1- Anatomy of the female reproductive system
external part
clitiros
labia
majora
minora
vaginal opening
internal part
ovaries
uterine tubes
infundibulum
fimbrae
ampulla
isthmus
uterine
uterus
fundus
body
internal OS
cervical canal
external OS
vagina
2 vaginal fornix
posterior to
urethra
blood supply
abdominal aorta
ovarian arteries
ovarian branch
tubal branch
interna illiac
ascending branch of uterian a
blood drainage
pampiniform plexus
uterine venous plexus
R & L ovarian veins
IVC
2- Histology of the female reproductive system
ovaries
encapsulated by the tunica albuginea
covered by the germinal epithelium
simple cuboidal epithelium
PRIMORDIAL FOLLICLES
principle follicles present before birth
consists of
primary oocyte
enveloped by
single layer of flattened follicular cells.
PRIMARY FOLLICLES
zona pellucida
SECONDARY FOLLICLES
enlargement of the zona granulosa
follicular antrum
MATURE (GRAAFIAN) FOLLICLE
corona radiata
uterine tubes
musculomembranous tube
simple columnar epithelial layer
peg cells
ciliated cells
uterus
outer wall of the uterus
perimetrium (Serosa)
middle layer
myometrium
inner most layer
endometrium
vagina
non-keratenized stratified squamous epithelium
3- Physiology of Female Reproductive Tract
Menstrual cycle
Under hormonal control
Pre-ovulatory phase
Characterized with high estrogen levels
Follicular phase in ovaries
Follicle development and release of oocyte
Proliferative phase in uterus
Endometrium thickening
Emergence of spiral arteries
Thin watery cervical mucus
More hospitable for sperms
Ovulation
In day 14 of the cycle
Due to Estorgen induced LH surge
Rupture of graafian follicle
Expulsion of the ovum
Entrance of ovum to fallopian tube
Post-ovulatory phase
Characterized with high progesterone levels
Luteal phase in ovaries
Formation of corpus luteum
Production of progesterone/ estrogen and inhibin
Degenerates to corpus albicans if there was no fertilization
Secretory phase in uterus
Spiral arteries grow longer
Uterine glands secrete more mucus
Thick cervical mucus
Less hospitable for sperms
Functional layer of endometrium sloughs off if there was no fertilization
Menstruation
Fertilization
In ampulla
3 Phases
Penetration of corona radiata
After capacitation of sperms
Penetration of zona pellucida
Acrosome reaction
Fusion of oocyte and sperm cell membrane
Cortical and zona reaction
4- Polycystic ovarian syndrome
PCOS
Caused by elevation of LH
Overstimulate theca cell
Produce androstenedione
Increase LH To FSH ratio
Insulin resistance
Hyperinsulinemia via inc androgenic enzymes and dec in SHBG
Clinical features
Hirsutism
Acne
Male pattern alopecia
Menstrual abnormalities
Weight gain 60%
Acanthus is nigricans
Risk factor
Genetic-Obesity - sedentary lifestyle - intrauterine androgen exposure
Morphology
Both ovaries will be enlarged with multiple subcortical cysts
9 - Population dynamics
crude birth rate
the number of live births per 1,000 population in a given year
general fertility rate
number of live births per 1,000 women ages 15-44 in a given year
age specific fertility rate
Number of births per 1000 women of a specific age (group) in a given year
compare fertility across countries and diffferent age groups
gross reproduction rate
TFR ∗ (Proportion of female births)
net reproduction rate
Takes into account mortality rate compared to GRR
therefore, will always be less than the GRR
8- Correlation and regression model
finding the line that best describes the data plot present
linear regression
outcome is continuous
important to include the dummy variable for the binary explanatory variables
interpretation using Y=mx+b
logistic regression
outcome is binary
the constant is the baseline odds
after getting the odds, they are converted to probability by dividing 1+odds
goodness of link
tests if the data is actually in a straight line or no
goodness of fit
tests if the line is good enough or no
indicates how far or close the points are
7- Prevalence and epidemiology of female infertility
PCOS has a prevalence of 10 percent of women worldwide
prevalence of PCOS is 18.3 percent in Qatar
6- labor
stages
stage 1
latent phase
active phase
transitional phase
stage 2
pushing stage
cardinal movements
engagement
flexion
internal rotation
extension
restitution
expulsion
stage 3
stage 4
starts with onset of true labor till the cervix is 10 cm dilated and 100% effaced
starts when the cervix is 100% effaced and 10cm dilated till the baby is delivered
starts from the expulsion of fetus till the expulsion of the placenta
starts after the placenta is delivered till 1-4 hrs after delivery
complications
postpartum hemorrhage
hematomas
lacerations
DVT
Infections
retained placenta
placenta accreta
hypertension disorders
labor induction
pharmacologically
PDE2 gel
mechanically
trans-cervical catheter
followed by amniotomy to shorten the time from induction to delivery
5- Management of PCOS
Lifestyle modification
Diet and exercise
Oral contraceptives
Managing (hirsutism)
Increased risk of venous thromboembolism (VTE)
if not effective for 6 months
Spironolactone
Finasteride
Induction of ovulation
Clomiphene citrate
Antagonist of Estrogen receptor
side effects
Abnormal vaginal/uterine bleeding
Letrozole
Subtopic 1
inhibitor of aromatase enzyme
side effects
constipation, hot flashes
Gonadotropins
Pulsatile gonadotropin-releasing hormone [GnRH]
Dopamine agonists
Dye test
with
laparoscopic ovarian drilling
Risks:
potential adhesion formation
others
intrauterine insemination
IVF