Saladin Chapter 27

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Saladin Chapter 27

• Female Reproductive System

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FUNCTION

• Provide offspring for survival of the species.

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FEMALE REPRODUCTIVE SYSTEM

• FUNCTIONS
• Produce gametes.
• Site for fertilization.
• Provide nourishment protection for offspring.

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FEMALE REPRODUCTIVE SYSTEM
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FEMALE REPRODUCTIVE SYSTEM Ovaries

• OVARIES from endodermal tissue.
• Produce secondary oocytes during oogenesis.
• Held by 3 ligaments broad part of parietal
  peritoneum, ovarian to uterus suspensory to
  pelvic wall.

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FEMALE REPRODUCTIVE SYSTEM Ovaries

• HISTOLOGY
• Germinal epithelium of simple squamous to
  cuboidal epithelium on outer surface.
• Tunica albuginea deep to germinal layer.
• Cortex contains ovarian follicles dense CT.
• Medulla loose CT, vessels, nerves.

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FEMALE REPRODUCTIVE SYSTEM Ovaries

• Ovarian follicle oocyte surrounding follicle
  cells - In cortex.
• Epithelial layers progressively become more
  numerous, fluid is secreted into space with
  oocyte.
• Graafian follicle large, fluid filled
  contains secondary oocyte ready for ovulation.
  Secretes estrogens.

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FEMALE REPRODUCTIVE SYSTEM Ovaries

• Corpus luteum remnants of follicle after
  ovulation.
• Secretes progesterone, estrogens, relaxin
  inhibin.
• Degenerates into corpus albicans.

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FEMALE REPRODUCTIVE SYSTEM Ovaries
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FEMALE REPRODUCTIVE SYSTEM Ovaries
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FEMALE REPRODUCTIVE SYSTEM UTERINE FALLOPIAN
TUBES

• Transport channels for ova.
• Usually site of fertilization ? zygote reaches
  uterus in about 7 days.
• Layers mucosa, smooth muscles serosa.
• Mucosa continuous with vagina uterine.

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FEMALE REPRODUCTIVE SYSTEM UTERINE FALLOPIAN
TUBES

• Path for infectious agents to enter peritoneal
  cavity ex. PID.
• Infundibulum portion closest to ovary.
• Fimbriae finger-like projections from
  infundibulum - Sweep- push ova into tube.

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FEMALE REPRODUCTIVE SYSTEM UTERINE FALLOPIAN
TUBES
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FEMALE REPRODUCTIVE SYSTEM Uterus

• Pathway for sperm.
• Site of menstruation.
• Site of implantation.
• Site of fetal development.

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FEMALE REPRODUCTIVE SYSTEM Uterus

• Parts
• Fundus
• Body uterine cavity
• Isthmus
• Cervix cervical canal
• External os

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FEMALE REPRODUCTIVE SYSTEM Uterus

• Secretory cells of the cervical mucosa lining
  produce cervical mucus.
• Held in place by 4 ligaments broad, uterosacral,
  cardinal, round.
• 3 layers Uterine Wall
• Perimetrium part of visceral peritoneum.
• Myometrium 3 layers of smooth muscles
  stimulated by oxytocin during labor.

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FEMALE REPRODUCTIVE SYSTEM UTERUS
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FEMALE REPRODUCTIVE SYSTEM Uterus

• Endometrium highly vascularized.
• Simple ciliated columnar epithelium secretory
  cells.
• 2 layers
• Stratum functionalis closest to uterine cavity
  shed during menstruation.
• Stratum basalis permanent layer which
  repeatedly gives rise to stratum functionalis.

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FEMALE REPRODUCTIVE SYSTEM Uterus

• Blood supply uterine arteries ? arcuate
  arteries ? radial arteries ? straight arterioles
  or spiral arterioles.
• Straight arterioles terminate in s. basalis
  supply materials needed to regenerate s.
  functionalis.
• Spiral arterioles penetrate into s. functionalis
  change markedly during menstrual cycle.

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FEMALE REPRODUCTIVE SYSTEM Uterus
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FEMALE REPRODUCTIVE SYSTEM Vagina

• Functions
• Passage for menstrual flow.
• Passage for sperm.
• Passage for childbirth.
• Tubular fibromuscular organ with mucus membrane
  of stratified squamous epithelium.

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FEMALE REPRODUCTIVE SYSTEM Vagina

• Mucus has large amounts of glycogen which
  decomposes to produce acids. The low pH retards
  microbial growth, but is harmful to sperm.
• Muscularis smooth muscle, rugae, highly
  stretchable.

