6Reproductive System
The
Week 1 Reproductive System
Female reproductive organ
anatomy
The female reproductive organs include
several key structures, such as the
ovaries, uterus, vagina, and vulva.
These organs are involved in fertility,
conception, pregnancy, and childbirth.
The reproductive organs also have a
significant influence on other aspects of
health. For example, the ovaries create
hormones that impact bone density,
cholesterol levels, heart health, and
mood.
What is the female reproductive
system?
The female reproductive system is a
group of organs that work together to
enable reproduction, pregnancy, and
childbirth. It also produces female sex
hormones, including estrogen and
progesterone.
The system consists of organs and
tissues inside the body and some that
are visible outside the body.
internal organs include:
-ovaries
-fallopian tubes
-uterus
-cervix
-vagina
Another organ, the clitoris, extends
both inside and outside the body. The
external area surrounding the vagina
is the vulva.
Not everyone who is assigned female
at birth has all of these organs.
Sometimes, people are born without
some parts or with a mixture of
female and male characteristics. This
is known as intersex.
Some people also undergo procedures
to remove some parts of the
reproductive system. Some of these
procedures take place for medical
reasons, while others are the result of
harmful cultural practices, such as
female genital mutilation.
Ovaries
Most females have two ovaries, one
on each side of the uterus. They are
about the shape and size of an almond
and have two key functions:
producing hormones and releasing
eggs.
At birth, two ovaries contain
approximately 700,000 oocytes,
which are immature eggs. When a
person reaches puberty, these eggs
begin to develop and mature inside
the ovary follicles. Around once each
month, the ovaries release a mature
egg. This process is known as
ovulation, and it is part of the
menstrual cycle. It is also what makes
pregnancy possible.
The hormones the ovaries produce
regulate the menstrual cycle. They
also:
● influence the development of
female sex traits
● facilitate pregnancy, childbirth,
and breast milk production
● contribute to the health of the
bones, heart, liver, brain, and
other tissues
● influence mood, sleep, and sex
drive
Fallopian tubes
The fallopian tubes are passageways
that carry eggs toward the uterus.
They consist of several parts:
● the infundibulum, which is a
funnel-shaped opening near the
ovaries
● the fimbriae, which are finger-
like projections surrounding the
opening
● cilia, which are hair-like
structures inside the fallopian
tubes
When an ovary releases an egg, fluid
and the fimbriae propel it toward the
fallopian tube opening. Once inside,
the cilia move the egg toward the
uterus. This journey takes about 7
days.
During this time, it is possible for
sperm to fertilize the egg if a person
has sexual intercourse. Most
fertilization happens in the fallopian
tubes. (specifically upper third of the
fallopian tube)
Uterus
The uterus is an organ that is about
the shape and size of a pear. It is also
known as the womb. It consists of
muscular walls and a lining
(endometrium) that grows and
diminishes with each menstrual cycle.
After ovulation, the endometrium gets
thicker in preparation for a fertilized
egg. If not fertilized, the egg dies, and
the lining of the womb sheds after
around 2 weeks. The lining breaks
down into blood, which then leaves
the body through the vagina. This is
menstruation, also called a period.
If an egg does become fertilized by
sperm, it will implant into the lining
of the uterus and begin to develop.
The cells divide and grow, becoming
an embryo. Over time, it grows into a
fetus, which receives oxygen and
nutrients from the placenta via the
umbilical cord.
When it is time for the fetus to be
born, the uterus begins strong muscle
contractions that dilate the cervix and
push the fetus out.
Cervix and vagina
The cervix is a narrow structure at the
bottom of the uterus. It has several
functions:
Producing mucus: The cervix
produces cervical mucus, which stops
sperm from entering the uterus when
a person is not fertile or when they are
pregnant.
Protecting against bacteria: The
mucus also stops bacteria from
entering the uterus and keeps the
vagina healthy.
Allowing fluids to drain: At the
bottom of the cervix is a small
opening that allows fluids, such as
menstrual blood, to pass through.
Below the cervix is the vagina, which
is a flexible, tubular structure that
connects the internal and external
reproductive organs. It sits behind the
bladder and in front of the digestive
tract.
The vagina allows fluids, such as
menstrual blood and discharge, to
leave the body. It also allows semen,
which contains sperm, to enter the
body.

This can happen in several ways, such
as during penetrative sex with
someone who has a penis, or during
artificial insemination. This is a
procedure where a doctor inserts
semen into the uterus to help someone
conceive.
Clitoris
Just inside the body, around the
entrance to the vagina, is the clitoris.
This organ is most well known for the
clitoral glans, which is a small but
highly sensitive tissue that sits above
the vaginal opening. Most of the
clitoris is actually internal.
The clitoral glans is at the top of the
clitoris. From there, the clitoris splits
into two parts that extend down either
side of the vagina. It is around 5
inches (12.7 centimeters) long and
consists of spongy tissue that contains
thousands of nerve endings.
The clitoris responds to sexual
stimulation. When a person
experiences arousal, it becomes
swollen. It is the main organ
responsible for female orgasms.
(Clitoris is equivalent to male’s
penis)
Vulva
The vulva is the external part of the
female reproductive system. It
includes the:
Vestibule: This is the entrance to the
vagina. Around the vestibule sit the
greater vestibular glands, which
produce fluid to keep the area from
getting dry. During sexual arousal,
these glands produce more fluid to
help with lubrication.
Hymen: Some people with vulvas also
have a hymen. This is a thin, delicate
tissue that partially covers the
entrance to the vagina. When
someone has penetrative sex for the
first time, the hymen can stretch or
break. But not everyone has a hymen,
and it can also stretch for a number of
other reasons. Learn more here.
Urethra: This is where urine comes Female reproductive anatomy also
from. The urethra is part of the influences sexual well-being, and
urinary system and sits just above the creates hormones that regulate a wide
vaginal opening. variety of functions around the body.

Labia minora: These are smaller lips

that surround the entrance to the Male Reproductive Organ
vagina.

Clitoral hood and glans: The clitoral

hood is a small piece of tissue that
protects the external part of the
clitoris. It sits at the top of the labia
minora.

Labia majora: These are the larger

lips that surround the vulva. After
puberty, they typically have pubic
hair. At the top of the vulva is also the
mons pubis, which is a rounded pad
of fat that sits over the pubic bone.
Summary
The female reproductive organs
include an array of parts that
influence health throughout a person’s
life. The reproductive system
undergoes significant changes during
the menstrual cycle, which starts
during puberty and ends with
menopause. If a person becomes
pregnant, it changes further to
accommodate a growing fetus.
EXTERNAL MALE GENITALIA
1. PENIS
- Has 3 layers of erectile tissue
- 2 corpora cavernousa
- 1 corpus spongiosum
- Gland is at the distal end of the
penis
A retractable casing of skin or
prepuce protects the glans at birth.
- Deposits spermatozoon in the female
reproductive tract
- Contains sensory nerve endings that
provide sexual pleasure
- Serves as an outlet for the urinary
tract
- Penile artery supplies blood to the
penis
2.SCROTUM
- Pouch-like structure made up of
skin, fasciae connective tissue, and
smooth-muscle fibers
- House the testes, epididymis, and
the lower portion of the spermatic
cord
- Protects the testes and spermatozoa
from high body temperature
3. TESTES
- Are 2 oval-shaped glandular organs
inside the scrotum
- Seminiferous tubules produces
spermatozoa
- Leydig’s cells produce testosterone,
the primary male sex hormone
- Sperm can’t survive at body
temperature; the testes are suspended
outside the body where the
temperature is approximately 1oF
lower than body temperature.
FOLLICLE-STIMULATING
HORMONE - Stimulates production
of sperm in the seminiferous tubules
LUTEINIZING HORMONE -
Stimulates production of testosterone
in the interstitial cells
FSH & Testosterone - stimulates
spermatogenesis.
INTERNAL GENITALIA
1. EPIDIDYMIS
- Tightly curled, the length totals 6m
- Responsible for conducting sperm
from the testis to the vas deferens or
storing it
- Sperm are immobile as they pass
through or stored here

