Chapter 8 Goals Page 257 Students will be able to: Name & locate female reproductive organs & learn their combining forms. Explain how these organs & their hormones function in the normal processes of ovulation, menstruation, & pregnancy. Identify abnormal conditions of the female reproductive system & of the newborn. Describe important laboratory tests & clinical procedures used in gynecology & obstetrics, & recognize related abbreviations. Apply you new knowledge to understanding medical terms in their proper contexts, such as medical reports & records.

Female Reproductive System Chapter 8 Pages 257 – 310

Page 258 Introduction Sexual reproduction = the union of the ovum (female gamete) & the sperm (male gamete) Gamete = a sex cell (has half the number of chromosomes needed to create a new organism) Fertilization = nuclei of the two gametes unite to form a single nucleus with half of the chromosomes/genetic code from each parent. Gonads = special organs in males (testes) & females (ovaries) produce the sperm & the egg.

Introduction: Cont. Page 258 After an ovum leaves the ovary, it travels down one of two fallopian tubes leading to the uterus. If coitus has occurred & sperm cells travel into the fallopian tube, it penetrates the ovum. Fertilization Zygote = fertilized ovum Embryo = 2 – 8 weeks Fetus = 8 – 38 or 40 weeks Gestation = The period of development within the uterus. Uterus = womb coitus = copulation, sexual intercourse gestation = pregnancy

Introduction: Cont. Page 258 Female are born with all the eggs, or ova, in the female ovary but begin to mature & are released from the ovary in a 21- to 28-day cycles when secondary sex characteristics develop. Menarche = the occurrence of the first cycle Menstruation = hormone changes resulting in the shedding of the uterine lining, & bleeding. Menopause = when all eggs have been released, hormone production diminishes & menstruation ends. secondary sex characteristics = body hair, breast development, structural changes in bones & fat

Introduction: Cont. Page 258 estrogen & progesterone = hormones of the ovaries Pituitary gland = secretes other hormones that govern the reproductive functions of the ovaries, breasts, & uterus. Gynecology = the study of the female reproductive system Obstetrics = a specialty concerned with pregnancy & the delivery of the fetus Neonatology = the study of the care & treatment of the newborn Hormones = play important roles in the processes of menstruation & pregnancy, & in the development of secondary sex characteristics. Obstetrics = Latin obstetrix means midwife Pituitary gland = located at the base of the brain Gynecology = organs, hormones, & diseases

Organs of the Female Reproductive System Pages 258 - 260 Organs of the Female Reproductive System Uterus, Ovaries & Associated Organs Adnexa = fallopian tubes, ovaries, & supporting ligaments

Organs of the Female Reproductive System Pages 258 - 260 Organs of the Female Reproductive System Ovaries = a pair of small almond-shaped organs located in the pelvis. Held in place on either side of the uterus by a utero-ovarian ligament Ovarian follicles = thousands of small sacs within each ovary (they each contains an ovum) Ovulation = maturation of an ovum; it’s follicle ruptures through the surface & releases the ovum from the ovary. Corpus luteum (meaning yellow body)= a ruptured follicle fills will yellow fat-like material. The corpus luteum secretes hormones (both estrogen & progesterone) that maintain the very first stages of pregnancy.

Organs of the Female Reproductive System Pages 258 - 260 Organs of the Female Reproductive System Fallopian tubes = lead from each ovary to the uterus. They are about 5 ½ inches long & lies near each ovary. Fimbriae = finger-like ends of the fallopian tube. They catch the egg after its release from the ovary. Cilia (small hairs) = line the fallopian tube & through their motion, sweep the ovum along. It usually takes the ovum about 2 to 3 days to pass through the fallopian tube.

Organs of the Female Reproductive System Pages 258 - 260 Organs of the Female Reproductive System Uterus = muscular walls & a mucus membrane lining filled with a rich supply of blood vessels. Situated between the urinary bladder & the rectum. The uterus (womb) normally is shape of a pear & is about 3 inches long in a non-pregnant woman Fundus = the rounded upper portion of the uterus Corpus = the larger, central section of the uterus Endometrium = the inner layer, a specialized epithelial mucosa of the uterus Myometrium = the middle, muscular layer of the uterine wall Uterine seroua = the outer, membranous tissue layer

Organs of the Female Reproductive System Pages 258 - 260 Organs of the Female Reproductive System Cul-de-sac = midway between the uterus & the rectum (in the abdominal cavity) Cervix = the narrow, lowermost portion of the uterus Vagina = a muscular mucus-lined canal structure, extends from the uterus to the exterior of the body. (usually about 3 inches long) Perineum = the region between the vaginal orifice & anus

