Stages of Human Sexual Response

Initial Response:
VASOCONGESTION – constriction of blood vessels
MYOTONIA – increased muscle tension
• Excitement Phase
•  muscle tension, moderate VS
• erotic stimuli causing  sexual tension, may last from minutes to hours
• blood flows into the penis, causing it to become erect
• the vaginal walls become moist, the inner part of the vagina becomes
wider, and the clitoris enlarges.
• Plateau Phase
•  and sustained tension near orgasm
• may last 30 sec – 30 minutes
• the glans at the head of the penis swells and the testes enlarge in the
male
• the outer vagina contracts and the clitoris retracts.
• Orgasm
• Involuntary release of sexual tension accompanied by physiologic and
psychologic release,
• the neuromuscular tension built up in the preceding stages is released
in a few seconds
• the vagina begins a series of regular contractions
• the penis also contracts rhythmically to expel the sperm and semen
(ejaculation)
• immeasurable peak of experience 2 – 3 seconds
• Resolution
• Return to normal state
• gradual return to the resting state that may take several hours
• the penis shrinks back to its normal size; in the female, the vagina and
other genital structures also return to their pre-excitement condition.
• VS return to normal
 REFRACTORY PERIOD – only period present in male, wherein he cannot restimulated
for about 10 – 15 minutes
Women have no such refractory period and can quickly become aroused
again from any point in the resolution stage.

Stages of Fetal Development

• In just 38 weeks, a fertilized egg (ovum) matures from a single cell to a fully
developed fetus ready to be born.
• fetal growth and development can be divided into three time periods:
➢ Pre-embryonic (first 2 weeks, beginning with fertilization)
➢ Embryonic (weeks 3 through 8)
➢ Fetal (from week 8 through birth) Table below contains common terms
used to describe the fetus at various stages in this growth.

Name Time Period

Ovum From ovulation to fertilization

Zygote From fertilization to implantation

Embryo From implantation to 5–8 weeks

Fetus From 5–8 weeks until term

Conceptus Developing embryo and placental structures
throughout pregnancy

Age of The earliest age at which fetuses survive if they are

viability born is generally accepted as 24 weeks or at the point a
fetus weighs more than 500–600 g

FERTILIZATION: THE BEGINNING OF PREGNANCY

• Fertilization (also referred to as conception and impregnation) is the union of an
ovum and a spermatozoon. This usually occurs in the outer third of a fallopian tube,
termed the ampullar portion.
• only one of a woman’s ova reaches maturity each month.

• Once the mature ovum is released (i.e., ovulation), fertilization must occur fairly quickly
because an ovum is capable of fertilization for only about 24 hours (48 hours at the
most). After that time, it atrophies and becomes nonfunctional.

• Because the functional life of a spermatozoon is also 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).
STEPS IN FERTILIZATION
Capacitation – ability of sperm to release proteolytic enzyme and penetrate the ovum
• Immediately after penetration of the ovum, the chromosomal material of the ovum
and spermatozoon fuse to form a zygote.

• Because the spermatozoon and ovum each carried 23 chromosomes (22 autosomes
and 1 sex chromosome), the fertilized ovum has 46 chromosomes.

• If an X-carrying spermatozoon entered the ovum, the resulting child will have two X
chromosomes and will be assigned female at birth (XX).

• If a Y carrying spermatozoon fertilized the ovum, the resulting child will have an X
and a Y chromosome and will be assigned male at birth (XY).

• Fertilization is never a certain occurrence because it depends on at least three

separate factors:

o Equal maturation of both sperm and ovum

o Ability of the sperm to reach the ovum
o Ability of the sperm to penetrate the zona pellucida and cell membrane and
achieve fertilization
• Out of this single-cell fertilized ovum (zygote), the future child and also the accessory
structures needed for support during intrauterine life (placenta, fetal membranes,
amniotic fluid, and umbilical cord) will form.

IMPLANTATION
• implantation refers specifically to the attachment of the fertilized egg to the uterine
lining, which occurs approximately 6 or 7 days after conception (fertilization).

• Implantation, or contact between the growing structure and the uterine endometrium,
occurs approximately 8 to 10 days after fertilization. (Pilliteri)
• Implantation usually occurs high in the uterus on the posterior
surface. If the point of implantation is low in the uterus, the
growing placenta may occlude the cervix and make birth of the
child difficult (placenta previa) because the placenta can block
the birth canal.