- Takes at least 12-20 days for the
sperm to travel the length of the
epididymis and a total of 64 days for
them to reach maturity
2. VAS DEFERENS
- Also called DUCTUS DEFERENS
- Carries sperm from the epididymis
through the inguinal canal into the
abdominal cavity where it ends at the
seminar vesicles into the ejaculatory
ducts
- Blood vessels and the vas deferens
together are referred as SPERMATIC
CORD
3. EJACULATORY DUCTS
- Located between the seminal
vesicles and urethra
4. URETHRA
- Extends from the bladder through
the penis to the external urethral
opening
- Serves as excretory duct for urine
and semen
4. SEMINAL VESICLES
- Secrete a viscous portion of the
semen that aids in spermatozoa
motility and metabolism because the
fluid is alkaline and sperm are more
motile in an alkaline fluid
6. PROSTATE GLAND
- Located just below the bladder
- Homologous to Skene’s glands in
females
- Secretes an alkaline fluid that
enhances spermatozoa motility and
lubricates the urethra during sexual
activity
7.BULBOURETHRAL/
COWPER’S GLANDS
- 2 pea sized glands that lie beside the
prostate and empty into the urethra
- Secrete an alkaline fluid that
neutralized acidic secretions in the
 female reproductive tract, thus
prolonging spermatozoa survival
- The alkaline fluid and sperm
combination is a thick, whitish
secretion termed SEMEN
Family Planning
Contraception can be used to prevent
pregnancy and some types will also
protect you from sexually
transmissible infections (STIs).
The Condom
The condom is the only form of
contraception that protects against
most STIs as well as preventing
pregnancy. This method of
contraception can be used on demand,
is hormone free and can easily be
carried with you. And it comes in
male and female varieties.
Male condoms are rolled onto an erect
penis and act as a physical barrier,
preventing sexual fluids from passing
between people during sex. The
female condom is placed into the
vagina right before sex. Based on
typical use, the female condom is not
quite as effective as the male latex
condom and it may take a little
practice to get used to.
Pros include: It’s the best protection
against STIs; can be used on demand;
hormone free.
Cons include: It can tear or come off
during sex if not used properly; some
people are allergic to latex condoms.
Facts about the female condom
- If used correctly, female condoms
are 95% effective.
-They protect against pregnancy and
sexually transmitted infections (STIs).
-A female condom needs to be placed
inside the vagina before there's any
contact with the penis.
-Always buy condoms that have the
CE mark or the BSI Kitemark on the
packet. This means they have been
tested to high safety standards.
-A female condom can get pushed
inside the vagina during sex, but it's
easy to remove them yourself if this
happens.
-Female condoms may not be suitable
for women who are not comfortable
touching their genital area.
-Female condoms should not be
reused. Open a new one each time
you have sex.
-Condoms have a use-by date on the
packaging. Do not use out-of-date
condoms.
The Oral Contraceptive Pill
It’s the little tablet taken once a day.
There are a few different types of pill
to choose from, so it’s about finding
the one that’s right for you. The
combined pill contains estrogen and
progestin and mini pill contains only
one hormone, a progestin. The pill
can have many benefits, however
remembering to take it on time is a
must.
Pros of taking the pill include:
Highly effective when used correctly;
permits sexual spontaneity and
doesn’t interrupt sex; some pills may
even reduce heavy and painful periods
and/or may have a positive effect on
acne.
Cons include: Forgetting to take your
pill means it won’t be as effective; it
can only be used by women; is not
suitable for women who can't take
oestrogen-containing contraception; it
does not protect against STIs.
Contraceptive patch
The contraceptive patch is a small
sticky patch that releases hormones
into your body through your skin to
prevent pregnancy. In the UK, the
patch's brand name is Evra.
Facts about the patch
-When used correctly, the patch is
more than 99% effective at preventing
pregnancy.
-Each patch lasts for 1 week. You
change the patch every week for 3
weeks, then have a week off without a
patch.
-You don't need to think about it
every day, and it's still effective if
you're sick (vomit) or have diarrhea.
-You can wear it in the bath, when
swimming and while playing sports.
-If you have heavy or painful periods,
the patch can help.
The patch can raise your blood
pressure, and some women get
temporary side effects, such as
headaches.
-Rarely, some women develop a
blood clot when using the patch.
The patch may protect against
ovarian, womb and bowel cancer.
It may not be suitable for women who
smoke and who are 35 or over, or who
weigh 90kg (14 stone) or more.
-The patch does not protect against
sexually transmitted infections (STIs),
so you may need to use condoms as
well.
How it works
The patch releases a daily dose of
hormones through the skin into the
bloodstream to prevent pregnancy.
It contains the same hormones as the
combined pill – estrogen and
progestogen – and works in the same
way by preventing the release of an
egg each month (ovulation).
It also thickens cervical mucus, which
makes it more difficult for sperm to
move through the cervix, and thins the
womb lining so a fertilised egg is less
likely to be able to implant itself.
How to use the patch
Apply your first patch and wear it for
7 days. On day 8, change the patch to
a new one. Change it like this every
week for 3 weeks, and then have a
patch-free week.
During your patch-free week you'll
get a withdrawal bleed, like a period,
although this may not always happen.
After 7 patch-free days, apply a new
patch and start the 4-week cycle
again. Start your new cycle even if
you're still bleeding.
Where to put the patch
Stick the patch directly onto your
skin. You can put it onto most areas
of your body, as long as the skin is
clean, dry and not very hairy. You
shouldn't stick the patch onto:
-sore or irritated skin.
-an area where it may get rubbed off
by tight clothing
-your breasts
It's a good idea to change the position
of each new patch to help reduce the
chance of skin irritation.
When the patch starts to work
If you start using the patch on the first
day of your period, and up to and
including the fifth day of your period,
you'll be protected from pregnancy
straight away.
If you start using it on any other day,
you need to use an additional form of
contraception, such as condoms, for
the first 7 days.
If you have a short menstrual cycle
with your period coming every 23
days or less, starting the patch on the
fifth day of your period or later means
you may not be protected against
pregnancy and will also need
additional contraception for the first 7
days.
You can talk to a GP or nurse about
when the patch will start to work, and
whether you need to use additional
contraception in the meantime.
What to do if a patch falls off
The contraceptive patch is very sticky
and should stay on. It shouldn't come
off after a shower, bath, hot tub, sauna
or swim.
If the patch does fall off, what you
need to do depends on how long it has
been off.
If it's been off for less than 48 hours:
-put a new patch on (don't try to hold
the old patch in place with a plaster or
bandage)
-change it on your normal change day
-you're protected against pregnancy if
you've used your patch correctly for
the past 7 days (and the 7 days before
your patch-free week, if you're in
week 1)
If it's been off for 48 hours or more,
or you're not sure how long:
-put on a new patch
-change it on your normal change day,
if you're in week 1 or 2 of your patch
cycle
-if you're in week 3, you need to start
a new patch cycle (this is now day 1
of your new cycle) and miss your
usual patch-free week
-whatever week you're in, use
additional contraception, such as
condoms, until you've had a patch on
for 7 days in a row
-you may need emergency
contraception if you had sex during
the patch-free break, or in week 1, and
the patch fell off during week 1. Or,
you had sex during week 2 or 3 when
a patch had not been on properly for
the previous 7 days. In these
situations, ask a GP or nurse for
advice.
What to do if you forget to take a
patch off
If you forget to take a patch off, what
you should do depends on how many
extra hours it has been left on.
If you remove it before going over 48
hours (it's been on for 8 or 9 days in
total):
-take off the old patch and put on a
new one
-change it on your normal change day
-you're protected against pregnancy if
you've used the patch correctly up
until the time you forgot to take it off
If a patch has been on for an extra 48
hours or longer (it's been on for 10
days or more):
-put on a new patch as soon as
possible
-change it on your normal change day
-use additional contraception, such as
condoms, until you've had the patch
on for 7 days in a row
-see a GP or nurse for advice if you've
had sex in the previous few days as
you may need emergency
contraception
If you forget to take the patch off after
week 3, take it off as soon as possible.
Start your patch-free break and start a
new patch on your usual start day,
even if you're bleeding. This means
you won't have a full week of patch-
free days.
You'll be protected against pregnancy
and won't need to use any additional
contraception. You may or may not
bleed on the patch-free days.
What to do if you forget to put a
patch on after the patch-free week
Put on a new patch as soon as you
remember. This is the beginning of
your new patch cycle. You'll now
have a new day of the week as your
start day and change day.
If you're more than 24 hours late
sticking on the patch (the interval has
been 8 days or more), you may not be
protected against pregnancy and will
need to use additional contraception,
such as condoms, for 7 days.
See a GP or nurse for advice if you've
had unprotected sex in the patch-free
interval, as you may need emergency
contraception.
Bleeding in the patch-free week
Some women don't always have a
bleed in their patch-free week. This is
nothing to worry about if you've used
the patch properly and have not taken
any medicine that could affect it.
See a GP or nurse for advice if you're
worried, or do a pregnancy test to
check if you're pregnant.
If you miss more than 2 bleeds, get
medical advice.
Who can use the patch
The contraceptive patch isn't suitable
for everyone, so if you're thinking of
using it, a GP or nurse will need to
ask about you and your family's
medical history. Tell them about any
illnesses or operations you've had, or
medicines you're taking.
You may not be able to use the patch
if:
-you're pregnant or think you may be
pregnant
-you're breastfeeding a baby less than
6 weeks old
-you smoke and are 35 or over
you're 35 or over and stopped
smoking less than a year ago
you're very overweight
-you're taking certain medicines, such
as St John's Wort, or medicines used
to treat epilepsy, tuberculosis (TB) or
HIV
You may also not be able to use the
patch if you have or have had:
-blood clots in a vein or artery (or an
immediate family member had a
blood clot before they were 45)
-a heart problem
-high blood pressure
-some blood conditions that increase
your chance of getting a blood clot,
such as lupus (systemic lupus
erythematosus)
-breast cancer
-migraine with aura (warning signs)
disease of the liver or gallbladder
Advantages and disadvantages of
the patch
Advantages:
-it's very easy to use and doesn't
interrupt sex
-unlike the combined oral
contraceptive pill, you don't have to
think about it every day – you only
have to remember to change it once a
week
-the hormones from the patch aren't
absorbed by the stomach, so it still
works if you're sick (vomit) or have
diarrhea
-it can make your periods more
regular, lighter and less painful
-it can help with premenstrual
symptoms
-it may reduce the risk of ovarian,
womb and bowel cancer
Disadvantages:
-it may be visible
-it can cause skin irritation, itching
and soreness
-it doesn't protect you against STIs, so
you may need to use condoms as well
-some women get mild temporary side
effects when they first start using the
patch, such as headaches, sickness
(nausea), breast tenderness and mood
changes – this usually settles down
after a few months
-bleeding between periods
(breakthrough bleeding) and spotting
(very light, irregular bleeding) is
common in the first few cycles of
using the patch – this is nothing to
worry about if you're using it properly
and you'll still be protected against
pregnancy
-some medicines can make the patch
less effective – see a GP, nurse or
pharmacist for advice
-you need to remember to change it
every week, so if it would be easier to
use a method that you don't have to
think about you may want to consider
the implant or intrauterine device
(IUD)
Disadvantages:
-it may be visible
-it can cause skin irritation, itching
and soreness
-it doesn't protect you against STIs, so
you may need to use condoms as well
–some women get mild temporary
side effects when they first start using
the patch, such as headaches, sickness
(nausea), breast tenderness and mood
changes – this usually settles down
after a few months
-bleeding between periods
(breakthrough bleeding) and spotting
(very light, irregular bleeding) is
common in the first few cycles of
using the patch – this is nothing to
worry about if you're using it properly
and you'll still be protected against
pregnancy
-some medicines can make the patch
less effective – see a GP, nurse or
pharmacist for advice
-you need to remember to change it
every week, so if it would be easier to
use a method that you don't have to
think about you may want to consider
the implant or intrauterine device
(IUD)
Blood clots
A very small number of people using
the patch may develop a blood clot in
a vein or an artery. Don't use the patch
if you've had a blood clot before.
Your risk is higher if:
-it's your first year of using the patch
-you smoke
-you're very overweight
-you're unable to move (immobile) or
use a wheelchair
-you have migraines with aura
(warning signs)
-a close family member has had a
heart attack, stroke or blood clot
before they were 45
Cancer
Research suggests that people who
use the contraceptive patch have a
small increased risk of being
diagnosed with breast cancer
compared with those who don't. But
this reduces with time after stopping
the patch.
Research also suggests there's a small
increase in the risk of developing
cervical cancer with long-term use of
estrogen and progestogen hormonal
contraception.
Intrauterine Device (IUD)
This small, T-shaped device is made
of material containing progesterone
hormone or plastic and copper and is
fitted inside a woman’s uterus by a
trained healthcare provider. It's a
long-acting and reversible method of
contraception, which can stay in place
for three to 10 years, depending on
the type.
Some IUDs contain hormones that are
gradually released to prevent
pregnancy. The IUD can also be an
effective emergency contraception if
fitted by a healthcare professional
within five days (120 hours) of having
unprotected sex.
IUDs containing coppers are 99%
effective and the ones containing
hormones are 99.8% effective, so
you’re about as protected as you
possibly can be by a contraceptive
method.
Cons include: Irregular bleeding and
spotting occurs in the first six months
of use; requires a trained healthcare
provider for insertion and removal;
does not protect against STIs.
The Contraceptive Implant
In this method, a small, flexible rod is
placed under the skin in a woman’s
upper arm, releasing a form of the
hormone progesterone. The hormone
stops the ovary releasing the egg and
thickens the cervical mucus making it
difficult for sperm to enter the womb.
The implant requires a small
procedure using local anesthetic to fit
and remove the rod and needs to be
replaced after three years. Women can
choose to use the implant as a long-
term contraceptive method.
Pros of the implant include: Highly
effective; doesn’t interrupt sex; is a
long-lasting, reversible contraceptive
option.
Cons include: Requires a trained
healthcare provider for insertion and
removal; sometimes there can be
irregular bleeding initially; does not
protect against STIs.
The Contraceptive Injection
The injection contains a synthetic
version of the hormone progestogen.
It is given into a woman’s buttock or
the upper arm, and over the next 12
weeks the hormone is slowly released
into your bloodstream. The
contraceptive injection uses
progestogen to prevent pregnancy.
Pros: The injection lasts for up to
three months; is very effective;
permits sexual spontaneity and
doesn’t interrupt sex.
Cons: The injection may cause
disrupted periods or irregular
bleeding; it requires keeping track of
the number of months used; it does
not protect against STIs.
Emergency Contraception Pill (The
‘Morning After’ Pill)
The Emergency Contraception Pill
can be used to prevent pregnancy
after sex if contraception wasn’t used,
a condom has broken during sex, or a
woman has been sexually assaulted.
While it is sometimes call the
‘Morning After’ pill, it can actually be
effective for up to five days after
having unprotected sex. The sooner it
is taken, the more effective it is; when
taken in the first three days after sex,
it prevents about 85% of expected
pregnancies.
This pill contains special doses of
female hormones. Any woman can
take the emergency contraception pill,
even those who cannot take other oral
contraceptive pills. It can be bought
over the counter at a pharmacy or
chemist without a prescription.
The common side effects of the
emergency contraceptive include
nausea, vomiting and the next period
may be early or delayed. Emergency
contraception does not protect against
STIs.
Emergency contraception can be used
after having sex to prevent pregnancy.
Contraceptive Ring This method
consists of a flexible plastic ring
constantly releasing hormones that is
placed in the vagina by the woman. It
stays in place for three weeks, and
then you remove it, take a week off
then pop another one in. The ring
releases the hormones oestrogen and
progestogen. These are the same
hormones used in the combined oral
contraceptive pill, but at a lower dose.
The contraceptive ring releases a
lower dose of hormones to control a
woman's ability to conceive than other
contraceptive methods like the pill.
Pros include: You can insert and
remove a vaginal ring yourself; this
contraceptive method has few side
effects, allows control of your periods
and allows your fertility to return
quickly when the ring is removed.
Cons include: It is not suitable for
women who can't take oestrogen-
containing contraception; you need to
remember to replace it at the right
time; does not protect against STIs.
Diaphragm