Organs of the Female Reproductive System Pages 258 - 260 Organs of the Female Reproductive System Vulva = the collective external genitalia of the female Bartholin glands = two small, rounded glands on either side of the vaginal orifice. Clitoris = an organ sensitive, erectile tissue located anterior to the vaginal orifice & in front of the urethral meatus. Labia majora = the outer lips of the vagina, surrounding the labia minora. Labia minora = smaller, inner lips Hymen = a thin membrane partially covering the entrance to the vagina (is broken apart during the first episode of intercourse)

Organs of the Female Reproductive System: Cont. Page 261 Organs of the Female Reproductive System: Cont. The Breast (Accessory Organ of Reproduction) Breasts = located on the upper anterior region of the chest & are composed mostly of mammary glands but also contain fibrous & fatty tissue Glandular tissue = contains milk glands or lobules that develop in response to hormones form the ovaries during puberty Lactiferous ducts (milk carrying) & Sinuses (cavities) = that carry milk to the nipple, which has small openings for the ducts to release their milk

Organs of the Female Reproductive System: Cont. Page 261 Organs of the Female Reproductive System: Cont. Mammary papilla = breast nipple Areola = the dark pigmented area around the mammary papilla During pregnancy the hormones from the ovaries & the placenta stimulate glandular & other tissue in the breasts to their full development. Parturition = giving birth after birth hormones from the pituitary gland stimulate lactation Lactation = the normal secretion of milk

Menstruation & Pregnancy Pages 262 – 263 Menstruation & Pregnancy Menstrual Cycle

Menstruation & Pregnancy Pages 262 – 263 Menstruation & Pregnancy Menstrual Cycle Days 1 – 5 = menstrual period; discharge of bloody fluid containing disintegrated endometrial cells, glandular secretions, & blood cells. Days 6 – 12; after bleeding ceases, the endometrium begins to repair itself. The maturing follicle in the ovary releases estrogen, which aids in the repair. The ovum grows in the follicle during this period.

Menstruation & Pregnancy Pages 262 – 263 Menstruation & Pregnancy Days 13 & 14 = ovulatory period; On about the 14th day of the cycle, the follicle ruptures & the egg leaves the ovary (ovulation), passing through the fallopian tube. Days 15 – 28; the empty follicle fills with a yellow material & becomes the corpus luteum. The corpus luteum functions as an endocrine organ & secretes the hormone progesterone into the bloodstream. This hormone stimulates the building up of the lining of the uterus in anticipation of fertilization of the egg & pregnancy.

Menstruation & Pregnancy Pages 262 – 263 Menstruation & Pregnancy If fertilization does not occur, the corpus lupus luteum in the ovary stops producing progesterone & regresses. At this time, lowered levels of progesterone & estrogen probably are responsible for some women’s symptoms of depression, breast tenderness, & irritability before menstruation. The combination of these symptoms is know as premenstrual syndrome (PMS). After 2 days of decrease in hormones, the uterus endometrium breaks down, & the menstrual period begins days 1 to 5.

Menstruation & Pregnancy Pages 262 – 263 Menstruation & Pregnancy If fertilization does not occur, the corpus lupus luteum in the ovary stops producing progesterone & regresses. At this time, lowered levels of progesterone & estrogen probably are responsible for some women’s symptoms of depression, breast tenderness, & irritability before menstruation. The combination of these symptoms is know as premenstrual syndrome (PMS). After 2 days of decrease in hormones, the uterus endometrium breaks down, & the menstrual period begins days 1 to 5. Days 1 – 5 = menstrual period; discharge of bloody fluid containing disintegrated endometrial cells, glandular secretions, & blood cells. Days 6 – 12; after bleeding ceases, the endometrium begins to repair itself. The maturing follicle in the ovary releases estrogen, which aids in the repair. The ovum grows in the follicle during this period. Days 13 & 14 = ovulatory period; On about the 14th day of the cycle, the follicle ruptures & the egg leaves the ovary (ovulation), passing through the fallopian tube. Days 15 – 28; the empty follicle fills with a yellow material & becomes the corpus luteum. The corpus luteum functions as an endocrine organ & secretes the hormone progesterone into the bloodstream. This hormone stimulates the building up of the lining of the uterus in anticipation of fertilization of the egg & pregnancy. If fertilization does not occur, the corpus lupus luteum in the ovary stops producing progesterone & regresses. At this time, lowered levels of progesterone & estrogen probably are responsible for some women’s symptoms of depression, breast tenderness, & irritability before menstruation. The combination of these symptoms is know as premenstrual syndrome (PMS). After 2 days of decrease in hormones, the uterus endometrium breaks down, & the menstrual period begins days 1 to 5. Cycles vary in length, ranging form 21 to 42 days or longer. Ovulation typically occurs 14 days before the end of the cycle. A woman with a 42-day cycle ovulates on day 28, where as a woman with a 21 day cycle ovulates on day 7

