REPRODUCTIVE HEALTH

Introduction:
Is a state of complete physical, mental and social
well-being and not merely the absence of disease
or infirmity, in all matters relating to
the reproductive system and to its functions and
processes at all stages of life in both man and
woman.
Introduction cont..

The definition suggests that reproductive health

encompasses:
• The ability to reproduce
• Freedom to control reproduction
• The ability to go through pregnancy and childbirth safely,
with successful maternal and infant survival and outcomes
• The ability to obtain information about and access to safe,
effective and affordable methods of family planning
• The ability to have a satisfying, safe sex life, free from fear
of pregnancy and disease
• The ability to minimize gynecologic disease and risk
throughout all stages of life
Introduction cont...
• Reproductive health, is concerned with
– people’s ability to have a responsible, satisfying and
safe sex life,
– their capability to reproduce, and
– their having the freedom to decide if, when and how
often to do so.
Embedded in this set of concerns are certain
implicit rights of both men and women:
Implicit rights of both men and women
within the reproductive health concerns
• To be informed of safe, effective, affordable and
acceptable methods of fertility regulation;
• To have access to safe, effective, affordable and
acceptable methods of fertility regulation of their
choice;
• To have access to appropriate health care
services that will enable women to go through
pregnancy and childbirth safely, and provide
couples with the best chance of having a healthy
infant.
 Introduction cont..
• Reproduction is a creation obligation of
procreation.
• The reproductive system is essential to
keeping a species alive, unlike other body
systems it’s not essential to keeping an
individual alive.
 Importance of Reproductive Health
• Reproductive health is a human right stated in
international law.
• Reproductive health plays an important role in
morbidity, mortality and life expectancy.
• Reproductive health problems are the leading
cause of women’s ill health and mortality
worldwide.
Global Indicators of Reproductive Health

• Fertility
• Life Expectancy (an expectation of the length of life,
calculated most typically from the time of birth to
reflect the overall health of a society.)
• Perinatal Mortality (deaths of infants in the period of
life closest to birth or while still in utero (stillbirths)).
• Low birth weight
• Maternal Mortality
 The pelvis

• The bony pelvis is comprised of 2 innominate

bones, the sacrum, and the coccyx.
• 3 bones fuse to make the Innominate bone
 Pubis - the anterior part
 Ischium - thick lower part
 Ilium - large flared outer part
Parts of the Ischium of obstetric importance
• The ischium has;
prominance known as the ischial tuberosity on
which the body rests when sitting.
Behind and a little above the tuberosity is an
inward projection, the ischial spine. In labour
the station of the fetal head is estimated in
relation to ischial spines.
• The pubis –
The pubic bone forms the anterior part.
The bone forms the pubic arch (rami)
Bones of the pelvis cont..

• The sacrum
a wedge shaped bone made of five fused
vertebrae.
The upper border forms the sacral promontary.
The anterior surface of the sacrum is concave
forms the hallow of the sacrum.
• The coccyx
Is the avestigial tail made of four fused vertebrae
forming a small triangular bone.
 Pelvic Joints = 4 in number

1. The symphysis pubis is a cartilgeous joint formed by

the two pubic bones along the midline.
2. The sacro iliac joints (2)are the strongest joints in the
body.
3. The sacro coccygeal joint is formed where the base of
the coccyx articulates with the tip of the sacrum.
• Importance
They give to provide more room for the fetal
head as it passes through the pelvis. The
ligaments within the joints are softened during
pregnancy endocrine activity thus allowing
movements.
 Pelvic ligaments

• Hold pelvic joints together

Interpubic ligaments at the symphysis pubis (1)
Sacro iliac ligaments (2)
Sacro coccygeal ligaments (1)
Sacro tuberous ligament (2)
Sacro spinous ligament (2)
Types of Pelvis

• (I) Gynaecoid pelvis

 Inlet is slightly transverse oval.
 Sacrum is wide with average concavity and
inclination.
Side walls are straight with blunt ischial spines.
Sacro- sciatic notch is wide.
Sub-pubic angle is 90-100o.
• .
(II) Anthropoid pelvis = Ape-like type.
 All antero-posterior diameters are long.
 All transverse diameters are short.
 Sacrum is long and narrow.
 Sacro-sciatic notch is wide.
 Sub-pubic angle is narrow.
(III) Android pelvis = Male type

 Inlet is triangular or heart-shaped with anterior

narrow apex.
 Side walls are converging (funnel pelvis) with
projecting ischial spines.
 Sacro-sciatic notch is narrow.
 Sub-pubic angle is narrow <90 degrees.
(IV) Platypelloid pelvis = It is a flat female type.
 All antero-posterior diameters are short.
 All transverse diameters are long.
 Sacro-sciatic notch is narrow.
 Sub-pubic angle is wide.
Types of Pelvis
 The Female Pelvis
The female bony pelvis is divided into:
1. False pelvis: above the pelvic brim and has no
obstetric importance.

