount of subcutaneous fat c. Secretes prostaglandin
is deposited
Prostaglandin (pain hormones)
- crease sole of foot
– this are hormones which
- lanugo: begins to diminish
contains chemicals that
40th week constricts the blood vessels in
the uterus and mix the muscle
- length: 48-52cm
layer contract causing painful
- weight: 3000g (7-7.5 lb)
cramps during menstruation
- fetus: kicks actively
and labour
- fetal hemoglobin
- fingernails: extend over the fingertips
- creases on soles of feet: cover at least
Layers of the Decidua
two third of the surface

Embryonic and Fetal Structures

1. Decidua – refers to the endometrial
lining during pregnancy
- Is the modified mucosal lining of the
uterus that forms in preparation of
pregnancy, it is form in the process
called decidualization under the
influence of the progesterone.
- The decidua forms the maternal part of
the placenta and remains for the A. Decidua basalis
duration of pregnancy. In the decidua - Thin basal layer
has endocrine function. - Works with the chorion in the
formation of the placenta
B. Decidua capsularis
- Envelops the embryo
C. Decidua vera
- Site of attachment of chorionic sac
2. Fetal membranes
- are membranes associated with
developing fetus, the two chorion
amniotic membranes are the
“AMNION and CHORION” these two
make up amniotic cell.
- Chorion – is to protect and nurture the
embryo, the chorion contains
chorionic fluid that protects the
embryo from shock and the chorionic
villi allow the exchange of nutrients,
oxygen and waste products with the
mother
- Closest to the uterine wall
- Becomes the placenta
- Amnion - a membranous sac which
surrounds and protects the embryo
- The chorion and amnion together form
the amniotic cell
- The chorionic villi emerge from the
chorion invade endometrium and
allow the transfer of nutrients from
maternal blood to fetal blood.
- Chorionic villi – this are microscopic
finger light projections that contains
capillaries to allow the blood to flow
through the placenta and the baby
3. Amniotic fluid
Functions:
Amniotic fluid is the protective liquid
contained by the amniotic sac which
serves the following function.
1. Protect the fetus – amniotic fluid
protects the fetus by cushioning
against blows to the mother’s
abdomen
2. Prevent heat loss
3. Maintains the fetal body temperature
at the constant level
4. Facilitates symmetrical fetal growth
5. Provides a repository for fetal waste
6. Helps open the cervix during labor
Amniotic fluid swallowed by the fetus helps
the formation of gastrointestinal tract
- At term the uterus contains 800-
1200ml of clear and yellowish
amniotic fluid with specific gravity of
10007 to 1.025 and a Ph of 7.0 to 7.25
- Amniotic fluid is also term as bag of
water.
- It regulates the temperature for the
baby
- Brown or greenish amniotic fluid
(the baby has pooped inside the
womb); then monitor the FHT of the
baby
- Red (bleeding)
Implications:
a. Polyhydramnios – more than 15000ml
b. Oligohydramnios (dry labor) – less
than 500ml
Amniotic sac – a tough but thin transparent
pair of membranes, which hold a developing
embryo until birth.
4. Umbilical cord/ Funis
- Lifeline of the embryo
- Measures from 30.5 to 90 cm in length
- And 2 cm in diameter at full term
- Contains two arteries and one vein
- Contains wharton’s jelly
- Wharton’s jelly – a gelatinous
substance that helps prevent kinking
of the umbilical cord
- Blood flows through the cord at about
400 ml/minute
One of the most embryonic and fetal feature is
the placenta
5. Placenta
- Disk shape structure formed from the
chorion, chorionic villi and decidua
basalis
- Contains 15-20 subdivisions called
cotyledons
- Weighs 450to 600g. measures from 15
to 25.5 cm in diameter, and is 2.5 to
3cm thick at full term
- The placenta contains two sides (the
maternal surface)
 - The maternal surface rough texture,
appears red color
- The fetal side or fetal surface is shiny
and grey
-
Functions of placenta
1. Transports mechanism between
mother and the fetus
2. Receives maternal oxygen
3. Produces hormones – estrogen and
progesterone
- Progesterone acts to maintain
pregnancy by supporting the lining of
the uterus which provides the
environment for the fetus and the
placenta to grow.
