Obstetrics & Gynaecological Abbreviation

1 AF Amniotic fluid
2 SGA Small gestational age
3 SIL Squamous intraepithelial lesion
4 SERMS Selective estrogen receptor
modulators
5 SCH Supracervical hysterectomy
6 POP pelvic organ prolapse
7 PROM Premature rupture of membranes
8 PUBS Percutaneous umbilical cord blood
sampling
9 PMS Premenstrual syndrome
1 PIH Pregnancy –induced hypertension
0

11 PGE2, Prostaglandin E2 , F2a

PGF2a

12 PAPP- Pregnancy- associated plasma protein

A A
13 OT Occiput transverse
15 OP Occiput posterior
16 OCP oral contraceptive pill
17 OA occiput anterior
18 MSAFP maternal serum alpha-fetoprotein

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19 LPD luteal phase deficiency
20 LGA large for gestational age
21 LBW low birth weight
22 LAVH laparoscopically assisted vaginal
hysterectomy
23 L/S Lecithin/Sphingomyelin ratio
ratio
24 L-1, L- abbreviations for lumbar vertebra,
2, L-3, spinal nerves,
25 IVM in vitro maturation
26 IVF-ET in vitro fertilization-embryo transfer
26 IUGR Intrauterine growth retradation
27 IUD intrauterine device
28 IgA, Immunoglobulin A, G, …
IgG
29 ITP Immune thrombocytopenic purpura
30 HT hormone therapy
31 hMG Human menopausal gonadotropin
32 HSG hysterosalpingography
33 HIV human immunodeficiency virus
34 HELLP hemolysis, elevated liver enzymes,
low platelets
35 HLA Human leukocyte (or lymphocyte)
antigen

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36 hCG Human chorionic gonadotropin
37 HBIG hepatitis B immune globulin
38 Hb hemoglobin
39 GIFT Gamete intrafallopian transfer
40 GDM gestational diabetes mellitus
41 GBS Group B streptococci
42 FHR Fetal heart rate
43 ET Estrogen therapy
45 ELISA Enzyme –linked immunosorbent
assay
46 EGA estimated gestational age
47 EFM Electronic fetal monitoring
48 EDD Estimated date of delivery
49 ECC endocervical curettage
50 DVT deep vein thrombosis
51 D&E Dilation and evacuation
52 D&C dilation and curettage
53 CST contraction stress test
54 CPD cephalopelvic disproportion
55 CA 125 cancer antigen 125
56 CIS carcinoma in situ
57 C-1, C- abbreviations for cervical vertebra,
2, C-3 spinal nerves,

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58 BPP Biophysical profile
59 bpm Beats per minute
60 BPD Biparietal diameter
61 ASC Atypical squamous cells
62 AIDS Acquired immunodeficiency
syndrome
63 AGC Atypical glandular cells
64 AGA appropriate gestational age
65 AFP alpha fetoprotein
66 AFI amniotic fluid index

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Obstetrics & Gynaecological Glossary

Accelerated labour When labour is speeded up after it's begun,

usually with a hormone drip.

Afterbirth Another word for the placenta.

Amniotic fluid A protective liquid, consisting mostly of water,

filling the sac surrounding the foetus in the
uterus.

Amniotic sac The sac that holds the protective liquid called
amniotic fluid that surrounds the foetus inside
the uterus.

Amniotomy This is the 'puncturing' of the amniotic sac,

which will release the amniotic fluid, and help
start labour. Also known as ARM, artificial
rupture of the membranes.

Antenatal Before the birth.

APH Acronym stands for ante-partum haemorrhage –

any serious bleeding from the vagina before the
birth.

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ARM Acronym stands for artificial rupture of the
membranes. Also known as amniotomy, see
above definition.

ART Acronym stands for assisted reproductive

technology. All treatments or procedures that
involve the handling of human eggs and sperm
for the purpose of establishing a pregnancy.
Types of ART include IUI, IVF, GIFT, ZIFT,
embryo cryopreservation, egg or embryo
donation, and surrogate birth.

ART cycle A process in which an ART procedure is carried

out, a woman has undergone ovarian
stimulation or monitoring with the intent of
having an ART procedure, or in the case of
frozen embryos, embryos have been thawed
with the intent of transferring them to a woman.
A cycle starts when a woman begins taking
fertility drugs or starts ovarian monitoring.

Atosiban (Brand An oxytocin antagonist used to delay imminent

name Tractocile) pre-term (premature) labour.

Caesarean An operation using a cut in the abdominal wall

(via an incision made in the mother's abdomen
and uterus) to deliver the baby when it is not
safe to deliver it through the vagina (-section,

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 -birth, -delivery, c-section).

Carbetocin A long-acting, oxytocin analogue that is used to

prevent uterine atony and post partum
haemorrhage following caesarean section.

Cervical canal The passage through the cervix connecting the

body of the uterus and vagina.

Cervical mucus The secretion from the cells lining the cervix,
which changes under the influence of the
female sex hormones.

Cervix The entrance to the uterus, or neck of the

womb.

Conception Fusion of the sperm and the egg cell.

Contraction The regular tightening of the uterus, working to

dilate and efface the cervix and to push the baby
downs the birth canal.

Corpus luteum This literally means 'Yellow Body'. The

structure formed in the ruptured follicle after
ovulation, which produces progesterone. If the
ovum (egg cell) is fertilised, the corpus luteum
continues to produce hormones to support the

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 early pregnancy. If fertilization does not occur,
the corpus luteum degenerates within 12-16
days.

Curettage A minor surgical procedure used to scrape out

the surface of the uterus (endometrium) with an
instrument called a curette.

