PHYSIOLOGY OF MENSTRUATION several Graafian follicle in the ovary, maturation

of the ovum and the production of estrogen. It is

Menstrual Cycle/Reproductive Cycle inhibited by high serum estrogen level. It is
active in early cycle.
- An episodic uterine bleeding in response to
- Luteinizing Hormone (LH)- it is active at the
cyclic hormonal changes. It is the process that
midpoint of the cycle. It is triggered by low
allows for conception and implantation of a new
serum progesterone level and LHRF. It
life.
stimulates the corpus luteum to produce
- PURPOSE: To bring an ovum to maturity and
progesterone and some estrogen. It is also
renew uterine tissue bed that will be responsible
hormone that responsible for ovulation – or the
for its growth should it be fertilized
release of the mature egg cell from the ovary.
Ovarian Follicle
3. Ovaries – the female gonads, produces
- Within the cortex of the ovary, the follicle at estrogen on the first half of the cycle and
different phases of development are found progesterone during the second half of the
- These are the: menstrual cycle.
Primordial - Estrogen – FSH stimulates the Graafian Follicle
Graafian to produce estrogen. It is metabolized in the
Corpus Luteum liver and excreted in the uterine.
Corpus Albican There are 3 kinds of estrogen:
Corpus-yellow 1. Estradiol – the most potent
Alba - white 2. Estriol – the one found in the urine
Primordial follicle 3. Estrone
- Progesterone - LH stimulates the corpus
- Primordial follicles ae formed during the luteum to produce progesterone.
intrauterine life. Most of them regress before -
birth 4. Uterus – the changes that occurs in the uterine
- Are the immature follicles inside the ovary that endometrium are due to the influence of the
contain immature ova ovarian hormones: estrogen and progesterone.
- Every menstrual cycle, several of these follicles
develop under influence of FSH
Graafian Follicle PHASES OF THE ENDOMETRIAL MENSTRUAL
CYCLE
- The term Graafian follicle is derived from the
1. Proliferative Phase or Follicular Phase
name Regner de Graaf, the Dutch anatomist
- It occurs during the first 4 or 5 days of the cycle
who first described it in 1672
or from day 5 to day 14 (6-13) after the first day
- After puberty, several follicles begin to develop
of menstruation on a 28 day cycle (last for 18-10
under the influence of the FSH. The developing
days)
follicle is termed Graafian follicle
- The endometrial lining is very thin
- The Graafian follicle is described as a blister like
- This half of the menstrual cycle is termed
structure barely visible to the naked eye (.25 to .
5 in). As it develops, the oocyte within it interchangeably the Proliferative phase,
matures. estrogenic phase, follicular phase, or post
menstrual phase
- The Graafian follicle secrete large amount of
- Levelling off of the endometrial growth occurs at
estrogen under influence of FSH.
ovulation
- Aside from the changes that happen in the
endometrium, estrogen also prepares the
4 Body Structures involved in Menstrual Structure
genital tract for the sperm migration by
1. Hypothalamus – is the ultimate initiator of the stimulating cervical glands to produce abundant
menstrual cycle. It releases GnRH. mucus that is thin, watery stretchable and
- Follicle stimulating hormone Releasing Factor transparent.
(FSHRH) – it is triggere by low serum estrogen
level; it stimulates the anterior Pituitary Gland to 2. Secretory Phase
release FSH. - Extends from the 14th day to 25th day of
- Luteinizing Hormone Releasing Factor (LHRF) – menstrual cycle
it is triggered by low progesterone level; it - The rising level of estrogen in the blood, inhibit
- Stimulates anterior pituitary gland to release LH. the APG to secrete FSH. Suppression of FSH,
the very high estrogen level and very low
2. Anterior Pituitary Gland (adenohypophysis) – progesterone level triggers the hypothalamus to
releases the following GH: release LHRF which in turn, stimulates the APG
- Follicle Stimulating Hormone (FSH) – it is to secrete LH, LH promote ovulation.
triggered by the FSHRH and low serum
estrogen level. It stimulates the development of
 - Occurs on the 14 (+2 or -2 days) before - Normal, regular menstruation that lasts for a few
menstruation. Changes that the woman can be days (usually 3 to 5 days, but anywhere from 2
observed: to 7 days is considered normal)
 Mittelschmerz - The average blood loss during menstruation is
Spinbarkheit 35ml with 10-80ml considered normal.
Increased basal body temperature
Menarche
After ovulation, the empty follicle is transformed - The first menstruation. Its is an event that
into corpus luteum. The formation of signifies the end of puberty and beginning of
progesterone in the corpus luteum, causes the reproductive years of a woman.
blood vessels in the endometrium to dilate and - Average age: 11-13(but may occur at 8 or 9-17
assume a spiral or corkscrew shape. These yrs. old) depending on conditions such as
changes increase further the vascularity of the heredity, nutrition, race
uterus. In addition, progesterone causes the - Often it occurs between the appearance of
endometrial gland to elongate, become more
pubic axillary hair or approximately 2 years after
active, and secrete a glycogen and mucin thelarche. The first menstrual cycles are usually
containing fluid.
anovulatory, painless and irregular.
As a result, the endometrium becomes very soft,
spongy and edematous, very rich in nutrients
CHARACTERISTICS OF NORMAL MENSTRUAL
from blood and glandular secretions, providing
CYCLE
an ideal protective and nutritive bed for the
ovum to implant should it be fertilized.