2. True pelvis: below the pelvic brim and related

to the child -birth.
 THE TRUE PELVIS
• The true pelvis is the bony canal through which
the fetus must
• pass during birth.
• Is the gynecoid pelvis (Female pelvis)
• It has
 a pelvic brim is rounded except where the sacral
promontory projects into it.
TRUE PELVIS cont..
 The pelvic cavity is extends from the brim above
to the out let below. These are two i.e,
‒ The anatomical out let formed by the lower borders
of each of the bones together with the sacro-
tuberous ligament. It is diamond in shape.
‒ The obstetrical out let is the space between the
narrow pelvic strait and the anatomical outlet.
Gynecoid pelvis (Female pelvis) (Adele Pilliter, 1995)
The Pelvic Inlet (Brim):
Boundaries:
• Sacral promontory, - alae of the sacrum, - sacroiliac joints,
iliopectineal lines,
• iliopectineal eminencies, - upper border of the superior
pubic rami,
• pubic tubercles, - pubic crests and - upper border of
symphysis
• pubis.
Diameters with obstetric importance:
• (A) Antero -posterior diameters:
• (1) Anatomical antero- posterior diameter (true conjugate)
= 11cm from the tip of the sacral promontory to the upper
border of the symphysis pubis.
(2) Obstetric conjugate = 10.5 from the tip of the
sacral promontory to the most bulging point on the
back of symphysis pubis which is about 1 cm below
its upper border. It is the shortest antero-posterior
diameter.
(3) Diagonal conjugate = 12.5 cm i.e. 1.5 cm longer
than the true conjugate. From the tip of sacral
promontory to the lower border of symphysis
pubis.
(4)Obstetric transverse diameter It bisects the true
conjugate and is slightly shorter than the
anatomical transverse diameter.
The Pelvic Cavity:

The boundaries are:

• - the roof is the plane of pelvic brim,
• - the floor is the plane of least pelvic
dimension,
• - anteriorly the shorter symphysis pubis,
• - posteriorly the longer sacrum.
The Pelvic Outlet:

• The boundaries are:

• - the roof is the plane of least pelvic
dimension,
• - the floor is the anatomical outlet,
• - anteriorly the lower border of symphysis
pubis,
• - posteriorly the coccyx.
• - laterally the ischial spines.
Important diameters of the pelvic outlet

• Obstetric antero-posterior diameter = 13 cm

from the tip of the sacrum to the lower border
of symphysis pubis as the coccyx moves
backwards during the second stage of labour.
• Bispinous diameter = 10.5 cm between the
tips of ischial spines.
Pelvic floor Or Pelvic diaphragm

• Is a muscular floor that demarcates the pelvic cavity and

perineum. Strengthened by condesed pelvic fascia,
Functions: -
• Protects pelvic organs
• It supports the weight of the abdominal and pelvic organs
• The muscles are responsible for the voluntary control of
micturition, defecation and play an important part in sexual
• It infulences the passive movement of the fetus through the
birth canal and relaxes to allow its exit from the pelvis.
• Resists intra abdominal pressure during cough and sneezing
e.t.c
Important land marks of female pelvis

A. Pelvic brim
- Sacral promentary posteriorly
- Superior ramus of the pubic bone antro lateral
- Upper inner boarder of the body of the pubic bone
- Upper inner boarder of the symphysis pubis anteriorly
B. Cavity
- Ischial spines
C. Out let
- Inferior pubic (arch) rami antero laterally
- Sacrotuberous ligament postro laterally
- Ischial tuberosity laterally
- Inferior border of symphsis pubis anteriorly.
- Tip of coccyx
CONTRACTED PELVIS
Anatomical definition:
• It is a pelvis in which one or more of its diameters is
reduced below the normal by one or more centimeters.
Obstetric definition:
• It is a pelvis in which one or more of its diameters is
reduced so that it interferes with the normal mechanism
of labour.
Factors influencing the size and shape of the pelvis:

1. Developmental factor : hereditary or congenital.

2. Racial factor.
3. Nutritional factor: malnutrition results in small
pelvis.
4. Sexual factor: as excessive androgen may
produce android pelvis.
5. Metabolic factor : as rickets and osteomalacia.
6. Trauma, diseases or tumours of the bony pelvis,
legs or spines
Causes in the pelvis:

• (A) Developmental (congenital):

