Maternal and Child Nursing
FEMALE REPRODUCTIVE ANATOMY AND PHYSIOLOGY
THE EXTERNAL REPRODUCTIVE ORGANS
A. Mons pubis or mons veneris – pad of fat which lies over the symphysis pubis covered by
skin and at puberty by short hairs; protects the surrounding delicate tissues from
trauma.
B. Labia majora – two folds of skin with fat underneath; contain Bartholin’s glands which
are believed to secrete a yellowish mucus which acts as a lubricant during sexual
intercourse. The openings of the Bartholin;s glands are located posteriorly on either
side of the vaginal orifice.
C. Labia minora – two thin folds of delicate tissues; form an upper fold encircling the
clitoris )called the prepuce) and unite posteriorly (called the fourchette) which is highly
sensitive to manipulation and trauma that is why it is often torn during a woman’s
delivery.
D. Glans clitoris - small erectile structure at the anterior junction of the labia minora,
which is comparable to the penis in its being extremely sensitive.
E. Vestibule – narrow speace seen when the labia minora are separated.
F. Urethral meatus – external opening of the urethra: slightly behind and to the side are
the openings of the Skene’s glands (which are often involved in infections of the
external genitalia).
G. Vaginal orifice or Introitus – external opening of the vagina covered by a thin
membrance (called hymen) in virgins.
H. Perinuem – area from the lower border of the vaginal orifice to the anus; contains the
muscles (e.g., pubococcoygeal and levator ani muscles) which support the pelvic organs,
the arteries that supply blood to the external genitalia and the pudendal nerves which
are important during delivery under anesthesia.
THE INTERNAL RERODUCTIVE ORGANS
A. Vagina – a 3-4 inch long dilatable canal located between the bladder and the rectum;
contains rugae (which permit considerable stretching without tearing); organ of
copulation; passageway for menstrual discharges and fetus.
B. Uterus
1. Hollow pear-shaped fibromuscular organ 3 inches lone, 2 inches wide, 1 inch thick
and weighing 50-60 gms. In a non-pregnant woman
2. Held in place by broad ligaments (from sides of uterus to pelvic walls; also hold
Fallopian tubes and ovaries in place) and round ligaments (from sides of the
uterus to the mons pubis)
3. Abundant blood supply from uterine and ovarian arteries
4. Composed of 3 muscle layers: perimetrium, myometrium and endometrium
5. Consists of three parts
1. Corpus (body)- upper portion with a triangular part called fundus
2. Isthmus – area between corpus and cervix which forms part of the
lower uterine segment
3. Cervix – lower cylindrical portion.
, 6. Organ of menstruation; site of implantation, retainment and nourishment of the
products of conception.
C. Fallopian Tubes – 4 inches long from each side of the fundus; widest part (called
ampulla) spreadsinto fingerlike projections (called fimbriae). Responsible for transport
of mature ovum from ovary to uterus; fertilization takes place in its outer third or outer
half.
D. Ovaries – almond-shaped, dull white sex glands near the fimbriae, kept in plact by
ligaments. Produce, mature and expel ova and manufacture estrogen and
progesterone.
PELVIS – although not a part of the female reproductive system but of the skeletal system, it is a
very important body part of pregnant women.
A. Structure
1. Two os coxae/innominate bones – made up of:
1. Ilium – upper extended part; curved upper border is the iliac crest.
2. Ischium – under part; when sitting, the body rests on the ischial
tuberosities; ischial spines are important landmarks.
3. Pubes – front part; join to form an articulation of the pelvis called
the symphysis pubis.
2. Sacrum – wedge-shaped, forms the back part of the pelvis. Consists of 5
fused vertebrae, the first having a prominent upper margin called the sacral
promontory.
3. Coccyx – lowest part of the spine; degree of movement between sacrum
and coccyx made possible by the third articulation of the pelvis called
sacroccygeal joint which allows room for delivery of the fetal head.
B. Divisions – set apart by the linea terminalis, an imaginary line from the sacral
promontory to the ilia on both sides to the superior portion of the symphysis pubis.
1. False pelvis – superior half formed by the ilia. Offers landmarks for pelvic
measurements; supports the growing uterus during pregnancy; and directs
the fetus into the true pelvis near the end of gestation.
2. True pelvis – inferior half formed by the pubes in front, the iliac and the
ischia on the sides and the sacrum and coccyx behind. Made up of three
parts:
1.Inlet – entranceway to the true pelvis. Its transverse diameter is
wider than its anterosposteior diameter. Thus:
1. Transverse diameter = 13.5 cm.
2. Anteroposterior diameter (AP) = 11 cm.
3. Right and left oblique diameter = 12.75 cm.
2.Cavity – space between the inlet and the outlet. Contains the bladder
and the rectum, with the uterus between them in an anteflexed
position towards the bladder.