4. Supplies the fetus with CHO, water,
fats, protein and minerals
5. Carries end products of fetal
metabolism to maternal circulation for
excretion
6. Transfers passive immunity to the
baby
Types of placenta separation
1. Dirty or Duncan – it is red in color and
rough
2. Shiny Schultz – it is shiny and grey in
color
Fetal circulation (video)
- Fetal circulation and transition to post
circulation that occurs after birth
- These specific structures associated
with fetal circulation include:
- Placenta
- Umbilical vein
- Ductu9s venosus
- Foramen ovale
- Ductus arteriosus
- Umbilical arteries
Blood reach nutrients and oxygen supplied by
the placenta flows to the:
- Umbilical vein to
- Ductus venosus blood flows from the
ductus venosus in to the
- Inferior vena cava up to the
- Right atrium
This blood mixes with blood returning to the
heart from the upper body by the superior vena
cava and from the lower body by inferior vena
cava
In the right atrium some of the blood flows to
right ventricle and some of the blood flows to
the foramen ovale to the left atrium and in to
left ventricle where they pump out to the aorta
to the body, blood that flows into the right
ventricle is them pump in to the pulmonary
artery, because the lungs are fluid instead of
air the vessels in the lungs are narrow creating
higher resistance to blood flow in to the lungs
Due to the high resistance of blood flow in the
pulmonary circulation and the lower resistance
blood flow in the systemic circulation blood
pump in to the pulmonary artery by right
ventricle is more likely to flow in to the ductus
arteriosus and then to the aorta, due to the high
blood flow in to the superior vena cava and
the inferior vena cava up to the right atrium,
pressures in the right atrium are higher in the
left atrium this promotes blood flow to the
foramen ovale at the atrial level.
Only 8% of right ventricle output flows into
the lungs providing nutrients for developing
lung tissues, most of the blood passes through
the ductus arteriosus into the aorta and out to
the body. The umbilical arteries allow blood to
flow from the body back to the placenta to be NOTE:
in reach of oxygen and nutrients. Once the
- two arteries and one vein. The vein
baby is born and takes a breath the umbilical
carries oxygen and nutrients from the
cord is clamp and the placenta is removed
placenta (which connects to the
from the systemic circulation. Immediately
mother's blood supply) to the baby.
transition from fetal to post-natal circulation
- neonatorum tetanus
begins.
With the elimination of the placenta from the
circulation, systemic vascular resistance
begins to raise, with each breath more alveoli
in the lungs extend and the vessels surrounds
in them dilate in response of the presence of
oxygen.
Pulmonary pressures begin to decrease,
although pulmonary pressure is lower than
systemic pressures within minutes after birth
it is 6 to 8 weeks before pulmonary vascular
resistance decreases to normal. In the post-
natal circulation blood no longer close to the
foraminal ovale or the ductus arteriosus, the
increase in the left atrial pressure after birth
forces the septum primum against septum
secundum functionally closing foraminal
ovale, within 3 months foraminal ovale
permanently closes as deposits defuse the
layers of septum wall together.
Point of clarification (video)
While the patent foraminal ovale or *** closed
by this time it also may not. Autopsy study in
adults indicate that 15 to 25 percent of adults
have a patent foraminal ovale which never
close. The shunt via the PFO after birth is
usually small.
The ductus arteriosus begins to close shortly
after birth, once the infant begins to breath.
Normally the ductus closes completely in 4 to
10 days. The ductus venosus is open at the
time of birth making central venous access
possible to the through the umbilical vein. As
vibrant infiltrates the ductus venosus it is
usually closes within 3 to 7 days, after it closes
the *** known as ligamentum venosum,
within a week after birth the umbilical vein
and the umbilical arteries are infiltrated with
vibrant and also become ligaments.