Menstruation & Pregnancy Pages 262 – 263 Menstruation & Pregnancy Cycles vary in length, ranging form 21 to 42 days or longer. Ovulation typically occurs 14 days before the end of the cycle. A woman with a 42-day cycle ovulates on day 28, where as a woman with a 21 day cycle ovulates on day 7

Menstruation & Pregnancy: Cont. Pages 263 – 264 Menstruation & Pregnancy: Cont. Pregnancy

Menstruation & Pregnancy: Cont. Pages 263 – 264 Menstruation & Pregnancy: Cont. Pregnancy Placenta = a vascular organ, forms after fertilization, attached to the uterine wall - connected to the embryo by the umbilical cord. The placenta is derived from maternal endometrium & from the chorion, the outermost membrane that surrounds the developing embryo. The maternal blood & the fetal blood never mix during pregnancy, but important nutrients, oxygen, & wastes are exchanged

Menstruation & Pregnancy: Cont. Pages 263 – 264 Menstruation & Pregnancy: Cont. Amnion = the innermost of the embryonic membranes, holds the fetus suspended in an amniotic cavity surrounded by amniotic fluid Human chorionic gonadotropin (hCG) the hormone used to test if women are pregnant.

Menstruation & Pregnancy: Cont. Pages 263 – 264 Menstruation & Pregnancy: Cont. The onset of true labor is marked by rhythmic contractions, dilation & thinning (effacement) of the cervix, & a discharge of bloody mucus from the cervix & vagina. In a normal delivery position, the baby’s head appears first (cephalic presentation). After vaginal delivery of the baby, the umbilical cord is cut. Afterbirth = The placenta is expelled.

Menstruation & Pregnancy: Cont. Pages 265 – 266 Menstruation & Pregnancy: Cont. Hormonal Interactions Hormone Production Sites Target Organ Effect FSH Pituitary gland Ovary Stimulates maturation of the ovum LH Stimulates ovulation Estrogen Ovary Placenta (during pregnancy) Uterus Builds up the endometrial lining During pregnancy the high levels of estrogen & progesterone from the ovary & placenta cause the pituitary gland stop producing FSH & LH. Therefore, while a woman is pregnant, additional eggs do not mature & ovulation cannot occur. Oral contraceptives (birth control pills work the same way. IUD (intrauterine device) work the same way. Hormone replacement therapy (HRT) given orally or as a transdermal patch or vaginal ring, relieves symptoms of menopause & delays the development of weak bones Hot flashes, insomnia, & vaginal atrophy (lining of the vaginal dries & thins, predisposing the affected woman to irritation & discomfort during sexual intercourse)

Menstruation & Pregnancy: Cont. Pages 265 – 266 Menstruation & Pregnancy: Cont. Hormone Production Sites Target Organ Effect Progesterone Ovary (corpus luteum) Placenta (during pregnancy) Uterus Sustains uterine lining & placenta during pregnancy hCG Placenta Ovary (corpus luteum) Sustains pregnancy

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal Pages 274 – 276 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal Gynecologic – Uterus carcinoma of the cervix malignant cells within the cervix (cervical cancer) cervicitis Inflammation of the cervix carcinoma of the endometrium (endometrial cancer) malignant tumor of the uterine lining (adenocarcinoma) endometriosis Endometrial tissue located outside the uterus fibroide Benign tumors in the uterus

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Pages 276 – 277 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Gynecologic – Ovaries ovarian carcinoma (cancer) malignant tumor of the ovary (adenocarcinoma) ovarian cysts collections of fluid within sacs (cysts) in the ovary

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Page 277 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Gynecologic – Fallopian Tubes pelvic inflammatory disease (PID) Inflammation & infection of organs in the pelvic region; salphingitis, oophoritis, endometritis, endocervicitis.