3.Outlet – inferior portion of the pelvis, bounded on the back by the
coccyx, on the sides by the ischial tuberosities and in front by the
inferior aspect of the symphysis pubis and the pubic arch. Its AP
diameter is wider than its transverse diameter.
C. Types/Variations
, 1. Gynecoid – “normal” female pelvis. Inlet is well rounded forward and back.
Most ideal for childbirth.
2. Anthropoid – transverse diameter is narrow, AP diameter is lager than
normal.
3. Platypelloid – inlet is oval, AP diameter is shallow
4. Android – “male” pelvis. Intel has a narrow, shallow posterior portion and
pointed anterior portion.
D. Measurements
1. External – suggestive only of pelvic size:
1. Intercristal diameter – distance between the middle points of the
iliac crests.
Average = 28 cm.
2. Interspinous diameter – distance between the anterosuperior iliac
spines.
Average = 25 cm.
3. Intertrochanteric diameter – distance between the trochanters of
the femur.
Average = 31 cm.
4. External conjugate/Baudelocque’s diameter – distance between the
anterior aspect of the symphysis pubis and depression below L5.
Average = 18-20 cm.
2. Internal – give the actual diameters of the inlet and outlet
1. Diagonal conjugate – distance between the sacral promontory and
inferior margin of the symphysis pubis. Average = 12.5 cm.
2. Important measurement because it is the diameter of the pelvic inlet.
Average = 10.5 – 11 cm.
3. Bi-ischial diameter/tuberischii – transverse diameter of the pelvic
outlet. Is measured at the level of the anus. Average = 11 cm.
MENSTRUATION
A. General Considerations
1. 300, 000 – 400, 000 immature oocytes per ovary are present at birth (were
formed during the first 5 months of intrauterine life, a process called
oogenesis); many of these oocytes, however, degenerate and atrophy (a
process called atresia). Only about 300-400 mature during the entire
reproductive cycle of women.
2. Ushered in by the menarche (very first menstruation in girls) and ends
with menopause (permanent cessation of menstruation, i.e., there are no
more functioning oocytes in the ovaries); age of onset and termination vary
widely depending on heredity, racial background, nutrition and even
climate.
3. Normal period (days when there is menstrual flow) lasts for 3-6 days;
menstrual cycle (from first day of menstrual period up to the first day of
next menstruation period) may be anywhere from 25-35 days, but accepted
average length is 28 days.
, 4. Anovulatory states after menarche are not unusual because of immaturity
of feedback mechanism. Anovulatory states also occur in pregnancy,
lactation and related disease conditions.
5. Associated terms
Amenorrhea – temporary cessation of menstrual flow.
Oligomenorrhea – markedly diminished menstrual flow, nearing
amenorrhea
Menorrhagia – excessive bleeding during regular menstruation.
Metrorhagia – bleeding at completely irregular intervals.
Polymenorrhea – frequent menstruation occurring at intervals of less
than 3 weeks.
Oligomenorrhea – markedly diminished menstrual flow.
6. Body structures involved
1. Hypothalamus
2. Anterior pituitary gland
3. Ovary
4. Uterus
7. Hormones which regulate cyclic activities
1. Follicle-stimulating hormone (FSH)
2. Luteinizing hormone (LH)
8. Effects of estrogen in the body
1. Inhibits production of FSH
2. Causes hypertrophy of the myometrium
3. Stimulates growth of the ductile structures of the breasts.
4. Increases quantity and pH of cervical mucus, causing it to become
thin and watery and can be stretched to a distance of 10-13 cm.
(Spinnbarkheit test of ovulation).
9. Effects of progesterone in the body
1. Inhibits production of LH
2. Increases endomentrial tortuosity
3. Increases endometrial secretions
4. Inhibits uterine motility
5. Decreases muscle tone of gastrointestinal and urinary tracts
6. Increases musculoskeletal motility
7. Facilitates transport of the fertilized ovum through the Fallopian
tubes
8. Decreases renal threshold of lactose and dextrose
9. Increases fibrinogen levels; decreases hemoglobin and hematocrit
10. Increases body temperature after ovulation. Just before ovulation
basal body temperature decreases slightly (because of low
progesterone level in the blood) and then increases slightly a day
after ovulation (because of the presence of progesterone)
B. Sequential steps of the menstrual cycle
1. On the third day of the menstrual cycle, serum estrogen level is at its
lowest. This low estrogen level serves as the stimulus for the hypothalamus
to produce the Follicle-Stimulating Hormone Releasing Factor (FSHRF).