A diaphragm is a small, soft silicon
dome is placed inside the vagina to
stop sperm from entering the uterus. It
forms a physical barrier between the
man's sperm and the woman's egg,
like a condom.
The diaphragm needs to stay in place
for at least six hours after sex. After
six - but no longer than 24 hours after
sex - it needs to be taken out and
cleaned.
Some of the pros: You can use the
same diaphragm more than once, and
it can last up to two years if you look
after it.
Some of the cons: Using a diaphragm
can take practice and requires keeping
track of the hours inserted. The
diaphragm works fairly well if used
correctly, but not as well as the pill, a
contraceptive implant or an IUD.
Sterilization
Sterilization is the process of
completely taking away the body’s
ability to reproduce through open or
minimal invasion surgery. It is a
permanent method of contraception,
suitable for people who are sure they
never want children or do not want
any more children. Sterilization is
available for both women and men
and is performed in a hospital with
general anesthesia.
Depending on the method used, you
would either have a general
anaesthetic, where you're asleep
during surgery, or local anaesthetic,
where you'd be awake but not feel any
pain.
Because sterilisation can be
permanent, it's only suitable for
people who definitely do not want to
have any children, or any further
children, in the future.
If you are thinking about sterilisation,
issues to talk with your doctor about
include your reasons for wanting to be
sterilised, whether other methods of
contraception might be more suitable
and any side effects, risks and
complications of the procedure.
Facts about female sterilisation
-Female sterilisation is more than
99% effective at preventing
pregnancy.
-You do not have to think about
protecting yourself against pregnancy
every time you have sex, so it does
not interrupt your sex life.
-It does not affect your hormone
levels and you'll still have periods.
-You'll need to use contraception up
until you have the operation, and until
your next period or for 3 months after
the operation (depending on the type
of sterilisation).
-As with any surgery, there's a small
risk of complications, such as internal
bleeding, infection or damage to other
organs.
-There's a small risk that the operation
will not work. Blocked tubes can
rejoin immediately or years later.
-If the operation fails, this may
increase the risk of a fertilised egg
implanting outside the womb (ectopic
pregnancy).
-Sterilisation is very difficult to
reverse, so you need to be sure it's
right for you.
-Sterilisation does not protect against
sexually transmitted infections (STIs),
so you may need to use condoms as
well.
How female sterilisation is carried
out
The surgeon will block your fallopian
tubes (tubal occlusion) by either:
-applying clips – plastic or titanium
clamps are closed over the fallopian
tubes
-applying rings – a small loop of the
fallopian tube is pulled through a
silicone ring, then clamped shut
-tying, cutting and removing a small
piece of the fallopian tube
This is a fairly minor operation and
many women return home the same
day.
Depending on your general health and
job, you can normally return to work
5 days after tubal occlusion, but avoid
heavy lifting for about a week.
You may have some slight vaginal
bleeding. Use a sanitary towel, rather
than a tampon, until this has stopped.
You may also feel some pain, like
period pain. You can take painkillers
for this.
Having sex
Your sex drive and sex life should not
be affected. You can have sex as soon
as it's comfortable to do so after the
operation.
If you had tubal occlusion, use
additional contraception until your
first period to protect yourself from
pregnancy.
Sterilisation does not protect against
sexually transmitted infections (STIs),
so you may need to use condoms.
Advantages and disadvantages of
female sterilisation
Advantages:
-more than 99% effective at
preventing pregnancy
-blocking the fallopian tubes and
removal of the tubes should be
effective immediately – but use
contraception until your next period
-it will not affect your sex drive or
interfere with sex
-it will not affect your hormone levels
Vasectomy (male sterilisation)
facts about vasectomy
-A vasectomy is more than 99%
effective.
-It's considered permanent, so once
it's done you don't have to think about
contraception again.
-It doesn't affect your sex drive or
ability to enjoy sex. You'll still have
erections and ejaculate, but your
semen won't contain sperm.
-You'll need to use contraception for
at least 8 to 12 weeks after the
operation, because sperm will still be
in the tubes leading to the penis.
-Up to 2 semen tests are done after the
operation to make sure that all the
sperm have gone.
-Your ball sack (scrotum) may
become bruised, swollen or painful –
some men have ongoing pain in their
testicles.
-As with any surgery, there's a small
risk of infection.
-It's very difficult to reverse, so be
sure it's right for you.
-A vasectomy doesn't protect against
sexually transmitted infections (STIs),
so you may need to use condoms as
well.
There are 2 types of vasectomy:
● a conventional vasectomy using
a scalpel (surgical knife)
● a no-scalpel vasectomy
No-scalpel vasectomy
-The doctor first numbs your scrotum
with local anaesthetic. They then
make a tiny puncture hole in the skin
of your scrotum to reach the tubes.
This means they don't need to cut the
skin with a scalpel.
-The tubes are then closed in the same
way as a conventional vasectomy,
either by being tied or sealed.
-There's little bleeding and no stitches
with this procedure. It's thought to be
less painful and less likely to cause
complications than a conventional
vasectomy.
Natural family planning (fertility
awareness)
Natural family planning (or "fertility
awareness") is a method of
contraception where a woman
monitors and records different fertility
signals during her menstrual cycle to
work out when she's likely to get
pregnant.
Facts about natural family planning
-If natural family planning is followed
consistently and correctly, it can be up
to 99% effective (1 to 9 women in
100 who use natural family planning
will get pregnant in 1 year).
-It is less effective if the instructions
are not carefully followed.
-There are no physical side effects,
and you can use it to plan when you
get pregnant.
-You have to keep a daily record of
your fertility signals, such as your
temperature and the fluids coming
from your cervix – it takes 3 to 6
menstrual (monthly) cycles to learn
the method.
-Your fertility signals can be affected
by illness, stress and travel.
-If you want to have sex during the
time when you might get pregnant,
you'll need to use contraception, such
as a condom, diaphragm or cap.
-By using condoms as well as natural
family planning, you'll help to protect
yourself against sexually transmitted
infections (STIs).
How natural family planning works
Natural family planning involves
identifying the signs and symptoms of
fertility during your menstrual cycle
so you can plan or avoid pregnancy.
There are 3 different fertility signals
you can monitor and record for
natural family planning. These are:
-the length of your menstrual cycle
-daily readings of your body
temperature
-changes to your cervical secretions
(cervical mucus)
It's best to record these measures
together to give you a more accurate
picture of when you're likely to be
most fertile.
You can use fertility charts to record
and track your measurements over the
course of each menstrual cycle. You
can download fertility charts from the
Fertility Education and Training site,
with information on how to use them.
You can also download smartphone
apps to track this information.
Your menstrual cycle and ovulation
(Calendar Method)
Your menstrual cycle lasts from the
first day of your period until the day
before your next period starts. This is
28 days on average but longer or
shorter cycles, from 21 to 40 days, are
normal.
During your cycle, an egg is released
from one of your ovaries (ovulation)
and travels down the fallopian tube. It
is usually released 10-16 days before
your next period. Occasionally, a
second egg is released, within 24
hours of the first egg.
The egg only lives for a maximum of
24 hours after ovulation, and a sperm
must meet the egg within that period
for pregnancy to happen.
You can get pregnant up to 2 days
after you ovulate. But if you've had
sex in the 7 days before ovulation, it's
possible to get pregnant because
sperm can live inside a woman's body
for up to 7 days and fertilise the egg
when it's released.
By tracking your cycle, you can
calculate when you're most likely to
be fertile (able to conceive). But you
need to allow for uncertainty over
exactly when you ovulate.
The length of a menstrual cycle can
vary over time, so to make sure your
calculations are as precise as possible,
measure your menstrual cycle over
the course of 12 months.
The temperature method (Basal
Body Temperature)
The temperature method is used
because there's a small rise in body
temperature after ovulation.
You'll need to use either a digital
thermometer or a thermometer
specifically designed for natural
family planning. Ear or forehead
thermometers are not accurate enough
for this.
The temperature method involves
taking your temperature every
morning before you get out of bed.
This should be done before eating,
drinking and smoking, and ideally at
the same time every morning.
Look out for 3 days in a row when
your temperature is higher than all of
the previous 6 days. The increase in
temperature is very small, usually
around 0.2C (0.4F). It's likely that
you're no longer fertile at this time.
Cervical secretion monitoring
method
There's a change in the amount and
texture of your cervical secretions
(cervical mucus) during different
times in your menstrual cycle.
You can check this by gently placing
your middle finger into your vagina
and pushing it up to around your
middle knuckle. For the first few days
after your period, you'll probably find
your vagina is dry and you cannot feel
any mucus.
As your hormone levels rise to
prepare your body for ovulation,
you'll probably find that you start to
produce mucus that is moist, sticky,
white and creamy. This is the start of
the fertile period of your menstrual
cycle.
Immediately before ovulation the
mucus will get wetter, clearer and
slippery – a bit like raw egg white.
This is when you're at your most
fertile.
The mucus should then soon return to
being thicker and sticky, and after 3
days you should no longer be fertile.
How effective is natural family
planning?
If natural family planning instructions
are carefully followed, this method
can be up to 99% effective. This
means that 1 to 9 women in 100 who
use natural family planning correctly
will get pregnant.
But if natural family planning
methods are not quite followed
correctly, more women will get
pregnant. It takes commitment and
practice to use natural family planning
effectively.
Who can use natural family
planning
Most women can use natural family
planning. However, certain situations
can affect fertility signs and you
might want to consider a different
method if:
-there could be a health risk to the
baby if you got pregnant
-you're having irregular period
-you have a short or long-term
condition affecting your fertility
signs, such as a sexually transmitted
infection (STI) or pelvic
inflammatory disease
-you're taking a medication that
disrupts production of cervical mucus
(ask your GP or a pharmacist if you're
not sure)
-you've recently stopped taking
hormonal contraception
-you've recently had a miscarriage or
abortion
-you've recently given birth and are
breastfeeding
-you regularly travel through different
time zones
-you have a vaginal infection such as
thrush or an STI, or you're at
increased risk of getting an STI
-you're not able to take your
temperature in the recommended way
-you're a heavy drinker
Advantages:
 ● It does not cause any side
effects.
● Natural family planning is
acceptable to all faiths and
cultures.
● Most women can use natural
family planning, as long as
they're properly trained by a
fertility awareness teacher.
● Once you've learned the
techniques, there should be no
further need for input from
health professionals.
● Natural family planning can be
used either to avoid pregnancy
or to become pregnant.
● It does not involve chemicals or
physical products.
● It can help you recognise
normal and abnormal vaginal
secretions, so you can be aware
of possible infection.
● It involves your partner in the
process, which can help
increase feelings of closeness
and trust.
● disrupt your fertility signs.
Disadvantages:
● Natural family planning does
not protect against STIs such as
chlamydia or HIV.
● You'll need to avoid sex, or use
contraception such as condoms,
during the time you might get
pregnant, which some couples
can find difficult.
● If you decide to abstain, there
can sometimes be up to 16 days
during which you cannot have
sex, depending on your cycle.
● It can be much less effective
than other methods of
contraception if the methods
are not followed accurately.
● It will not work without
continued commitment and
practice.
● It can take several menstrual
cycles before you become
confident in identifying your
fertile time. During this time,
you'll have to use barrier
contraception, such as
condoms.
● You'll need to keep a daily
record of your fertility signs.
● It's not suitable for every
woman.
● Stress, illness, travel, lifestyle
and hormonal treatments can
● If you use the emergency
contraceptive pill, you'll need
to wait for 2 complete cycles
before relying on natural family
planning again.
Lactational amenorrhoea method
(LAM)
You're unlikely to have any periods if
you breastfeed exclusively (give your
baby breast milk only) and your baby
is under 6 months old. Because of
this, some women use breastfeeding
as a form of natural contraception.
This is known as the lactational
amenorrhoea method (LAM).
When used correctly and consistently,
less than 2 in 100 women who use
LAM will get pregnant in the first 6
months. However, take care to use the
method correctly. Do not feed your
baby other foods because this may
reduce your lactation.
LAM becomes unreliable when:
● gaps between feeds are longer
than 4 hours during the day or
longer than 6 hours at night
● other foods or liquids are
substituted for breast milk
● your baby reaches 6 months old
● you have a period
After having a baby, it is possible to
get pregnant before your periods start
again. This is because you ovulate
around 2 weeks before your period.
Sex and Fertilization
SEX
-Act of copulation / “coitus
SEXUAL RESPONSE CYCLE
4 Stages of Sexual Response:
1. EXCITEMENT PHASE
- Physical and psychological stimulus
- Arterial dilatation and venous
constriction in the genital area
Physiological changes in woman:
- clitoris increase in size
- Lubrication
- Vagina widens
- Breast nipples become erect
- Increase BP, HR, RR
Physiological changes in men:
- Erection
- Scrotal thickening
- Elevation of the testes
- Increase BP, HR, RR
2. PLATEAU PHASE
- Reached first before orgasm
- Women: formation of orgasmic
platform, increased nipple
engorgement
- Men: full distention of the penis
3.ORGASM PHASE
- Discharge of accumulated sexual
tension
- Shortest stage
4.RESOLUTION STAGE
- External and internal organs return
to their uncrossed state