Dilation/dilatation The amount the cervix has opened in

preparation for childbirth, dilation is measured
in centimetres. “Fully dilated” means you're at
10 centimetres and are ready to push.

Dinoprostone A vaginal prostaglandin formulation for

(Brand name initiation and continuation of cervical ‘ripening’
‘Propess’) at term.

Donor embryo An embryo formed from the egg of a woman

who has donated it for transfer to a woman who
is unable to conceive with her own eggs (the
recipient).

Dysfunctional Also called ‘failure to progress’. Diagnosis

labor given to a woman whose labour does not follow
a “normal” pattern and is severely prolonged.

Early labour Usually when regular contractions have

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 occurred for two hours or more, as frequent as
every five minutes to every twenty minutes.
The cervix dilates up to three or four
centimetres during this stage.

Eclampsia A dangerous, pregnancy-induced condition

affecting mother and baby during pregnancy.
Symptoms may include elevated maternal blood
pressure, fluid retention, swelling of ankles and
hands, sudden weight gain, protein in the urine
and fits.

Egg retrieval - also A procedure to collect the eggs contained in the

called oocyte ovarian follicles.
retrieval

Egg transfer - also The transfer of retrieved eggs into a woman's

called oocyte fallopian tubes through laparoscopy. This
transfer procedure is used only in GIFT (see definition).

Egg A female reproductive cell - also called an

oocyte or ovum.

Embryo transfer Placement of embryos into a woman's uterus

through the cervix after IVF (see definition) or,
in the case of ZIFT (see definition), into her
fallopian tubes.

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Embryo An egg that has been fertilised by a sperm and
that has undergone one or more divisions.
Refers to the initial stages of development up to
around eight weeks after conception.

Endometriosis The presence of tissue similar to the uterine

lining in locations outside the uterus, such as
the ovaries, fallopian tubes, and abdominal
cavity.

Endometrium The inner lining of the uterus which is shed

during menstruation.

Failure to Progress Also called dysfunctional labour. Diagnosis

given to a woman whose labour does not follow
a “normal” pattern and is severely prolonged.

Fertilisation The penetration of the egg by the sperm and the

resulting fusion of genetic material that
develops into an embryo.

Foetus The unborn child from around eight weeks after

conception
(when all major organs are formed and it begins
to resemble a human being)
to the time of birth. (Before then, it's considered
an embryo.) The word foetus means “young
one.”

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Follicle A small fluid-filled structure in the ovary which
contains the ovum or egg cell.

Follicle-stimulating A hormone secreted by the pituitary gland,

hormone (FSH) which initiates the development of one or more
ovarian follicles.

Follicular phase The part of the menstrual cycle which precedes

ovulation.

Fresh eggs, sperm, Eggs, sperm, or embryos that have not been
or embryos frozen. However, fresh embryos may have been
conceived using either fresh or frozen sperm.

Gamete A reproductive cell, either a sperm or an egg.

GIFT Acronym stands for gamete intrafallopian

transfer. An ART procedure that involves
removing eggs from the woman's ovary,
combining them with sperm, and using a
laparoscope to place the unfertilised eggs and
the sperm into the woman's fallopian tubes
through a small incision in her abdomen.

Gynaecologist A doctor who specialises in disorders of the

female reproductive system and includes the
treatment of infertility.

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Heamorrhage Bleeding, either internally or externally.

Hormone A chemical messenger that is made in one part

of the body and affects the functions of cells in
various parts of the body.

Human chorionic The hormone pregnancy tests look for, secreted

gonadotrophin by the placenta. This hormone prolongs the life
(hCG) span of the corpus luteum as well as stimulating
the production of progesterone, thereby creating
the ideal environment for the embryo. hCG also
has important effects outside the ovary.

Hypertension High blood pressure.

ICSI Acronym stands for intra-cytoplasmic sperm

injection. A procedure in which a single sperm
is injected directly into an egg. This procedure
is most commonly used to overcome male
infertility problems.

Implantation The process by which the fertilised egg embeds

in the endometrium.

Incompetent cervix A cervix that does not function properly during

pregnancy and is likely to dilate prematurely
and cause a miscarriage.

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Induced labour When labour is started or accelerated through
intervention, including the use of an IV drip of
the hormone oxytocin, placing a prostaglandin
formulation on the cervix (such as Propress), or
by rupturing the membranes.

IUGR Acronym stands for Intrauterine growth

retardation. The growth of the foetus is
abnormally slow. After the birth, the baby
appears smaller than the dates say he or she
should be.

IVF Acronym stands for in-vitro fertilisation. An

ART procedure that involves removing eggs
from a woman's ovaries and fertilising them in
the laboratory. The resulting embryos are then
transferred into the woman's uterus through the
cervix.

Labour Regular contractions of the uterus that result in

dilation of the cervix.

Laparoscopy A surgical procedure in which an fibreoptic

instrument (a laparoscope) is inserted into the
pelvic area through a small incision in the
abdomen.

Live birth Any infant delivered with signs of life after 28

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 or more weeks of gestation.

Luteal phase The post-ovulatory phase of the menstrual cycle

characterised by the growth and development of
the corpus luteum.

Luteinising A hormone from the pituitary gland that

hormone (LH) stimulates ovulation and the development of the
corpus luteum. The increased release of this hormone
on about day 12 to 13 of a normal menstrual cycle
causes ovulation to occur approximately 24 hours
later.

Membranes The fibrous layers around the baby and fluid,

forming the amniotic sac.

