The lesson started, with a gentle reminder of the sensitive topic that we are to be kind to our colleagues, to express our views calmly, we are all individuals and must respect one another.

If affected by any of the topics covered (pregnancy, fatal development, fertility, FGM and sex) please feel free to take a small break and re-join us when you are able to.

The lesson continued with the reproductive anatomy of both male and female.

The female Reproductive Anatomy:

• External Genitalia
• Internal Genitalia
• Reproductive Cycle
• Breasts

The male Reproductive Anatomy:

• Scrotum, Testes, Seminal Vesicles, Ejaculatory ducts, Prostate gland, Urethra
• Penis – Erection & Ejaculation.

 

We looked at sex and gender. According to Boore et al 2021, they stated that “Sex refers to the biological composition of male and female, in the historically accepted sense. Gender is the social expression of the sense of being female, for example and is largely socially, culturally, and psychologically determined.”

 

The functions of the female reproductive system include:

• Formation of Ova
• Reception of Spermatozoa
• Provision of suitable environments for fertilisation and foetal development
• Parturition (childbirth)
• Lactation (Production of breastmilk)

The structure and function in closer details:

The Vagina:

• Fibromuscular tube
• Opens into the vestibule at its distal end and the uterine cervix at its proximal end.
• It runs upwards and backwards at approximately a 45-degree angle.

 

Functions:

• Acts as the receptacle for the penis during sexual intercourse
• Provide an elastic passageway for the baby during childbirth.

 

 

The uterus:

• Hollow, muscular pear shaped organ
• Lies in pelvic cavity between the urinary bladder and the rectum
• Sits almost at right angles to vagina
• Anterior wall rests partly on bladder below
• 5 cm long; 5cm wide
• Weighs between 30-40g

Fundus:

• Dome shaped part above the openings of the uterine tubes

 

Body:

• Upper 2/3rds of the uterus
• Pear-shaped.

 

Cervix:

• Narrow neck of the uterus
• Usually around 2.5cm long.

 

A series of ligaments keep the uterus in place.

The perimetrium is the layer of peritoneum that covers the uterus, uterine tubes and ovaries like a blanket.

The myometrium is the thickest layer in the uterine wall.

Mass of smooth muscles interlaced with blood vessels and nerves.

 

The endometrium is the functional layer that:

• Thickens and becomes rich in blood vessels in the first half of the menstrual cycle.
• If the ovum is not fertilised this layer is shed during menstruation.

 

 

 

 

 

The basal layer is the Sits next to the myometrium and is not lost during menstruation.

The fallopian Tubes –

The Structure:

• 10cm long
• Each tube has finger like projections (Fimbriae)
• Covered with peritoneum
• Lined with ciliated epithelium.

 

The Function:

• Propel ovum from the ovary using peristalsis and ciliary movement
• Fertilisation occurs, zygote propelled to uterus for implantation.

 

The function of the ovary:

• To produce ova
• To produce the female steroid hormones oestrogen and progesterone.

 

The two ovaries:

• Develop from embryonic gonadal ridges at 6 weeks of embryological development.
• Recognisable >10 weeks
• Composed of interstitial tissue and follicles
• Measure 3cm x 2cm x 1cm
• Weigh 6 grams.

 

The female reproductive cycle:

• It occurs every 26-30 days from puberty – menopause
• Consists of changes taking place concurrently in both ovaries  + uterine lining
• Stimulated by changes to blood hormone levels
• Hormones are regulated by negative feedback mechanisms.

 

The menstrual phase of the reproductive cycle:

• The functional layer of endothelium is shed
• Mostly lasts from 4-7 days (depending on length of cycle)
• Progesterone and oestrogen levels fall
• If the ovum is not fertilised = corpus luteum degenerates
• Painful cramping of the uterus
• Excessive pain = dysmenorrhea
• Can be a sign of endometriosis.

 

 

The Proliferative Phase of the reproductive cycle: Usually lasts 10 days

• One or more ovarian follicles are stimulated by FSH and grow towards maturity.
• They are producing oestrogen which stimulates the proliferation of a functional layer in the endometrium in preparation to receive a fertilised ovum.
• Rising levels of oestrogen stimulate a surge in LH which triggers ovulation
• One follicle will rupture releasing an ovum which is now called an oocyte.

 

The secretory phase of the reproductive cycle. Usually lasting 14 days.

• After ovulation LH from the anterior pituitary gland stimulates development of the corpus luteum from the ruptured follicle.
• The corpus luteum produces progesterone, oestrogen and inhibin.
• Progesterone increases production by secretory glands of watery mucous to assist the spermatozoa through the uterus to uterine tubes where the ovum is usually fertilised.
• After ovulation the combination of oestrogen and progesterone supress the hypothalamus and the anterior pituitary gland, and therefore FSH and LH levels fall.

 

Ovum Fertilised:

• No menstruation
• The fertilised ovum (zygote) travels down the uterine tube and embeds into the uterine lining, where it produces hCG
• hCG keeps the corpus luteum intact enabling the continued secretion of progesterone and oestrogen for the first 3-4 months of pregnancy. This ensures no further ovum are release
• When developed the placenta continues to produce oestrogen, progesterone, and gonadotrophins.

 

Anatomy of the female breast:

Growth initiated in puberty by an increase in hormones. The hormones are as follows:

• Oestrogen

Where are these hormone made? In the

• Ovaries
• Small amount in the adrenal glands.

 

What do they do specifically?

• The Oestrogen encourages growth of the milk ducts
• The Progesterone stimulates the lobules to prepare for lactation.

