MATERNAL AND CHILD NURSING MANALO, COREEN ANGELIE G.

GOALS AND PHILOSOPHIES OF MATERNAL AND CHILD HEALTH NURSING

OBSTETRICS – or the care of women during childbirth, is derived from the Greek
word “obstare” which means to “keep watch”
PEDIATRICS – is a word derived from the Greek word “Pais” meaning “child”
- The care of childbearing and childrearing families is a major focus of nursing
practice, because to have healthy adults, you must have healthy children.
- To have healthy children. It is important to promote the health of the child-
bearing woman and her family from the time before the children are born
until they reach adulthood.
- The nurse’s role in all these phases focus on promoting healthy growth and
development of the child and family in both health and illness.
- The full scope of nursing practice in this area is not two separate entities but
rather a continuum: maternal and child health nursing.
- The primary goal of maternal and child health nursing can be stated simply
as the promoting and maintenance of optimal family health to ensure
cycles or optimal childbearing and childrearing .
THE RANGE OF PRACTICE INCLUDES:
 Preconceptual health care
 Care of women during three trimesters of pregnancy and the
puerperium (the 6 weeks after childbirth, sometimes termed
the fourth trimester of pregnancy)
 Care of the infant during the perinatal period (6 weeks before
conception to 6 weeks after birth)
 Care of children from birth through adolescence
 Care of setting as varied as the birthing room, the pediatric ICU
and at home.
PHILOSOPHIES
- Maternal and child health nursing is family centered; assessment must
include both family and individual assessment data.
- Maternal and child health nursing is community centered; the health of
families depends on and influences the health of communities.
- Maternal and child nursing is evidence based, because this is the means
whereby critical knowledge increases.
- A maternal and child health nurse serves as an advocate to protect the rights
of all family members, including the fetus.
- Maternal and child health nursing includes a high degree of independent
nursing functions because teaching and counseling are major interventions.
- Promoting health and disease prevention are important nursing roles
because these protect the health of the next generation.

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- Maternal and child health nurses serves as important resources for families
during childbearing and childrearing as these can be extremely stressful
times in a life cycle.
- Personal, cultural, and religious attitudes and beliefs influence the meaning
and impact of childbearing and childrearing on families.
- Circumstances such as illness or pregnancy are meaningful only in the
context of a total life.
- Maternal and child health nursing is a challenging role for nurses and a major
factor in keeping families well and optimal functioning.
ADVANCE-PRACTICE ROLES FOR NURSES IN MATERNAL AND CHILD HEALTH

CLINICAL NURSE SPECIALIST – nurses prepared at the master’s or doctorate

degree level who are capable of acting as consultants in their area of expertise. As
well as serving as role models, researchers, and teachers of quality nursing care.
Examples of areas of specialization are neonatal, maternal, child, and
adolescence health care; genetics; child birth education; and lactation
consultation
CASE MANAGER – A graduate-level nurse who supervises a group of patients
from the time they enter a health care setting until they are discharged from the
setting or, in a seamless care system, into their homes as well as monitoring the
effectivess, cost, and satisfaction of their health care.
NURSE PRACTITIONER – doctor of nursing practice programs are designed to
prepare nurse practitioner with he highest level of practice expertise integrated
with the ability to translate scientific knowledge into complex clinical interventions.
- Preparing nurse practitioners at the doctor of nursing practice level has the
potential to expand the scientific basis for practice as well as create leaders
for organization.
WOMEN’S HEALTH NURSE PRACTITIONER – has advanced study in the
promotion of health and prevention of illness in women.
- Such a nurse plays a vital role in educating women about their bodies and
sharing with them the minor methods to prevent illness
- They care for women with illnesses such as STI, and offer information and
counsel them about reproductive planning
PEDIATRIC NURSE PRACTITIONER – a nurse prepared with extensive skills in
physical assessment, interviewing, and well-child counseling and care.
- In this role, a nurse interviews parents as part of an extensive health history
and performs a physical assessment of the child.

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- If the nurse’s diagnosis as that the child is well, he or she discusses with the
parents any childbearing concerns mentioned in the interview, administers
any immunization needed, offers necessary anticipatory guidance (based on
the plan of care), and arranges a return appointment for the next well child
checkup.
NEONATAL NURSE PRACTITIONER – an advanced – practice role for nurses who
are skilled in the care of newborns, both well and ill.
- NNPs may work in Level 1, Level 2, or Level 3 newborn nurseries, neonatal
follow up clinics or physician group.
- Responsibilities include managing and caring for newborns in extensive care
units, conducting normal newborn assessments and physical examinations
and providing high-rise follow up discharge planning.
FAMILY NURSE PRACTITIONER – an advance-practice role that provides health
care not only to women and children but also to my family as a whole. In
conjunction with a physician.
- An FND can provide prenatal care for a woman with an uncomplicated
pregnancy.
- The FNP takes the health and pregnancy history, performs physical and
obstetrics examinations, orders appropriate diagnostic and laboratory tests.
And plans continued care throughout the pregnancy and for the family
afterward.
CERTIFIED NURSE-MIDWIFE – an individual educated in the two disciplines of
nursing and midwifery and licensed.
- Plays an important role in assisting women with pregnancy and childbearing.
- Either independently or in association with a physician, the nurse-midwife
assumes full responsibility for the care and management of women with
uncomplicated pregnancies.
- Nurse-midwives play a role large in making birth and unforgettable family
event as well as helping to ensure a healthy outcome for both mother and
child.
INTRAUTERINE DEVELOPMENT
- The sex of an individual is determined at the moment of conception by the
chromosome information supplied by the particular ovum and sperm that
joined to create the new life.
- A gonad is a body organ that produces the cells necessary for reproduction
(the ovary in females, the testis in males)
- An approximately week 5 of intrauterine life, primitive gonadal tissue is
already performed.

