Maternal Nursing

Anatomy and Physiology

Reproductive Development
 Begins during intrauterine life
 Full function is initiated at puberty
 Hypothalamus – synthesis and releases GnRH
 Anterior pituitary gland – release FSH and LH
 FSH and LH – initiate production of androgen and
estrogen
 Initiate visible signs of maturity – secondary sex
characteristic
Intrauterine Development
 Sex – determined at the moment of conception
 Gonad – body organ that produces sex cells
(testis-males, ovary-females)
 Week 5 – primitive gonadal tissue is already
formed
 Week 7 or 8 – differentiates into primitive testes
 Testosterone formation begins
 Mesonephric (wolffian) – develop into the male
reproductive organ
 Week 10 – testosterone not present
 Gonadal tissue differentiates into ovaries
 Paramesonephric (mullerian) – develops into
female reproductive organs
 Oocytes – cells that develop into eggs throughout
woman’s mature years
 Already formed in ovaries
 Week 12 – external genitals become visible
 Testosterone secretion halted in utero –
chromosomal male born with female-
appearing genitalia
 Testosterone during pregnancy –
chromosomal female born with male-
appearing genitalia
Pubertal Development
 Secondary sex characteristics begin
 Girls – develop earlier
Role of Androgen
 Androgenic hormones
 Responsible for muscular development,
physical growth, and increase in sebaceous
gland secretions
 Males - adrenal cortex and testes
 Females – adrenal cortex and ovaries
 Testosterone in males:
 Development of:
 Testes, scrotum, penis, prostate and seminal
vesicles
 Axillary and facial hair
 Laryngeal enlargement accompanied by voice
change
 Maturation of spermatozoa
 Closure of growth in long bones
 Testosterone in females:
 Enlargement of the labia majora and clitoris
 Formation of axillary and pubic hair
 Adrenarche
Role of Estrogen
 Triggered by FSH
 Excreted by ovarian follicle
 Estrone (E1), estradiol (E2), estriol (E3)
 Influences the development of:
 Uterus, fallopian tubes, vagina
 Typical female fat distribution and hair patterns
 Breast - trelarche
 End to growth
Secondary Sex Characteristics
 Girls
 Order of changes:
 1. Growth spurt
 2. Increase in the transverse diameter of the pelvis
 3. Breast development
 4. Growth of pubic hair
 5. Onset of menstruation
 6. Growth of axillary hair
 7. Vaginal secretions
 Menarche – the first menstrual period
 Ave. age – 12.5 years
 9 – 17 years old
 First year – irregular
 Males
 Production of spermatozoa does not begin
in intrauterine life
 Produced in a continuous process
 From puberty throughout life span
 64 days - mature
 Order of change:
 1. Increase in weight
 2. Growth of testes
 3. Growth of face, axillary, pubic hair
 4. Voice changes
 5. Penile growth
 6. Increase in height
 7. Spermatogenesis
Anatomy and Physiology