The corpus luteum has an average lifespan of 7-

8 days. If no fertilization occurs at this time, it
regresses and become non-functional 10-12
days after ovulation resulting in withdrawal of
progesterone.

It is called as Progestational, Luteal, and

Premenstrual Phase.

3. Ischemic Phase
- If fertilization does not occur, the corpus luteum
in the ovary begins to regress after 8-10 days 
estrogen and progesterone decreases
formation and release of prostaglandin Menstrual Disorder
vasopasm of the spiral arteries and contraction
of myometrium (24th or 25th day)  the 1. Oligoovulation
capillaries rupture, with minute hemorrhage and -Infrequent or irregular ovulation
the endometrium slough off.
2. Anovulation
4. Menstrual Phase -Absence of ovulation
- Discharges:
- Blood from the ruptured capillaries 3. Hypermenorrhea
- Mucin from the glands -Very little flow (less than 10ml)
- Fragments of the endometrial tissue
- The microscopic, atrophied and unfertilized 4. Polymenorrhea
ovum -Regular cycles with intervals of 21 days or
fewer

MENSTRUATION 5. Metrorrhagia
- Is also called menstrual bleeding, menses, -Frequent but irregular menstruation
catamenia or period
- The flow of menses normally serves as a sign 6. Menorrhagia
that a woman has not become pregnant -Sudden heavy flows or amounts in excess
- During the reproductive years, failure to of 80ml.
menstruate may provide the first indication to a
woman that she may have become pregnant. 7. Menemetrorrhagia
-Heavy menstruation that occurs frequently
and irregularly.
Eumenorrhea
8. Oligomenorrhea
-Cycles with intervals exceeding 35 days
 - The last residues of corona and zona pellucida
9. Amenorrhea are shed by the growing structure, the
-3 to 6 months without menses (in the blastocyst brushes against the rich uterine
absence of pregnancy) during a woman’s endometrium – it is called apposition, then it
reproductive years. attached to the surface of the endometrium
(adhesion) and settles down into soft folds
(invasion)
- As it implants, the trophoblast cell releases
enzyme that digest endometrial cells at the area
of implantation that cause rupture of several
FERTILIZATION AND IMPLANTATION capillaries resulting in bleeding at the
implantation site with the blastocyst being
- The beginning of pregnancy. embedded in a pool of blood (implantation
- It is the union of an ovum and spermatozoon. It bleeding)
is also referred to as conception, impregnation - Ideal site: fundal portion on the posterior surface
or fecundation. (2/3 of case are implanted anteriorly; 1/3 cases
- When the sperm cell reaches the uterus, its are implanted at the posterior surface)
head undergoes structural changes called - Once implanted the zygote is now term as
capacitation – the outer covering of the head of Embryo
the sperm cell disappears and tiny holes appear BLASTOCYST
on it.
- When it meets the ovum in the fallopian tube, it - Is a ball structure composed of an inner cell
secretes the enzymes hyaluronidase through mass, called embryonic disc or blastocele
the hole of its head which dissolves the a. Embryonic disc or embryonic cells:
outermost covering of the egg cell, corona Ectoderm
radiata. Mesoderm
- Once the outer covering of the ovum Entoderm
disintegrated, the sperm secretes another b. An outer layer of rapidly developing cells
enzyme called acrosin, which dissolves the called trophoblast or trophoderm it has the
portion of the zona pellucida that the sperm following function:
encounters as it enters the ovum. Absorbs nutrient from the endometrium
Secrete the hormone human chorionic
ZYGOTE: The first cell of the human body gonadotropin necessary for prolonging life of
Two Types of Cells: the corpus luteum
- Trophodherm layer gives rise to the:
1. Body cells or somatic cells contain 46 Placenta
chromosomes Fetal membrane
2. Sex cells or gametes are the ovum and sperm Umbilical cord
cell Amniotic fluid