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- In both sexes, two undifferentiated ducts, the mesonephric (wolffian) and

paramesonephric (Mullerian) ducts, are present.
- Mesonephric ducts develop in males.
- Paramesonephric ducts develop in females.
- By week 7-8, in chromosomal males, this early gonadal tissue differentiate
into primitive testes and begins formation of testosterone.
- Under the influence of testosterone, the mesonephric ducts begins to
develop into the male reproductive organs and the paramesonephric duct
regresses.
- If testosterone is not present by week 10, the gonadal tissue differentiates
into ovaries, and the paramesonephric ducts develop into female
reproductive organs.
- All of the oocytes (cells that will develop into eggs throughout the woman’s
mature years) are already formed in ovaries at this stage (Mackay, 2009)
- At about 12 week, the external genitals develop in males, under the
influence of testosterone, penile tissue elongates and the urogenital fold on
the ventral surface of the penis closes to form the urethra; in females with no
testosterone present, the urogenital fold remains open to form the labia
majora in the female.
- If, for some reason, testosterone secretion is halted in utero, a chromosomal
male could be be=orn with female apprearing genitalia.
PUBERTAL DEVELOPMENT
- Puberty is the stage if life at which secondary sec changes begin the changes
are stimulated when the hypothalamus synthesizes and releases
gonadotropin-releasing hormone (GnRH) and which in turn triggers the
anterior pituitary to begin the release of follicle stimulating hormone
(FSH) and leutinizing hormone (LH)
- FSH and LH initiates the production of androgen and estrogen which in turn
initiate secondary sex characteristics, the visible signs of maturity.
- Girls are beginning dramatic development and maturation of reproductive
organs in earlier ages than ever before (9 to 12 years)
- The hypothalamus, under the direction of the central nervous system (CNS)
may serve as a gonadostat or regulation mechanism set top “turn on”
gonad functioning at this stage.
ROLE OF ANDROGEN
- Androgenic hormones are the hormones responsible for muscular
development, physical growth, and the increase in sebaceous gland
secretions that causes typical acne in both boys and girls.
- In males, androgenic hormones are produced by the adrenal cortex and the
testes; in females, by the adrenal cortex and the ovaries

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- The level of the primary androgenic hormone, testosterone, is low in males

until puberty (approximately age 12 to 14 years)
- In girls testosterone influences enlargement of the labia majora and clitoris
and formation of axillary pubic hair.
- This development of pubic and axillary hair because of androgen stimulation
is termed adrenarche.
ROLE OF ESTROGEN
- When triggered at puberty by FSH, ovarian follicles in females, begin to
excrete a high level of the estrogen.
- This hormone is actually not one substance but three compounds (estrogen
(E1), estradiol (E2), estriol (E3))
- The increase in estrogen levels in the female at puberty influences the
development of the uterus, fallopian tube, and vagina. Typical female fat
distribution and hair patterns, breast development, and an end to growth
because it closes the epiphyses of long bone.
- The beginning of breast development is termed thelarche.
PUBERTY – is the stage of life at which secondary sex characteristics begin.
GIRLS (estrogen) BOYS (testosterone)
Growth spurt Increase in weight
Increase in the transverse diameter of Growth of testes
the pelvis.
Breast development Growth of face, axillary, and pubic hair
Growth of pubic hair Voice changes
Onset of menstruation Penile growth
Growth of axillary hair Increase in height
Vaginal secretions Spermatogenesis

ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM

MALE EXTERNAL STRUCTURES
SCROTUM – a rugated-skin covered, muscular pouch suspended from the
perineum
- The functions are to support the testis, and to help regulate the temperature
of sperm.
- In very cold weather, the scrotal muscle contracts to bring the testis closer to
the body, on very hot weather, or in the presence of fever, the muscle
relaxes. Allowing the testes to fall away from the body.
o The looseness of the scrotum is intentional to provide expansion and
contraction.

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o It lowers temperature by 3 degrees

o In this way, the temperature of the testes can remain as even as
possible to promote the production and viability of sperm.
TESTES – are two ovoid glands, 2 to 3 cm wide, that lie in the scrotum.
- Each testis is incased by a protective white fibrous capsule and is composed
of several lobules, with each lobule containing interstitial cells (Leydig’s
cell) and a seminiferous tubule.
- SEMINEFEROUS TUBULES – produce spermatozoa
- LEYDIG’S CELL - are responsible for the production of testosterone.
- Testes in a fetus first form in the pelvic cavity. They descend late in
intrauterine life (about the 34th to 38th week), into the scrotal sac.
- Because this descent occurs so late in pregnancy, many male preterm
infants are born with undescended testes.
- Testes that remain in the pelvic cavity may not produce viable sperm and are
associated with a 4 to 7 times higher incidence of testicular cancer.
- The hypothalamus releases GnRH, which in turn influences the anterior
pituitary gland to release FSH and LH.
- FSH is then responsible for the release of androgen-binding protein (ABP)
- LH is responsible for the release of testosterone
- ABP binding of testosterone promotes sperm formation. As the amount of
testosterone increases, a feedback effect on the hypothalamus and anterior
pituitary gland is created that slows the production of FSH and LH and
ultimately decreases or regulates sperm production.
- in most males, one testis is slightly larger than the other and to suspended
slightly lower in the scrotum than the other (usually the left one)
- because of this, testes tend to slide past each other more readily on sitting
or muscular activity, and there is less possibility of trauma to them
- spermatozoa do not survive at a temperature as high as that of the
body. However, so the location of the testes outside the body, where the
temperature is approximately 1 degree F lower than the body temperature,
provides protection for the sperm survival.
FOOTNOTE: testis = singular ; testes = plural; xy = male; xx = female;
undescended testis = cryptorchidism
PENIS – tubular structure located above the scrotum, composed of shaft and
glans.
- Half of it is an internal root and hair is the external visible shaft.
- Soft and flaccid (2.5 inches to 4 inches)
- Erection – blood vessels in the shaft become congested, penis become hard
and erect (5.5 inches to 7 inches)