Generally takes 30 min

Functional life of a spermatozoa is
about 48h, possibly as long as 72h

- Ova about 24h possibly as long as

48h

- The ovum is surrounded by a ring

of mucopolysaccharide fluid (zona
pellucida) and a circle of cells
FERTILIZATION
(corona radiata) - serve as protection
CONCEPTION / IMPREGNATION /
from injury
FECUNDATION
- Union of ovum and spermatozoon
- Fertilized egg is called ZYGOTE

OVUM - from ovulation to

Fertilization usually occur in the outer
fertilization
3rd of the Fallopian tube, the
ZYGOTE - from fertilization to
ampullae portion
implantation
EMBRYO - from implantation to 5-8
- Normally, an ejaculation of semen
weeks
averages 2.5 ml of fluid containing
FETUS - From 5-8 weeks until term
50M - 200 million spermatozoa per
CONCEPTUS - developing embryo /
milliliter or an average of 400
fetus and placental structures
million / ejaculation
throughout pregnancy
- Spermatozoa deposited in the vagina
during intercourse generally reach the
cervix within 90 sec and the other end
of the Fallopian tube within 5 min
after deposition
CAPACITATION
- Final process that sperm must
undergo to be ready for fertilization
- The sperm move toward the ovum
Changes in the plasma membrane of
the sperm head, reveals the sperm -
binding receptor sites
HYALURONIDASE
- Proteolytic enzyme
-Released by the spermatozoa and
acts to dissolve the layer of cells
protecting the ovum
Normally, only one spermatozoon is
able to penetrate the cell membrane of
the ovum. Once it penetrates the zona
pellucida, the cell membrane becomes
impervious to other spermatozoa.
After the spermatozoon penetrates the
ovum, its nucleus is released into the
ovum, its tail degenerates and its head
enlarges and fuses with the nucleus of
the ovum. This fusion provides the
fertilized ovum, called a zygote with
46 chromosomes. The spermatozoon
and ovum each carried 23
chromosomes (22 autosomal and 1
sex chromosome)
3 SEPARATE FACTORS FOR
FERTILIZATION TO OCCUR
1. Maturation of both sperm and
ovum
2. Ability of sperm to reach the
ovum
3. Ability of the sperm to
penetrate the zona pellucida
and cell membrane and achieve
fertilization
IMPLANTATION
- Occurs when the cellular wall of
growing structure / zygote implants - this structure attaches to the uterine
itself in the endometrium of the endometrium
anterior or posterior fundal region, 8-
9 days after fertilization after the - the cells in the outer ring are known as
trophoblasts which will form into
corona and zona pellucida
placenta and membranes
degenerates
-the inner cell mass (enclosed within the
- After fertilization. It takes 3-4 days trophoblast will form the embryo)
for the zygote to reach to the body of
the uterus (free floating). During this
time, mitosis cell division, or cleavage
begins.

- Day 2 - 1st cell division

- Day 3 - morula; bumpy appearance;

consists of 16-50 cells; body of the
uterus; floats free in the uterine cavity
for 3-4 days

After implantation, the endometrium is

Day 4 called the DECIDUA

Once implanted, the zygote is called an

EMBRYO

- Blastocyst; large cells collect at the

periphery of the ball, leaving a fluid
space surrounding an inner cell mass
 -experienced nausea

5. VIVID DREAMS
-experienced vivid dreams right
before/during/after the period

(Notes from the video : SIGNS OF 6. CHANGES IN BREAST

IMPLANTATION) - More sore and tingling
- Tenderness
1. IMPLANTATION BLEEDING - Breast gets ready for
- Spotting breastfeeding
- Not received a flow (like
how periods usually do)
-
2. TEMPERATURE DIP & RISE
Antepartum Care
- Experienced dip (low)
temperature then right after that
day it will rise (high)
temperature
- Morning is the accurate time of
the temperature

3. IMPLANTATION
CRAMPING
- Fertilized egg implants to the
DIAGNOSIS OF PREGNANCY
uterus, the uterus gets irritated
and sheds some blood and SIGNS AND SYMPTOMS OF
cause cramping PREGNANCY
- Not the same as period
cramping PRESUMPTIVE (presume)
- Should not be intensify Presumptive means speculation or
- Very mild like cramping unconfirmed.

4. NAUSEA/FOOD AVERSIONS/
Presumptive signs and symptoms of
FATIGUE
pregnancy are those signs and
symptoms that are usually noted by
the patient, which impel her to make
an appointment with a physician.
These signs and symptoms are not
proof of pregnancy but they will make
the physician and woman suspicious
of pregnancy.
Amenorrhea (Cessation of
Menstruation).
(absence of menstruation)
(1) Amenorrhea is one of the earliest
clues of pregnancy. The majority of
patients have no periodic bleeding
after the onset of pregnancy.
However, at least 20 percent of
women have some slight, painless
spotting during early gestation for no
apparent reason and a large majority
of these continue to term and have
normal infants.
(2) Other causes for amenorrhea must
be ruled out, such as:
(a) Menopause.
(b) Stress (severe emotional shock,
tension, fear, or a strong desire for a
pregnancy).
(c) Chronic illness (tuberculosis,
endocrine disorders, or central
nervous system abnormality).
(d) Anemia.
(e) Excessive exercise.
Nausea and Vomiting (Morning
Sickness).
(1) Usually occurs in the early
morning during the first weeks of
pregnancy.
(2) Usually spontaneous and subsides
in 6 to 8 weeks or by the twelfth to
sixteenth week of pregnancy.
(3) Hyperemesis gravidarum. This
is referred to as nausea and vomiting
that is severe and lasts beyond the
fourth month of pregnancy. It causes
weight loss and upsets fluid and
electrolyte balance of the patient.
(4) Nausea and vomiting are
unreliable signs of pregnancy since
they may result from other conditions
such as:
(a) Gastrointestinal disorders (hiatal
hernias, ulcers, and appendicitis).
(b) Infection (influenza and
encephalitis).
(c) Emotional stress, upset (anxiety
and anorexia nervosa).
(d) Indigestion.
MGT: Dry toast / crackers before
arising in the morning; avoid greasy /
fatty foods; avoid highly seasoned
foods; eat small, frequent meals
Frequent Urination
(1) Frequent urination is caused by
pressure of the expanding uterus on
the bladder.
(2) It subsides as pregnancy
progresses and the uterus rises out of
the pelvic cavity.
(3) The uterus returns during the last
weeks of pregnancy as the head of the
fetus presses against the bladder.
(4) Frequent urination is not a definite
sign since other factors can be
apparent (such as tension, diabetes,
urinary tract infection, or tumors).
MGT:
● Decrease fluid intake in the
evening
● Avoid caffeine and tea
● Void as soon as the urge is felt
● Teach how to perform Kegel’s
exercise
● Report signs of UTI at once
Breast Changes
(1) In early pregnancy, changes start
with a slight, temporary enlargement
of the breasts, causing a sensation of
weight, fullness, and mild tingling.
Breast Changes during Pregnancy:
(2) As pregnancy continues the
patient may notice:
(a) Darkening of the areola–the brown
part around the nipple.
(b) Enlargement of Montgomery
glands–the tiny nodules or sebaceous
glands within the areola.
(c) Increased firmness or tenderness
of the breasts.
(d) More prominent and visible veins
due to the increased blood supply.
(e) Presence of colostrum (thin
yellowish fluid that is the precursor of
breast milk). This can be expressed
during the second trimester and may
even leak out in the latter part of the
pregnancy.
(3) These breast changes can be more
positive if the patient has not recently
delivered and is not presently
breastfeeding.
Vaginal Changes
(1) Chadwick’s sign. The vaginal
walls have taken on a deeper color
caused by the increased vascularity
because of increased hormones. It is
noted at the sixth week when
associated with pregnancy. It may
also be noted with a rapidly growing
uterine tumor or any cause of pelvic
congestion.
(2) Leukorrhea. This is an increase
in the white or slightly gray mucoid
discharge that has a faint musty odor.
It is due to hyperplasia of vaginal
epithelial cells of the cervix because
of increased hormone levels from the
pregnancy. Leukorrhea is also
present in vaginal infections.
Quickening (Feeling of Life)
(1) This is the first perception of fetal
movement within the uterus. It
usually occurs toward the end of the
fifth month because of spasmodic
flutter.
(a) A multigravida can feel
quickening as early as 16 weeks.
(b) A primigravida usually cannot feel
quickening until after 18 weeks.
(2) Once quickening has been
established, the patient should be
instructed to report any instance in
which fetal movement is absent for a
24-hour period.
(3) Fetal movement early in
pregnancy is frequently thought to be
gas.
Skin Changes
(1) Striae gravidarum (stretch marks).
These are marks noted on the
abdomen and/or buttocks.
(a) These marks are caused by
increased production or sensitivity to
adrenocortical hormones during
pregnancy, not just weight gain.
(b) These marks may be seen on a
patient with Cushing’s disease or a
patient with sudden weight gain.
(2) Linea nigra-This is a black line in
the midline of the abdomen that may
run from the sternum or umbilicus to
the symphysis pubis
This patient has both striae
gravidarum (stretch marks) and the
midline linea nigra
(b) This appears on the primigravida
by the third month and keeps pace
with the rising height of the fundus.
(c) The entire line may appear on the
multigravida before the third month.
(d) This may be a probable sign if the
patient has never been pregnant.
(3) Chloasma. This is called the
“Mask of Pregnancy.” It is a bronze
type of facial coloration seen more on
dark-haired women. It is seen after the
sixteenth week of pregnancy.
(4) Fingernails. Some patients note
marked thinning and softening by the
sixth week.
Fatigue
This is a common complaint by most
patients during the first trimester.
Fatigue may also be a result of
anemia, infection, emotional stress, or
malignant disease.
Positive Home Test
These tests may not always be
accurate, however, they are very
effective today if they are performed
properly.
PROBABLE SIGNS
- Probably pregnant
- Objective evidence
- Still not positive or true
diagnostic findings
A) . ERUM LAB TEST (1 WEEK)
-test of blood serum reveal the
presence of Human Gonadotropin
Hormone (HGH) ; pregnancy test
B). UTERINE ENLARGEMENT
-assessed by abdominal palpation
-Bartholomew’s rule of fours
C). GOODELL'S SIGN (6
WEEKS)
-softening of the cervix; as soft as the
lips related to increase vascularity,
edema, mucous secretion, and
hyperplasia of cervical glands
-MUCUS PLUG / OPERCULUM - -softening of the lower uterine
results from the secretion. This segment with a soft , spongy
protects the baby from infection while consistency
in the uterus. This expelled during -Assessment by bimanual
labor examination
-Leukorrhea- increase mucous
secretions.