• Small gynaecoid pelvis ( generally contracted pelvis).
• Small android pelvis.
• Small anthropoid pelvis.
• Small platypelloid pelvis ( simple flat pelvis).
• Naegele’s pelvis: absence of one sacral ala.
• Robert’s pelvis: absence of both sacral alae.
• High assimilation pelvis: The sacrum is composed of 6
vertebrae.
• Low assimilation pelvis: The sacrum is composed of 4
vertebrae.
• Split pelvis: splitted symphysis pubis.
• (B) Metabolic:
• 1- Rickets.
• 2- Osteomalacia ( triradiate pelvic brim).
• (C) Traumatic : as fractures from RTA, fall from heights,
wife beating, .
• (D) Neoplastic: as osteoma.
Causes in the spine:
• Lumbar kyphosis.
• Lumbar scoliosis.
• Spondylolisthesis: The 5th lumbar vertebra with the
above vertebral column is pushed forward while the
promontory is pushed backwards and the tip of the
sacrum is pushed forwards leading to outlet contraction.
• TB of the spine.
Causes in the lower limbs:
• Dislocation of one or both femurs.
• Atrophy of one or both lower limbs. N.B. oblique
or asymmetric pelvis: one oblique diameter is
obviously shorter than the other. This can be
found in:
1- Naegele’s pelvis.
2- Scoliotic pelvis.
3- Diseases, fracture or tumours affecting one side.
Diagnosis of Contracted Pelvis
History of :
• Rickets: is expected if there is a history of
delayed walking and dentition.
• Trauma or diseases of the pelvis, spines or
lower limbs.
• Bad obstetric history: e.g. prolonged labour
ended by;
- difficult forceps,
- caesarean section or
- still birth.
 Examination:

• (I) General examination:

• Gait: abnormal gait suggesting abnormalities in the
pelvis, spines or lower limbs.
• Stature: women with less than 150 cm height usually
have contracted pelvis.
• Spines and lower limbs: may have a disease or lesion.
• Manifestations of rickets as:
- square head,
- rosary beads in the costal ridges.
- pigeon chest,
- Harrison’s sulcus and - bow legs.
• Dystocia dystrophia syndrome: the woman is
- short,
- stocky,
- sub-fertile,
- has android pelvis and
- masculine hair distribution,
- with history of delayed menarche.
NB This woman is more exposed to occipito-
posterior position and dystocia.
Abdominal examination

• Non-engagement of the head: in the last 3-4

weeks in primigravida
• Pendulous abdomen: in a primigravida.
• Mal-presentations: are more common
• Pelvimetry:
• It is assessment of the pelvic diameters and
capacity done at 38-39 weeks. It includes:
Pelvimetry: 1
• It is assessment of the pelvic diameters and
capacity done at 38-39 weeks. It includes:
(I) Clinical pelvimetry:
• i) Internal pelvimetry for:
- inlet,
- cavity, and
- outlet.
• ii) External pelvimetry for:
- inlet and
- outlet.
Pelvimetry: 2

(II) Imaging pelvimetry:

i) X-ray.
ii) Computerised tomography (CT).
iii) Magnetic resonance imaging (MRI) .
Internal pelvimetry 3
Is done through vaginal examination
(I) The inlet:
1- Palpation of the pelvic brim: Note whether it is
round or angulated, causing the fingers to dip into a
V-shaped depression behind the symphysis.
2- Diagonal conjugate: Normally, is at 12.5 - 13 cm
sacral promontary should not be felt. If it is felt get
the true conjugate by subtracting 1.5 cm from the
diagonal conjugate. This assessment is not done if
the head is engaged.
(II) The Cavity :
1. Height, thickness and inclination of the symphysis.
Note if;
• straight, convergent or divergent starting from the
pelvic brim down to the base of ischial spines in the
direction of the base of the ischial tuberosity.
2. Shape and inclination of the sacrum.
3. Side walls
4- Ischial spines:
• Whether difficult to identify at all, or easily felt but
not large or very prominent (large and encroaching
on the cavity).
III) The outlet:
1- Subpubic angle: Normally, it admits 2 fingers.
2- Bituberous diameter: Normally, it admits the
closed fist of the hand (4 knuckles).
3- Mobility of the coccyx. by pressing firmly on it
while an external hand on it can determine its
mobility.
4- Anteroposterior diameter of the outlet: from
the tip of the sacrum to the inferior edge of the
symphysis
 Summary