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GLANS – the distal end of the organ is bulging sensitive ridge of tissue which has
the external urinary meatus at its tip (most sensitive)
CORONA - the proximal margin of the glans
PREPUCE – also called the foreskin (UTI CAUSE)
- Loose skin attached to the shaft, allowing for expansion during erection.
- Retractable casing of skin that protects the nerve sensitive glans and birth.
FRENULUM – Ventral fold of tissue attaches the skin of the glans.
- Contains the urethra as well as the corpora cavernosa
o 2 dorsal erectile tissues known as the corpora cavernosa
o 1 midventral tissue known as the corpus spongiosum.
 Surrounds penile area
 Expands distally to form the glans penis.
ERECTION PROCESS
Sexual excitement  nitric acid is released from the endothelium of B.V  results
in the engorgement or an increase of the blood flow to the arteries of the penis 
the ischiovernosus muscle at the penis base then contracts  trapping both veins
and arterial blood in the 3 sections of erectile tissue  leading to distenstion and
erection of the penis.
EPIDYMIS – seminiferous tubule of each testes leads to a tightly coiled tube.
- The epididymis is approximately 10 ft long
- The site of sperm maturation and storage.
- Responsible for conducting sperm from the testes to the vas deferens.
- Contains smooth muscle to propel sperm during ejaculation.
- Sperm are immobile and incapable of fertilization as they passed or are
stored at the epididymis level.
- It takes 12-20 days to travel the length of the epididymis.
- A total of 64 days to reach maturity.
o ASPERMIA – absence of sperm
o OLIGOSPERMIA – less than 20 million per mL.

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 These are problems that do not appear to respond immediately

to therapy but rather only after 2 months.
VAS DEFERENS (ductus venosus) – it carries sperm from the epididymis
through the inguinal canal into the abdominal cavity where it ends at the seminal
vesicle and ejaculatory ducts. It is about 40cm long.
- The vas deferens serve as a transport function and the area of the ampulla
serves as a storage.
- Sperm mature as they passed through the vas deferens.
- It is believed that the vas deferens acts as reservoir for sperm between
ejaculation.
SEMINAL VESICLES – 2 convoluted pouches that lie along the lower portion of
posterior surface of the bladder and empty into the urethra by way of ejaculatory
ducts.
- Secretes seminal fluid
- Sperm becomes increasingly motile because of the viscous portion of the
semen secreted by these glands which serves as nutrients and more
favorable pH.
EJACULATORY DUCTS – these are formed by the fusion of the vas deferens and
the seminal vesicle.
- The ejaculatory ducts empty into the urethra.
- The ejaculatory ducts are part of the human male anatomy which cause the
reflex action of ejaculation. Each male has two of them.
- They begin at the vas deferens pass through the prostate and empty into the
urethra at the colliculus seminalis. During ejaculation, semen passes
through the ducts and exits the body via the penis.
PROSTATE GLAND – a chestnut size gland that lies just below the bladder, the
urethra passes through the center of it, like the whole donut.
- When added to the secretion from the seminal vesicles and the
accompanying sperm from the epididymis, this alkaline fluid further protects
sperm from being immobilized by the naturally low pH level of the urethra.
BULBOURETHRAL GLAND – 2 bulbourethral or cowper’s gland lie beside the
prostate gland and by short ducts empty into the urethra.
- Secretes an alkaline fluid that helps counteract the acid secretions of the
urethra and ensure the passage of spermatozoa.

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- Produces small droplets of fluid during sexual activity that neutralizes the
acidity of the male urethra and in the transport of sperm.
- 5% semen
URETHRA – a hollow tube leading from the base of the bladder, which after
passing through the prostate gland continues to the outside through the shaft and
glans of the penis. It has three sections:
o PROSTATIC – within the prostate
o MEMBRANOUS – within the urogenital diaphragm
o PENILE (spongy) – within the penis.

