Obstetrics Cardinal

Female Reproductive Organ Round 4 pairs of ligaments that

Uterosacral support the Uterus
External Structures Broad
Uterus
Mons Pubis- is a fatty pad that lies over the anterior surface
of the symphysis pubis covered with curly hair (puberty) Corpus isthmus
Cervix
Labia Majora- are two rounded folds of fatty tissue covered
with skin that extend downward and backward from the mons Uterine walls
pubis *Endometrium-shed during menstruation

Labia Minora- are two flat, reddishfolds of tissue visible *Myometrium-Extends longitudinal, transverse,
whenthe labia majora are separated oblique

Prepuce- hoodlike covering of the clitoris formed by fusing Longitudinal Fibers- mostly found in the fundus
of labia minora and this arrangement assist in
expelling the fetus duringbirth
Frenulum- fold tissue under the clitoris process
Middle layer-has fibers that form a figure 8 and
Fourchette – a thin flat tissue, junction of two labia minora this arrangement assist in
underneath the vaginal opening at midline. constricting blod vessels after
childbirth and control blood loss.
Clitoris- is located underneath the prepuce composed of Circular Fibers- help keep the cervix closed
erectile tissue with numerous sensory nerve endings. during pregnancy and prevent
menstrual blood from flowing back
Viginal Vistibule- is an “almond-shaped” area enclosed by the into the uterine tubes during
labia minora that contains opening to the urethra, Skene menstruation.
glands, Vagina, and Bartholin Glands. *Peritoneum

Urethra-2.5 cm below the clitoris

Skene Glands- are located on each side of the urethra and Cul-de-sac of Douglas - deep pouch, or recess posterior to the
produce mucus, which aids in lubrication of the vagina. cervix and formed by the posterior ligament.

Hymen- a connective tissue membrane, surrounds the vaginal Fundus- dome shaped, top of the uterus, site where the uterine
opening. tubes enter the uterus.

Bartholin glands- lie under the constrictor muscles of the
vagina and are located posteriorly on the sides of the vaginal
opening, also secreting mucus during sexual arousalto
lubricate the vaginal introitus
Perineum- found between the fourchette and the anus, a skin
covered muscular area tha t covers the pelvic structure. Pelvic
organs are supported by mucles and ligaments to for a sling.
Internal Structures
Isthmus-(lower uterine segment) separate the
Corpus and the Cervix
Cervix- made mostly with fibrous connective tissue and
elastic tissue, making it possible for the cervix to stretch
during vaginal childbirth
Internal OS- the opening between the uterine cavity and the
canal that connects the uterine cavity to the vagina 9
endocervical canal

Vagina - is a fibromuscular, collapsible tubular structure that
extends from the vulva to the uterus and lies between the
bladder and the rectum.
- serves as a passageway for menstrual flow,
copulation and birthcanal
Rugae- allow the vagina to expad during childbirth
Estrogen Deprivation= after childbirth, during lactation, and
menopause causes dryness and thinnes of the vaginal walls
and smoothing of the rugae.
pH 4-5 acidic vaginal secretion.
Fornices- pockets (anterior, posterior & lateral) palpation area
Enternal OS- narrowed opening between the endocervix and
the vagina, a small circular opening in women who have never
been pregnant. Fells like the nose with a dimple on the center.
Outer Cervix- covered with a layer os squamos epithelium.
Mucosa of the cerviacal canal- coverd with columnar
epithelium and contains numerous glans that secrete mucus in
response to ovarian hormones.
Squamocolumnar junction (transformation jxn)- where
two types of cells meet is usually located just inside th
cervical os.
- Common site os neoplastic changes and site for Pap Smear.