F). BRAXTON’S HICKS

D). CHADWICK’S SIGN (6
WEEKS)
Dark violet-blue color of vaginal
mucous membrane related to increase
blood supply (vagina, cervix, vulva
CONTRACTIONS
-Painless uterine contractions that
recur throughout pregnancy
-occurring at intervals between 5-10
minutes
-responsible for the false labor pains
in the later part of pregnancy.
G). BALLOTTEMENT
-passive fetal movements in response
to tapping of the lower portion of the
uterus or cervix.

E. HEGAR’S SIGN H). PALPABLE FETAL OUTLINE

- assessed by abdominal palpation.
POSITIVE SIGNS
- Absolute evidence (Notes from the video “Signs of
Pregnancy, Probable, Positive”)
FHR- Fetal Heart Rate
Funic soufflé- Funic souffle (also PRESUMPTIVE :
known as funicular or fetal souffle), is P- period absent (amenorrhea)
a blowing sound heard in synch R- really tired
with fetal heart sounds, and may E- enlarged breast
originate from the umbilical cord. S- sore breast
U- urination
Uterine soufflé- Uterine souffle or M- movement perceived (quickening)
placental souffle is a soft, blowing E- Emesis/ nausea
sound heard using a stethoscope,
usually in the second trimester of PROBABLE:
pregnancy (13–28 weeks). This P- positive pregnancy test
sound is heard most clearly in the R- returning of fetus when uterus is
lower part of the uterus and is pushed (Ballottement )
synchronous with the pulse of the O- outline of fetus palpated
mother. B- Braxton Hick constraction
A- softening of cervix “Goodell’s
sign”
FETAL MOVEMENT B- bluish color (Chadwick’s sign)
- When felt by the examiner, after the L- lower uterine segment soft
16th week but usually about 5 months (Heger’s)
E- enlarge uterus
ULTRASONOGRAPHY
- Maybe detected as early as the 6th POSITIVE:
week of gestation, although usually F- fetal movement
done at 16 - 18 weeks E- electronic device
T- the delivery of the baby
ROENTGENOGRAPHY U- ultrasound
- X-ray of fetal skeleton; usually done S- see inside movement
at 14th - 20th week
PHYSIOLOGIC CHANGES OF - Increase vascularization of the
PREGNANCY respiratory tract caused by increased
estrogen levels
REPRODUCTIVE SYSTEM
- Uterine changes - Shortening of diaphragm caused by
the enlarging uterus
- “Practice contractions”
- Increase tidal volume causing slight
- Braxton Hick’s contractions hyperventilation

- Amenorrhea - Slight increase (2 bpm) in

respiratory rate
- Cervical changes
METABOLIC
- Vaginal changes - Increase water retention caused by
higher levels of steroids sex hormones
- Ovarian changes
- Decrease serum CHON levels
- Changes in the breasts
- Increase intra-capillary pressure and
permeability

INTEGUMENTARY SYSTEM - Increase levels of serum lipids,

- Hyperactive sweat and sebaceous lipoproteins, and cholesterol
glands
- Increase iron requirements
- Hyperpigmentation
- Increase CHO needs
- Palmar erythema & increase
angiomas - Increase body temperature

- Increase hair & nails growth Weight gain 25 - 30 lb (11.3 - 13.6

kg)
RESPIRATORY SYSTEM
Allowable weight gain in pregnancy

1st trimester - 2-4 lb
2nd trimester - 11 - 13 lb
3rd trimester - 11 - 13 lb
CARDIOVASCULAR
Heart
- Increase cardiac workload > increase
cardiac output > left ventricular
hypertrophy > palpitations, increase
heart rate
- Stroke vol >increase 10 - 30%
- Heart displaced up and the left, PMI
shifts about 1.5 cm to the left
Blood
- Increase iron demand
- Increase water retention
- Decrease blood viscosity
increase blood flow
->pulmonic and apical systolic
murmurs
- Increase progesterone > increase
fibrinogen > increase clotting factor
XII, IX, and X at term
Blood Volume
- Circulating blood volume increase
by 30-50% by water and Na retention
approximately 1,500 cc Blood
Pressure
- Brachial artery pressure highest
when sitting; lowest when at lateral
recumbent position
- 2nd & 3rd trimester - increase
relaxin > vasodilation,
muscle relaxation and decrease
muscle tone > decrease peripheral
resistance > decrease BP
- Venous compression > increase
venous stasis > pronicity to
thrombosis
- BP is lowest on the 2nd trimester
because of pseudoanemia
and - Compression of iliac veins leads to.
- Supine hypotensive syndrome
- increase hydrostatic pressure in leg
veins > varicose veins and dependent
edema
GASTROINTESTINAL
- Stomach displaced upward >
increase reflux of acids in the lower
esophagus > heartburn (pyrosis) and
flatulence - related to increase HCG,
progesterone
- Increase progesterone > decrease GI
motility and emptying > tendency for
N&V
EPULIS OF PREGNANCY - due to
estrogen
A pregnancy epulis is a benign
(harmless) tumour and does not have
the potential to become cancerous.
Some women may have the epulis
removed during pregnancy for
cosmetic reasons, or because the
diagnosis is uncertain. However, if
left alone, the epulis will usually
become smaller or disappear after
childbirth.
Hemangiomas of gingival
capillaries (epulis of pregnancy) are
treated with proper dental hygiene and
avoidance of trauma. Surgical
excision, cryotherapy, and
electrodesiccation can cause
unnecessary blood loss or permanent
disfigurement and should be avoided.
The lesion usually resolves
spontaneously after delivery.
- Thicker bile secretion due to
progesterone
PTYALISM - due to increase level of
estrogen
Ptyalism gravidarum (PG) also
known as hypersalivation or
sialorrhea is a condition of
hypersalivation that affects pregnant
women early in gestation. Symptoms
include massive saliva volumes (up to
2 liters per day), swollen salivary
glands, sleep deprivation, significant
emotional distress, and social
difficulties.
Management:
● Chewing on ice
● Using a minty mouthwash
● Brushing your teeth often with
a minty toothpaste — it's also
good for dental care, which is
extra important during
pregnancy
● Chewing sugarless gum
● Eating or drinking something
sour, like sucking on lemon
slices
● Carrying tissues and a wipe
towel with you at all times, so
you can blot any saliva that
escapes from your mouth

URINARY SYSTEM
- Diuresis > pressure of enlarging
uterus to bladder in 1st trimester

- Relieved when uterus rises out of the

pelvis in 3-4 months but returns with
LIGHTENING (2 weeks before onset
of labor)

SKELETAL SYSTEM
Postural Changes
- Lumbosacral curve increases
accompanied by a compensatory
curvature in the cervicodorsal region

- Characteristic posture in pregnancy:

Backward tilt of torso to balance the
weight of the enlarging abdomen >
strain on back and thigh muscles and
ligaments > back pains and cramps
later in pregnancy

- Waddling-Gait of Pregnancy - duck-

like movement of pelvis when
walking due to pelvic instability
caused by the enlarging abdomen and
relaxation of sacro-iliac joint and
symphysis pubis
- Enlarging uterus > anterior
abdominal wall stretching > umbilical
stretched > DIATASIS RECTI
I.ENDOCRINE SYSTEM
- The major endocrine gland during
pregnancy is the
PLACENTA
- Increase BMR (up to 25% at term)
- Increase iodine metabolism from
slight hyperplasia of the thyroid gland
- Slight parathyroidism
- Production of PROLACTIN
- ESTROGEN & PROGESTERONE
> GnRH suppression > decreases
gonadotrophic hormones > no
ovulation
- Increase HCG > (+) pregnancy test
> prolongs life of corpus luteum >
continued production of estrogen and
progesterone > continued vascularity
of endometrium > support life of
embedded embryo / fetus
- Increase HPL detectable as early as
3 weeks and found in the maternal
blood by 6th week > decrease ability
of the mother to use insulin (anti-
insulin effect) > increase maternal
serum glucose supply to support the
fetus & placenta > may cause
GESTATIONAL DIABETES
- Increase maternal cortisol / steroids
> also has anti-insulin effect >
increase maternal serum glucose
supply to support the fetus and
placenta > may contribute to
development of Gestational DM
- Increase OXYTOCIN (later part of
pregnancy) > stimulates the milk let-
down reflex for the release of milk
after delivery of the baby and
stimulates labor contractions to occur
at term
IMMUNOLOGIC SYSTEM
- Only maternal IgG cross placental
barrier to provide the baby with
antibodies in the early neonatal period
- IgA is secreted in colostrum
providing baby with additional
gastrointestinal protection during
breastfeeding
- Fetal immune system develops as
early as the 7th week and antigen
recognition by 12th week
- Fetus develops all types of
immunoglobulins by 12th week,
except IgA with highest amount at
term before delivery
PSYCHOLOGICAL /
EMOTIONAL RESPONSES TO
PREGNANCY
1. AMBIVALENCE
- Refers to the interwoven feelings of
wanting and not wanting that always
exist at high levels
- Normal response in both the woman
and her partner
- Lack of knowledge of or preparation
for parenthood and children may also
contribute to ambivalence
2. GRIEF
- Commonly occurs as a result of
changes in the woman’s role
3. NARCISSISM
- Self-centeredness / egocentrism
- Generally an early reaction to
pregnancy
- Occurs as the woman becomes
focused on herself and the changes
occurring in her body
4. INTROVERSION /
EXTROVERSION
- Some pregnant women become
introverted during pregnancy,
focusing entirely on their bodies and
themselves
- Other women become extroverted -
may increase their participation in
activities and appear more outgoing,
they may view their expanding
abdomen with a sense of fulfillment
5. STRESS REACTION
- For some women pregnancy can be
a time of stress
- The woman and her partner may
view the pregnancy as interfering with
his or her ability to accomplish daily
tasks
- Adequate support systems can help
alleviate some of this stress and aid in
adapting to the pregnancy
6. EMOTIONAL LABILITY
- Mood changes occur frequently
- May be the result of the woman’s
introversion and narcissism
 - During the 2nd trimester, as blood
- Additionally, hormonal changes, flow to the pelvic area increases to
specifically increase estrogen and supply the placenta, libido and sexual
progesterone contribute to this lability enjoyment rise markedly

- Feelings are easily hurt by remarks - During the 3rd trimester, it may
that would have been laughed off remain high or decrease because of
before the awkwardness of finding a
comfortable position and increasing
7. COUVADE SYNDROME abdominal size
“uray”
- Partner may experience discomforts 9. BODY IMAGE &
such as nausea & vomiting, fatigue or BOUNDARY
weight gain, similar to or possibly - The way your body appears to
more intense than those that the yourself
pregnant woman experiences
- A zone of separation you perceive
- The more he is involved or attuned between yourself and objects or other
to the changes of his partner’s people
pregnancy, the more symptoms he
may experience

- These discomforts are normal and

temporary and become problematic DEVELOPMENTAL /
only if the partner becomes delusional PSYCHOLOGICAL TASKS OF
or emotionally disruptive PREGNANCY

