Transcript ،نينثلإا 16 ،نابعش 1437

‫‪2‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬
Female Reproductive System
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
3
Anatomy of the Female
Reproductive System
External genital organs
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
Internal genital organs
4
External genital organs:
The perineum:

the female reproductive system begins at the external genital area— or
vulva—which runs from the pubic area downward to the rectum.

Two folds of fatty, fleshy tissue surround the entrance to the vagina and
the urinary opening,
a) the labia major, or outer folds,
b) the labia minor, or inner folds, located under the
labia major.

The clitoris, is a relatively short organ (less than one inch long), When
stimulated sexually, the clitoris can become erect.

The hymen, a thin membrane protecting the entrance of the vagina.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
5
‫‪6‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬





The Vagina
The Cervix
The Uterus
The Ovaries
The Fallopian Tubes
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
7
The Vagina
The vagina is a muscular, ridged sheath connecting the
external genitals to the uterus serving as the birth canal.
 A) The anterior borders include the bladder
and the urethra.
B) Laterally, the ureters and broad and
round ligaments.
C) Posteriorly, the peritoneum and the rectovaginal
fascia.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
8
The Cervix:
The vagina ends at the cervix, the lower portion or neck of the
uterus.
The vagina ends at the cervix (external os) , the lower
portion or neck of the uterus (internal os).
The Uterus
The uterus is the muscular organ which holds the developing
baby during the nine months after conception, nourishment of
the fetus through the placenta.
Its weight is about 60gm. and size its is about 6.5 cm.
It is divided into fundus, body and neck.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
9
‫‪The Ovaries‬‬
‫‪10‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬
The Ovaries
11

The ovaries are a woman's storehouse of egg cells.

They are among the first organs to be formed as a female
baby develops in the uterus.

Through hormonal influence, one ovum is developed per
month. It then travels into the fallopian tube and has the
potential to be fertilized.

One ovary is located on either side of the uterus, incased
in the posterior aspect of the broad ligaments.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
The Fallopian Tubes

Beyond the uterus, the fallopian tubes bring mature ova from
the ovaries to the uterus via peristaltic action.

Each of these tubes is roughly five inches long and ranges in
width from about one inch at the end next to the ovary, to the
diameter of a strand of thin spaghetti at the uterus.

The fallopian tubes connect the uterine cavity to the
abdominal cavity. The opening at the abdominal site is lined
with cilia to promote the peristalsis necessary to convey the
ovum into the tube
They are situated in the superior margin of the broad
ligament

12
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
Ligaments supports

Round ligaments:
are fibrous cords attaching to the uterus and the libia majora

Broad ligaments
are large folds of peritoneum separating the pelvis to anterior
and posterior divisions.

The lower portion of the ligament is called the cranial
ligaments, it attaches to lateral aspect of the uterus to
supravaginal area of the cervix.

