IV.

Physical Examination
Height and Weight
 Weight: 57.9 kg.
 Height: 5’3 ft.

Vital Signs
 BP: 110/70 mmHg
 T: 36.4°C
 PR: 841 bpm
 RR: 20 bpm
 SpO2: 99%

V. Anatomy and Physiology

Female Reproductive System

The role of the reproductive

system is to produce offspring. The
female ovaries produce eggs, or ova; the
female duct system consists of the uterine
tubes, uterus, and vagina. The uterus
provides the site for the development of
the fetus (immature infant) once
fertilization has occurred. Mammary
glands of female breasts produce milk to
nourish the newborn.

A. FUNCTIONS
The female reproductive system
enables a woman to:
● produce eggs (ova)
● have sexual intercourse
● protect and nourish a fertilized egg until it is fully developed
● give birth

B. PARTS:

EXTERNAL GENITALIA
  Vulva: also called the external genitalia or pudendum.
 Mon pubis: a round, firm pad of adipose tissue covering the symphysis pubis.
 Labia majora and Labia minora: encircle a space termed the vestibule. Within this space the
urethral meatus appears as a dimple 2.5 cm posterior to the clitoris.
 Clitoris: a small, pea-shaped erectile body that is highly sensitive to tactile stimulation.
 Vaginal orifice: posterior to the urethral meatus. It appears either as a thin median slit or a large
opening with irregular edges, depending on the presentation of the membranous hymen.
 Hymen: a thin, circular or crescent-shaped fold that may cover part of the vaginal orifice or may
be absent completely.
 Vestibular (Bartholin) glands: either side and posterior to the vaginal orifice; secrete a clear
lubricating mucus during intercourse.

INTERNAL GENITALIA

 Vagina: a flattened tubular canal extending from the orifice up and backward into the pelvis.
 Cervix: at the end of the canal, it projects into the vagina.
 Uterus: a pear-shaped, thick-walled, muscular organ. It is flattened anteroposteriorly, measuring
5.5 to 8 cm long by 3.5 to 4 cm wide and 2 to 2.5 cm thick, and is movable.
 Fallopian tubes: are two trumpet-shaped, pliable tubes, 10 cm in length, extending from the
uterine fundus laterally to the brim of the pelvis, with their ends near the ovaries.
 Ovary: each ovary is oval, 3 cm long by 2 cm wide by 1 cm thick, and serves to develop ova
(eggs) and the female hormones.

Ovaries

Most females have two

ovaries, one on each side of the
uterus. They are about the shape and
size of an almond and have two key
functions: producing hormones and
releasing eggs. At birth, two ovaries
contain approximately 700,000
oocytes, which are immature eggs.
When a person reaches puberty,
these eggs begin to develop and
mature inside the ovary follicles.
Around once each month, the
ovaries release a mature egg.

Fallopian Tubes

The fallopian tubes are passageways that carry eggs toward the uterus. The walls of each tube
have an external serous layer, a middle muscular layer, and an internal mucous layer that is continuous
with the inner lining of the uterus.
Each uterine tube can be divided into three parts:
 Infundibulum - which are finger-like projections surrounding the opening cilia; responsible for
picking up the egg released by the ovary.
 Isthmus - connects with the uterus.
 A dilated portion, the ampulla, curves over the ovary.
Egg fertilization usually occurs in the ampulla. The eggs then travel through the isthmus into the uterus.

Uterus

It is also known as the womb. It consists of muscular walls and a lining (endometrium) that grows
and diminishes with each menstrual cycle. Also, an organ that receives the fertilized egg and supports its
development during pregnancy.

Cervix

The cervix is a narrow structure at the bottom of the uterus. It has several functions:

 Producing mucus: The cervix produces cervical mucus, which stops sperm from entering the
uterus when a person is not fertile or when they are pregnant.
 Protecting against bacteria: The mucus also stops bacteria from entering the uterus and keeps the
vagina healthy.
 Allowing fluids to drain: At the bottom of the cervix is a small opening that allows fluids, such as
menstrual blood, to pass through.

Vagina: A Tunnel With Three Core Functions

The vagina extends down from the cervix, the lower part of the uterus, to the vestibule, which is
part of the vulva and the external genitalia. It sits behind the bladder and in front of the rectum. An inner
mucous membrane lines the smooth muscle walls of the vagina. This lining, like the inner layer of the
uterine tubes, is continuous with the mucous lining of the uterus.

The vagina has three core functions:

 It carries menstrual flow outside the body.

 It receives the male penis during sexual intercourse.
 It serves as a birth canal during labor.