FEMALE REPRODUCTIVE ANATOMY AND PHYSIOLOGY
THE EXTERNAL REPRODUCTIVE ORGANS
A. Mons pubis or mons veneris – pad of fat which lies over the symphysis pubis covered by
skin and at puberty by short hairs; protects the surrounding delicate tissues from
trauma.
B. Labia majora – two folds of skin with fat underneath; contain Bartholin’s glands which
are believed to secrete a yellowish mucus which acts as a lubricant during sexual
intercourse. The openings of the Bartholin;s glands are located posteriorly on either
side of the vaginal orifice.
C. Labia minora – two thin folds of delicate tissues; form an upper fold encircling the
clitoris )called the prepuce) and unite posteriorly (called the fourchette) which is highly
sensitive to manipulation and trauma that is why it is often torn during a woman’s
delivery.
D. Glans clitoris - small erectile structure at the anterior junction of the labia minora,
which is comparable to the penis in its being extremely sensitive.
E. Vestibule – narrow speace seen when the labia minora are separated.
F. Urethral meatus – external opening of the urethra: slightly behind and to the side are
the openings of the Skene’s glands (which are often involved in infections of the
external genitalia).
G. Vaginal orifice or Introitus – external opening of the vagina covered by a thin
membrance (called hymen) in virgins.
H. Perinuem – area from the lower border of the vaginal orifice to the anus; contains the
muscles (e.g., pubococcoygeal and levator ani muscles) which support the pelvic organs,
the arteries that supply blood to the external genitalia and the pudendal nerves which
are important during delivery under anesthesia.
THE INTERNAL RERODUCTIVE ORGANS
A. Vagina – a 3-4 inch long dilatable canal located between the bladder and the rectum;
contains rugae (which permit considerable stretching without tearing); organ of
copulation; passageway for menstrual discharges and fetus.
B. Uterus
1. Hollow pear-shaped fibromuscular organ 3 inches lone, 2 inches wide, 1 inch thick
and weighing 50-60 gms. In a non-pregnant woman
2. Held in place by broad ligaments (from sides of uterus to pelvic walls; also hold
Fallopian tubes and ovaries in place) and round ligaments (from sides of the
uterus to the mons pubis)
3. Abundant blood supply from uterine and ovarian arteries
4. Composed of 3 muscle layers: perimetrium, myometrium and endometrium
5. Consists of three parts
1. Corpus (body)- upper portion with a triangular part called fundus
2. Isthmus – area between corpus and cervix which forms part of the
lower uterine segment
3. Cervix – lower cylindrical portion.
, 6. Organ of menstruation; site of implantation, retainment and nourishment of the
products of conception.
C. Fallopian Tubes – 4 inches long from each side of the fundus; widest part (called
ampulla) spreadsinto fingerlike projections (called fimbriae). Responsible for transport
of mature ovum from ovary to uterus; fertilization takes place in its outer third or outer
half.
D. Ovaries – almond-shaped, dull white sex glands near the fimbriae, kept in plact by
ligaments. Produce, mature and expel ova and manufacture estrogen and
progesterone.
PELVIS – although not a part of the female reproductive system but of the skeletal system, it is a
very important body part of pregnant women.
A. Structure
1. Two os coxae/innominate bones – made up of:
1. Ilium – upper extended part; curved upper border is the iliac crest.
2. Ischium – under part; when sitting, the body rests on the ischial
tuberosities; ischial spines are important landmarks.
3. Pubes – front part; join to form an articulation of the pelvis called
the symphysis pubis.
2. Sacrum – wedge-shaped, forms the back part of the pelvis. Consists of 5
fused vertebrae, the first having a prominent upper margin called the sacral
promontory.
3. Coccyx – lowest part of the spine; degree of movement between sacrum
and coccyx made possible by the third articulation of the pelvis called
sacroccygeal joint which allows room for delivery of the fetal head.
B. Divisions – set apart by the linea terminalis, an imaginary line from the sacral
promontory to the ilia on both sides to the superior portion of the symphysis pubis.
1. False pelvis – superior half formed by the ilia. Offers landmarks for pelvic
measurements; supports the growing uterus during pregnancy; and directs
the fetus into the true pelvis near the end of gestation.
2. True pelvis – inferior half formed by the pubes in front, the iliac and the
ischia on the sides and the sacrum and coccyx behind. Made up of three
parts:
1.Inlet – entranceway to the true pelvis. Its transverse diameter is
wider than its anterosposteior diameter. Thus:
1. Transverse diameter = 13.5 cm.
2. Anteroposterior diameter (AP) = 11 cm.
3. Right and left oblique diameter = 12.75 cm.
2.Cavity – space between the inlet and the outlet. Contains the bladder
and the rectum, with the uterus between them in an anteflexed
position towards the bladder.