- The seminal vesicles, prostate gland, and cowper’s gland produce a liquid
called a seminal plasma which:
- Aids in the transport of sperm.
- Provides energizing nutrients for the sperm
- Contains form of sugar (fructose, mucous, salts, and water base
buffers, coagulator to aid sperm in their journey)
- The sperm collectively make up the semen.
SEMEN/SEMINAL FLUID
- Thick, creamy white fluid with the consistency of mucus or egg whites.
- Normal amount of 2 ml – 6ml per ejaculation
- Fertile man with dispel 20 – 160 million sperm for ejaculation
SPERMATOZOON – is made up of a head and a tail
- The head carries the male’s haploid number of chromosomes (23). The part
that enters the ovum at fertilization.
- The tail specialize in motility
- Sperm may be stored in male genitalia for 42 days
- Sperm can live only 2-3 days in the female genital tract once ejaculated.
FEMALE REPRODUCTIVE SYSTEM
FUNCTIONS:
- It produces the female egg cells necessary for reproduction called the ova or
oocytes

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- It is designed to transport the ova to the site of fertilization

- If fertilization does not take place, the system is designed to menstruate.
- It produces female sex hormone that maintain the reproductive cycle.
MONS VENERIS/ PUBIS – The mons veneris is a pad of adipose tissue located
over the symphysis pubis, the pubic bone.
- It is covered by a triangle of course, curly hairs.
- The purpose is to protect the junction of the pubic bone from trauma
- It contains many nerve endings that makes the mons pubis sensitive to
touch and pressure.
LABIA MAJORA – consists of 2 rounded folds of fatty tissue. It is analogous to the
scrotum.
- The outer lips separates downwards from the mons that meet again below
the vagina introitus.
- It contains multitude of sebaceous and sweat glands.
- It also serves as protection for the external genitalia and the distal urethra
and vagina.
LABIA MINORA – located posterior to the mons pubis veneris, spread 2 hairless
folds of connective tissue.
- It has two smaller lips located within the labia majora
- It appears thin pale pink in color.
- When stimulated, it turns to dark red or dark pink due to presence of blood
vessels, no hair, smooth in texture.
- The interval structure is covered with mucous membrane and the external
portion with skin.
CLITORIS – It is small rounded organ of erectile tissue at the forward junction of
the labi minora, covered by a fold of skin called prepuce.
- The clitoris is sensitive to touch and temperature and is the center for sexual
arousal and orgasm in the female.
- It contains erectile tissue, blood vessels, and nerves.
- It is made up of erectile tissue which many large and small venous channels
surrounded by large amount of involuntary muscle tissue, the
ischiocavernosa facilitate erection of the organ.

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o It measures 5 – 6 mm long and 6 – 8mm across

o Has very rich blood and nerve supplies
FUNCTIONS:
o Stimulate and elevate levels of sexual tension
o Serve as a landmark in locating urethral opening during
catheterization.
FOURCHETTE – Is the ridge of tissue formed by the posterior joining the labia
minora and labia majora
- This structure is sometimes cut (episiotomy) during childbirth to enlarge
the vaginal opening.
VESTIBULE – it is a flattened smooth surface inside the labia
- The opening of the bladder or the urethra, and the vagina, are born arise
from the vestibule.
HYMEN – is a tough but elastic semicircle of tissue that covers the opening to the
vagina in childhood.
- It is comprised mainly of connective tissue both elastic and collagen both
surfaces are covered by stratified squamous epithelium.
- The hymen can be broke through strenuous physical activity or masturbation
- It is often torn during the time of first sexual intercourse.
PARAURETHRAL/SKENE’S GLAND – A pair of small glands lying on each side of
the urethra
- They produce a small amount of mucus and are especially susceptible to
gonorrheal infection
- It is homologous to male prostate.
URETHRAL MEATUS/ ORIFICE – although not a true part, it is considered as part
of the reproductive system because of its closeness and relationship to the vulva.
VAGINAL ORIFICE/ INTROITUS – Occupies the lower portion of the vestibule and
varies considerably in size and shape.
- The vagina has an abundantly vascular supply.
VULVOVAGINAL/BARTHOLIN’S GLAND – Pair of small, pea-sized glands located
within the substances of the labia majora.

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- They correspond to the bulborethral or cowper’s gland in male

- The gland secretes a amount of clear viscid mucus during sexual excitement.
OVARY – It is approximately 4cm long by 2cm in diameter and approximately
1-5 cm thick and the size and shape of an almond.
- Each ovary contains approximately 200,000 to 400,000 follicle during
female’s childbirth
- It secretes hormones estrogen and progesterone which initiate and regulate
menstrual process
FUNCTION:
o Ovulation
o Hormone production
 These also serves as a counterpart to the testes of male.
LAYERS OF THE OVARY
 TUNICA ALBUGENIA – Dense and dull white and serves as protective layers
of the ovary
 CORTEX – Main functional part because it contains ova, graafian follicles,
corpora lutea, degenerated corpora lutea (corpora albicantia)
 MEDULLA – or central portion of the ovary is composed of loose connective
tissue
UTERUS – pear-shaped approximately 3 inches long, purpose is to house and
nurture a pregnancy.
- It receives the ovum from the fallopian tube, to produce a place for
implantation and nourishment during the fetal growth and it furnish
protection to a growing fetus expel from the women’s body.
- a hollow, muscular, pear-shaped organ located in the lower pelvis ,
posterior to the bladder and anterior to the rectum.
- during childhood, it is approximately the size of an olive, and its proportions
are reversed from what they are later (e.g: the cervix is the largest portion of
the organ; the uterine body is the smallest.)
- when a girl reaches approximately 8 years of age, an increase in the size of
the uterus begins.
- An adolescent is closer to 17 years old before the uterus reaches its adult
size
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THREE LAYERS OF THE UTERUS