The Reproductive System

 Gynecology – study of the female
reproductive organs
 Andrology – study of the male reproductive
organs
Male Reproductive System
 External structures:
 1. Scrotum
 Support the testes and help regulate the
temperature of the skin
 2. Testes
 Leydig’s Cells – responsible for production of the
male hormone testosterone
 Seminiferous tubules – produce spermatozoa
 FSH – resposible for the release of androgen-
binding protein (ABP)
 LH – responsible for the release of testosterone
 One testis is slightly larger than the other
 3. Penis
 2 Corpus cavernosa
 Corpus spongiosum
 Penile artery – provides blood supply for the penis
 Parasympathetic nerve – penile erection
 Glans – bulging, sensitive ridge of tissue
 Prepuce – retractable skin protecting the
glans
 Circumsicion – removal of the prepuce
 Internal structures:
 1. Epididymis – approx 20 foot long
 Conducts sperm from the testis to the vase
deferens
 2. Vas deferens (ductus deferens)
 Carries sperm from the epididymis to seminal
vesicles and the ejaculatory ducts
 Spermatic cord – blood vessels and the vas
deferens
 3. Seminal vesicle
 Empty into the urethra by way of the
ejaculatory ducts
 Produces a viscous portion of the semen
 4. Ejaculatory ducts
 Pass through the prostate gland and join the
seminal vesicles to the urethra
 5. Prostate gland
 Chestnut-sized gland that lies below the bladder
 Secretes thin, alkaline fluid
 6. Bulbourethral glands
 Cowper’s gland
 Secrete alkaline fluid
 Semen – prostate gland (60%), seminal vesicles
(30%), epididymis (5%), bulbourethral glands
(5%)
 7. Urethra
 Approx 8 in (18 to 20cm)
Female Reproductive System
 External Structures:
 1. Mons veneris – protect the junction of the pubic
bone from trauma
 2. Labia minora – abundant with sebaceous glands
 3. Labia majora – protection for the external
genitalia and thedistal urethra and vagina
 4. Vestibule – flattened surface inside the labia
 Give rise to the urethra and the vagina
 5. Clitoris – 1 to 2 cm rounded organ of
erectile tissue
 Center of sexual arousal and orgasm
 6. Prepuce – covers the clitoris
 7. Skene’s gland (paraurethral glands) – one
on each side of the urethral meatus
 8. Bartholin’s gland (vulvovaginal glands) –
located lateral to the distal vagina
 Both glands – secretions help lubricate the
external vagina
 Secretions with alkaline pH
 9. Fourchette – ridge tissue formed by the
posterior joining of the two labia minora
and labia majora
 Cut during childbirth
 10. Perineal body – muscular area
 11. Hymen – semicircle of tissue that
covers the opening of the vagina
Blood Supply
 Pudendal artery and inferior rectus artery –
supply the external genitalia
 Pudendal vein – venous return
Nerve Supply
 Ilioinguinal and genitofemoral nerves (L1)
– anterior portion of the vulva
 Pudendal nerve (S3) – posterior portions of
the vulva and vagina
 Internal Structures:
 1. Ovaries – produce, mature and discharge
ova
 Produce estrogen and progesterone
 Estrogen – prevent osteoporosis
 Keep cholesterol levels reduced
 Principal divisions:
 A. Protective layer of epithelium
 B. Cortex – filled with ovarian and graafian
follicles
 C. Central medulla – contains nerves, blood
vessels, lymphatic tissue and some smooth
muscle tissue
 2. Fallopian tubes – approx 10cm long
 Convey the ovum from the ovaries to the
uterus
 Provide a place for fertilization
 Interstitial – lies within the uterine wall
 1cm long
 1mm in diameter
 Isthmus – 2cm long
 Portion that is cut and sealed in a tubal ligation
 Ampulla – 5cm long
 Fertilization takes place
 Infundibulum – 2 cm long
 Funnel-shaped
 Rim is covered with fimbriae
 Lining is composed of mucous membrane
and ciliated cells
 Produces peristaltic movement
 3. Uterus – hollow, muscular, pear-shaped
organ
 8 years of age – increase in the size of the
uterus begins
 17 years of age – reaches adult size
 Functions:
 Receive the ovum from the fallopian tube
 Provide a place for implantation
 Nourishment during fetal growth
 Furnish protection to a growing fetus
 Expel fetus from woman’s body
 Divisions:
 Body or corpus – uppermost part
 Expands to contain the growing fetus
 Cornua – upper aspects
 Fundus – portion of the uterus between the
points of attachment of the fallopian tubes
 Isthmus – short segment between the body
and cervix
 Enlarges to accommodate the aid in
accommodating the growing fetus
 Most commonly cut in CS
 Cervix – lowest portion
 Cervical canal – central cavity
 Internal cervical os – opening of the canal
at the junction of the cervix and isthmus
 External cervical os – distal opening to the
vagina
Uterine Layers
 Endometrium – innermost, mucous
membrane
 Basal layer – closest to the uterine wall
 Not influenced by hormones
 Glandular layer – influenced by estrogen
and progesterone
 Grows and becomes thick
 Shed as menstrual flow
 Myometrium – middle one, muscle fibers
 Constrict the tubal junctions
 Holds the internal cervical os
 Constrict blood vessels
 Myomas, benign uterine tumors
 Perimetrium – outer one, connective tissue
 Add strength and support to the structure
Cervical Layer
 Endocervix – mucous membrane
 Secrete mucus
 Estrogen peak – 700ml/day
 Estrogen very low – few milliliters
 Stratified squamous epithelium – similar to
the lining of the vagina
 Important when obtaining a Papanicolaou
smear
Uterine Blood Supply
 Uterine arteries – uterus
 Ovarian artery – ovary
 Joins the uterine artery
 Uterine veins – empty into the internal iliac
veins
Uterine Nerve Supply
 Supplied by efferent (motor) and afferent
(sensory) nerves
 Efferent – T5 to T10
 Afferent – T11 to T12
 Epidural anesthesia
Uterine Supports
 Posterior ligament – forms Douglas’ cul-de-
sac
 Broad ligaments – cover the uterus front
and back and extend to the pelvic sides
 Round ligaments – steady the uterus
 4. Vagina – organ of intercourse
 Convey sperm to the cervix
 Birth canal
 Anterior wall – 6-7 cm
 Posterior wall – 8-9 cm
 Fornices – recesses on all sides of the cervix
 Anterior fornix – front
 Posterior fornix – behind
 Pooling of semen
 Lateral fornix – sides
 Rugae – folds
 Bulbocavernosus – circular muscle at the
external opening of the vagina
 Blood Supply - Vaginal artery
 Nerve – sympathetic and parasympathetic at
S1 to S3 levels
 Glycogen rich – broken down by
Doderlein’s bacillus
Breast
 Ectodermic tissue
 Estrogen – increase in size
 Connective tissue and deposition of fat
 Glandular tissue – undeveloped
 Milk glands – 20 lobes
 Acinar cells – produce milk
 Lactiferous duct – reservoir for milk
 Nipple – transmits sensations to the
posterior pituitary gland to release oxytocin
 Oxytocin – constricts milk gland cells and
push milk forward
 Areola – Montgomery’s tubercles
 Blood supply – axillary, internal mammary
and intercostal arteries
Pelvis
 Support and protect
 Four united bones:
 1. 2 Innominate bones
 2. Coccyx
 3. Sacrum
 Innominate bones:
 1. Ilium – iliac crest
 2. Ischium
 Ischial tuberosities
 Ischial spines
 3. Pubis – symphysis pubis
 Sacrum – sacral prominence
 Coccyx – 5 fused small bones
Divisions
 False pelvis:
 Superior half
 Supports the uterus
 Aids in directing the fetus into the true
pelvis
 True pelvis:
 Inferior half
 Linea terminalis:
 Imaginary line that divides the true and false
pelvis
 Drawn from the sacral prominence to the superior
aspect of the symphysis pubis
 Inlet - entrance to the true pelvis
 Outlet – inferior portion of the pelvis
 Pelvic cavity – space between the inlet and outlet
 Curved
 Slows and controls the speed of birth
 Compresses the chest of the fetus
 Midplane – level of the ischial spines