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Pages 278 - 280 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Gynecologic – Breast carcinoma of the breast (breast cancer) malignant tumor of the breast (arising from milk glands & ducts) fibrocystic breast disease Numerous small sacs of fluid surrounded by dense strands of fibrous tissue in the breast

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Pages 280 - 281 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Pregnancy abruptio placentae Premature separation of the normally implanted placenta ectopic pregnancy Implantation of the fertilized egg in any site other than the normal uterine location multiple gestations more than one fetus inside the uterus placenta previa Implantation of the placenta over the cervical opening or in the lower region of the uterus preeclampsia Abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, & headache.

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Page 281 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Neonatal Down syndrome Chromosomal abnormality (trisomy 21) results in mental retardation, retarded growth, a flat face with a short nose, low-set ears, & slanted eyes. erythroblastosis fetalis Hemolytic disease in the newborn (HDN) caused by a blood group (Rh factor) incompatibility between the mother & the fetus hyaline membrane disease Acute lung disease commonly seen in the premature newborn (RDS)

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Page 282 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Neonatal hydrocephalus Accumulation of fluid in the spaces of the brain meconium aspiration syndrome Abnormal inhalation of meconium produced by a fetus or newborn pyloric stenosis Narrowing of the opening of the stomach to the duodenum

Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Page 281 Pathology: Gynecologic, Breast, Pregnancy, & Neonatal: Cont. Neonatal – The Apgar Scoring system SIGN Score 1 2 Heart rate Absent Below 100 Over 100 Respiratory effort Slow, irregular Good, crying Muscle tone Limp Some flexion of extremities Active motion Response to catheter in nostril No Response Grimace Cough or sneeze Color Blue, pale Body pink, extremities blue Completely pink The Apgar score is a system of scoring an infant’s physical condition at 1 & again 5 minutes after birth. Heart rate, respiration, color, muscle tone, & response to stimuli each are rated 0, 1, or 2. The maximum total score is 10. Infants with Apgar scores below 7 require immediate medical attention such as suctioning of the airways or oxygen to help breathing.

Clinical Tests & Procedures Page 282 Clinical Tests & Procedures Clinical Tests Pap test (Pap smear) Microscopic examination of stained cells removed from the vagina & cervix Pregnancy test Blood or urine test to detect the presence of hCG

Clinical Tests & Procedures: Cont. Page 283 Clinical Tests & Procedures: Cont. Procedures – X-Ray Studies hysterosalpingography (HSG) X-ray imaging of the uterus & fallopian tubes after injection of contrast material mammography X-ray imaging of the breast

Clinical Tests & Procedures: Cont. Pages 283 – 284 Clinical Tests & Procedures: Cont. Procedures – Ultrasound Examination & Magnetic Resonance Imaging (MRI) breast ultrasound imaging & breast MRI Technologies using sound waves & a magnetic field to create images of breast tissue pelvic ultrasonography Recording images of sound waves as they bounce off organs in the pelvic region

Clinical Tests & Procedures: Cont. Pages 284 – 286 Clinical Tests & Procedures: Cont. Gynecologic Procedures aspiration withdrawal of fluid from a cavity or sac with an instrument using suction cauterization Destruction of tissue by burning colposcopy visual examination of the vagina & cervix using a colposcope conization Removal of a cone-shaped section (cone biopsy) of the cervix cryosurgery Use of cold temperatures to destroy tissue

Clinical Tests & Procedures: Cont. Pages 284 – 286 Clinical Tests & Procedures: Cont. Gynecologic Procedures culdocentsis Needle aspiration of fluid from the cul-de-sac dilation & curettage (D&C) Widening the cervix & scraping off the endometrial lining of the uterus exenteration Removal of internal organs within a cavity laparoscopy Visual examination of the abdominal cavity using an endoscope (laparoscope) tubal ligation Blocking the fallopian tubes to prevent fertilization from occurring

Clinical Tests & Procedures: Cont. Pages 286 – 287 Clinical Tests & Procedures: Cont. Procedures – Procedures Related to Pregnancy abortion (AB) Termination of pregnancy before the embryo or fetus can exist on its own amniocentesis Needle puncture of the amniotic sac to withdraw amniotic fluid for analysis cesarean section Surgical incision of the abdominal wall & uterus to deliver a fetus chronic villus sampling (CVS) Sampling of placental tissues for prenatal diagnosis

Clinical Tests & Procedures: Cont. Pages 286 – 287 Clinical Tests & Procedures: Cont. Procedures – Procedures Related to Pregnancy fetal monitoring Continuous recording of the fetal heart rate & maternal uterine contractions to assess fetal status & progress of labor In vitro fertilization (IVF) Egg & sperm cells are combined outside the body in a laboratory dish (in vitro) to facilitate fertilization