1. THE BODY OR CORPUS - portion of the structure that expands so
greatly to contain the growing fetus.
o The portion of the uterus between the points of attachment of the
fallopian tube is called fundus = the portion that can be palpated
to measure uterine growth and the force of uterine contraction
during labor.
o The upper most part and forms the bulk of the organ
o The lining of the cavity is continuous with that of the fallopian tubes,
which enter at its upper aspects (the cornual)
o During pregnancy, the body of the uterus is the portion of the structure
that expands to contain the growing fetus.
2. ISTHMUS – Short segment between the body and cervix, during
pregnancy, this portion also enlarges greatly to aid in accommodating the
growing fetus.
o It is the portion of the uterus that is cut when a fetus is delivered by
CS.
o In the nonpregnant uterus, it is only 1mm to 2mm in length. During
pregnancy, this portion also enlarges greatly to aid in accommodating
the growing fetus.
o It is the portion of the uterus that is most commonly cut when a fetus
is born by cesarian birth.
3. CERVIX – lowest portion of the uterus. It represents approximately one
third of the total uterus size and is approximately 2 to 5 cm long
o Approximately half of it lies above the vagina and half extends into the
vagina.
o CERVICAL CANAL – central cavity.
INTERNAL CERVICAL OS – junction of the canal at the isthmus
EXTERNAL CERVIAL OS – distal opening to the vagina
FUNCTIONS:
 Provide lubrication
 Act as a bacteriostatic agent
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 Provide an alkaline environment to shelter deposited sperm from

the acidic vagina
- Secretory cells of the cervix produce about 20 – 60 ml of mucus/day
- At the time of ovulation, this mucus becomes thinner and more alkaline.
- Mucus provides for the energy needs of the sperm, provides sperm from
environment of the vagina
- The mucous membrane lining the cervix is termed the endocervix. The
endocervix, continuous with the endometrium, is also affected by the
hormones, but changes are manifested in a more subtle way.
- The cells of the cervical lining secretes mucus top provide a lubricated
surface so that spermatozoa can readily pass through the cervix.
- Because mucus is alkaline, it helps decrease the acidity of the upper vagina,
aiding in sperm survival.
- During pregnancy, the endocervix becomes plugged with mucus, forming a
seal to keep out ascending infections.
LAYERS OF UTERUS
1. PERIMETRIUM – A part of the visceral peritoneum
o Outermost layer of the uterus, serves the purpose of adding strength
and support to the structure.
2. MYOMETRIUM – bulk of uterus (three layers of muscle that contract
under influence of oxytocin during labor)
o Muscle layer of the uterus is composed of three interwoven layers of
smooth muscle, the fibers of which are arranged in longitudinal,
transverse, and oblique directions.
o This network offers extreme strength to the organ. It also serves the
important function of constricting the tubal junctions and preventing
regurgitation of menstrual blood into the tubes.
o It also holds the internal cervical os closed during pregnancy to prevent
a preterm birth
o When the uterus contracts at the end of pregnancy to expel fetus
3. ENDOMETRIUM – highly vascular mucosa
o STRATUM FUNCTIONALIS – Shed during menstruation

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o STARATUM BASALIS – deeper permanent layer, gives rise to new

stratum functionalis.
FALLOPIAN TUBE – slender structure that extends from either side of the uterus
and end in a fringed fashion near each ovary.
- It transports mature ovum form the ovary to uterus and to provide place for
fertilization of the ovum
- It takes about 3 days for an egg to travel the length, but unfertilized egg
lives only 24 hours. If unfertilized it will die before it arrives in the uterus.
FUNCTIONS:
o Site of fertilization
o Provide transport for the ovum from the ovary to the uterus

- Serve as a warm, moist, nourishing environment for the ovum or zygote.

PARTS OF THE FALLOPIAN TUBE
1. INSTERSTITIAL PORTION – lies within the uterine wall
o Lumen is 1mm in diameter
o Approximately 1cm in length
2. ISTHMUS – the next distal portion
 2cm in length
 This portion is cut and sealed in the tubal ligation
3. AMPULLA – Longest portion
 5cm in length
 Fertilization of ovum occurs
4. INFUNDIBULAR – most distal segment
 2cm in length
 Funnel shape
 The rim of the funnel is covered by fimbrae or small hairs that
 Help to guide the ovum into the fallopian tube
LAYERS OF FALLOPIAN TUBE
 PERITONEAL (serous) – covers the tubes

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 SUBSEROUS (adventitial) – contains the blood and nerve supply

 MUSCULAR – responsible for the peristaltic movement of the tube
 MUCOSAL – composed of ciliated and unciliated cells with the number
of ciliated cells more abundant at the fimbrae.

UTERINE DEVIATION
- Several uterine deviations (shape and position) may interfere with fertility or
pregnancy in the fetus, the uterus first forms with a septum or a fibrous
division, longitudinally separating it into two portions.
- As the fetus matures, this septum dissolves, so that typically at birth no
remnant of the division remains. In some women, the septum never
atrophies, and so the uterus remains as two separate compartments.
- Still other women have oddly shaped “horns” at the junction of the fallopian
tube, termed a bicornuate uterus.
- Any of these malformations may decrease the ability to conserve or to carry
a pregnancy to term.
ANTEVERSION – A condition in which the entire uterus is tipped far forward
RETROVERSION – a condition in which the entire uterus is tipped backward.
ANTEFLEXION – A condition in which the body of the uterus is bent sharply
forward at the junction with the cervix.
RETROFLEXION – A condition in which the body is bent sharply back just
above the cervix.