MULTIPLE PREGNANCY AND FETAL POSITIONS

 The presence of more than one fetus in the uterus is called a multiple pregnancy. Twins occur in
about one in 80 pregnancies, and triplets in about one in 8,000. Both events are becoming more common,
partly due to improved antenatal care and also increasing use of
fertility methods such as IVF (in vitro fertilization). After about
30 weeks, the most common fetal position is head down, facing
the mother’s back, with the neck flexed forward. Such a position
eases passage through the birth canal. However, about 1 in 30
full-term deliveries is breech, in which the baby’s buttocks
emerge before the head.

Monozygotic Twins
A single fertilized egg, or zygote, forms an embryo that
splits into two. Each develops into a fetus. The two have the same genes and sex and share one placenta.
They look alike and are known as “identical” twins.

Dizygotic Twins
Most of the time, a woman releases a single egg during an ovulation cycle. However, in
approximately 1 percent of ovulation cycles, two eggs are released and both are fertilized. Two zygotes
form, implant, and develop, resulting in the birth of dizygotic
(or fraternal) twins. Because dizygotic twins develop from two
eggs fertilized by two sperm, they are no more identical than
siblings born at different times. Two eggs are fertilized and
develop separately, each with its own placenta. They may be
different or the same sex. Also called “fraternal twins”, they
have the same degree of resemblance as any brothers and sisters.

Head down, sideways (vertex-cephalic,

transverse)
 If one twin is lying sideways or diagonally (oblique), there's a chance the baby may shift position
as your labor progresses, or your doctor may try to turn the baby head-down via external cephalic version
or internal podalic version (changing position in the uterus), which means you may be able to deliver both
vaginally.

Changes In The Cervix

The cervix is the firm band of muscle and connective tissue that forms the neck-like structure at
the bottom of the uterus. In late pregnancy, the cervix softens in readiness for childbirth. Sporadic uterine
tightenings, known as Braxton–Hicks contractions, help to
thin the cervix so that it merges with the uterus’s lower
segment. Braxton–Hicks contractions are usually painless,
and occur through much of pregnancy, becoming
noticeable only after mid-term. Cervix softening As labor
nears, the cervix tissues lose their firm consistency. They
become softer and more spongy, affected by natural
substances in the blood called prostaglandins.

Cervix Thinning
The cervix becomes wider and thinner and merges smoothly
into the uterus wall above. The process of softening and
thinning is known as effacement.

Contractions
When pregnancy reaches full term, the uterus is the largest and
strongest muscle in the female body. When its muscle fibers shorten,
with the eventual aim of expelling the fetus, it is known as a uterine
contraction or simply a “contraction”. True contractions, as opposed
to Braxton–Hicks contractions, are regular and become steadily more
frequent, more painful, and long-lasting. The main area of
contraction is in the uterine fundus (upper uterus), which stretches,
causing the lower uterus and cervix to thin. Judging when true labor
has started can be difficult due to “false alarms”.
Birth Of The Baby
Around week 36 (usually), the process
of labor begins. In the first stage, dilation,
hormones stimulate downward contractions
of the uterine walls. The contractions push
the head of the fetus against the cervix at
the lower end of the uterus. The cervix
dilates. In the second stage, expulsion,
powerful contractions push the head and
the rest of the body through the dilated
cervix, and out through the vagina and the vulva. The baby is born. Further contractions expel the
placenta to complete the placental stage.
Homeostatic Relationships between the Reproductive System and Other Body
Endocrine System Gonadal hormones exert feedback effects on hypothalamic-pituitary axis;
placental hormones help to maintain pregnancy.
Lymphatic Developing embryo/fetus escapes immune surveillance (not rejected);
System/Immunity transport sex hormones; immune cells protect reproductive organs from
disease; IgA is present in breast milk.
Digestive System Digestive organs crowded by developing fetus; heartburn, constipation
common during pregnancy. It also provides nutrients needed for health.
Urinary System Compression of bladder during pregnancy leads to urinary frequency and
urgency. Kidneys dispose of nitrogenous wastes and maintain acid-base
balance of blood of mother and fetus.
Muscular System Abdominal muscles are active during childbirth; muscles of the pelvic floor
support reproductive organs and aid erection of clitoris.
Nervous System Sex hormones feminize the brain and influence sex drive. Hypothalamus
regulates timing of puberty; neural reflexes regulate sexual response.
Respiratory System Late stages of pregnancy impair descent of the diaphragm, causing difficult
 breathing. It provides oxygen; disposes of carbon dioxide; vital capacity and
respiratory rate increase during pregnancy.
Cardiovascular System Estrogens lower blood cholesterol levels and promote cardiovascular health
in premenopausal women; pregnancy increases workload of the
cardiovascular system.
Integumentary System Estrogen increases skin hydration; enhances facial skin pigmentation during
pregnancy.
Skeletal System Estrogen feminizes skeleton and maintains bone mass in women. The bony
pelvis encloses some reproductive organs; if narrow, the bony pelvis may
hinder vaginal delivery of an infant.