- The mature ovum has 23 chromosomes (22

autosomes and one X chromosomes) Two Distinct Layer of Trophoblast
- The sperm cell has 22 autosomes and one X or
Y chromosomes 1. Cytotrophoblast/Langhan’s Layer
- Zygote has 46 chromosomes or 23 pairs - Protects the fetus against treponema pallidum
- XX = girl ; XY = boy (syphilis) but only until the second trimester
- Journey: 3-4 days from FT to the uterus because after third month of pregnancy the cell
- 1st 24 hours: First cell division = blastomere; becomes less numerous making it an ineffective
subsequent division every after 22 hours barriers against syphilis.
- 16 blastomeres or more = morula 2. Syncytiotrophoblast/Syncytium/Plasmotrophobla
- Morula continue to multiply in the uterine cavity st
for 3-4 more days while floating inside the - The outer layer which originates from the
uterus cytotrophoblast is composed of multinucleated
- Upon reaching the uterine cavity the remaining cells without cell boundaries. During the second
zona pellucida disintegrates and morula is now trimester, only a small cytotrophoblast cells
term as blastocyst remain so that is the syncytium that functions as
the primary barrier. However it is a poor barrier
being composed only of a single layer of cells
IMPLANTATION that is capable of blocking completely only a
limited number of high molecular weight
- It is the contact between the growing structure substances such as insulin and HCG.
and the uterine endometrium
- It occurs approximately 8-10 days after
fertilization CHRIONIC VILLI
 fetus and the amniotic fluid. It is continuous with
As early as 12 days after fertilization tiny umbilical cord and covers the fetal surface of the
projection around the zygote, called villie can be placenta and is also the outer covering of the
seen. These villi are classified as: umbilical cord. The amniotic membrane contains
1. Chorion frondosum: these are the chorionic cells that produce amniotic fluid.
villi in contact with decidua basalis that
Amniotic Fluid
proliferate rapidly because they receive rich
blood supply from the uterus. They will later - The amniotic fluid is the medium in which the
form the fetal side of the placenta. These villi fetus and the cord float inside the amniotic
are responsible for absorbing nutrients and membrane
oxygen from maternal blood stream and - It is not in static state but it is continuous turn
disposing of fetal waste product including over; 350-500ml of it is produced and replaced
carbon dioxide. each hour. Daily exchange of amniotic fluid at 6
2. Chorion Laeve: these are the chorionic villi months is around 6 gallons.
not involved with the implantation that
gradually degenerates, becoming very thin,
and eventually forming the chorionic Production and removal of amniotic is achieved through
membrane. These villi are also referred to as the following mechanisms:
the bald chorion. The chorion leave is
1. The fetus contributes to the amniotic fluid by:
composed of cytotrophoblasts and fetal
Active secretion from the epithelium of the
mesodermal cells.
amniotic membrane
Transudation from the fetal circulation
Fetal urination. Fetal urine is the primary
Decidua: The Endometrium Of Pregnancy source of amniotic fluid late in pregnancy
Functions:
2. The mother contributes to the amniotic fluid by
- The decidua is the most ideal site for transudation from maternal circulation. Maternal
implantation because of its rich blood supply serum composes most of the fluid early in
that ensures optimum placental growth and pregnancy.
development
- It provides easy access to the birth of the baby 3. Removal or uptake of amniotic fluid is by:
at the end of gestation as it is continuous with Absorption through the amnion to the
the birth canal maternal circulation
- It may prevent infections coming from the By fetal swallowing, this is the chief
vagina and cervix. mechanism which controls the volume of the
- It produces the following hormones: prolactin, fluid.
relaxin, corticotrophin releasing hormone (CRH),
growth hormones, prostaglandin, oxytoxin and
endothelin -1. Volume
- The volume of the amniotic fluid increases from
It is composed of three layers: the first trimester until the 38 th week. Then, It
Decidua Vera: the remaining portion of the uterine diminishes slightly until them.
lining - Normally, amniotic fluid volume ranges from
500-1200ml averaging at 1000ml.
Decidua Basalis: the layer where implantation takes
place, it will later from the maternal side of the placenta. Composition

