This part of my slide show is about physiology of female genital tract

1. EMBRYOLOGY & CONGENITAL
MALFORMATION OF FEMALE GENITAL TRACT
Ephrem Yohannes(MSc in Maternity
and Neonatology)
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2. Embryology
• Union of egg & sperm
• Takes place in the fallopian tube
• It must take place within a few hours,
and no more than a day after ovulation.
Fertilization:
• Is a mature ovum after fertilization
• A diploid cell with 46 chromosomes that
then undergoes cleavage into
blastomeres
Zygote:
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3. • Zygote undergoes slow cleavage for 3 days while
still within the fallopian tube.
• Blastomeres continues to divide a solid ball of
cells; the morula is produced.
• Morula:
 Enters the uterine cavity about 3 days after
fertilization.
Accumulation of fluid b/n the cells of the
morula results in the formation of the early
blastocyst.
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5. • Blastocyst:
As early as 4 to 5 days after fertilization, the 58-cell
blastula differentiates into:
 5 embryo-producing cells—the inner cell mass,
and
53 cells destined to form trophoblasts .
Blastocyst is released from the zona pellucida as a result
of secretion of specific proteases from the secretory-
phase endometrial glands.
Release from the zona pellucida allows blastocyst
produced cytokines and hormones to directly
influence endometrial receptivity.
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6. • Blastocyst Implantation:
It takes place 6 or 7 days after fertilization.
• Divided into three phases:
1. Apposition: Initial contact of the blastocyst to the
uterine wall
2. Adhesion: Increased physical contact b/n the
blastocyst & uterine epithelium; &
3. Invasion: penetration & invasion of
syncytiotrophoblast & cytotrophoblast into the:
 Endometrium
 Inner third of the myometrium and
 Uterine vasculature.12/2/2019 6

7. • Successful implantation requires:
Receptive endometrium appropriately primed
with estrogen & progesterone.
Uterine receptivity is limited to 20 to 24 days of
the cycle .
• At the time of its interaction with the
endometrium, the blastocyst is composed of 100
to 250 cells.
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8. Biology of the trophoblast
• Trophoblast differentiation
 By the 8th day post fertilization the trophoblast
differentiated to :
 Outer: Syncytiotrophoblast
 Inner: Cytotrophobasts
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9. Syncytiotrophoblast
• Outer multinucleated Syncytium
• Nuclei are multiple and diverse in size and shape
• The cytoplasm is amorphous, with out cell border
• No individual cells, only a continuous syncytial
lining-facilitate transport across the
syncytiotrophoblast
• Acts as the 1⁰ secretory component with in the
placenta
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10. Cytotrophobasts
• Inner layer, mononuclear
• Has well demarcated cell border, single nucleus
• Ability to undergo DNA synthesis and mitosis
• Are the germinal cells for the syncytium
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Tadesse Gure (MD, Assistant professor of
OBGYN)
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12. Trophoblast further differentiates
1.Villous trophoblast
Gives to chorionic villi of the placenta
Function-transport oxygen and
Nutrients between the fetus and mother
2. Extravillous trophoblast
 Migrates into the decidua & myometrium and also
penetrates maternal vasculature.
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13. Development of Genital Ducts
• Both male and female embryos have two pairs of genital ducts
• The mesonephric ducts (wolffian ducts) play an important role
in the development of the male reproductive system
• The paramesonephric ducts (mullerian ducts) have a leading
role in the development of the female reproductive system
• Till the end of sixth week, the genital system is in an
indifferent state, when both pairs of genital ducts are present
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14.  The mesonephric ducts, which drained urine
from the mesonephric kidneys play a major role
in the development of male reproductive system
The paramesonephric ducts play an essential role in
the development of the female reproductive system
The funnel shaped cranial ends of these ducts open
into the peritoneal cavity
The paramesonephric ducts
pass caudally, parallel to the
mesonephric ducts
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15. • Both the
paramesonephric
ducts pass caudally
and reach the future
pelvic region
• Cross ventral to the
mesonephric ducts
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16. Fuse to form a Y-shaped
uterovaginal primordium in
the midline
This tubular structure projects into
the dorsal wall of the urogenital
sinus and produces an elevation
called sinus (muller) tubercle
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17. Development of Female Genital Ducts &
Glands
• In female embryos, the mesonephric ducts regress
because of the absence of testosterone
• Paramesonephric ducts develop because of the
absence of mullerian inhibiting substance (MIS)
• Female sexual development does not depend on the
presence of ovaries or hormones
• The paramesonephric ducts form most of the female
genital tract
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21.  The caudal fused
portions of these ducts
form the uterovaginal
primordium
 It gives rise to uterus and
superior part of vagina
The uterine tubes develop from the
unfused cranial part of the
paramesonephric ducts
 The endometrial stroma and myometrium are
derived from splanchnic mesenchyme
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22. Development of Female Genital Ducts &
Glands
• Fusion of the paramesonephric ducts also
brings together a peritoneal fold that forms
the broad ligament
• Also forms two peritoneal compartments, the
rectouterine pouch and the vesicouterine
pouch(fig)
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23. • Development of the Uterus and Vagina
• The fibromuscular wall of the vagina develops from
the surrounding mesenchyme.
• Contact of the uterovaginal primordium with the
urogenital sinus, forming the sinus tubercle, induces
the formation of paired endodermal outgrowths,
the sinovaginal bulbs.(fig)
• They extend from the urogenital sinus to the caudal
end of the uterovaginal primordium. The sinovaginal
bulbs fuse to form a vaginal plate.
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24. • Later the central cells of this plate break down,
forming the lumen of the vagina.
• Until late fetal life, the lumen of the vagina is
separated from the cavity of the urogenital
sinus by a membrane, the hymen.
• The membrane is formed by invagination of
the posterior wall of the urogenital sinus,
resulting from expansion of the caudal end of
the vagina.
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25. • The hymen usually ruptures during the
prenatal period and remains as a thin fold of
mucous membrane just within the vaginal
orifice.
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26. Congenital malformation of female
genital tract
• Uterine anomalies occur in 2-4% of fertile
women with normal reproductive outcomes.
• DEVELOPMENTAL DEFECTS:
• There are three common developmental
defects of the müllerian system to consider:
Agenesis
Lateral fusion defects
Vertical fusion defects
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27. • The Mayer-Rokitansky-Küster-Hauser (MRKH)
syndrome refers to congenital absence of the
vagina with variable uterine development; it is
the result of müllerian agenesis.
Agenesis :
• Derived from incomplete degeneration of the
central portion of the hymen
• Include imperforate, microperforate, septate,
and cribriform hymen
ANOMALIES
OF THE
HYMEN :
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29. Imperforate hymen
Definition:
• One of the most common obstructive lesions of the female genital tract.
Clinical features:
• Periodic lower abdominal pain,
• Primary amenorrhea,
• Urinary symptoms,
• Abdominal swelling,
• Ultrasound findings
Treatment:
• Cruciate incision, use of antibiotics
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30. Incomplete Hymenal fenestration:
Definition:
• Incomplete fenestration of the hymenal opening [microperforate, septate, or
cribiform ) is often asymptomatic.
Clinical feature: inability to
• Insert tampons,
• Douches, or
• Vaginal creams, or
• Difficulty with coitus.
• Retained blood may become infected & lead to bilateral tuboovarian abscesses.
Treatment:
• Resection of the excess hymenal tissue to create a functional hymenal ring.
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32. ANOMALIES OF THE VAGINA
1. Transverse vaginal septum
2. Longitudinal vaginal septum
3. Obstructed hemi-vagina
4. Agenesis of vagina
5. Agenesis of lower vagina
6. Vaginal cyst
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33. Transverse vaginal septum:
Definition:
• Failure of fusion and/or canalization of the
urogenital sinus and müllerian ducts.
Depending on the site:
• Upper vagina(46%)
• Middle portion(35-40%)
• Lower vagina(15-20%)
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37. Uterus
• The uterus is a muscular organ that receives
the fertilized oocyte and provides an
appropriate environment for the developing
fetus.
• Before the first pregnancy, the uterus is about
the size and shape of a pear, with the narrow
portion directed inferiorly.
• After childbirth, the uterus is usually larger,
then regresses after menopause