3.Outlet – inferior portion of the pelvis, bounded on the back by the
coccyx, on the sides by the ischial tuberosities and in front by the
inferior aspect of the symphysis pubis and the pubic arch. Its AP
diameter is wider than its transverse diameter.
C. Types/Variations
, 1. Gynecoid – “normal” female pelvis. Inlet is well rounded forward and back.
Most ideal for childbirth.
2. Anthropoid – transverse diameter is narrow, AP diameter is lager than
normal.
3. Platypelloid – inlet is oval, AP diameter is shallow
4. Android – “male” pelvis. Intel has a narrow, shallow posterior portion and
pointed anterior portion.
D. Measurements
1. External – suggestive only of pelvic size:
1. Intercristal diameter – distance between the middle points of the
iliac crests.
Average = 28 cm.
2. Interspinous diameter – distance between the anterosuperior iliac
spines.
Average = 25 cm.
3. Intertrochanteric diameter – distance between the trochanters of
the femur.
Average = 31 cm.
4. External conjugate/Baudelocque’s diameter – distance between the
anterior aspect of the symphysis pubis and depression below L5.
Average = 18-20 cm.
2. Internal – give the actual diameters of the inlet and outlet
1. Diagonal conjugate – distance between the sacral promontory and
inferior margin of the symphysis pubis. Average = 12.5 cm.
2. Important measurement because it is the diameter of the pelvic inlet.
Average = 10.5 – 11 cm.
3. Bi-ischial diameter/tuberischii – transverse diameter of the pelvic
outlet. Is measured at the level of the anus. Average = 11 cm.
MENSTRUATION
A. General Considerations
1. 300, 000 – 400, 000 immature oocytes per ovary are present at birth (were
formed during the first 5 months of intrauterine life, a process called
oogenesis); many of these oocytes, however, degenerate and atrophy (a
process called atresia). Only about 300-400 mature during the entire
reproductive cycle of women.
2. Ushered in by the menarche (very first menstruation in girls) and ends
with menopause (permanent cessation of menstruation, i.e., there are no
more functioning oocytes in the ovaries); age of onset and termination vary
widely depending on heredity, racial background, nutrition and even
climate.
3. Normal period (days when there is menstrual flow) lasts for 3-6 days;
menstrual cycle (from first day of menstrual period up to the first day of
next menstruation period) may be anywhere from 25-35 days, but accepted
average length is 28 days.
, 4. Anovulatory states after menarche are not unusual because of immaturity
of feedback mechanism. Anovulatory states also occur in pregnancy,
lactation and related disease conditions.
5. Associated terms
Amenorrhea – temporary cessation of menstrual flow.
Oligomenorrhea – markedly diminished menstrual flow, nearing
amenorrhea
Menorrhagia – excessive bleeding during regular menstruation.
Metrorhagia – bleeding at completely irregular intervals.
Polymenorrhea – frequent menstruation occurring at intervals of less
than 3 weeks.
Oligomenorrhea – markedly diminished menstrual flow.
6. Body structures involved
1. Hypothalamus
2. Anterior pituitary gland
3. Ovary
4. Uterus
7. Hormones which regulate cyclic activities
1. Follicle-stimulating hormone (FSH)
2. Luteinizing hormone (LH)
8. Effects of estrogen in the body
1. Inhibits production of FSH
2. Causes hypertrophy of the myometrium
3. Stimulates growth of the ductile structures of the breasts.
4. Increases quantity and pH of cervical mucus, causing it to become
thin and watery and can be stretched to a distance of 10-13 cm.
(Spinnbarkheit test of ovulation).
9. Effects of progesterone in the body
1. Inhibits production of LH
2. Increases endomentrial tortuosity
3. Increases endometrial secretions
4. Inhibits uterine motility
5. Decreases muscle tone of gastrointestinal and urinary tracts
6. Increases musculoskeletal motility
7. Facilitates transport of the fertilized ovum through the Fallopian
tubes
8. Decreases renal threshold of lactose and dextrose
9. Increases fibrinogen levels; decreases hemoglobin and hematocrit
10. Increases body temperature after ovulation. Just before ovulation
basal body temperature decreases slightly (because of low
progesterone level in the blood) and then increases slightly a day
after ovulation (because of the presence of progesterone)
B. Sequential steps of the menstrual cycle
1. On the third day of the menstrual cycle, serum estrogen level is at its
lowest. This low estrogen level serves as the stimulus for the hypothalamus
to produce the Follicle-Stimulating Hormone Releasing Factor (FSHRF).