UTERINE BLOOD SUPPLY

- The large descending abdominal aorta divides to form two iliac arteries, main
division of the iliac arteries are the hypogastric arteries.
- These further divides to form the uterine arteries and supply the uterus.
- Because the uterine blood supply is not far removed from the aorta, it is
copious and adequate to supply the growing needs of a fetus.
- As a uterus enlarges with pregnancy, the vessels “unwind” and so can
stretch to maintain an adequate blood supply as the organ enlarges
UTERINE NERVE SUPPLY

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- The fact that sensory innervation from the uterus registers lower in the
spinal column than does mototr control has implications in controlling pain in
labor.
- An anesthetic solution can be injected near the spinal column to stop pain of
uterine contractions at the T11 and T12 levels without stopping motor
control or contractions (registered higher, at the T5 to T10 level)
UTERINE SUPPORTS
- The uterus is suspended in the pelvic cavity by several ligaments that also
help support the bladder and is further supported by combination of fascia
and muscle.
- Because it is not fixed, the uterus is free to enlarge without discomfort during
pregnancy.
- If its ligaments become over-stretched during pregnancy, they may not
support the bladder well afterward, and the bladder can then herniate into
the anterior vagina (cystocele)
- If the rectum pouches into the vaginal wall, a rectocele.
- a fold in the peritoneum behind the uterus forms the posterior ligament. This
creates a pouvh (Douglas’ cul-de-sac) between the rectum and uterus.
- Because this is the lowest point of the pelvis, any fluid such as blood that
accumulates from a condition such as ruptured tubal (ectopic) pregnancy
tends to collect in this space.
- The space can be examined for the presence of fluid or blood to help in
diagnosis by inserting a culdoscope through the posterior vaginal wall
(culdoscopy) or a laparoscope through the abdominal wall (laparoscopy)

SEXUAL HEALTH
- Is a multidimensional concept.
- It can be defined broadly by stating that sexuality integrates the somatic
(bodily), emotional, intellectual, and social aspects of a human sexual
being.
- It involves the anatomy and physiology of the human body, as well as one’s
attitudes and feelings about oneself.
- It is not synonymous with the act of physical intercourse.
BIOLOGIC GENDER – is the term used to denite chromosomal sexual
development: male (XY) or female (XX)

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GENDER/SEXUAL IDENTITY – Is the inner sense a person has of being male

or female (which may be the same or different from biologic gender)
GENDER ROLE – is the behavior a person conveys about being a male or
female.
COMPONENTS OF SEXUALITY
1. REPRIDUCTIVE SEXUALITY – involves the biological aspects of conception
and procreation. It also includes the sexual response.
2. GENDER SEXUALITY – deals with the social and emotional aspects of being
a man or a woman.
3. EROTIC SEXUALITY – refers to sexual love and arousing sexual desires.
4. SEXUAL HEALTH – according to WHO, sexual health is the integration of the
somatic, emotional intellectual, and social aspects of sexual well-being in
ways that are positively enriching and that enhance personality,
communication and love. This definition recognizes a number of factors:
1. That sexuality is one of the major determinants of the human personality.
The human being is not desexualized (neuter); he or she has
characteristics that are masculine/feminine with a combination of qualities
2. The sexual expression is communicative expression
3. That in its mature expression, sex cannot be separated from love.
SEXUAL HEALTH HAS 3 BASIC ELEMENTS:
1. Capacity to enjoy and control sexual and reproductive behavior in
accordance with social and personal ethics.
2. Freedom from fear, shame, guilt, false beliefs, and other psychological
factors inhibiting sexual response and impairing sexual relationship.
3. Freedom from organic disorders, diseases, and deficiencies that interfere
with sexual and reproductive function.
DEVELOPMENT OF GENDER IDENTITY
- Gender identity appears to be primarily influenced by psychosocial
circumstances.
- Gender role is culturally influenced. In this society, women have in the past
been viewed as kind and nurturing, with sole responsibility for childbearing
and homemaking. Men were viewed as being expectd to provide financial
support t=for the family.

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- An individual’s sense of gender identity develops throughout an entire span,

and the stage is set even before a child is born.
INFANT – People generally bring girls dainty rattles and dresses with ruffles,
they are treated more gently by parents and held and rocked more than male
babies.
- People tend to buy boys with bigger rattles and sports-related jogging suits.
- A girl might be told “Don’t cry. You don’t look pretty when you cry”
- A boy might be told “you’ve got to learn to be tougher than that if you’re
ever going to make it into this world”
TODDLER AND PRESCHOOLER
- 2 YEARS OLD: Aware of their gender
- 3 years: can tell other children of their gender.
- 5 or 6 years: know their gender is permanent: capable of orgasm
- 6 years: sexuality has been internalized and preference for sexual partners in
adulthood.
- Expected behavior by modeling.
SCHOOL AGE
- In school, the difference between girls and boys grows wider. Teachers often
contribute to the difference in children by expecting boys to be poorer
readers, to write less neatly and to act rougher in the school hallways.
ADOLESCENT
- Secondary sex characteristics
- Obtain sexual information
- Sexual fantasies (masturbation)
ADULT
- Intimacy
- Childbearing
TYPES OF SEXUAL ORIENTATION
 HETEROSEXUALITY – one who finds sexual fulfillment with a member of
opposite gender

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o Usually begins at puberty (10-12 y/o)

