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Integrated Pathophysiology (Nursing 3Pa2) Module 1 - Reproduction

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John Marsh
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McMaster University

Integrated Pathophysiology for Nursing (Nursing 3Pa2)

Module 1 – Reproduction

Pathophysiology Module 1: Alterations in Reproduction
Terminology
 HPO Axis: hypothalamic pituitary ovarian axis, the main hormonal feedback pathway responsible for
the reproductive system.
 Menarche: the first menstrual cycle achieved.
 Os: the opening from the uterus from the cervix into the vagina, can measure the dilatation of the os
to monitor the process of labour.
 Fundus: the top of the uterus, during pregnancy this can be used as a measurement point for
monitoring growth of the fetus (symphysis-fundal height), after delivery the fundus is palpated to
monitor the resolution phase.
 Infertility: failure to achieve pregnancy after one year of unprotected intercourse, noting that if the
female partner is over 35 years then the interval is shortened to 6 months.
 IUI: intra uterine insemination, where a small catheter is passed into the uterus via the vagina and
cervix so that the semen may be instilled directly into the uterus.
 IVF: in vitro fertilization, the process by which the ova and semen are collected from the individuals
and mixed together to permit fertilization to occur and after 3-5 days later 1-2 growing embryos are
returned fertilized ova can be frozen for future attempts.
 Prenatal: the period of time from conception to the birth of the infant, also known more commonly
within the health care community as the antenatal period.
 Postnatal: the period of time from the delivery of the infant until complete resolution of the body to
the pre-pregnant state, usually 6-8 weeks.
 Parity: the number of deliveries that a woman has had over 20 weeks gestation, when this number is
over 5 this is considered to be a state of grand multiparity, or the woman is referred to as a grand
multipara.
 GTPAL: a short hand for describing a woman’s obstetrical history G: gravida, or total number of
pregnancies, including miscarriages, abortions and stillbirths, T: term, the total number of deliveries
over 37 weeks gestational age, P: preterm, the total number of deliveries between 20 and 37 weeks
gestational age, A: abortions, which can be spontaneous (occurring on their own) or therapeutic
(occurring by surgical intervention), L: the number of living children.
 Viability: the point at which should a fetus deliver there is a reasonable expectation of survival,
usually defined as 500 gm or more than 20 weeks gestation. This is a contentious issue and will not
be further discussed.
 Fetal presentations Macrosomia: when the fetal head size has grown larger than can be passed
vaginally. Polyhydramnios: the amount of amniotic fluid is more than 2 standard deviations above
the norm for gestational age.
Normal Female Anatomy
 Remember that the sexual differentiation of an embryo occurs around the 7th week of gestation
and is determined by the sex chromosome. XX for female and XY for male.
 The SRY protein on the male Y chromosome is the testes determining factor. In females, without
exposure to this protein, will develop the vagina, uterus, and fallopian tubes otherwise known as
the Mullerian ducts.
 The ovaries produce the secondary oocytes and hormone such as estrogen, progesterone, inhibin
and relaxin. At birth, the ovaries of the female newborn contain all their primary oocytes and
their secondary oocytes are formed after puberty once a month at ovulation.
 The uterine tubes or fallopian tubes transport the secondary oocyte to the uterus and normally
these tubes are the sties—remember left or right—where fertilization occurs.
 The uterus is the site of implantation for the fertilized ovum. This muscular organ is where the
fetus will develop during pregnancy and will promote the progression of labour. Review the 3
layers: endometrium, myometrium, and perimetrium.
 The vagina is the receptacle for sperm during intercourse and also the passageway for childbirth.
 The position of the uterus in the pelvis is something females are born with and this uterine
position it will remain the same throughout their lifetimes. During a routine pelvic examination, a
clinician can palpate the uterus during a bimanual examination to determine their uterine lie or
position as per the diagram. This does not affect fertility.
Female Hormones (brief overview)
 With the onset of puberty the hypothalamic neurosecretory cells release the gonadotropin releasing
hormone (GnRH which subsequently binds to the anterior pituitary’s cells called the gonadotrops and
stimulates them to increase the secretion of the follicular stimulating hormone (FSH) and luteinizing
hormone (LH). FSH stimulates the growth of follicles of the ovaries to produce estrogen,
progesterone and inhibin. LH is responsible for stimulating the ovulation, remembering the LH surge
and the formation of the corpus luteum.
 Estrogen is responsible for the development and maintenance of the female reproductive structures,
secondary female characteristics such as adipose tissue deposition, voice pitch, broad pelvis and
pattern of hair growth. As estrogen can work synergistically with human growth hormone, it can
increase protein synthesis including bones. Lastly, estrogen lowers blood cholesterol, although the
exact mechanism is unknown.
 Progesterone is secreted mainly by the cells of the corpus luteum in the last two week of the
menstrual cycle. It works with estrogen to prepare and maintain the endometrium and to prepare for
the mammary glands for lactation.
 Relaxin is produced by the corpus luteum and it has a role to play with the relaxation of the uterine
smooth muscle.
 Inhibin is secreted by the granulosa cells of the follicles and together with the levels of estrogen and
progesterone, these hormones provide feedback for the HPO axis, either stimulating or inhibiting
further release of FSH and LH.

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Integrated Pathophysiology (Nursing 3Pa2) Module 1 - Reproduction

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