Menstruation, The cyclic shedding of the endometrium, consisting

menses, menstrual of blood, mucus and cellular debris. Menstruation
period normally occurs about two weeks after ovulation.

Mucous Plug Pinkish mucous discharge - which blocks the

cervix during pregnancy.

Multiple birth A pregnancy that results in the birth of more

than one infant.

Neonatal Referring to the newborn period (the first four

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 weeks of life).

Obstetrician A doctor who specialises in pregnancy, labour

and delivery.

Oestrogen A hormone, produced mainly by the ovaries,

responsible for female sexual development and
female secondary sex characteristics. Increasing
oestrogen levels in the follicular phase of the
menstrual cycle (pre-ovulatory phase)
stimulates significant changes in the cervix,
cervical mucus, and the endometrium.

Oocyte A matured female reproductive cell - also called

an egg or ovum.

Ovarian The use of ultrasound and/or blood or urine tests to

monitoring monitor the development of ovarian follicles.

Ovarian The use of gonadotropins to stimulate the

stimulation ovaries to develop follicles and eggs.

Ovary One of a pair of female sex glands which

produce ova and the female sex hormones
oestrogen and progesterone. These hormones
control the menstrual cycle and female
secondary sex characteristics.

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Ovulation The release of a mature ovum or egg cell from
the ovarian follicle.

Ovulatory cycle A cycle in which ovulation occurs,

characterised by a bi-phasic temperature chart.

Ovum: ova (plural) An egg (female reproductive cell).

Oxytocin The hormone secreted by the pituitary gland

that stimulates contractions and the milk-eject
reflex (let-down).

PIH Acronym stands for pregnancy-induced

hypertension (high blood pressure).

Pituitary gland The 'master' endocrine (ductless) gland at the

base of the brain which produces many
important hormones, some of which trigger
other glands into making their own hormones.
The pituitary functions include hormonal
control of the sex glands (ovaries and testes).

Placenta The structure attaching the umbilical cord and

(afterbirth) the foetus to the wall of the uterus, through
which the foetus obtains its nutrients and
oxygen and through which its excretory
products are transferred to the mother. The

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 placenta also makes several hormones.

Post term: When pregnancy lasts beyond 42 weeks.

Postnatal The period after the birth.

Postpartum The period of time after a baby's birth.

Pre-eclampsia The precursor to eclampsia, a condition

involving high blood pressure, swelling due to
fluid retention, and abnormal kidney function
and is, in itself, risky to mother and baby.

Pre-embryo A fertilised egg in the early stage of

development prior to cell division.

Pregnancy test A blood or urine test that determines the level of the
human chorionic gonadotropin (hCG) hormone.
Elevated levels of this hormone are chemical
evidence of a pregnancy.

Pregnancy The condition of nurturing the embryo or foetus

within the woman's body, lasting from
conception to birth.

Pregnancy, Pregnancy documented by a blood or urine test

Chemical that shows a rise in the level of the human

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 chorionic gonadotropin (hCG) hormone.

Pregnancy, Pregnancy documented by the presence of a

Clinical gestational sac on ultrasound.

Premature Pre-term, before the 37th week of pregnancy.

Pre-term Before the 37th week of pregnancy.

Progesterone A hormone which is produced in increasing

quantities by the ovary after ovulation and by the
placenta during pregnancy.

Progestogen Progesterone and progesterone-like drugs.

PROM Acronym stands for premature rupture of

membranes and means a woman's water has
broken early.

Propess A vaginal formulation of dinoprostone

(dinoprostone) (prostaglandin) used to control induction of
labour and the ‘ripening’ of the cervix.

Sperm The male reproductive cell.

Stimulated cycle An ART cycle in which a woman receives drugs

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 to stimulate her ovaries to produce more
follicles.

“Swim-up” A technique that selects and concentrates sperm

technique that are most capable of fertilising the egg.

Term Referring to a ‘full’ 40 week pregnancy.

Tractocile An oxytocin antagonist used to delay imminent

(atosiban) pre-term (premature) labour

Trimester Each three-month period during the nine

months of pregnancy.

Tubal factor A cause of infertility related to structural or

functional damage to one or both fallopian
tubes.

Ultrasound High frequency sound waves. A non-invasive

technique for visualising the follicles in the
ovaries and the gestational sac or fetus in the
uterus. Can be performed either transabdominal
or transvaginal.

Umbilical Cord The cord that carries blood, oxygen and

nutrients to the baby from the placenta during
pregnancy.

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Unexplained cause Infertility for which no cause has been
of infertility determined despite a comprehensive evaluation.

Unstimulated cycle An ART cycle in which the woman does not

receive drugs to stimulate her ovaries to
produce more follicles. Instead, follicles
develop naturally.

Uterine factor A cause of infertility related to defects in the

uterus.

Uterus (womb) The pear-shaped muscular organ in which the

fertilised ovum implants and grows for the
duration of pregnancy.

Vagina The muscular canal extending from the cervix

to the opening at the vulva.

Washed sperm Sperm which is washed to reduce the risk of

infection (because the cervical mucus is by-
passed).

Waters breaking The waters or amniotic sac bursts during early

labour, generally when the baby is ready to be
delivered.

ZIFT (zygote An ART procedure in which eggs are collected

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 intrafallopian from a woman's ovary and fertilised in the
transfer) laboratory. A laparoscope is then used to place
the resulting zygote (fertilised egg) into the
woman's fallopian tubes through a small
incision in her abdomen.

AN ATOM Y OF F EM AL E RE PR OD UC TI VE
SYSTEM
Out lines:
I -External female genital organs (the vulva):
1. The mons pubis or mons veneris.
2. The labia majora.
3. The labia minora.
4. The clitoris.
5. The vestibule.
6. The urethral orifice.