• Almost immediately, the blastocyst burrows deeply into the

endometrium and establishes an effective communication
network with the blood system of the endometrium.
• Once implanted, the zygote is called an embryo.
• Implantation is an important step in pregnancy because as
many as 50% of zygotes never achieve it (Gardosi, 2012).
• In these instances, the pregnancy ends as early as 8 to 10 days
after conception, often before a woman is even aware she was
pregnant.
• Occasionally, a small amount of vaginal spotting appears on
the day of implantation because capillaries are ruptured by
the implanting trophoblast cells.
• A woman who normally has a particularly scant menstrual
flow could mistake implantation bleeding for her menstrual
period. If this happens, the predicted date of birth of her baby
(based on the time of her last menstrual period) will be
calculated 4 weeks late.
Embryonic and Fetal Structures
The placenta and membranes, which will serve as the fetal lungs,
kidneys, and digestive tract in utero as well as help provide
protection for the fetus, begin growth in early pregnancy in
coordination with embryo growth
The endometrium is now typically termed the decidua (the Latin word
for “falling off”) because it will be discarded after birth of the child.
Umbilical cord (Funis) – whitish gray (50 – 60 cm)
• Short → abruptio placenta, uterine inversion
• Long → cord prolapse, cord coil
• 3 vessels (AVA) – Artery Vein Artery
• Wharton’s Jelly – protects the umbilical cord

Placental Circulation
➢ As early as the 12th day of pregnancy, maternal blood begins to collect in
the intervillous spaces of the uterine endometrium surrounding the
chorionic villi.
➢ By the third week, oxygen and other nutrients such as glucose, amino
acids, fatty acids, minerals, vitamins, and water osmose from the maternal
blood through the cell layers of the chorionic villi into the villi capillaries.
From there, nutrients are transported to the developing embryo.
➢ Placental transfer is dynamic, allowing all but a few substances to cross
from the mother into the fetus.
➢ Because almost all drugs are able to cross into the fetal circulation, it is
important that a woman take no nonessential drugs (including alcohol and
nicotine) during pregnancy (Ordean, Kahan, Graves, et al., 2015).
 ➢ For example, alcohol perfuses across the placenta and may cause fetal
alcohol spectrum disorder (e.g., unusual facial features, low-set ears, and
cognitive challenge).

➢ Because it’s difficult to tell what quantity is “safe,” pregnant women are
advised to drink no alcohol during pregnancy to avoid these disorders
(Rogers & Worley, 2012).

Terratogens – any drug or irradiation, the exposure to which may cause damage to the fetus
• DRUGS
o Streptomycin – anti – TB – (quinine) damage to the 8th cranial nerve → poor
learning and deafness/ ototoxic
o Tetracycline – stoning the tooth enamel, inhibits long bone growth
o Vitamin K – hemolysis, destruction of RBC, jaundice, hyperbilirubenemia
o Iodides – enlargement of thyroid and goiter
o Thalidomides – anti-emetics → Amelia or Pocomelia (absence of distal part of
extremities)
o Steroids – cleft lip or palate and even abortion
o Lithium – congenital maformation
• ALCOHOL – Low birth weight, fetal alcohol syndrome characterized by microcephaly
(condition where a baby's head is much smaller than expected)
• SMOKING – LBW (low birth weight)
• CAFFEINE – LBW (low birth weight)
• COCCAINE – LBW, abruptio placenta
• TORCH – group of infections that can cross the placenta or ascend through the birth
canal and adversely effect fetal growth
o Toxoplasmosis – Infection usually occurs by eating undercooked
contaminated meat, exposure from infected cat feces, or mother-to-child
transmission during pregnancy.
o Others - Hepa AB, HIV, Syphillis
o Rubella - called German measles or three-day measles. – can cause
deafness in babies, still birth, abortion
▪ Rubella Titer – N @ 1:10 or  = immunity to rubella = notify doctor
▪ Rubella vaccine after delivery for 3 mos. No pregnancy for 3 mos.
o Cytomegalo virus
o Herpes Simplex virus
➢ Theoretically, because the exchange process depends on osmosis, there is
no direct exchange of blood cells between the embryo and the mother
during pregnancy.
➢ Occasionally, however, fetal cells do cross into the maternal bloodstream as
well as fetal enzymes such as α-fetoprotein (AFP) produced by the fetal
liver (this allows testing of fetal cells for genetic analysis as well as the level
of AFP in the maternal blood).
➢ As the number of chorionic villi increases with pregnancy, the villi form an
increasingly complex communication network with the maternal
bloodstream. Intervillous spaces grow larger and larger, becoming
separated by 30 or more partitions or septa.
➢ These compartments, known as cotyledons, are what make the maternal
side of the placenta look rough and uneven.
➢ 15 – 28 cotyledons