• Important to understand
normal anatomy to properly
care for women, promote
reproductive health and pelvic
complications.
 Female external genitalia = the Vulva
• Mons veneris
• Labia Majora
• Labia Minora
• Clitorus
• Vestibule
• Urethral meatus
• Vaginal introitus (opening)
• Perineum
 The vulva
• The mons veneris – fatty pad tissue over the
Symphysis pubis on which pubic hair grows.
• labia majora – outer lip extends from mons
veneris posteriorly to the perineum.
• labia minora - inner lips flapped over by the
majora anteriorly encloses clitoris and
posteriorly forms furchette.
• The furchette is ridge of tissue formed by the
posterior joining of the two labia minora and
the labia majora
• The clitoris is a small rounded organ of
erectile tissue at the forwarded junction of the
labia minora.
• The vestibule is the flattened, smooth surface
in side the labia
• The vaginal orifice – opening to the vagina
• Bartholin's glands (volvo vaginal glands) are
located just lateral to the vaginal opening on
the sides.
• The vulval blood supply comes mainly from
the pudendal arteries and apportion of the
inferior rectus aretery. The blood drains
through the pundendal veins.
• Lymphatic drainage - inguinal glands
• Nerve supply - branch of pudendal nerve
• The nerve supply is important in second stage
of labor for performing and repairing
episiotomy.
Nerve supply
Internal female genital organs
 The vagina
• Position – is a canal running from the vestibule
to the cervix.
• Relations:-
• A knowledge of the relation of the vagina is
essential for the accurate examination of the
pregnant woman and her safe delivery. It is
found in front of the rectum and behind the
bladder and urethrea.
• Structure
• - the posterior wall is longer than the antrerior
Vagina cont..
Layers
• squamins epithelium, vascular connective tissue,
weak inner coat of circular fibers and stronger
outer coat of longitudinal fibers. Pelvic fascia
surrounds the vagina forming a layer of
connective tissue.
Contents
• the vaginal fluid is strongly acidic (PH 4.5)
Vagina cont..
Blood supply
• from braches of the internal iliac artery and
drains through corresponding Veins.
Lymphatic drainage
• via the inguinal, the internal iliac and the sacral
glands drains the lymphatic fluid.
 The non-pregnant uterus
Definition
• The uterus is hallow muscular, flattened pear shaped organ
situated in the cavity of a true pelvis.
Size
• Weighs 60 grams, 7.5 cm long, 5cm wide and 2.5cm in depth,
thickness of each wall 1.25 -1.3 cm thick, Cavity measures 6.4 cm
long with a volume of 4 milliliters.
Position
• Lies below the pelvic brim
• Ante-version thus leans forward, ante-flexion thus bends forwards
on itself
 Uterus cont..
Relationships
• Anterior - the utero pouch and the bladder,
• posterior - the rectal pouch (pouch of Douglas)
and rectum,
• inferior - the vagina and the anterior and posterior
vaginal fornices,
• superior - lie the intestines,
• lateral - on both sides of the walls are the broad
ligaments, the fallopian tubes and the ovaries.
 Uterus cont..
Parts of the uterus
• The body or corpus - the upper 2/3 and the greater part of the
uterus.
• The fundus - the domed upper wall between the insertions of
the fallopian tubes.
• The cornua - are the upper outer angle of the uterus where
the fallopian tubes join.
• The cavity - is a potential space between the anterior and
posterior walls.
• The isthmus – measures 7mm long is a narrow area between
the cavity and the cervix, It enlarges during pregnancy to form
the lower uterine segment.
 Uterus cont..

• The cervix or neck - protrudes in to the vagina.

• The internal os (mouth) is the narrow opening
between the isthmus and the cervix
• The external os is a small round opening at the
lower end of the cervix.
• Layers:- The uterus has three layers, of which the
middle muscle layer is the thickest.
Uterus cont..
The endometrium: -
• Highly specialized active membrane of columnar
epithelium glands dip down to the level of the muscle
layer.
• Secrets an alkaline secretion into the cavity
• Has a connective tissue cells of stroma type which are
rapidly regenerative.
• This action allows the constant uterine changes
throughout the menstrual cycle.
• Highly vascular hence enables the uterine functions of
monthly blood shedding,
• Provides accommodation for the fetus during pregnancy
and bleeding after birth.
Uterus cont..
The myometrium or muscle coat
• Forms seven-eighths of the thickness of the uterus
• Thick in the upper part of the uterus and is thinner in the isthmus
and cervix.
The three layers:
1. Outer layer - longitudinal muscle fibers more concentrated in the
upper part of the uterus. runs from the fundus downwards to join
the longitudinal muscles of the vaginal walls at the back and in
front of the uterus. Its function is to contract and retract during
pregnancy and labor.
2. Middle layer - oblique muscle fibers arranged in interlacing
manner (criss-cross). Cross the upper part of the uterus obliquely
from the funds to the side. The function is to contract pulling on
the uterine muscles to seal them off controlling bleeding during
and after birth.
Uterus cont..
3. Inner layer - muscle fibers arrangement is in a
circular manner chiefly found around the orifices
(openings) to the fallopian tubes and the lower
part of the uterus particularly the cervical canal.
The perimetrium
• Double serous membrane, an extension of the
peritoneum, dragged over the uterus, extends to
form the broad ligaments.
• Is firmly attached to the myometrium except at
the lower anterior part at the level of isthmus,
the peritoneum is reflected on to the bladder.
Uterus cont..
Uterine Supports
• Pelvic floor give the main support and the ligaments
maintain the position.
• Two broad ligaments – are the most important support of
the uterus. They are a double fold of the peritoneum on
both sides continuous with the perimentrium extending
down ward attaching to the pelvis with a fibrous tissue.
• Two Round ligament – keep the uterus in the ante-version
and ante-flextion position. They run from near the fundus
of the uterus in front down and outward passing through
the anterior abdominal wall crosses the pelvic fascia
ending in the labia majora.
Uterus cont..

• Blood supply – The uterine artery arrives at the

level of the cervix and is a branch of the internal
iliac artery. The blood drains through
corresponding veins.
• Nerve supply – from the autonomic nervous
system, sympathetic and para smpathetic via
pelvic plexus.
• Lymphatic drainage is by the inguinal glands,
internal and external common iliac glands.
Uterus cont..