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 7. The Vaginal orifice (Vaginal introitus).
8. The Hymen.
9. Bartholin's glands.
10.The perineal body.
II- internal female genital organs:
1. The ovaries (female gonads).
2. The fallopian tubes or uterine tubes

3. The uterus .
4. Vagina.

General objective:
To understand anatomy and physiology of female reproductive
system .

Specific objective:
At the end of this lecture the student should be able to:

1- Identify the external female genital organs.

2- Identify the internal female genital organs .

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 3- List the functions of ovaries, fallopian, tubes, uterus and

vagina.

4- Explain the three main tissue layers of the uterus.

Anat om y
Anatomy of female reproductive system consists of:
Bony pelvis & soft tissue,
soft tissue consists of:
1-External female genital organs {The Vulva}.
2-Internal female genital organs.

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-: I-The Vulva consists of the following structures
1. The mons pubis or mons veneris: is a pad of fat, covered
with pubic hair from the time of puberty,
Function: is the protection of the symphysis pubis during
intercourse
Location: over the symphysis pubis.
2. The labia majora: are two folds of fat and areolar tissue,
covered with skin and pubic hair on the outer surface.
Function: is the protection of the vaginal introitus
Location: arise in the mons veneris and merge into the
perineum behind.
3. The labia minora : two thin folds of skin lying between the
labia majora. Anteriorly, divide to enclose the clitoris,
posteriorly, fuse forming the fourchette.
Function: is erotic, in response to stimulation and are highly
sensitive.
Location: between the labia majora
4. The clitoris: (corresponding to the male penis). is a small
rudimentary organ, very sensitive and highly vasculars

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 Function: is sexual stimulation.( plays a part in the orgasm
of sexual intercourse.)
5. The vestibule:
Location: the area in which the openings of the urethra and
the vagina are situated & enclosed by the labia minora.

6. The urethral orifice

Location 2.5 cm posterior to the clitoris, the openings of Skene's
ducts lie on either side,which are two small blind-ended tubules 0.5
.cm long running within the urethral wall
7. The Vaginal orifice(Vaginal introitus)

Location occupies the posterior two-thirds of the vestibule.

The orifice is partially closed by the hymen
8. The Hymen, a thin membrane which tears during sexual
intercourse or during the birth of the first child.
It has one or more openings to allow escape of menstrual
blood.
Shape of Hymen: annular cresentic cribiform
Elastic imperforate
9. Bartholin's glands: are two small glands which open on
either side of the vaginal orifice
Function: secrete mucus, which lubricates the vaginal
opening.
Location: in the posterior part of the labia majora

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 10.The perineal body
This is pyramid of muscle and fibrous tissue situated between the
vagina and the rectum. It is made up of fibres from muscles,The
perineal body measures 4 cm in each direction&play an importantat
.function in supporting the reproductive organs

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 II- Internal female genital organs

1. The ovaries: (female gonads) comparable to the testes in

the male & similar to almonds in size& shape.
Location: Are located on either side of the uterus ,below
and behind the fimbriated ends of the ova ducts.
Functions: The ovaries produce ova (ovulation) and the
hormones oestrogen, progesterone & androgen.
Structure: The ovary is composed of a medulla and cortex,
covered with germinal epithelium.

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 **The medulla: it
is made of fibrous tissue
and the ovarian blood
vessels, lymphatics and
nerves travel through it.
The hilum where these
vessels enter lies just
where the ovary is
attached to the broad
ligament and this area is
called the mesovarium.
The medulla is the
supporting framework
**Thecortex:It
contains the ovarian
follicles in different
stages of development, surrounded by stroma. The outer layer is
formed of fibrous tissue known as the tunica albuginea; the
cortex is the functioning part of the ovary.

Supports:
Supported from above by the ovarian ligament
medially and the infundibulopelvic ligament laterally.
Relations:
Anterior: the broad ligaments.
Posteiror: The intestines.

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Lateral: The infundibulopelvic ligaments and the side wall of the
pelvis.
Superior: The Fallopian tubes.
Medial: The uterus and the ovarian ligament
2. The fallopian tubes or uterine tubes
Open pass way extended from the cornua of the uterus towards the
sidewalls of the pelvis.each tube is 10cm in long

Parts of the tube:

1. Interstitial portion: is 1 cm long and lies within the wall of
the uterus. Its lumen is 1 mm wide.
2. The isthmus: is narrow part, which extends for 2 cm from
the uterus.

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 3. the ampulla: is the wider portion of the tube where
fertilization usually occurs. It is 5 cm long.
4. The infundibulum: is 2 cm long is the funnel-shaped fringed
end which is composed of fimbriae. One fimbria is elongated
to form the ovarian fimbria which is attached to the ovary.
Functions:
1-Receives the spermatozoa as they travel upwards
2- provides a site for fertilization.
3-Ovum transport and pick up.
4-Embryo transport and nourishment.
Position:
The fallopian tubes extend laterally from the cornua of the
uterus towards the side walls of the pelvis. They arch over the
ovaries; the fringed ends hovering near the ovaries in order to
receive the ovum.
Relations:
Anterior, posterior and superior. The peritoneal cavity and the
intestines .
Lateral. The sidewalls of the pelvis .
Inferior. The broad ligaments and ovaries lie below the tubes.
Medial. The uterus lies between the two fallopian tubes.
Supports:
The fallopian tubes are held in place by their attachment to
the uterus. The peritoneum folds over them, draping down below as
the broad ligaments and extending at the sides to form the
infunibulopelvic ligaments.