Utero sacral ligaments
attach the sacrum to the posterior aspect of the cervix to
support the cervix
13
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
‫‪14‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬
The pelvic floor
 It is the soft tissue strcture which fill the pelvic out let. It
includes the following from above downwards.
 Pelvic peritoneum:
 It has a very little support for the pelvic organs. It covers
the blooder, the anterior surface of the uterus, posterior
surface of the uterus, upper part of the vagina and colon
at the level of 3rd sacral vertebra.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
15
 2. Pelvic cellular tissue (endo pelvic fascia):
 With its condensation around the cervix. Its values are
packing the pelvic organs togather and form the cervical
legaments
 3. Levator ani (pelvic diaphragm) muscle:
 the pelvic floor is composed of the levator ani and the
coccyygeal muscles. The levator ani is a bilateral sheet
of muscle which slopes down to fuse with its opposite
half both in front and behind the rectum. The levator ani
is composed of the three parts.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
16
 The pubo coccygous muscle:
 It arises from the posterior surface of the pubic bone. Its
anterior fibers pass backwards on either side of the vagina., to
decussate in the apex of the perineal body. The posterior
fibers pass backwards on either side of the rectum, to unite
with those of the opposite side, and hindmost fibers reach the
coccyx. Decussating of the muscle fibers between the rectum
and vagina, result in two openings in the pelvic diaphragm;
The rectal hiatus, throw which passes the rectum and the
urogenital hiatus, through which pass the vagina and urethra.
Contraction of the levators will lead to narrowing of the
hiatuses as well as raising the organs ( bladder, uterus and
rectum) which lie above it
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
17
 The ileo-coccgeous muscle: arises from the tenuous
arch which covers the upper part of the obterator
internus muscle and it is inserted into the coccyx and the
ano- coccygeal raphe.
 The ischio-coccygeous muscle: Arises from the spine
of the ischium by narrow origin and it fans out to be
inserted in the sides of the coccyx.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
18
Action of the levator ani:
A) Strong support of the bladder, vagina
and anus.
B) Sphintric action.
C) Gutter like action.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
19
Anatomy of pelvic floor muscles
Muscle
Origin
Insertion
Action
Innervation
anal sphincter,
external
perineal body or central
tendinous point of
the perineum
encircles the anal canal;
superficial fibers
attach to the
coccyx
constricts the anal canal
inferior rectal nerves (from
the pudendal nerve)
anal sphincter,
internal
encircles the anal canal
encircles the anal canal
constricts the anal canal
parasympathetic fibers
from S4
bulbospongiosus,
in female
perineal body and fascia
of the bulb of the
vestibule
perineal membrane and
corpus cavernosum
of the clitoris
compresses the vestibular
bulb and constricts
the vaginal orifice
deep branch of the perineal
nerve (from pudendal
nerve
coccygeus
ischial spine
side of the coccyx and
lower sacrum
elevates the pelvic floor
branches of the ventral
primary rami of
spinal nerves S3-S4
deep transverse
perineus
medial surface of the
ischial ramus
contralateral muscle and
perineal
body/central
tendinous point
fixes and stabilizes the
perineal body/central
tendinous point
deep branch of perineal
nerve from pudendal
nerve
iliococcygeus
arcus tendineus levator
ani and the ischial
spine
anococcygeal raphe and
the coccyx
elevates the pelvic floor
branches of the ventral
primary rami of
spinal nerves S3-S4
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
20
Muscle
Origin
Insertion
Action
Innervation
levator ani
posterior surface of
the body of the
pubis, fascia of the
obturator internus m.
(arcus tendineus
levator ani), ischial
spine
anococcygeal raphe and
coccyx
elevates the pelvic
floor
branches of the ventral primary
rami of spinal nerves S3-S4
puborectalis
posterior aspect of
the body of the pubis
unites with the
puborectalis m. of other
side posterior to the
rectum
draws the distal rectum
forward and
superiorly; aids in
voluntary retention of
feces
branches of the ventral primary
rami of spinal nerves S3-S4
pubovaginalis
posterior aspect of
the body of the pubis
fascia of the vagina and
perineal body
draws the vagina
forward and superiorly
branches of the ventral primary
rami of spinal nerves S3-S4
sphincter ani
externus
perineal body or
central tendinous
point of the
perineum
encircles the anal canal;
superficial fibers attach
to the coccyx
constricts the anal
canal
inferior rectal nerves (from the
pudendal nerve)
sphincter ani
internus
encircles the anal
canal
encircles the anal canal
constricts the anal
canal
parasympathetic fibers from S4
transverse perineus,
deep
medial surface of the
ischial ramus
contralateral muscle and
perineal body/central
tendinous point
fixes and stabilizes the
perineal body/central
tendinous point
deep branch of perineal nerve
from pudendal nerve
transverse perineus,
superficial
medial surface of the
ischial ramus
contralateral muscle and
the perineal body/central
tendinous point
fixes and stabilizes
perineal body/central
tendinous point
deep branch of perineal nerve
from pudendal nerve
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
21
‫‪22‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬

In all mammalian species, there are extensive biochemical,
physiological and structural changes during pregnancy and
the puerperium:

The causes of these changes are:
1. To provide a suitable environment for nutrition, growth
and development.
2. To prepare the mother for the process of parturition and
subsequent support of the new born baby.
All changes that occur in pregnancy to achieve these objectives
are both visible and suitable.
23
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
The Cervix:

Physiological and anatomical changes::
During pregnancy,: The cervix is closed by a mucus plug
providing a protective barrier between the vagina and the uterine
contents.
During labor and delivery: The cervix shorten and widen (dilates),
A 10 cm opening is left between the uterus and vagina to allow
passage of the fetus into the birth canal.
Cerclage: is a dilatation of the cervix prematurely.
24
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
The Uterus

Physiological and anatomical changes during pregnancy:
The uterus will:
1) ↑ weight from 60 to 1000g
2) ↑ size from 6.5 to 32 cm
3) Expands into the abdominal cavity due to
The growth of the fetus
↑ in connective tissue
↑ the size and number of blood vessels
supplying the uterus
25
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
‫‪27‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬
During pregnancy:

↑ Heart rate, reaching a peak of 10 to 15 beats/min
over non pregnant values.

↑ Blood volume 40% above non pregnant values.