Function
• It prepares for receiving the fertilized ovum
(embryo) by shedding blood every month
(menstruation).
• Accommodates the fetus during pregnancy
and contracts to expel the fetus at term or
otherwise.
• After birth, it is responsible for controlling
bleeding.
Fallopian tubes (uterine tubes/oviducts/salpnix)

Definition
• Are two muscular long narrow J-shaped tubes.
• They extend laterally from the uterus at the
cornua, opening into the abdominal peritoneal
cavity to near the ovaries.
Structure
• Each tube measures 10 – 13 cm long, 6 mm thick
with a diameter of 0.5 – 1.2 cm.
Fallopian cont..
Structure
• Consists of four parts and each part has different dimension of the
diameter.
1. Interstitial portion lies within the uterus opening into the cavity
with a diameter of 1mm.
2. Isthmus portion next to the interstitial adjacent to the body of the
uterus the diameter is 1mm and 2.5cm long.
3. Ampulla is the wider portion of the tube in which fertilization take
place measures 5cm long.
4. Infundibulum is funnel (trumpet) shaped extremity with finger like
projections called fimbriae. It opens up into the peritoneal cavity
hanging over the ovaries. One of the longest fimbria called ovarica
(ovarian fimbria) is attached to the ovary.
- It is that guides the ovum to the fallopian tube for fertilization.
- It is in this part that fertilization occurs.
Fallopian cont..
Microscopic structure
• The outer covering is the peritoneum of the broad
ligament only over the superior part.
• The walls are of circular and longitudinal muscle
fibers.
• The inner lining is of mucus membrane which
secrets lymph. It has a ciliated epithelium lining
thrown into deep longitudinal folds called plicae.
The inner lining is more developed in the ampulla
portion. The movement of lymph and the action of
the cilia propels the ovum before and after
fertilization to the uterus.
Fallopian cont..
Relationships
• Superiorly are the coils of the intestines, laterally is the body of the uterus,
inferiorly is the ovary and the broad ligament fascia, posteriorly is the round
ligament.
Functions
• Provides a site for fertilization
• It supplies the fertilized ovum with nutrition during its continued journey to
the uterus.
• Supports - are held in place by their attachment to the uterus.
• Blood supply
• Mainly from the ovarian artery and vein some branches of uterine artery
and vein.
• Lymphatic drainage
• Lumber glands
• Nerve supply
• Mainly from the ovarian plexus
Clinical importance of the fallopian tubes
• Ectopic pregnancy – this may be in the tubes at the isthmus portion
usually.
• Tubal abortion - the fertilized ovum is discharged into the peritoneal
cavity. It may die and be absorbed, or end into the abdominal cavity.
• Abdominal pregnancy – embryo embeds onto the peritoneum or
the intestines, the pregnancy may continue to term but there will be
no spontaneous labor delivery is by laparotomy.
• Tubal mole – the fertilized ovum dies and remains in the tube
• Tubal infection (salpingitis) resulting into blocked ducts partially or
total due to adhesions resulting into tubal ectopic pregnancy or
sterility. Sometimes if infection is not attended to may result into
peritonitis.
• Rectal pouch Pregnancy - forms a haematoma leading to infection
causing a fistula through which blood and bones may be passed per
rectum.
 The ovaries

Definition
• Are two small female flattened gonads producing sex hormones and
ova for reproduction.
Position
• Situated in the shallow fossa on the lateral walls of the pelvis. Lies
suspended from the angles of the uterus at the posterior folds of the
broad ligament near the fimbriated end of the fallopian tube just below
the brim of the pelvis.
Gross structure
• Almond shaped, white in colour with a corrugated surface.
• The anterior border is the Hilum (depression of groove) at which blood
and lymphatic vessels, nerves enter and leave the ovary. The posterior
part is convex and free.
• Measures 3.8 cm long, 1.9 cm broad, and 1.25 cm thick.
Ovaries cont..
Microscopic structure
• Varies with age; At infancy and child hood it is solid in consistency.
At puberty and the childbearing age, the ovary under goes
changes of the four phases of menstrual cycle. At menopause, it is
rough due to scared tissue from the ovulation process.
• The cortex – is the outer and functional part composed of;
― Outer covering the germinal epithelium is a modified form of
peritoneum called tunica albagnea.
― The stroma or bed - The main substance of the ovaries consists
of a loose mesh work of connective tissue. In here embedded are
the primordial cells about 200,000 in number.
• The medulla - is the inner part directly attached to the
mesovorian. It is a supporting framework of connective tissue,
blood and lymphatic vessels and nerves.
Ovaries cont..
• During infancy, at 30 weeks of gestation the germinal epithelium grows
down into the ovarian cortex to form primordial follicles, which are
primitive egg cells.
• After birth but before puberty these capsular cells increase in number
and liquor folliculi fills in cavity of the follicle.
• As the girl advances in age, some of the capsular cells convert into
primitive Graafian follicles. From puberty through the childbearing age,
the primordial follicles undergo development stages. Only one
primordial follicle fully matures and surfaces as a Graafian follicle ready
for ovulation.
• The Graafian follicle consists of a thin delicate layer theca a connective
tissue lined with membrane granulosa. After ovulation, the Graafian
follicles undergo a degenerative process. Blood fills the space
previously occupied by the ovum and the liquor folliculi forming a new
structure from the granulosa cells. It multiplies building up a dense
mass yellow in colour the corpus luteum to act as an endocrine gland
for only one menstrual cycle.
Ovaries cont..
• It degenerates during following the menstrual cycle
and gradually becomes absorbed by phagocytic action
forming a white body the corpus albicans. The corpus
albicans contracts leaves a scar on the surface.
However, when fertilization takes place the corpus
leteum persist and is fully developed at the end of the
first trimester.
• By term it gradually its action declines and involutes,
at the onset of labor it is at the size of the menstrual
corpus leteum. It is completely absorbed by the
second or third month after birth.
• Note the Graafian follicles do not mature therefore
ovulation ceases.
 Ovaries cont..