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 The peristaltic movement of the fallopian tube is due to the
action of the smooth muscles. The tube is covered with peritoneum
but the infundibulum passes through it to open into the peritoneal
cavity.

3. The uterus

It is ahollow, muscular, pear –

shaped organ in non pregnant
woman,it is 7.5 cm long , 5cm
wide and 2.5cm in depth,each
wall being 1.25 cm thick.
Function: shelter the fetus
during pregnancy. It prepares
for this possibility each month and following pregnancy it expels
the uterine contents.
Location: situated in the true pelvis , between the bladder and
rectum.( In pelvic cavity)
parts of the uterus: The uterus consists of the following parts:
. The body or corpus makes up the upper two thirds of the
uterus and is the greater part.
. The fundus is the domed upper wall between the insertion
of the fallopian tubes.
. The cronua are the upper outer angles of the uterus where
the fallopian tubes join.

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 . The cavity is a potential space between the anterior and
posterior walls. It is triangular in shape, the base of the triangle
being upper most.
. The isthmus is a narrow area between the cavity and the
cervix, which is 7 mm long. It enlarges during pregnancy to
form the lower uterine segment.
. The cervix or neck: the cervix forms the lower third of the
uterus and measures 2.5cm in each direction. It is narrow lower
part of the uterus composed of fibrous connective tissue, projects
into the vagina & is divided into two portions :
a-vaginal portion :
Below the attachment site that protrudes into the vagina .
b- Supra vaginal portion :
Above the site of attachment of the cervix to the vaginal wall.
. 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. After childbirth this becomes a transeverse slit.
The cervical canal: is a continuation of the uterine cavity, lies
between the internal & the external os, and is narrow at each end
&wider in the middle.

Layers of the uterus:

The uterus has three layers:

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 The perimetrium: (the outer layer) double membrane drape
over the uterus , an extension of the peritoneum covering all but
narrow on either side .
The myometrium: (muscle coat) is thick in the upper part of
the uterus and is more sparse in the isthmus and cervix.
The endometrium: (mucous membrane) on a base of
connective tissue &constantly changing in the thickness throughout
menstrual cycle
The basal layer does not alter, but provides the foundation
from which the upper layers regenerate.
Supports:

The uterus is supported by the pelvic floor and maintained in

position by several ligaments of which those at the level of the
cervix are the most
Important. . Pubocervical ligaments: pass from the cervix under the
bladder to the pubic bones.

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• Transverse cervical ligaments (cardinal ligaments) from the
sides of the cervix to the side walls of the pelvis.
• Uter sacral ligaments pass backwards from the cervix to the
bladder to the pubic bones.
• Broad ligaments: fold of peritoneum which are draped over
the fallopian tubes and spread from side of the uterus to the
side wall of the pelvis .
• Round ligaments: fibromuscular cords from upper,outer
angles of uterus,through inguinal canal ,terminating in labia
majora.
• The ovarian ligaments: also begin at the cornea of the uterus
but behind the fallopian tubes and pass down between the
folds of the broad ligament to the ovaries.It is helpful to note

that the round ligament, fallopian tube and the ovarian

ligament are very similar in appearance and arise from the
same area of the uterus. This makes careful identification
important when tubal surgery is undertaken.

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Relations
Superior. Above the uterus lie the intestines.
Inferior. Below the uterus is the vagina.
Lateral. On either side of the uterus are the broad ligaments,
the fallopian tubes and the ovaries.
Anterior: In front of the uterus lie the uterovesical pouch and
the bladder.
Posterior: Behind the uterus are the rectouterine pouch of
Douglas and the rectum.

4. Vagina: passage as
canal running from
the vestibule to the
cervix, passing
upwards and
backwards into the
pelvis along a line
approximately
parallel to the plane
of the pelvic brim.
Structure:
The posterior wall is 10 cm long while the anterior wall is
only 7.5 cm in length because the cervix projects at a right angle
into its upper part. the vaginal walls stretch during intercourse and
child birth due to folds as rugae. In the nulliparous adult the vagina
is H- shaped in section .
Functions:

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 1- allows the escape of the menstruation and act as excretory
duct for uterine secretion
2- receives semen from the male during sexual intercourse
3-provides an exit for the fetus during delivery.
Contents:
There are no glands in the vagina. the fluid is strongly acid
(pH 4.5) due to the presence of lactic acid formed by the action of
dodelein's bacilli on glycogen found in the squamous epithelium of
the lining.

Layers:
The lining is made of squamous epithelium. Beneath the epithelium
lies a layer of vascular connective tissues. The muscle layer is
divided into a weak inner coat of circular fibres and a stronger outer
coat of longitudinal fibres.Pelvic fascia surrounds the vagina,
forming a layer of connective tissue.
Relations:
Superior. Above the vagina lies the uterus.
Inferior. Below the vagina lie the external genitialia.
Lateral: Beside the upper two-thirds are the pelvic fascia and
the ureters, which pass beside the cervix.
Anterior. Vaginal wall is related to bladder and urethra.
Posterior. Behind, the pouch of Douglas, the rectum and the
perineal body each occupy approximately one-third of the posterior
vaginal wall.

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 ME NS TRUATIO N

Out lines:
1. Introduction.
2. Definition of menstruation.
3. Phases of menstrual cycle. Consists of:
I - Endo martial cycle:
• Menstrual phase.
• Proliferate phase.
• Isocheims phase.

II- Ovarian cycle. Consists of:

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 • Follicular phase.
• Lateral phase.

4.Teaching about menstrual health.