8. CHANGES IN SEXUAL FIRST TRIMESTER - Acceptance of

DESIRE the Pregnancy
- During the 1st trimester, most
women report a decrease in libido - “I am pregnant”
because of the nausea, fatigue and
breast tenderness - Pregnancy confirmation may leave
some couples with disbelief, shock, or
amazement
- The woman & her partner must learn THIRD TRIMESTER - Preparation
to accept the reality of the pregnancy for Parenthood

- Some couples experience some - “I’m going to be a Mother”

degree of ambivalence
- The couple work on preparing to
- Feeling the fetus move or seeing the become parents
fetus on an ultrasound can help the
couple achieve acceptance - The couple begin to demonstrate
“nesting” behaviors such as preparing
SECOND TRIMESTER - Acceptance the baby’s room, shopping for
of the Baby necessary baby items, and discussing
names
- “I’m Going to Have a Baby”
- The couple may attend childbirth
- The woman and her partner work to education classes
accept the baby
- The couple may review relationships
- Acceptance of the baby refers to with their own parents and engage in
acknowledgment that the fetus is a role-playing and fantasizing about
distinct individual, separate from the being a parent
mother MATERNAL DISCOMFORTS
ASSOCIATED WITH
- Feeling the fetus move or hearing its PREGNANCY
heartbeat demonstrates that the fetus
is an active being FIRST TRIMESTER

- The woman and her partner begin 1. Nausea & Vomiting

active preparations for the baby 2. Breast enlargement and
tenderness
- A good way to measure the level of 3. Urinary frequency and urgency
a woman’s acceptance of the coming 4. Nasal stuffiness, discharge, or
baby is to measure how well she obstruction
follows prenatal instructions 5. Leukorrhea
 6. Fatigue
7.
SECOND TRIMESTER
1. Heartburn / pyrosis
2. Constipation
3. Hemorrhoids
- commonly known as PILES
- Over dilation of veins under the
mucous membrane in the rectal / anal
area or both related to the weakness in
the walls of the rectum
- Maybe INTERNAL or EXTERNAL
and straining related bowel movement
may cause bleeding
- Pressure on the pelvic veins by the
enlarging uterus, which interferes
with venous circulation
MGT:
- Avoid constipation
- Avoid prolonged standing
- Avoid constrictive clothing
- Topical ointments / anesthetic
- Sitz baths or apply warm soaks
- Lie on her side with feet slightly
elevated
- Re-insert external hemorrhoids, by
placing patient in side lying / knee-
chest position, using a lubricant and
using only gentle pressure
4. Backache
5. Leg Cramps
6. Ankle Edema
7. Shortness of breath
8. Fainting spells / Hypotension
9. Varicose veins
10.Braxton Hick’s contractions
- are normal throughout the entire
pregnancy, maybe more pronounced
in the latter part of pregnancy
11. Headache
DANGER SIGNS OF
PREGNANCY
1. Severe, persistent vomiting
2. Vaginal bleeding
3. Sudden escape of fluid from the
vagina
4. Chills and fever
5. Epigastric / Abdominal or
Chest pain
6. Swelling of finger / face
7. Vision disturbances
8. Seizures / muscular irritability
9. Frequent, severe headaches
 10.Decrease urine output
11.Rapid weight gain
12.Increase or decrease fetal
movements
PREGNANCY TIMELINE
Terms:
Gravidity- is defined as the number
of times that a woman has been
pregnant, regardless of the outcome.
Either twins or multiples count as
ONE.
Parity- is defined as the number of
times that she has given birth to a
fetus with a gestational age of 24
weeks or more, regardless of whether
the child was born alive or was
stillborn.
Nullipara- a woman (or female
animal) that has never given birth.
Primigravida- a woman who is
pregnant for the first time.
Nulligravida- a woman who has
never been pregnant
Multigravida- a woman who has
been pregnant more than once
Grand multipara- is a woman who
has already delivered five or more
infants who have achieved a
gestational age of 24 weeks or more,
and such women are traditionally
considered to be at higher risk than
the average in subsequent
pregnancies.
Grand multigravida- has been
pregnant five times or more.
Great grand multipara- has
delivered seven or more infants
beyond 24 weeks of gestation.
A 28-year-old female gives birth to
twins at 38 weeks gestation. This is
her first pregnancy. best describes the
patient’s gravidity and parity
Gravida 1, Para 1
Gravida 1, para 1… Gravida is the
number of times the woman has been
pregnant, regardless the outcome. The
patient has been pregnant just once
(twins or multiples count as ONE).
Parity is the number of births (hence
completed pregnancies) that occurred
at greater than 20 weeks gestation.
The patient’s parity is 1 (twins or
multiples count as ONE).
A more elaborate coding system used
elsewhere, including America, is
GTPAL (G = gravidity, T = term
deliveries, P = preterm deliveries, A =
abortions or miscarriages, L = live
births).
A full-term (T) pregnancy lasts
between 39 weeks, 0 days and 40
weeks, 6 days. This is 1 week before
your due date to 1 week after your
due date.
At 37 weeks, your pregnancy is
considered full-term. The average
baby weighs around 3-4kg by now.
Your baby is ready to be born. Your
baby's lungs, liver, and brain go
through a crucial period of growth
between 37 weeks and 39 weeks of
pregnancy. Waiting until 39 weeks,
now called "full term," gives your
baby the best possible chance for a
healthy start in life.
Preterm birth (premature) is when a
baby is born too early, before 37
weeks of pregnancy have been
completed.
Abortion termination of a human
pregnancy during the first 28 weeks
of pregnancy.
Example:
A 30 year old female is 25 weeks
pregnant with twins. She has 5 living
children. Four of the 5 children were
born at 39 weeks gestation and one
child was born at 27 weeks gestation.
Two years ago she had a miscarriage
at 10 weeks gestation. What is her
GTPAL?*
G=7, T=4, P=1, A=1, L=5
A 27 year old female is currently 16
weeks pregnant. She has 2 year-old
twins that were born at 39 weeks
gestation and a 5 year-old who was
born at 40 weeks gestation. She had
no history of miscarriage or abortion.
What is her GTPAL?*
G=3, T=2, P=0, A=0, L=3
Estimated Date of Delivery / EDC -
Expected Date of Confinement
NAGELE’s Rule
- Count back 3 calendar months from
the 1st day of LMP then add 7 days.
- e.g. Oct 5 , ---> 10-3, 5+7 Mc Donald’s rule becomes inaccurate
during the 3rd trimester of pregnancy
=. 7. 12

July 12
DATE OF QUICKENING
Primigravida:

- Date of quickening + 4 months

and 20 days = EDC

Multigravida:
2. Bartholomew’s Rule of Fours
- Date of quickening + 5 months - Measures age of gestation by
and 4 days = EDC determining the position of the fundus
in the abdominal cavity
First three months = +9 +7
AGE OF GESTATION

1. MC DONALD’S rule Normal length of pregnancy:

- uses fundal height to determine
duration of pregnancy

- Measurement is made from the

notch of the woman’s symphysis
pubis to over the top of the

uterine fundus as the woman lies

supine

- Typically, the distance from the

fundus to symphysis pubis in Days - 267 - 280
centimeters is equal to the week of
gestation between 20th - 31st week Weeks - 40 - 41 weeks
 - The embryo is highly vulnerable to
Lunar months - 10 injury from maternal drug use, certain
maternal infections and other factors
Calendar months - 9 3. Fetal Period
- Begins with the 8th week of
Trimesters – 3 gestation and continues until birth (9
weeks/2months-birth)

THE FETUS - During this period, the embryo, now

called a FETUS matures, enlarges and
STAGES OF FETAL grows heavier
DEVELOPMENT:
-The head is disproportionately larger
1. Pre-embryonic Period when compared its body - lacks
- Begins with fertilization and last a subcutaneous fat
about 3 weeks

- As the zygote passes through the
Fallopian tube, it undergoes a series
of mitosis divisions, or cleavage
- Once formed, the zygote develops
into morula and then blastocyts
eventually becoming attached to the
endometrium.
2. Embryonic Period
- Begins with the 4th week of
gestation and ends with the 7th week
(2wk - 8 wks)
- Germ layers develop, giving rise to
organ systems
(Notes from the video: fetal
development)
The embryonic stage of development
begins at day 15 after conception and
continues through week 8. Basic
structures of all major body organs
and the main external features are
completed during this time period,
including internal organs.
By week three the brain, spinal cord,
and the heart begin to develop along
with the gastrointestinal tract. Here,
the neural tube forms which later
becomes the spinal cord. Also, leg
and arm buds begin to appear and
grow out from the small body.

In week four the brain begins to
differentiate and the limb buds grow
and develop more.
In week five, the heart now begins to
beat a regular rhythm . Beginning
structures of the eyes and ears are
noticeable. Some cranial nerves are
now visible and muscles connect to
nerves.
In week six, (first trimester) the
formation of the lungs begins and
fetal circulation is established. The
liver begins producing red blood cells
and the brain develops further. Here,
the primitive skeleton forms and the
central nervous system is now
detectable with brain waves.
In week seven, we see a straightening
of the trunk. Nipples and hair follicles
form, along with elbows and toes.
Arms and legs begin to move more
frequently and the diaphragm is
formed. The mouth and lips become
visible along with early tooth buds.
In week eighth, there is a rotation of
the intestines and facial features
continue to develop. The development
is now complete and the embryo
begins to resemble a human being.
In weeks nine through 12:
sexual differentiation continues. Buds
for all 20 temporary teeth are now laid
down and the digestive system shows
activity. In this stage, the head makes
up nearly half the size of the fetus.
The face and neck are well formed
and the urogenital tract completes its
development. Red blood cells are
produced in the liver and urine begins
to produce and excreted. The fetal
gender can be determined by week 12
using an ultrasound, which also
reveals limbs that are long and thin
and digits that are well-formed.
In weeks 13-16, a fine hair called
“lanugo” develops on the head. The
fetal skin is almost transparent as
bones become harder. (week 14) The
fetus makes active movements and
sucking motions are made with the
mouth.
Week 15 (second trimester) the fetus
swallows amniotic fluid and external
genitalia are recognizable at this
stage.
Weeks 16, fingernails and toes are
also present as the fetus’ weight
quadruples. It is usually during this
phase that fetal movement , also
known as quickening, is detected by
the mother.
Week 17-20, show a rapid brain
growth with fetal heart tones that can
be heard with a stethoscope. The
kidneys will continue to secrete urine
into the amniotic fluid.
The vernix caseosa, which is a white
greasy film, now covers the fetus.
Week 20- The eyebrows and head
hair may appear and brown fat is
deposited to help maintain the fetus’
temperature. Muscles are well
developed and nails are present on
both fingers and toes.
During weeks 21-24:
Week 22:eyebrows and lashes are
well formed. The fetus has a hand
grasp and startle reflex.
Week 23: Alveoli begin forming on
the lungs and skin remains translucent
and red.
Week 24: The eyelids still remain
sealed and the lungs begin to produce
surfactant.
During the weeks 25-28, the fetus
reaches about 15 inches.
Week 26-27: There is a rapid
development of the brain and eyelids
are able to open and close.
Week 28: The nervous system is now
able to control some functions of the
fetus. Fingerprints are also set.
Subcutaneous fat is now visible under
skin. Blood formation shifts from the
spleen to bone marrow and the fetus
usually assumes a head down
position.
In weeks 29-32, there is a rapid
increase of body fat. There is an
increased central nervous system
control over body functions and
rhythmic breathing is now
established. However, the lungs are
not fully mature. Pupillary reflex is
now present and the fetus stores iron,
calcium, and phosphorus.
During the 33-38 weeks, (third
trimester) :
- the testes are in the scrotum of the
male fetus.
-Lanugo begins to disappear.
-The fetus has a good strong hand
grasp reflex and increases in body fat.
-earlobes are formed and firm.
-fingernails reach the end of the
fingertips and small breast buds are
present on both sexes. The mother
supplies the fetus with antibodies
against disease.
-The fetus is considered full-term at
38 weeks, when the fetus fills all the
available space in the uterus.
EMBRYONIC AND FETAL
STRUCTURES
DECIDUA
-refers to the endometrial lining
during pregnancy
3 Separate layers:
DECIDUA BASALIS - lies directly
under the embryo; it’s where
trophoblasts connect to the maternal
blood vessels
DECIDUA CAPSULARIS - Stretches
over or forms a capsule over the
trophoblast; enlarges as the embryo
grows; eventually coming into contact
& fusing at the opposite side of the
uterine wall
DECIDUA VERA/PARIETAL -
remaining area of the endometrial
lining
ENDOCRINE FUNCTIONS OF
THE DECIDUA
- Secretes PROLACTIN to promote
lactation
- Secretes RELAXIN, which relaxes
the connective tissue of the symphysis
pubis and pelvic ligaments; also
promotes cervical dilation
- Secretes PROSTAGLANDIN,
important for mediating several
physiologic functions
CHORIONIC VILLI
- Develops on the 11th / 12th day
- Miniature villi or probing fingers
that reach out from the single layer of
cells into the uterine endometrium
2 layers of chorionic villi:
1. SYNCYTIOTROPHOBLAST/
SYNCYTIAL LAYER
-Produces HCG, somatomammotropin
(HPL), estrogen and progesterone
- Outer layer
 2. CYTOTROPHOBLAST/ Fetal side - shiny and gray
LANGHAN’S LAYER

- Inner layer

- Develops after fertilization - 12 days

gestation

- Functions in early pregnancy by

protecting the growing embryo and
fetus from certain infectious
organisms.