Support
• Ovarian ligament attaches them to the uterus, the
mesovarian to the broad ligament and the
mesosalpinix to the fallopian tubes. To the pelvis is
by the suspensory (infundibulo-pelvic ligament).
Blood supply: -
• Supplied by the ovarian arteries and drains by the
ovarian veins. The right ovarian vein joins the inferior
vena cava, but the left returns its blood to the left
renal vein.
• Lymphatic drainage is to the lumbar glands
• Nerve supply is from the ovarian plexus.
 Ovaries cont..

• Function: -
• Ovulation – rapture of the matured Graafian
follicle and expulsion of the ovum occurring
monthly from puberty through the childbearing
age of a woman. This occurs between the 12th
and 16th days of the menstrual cycle. One mature
Graafian follicle comes to the surface of the
ovary at a time raptures and releases the ovum
that is attracted to the fallopian tube by the
ovarian fimbria.
The figure below illustrates ovulation.
 Ovaries cont..
Endocrine action –
• the ovary produces hormones progesterone and oestrogenic.
oestrogenic hormones produced are oestriol, oestradiol, and
oestrone of these oestriol is excreted in larger quantities than
the rest.
• The corpus leteum produces Progesterone hormone
influenced by the luteinizing hormone from the anterior lobe
of the pituitary gland. Its action is during the secretory phase
of the menstrual cycle, it can only affect tissues that have
been acted on by oestrogens.
• During pregnancy oestriol essentially is a growth hormone
concerned with; growth of the fetus, decidua, breasts and
myometrium. It is secreted in urine and used to know the
well-being of the fetus.
Ovaries cont..

• The progesterone hormone causes proliferation

of the decidua to meet the nutritional needs of
the growing embryo. It also causes the secretory
function of the breasts.
• During labor both hormones are produce
powerful rhythmic uterine contractions.
However, they are not known to play part in the
initiation of labor. After the birth of the placenta
as the chief source of these hormones, their
levels go down immediately.
• Shape Each breast is a hemispherical swelling and has
a tail
• of tissue extending towards the axilla (the axillary tail
of
• spence).
• Size The size varies with each individual and with the
stage of
• development as well as with age. It is not uncommon
for one
• breast to be little or larger than the other.
 Anatomy of the breast
• Mammary glands and accessory organs of reproductive
system
• situated on each side of the sternum and extends between
the second and sixth rib.
• Lie in the superficial fascia of the chest wall over the
pectoralis major muscle, and are stabilized by suspensory
ligaments.
• Shape is Hemispherical extends from the axillary tail of
spence.
• The size varies with each individual and with the stage of
development as well as with age.
• Shape and size is of less significance in relation to its
function.
 Breast cont..
• Size and shape varies with each individual
and with the stage of development as well as
with age. It is not uncommon for one breast to
be little or larger than the other.
Breast shapes and nipple sizes

12/2A
 20/2

12/2B
 Breast Cont..
Gross structure
• The axillary tail is the breast tissue extending towards the axilla.
• The areola is a circular area of loose, pigmented skin about 2.5 cm
in diameter the centre of each breast. It is a pale pink colour in a
light- skinned women, darker in dark skinned women, the colour
deepens with pregnancy.
• Within the area of the areola lie sebaceous glands - Montgomery's
tubercles enlarge in pregnancy. Secrete sebaceous substance to
lubricate the areola. They contain mother’s smell, which helps the
baby to find the breast and to recognize her.
• The nipple is a protuberance lying in the centre of the areola,
composed of pigmented erectile tissue covered with epithelium.
Contains the openings of the lactiferous ducts to the ampulla.
Microscopic structure
 Microscopic structure
• The breast is composed largely of glandular tissue, but also
of some fatty tissue, which determine the size and is
covered with skin. This glandular tissue is divided into about
18 - 20 independent lobes separated by bands of fibrous
tissue
• The lobes are made of internal structure may be described
as a cauliflower or broccoli vegetable.
• Alveoli: Each alveolus is lined by milk- secreting cells the
acini which extract from the capillary network of the
mammary blood supply the factors essential for milk
production. Influenced by the prolactin hormone.
- Around each alveolus lie myoepithelial cells, sometimes
called ‘basket’ or ‘spider’s cells. They are stimulated by
oxytocin hormone to contract to release the secreted milk.
Breast cont..