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FEMALE REPRODUCTIVE SYSTEM Vulva

• External female genitalia.
• Mons pubis skin adipose cushion of pubic
  symphysis.
• Labia majora 2 folds of skin with sebaceous
  sudoriferous glands.
• Labia minora 2 folds medial to majora contain
  mostly sebaceous gland.

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FEMALE REPRODUCTIVE SYSTEM Vulva

• Clitoris small mass of erectile tissue nerves
  with prepuce a glans analogous to penis.
• Vestibule cleft between labia minora contains
  hymen, vaginal orifice, urethral orifice duct
  openings.
• Paraurethral glands equiv. To prostate secrete
  mucus.

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FEMALE REPRODUCTIVE SYSTEM Vulva

• Greater vestibular glands equiv. To Cowpers
  produce mucus for lubrication.

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FEMALE REPRODUCTIVE SYSTEM Mammary Glands

• Modified sudoriferous glands which produce milk.
• Areola pigmented area around nipple contains
  modified oil glands.
• Function lactation control prolactin
  synthesis oxytocin ejection.

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FEMALE REPRODUCTIVE SYSTEM Mammary Glands

• 15-20 lobes separated by adipose tissue.
• Subdivided into lobules with clusters of alveoli
  milk secreting glands.
• Produce milk passes to lactiferous sinuses
  storage to lactiferous ducts to nipple.

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Mammary Glands
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Breast Cancer

• 12 or more of population
• Begin in mammary ducts - metastasize via axillary
  nodes
• 2 genes that cause it have been identified - BRCA
  1 and 2.

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Breast Cancer

• Most is non-hereditary
• Treatment - lumpectomy, simple or radical
  mastectomy, radiation and chemo

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Breast Cancer
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Breast Cancer
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Breast Cancer
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PUBERTY MENOPAUSE

• PUBERTY
• USA - 9 - 10 onset
• GnRH --gt FSH LH
• FSH --gt follicles --gt estrogens, progesterone
  inhibin
• Estrogens "feminize" body

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PUBERTY MENOPAUSE

• Phases
• thelarche - breast development
• pubarche - hair, etc.
• menarche - beginning of menstruation - related to
  nutrition and body fat status
• ovulation doesn't usually start until a year
  later.

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PUBERTY MENOPAUSE

• Progesterone - prepares uterus for possible
  pregnancy
• Inhibin suppresses FSH

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PUBERTY MENOPAUSE

• MENOPAUSE - when cycling ceases
• begins when egg count drops below 1000
• organs atrophy
• hot flashes - sudden dilation of cutaneous
  vessels
• Hormone replacement therapy - progesterone and/or
  low dose estrogen - have risks.

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Oogenesis

• Primordial germ cell from yolk sac migrates to
  ovary during development.
• Mitosis ? a primary oocyte 2N Primary oocyte
  enters meiosis I, stops primary follicle.
• At puberty LH levels rise, oocyte completes
  meiosis I Secondary oocyte polar body.

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Oogenesis

• In monthly cycles, one or more secondary oocytes
  enter meiosis II, stop at metaphase II.
• If fertilization occurs ? completes meiosis II
  ovum.
• Ovum nucleus fuses with sperm ? zygote if no
  fertilization, ovum degenerates.

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Sexual Cycle

• 28 days on average
• Control hypothalamus --gt pituitary --gt ovaries
  --gt uterus
• Ovarian cycle 2 phases - follicular luteal

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Sexual Cycle

• Follicular Phase preantral - before birth,
  antral phases
• Primordial follicle - develops 12-16 wks
  gestation - oocyte in early meiosis single
  layer of follicular cells
• Primary follicle - pre-birth - follicular cells
  thicken and ad layers -- gt zona pellucida
  glycoprotein gel

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Sexual Cycle

• Secondary antral follicle - develops from
  primary to Graafian several develop each
  month.
• Dominant follicle - The one that wins the race to
  develop first undergoes ovulation expulsion
  from Graafian follicle into body cavity.

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Sexual Cycle

• The time BEFORE ovulation is the pre-ovulatory
  period
• Ovulation - rupture of follicle - omit
  mechanism

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Sexual Cycle

• The Luteal phase then begins - the corpus luteum
  develops from the remnants of the Graafian
  follicle secretes Es P increases 10X
• If no pregnancy --gt stops secretion and becomes
  corpus albicans.