Decidua Capsularis: The Layer which encloses the - It is composed of 99% water and 1% solid
blastocyst after implantation. particles.
- It contains albumin, urea, uric acid creatinine,
lecithin, sphingomyelin, bilirubin, minerals are
FETAL MEMBRANES suspended materials such as desquamated
epithelial cells and vernix caseosa.
The fetal membranes enclose the fetus and the
amniotic fluid and proect the fetus against ascending Color
bacterial infection as long as it is not ruptured. - It is clear and colorless to straw colored
1. Chronic membrane: this membrane originates
pH:
from the portion of the chronic villi not involve
with implantation, the chorion leave. It is thick, - 7.00 to 7.25 reaction is neutral to alkaline.
opaque and friable. It is in contact with the
deciduas and is attached at the margins of the Specific gravity:
placenta. It functions to provide support to the - 1.005 to 1.025
amniotic membrane.
2. Amniotic: it is smooth, this, tough and
translucent membrane directly enclosing the
FUNCTION OF AMNIOTIC FLUID: the intraabdominal portion of the umbilical
vesicles which extends from the umbilicus to the
1. Protection:
intestines atrophy and disappear. Sometimes it
- Of the fetus from trauma, blows and pressure
remain patent, a condition called Meckel
- Of the fetus from the uterine contractions
Diverticulum.
- Of the fetus from sudden changes in
- Wharton’s Jelly: It is gelatinous substance found
temperature
inside the cord.
- Of the cord from pressure
2. Promotes symmetrical musculoskeletal
development by allowing freedom of movement.
3. Acts as an excretion and secretion system. Placenta
4. Source of oral fluid for the fetus who swallows it Origin: The placenta is formed from the chorionic villi
5. Aids in diagnosis of maternal and fetal and decidua basalis.
complications through amniocentesis.
6. Assist in labor by: Weight: The placenta is discoid organ weighing
- Intact membranes aids in effacement and approximately 500 grams at term with a diameter of 15
dilation of the cervix. to 20 cm and about 3 cm thick.
- Once it ruptures, the fluid washes the birth
- It occupies about ¼ of the uterine cavity.
canal and serves as an antiseptic.
Uteroplacental blood flow at term is 700 to 900
- It acts as lubricant making the birth canal more
ml.
slippery for the passage of the fetus.