↑ Cardiac out put up to 30% to 50% at 28 to 32 weeks
of pregnancy.

↓ Arterial blood pressure due to :
Reduction in systemic vascular resistance.
Reduction of peripheral vascular tone. (release of
relaxin hormone.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
28
Maternal position has an effect on blood pressure particularly if
the uterus compresses the inferior vena cava. This occurs in
lying position and disappears in the left sidling position, (supine
hypotension or Vena cava syndrome) affects 3% to 11% of
pregnant women.
 Occlusion of inferior vena cava leads to:
↓ Venous return.
↓ Central venous pressure.
↓ Left ventricular output.
↓ Cardiac output by 25%

No change in pulse or blood pressure due compensatory
vasoconstriction.
 Mitral valve prolapsed is the most common problem of pregnant
women.
During pregnancy:
1)
2)
3)
4)
5)
Breathing becomes more costal than abdominal or
diaphragmatic. Additionally most women are mouth
breathers during pregnancy.
The diaphragem is elevated due expansion of the
uterus.
No change of respiratory rate, ↑ oxygen consumption.
↑ Respiratory tidal volume by 200ml resulting in
deeper breathing.
↑ Respiratory minute by 29% due to ↑ in progesterone
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
30
hormone level
Breast Changes




Increase blood flow to breasts
Increased size
Increased ductal growth, alveolar enlargement
Lactation dependent on





Estrogen
Progesterone
Prolactin
Cortisol
Insulin
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
31
Skin Changes
 Increased estrogen levels may cause:
hyper pigmentation between the umbilicus and symphysis pubis ,
nipples(1st and2nd areola, abdominal midline (linea Ingra) and mask
face, which is butterfly pigmentation of the forehead, nose, upper lip
and checks (chloasma gravid arum).
 Hyper dynamic circulation and high levels of estrogen may cause:
spider naevi and palmer erythema.
 Stria gravid arum ("stretch marks") due to:
over stretching of the skin, the elastic fibers may rupture together
with small blood vessels, more marked below the umbilicus, on the
breast, the buttocks and thighs (appear in some women).
 Falling of hairs and brittleness of nails may occur during pregnancy.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
32
Weight Gain in Pregnancy
Normal weight gain is approximately 12.5kg (usually at a rate of
0.5kg per week for the last 20 weeks). 5kg is the fetus, placenta,
membranes and amniotic fluid and the rest maternal stores of fat
and protein and increased intra and extra-vascular volume.
Daily energy requirements in pregnancy are increased to about
2000-2500calories per day.
Associated with good outcome, i.e. delivery of normal sized baby
Total pregnancy expenditure is 75,000kcalories.
The basal metabolic rate increases by 15-20%.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
33
Musculoskeletal Changes in Pregnancy







↑ levels of relaxin may cause:
↑ ligamental laxity (↓ligamentous tensile strength, ↑mobility of
structures supported by ligaments will contribute to:
back pain and pubic symphysis dysfunction, joint injury
specially weight bearing joints of the back, pelvis, and lower
extremities.
Shift in posture with forward head, round shoulders, exaggerated
lumbar lordosis, hyper-extended knees, and pronated feet.
Change of the center of gravity, resulting in changes in balance.
Change of the length of muscles.
Total calcium levels decreased but ionized calcium levels normal
No loss of bone density during pregnancy.
In some pregnant women there is a tendency of decalcification of bones
and sublaxation of joints specially sacroiliac joint and symphysis pubis,
leading wadlling gait.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
34
Urinary tract
 The smooth muscle of the renal pelvis and ureters become
relaxed and dilated
 kidneys increase in length by 1cm
Ureters become longer, more curved
↑ residual urine volume.
 Bladder smooth muscle also relaxes
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
35
Gastro-Intestinal tract
• Morning sickness and vomiting in early months.
• Heart burn and indigestion.
• Constipation due pressure on the intestines by enlarged
uterus, relaxation of the smooth muscle fibers by relaxin
hormone and sedentary habits during pregnancy.
• Piles.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
36
Metabolic and endocrine
 ↑relaxin hormone by corpus luteum during pregnancy
and menstrual period.
 ↑other hormones secreted by placenta, ovaries and
adrenal cortex such as: estrogen, progesterone, human
placental lactogen.
 Edema in the hands, feet, face and eyelids due to water
retention and circulating hormones causing ↑ Capillary
permeability.
1437 ،‫ شعبان‬16 ،‫اإلثنين‬
37
‫‪38‬‬
‫اإلثنين‪ 16 ،‬شعبان‪1437 ،‬‬