The following are the abnormalities:

• If a woman notices any changes out of the ordinary to her breasts or external genitalia = refer to the GP and practice nurse.
• Document findings clearly, draw a diagram if possible (only if observed).
• Refer to a sexual health clinic if lesions/discharge/growths detected in external genitalia.

 

We also looked at Female Genital Mutilation (FGM), that the:

• Female Genital Mutilation is illegal in the UK.
• There are different types of mutilation (Type I,II,III0
• The practice causes serious harm to female genitalia leading to a host of health problems.
• As a nurse you must document the occurrence refer onwards to the GP and an FGM clinic (especially if the woman is of childbearing age).

 

The male reproductive system and its functions. The function of this system are:

• Production, maturation and storage of spermatozoa
• Delivery of spermatozoa into the female reproductive tract
• Urethra is the passageway for urine excretion.

 

The sperm.

The head of the sperm:

• Almost completely filled with the nucleus which contains the DNA.
• Also contains enzymes which are needed to penetrate the outer layers of the ovum.

 

The body of the sperm:

– Filled with mitochondria to provide energy to fuel propulsion

The tail of the sperm:

• Whip Like – used for mobility to propel along female reproductive tract.

 

The lesson continued with pregnancy, we looked at ovulation to conception and fertilization of the ovum.

• Normally 6-7 days after fertilisation, the blastocyst begins to embed in the uterus and is completely buried by the 11^th
• The first stage of foetal development is the formation of two enclosed cavities which lie adjacent to each other, the amniotic sac, and the yolk sac.

 

 

The first 14 days:

• The blastocyst is nourished by its own cytoplasm. Primitive blood vessels for the embryo begin to develop in the mesoderm.

 

The next 14 – 28 days:

• Embryonic bloods vessels connect up with blood vessels in the chorionic villi of the primitive placenta. Embryo/maternal circulation is thus established and blood is circulating.
• Head of embryo can be distinguished from the body
• Leg buds and then arm buds appear
• Major body systems are present in rudimentary form.

 

• – 42days:

 

• Length Is approximately 12mm by the end of the 6^th
• Arms begin to elongate and hands take shape
• Rudimentary eyes and ears appear
• Ears are apparent but low set
• First movements can be detected on ultrasound from 6 weeks.

 

The development of the foetus. At 8-10/40:

• Head approximately the same size as the body.
• Fingers and toes can be defined
• Eyelids are formed but closed until 25^th week
• Intestines herniate into the umbilical cord because there is no room in the abdomen
• Cord insertion is very low in the abdomen
• If the mother’s abdomen is palpated too forcefully, the foetus will move away (observed on scan).

 

The screening for inherited condition:

• Antenatal screening tests include screening for sickle cell disease and thalassaemia, infectious diseases, the 20-week anomaly scan and screening for Down’s syndrome.
• Women should be told about the risks, benefits and limits of these tests.
• Screening for sickle cell disease and thalassaemia should be offered before 10 weeks.
• This is so women and their partner can find out about all their options and make an informed decision if their baby has a chance of inheriting these conditions.

 

 

 

 

At 12 -40:

• Body length is approximately 9 cm
• Weight 14g
• Foetal circulation is functional
• Renal tract begins to function
• Sucking and swallowing reflexes are present
• External genitalia are apparent and sex can be determined.
• Women can miscarry at early gestations due to a variety of reasons.
• Some spontaneous miscarriages occur early due to abnormalities in cell division.
• Women are offered early screening to detect some abnormalities early do they can make an informed choice on whether to continue the pregnancy. Especially prudent if the pregnancy is not compatible with life
• Around 1 in 4 pregnancies end in miscarriage (spontaneous and planned).

 

At 16 – 20/40:

• The rate of growth begins to slow down.
• The head is now erect and half the length of trunk.
• Facial features are distinctive with ears sited in normal position
• Eyelids, eyebrows and finger nails are all well developed
• Legs are in proportion with the body
• Skeleton is visible on x-ray examination
• Fetal movements can be felt by the mother from 18/40
• Fetal heart can be heard with a hand held Doppler from around 16/40
• Renal tract is functioning, 7-17mls urine being passed in 24 hours.

 

At 28 – 32/40:

• Lanugo begins to diminish
• Body beginning to become more rounded as fat is laid down.

 

At 32 – 36/40:

• Lanugo mostly shed, skin still covered in vernix
• Finger and toe nails reach the top of the digits
• Umbilicus now lies more centrally in the abdomen.

 

At 36 – 40/40:

• Ossification of skull bones is still not complete, but this is an advantage and facilitates the passage of the foetus through the birth canal.

 

 

Once the baby is born:

• Birth top-to-toe check – weight, head circle, Vitamin K, X2 baby labels
• Referrals made (not always addressed immediately with the mother unless asked a specific question)
• NIPE exam (within 72 hours) – time for further discussion
• Hearing screen (birth to 72 hours)
• Day 5 New born blood spot screening for inherited diseases:

MCADD, PKU, Cystic fibrosis, Sickle cell, Congenital Hypothyroidism

• 8 week check – GP

(Referrals for abnormalities must have been actioned.

 

 

KSB ADDRESSED.

 

KNOWLEDGE.

 

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11: Understand the factors that may lead to inequalities in health outcomes.

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

K17: Understand commonly encountered mental, physical, behavioural, and cognitive health conditions as applied to delivery of care.

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, and pain.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.

 

 

 

 

 

SKILLS

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements.

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance.

 

 

 

 

 

BEHAVIOUR

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy, and preferences.

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.

B3: Be adaptable, reliable, and consistent, show discretion, resilience, and self-awareness.