 HOMOSEXUALITY - A person who finds sexual fulfillment with a member of
his or her own sex.
o Usually they prefer to be called as “gay” for men and “lesbian” for
women
 BISEXUALITY – People are bisexual if they achieve sexual satisfaction from
both homosexual and heterosexual relationship.
 TRANSEXUALITY – is an individual who, although one biologic gender, feels
as is he or she should be of the opposite gender
o sex change operations (synthetic vagina/penis)
TYPES OF SEXUAL EXPRESSION
CELIBACY – abstinence from sexual activity.
- It is also a way of life for many adults and one becoming fashionable among
a growing number of young adults.
- The ability to concentrate on the means of giving and receiving love rather
than through sexual expressions.
TRANSVESTISM – individual who dresses to take on the role of the opposite sex.
VOYEURISM – sexual arousal by looking at another’s body. Almost all children and
adolescents pass through a stage when voyeurism is appealing
SADOMASOCHISM – involves inflicting pain (sadism) or receiving pain
(masochism) to achieve sexual satisfaction.’
MASTURBATION – self-stimulation for erotic pleasure.
- Children between ages 2 to 6 yeasr discover masturbation as an enjoyable
activity as they explore their bodies.
EROTIC STIMULATION – the use of visual materials such as magazines or
photographs for sexual arousal
FETISHISM – sexual arousal by the use of certain objects or stimulations
EXHIBITIONISM – revealing one’s genitals in public
PEDOPHILES – interested in sexual encounters with children
- Paraphilia, in which are sexual interest in objects, situations, or individuals
that are highly atypical.

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- Nepiophilia, and infantophilia describe a sexual experience for toddlers

and infants (usually 0 -3 )
- Agalmatophilia sexual attraction to a statue, doll, mannequin, or other
similar figurative object.
- Maschalagnia an individual is sexually attracted to armpits.
- Necrophilia also called thanatophilia or necrolagnia, is the sexual
attractions to cropses
- Pictophilia pornography or erotic art, particularly pictures.
- Zoophilia – aroused with animals
DISORDER OF SEXUAL FUNCTIONING
ERECTILE DYSFUNCTION – Formerly referred to as impotence.
o Inability to produce or maintain an erection long enough for vaginal
penetration or partner satisfaction.
o Drug of choice for erectile dysfunction is sildenafil
PREMATURE EJACULATION – ejaculation before penile contact often use to
mean ejaculation before sexual partner’s satisfaction as well
o can be unsatisfactory and frustrating to both partners
o can be psychological
Failure to achieve orgasm
o can be due to poor sexual technique
o or possible negative attitudes toward sexual relationships
VAGINISMUS – involuntary contraction of the muscles at the outlet of the
vagina when coitus is attempted.
o This muscle contraction prohibits penile penetration
DYSPAREUNIA – pain during coitus can be due to endometriosis
INIHIBITED SEXUAL DESIRE – lack of desire for sexual relations may be a
concern of young or middle-ages adults. Support or a caring sexual partner
or relief of the tension causing the stress allows a return to sexual interest

THE HUMAN SEXUAL RESPONSE

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- Sexuality has always been a part of human life, but it is only in the past few
decades that it has been studied scientifically by experts in the field of sex
research
- One common finding of researches has been that feelings and attitudes
about sex vary widely – the sexual experience is unique to each individual,
but sexual physiology, that is, how the body responds to sexual arousal, has
common features.
FOUR PHASE RESPONSE CYCLE
EXCITEMENT
- Physiologically, sexual response can be analyzed in terms of two processes.
- Vasocongestion – reflex dilation of penile blood vessels (erection) and
circumvaginal blood vessels (lubrication), causing engorgement and
distention of the genitals
- Myotonia – arousal is characterized by increased muscular tension, resulting
in voluntary, and involuntary rhythmic contractions (pelvic thrusting, facial
grimacing, carpopedal spasms)

PLATEAU
Women
Wall of lower 1/3 vagina and labia
minora become greatly engorge,
forming the “orgasmic platform”
Clitoris retracts under the clitoral hood,
preventing direct stimulation
Increased nipple engorgement
Men
Preorgasmic emission of two or three
drops of mucoid substance from
Cowper’s gland.
Testes continue to elevate (situated
close to the body) to facilitate
ejaculatory pressure.
heart rate increases to 100-175 bpm
and RR to 40 breaths per minute

ORGASMIC
WOMEN
Strong, rhythmic (every 0.8 s)
contractions (3-15) in the orgasmic
platform
Uterus contracts rhythmically
Subjectively described as:
Stage 1: “sensation of
MEN
testes at maximum elevation
Rhythmic contractions at 0.8 sec
intervals
Subjectively describes as:
Stage 1: “point of inevitability”

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suspension” occurring just before ejaculation

Followed by intense sensual
awareness, clitorally oriented
Stage 2 “suffusion of warmth”
especially in the pelvic area.
Stage 3: “pelvic throbbing”
located in the vagina and lower
pelvis
lasting for 2/3 seconds, awareness
of presence of fluid in the urethra.
Stage 2: “ejaculation with
rhythmic contractions” capable
of expelling semen upto 24 inches

RESOLUTION
WOMEN
- Blood leaves engorged walls of the vagina and labia minora and majora
return to their unaroused state
- Clitoris returns from under the hood
- Uterus descends and cervix dips into seminal pool
MEN
- 50% of erection is lost rapidly

REFRACTORY PERIOD
- Time necessary to complete the cycle again; varies from a few minutes to
several days depending on age and state of physical and emotional health
BIPHASMIC RESPONSE (Independent Components)
1. GENITAL VASOCONGESTION REACTION
a. SWELLING/PENILE ERECTION – regulated by parasympathetic NS
 Corpora cavernosa becomes engorged with blood
 Valves in the penile veins close by reflex action, preventing loss
of blood
b. LUBRICATION/SWELLING – vasocongestive reaction in the females
 Dilation of circumvaginal venous plexus transudate through
vaginal walls – lubrication.
 Formation of orgasmic platform (analogous to erection)