➢
➢ To provide enough blood for exchange, the rate of uteroplacental blood
flow in pregnancy increases from about 50 ml/min at 10 weeks to 500 to
 600 ml/min at term. No additional maternal arteries appear after the first 3
months of pregnancy; instead, to accommodate the increased blood flow,
the arteries increase in size.
➢ The woman’s heart rate, total cardiac output, and blood volume all increase
to supply blood to the placenta (Pipkin, 2012).
➢ Braxton Hicks contractions, the barely noticeable uterine contractions
present from about the 12th week of pregnancy on, aid in maintaining
pressure in the intervillous spaces by closing off the uterine veins
momentarily with each contraction.
➢ Uterine perfusion and placental circulation are most efficient when the
mother lies on her left side, as this position lifts the uterus away from the
inferior vena cava, preventing blood from becoming trapped in the
woman’s lower extremities.
➢ If the woman lies on her back and the weight of the uterus compresses on
the vena cava, known as vena cava syndrome, placental circulation can be
so sharply reduced that supine hypotension (i.e., very low maternal blood
pressure and poor uterine circulation) can occur (Coad & Dunstall, 2011a).
At term, the placental circulatory network has grown so extensively that a
placenta weighs 400 to 600 g (1 lb), one-sixth the weight of the newborn.
➢ If a placenta is smaller than this, it suggests circulation to the fetus may
have been compromised and/or inadequate.
➢ A placenta bigger than this also may indicate circulation to the fetus was
threatened because it suggests the placenta was forced to spread out in an
unusual manner to maintain a sufficient blood supply. The fetus of a
woman with diabetes may also develop a larger than usual placenta from
excess fluid collected between cells.
➢ Pregnancy – 266 – 288 days/ 37 – 42 weeks
Endocrine Function of the PLACENTA
- Hormone producing function
a. Human Chorionic Gonadotropin
• The first placental hormone produced, hCG, can be found in maternal
blood and urine as early as the first missed menstrual period (shortly after
implantation has occurred).
• Levels vary throughout pregnancy. The pregnant woman’s blood serum
will be completely negative for hCG within 1 to 2 weeks after birth. Finding
no serum hCG after birth can be used as proof that placental tissue is no
longer present.
b. Progesterone
• Estrogen is often referred to as the “hormone of women,” and progesterone
as the “hormone that maintains pregnancy.”
• This is because, although estrogen influences a female appearance,
progesterone is necessary to maintain the endometrial lining of the uterus
during pregnancy.
• It is present in maternal serum as early as the fourth week of pregnancy as a
result of the continuation of the corpus luteum.
• After placental production begins (at about the 12th week), the level of
progesterone rises progressively during the remainder of the pregnancy.
 • This hormone also appears to reduce the contractility of the uterus during
pregnancy, thus preventing premature labor.
c. Estrogen
• Estrogen (primarily estriol) is produced as a second product of the syncytial
cells of the placenta. Estrogen contributes to the woman’s mammary gland
development in preparation for lactation and stimulates uterine growth to
accommodate the developing fetus.
d. Human Placental Lactogen (Human Chorionic Somatomammotropin)
• hPL is a hormone with both growth-promoting and lactogenic (i.e., milk-
producing) properties.
• It is produced by the placenta beginning as early as the sixth week of
pregnancy, increasing to a peak level at term.
• It promotes mammary gland (breast) growth in preparation for lactation in the
mother. It also serves the important role of regulating maternal glucose,
protein, and fat levels so adequate amounts of these nutrients are always
available to the fetus.

THE AMNIOTIC MEMBRANES

➢ The chorionic villi on the medial surface of the trophoblast (i.e., those that are not
involved in implantation because they do not touch the endometrium) gradually thin until
they become the chorionic membrane, the outermost fetal membrane.
➢ The amniotic membrane, or amnion, forms beneath the chorion.
➢ The amniotic membrane is a dual-walled sac with the chorion as the outmost part and
the amnion as the innermost part.
➢ The two fuse together as the pregnancy progresses, and by term, they appear to be a
single sac.