• Small lactiferous ducts (tubules) connect the

alveoli to the central duct.
• Lactiferous duct is the main lets the milk
down for storage awaiting extraction through
breastfeeding.
• Ampulla: the widened-out portion of the
lactiferous ductile under the areola where
milk is stored. It narrows to form milk ducts
(lactiferous tubules) in the nipple.
 Breast cont..
Blood supply
• Blood is supplied to the breast by the internal mammary, the
external mammary and the upper intercostal arteries. Venous
drainage is through corresponding vessels into the internal
mammary and axillary veins.
Lymphatic drainage
• Largely into the axillary glands, with some drainage into the
portal fissure of the liver and mediastinal glands. The lymphatic
vessels of each breast communicate with one another.
Nerve supply
• The skin is supplied by branches of the thoracic nerves. There is
also some sympathetic nerve supply, especially around the
areola and nipple.
 Breast cont..
• The function of the breast is largely controlled
by hormone activity.
• Prolactin and oxytocin hormone influence
breast milk production and secretion.
 Prolactin
Secreted DURING
and AFTER feed to Sensory impulse
produce NEXT feed from nipple

Prolactin in
blood

Baby
suckling More prolactin
secreted at night
Suppresses
ovulation
 Oxytocin Reflex 3/4

Works BEFORE or
DURING feed to Sensory impulse
make milk FLOW from nipple

Oxytocin in
blood

Baby
suckling
Makes uterus
contract
 Helping & Hindering Oxytocin Reflex

These HELP reflex

- Worry
- Thinks lovingly
of baby - Stress
- Sound of baby - Pain
- Sight of baby - Doubt
- Confidence

These HINDER
reflex
Signs and Sensations of an Active Oxytocin Reflex
A mother may notice:

• A squeezing or tingling sensation in her breasts just before she feeds her
baby, or during a feed.
• Milk flowing from her breasts when she thinks of her baby, or hears him
crying.
• Milk dripping from her other breast, when her baby is suckling.
• Milk flowing from her breasts in fine streams, if her baby comes off the
breast during a feed.
• Pain from uterine contractions, sometimes with a rush of blood, during
feeds in the first week.
• Slow deep sucks and swallowing by the baby, which show that breast milk is
flowing into his/her mouth
 Breast cont..
Congenital abnormalities
• Extra nipples
• Inverted nipple (true or false)
• Auxiliary lobes
• Long and big nipples
Physiological
• Leaking breast milk during pregnancy
• Cloasma - areola pigmentation

Pathological
• Mastitis
• Breast abscess
• Fungal infection of the breasts
• Eczema
• Tumors benign or malignant
• Fibro adenoma - fibrotic and
• glandular components due to estrogen stimulation
 Male reproductive system
• Structure of the Male Reproductive System.
The male reproductive system includes the
penis, scrotum, testes, epididymis, vas
deferens, prostate, and seminal vesicles.
• The penis and the urethra are part of the
urinary and reproductive systems.
Male reproductive cont..
The male has reproductive organs, or genitals,
that are both inside and outside the pelvis. i.e.
• the testicles
• the duct system, which is made up of the
epididymis and the vas deferens
• the accessory glands, which include the
seminal vesicles and prostate gland
• the penis
Male reproductive organs
Vas deferens
• muscular tube that passes upward alongside the testicles and transports the
sperm-containing fluid called semen.
Epididymis
• A set of coiled tubes (one for each testicle)hang in the scrotum, connects to
the vas deferens.
The accessory glands, including the seminal vesicles and the prostate gland,
provide fluids that lubricate the duct system and nourish the sperm.
The seminal vesicles
• are sac-like structures attached to the vas deferens to the side of the bladder.
The prostate gland,
• produces some of the parts of semen, surrounds the ejaculatory ducts at the
base of the urethra, just below the bladder.
The urethra
• is the channel that carries the semen to the outside of the body through the
penis. The urethra is also part of the urinary system because it is also the
channel through which urine is passed out.
• The organs of the male reproductive system
are specialized for three primary functions:

1. To produce, maintain, transport, and nourish

sperm (the male reproductive cells), and
protective fluid ( semen ).
2. To discharge sperm within the female
reproductive tract.
3. To produce and secrete male sex hormones.
 The penis