Umbilical Cord: Maternal and Fetal sides:

Function: 1. Maternal side: It faces the mother, composed of
- The umbilical cord or funis is the structure that 15 to 20 cotyledons. Each cotyledon is supplied
connects the fetus to the placenta. Its main with one artery and one vein. The lobe is a
function is to carry oxygen and nutrients from collection of many villi rami which terminate in
the placenta to the fetus and return one main stem villi called truncal. The lobes are
unoxygenated blood and fetal waste products to separated by grooves called septa.
the placenta. 2. Fetal side: It faces the fetus. The amnion that
covers it gives shiny appearance.
Blood Vessels:
Placental barrier
Two arteries which carry the most unoxygenated
blood to the placenta and one vein which carries the - Maternal and fetal blood, does not mix although
most oxygenated blood to the fetus. the oxygen and nutrient supply of the fetus
In about 1% of singleton pregnancies, the umbilical comes from the mother. Fetal and maternal
cord contain only two vessels, this condition id often circulation is separated by cytotrophoblast,
associated with renal anomalies. This increases by 6 to syncytium, and walls of fetal blood vessels.
7% in multiple pregnancies. Passage of substances across the placenta: the
Length exchange o substance between the mother and the
fetus is regulated by the following processes.
- It is about 50 to 55cmlong and 2cm in diameter.
Diffusion
It appears dull white, moist and covered by
amnion. Facilitated diffusion
Short cord which may lead to: Active transport
- Intrapartum hemorrhage due to premature Pinocytosis
separation of the placenta
- Delayed descent of the fetus during labor Defects in the placenta
- Inversion of the uterus

Long cord may lead to: FUNCTIONS OF THE PLACENTA

- Cord presentation Two Main Functions
- Coiling of the cord around the neck
- True knots of the cord - It serves as a transfer organ for metabolic
products
- It produces or metabolizes the hormones and
enzymes necessary in the maintenance of
Origin
pregnancy
- The umbilical cord originated from the yolk sac
and umbilical vessels. The nourishment of the placenta comes from
- Early in fetal life the umbilical vesicle and the the maternal blood and it can grow only up to a
intestines are connected to each other. Later, limited time, after which, it begins to degenerate
 with functional capacity and oxygen - Spermatogenesis is the maturation of sperm
consumption diminishing. This happens after cell. It takes about 64 days for sperm cell to
40-42 weeks of gestation. attain maturity.
It has 3 parts:
head – contain the chromatin materials
Other functions: neck – or mid-piece that provides energy for
- Respiratory System – Exchange of gases takes movement
place at the placenta through the process of tail – responsible for its motility
diffusion and not in fetal lungs - Life span: 48-72 hours or 2-3 days after
- Renal system – waste products of the fetus are ejaculation. The sperm must be in the genital
excreted through the placenta and detoxified in tract about 2-6 hours before they can fertilize
the mother’s liver. Waste products of the fetus the ovum to give time for capacitation to occur.
such as urea are passed to maternal blood by
simple diffusion through the placenta.
- Gastrointestinal System – nutrients pass from
the placenta to the fetus via active transport and
diffusion.
- Circulatory system – feto-placenta circulation is
functional 17 days after fertilization
- Production of enzyme – enzymes produced by FETAL DEVELOPMENT
the placenta include oxytocinase, monoamino  Zygote – the cell that results from fertilization
oxidase, insulinase, histamines, and heat stable of the ovum by the sperm cell. This is the
alkaline phosphatase. fertilized ovum from conception to two
- Endocrine system – the placenta produces the: weeks.
HCG, estrogen, progesterone, and HPL,  Blastomere - mitotic division of the zygote
adrenocorticotropic hormone and growth gives rise to daughter cells called
hormone. blastomeres.
 Morula – the solid ball of cells formed by 16
or more blastomeres.
FETAL DEVELOPMENT  Blastocyst – after the morula reaches the
uterus
Three Division of Fetal Development
 Embryo – extends from 7 – 8th day to seven-
 Pre-embryonic (first 2 weeks, beginning with eight week postconception. The zygote is
fertilization) considered embryo after the appearance of
 Embryonic (wee 3 through 8) the villi.
 Fetal (week 8 through birth)  Fetus – from eight week until term
 Conceptus – refer to all products of
TERMS USED TO DENOTE FETAL DEVELOPMENT conception.
1. Ovum: from ovulation to fertilization CARDIOVASCULAR SYSTEM
2. Zygote: from fertilization to implantation
3. Embryo: from implantation to 3 or 5-8 weeks - The first site of hematopoiesis is the yolk sac.
4. Fetus: from 5-8 weeks until term Others: liver, bone marrow, and spleen.
5. Conceptus: developing embryo or fetus and - At midpregnancy, hemoglobin level is 15g/dl. It
placental structure throughout pregnancy rises until term to 18 g/dl. Hct = 53%
- Fibrinogen and clotting factors esp. those
OVUM
dependent to Vit K is decreased at birth.
- The ovum or sex cell is the female sex cell or
Special Structure in Fetal Circulation
gamete
- Oogenesis refers to the development and 1. Foramen Ovale – connects the left and right
maturation of ovum atrium, bypassing the lungs.
- The ovum is regularly released by the ovary Obliterated: fossa ovalis
through the process of ovulation 2. Umbilical vein – brings oxygenated blood
- It has 2 layers of protective covering, the outer coming from the placenta to heart and liver 
layer is corona radiata ( a circle of cells) and the ligamentum teres
inner layer is zona pellucida ( a 3. Umbilical arteries – carry unoxygenated blood
mucopolysaccharide fluid) from the fetus to placenta  umbilical ligaments
- The egg cell has life span of 24 hours, thus it 4. Ductus Venosus – carry oxygenated blood from
can only be fertilized within this period. After this umbilical vein to inferior vena cava, bypassing
time it regresses and non functional. the fetal liver  ligamentum venosum.
5. Ductus arteriosus – carry oxygenated blood
SPERM CELL from pulmonary artery to aorta bypassing fetal
- The sperm cell or spermatozoa is the male cell lungs  ligamentum arteriosum
or gamete.
DIGESTIVE SYSTEM