➢
➢ They have no nerve supply, so when they spontaneously rupture at term (a pregnant
woman’s “water breaks”) or are artificially ruptured via a procedure, neither the pregnant
woman nor fetus experiences any pain.
THE AMNIOTIC FLUID

• Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during
pregnancy. It is contained in the amniotic sac.

• Because the fetus continually swallows the fluid, it is absorbed from the fetal intestine into
the fetal bloodstream

it goes to the umbilical arteries and to the placenta and is exchanged across the
placenta to the mother’s bloodstream.

• At term, the amount of amniotic fluid has grown so much it ranges from 800 to 1,200 ml.
• Polyhydramnios - the excessive accumulation of amniotic fluid — the fluid that
surrounds the baby in the uterus during pregnancy.

Possible causes:

✓ the fetus is unable to swallow (esophageal atresia or anencephaly are the

two most common reasons),
✓ diabetes because hyperglycemia causes excessive fluid shifts into the
amniotic space

• Early in fetal life, as soon as the fetal kidneys become active, fetal urine adds to the
quantity of the amniotic fluid.
• A disturbance of kidney function, therefore, may cause oligohydramnios or a
reduction in the amount of amniotic fluid.
• Oligohydramnios can be detected by ultrasound
• amniotic fluid is mainly water with electrolytes, but by about the 12-14th week the liquid also
contains proteins, carbohydrates, lipids and phospholipids, and urea, all of which aid in the
growth of the fetus.
 Functions:
• The most important purpose of amniotic fluid is to shield the fetus against pressure or a
blow to the mother’s abdomen. (PROTECTION)
• Because liquid changes temperature more slowly than air, it also protects the fetus from
changes in temperature. (TEMPERATURE CONTROL)
• it aids in muscular development, as amniotic fluid allows the fetus freedom to move.
(MUSCULAR DEVELOPMENT)
• it protects the umbilical cord from pressure, thus protecting the fetal oxygen supply.
• Even if the amniotic membranes rupture before birth and the bulk of amniotic fluid is
lost (PROM/ LEAKING AMNIOTIC FLUID), some will always surround the fetus in utero
because new fluid is constantly being formed.

Amniotic fluid is slightly alkaline, with a pH of about 7.2. Checking the pH of the fluid at
the time membranes rupture and amniotic fluid is released helps to differentiate
amniotic fluid from urine because urine is acidic (pH 5.0 to 5.5).

Nitrazine Paper Test – differentiate amniotic fluid and urine Blue geen → +
rupture of bag of H2O
Diagnostic Test for Amniotic Fluid → Amniocentesis
club foot
ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS
Following the moment of fertilization, the zygote, which later becomes an embryo and
then a fetus, begins to grow at an active pace.

STEM CELLS
• During the first 4 days of life, zygote cells are termed totipotent stem cells, or cells so
undifferentiated they have the potential to grow into any cell in the human body.
• In another 4 days, as the structure implants and becomes an embryo, cells begin to show
differentiation or lose their ability to become any body cell. Instead, they are slated to
become specific body cells, such as nerve, brain, or skin cells, and are termed
pluripotent stem cells. In yet another few days, the cells grow so specific they are
termed multipotent, or are so specific they cannot be deterred from growing into a
particular body organ such as spleen or liver or brain (Chen, Sun, Li, et al., 2016).

ZYGOTE GROWTH
• As soon as conception has taken place, development proceeds in a cephalocaudal
(head-to-tail) direction; that is, head development occurs first and is followed by
development of the middle and, finally, the lower body parts. This pattern of
development continues after birth as shown by the way infants are able to lift up their
heads approximately 1 year before they are able to walk.