• Is made up of the shaft and the glans the main

and tip (head) respectively. At the end of the
glans is a small slit or opening, through which
semen and urine exit the body
• The inside of the penis is made of a spongy
tissue that can expand and contract.
Disorders of the Scrotum, Testicles, or Epididymis
• Conditions affecting the scrotal contents may involve the testicles,
epididymis, or the scrotum itself.
Testicular trauma.
• Even a mild injury to the testicles can cause severe pain, bruising, or
swelling. Most testicular injuries happen when the testicles are struck,
hit, kicked, or crushed, usually during sports or other trauma.
Testicular torsion,
• when one of the testicles twists around, cutting off its blood supply, is
also a medical emergency that, thankfully, is not common. Surgery is
needed to untwist the cord and save the testicle.
Varicocele. This is a varicose vein (an abnormally swollen vein) in the
network of veins that run from the testicles. Varicoceles often develop
during puberty. A varicocele damages the testicle or decrease sperm
production thus accounts for 37% of infertility in male.
Disorders cont..
• Inguinal hernia. When a portion of the intestines pushes through
an abnormal opening or weakening of the abdominal wall and
into the groin or scrotum, it is known as an inguinal hernia. The
hernia may look like a bulge or swelling in the groin area. It is
treated with surgery.
• Epididymitis is inflammation of the epididymis, the coiled tubes
that connect the testes with the vas deferens. It is usually caused
by an infection, such as the sexually transmitted disease
chlamydia, and results in pain and swelling next to one of the
testicles.
• Hydrocele. A hydrocele is when fluid collects in the membranes
surrounding the testes. Hydroceles may cause swelling in the
scrotum around the testicle but are usually painless. In some
cases, surgery may be needed to correct the condition.
 The Fetal Skull

• It is large in comparison with the true pelvis and

some adaptation between skull and pelvis must
take place during labour.
• An understanding of the landmarks and
measurements of the fetal skull enables to
recognize normal presentation and positions and
to facilitate delivery with the least possible
trauma to mother and baby.
Division of the skull: vault and Base
 The vault
• Dome shaped part above the imaginary line
drowns between the orbital ridges and the nape
of the neck.
Five bones that form the vault.
• One occipital bone lies at the back of the head
and forms the region of the occiput.
• Two parietal bones lie on either side of the skull.
• Two frontal bones from the forehead or sinciput.
 The base

• Is composed of bones which are firmly united to

protect the vital centers in the medulla.
• 14 small bones that form the face - firmly united
and non- compressible.
 Sutures and fontanels

• Sutures are cranial joints and are formed where two

bones adjoin. Where two or more sutures meet,
fontanel is formed.
Types of sutures
1. The lambdoidal suture is shaped like the Greek letter
lambda and separates the occipital bone from the two
parietal bones.
2. The sagital suture lies between the parietal bones
3. The coronal suture separates the frontal bones from the
parietal bones, passing from one temple to the other.
4. The frontal suture runs between the two haves of the
frontal bone
 Types of Fontanel

1. The posterior fontanel or lambda is situated at the

junction of the lambdiodal and sagital sutures.
Triangular in shape and can be recognized
vaginally.
2. The anterior fontanel or bregma is found at the
junction of the sagital, coronal and frontal sutures
and recognized vaginally. Diamond shaped
N.B The sutures and fontanels consist membranous
spaces, allows a degree of overlapping of the skull
bones during labour and delivery.
 Regions of the Skull
1. The occiput lies between the foramen magnum and the
posterior fontanel. The sub-occipital region is the part
below the occipital protuberance.
2. The vertex is bounded by the posterior fontanel, the
parital eminences and the anterior fontanele. Of the
96% of the babies born head first, 95% present by the
vertex.
3. The sinciput or brow extends from the anterior
fontanelle and the coronal suture to the orbital ridges.
4. The face is small in new born baby. It extends from the
orbital ridges and the root of the nose to the junctions of
the chin and the neck. The point between the eye brows
is known as the glabella. The chin termed the mentum
and is an important land mark.
 Land Marks of the Fetal Skull

• Sinciput
• Occiput
• Glabella
• Anterior fontanel
• The vertex
• Posterior fontanelle
• Occipital protuberance
• The mentum
Fetal skull (V.RUTH BENNETT. LINDA K. BROWN, 1993)
 Diameters of the Fetal Skull

• The measurement of the skulls are transverse, antero-

posterior or longitudinal.
Transverse diameters
• Bi-parietal diameter 9.5 cm between the parietal
eminence
• Bi-temporal diameter 8.2cm between the furthest
points of the coronal suture at the temples.
Antero-posterior or longitudinal diameters
• Sub-occipito-bregmatic 9.5 cm from below the
occipital
• protuberance to the center of the anterior fontanel or
bregma
 Diameters cont..
• Sub-occipitofrontal 10cm from below occipital
protuberance to the center of the frontal suture.
• Occipitofrontal 11.5 cm from the occipital
protuberance to the glabella.
• Mentovertical 13.5cm from the point of the chin to
the highest point on the vertex slightly nearer to the
posterior than to the anterior fontanele.
• Sub-mento-vertical 11.5 cm from the point where the
chin joins the neck to the highest point on the vertex.
• Sub-mento-bregmatic 9.5cm from the point where
the chin joins the neck to the center of the bregma.
Antero-posterior or longitudinal Diameters of Fetal Skull
V. RUTHBENNETT. LINDA K. BROWN, 1993