- Part of the yolk sac develops into the primitive

gut
1. Foregut: pharynx, part of the lower respiratory
tract, esophagus, first half of the duodenum,
liver pancreas and gall bladder.
2. Midgut – distal half of the duodenum, jejunum
and ileum, the cecum and appendix and the
proximal half of the colon.
3. Hindgut: develops into distal of the colon,
rectum, parts of the anal canal, urinary bladder
and urethra

- 12 weeks: the fetus swallows amniotic fluid;

meconium is present – lack or green and sticky
in nature.
- Swallowing and sucking reflex are not mature
until about 32 weeks.
- 26 weeks: fetus begins to store brown fats to be
utilized as a source of heat in the first few hours
after birth.
- 36 weeks: the GI secretes enzyme necessary
for digestion of CHO and CHON.
Fetal Liver

- 9 weeks: begins to store glycogen

- It cannot synthesize coagulation factors
because of lack of vitamin K(sterile)
Pancreas

- Originates from the foregut and is form between

the 5th and 8th weeks
- The islets of Langerhans develop during 12th
week and produces insulin beginning 20th week.
The fetus produces and utilizes its own insulin.
- No maternal insulin enters the fetal circulation.
But excess glucose from a diabetic mother is
transferred to the fetus.
Musculoskeletal System

- 4 weeks: part of the mesoderm gives rise to the

bones and mucles
- 13 weeks the skeleton begins to calcify.

Urinary System

- The primitive urinary system, the pronephrons

and mesonephrons develops before the
metanephrons.
- Developmental failure in the first two nephrons
will result in abnormalities in the urinary system.
- The kidneys are functionally immature
throughout the fetal life. The mature fetus has
limited capacity to concentrate urine resulting in
hypotonic urine with low electrolyte
concentrations.
- 30 weeks urine production is 10ml per hour
- At term it is 27ml/hr or 650 ml per day
- Fetal kidneys are not essential to fetal survival
in utero but they are important in regulating the
amount of amniotic fluid. Oligohydramnios and
hypoplasia of the lungs are often associated
with fetal anuria.