General objective:

To provide the students with knowledge about physiology of

menstruation .

Specific objectives:

At the end of this lecture the student should be able to:

1- Define the menstrual cycle.

2- List phases of menstrual cycles.

3- Explain the characteristics of each phase.

4- Educate about menstrual health.

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 ME NS TRUATIO N
INTRODUCTION:
The first menstruation occurs is called the menarche, which
usually occurs between 11 and 13 years of age.
Menstruation is normal and necessary part of healthy women
hood. It is defined as the monthly shedding of the uterine lining in
response to cyclic hormonal changes.
Menstruation is normal physiologic event shared by all
women yet each woman's experience is unique. How a woman
experiences menstruation depends on sociocultural factors, her
attitudes about her body, sexuality, and reproductive function. It is
also properly called menses catamenia, and more commonly period
or monthly flow; menstruation is not an illness but an expected and
necessary part of healthy mature woman hood.

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 Definition of menstruation:
Menstruation is defined as cyclic uterine bleeding in response
to cyclic hormonal changes. Menstruation occurs when the ovum is
not fertilized and begins about 14 days after ovulation in a 28-day
cycle. The menstrual discharge, also referred to as the menses, it
composed of blood mixed with cervical and vaginal secretion
bacteria, mucus, leukocytes and other cellular debris, the menstrual
discharges is dark red & has a distinctive odor.
The usual duration of the menstrual cycle is 3-5, days, but
flows as short as I day & as long as 8 days can occur in normal
women. The average amount of blood lost is 30 ml but may range
normally from slight spotting to 80 ml. Loss of more than 80 ml. is
abnormal. Obviously, the amount of flow can be affected by various
factors, including thickens of the endometrium, medication and
diseases that affect the clotting mechanism.

Usually the blood is liquid, but if the rate of hemorrhage is

excessive, Clots of various sizes may appear. Considerable attention
has been directed to the usual state of incoagulability of menstrual

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blood. The menstrual flow consists of a varying mixture of cellular
debris, mucus, and blood.
The average daily loss of iron is 0.5 to 1 mg., decrease the
body's iron supplies resulting in the need for iron.
Ovulation does not always occur in the early menstrual cycle
and around menopause.
The menstrual cycle can be considered as two intermittent
cycles. One cycle takes place in the uterus & the other cycle takes
place in the ovary .
I-Endometrial cycle
The Endometrial cycle consists of four phases : Menstrual
phase, Proliferative phase, Secretory phase , Ischemic phase.
1-Menstrual phase:
When pregnancy does not occur, progesterone and estrogen
levels fall. Disintegration of the uterine lining that was prepared to
receive a fertilized ovum (Function layer) follows. The menstrual
phase begins and functional layer of the uterine lining is shed. The
first day of menses marks the beginning of another menstrual cycle.

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2-Proliferative phase: The proliferate phase begins when the
endometrial glands enlarge, becoming twisted and longer, in
response to increasing amount of estrogen. The blood vessels
become prominent &
dilated & the
endometrium increase
in thickness six fold
to eight folds. This
gradual process
reaches its peak just
before ovulation. The
cervical mucosa
becomes thin, clear,
watery, and more
alkaline, making the mucosa more favorable to spermatozoa. As
ovulation nears, the cervical mucous shows increased elasticity,
called spinnbarkeit.
At ovulation the mucus will stretch more than 5cm B.Spinnbarkiet
3- Secretary phase:
The secretory phase follows ovulation. The endometrium,
under progestron influence, undergoes slight cellular growth.
Progesterone, however, causes such marked swelling and growth
that the epithelium is changed into folds. The amount of tissue
glycogen increases. The glandular epithelial cells begin to fill with
cellular debris, and the glands become tortuous and dilate. The
glands secrete small quantities of endometrial fluid in preparation

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for a fertilized ovum. The vascularity of the entire uterus increases
greatly, providing a nourishing bed for implantation. If implantation
occurs, the endometrium, under the influence of progesterone,
continues to develop and become even thicker.

4-Ischemic phase :
On the twenty - sixth day of the menstrual cycle ,if pregnancy has
not occured ,the corpus luteum begins to degenerate .
Approximately 2 days later the thickened lining of the uterus starts
to disintegrate, having lost its progesterone and estrogen support.
Menstrual bleeding marks the end of the Ischemic phase and the
beginning of anew-menstrual cycle.

II-Ovarian cycle
Ovarian cycle consists of two phases:
a) Follicular phase
The follicular phase of the ovarian cycle lasts from
approximately the fourth to the 14th day during these 10 days. The
ovary is under the influence of FSH secreted by the pituitary. Its
function is to stimulate a number of ovarian follicles to grow,
develop, and produce estrogen.
This maturing follicle is called the grafian follicle. This
follicle and other ovarian tissue are filled with estrogenic fluid,
which is secereted in relatively large amounts into the blood one of
the functions of estrogen at this time is to build up or thicken the
lining of the uterus. As the follicle enlarge it pushed to the surface

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of the ovary to create ablister bulge that may be clearly seen if the
ovary is observed directly finally with the peak in LH at midcycle
ovulation occurs, and the empty follicle begins its to formation into
the corpus lutuem. This follicular phase of the ovarian menstrual
cycle varies in length from woman to women.
The follicular phase is marked by the rapid growth and repair
of the endometrial tissue after the menses. This regeneration is
thought to be activated by the hormonal control of estrogen which
produces its maximum effect until ovulation occurs.
B- Luteal phase:
The luteal phase of the ovarian cycle begins on
approximately the 15th day of the menstral cycle and ends on
approximately the 28th day. The luteal phase begins when the
graafian follicle rupture and the ovum is released. The precise
mechanism cause rupture is not known, but the following factors
contribute:
1. Increased pressure of fluid within the graafian follicle.
2. Compression of the surrounding blood vessels.