PRIMARY GERM LAYERS

• As a fetus grows, body organ systems develop from specific tissue layers called germ
layers. At the time of implantation, the blastocyst already has differentiated to a point at
which three separate layers of these cells are present: the ectoderm, the endoderm, and
the mesoderm.
• Each of these germ layers develops into specific body Systems. Knowing which structures
arise from each germ layer is helpful to know because coexisting congenital disorders
found in newborns usually arise from the same germ layer.
• For example, a fistula between the trachea and the esophagus (both of which arise from
the endoderm layer) is a common birth anomaly. In contrast, it is rare to see a newborn
with a malformation of the heart (which arises from the mesoderm) and also a
malformation of the lower urinary tract (which arises from the endoderm).
• One reason rubella infection is so serious in pregnancy is because this virus is capable of
infecting all three germ layers so can cause congenital anomalies in a myriad of body
systems (White, Boldt, Holditch, et al., 2012).
ORIGIN OF BODY TISSUE

Germ Layer Body Portions Formed

Ectoderm Central nervous system (brain and spinal cord)
Peripheral nervous system
Skin, hair, nails, and tooth enamel Sense
organs Mucous membranes of the anus, mouth,
and nose Mammary glands

Mesoderm Supporting structures of the body (connective

tissue, bones, cartilage, muscle, ligaments, and
tendons) Upper portion of the urinary system
(kidneys and ureters) Reproductive system
Heart, lymph, and circulatory systems and
blood cells

Endoderm Lining of pericardial, pleura, and peritoneal

cavities Lining of the gastrointestinal tract,
respiratory tract, tonsils, parathyroid, thyroid,
and thymus glands Lower urinary system
(bladder and urethra)

CARDIOVASCULAR SYSTEM
• The cardiovascular system is one of the first systems to become functional in
intrauterine life.
• Simple blood cells joined to the walls of the yolk sac progress to become a network of
blood vessels and a single heart tube, which forms as early as the 16th day of life and
beats as early as the 24th day.
• The septum that divides the heart into chambers develops during the sixth or seventh
week; heart valves develop in the seventh week.
• The heartbeat may be heard with a Doppler instrument as early as the 10th to 12th week
of pregnancy.
• An electrocardiogram (ECG) may be recorded on a fetus as early as the 11th week,
although early ECGs are not accurate until conduction is more regulated at about the 20th
week of pregnancy.
• The heart rate of a fetus is affected by oxygen level, activity, and circulating blood volume,
just as in adulthood.
• After the 28th week of pregnancy, when the sympathetic nervous system matures, the
heart rate stabilizes, and a consistent heart rate of 110 to 160 beats/min is assessed.
Fetal Circulation
Fetal circulation (Fig. below) differs from extrauterine circulation because the fetus derives
oxygen and excretes carbon dioxide not from gas exchange in the lungs but from exchange in the
placenta.

• Blood arriving at the fetus from the placenta is highly oxygenated.

• This blood enters the fetus through the umbilical vein (which is still called a vein even
though it carries oxygenated blood because the direction of the blood is toward the
fetal heart). Specialized structures present in the fetus then shunt blood flow to first supply
the most important organs of the body: the liver, heart, kidneys, and brain.
• Blood flows from the umbilical vein to the ductus venosus, an accessory vessel that
discharges oxygenated blood into the fetal liver, and then connects to the fetal inferior
vena cava so oxygenated blood is directed to the right side of the heart.
• Because there is no need for the bulk of blood to pass through the lungs, the bulk of this
blood is shunted as it enters the right atrium into the left atrium through an opening in
the atrial septum called the foramen ovale.
• From the left atrium, it follows the course of adult circulation into the left ventricle, then
into the aorta, and out to body parts
• A small amount of blood that returns to the heart via the vena cava does leave the right
atrium by the adult circulatory route; that is, through the tricuspid valve into the right
ventricle and then into the pulmonary artery and lungs to service the lung tissue. However,
the larger portion of even this blood is shunted away from the lungs through an additional
structure, the ductus arteriosus, directly into the descending aorta.
• As the majority of blood cells in the aorta become deoxygenated, blood is transported from
the descending aorta through the umbilical arteries (which are called arteries because
they carry blood away from the fetal heart) back through the umbilical cord to the
placental villi, where new oxygen exchange takes place. At birth, an infant’s oxygen
saturation level is 95% to 100% and pulse rate is 80 to 140 beats/min.
• Because there is a great deal of mixing of blood in the fetus, the oxygen saturation level
of fetal blood reaches only about 80%. A normal fetal heart rate is 110 to 160 beats/min,
supplying needed oxygen to cells. Even with this low blood oxygen saturation level,
however, carbon dioxide does not accumulate in the fetal system because it rapidly diffuses
into maternal blood across a favorable placental pressure gradient.