Uterus- is a muscular organ shaped like and upsidedown pear
that sits midline in the pelvic cavitybetween the bladder and
the rectum above the vagina.
- serves for reception, implantation, retention, and
nutrition of ther fertilized ovumand later the fetus during
pregnancy and expulsion of the fetus during childbirth,
also for cyclic menstruation.
Fallopian tube- attach to the utertine fundus supported by
braod ligaments (8-14 cm in leght)
- provide a passage between the ovaries
and the uterus for the passage of the
ovum.
Ovaries- are two almond-shaped organs located on each side
of the uterine tubes
 - for ovulation and production of Estrogen,
Progesterone, and Androgen.
PCPS/07-2409
Breast
- paired mammary glands loc. @ 2nd and 6th ribs
- lies over the pectoralis major b/w strnum and midmaxillary
line
-attatced to the muscles by a connective tissue called Fascia.
Tail of Spence- extension to the axilla
Serratus anterior muscle-where the lowest third of the breast
overlies
Estrogen stimulates growth of the breast and increases
vascularity of breast tissue
Progesterone- Increase of this hormone @ pubety causes
maturation of mammary gland tissue specifically lobules and
acinar structures.
Fat deposition- during adolescence may contribute to increase
in size.
15-20 lobes- each breast is made of..
Lobules- division of lobes, cluster of acini
Acinus – a sac-like terminal part of a compound gland
emptying through a narrow lumen or duct.
Acini- lined lined with epithelial cells that secrete colostrun
abd milk.
Myoepitheilium- expels milk from acini by cxn
Mamary papilla- “single nipple” surrounded by areola.
Contains 15-20 openings of lactiferous ducts
Areola- rough looking due to sebaceous glands, Montgomery
tubercles directly beneath the skin that secrete substance
believed to lubricate the nipples.
Lactiferous sinuses/ampullae – formed when ducts converge
and dilate which servers a milk reservoir.
Cooper’s Ligaments- provide support to the mammary glands
while permitting their mobility on the chest wall.
Menstruation
Puberty- transitional stage between childhood and sexual
maturity.
8-11y/o secretions of small amounst of estrogen is visible.
Menarche- “first menstruation.”
Menstrual Cycle
Menstruation is a periodic uterine bleeding that begins approx.
14 days of ovulation.
-Adequate prodxn of estrogen is needed for regular
menstruation.
-It is a complex interplay of events that occur simultaneously
in the endometrium, hypothalamus, ovaries and the pituitary
glands.
- prepares the uterus for pregnancy.
-28 day cycle (some may vary)
-ave. 5days (ranges 3-6days)
-ave. 50ml (20-80ml) of blood
Factors: physical emotional environmental
Hypothalamus-pituitary cycle
Occurs when there is no fertilization and implantation and
levels of progesterone and estrogen decline, menstruation
occurs and the hypothalamus is once again stimulated to
secrete GnRH
Gonadotropin Releasing Hormone (GnRH)
-it stimulates the pituitary secretion of
foliicle-stimulating hormone (FSH)
FSH- stimulates the development of ovarian graafian
follicles and their prodxn of estrogen
Luteinizing Hormone (LH)- from pituitary gland
triggered by decrease of estrogen level and
Hypothalamin GnRH
- for expulsion of the ovum from the
graafian follicle by approx. 24-36hrs.
- peaks @ 13-14day of a 28-day cycle.
Corpus luteum- regresses if fertilization and
implantation does not occur by the time of ovulation
period.
Ovarian Cycle
Primutive graafian follicles- contains immature
oocytes(primordial ova)
1-30 follicles begin to mature before ovulationin each
ovaryunder the influence of FSH and estrogen
Preovulatory LH surge- affect the selected follicle.
Follicular Phase- - oocytes mature, ovulation occurs and the
empty follicles begins its transformation in to the corpus
luteum.
Midcycle bleeding exp. By 10% of women where in there is
sufficient bleeding
Luteal Phase (Postovulatory phase)- begins immediately after
the ovulation and ends with the start of menstruation. It
requires 13, 14, 15 days.
Corpus letuem – reaches its peak of fxnal activity 8 days after
ovulation, secreting both estrogen and progesterone
* with no implantation in the endometrium it regresses,
steroids level drop, and menstruation occurs.
Endometrial Cycle
4 faces
1) Menstrual phase- periodic vasoconstriction in the upper
layers of the endometrium occurs to shed fxnal 2/3 of the
endometrium.
Basalis- the remaining glandular remnant or
stromal cells
2) Proliferative phase – rapid growth lasting fr. 5 th day to the
time of ovulation.
-Endometrial surface is completely restored
in approx. 4days or slight bere bleeding ceases
-8fold to 10fold thickening occurs with
leveling off of growth at ovulation.
- depends on estrogen stimulation derived
from ovarian follicles.
3) Secretory Phase - extends from the day of ovulation to
approx. 3days before the next menstrual period
*-after ovulation larger amount of
progesterone is produced.
-endometrium thickens and becomes
luxuriant of blood and glandular secretions, a suitable
protective and nutritive bed for a fertilized ovum.
Implantation- 7-10days after ovulation
4) Ischemic Phase – the blood supply to the fxnal
endometrium is blocked and necrosis develops.
Other Cyclic Changes
Spinnbarkeit- stretchable quality
Mittelschmerz- localized abdominal pain.
Climacteric- is a transitional phase during which ovarian fxn
and prdxn of hormone decline.
Menopause- refers to the final menstruation with an ave. of
51.4y/o (35-60 y/o)
Perimenopause- ovarian fxn declines, ova slowly diminish
and menstrual cycles are an ovulatory, resulting in irregular
bleeding; ovary stops producing estrogen and eventually
menses no longer occurs.
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