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 Pituitary control

The luteal phase this postovulatory phase of the ovarian cycle

usually requires 14 days Range of 13 to 15 days The corpus luteum
continue, to produce estrogen but, in addition, manufactures the
hormone progesterone, which further prepares the uterus for
pregnancy if fertilization occur the corpus leutum continuons to
produce hormone estrogen and progesterone until placenta
formation, but when the ovum is not fertilized the corpus luteum
degenerates, becoming a dry, ascarred areas called the corpus
albican. It produces no hormones, estrogen and progesteron level
drop. A aresult, the endometrium being to shed and menstrual flow
begins.

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 Teaching About menstrual Health

AREA OF TEACHING POINTS

CONCERN
Exercise It's good to continue moderate
exercise during menses because it
increase abdominal tone. Sustained
excessive exercise.
Activities of daily life Nothing is contraindicated (many
people believe incorrectly that things
like washing hair are harmful).
Pain relief Any mild analgesic is helpful.
Prostaglandin inhibitors such as
ibuprofen are specific to menstrual
pain. Applying local heat may also be
helpful.
Rest More rest may be helpful if
dysmenorrheal interferes with sleep at
night.
Nutrition Many women need iron
supplementation to replace iron lost in
menses.

• Self-care during menstruation also varied widly

depending on cultures religions, and symptoms.

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• Health education to correct misinformation about
the menstrual cycle. Discusses the client’s attitude
toward menstruation to assess understanding or
misconceptions. The adolescent may feel shame, or
low self-esteem. The nurse can educate and promote
positive self-image by emphasizing that
menstruation is a normal physiologic response to
maturation.

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 Fer tili za tio n

Out lines:
1- Definition of fertilization.

2- Early development of the fertilized ovum.

3- Formation of the deciduas.

4- Formation of the placenta.

5- Abnormalities of the placenta.

6- Functions of amniotic fluid.

7- Abnormalities of umbilical cord.

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General objectives: -
To provide the students with knowledge about physiology of
reproduction.
Specific objectives: -
At the end of this lecture the student should able to:
1- Define the fertilization.
2- Explain early development of the fertilized ovum.
3- Differentiate parts of the deciduas.
4- List the functions of the deciduas.
5- Identify changes of the inner call mass.
6- Observe the surfaces of the placenta.
7- List the functions of the placenta.
8- Understand abnormalities of the placenta.
9- Illustrate knowledge about amniotic fluid.
10- Enumerate the functions of the amniotic fluid.
11-Inform the abnormalities of umbilical cord.

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 Fer tili za tio n
Definition:
It is the union of the sperm from the male with the
ovum from the female.
Ovum development ----Fertilization-----Entry into the uterus
The ovum is fertilized by a sperm inside the fallopian tube
and is transport to the uterus, it implants on the endometrium of the
upper section of the uterus where it undergoes development as an
embryo.

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 The fertilized egg is propelled along the remaining half of the
tube by wafting of cilia of the cells lining to the tube and the
peristaltic action of the muscle wall.
Sex determaination
The sex of the fetus is determained at fertilization by the sex
chromosome contained in the sperm- if it is X; an XX cell is
produced while develops into a female. If it is Y, an Xy cell is
produced, which forms a male.

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 This Journey of three inches takes about 3 days, As it moves
along it undergoes a process of rapid cell division.
The one cell splits into 2, the 2 split to form 4 cells, then 8,
16 and so on. This rapid cell division or cleavage is done by
mitosis. Mitosis is nuclear division in which each of the 46
chromsomes first splits, so that 2 sets of 46 are formed. The cell
then splits into two, each enclosing a nucleus with 46
chromosomes. Each of these (daughter) cells has exactly the same
chromosomes composition as the original cell.

The first cell division is completed about 30 hours following

fertilization.If an egg is un fertilized, as most commonly occurs, the
egg undergoes division by it self into 2, or 4 cells and then dies to
be absorbed in the tube or uterus .
By the end of about 96 hours after fertilization, a cluster of
about 16 cells has formed inside the original egg cell wall, which
then enters the uterine cavity .

Cleavage division
The cells decrease in size as they increase in number. This
make it possible for all the cells to remaine enough to be able to
contained in the original cell wall which can
through the small opening between the tube and the uterus.

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 Implantation of the ovum
Implantation of
the ovum about
the 4th day
of conception,
about day 21
of the menstrual cycle , the
blastocyst settles on the endometrium to
begin the process of implantation or
nidation .
(By this process the ovum buries it
self inside the endometrium.implantation coincides with
developmental phase of the endometrium when it is most prepared
for a fertilized ovum.

By means of digestive enzymes secreted, the outer trophoblast cells

in contact with the endometrium eat through the cell linings and
burrow through to bury the blast cyst deep inside the endometrium
.the lining then patches it self up over the mass to complete the
process in about 7days,that is ,at about 14days after conception.
This concides with about day 28 of the menstrual, when the women
will be expecting her period.

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8 light bleeding may occur as the trophoblastic cells eat through
blood vessels during implantation. This may be mistaken for
apcanty menstrual flow.

Is the epithelial lining repairs it self to enclose the blast cyst ,the
blood vessels begins to provide the blast cyst with oxygen and
nourishment.