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FEMALE REPRODUCTIVE CYCLE

• MENSTRUAL CYCLE build up, breakdown and
  disposal of endometrium monthly.
• 1. General 4 phases involve hormonal changes
  brain, pituitary, ovaries, uterus, cyclic
  changes in breast and cervical tissue - Average
  cycle 28 days 24-35 range

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FEMALE REPRODUCTIVE CYCLE

• 2. Proliferative phase - days 6-14
• Estrogen stimulates replacement of stratum
  functionalis via mitosis in stratum basalis ?
  increases endometrium thickness
• Estrogen also stimulates formation of
  progesterone receptors

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FEMALE REPRODUCTIVE CYCLE

• 3. Secretory phase days 15-28
• Progesterone stimulates increased proliferation
  of endometrial glands and stimulates release of
  glycogen from them.
• Progesterone also stimulates vascularization and
  thickening of the stratum functionalis and an
  increase in tissue fluid

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FEMALE REPRODUCTIVE CYCLE

• 4. Premenstrual phase
• If fertilization does not occur,m corpus luteum
  degenerates to Corpus albicans and get low
  Progesterone and Estrogen levels ?constriction of
  spiral arterioles ? ischemic phase ? necrosis,
  degeneration

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FEMALE REPRODUCTIVE CYCLE

• 5. Menstrual phase first 1-5 days
• Cells supplied by spiral arterioles slough off
  results in total loss of stratum functionalis
  50-150 mL blood, tissue and fluid

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http//www.schneiderchildrenshospital.org/peds_htm
l_fixed/peds/adolescent/cycle.htm
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Gestation

• 39 weeks see Ch. 29 for stages
• Embryonic phase zygote - through week 8.
• Fetal phase 9-39 weeks.
• Neonate first 6 wks after birth

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Hormones of Pregnancy

• 1. HCG from blastocyst placenta stimulates
  growth of corpus luteum to continue progesterone
  estrogen production
• 2. Estrogens - most effects from estrodiol.
  Increases 30X during pregnancy 1st 12 wks from
  CL, then placenta stimulates fetal maternal
  tissue growth, breast growth, etc.

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Hormones of Pregnancy

• 3. Progesterone CL, then placenta. With
  Estrogen suppresses pituitary no additional
  follicle development,, suppresses
  contractions, keeps endometrium intact
• See Table 28.2 for other hormones of pregnancy
• OMIT Adjustments to Pregnancy

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Childbirth

• 1. Vertex position most common move into
  at 7th mo.
• 2. Uterine contractility Braxton Hicks
  contractions twitches of uterus
• 3. Labor contractions onset of birth
  parturition

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Childbirth

• Increases in ES overrides P, to allow
  contractions of the uterine muscles
• Oxytocin stimulates contractions in concert
  with prostaglandins produced by fetal membranes,
  
• Relaxin increases the flexibility of the pubic
  symphysis

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Childbirth

• Stretching of smooth muscles also promotes onset
  of contractions fetal dancing

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LABOR

• Birth parturition.
• Increases in ES overrides P, to allow
  contractions of the uterine muscles.
• Oxytocin stimulates contractions, relaxin
  increases the flexibility of the pubic symphysis.

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LABOR
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LABOR 3 stages

• Stage of Dilation - onset of contractions,
  rupture of amniotic sac, dilation of cervix.
• Stage of Expulsion - from point of maximal
  cervical dilation until baby's body exits through
  the vagina.
• Placental stage - time required after expulsion
  of the infant until placenta is expelled.

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LABOR 3 stages
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LABOR 3 stages
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LABOR 3 stages

• Puerperium post delivery 6 wks body is
  returning to normal
• 1. uterine involution
• 2. lactation nursing for median age 2.8
  years world wide.

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Lactation

• Mammaries develop under stimulation of estrogen
  and other hormones. Many ducts.
• Colostrum milk
• 1. colostrums low fat milk 1-3 days, has
  antibodies that get into circulation

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Lactation

• 2. milk prolactin stimulates synthesis
  antagonized by steroids hence no
  production DURING pregnancy hormone
  surge with each feeding stimulates
  production for next feeding

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Lactation

• 3. few women become pregnant while
  nursing, but SOME do inhibits GnRH
• 4. postpartum cycles are usually anovulatory
  for several months
• Milk ejection oxytocin stimulus is suckling
• CONTRACEPTION review methods pages 1096 1098.