PLACENTA
- Latin for pancake
MECHANISMS OF PLACENTA:
- is formed by the union of chorionic
villi and decidua basalis SCHULTZ’ mechanism
- fetal side goes out first
- Contains 15 - 29/30 subdivisions - Most common; 80% of deliveries
called COTYLEDONS
DUNCAN’s mechanism
- Maturity: 12 weeks/3 months; - 20%
functions most effectively through 40
- 41 weeks 15- 29 subdivisions called cotyledons

- Weighs 400-600 gm; 1/6 of the FUNCTIONS OF THE

weight of the baby; measures from
15-20cm in diameter and 2-3cm in
depth at term
2 parts:
PLACENTA
1. Respiration, circulation
- 1 Umbilical vein - carries
oxygenated blood

Maternal side - has a rough surface - 2 Umbilical arteries - carry

deoxygenated blood
- Foramen ovale - septal opening
between the atria of the fetal heart
- Ductus arteriosus - connects the
pulmonary artery to the aorta,
allowing blood to shunt around the
fetal lungs
- Ductus venous - carries oxygenated
blood from the umbilical vein to the
inferior vena cava bypassing the liver
2. Nutrition
- supplies the fetus with CHO, H2O,
fats, CHON, minerals and inorganic
salts
3. Protection
- transfers passive immunity via
maternal antibodies (IgG)
4. Excretion
- it carries end products of fetal
metabolism to the maternal
circulation for excretion
5. Endocrine function
- produces hormones
HCG - first hormone produces
Estrogen - hormone of women
- primarily Estriol
- contributes to the mother’s
mammary gland development
- stimulates uterine growth to
accommodate the developing fetus
Progesterone - hormone of mothers
- necessary to maintain the
endometrial lining of the uterus
during pregnancy
- reduce the contractility of the uterine
musculature during pregnancy, which
prevents premature labor
HPL / Human Chorionic
Somatomammotropin
- Growth promoting and lactogenic
properties
- Regulates maternal glucose, CHON,
and fat levels
(Notes from the video “The Placenta:
It’s Development and Function”)
Development of the placenta begins
during implantation when the
blastocyst adheres to the endometrial
epithelium. Trophoblast cells
differentiate into an inner Sado
trophoblast layer and an outer since
the co-trophoblasts proliferate newly
formed cells migrate into the
syncytiotrophoblasts and lose their
cell membrane forming a rapidly
growing multinucleated mass.
The cytotrophoblast secretes
proteolytic enzymes and the sincere
trophoblast sends out finger-like
projections allowing the blastocyst to
embed into endometrium.
Lacunae or spaces begin to form
within the syncytial trophoblast as the
sensational trophoblast erodes the
endometrial blood vessels of the
gland, the lacunae become filled with
maternal blood and glandular
secretions.
Isolated lacunae used to form a
network through which maternal
blood flows thus establishing utero
placental circulation
Toward the end of the week, small of
projections cytotrophoblast begin to
expand into the subsea triple blast
forming primary chorionic villi early
in the third week extraembryonic
mesoderm grows into these villi
forming a core of loose connective
tissue at which point the structure in
the nest secondary politically aligned
by the end of the third week
embryonic blood vessels have begun
to form in the extraembryonic
mesoderm of the secondary chorionic
villi transforming then into tertiary
bionic- the line motto trophoblast
cells from the tertiary villi grow
toward the decidua by stylus and
spread across it to form inside a triple
plastic shell villi that are connected to
the Decidua basalis through the side
of the triple plastic shell are called
Anchoring thumbs
real icons and the sides of the stimuli
are called branch building
 Oxygenated fetal blood travels
through ains converging into a single
These branch reliant are surrounded umbilical vein that goes to the fetus.
by the interval of space and will serve
as the main signs of exchange
between the mother and fetus.

By the fourth week, fetal blood flow

is established poorly oxygenated
blood is transported to the placenta
from the fetus via paired umbilical
arteries
Blood returns to the maternal
circulation through endometrial fades
or stops by the pressure of incoming
arterial blood.

The placenta nourishes the fetus

throughout development and is
delivered shortly after parturition .
to the placenta from the fetus via
paired umbilical arteries these arteries
send branches into the toilet villi and UMBILICAL CORD
divide to capillary networks at the
terminal ends.
Carbon dioxide and waste are
removed from the field circulation of
classic essential membrane to the
maternal blood and the interval of
space.

Oxygen and nutrients are transported

across the placental method in the
maternal blood to the fetal capillaries.
- Originates from the amnion and
chorion
- Serves as the lifeline from the
embryo to the placenta; provides
circulatory pathway
- The chorionic villi on the medial
surface of the trophoblast gradually
thin and leave the medial surface of
the structure smooth

- About 53 - 55 cm (21 inch) in length - The smooth chorion eventually

at term becomes the chorionic membrane, the
outermost fetal membrane
3 Parts:
Chorion - outer wall of blastocyst
● 1 vein
- covering of the fetus
● 2 arteries
- holds the sac of amniotic fluid
Wharton’s jelly - gelatinous
substance that helps prevent kinking Amniotic / amniotic membrane -
of the cord in uterus (cord coiling / holds / lines amniotic fluid
nuchal cord); gives the cord body and
prevents pressure on the veins and - inner fetal membrane
arteries
- forms beneath the chorion

FETAL MEMBRANES & - also produces the fluid (amniotic

AMNIOTIC FLUID fluid)

Amniotic fluid - source is the fetal

urine and amnion secretions

Characteristics:

- clear / yellowish

- 800 - 1200 cc

- 7.2 pH
Amniotic fluid is responsible for:
Protecting the fetus: The fluid
cushions the baby from outside
pressures, acting as a shock absorber.
Temperature control: The fluid
insulates the baby, keeping it warm
and maintaining a regular
temperature.
Infection control: The amniotic fluid
contains antibodies.
Lung and digestive system
development: By breathing and
swallowing the amniotic fluid, the
baby practices using the muscles of
these systems as they grow.
Muscle and bone development: As the
baby floats inside the amniotic sac, it
has the freedom to move about, giving
muscles and bones the opportunity to
develop properly.
Lubrication Amniotic fluid prevents
parts of the body such as the fingers
and toes from growing together;
webbing can occur if amniotic fluid
levels are low.
Umbilical cord support: Fluid in the
uterus prevents the umbilical cord
from being compressed. This cord
transports food and oxygen from the
placenta to the growing fetus.
Normally, the level of amniotic fluid
is at its highest around 36 week of
pregnancy, measuring around 1 quart.
This level decreases as birth nears.
When the waters break, the amniotic
sac tears. The amniotic fluid
contained within the sac then begins
to leak out via the cervix and vagina.
The waters usually break toward the
end of the first stage of labor. When
this happens, it is time to contact the
health provider as delivery may be
imminent.
Problems of Amniotic Fluid:
Oligohydramnios - lesser amount of
amniotic fluid (300cc)
Polyhydramnios- excessive amount
of fluid (3000-5000cc)
Embryonic Germ Layers:

The endoderm is the innermost of the
three germ layers. Cells derived from
the endoderm eventually form many
of the internal linings of the body,
including the lining of most of the
gastrointestinal tract, the lungs, the
liver, the pancreas and other glands
that open into the gastrointestinal
tract, and certain other organs, such as
the upper urogenital tract and female
vagina. Endoderm cells give rise to
certain organs, among them the colon,
the stomach, the intestines, the lungs,
the liver, and the pancreas.
The ectoderm, on the other hand,
eventually forms certain “outer
linings” of the body, including the
epidermis (outermost skin layer) and
hair.
The mesoderm also is the precursor
to mammary glands and the central
and peripheral nervous systems.
EMBRYONIC AND FETAL
STRUCTURES
1. Cardiovascular System
- One of the 1st systems to become
functional in intrauterine life
- Single heart tube forming as early as
the 16th day of life, beating as early
as the 24th day
- Heart beat may be heard with a
Doppler as early as the 10th - 12th
week of pregnancy; 16th - 20th week
with a stethoscope
(Notes from the video: Fetal
circulation right before birth)
Before a baby is born, there are a lot
of adaptations that we see that allow
the baby to take nutrients and oxygen
from mom and successfully get those
nutrients and oxygen to the different
cells that need them in the body
Before birth while the baby is still in
the uterus
The placenta has mom’s blood. And
the baby actually sticks its little
capillaries (oxygen is getting picked
up) it’s getting oxygenated
Umbilical vein is actually going to
carry oxygen and blood back towards
the liver area,
Adaptation:
1. Umbilical vein- once the
blood goes into the umbilical
vein, it has kind of a branch
 point. It can either go to the
right or to the left.
If it goes to the left, it’s going to enter
the liver.
Ductus Venosus- is basically going to
allow blood to go from the umbilical
vein, through it. It’s like a little tube
just like any other blood vessel. It’s
going through it and on other side, it
hits and meets up with the inferior
vena cava (IVC)
Inferior Vena Cava (IVC)
-is a large vein picking up blood from
the right leg and left leg (branch)
- IVC meets up with the blood coming
from the umbilical vein, which is very
oxygenated. The blood rises up from
the right atrium on this side. And
simultaneously, you actually have
blood from the Superior vena cava
(SVC)
2. Ductus Venosus- shortcut from
the umbilical vein over to the
inferior vena cava
When the blood is in the right atrium,
it has a couple of options:
First, it could simply go down into
the right ventricle and some of the
blood does that. It just goes right to
the ventricle. And if it goes into the
right ventricle , it’s going to get
squeezed, it goes into the pulmonary
artery.
The pulmonary artery has a branch
over the lungs on both sides.
Remember, once the blood kind of
approaches the lungs, we have to
think about what’s going on inside of
the lungs.
Air sacs- actually are not full of air
but a fluid ( it’s because the baby is
still inside the uterus and it’s full of
fluid)
If it’s full of fluid, that means there's
not much oxygen. What’s happening
there is that there’s a process called
hypoxic pulmonary vasoconstriction -
the alveolus literally tries to help
constrict the arteriole.
And because there’s no oxygen, the
alveolus is going to cause the little
arteriole to basically contract down.
If there’s a lot of resistance, the
pressure in the pulmonary artery is
going to be very high.
The right atrial pressure starts getting
high that it starts getting so high that
it starts getting higher than the
pressure at the left atrium .
A little bit of blood flow that starts
going from the right atrium across
that foramen ovale, that allows blood
to actually go across to it.
3. Foramen ovale- allows blood
to go from one atrium over to
the other.
From the left atrium, blood is going to
go down into the left ventricle and it’s
going to squeeze in the aorta and the
aorta is distributing blood all the way
down.
4. Ductus Arteriosus
- Allows the blood to go from the
pulmonary artery to the aorta.
- This explains why there’s not
too much blood coming back
through the pulmonary veins.
 - It’s because a lot of the blood
goes into the pulmonary artery
trunk, ends up going into the
aorta
5. Umbilical artery- bringing
blood back towards the
placenta.
The placenta has low resistance and it
makes the blood divert towards it.
2. Respiratory System
- 3rd week, respiratory and digestive
tracts exists as a single tube
- End of 4th week, a septum begins to
divide the esophagus from the
trachea. At the same, lung buds
appear on the trachea
- Spontaneous respiratory movements
begins as early as 3 months
- SURFACTANT, a phospholipid
substance is formed and excreted by
the alveolar cells at about 24th week.
This decreases alveolar surface
tension on expiration, preventing
alveolar collapse
Surfactant has 2 components:
- 35th weeks - lecithin and
sphingomyelin ( L/S )
- Ratio: 2:1
- With fetal lung movements,
surfactant mixes with amniotic fluid
3. Nervous System
- Develops during 3rd and 4th week
of life
- Neural plate (thickened portion of
ectoderm) is apparent by 3rd week of
gestation
- Brain waves can be detected on EEG
by the 8th week
- By 24th week, the ear is capable of
responding to sound; the eye exhibit a
pupillary reaction, indicating sight is
present
4. Endocrine System
- They mature in intrauterine life
5. Digestive System
- Separated from the respiratory tract
at about 4th week
- MECONIUM (first feces sa fetus)
forms in the intestines as early as the
16th week. It consists of cellular
wastes, bile, fats, mucoproteins,
mucopolysaccharides, and portions of
the vernix caseosa
- Meconium is black or dark green
(obtaining its color from bile pigment
and sticky
- Sucking and swallowing reflexes are
not mature until the fetus is about 32
weeks or the fetus weighs 1500 gm
6. Musculoskeletal System
- Quickening - 1st fetal movements
perceived by the mother
16th week - multiparous
20th week - primipara
- Fetus can be seen to move on
ultrasound as early as 11th week
7. Reproductive System
- Child’s sex is determined at the
moment of conception
- Can be determined as early as 8
weeks by chromosomal analysis
- Gonads form at about 6th week
- Testes first form into the scrotal sac
late in intrauterine life at the 34th -
38th week
8. Urinary System
- Rudimentary kidneys are present as
early as the end of the 4th week
- Urine is formed by the 12th week
and is excreted into the amniotic fluid
by the 16th week of gestation
- At term, fetal urine is being excreted
at the rate of 500 ml/ day
9. Immune System
- IgG maternal antibodies cross the
placenta into the fetus primarily
during the 3rd trimester of pregnancy,
giving a fetus temporarily passive
immunity against diseases for which
the mother has antibodies
- The level of passive IgG
immunoglobulins peaks at birth and
then decreases over the next 9 months
10. Integumentary System
Skin covered by soft downy hairs
(lanugo), and a cream cheese like
substance Vernix Caseosa - secreted
by sebaceous glands, important for
lubrication, provide warmth, and keep
skin from macerating.

ASSESSMENT of FETAL WELL-
BEING
1. FETAL MOVEMENT
-Also called “quickening” described
as light fluttering
-Typically follows a consistent
pattern, usually on the average of at
least 10x/per day
Sandovsky method
to assess the fetal movement, ask the
woman to lie in a recumbent position
after a meal and record the number
of fetal movements within an hour. In
every 10 minutes, the fetus normally
moves twice or 10 to 20 times in an
hour.
Cardiff method
A way to assess intrauterine well-
being in which the expectant woman
records fetal movement during her
usual activities. There should be at
least 10 movements within a 12-hour
period; if fewer than 10 movements
are perceived, further medical
evaluation is needed.
2. FETAL HEART SOUNDS /
RATE
-Heart rate should be 120 - 160 bpm
A. Rhythm Strip Testing
-Assessment of the FHR in terms of
baseline and long and short
variability.
-Rhythm strips requires the mother to
remain in a fixed position for 20
minutes
Baseline- refers to the average rate of
the FHR per minute.
Short- Term Variability / Beat- to-
Beat Variability- small changes in
rate that occur from second to
second.
Long- Term Variability - the
differences in the heart rate that occur
in the 20-minute time period.
B. Non- Stress Test (NST)
-Measures the response of the FHR to
fetal movement
-The woman pushes a button attached
to the monitor whenever she feels the
fetus move.
-Fetal movement typically results in
an increase FHR of about 15 bpm

-This increase should be sustained for

about 15 seconds and turn to baseline
or average when fetus quiets down

-Absence of an increase in FHR with

movement is high suggestive of fetal
hypoperfusion/ fetal hypoxia

-Non-stress test is usually done for

10-20 minutes or 20-40 minutes

-The test is REACTIVE if two

accelerations of FHR (15bpm or
more) lasting for 15 seconds occur
with the fetal movements

C. Stress Test/ Contraction Stress

Tests/ Oxytocin Challenge
Test (OCT)
Method of evaluating fetal ability to
withstand decreased O2 supply and
the physiologic stress of an oxytocin.

-Induced contractions before true

labor begins.

D. Nipple Stimulation Stress Test

(Notes from the video “Non- Stress/
Stress Test” )
(Breast Self -Stimulation)
-Carries the risk of hyperstimulation
or embarrassment because it can’t be
controlled if there’s hyperstimulation.
-May require nipple rolling or
application of warm washcloths to
one nipple
-Induce contractions by activating
sensory receptors in the areola,
triggering the release of oxytocin by
the posterior pituitary gland
-Exhibits the same reactive pattern as
the reactive NST result and the same
pattern as the abnormal OCT result.
3. BIOPHYSICAL PROFILE
-Assesses several variable
● Fetal breathing movements
● Fetal body movements
● Fetal muscle tone
● Fetal amniotic fluid volume
● Fetal heart rate reactivity
PLACENTAL GRADE
-Each variable is scored as 0-2, with 0
indicating abnormal finding and 2
indicating a normal finding ; some
institutions use a scoring system of 0,
1 and 2; total score is then calculated
-This profile is commonly referred to
as the FETAL APGAR SCORE
because scoring is similar to that of
the NEONATAL APGAR SCORE
-Can detect CNS depression
4. ULTRASOUND
-Provides immediate results without
potential harm to the fetus or the
mother
-Non-invasive and painless
-Provides info about fetal presence,
size, position, and presentation,
placental location, amniotic fluid and
gestational maturity via biparietal
measurements
-Evidence of normal fetal growth or
possible defects or malformations,
fetal death, malpresentations,
placental abnormalities, multiple
gestation and hydra nips or
oligohydramnios
-It is helpful if the mother has a full
bladder at the time of the procedure.
-May also be done by an intravaginal
technique
5. BIPARIETAL DIAMETER
 - The widest transverse diameter
of the fetal head; a side to side
measurement obtained using
the ultrasound
- Measurements can be made by
12-13 weeks of gestation

-Typically, if biparietal diameter is

8.5 cm or more, the fetus will weigh
more than 5.5 lb (2,500g)

6. DOPPLER UMBILICAL
VELOCIMETRY
- Measures the velocity at which
RBC on the uterine and fetal vessels
are traveling

7. PLACENTAL GRADING
-Placentas can be graded by the
ultrasound as 0 (a placenta 12-24
weeks), 1 (30-32 weeks), 2 (36weeks)
Because fetal lungs are apt to be
mature at 38 weeks; a grade 3
placenta suggests that the fetus is
mature.

8. AMNIOTIC FLUID VOLUME

(Notes from the video: “Grades of
Placenta”)
ASSESSMENT
-Amount of amniotic fluid present is
an important fetal assessment measure
because a portion of the fluid is
formed by fetal kidney output

9. ELECTROCARDIOGRAPHY
- May be recorded as early as the
11th week of pregnancy
10. MRI
-Has the potential to replace or
complement ultrasound s a fetal
assessment technique
-It may be most helpful in diagnosing
complications such as ectopic
pregnancy/ trophoblast disease.
11. MATERNAL SERUM
ALPHA-FETOPROTEIN
-Requires a blood sample obtained via
venipuncture to evaluate the level of
alpha fetoprotein in the mother’s
serum.
-Fetal liver produces alpha fetoprotein
- This CHON crosses the placenta
and appears in the mother’s serum
-Alpha-fetoprotein begins to rise at 11
weeks gestation, then steadily
increases until term
-Elevated maternal serum AFP
(MSAFP) level suggest a neural tube
defect or other neural tube anomaly
(open spinal/abdominal defect)- open
body defects
-Decrease MFAP levels are associated
with Down Syndrome
PARENTAL VISIT
During a normal pregnancy, return
appointments are usually scheduled:
● Every 4 weeks through the
32nd week
● Every 2 weeks through the 36th
week
● Every week until birth
Purpose of Prenatal care:
-Establish a baseline of present health
-Determine gestation age of the fetus
-Monitor fetal development
-Identify the woman at risk for
complications
-Minimize the risk of possible
complications by anticipating and
preventing problems before occur
- Provide time for education about
pregnancy and possible dangers
BATHING
During the pregnancy, sweating tends
to increase because the woman
excretes waste products for herself
and the fetus. She also has increased
vaginal discharges
For these reasons, today daily baths or
showers are recommended
If membrane ruptures or vaginal
bleeding is present, tub baths are
contraindicated because there would
be danger of contamination of uterine
contents.
BREAST CARE
Proper breast support promotes
comfort, retains breast shape, and
prevents back strain.
Washing the breast with clear water
and no soap is recommended
Gauze/breast pads may be needed if
the woman’s secretion of colostrum is
significant
DENTAL CARE
Dental check-up early in pregnancy
and routine examination and cleaning
are encouraged
Nausea and vomiting, heartburn, and
hypermedia of gums may lead to a
poor oral hygiene and dental caries
The fetus receives calcium and
phosphorus from the pregnant
patient’s diet, not form her teeth
Nutritious snacks, such as fresh fruits
and vegetables, are recommended to
avoid excessive contact of sugar with
teeth.
PERINEAL HYGIENE
Douching is contraindicated.
The force of the irrigating fluid could
possibly enter the cervix and lead to
infection
DRESSING/ CLOTHING
Clothes should be non-constrictive
(impede lower extremity circulation)
Low to mid heeled shoes are
recommended to prevent backache
and poor balance
Comfort is the key :)
SEXUAL ACTIVITY
Sexual behavior is usually
unrestricted in compilation free
pregnancies
Discouraged on the 36th week, it
causes premature labor.
IMMUNIZATIONS
Immunizations with attenuated live
viruses (mumps) shouldn’t be given
during pregnancy because of their
teratogenic effect on the developing
of the embryo
Vaccinations with killed viruses
(DPT) may be given.
PRECAUTIONS
Working site should be checked for
potential environmental hazards, such
as pesticides, anesthetic gas, and
heavy metals such as lead and
mercury (kay maka cause daw og
microcephalus/ microcephaly sa
baby)

Work duties may have to be altered to

avoid excessive physical strain; rest
periods need to be scheduled to avoid
fatigue

When riding in a car, seat belts should

be worn low, under the abdomen

If a long trip is planned, the woman

should get out of the car every hour to
walk around

Airplane travel is permissible in

places with well- pressurized cabins;
some airlines have restrictions for
over 7 months pregnant.

TERATOGENS
Any factor, chemical or physical that
adversely affects the fertilized ovum,
embryo, or fetus.