The developing cells remain in the uterine cavity for about 4 days
before embedding. They leave the original cell wall and grow in
size. Fluid-filled cavity is formed, pushing some of the cells to one
side. Two distinct layers are now formed :
1-The outer cell mass is called trophoblast or future feeding layer.
These cells become the placenta, or after birth.

2-The inner cell mass is called embryo blast, or future embryo

layer. These cells become the fetus.

The whole mass, including the cavity, is called the blastocyst; this is
the stage at which it embeds.

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-Differentiation of deciduas

1-

decidua basils: which beneath the blast cyst.

2- decidua capsularis: which lies directly over the blast cyst and
separate it from the uterine cavity.
3- deciduas Vera: which line the remainder of the cavity.

Changes in the inner cell mass

After implantation, during the third week after fertilization, cell
differential begins within the inner cell mass (embryoblast). Two
cavities. The inner cell mass in now referred to as the embryo.

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 One cavity is known as the yolk sac. This provides
nourishment for the developing embryo for a brief time, after which
it disappears. Another cavity is known as the amniotic sac and
contains fluid, will encopsulate the developing embryo and protect
it up to full.
In the embryonic area the following organization of cells occurs:

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1- The layer closest to the amniotic sac forms the "ectoderm"(or
outside layer) the ectoderm forms the nervous system, skin, and
certain lining mucosa.
2- The layer closest to the yolk sac forms the "endoderm" (or inner
layer), the endoderm forms the mucosa of the digestive tract and
epithelium of the liver, pancreas, lungs and bladder.
3- The third layer formed between these two is known as the
"mesoderm" (or mid layer). The mesoderm forms the structure of
the body bone, muscles, heart, and the circulatory system.
All these layers in the embryonic area are known collectively as the
embryonic plate.
Differentiation of cells:- (Formation of placenta)
As the blasto cyst embeds it self in the endometrium,
The trophoblast or outer cell layer
becomes known as the chorion.
Finger like projections develop all over
the surface of the chorion called
chronic villi. Each villus will eventually
contain tiny blood vessels, which will
serve as a channel through which the
ovum will receive oxygen & nourishment
from the maternal blood surrounding it.
The villi at the site of deciduas basils grow and branch forming
chorion frondosum and together with the decidua basal is form the
placenta.

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 The placenta Is an essential part of that relationship, lying as it
does at the interface between mother and baby. It is a joint in which
both partners invest tissues and other resources. It is part called
‘fetal supply line’ from approximately the third month after
conception until birth.
The placenta has two surfaces:

Fetal surface and maternal surface .

A-Maternal surface:
- Irregular.
- Divided into 15-20 masses called cotyledons.
- The cotyledons are separated by grooves.
-These grooves are called placental septa
.

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B-Fetal surface:
- Smooth
- Covered by amnion.
- The umbilical cord is attached to its center.
Functions of the placenta :
1- Nutritive function:
It supplies the foetus with water, carbohydrates, proteins, lipids,
electrolytes and vitamins.
2-Respiratory function: it exchanges O2 and CO2.
3-Excretory function: it gets rid of urea, creatinine.
4- Endocrine function: it secretes the following hormones:
chorinoic gonadbtrophins, oestrogens and progesterone.
5- Protective function: it protects the foetus against
microorganism.
Abnormalities of the placenta:
1-Abnormal position (Placenta praevia)

2- Abnormal of attachment:
Normally, the umbilical cord is attached to the placenta near the
center of its fetal surface. Abnormally it may have:
* Marginal or battle dore attachment. In this condition the
umbilical cord is attached to the margin of the placenta.
* Velamentous attachment of the umbilical cord: in this condition
the cord is attached to the amniotic membrane and umbilical vessels
extend to reach the placenta as a bundle of branches covered with
amnion.

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 3-Abnormal of number: normally there is one placenta.
Abnormally, there may be:
* Placenta succenturiata: In this condition one or more separate
pieces of placental tissue is seen at some distance from the
original placenta.
* Placenta bipartita: the placenta is bilobed. It is seen in some twin
pregnancies.
* Placenta tripartita. Placenta is trilobed.
Amniotic Fluid
Volume: One litre (average) if ↑2 litres = poly hydramnios if
↓ ½ litre = Olilgo hydraminios. Its volume reaches a peak at 38 w,
then slightly ↓up to term then more rapidly ↓ there after.
Rate of Formation: ½ Litre / h. Composition: 99% water,
solid 1% as protein, surgars, phosphlipids as lecithen and
sphingomylin which are formed in the fetal lung alveoli and act as
surfactant to prevent lung collapse after delivery.
Function of the amniotic Fluid:
1. Protection of the fetus from external trauma.
2. Facilitates the movement of the fetus.
3. Nutrition.
4. Excretion of the fetal urine.
5. Contains antiseptic so it prevents infection.
Umblical Cord at Term
Development – Mesoderm (Ventral stalk).
Length – 50 cm. Diameter – 1-2 cm.
Insertion – Central.
Content – 2 arteries + one vien surrounded by Wharton’s jelly
.

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Abnormalities
1. Abnormalities In length:
a. Too long Leads to
• Prolapsed cord.
• Twisting.
• Coiling around fetal neck
b. Too short leads to:
• Prolonged labor.
• Premature placental separation.
• Acute inversion of the uterus.
2. Abnormal insertion: ↑
• Velamentous insertion àVasa previa.
• Peripheral insertion à Battle door placenta.
3. Knots. Are 2 types:
• True knote àcause fetal death & ↑ in am. Fluid.
• False knote à thickening of Wharton’s jelly (no
effect).
4. Twisting à Torsion à Fetal anoxia à Fetal death.

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