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 Uterus becomes engorged and rises slightly to place the cervix in

position for better chances of fertilization
2. REFLEX CLONIC-MUSCULAR CONTRACTIONS
a. EMISSION (ejaculatory inevitability) – contraction of the vas deferens,
the prostate, the seminal vesicles and the internal part of the urethra.
b. EJACULATION – external mechanism causes spurting of semen
outward from the penis.
 FEMALE ORGASMS – series of reflex, involuntary rhythmic
contraction of the orgasmic platform.
MENSTRUATION CYCLE
- This is a monthly menstrual bleeding (also called menstruation or menstrual
cycle) that you have from your early teen years until your menstrual periods
end around age 50 (menopause)
- About once a month, the uterus grows a new, thickened lining
(endometrium) that can hold a fertilized egg.
- When there is no fertilized egg to start a pregnancy, the uterus then sheds
its lining.
- The menstrual cycle is measured from the first day of menstrual bleeding,
Day 1, up to Day 1 of your next menstrual bleeding.
- A teen’s cycles tend to be long (up to 42 days), growing shorter over several
years.
- The average menstrual period is 5 days.
- The amount of blood loss every menstrual period is 30 to 80 ml.
- The normal color of the menses is dark red that contains mucus and
endometrial cells.
ORGANS INVOLVED IN MENSTRUATION
- Hypothalamus – stimulates anterior pituitary gland to begin production of
gonadotropic hormones.
- Pituitary Gland – under the influence of LNHR, the anterior pituitary gland
produces 2 hormones that act on the ovaries to further influence
menstruation.
Follicle Stimulating Hormone (FSH) – a hormone that is active early in a cycle
and is responsible for maturation of the ovum.
Luteinizing Hormone (LH) – a hormone that becomes most active at the
midpoint of the cycle and is responsible for ovulation or release of the mature egg
cell from the ovary, and growth of the uterine lining.

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- Ovaries: one ovum matures in one or the other ovary and is discharge from
it each month.
- Uterus: stimulation from the hormones produces by the ovaries causes
specific monthly effects on the uterus.
Estrogen (Hormone for Women)
1. Stimulate the growth, development, and maintenance of female reproductive
structures, secondary sex characteristics and the breasts.
2. They help regulate fluid and electrolyte balance.
3. They stimulate protein synthesis.
4. They lower blood cholesterol level.
5. Spinnbarkeit and ferning
6. Thickening of the endometrium
Progesterone
- Is secreted mainly by the corpus luteum and works with estrogen to prepare
the endometrium for implantation and mammary glands for lactation.
- Decreased GI motility
- Increase permeability of kidney to lactose and dextrose.
- Responsible for the mood swings of the mother
- Mammary gland development.
OVARIAN CYCLE
The Follicular Phase: Day 1 through Day 13
- In response to follicle stimulating hormone (FSH) released from the pituitary
gland in the brain, ultimately one egg matures.
Ovulation: Day 14
- At about day 14, in response to a surge of luteinizing hormone, the egg is
released from the ovary.
- The egg travels through the fallopian tube toward the uterus.
The Luteal Phase: Day 14 through 28
- The remains of the follicle become the corpus luteum which releases
progesterone.
UTERINE CYCLE
Proliferative Phase: Days 5 – 14 (starts at day 5 because of menstruation
(shedding)
- The uterine lining increases rapidly in thickness, and the uterine glands
proliferate and grow.

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Secretory Phase: Days 14 through 28

- When an egg is not fertilized, the corpus luteum gradually disappears,
estrogen and progesterone levels drop, and the thickened uterine lining is
shed. This is menses (your period)
TIME OF OVULATION
- An easy way to approximate the time of ovulation for women with regular
cycles is to subtract 16 from the number of days in the cycle then add 4. This
will calculate the span of days in which ovulation is most likely to occur.
SIGNS AND SYMPTOMS OF OVULATION
- MITTLESCHMERZ – the abdominal tenderness on left/right iliac regions,
brought about by peritoneal irritation due to blood coming out from the
graafian follicle.
- SPINNBARKEIT – vaginal secretion is clear and transparent.
- Changes in vaginal mucus
- Goodel’s sign
- Mood changes
- Breast tenderness
- Increased level of progesterone
- Change in basal body temperature
FERTILIZATION
OVUM – from ovulation to fertilization
ZYGOTE – from fertilization to implantation
EMBRYO – from implantation to 5 – 8 weeks
FETUS – From 5 – 8 weeks until term
CONCEPTUS – Developing embryo or fetus and placental structure throughout
pregnancy.

Ovum (zone pellucide and corona radiata)

Capacitation
Hyalurodinase (proteolytic enzyme)
Ovum and spermatozoa fuse together (zygote)
Morula (16 – 50 cells)
Blastocyst with trophoblast cells (forming placenta and membrane)
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- Implantation or contact between the growing structure and the uterine

endometrium occurs approximately 8 – 10 days after fertilization.
- Apposition – the blastocyst brushes against the rich uterine endometrium
- Adhesion – it attaches to the surface of the endometrium
- Invasion – the blastocyst settles down into its soft folds.
o Once the zygote implanted it is an EMBRYO

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