38. Ovaries
• Female sex cells, or gametes, develop in the ovaries
by a form of meiosis called oogenesis.
• The sequence of events in oogenesis is similar to the
sequence in spermatogenesis, but the timing and
final result are different.
• Early in fetal development, primitive germ cells in the
ovaries differentiate into oogonia.

39. Ovaries
• Female sex cells, or gametes, develop in the ovaries by a form
of meiosis These divide rapidly to form thousands of cells, still
called oogonia, which have a full complement of 46 (23 pairs)
chromosomes.
• Oogonia then enter a growth phase, enlarge, and become
primary oocytes.
• Many of the primary oocytes degenerate before birth, but
even with this decline, the two ovaries together contain
approximately 700,000 oocytes at birth. This is the lifetime
supply, and no more will develop

40. Uterine anomalies
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41. • Septate/Arcuate uterus
• Unicoruate uterus
• Bicornuate uterus
• Uterine didelphys
Vertical fusion defect
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Tadesse Gure (MD, Assistant professor of
OBGYN)

44. Septate uterus
A septate uterus:
• Has a normal external surface but two endometrial
cavities.
• Develops from a defect in canalization or resorption
of the midline septum b/n the two müllerian ducts.
It can be:
• Partial
• complete
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46. Unicornuate uterus
• Is an example of an asymmetric lateral fusion
defect.
• One cavity is usually normal, with a fallopian
tube and cervix, while the failed müllerian
duct has various configurations
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49. Bicornuate uterus
• A uterus in which the fundus is indented
(arbitrarily ≥ 1 cm) & vagina is generally normal .
• Results from only partial fusion of the
müllerian ducts.
• It can be:
Partial
complete
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51. Uterine didelphys
Uterine didelphys:
• Occurs when the two müllerian ducts fail to fuse
• Duplication of the reproductive structures
Duplication is limited to the uterus & cervix although
duplication of the:
• Vulva
• Bladder
• Urethra
• Vagina and
• Anus may also occur.
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53. Obstetric complications
• risks of miscarriage,
• Prematurity,
• IUGR
• APH &PPH
• Cervical incompetence
• Malpresentation
• HDP
• Cesarean delivery
• Preterm delivery
• Uterine rupture
• obstetric complications
are most common in
women with a uterine
septum and least
common in those with
an arcuate uterus
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54. Diagnosis
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55. Physiology of Female Reproductive organ
• Egg cells or ova transported to a site where
they may be fertilized by sperm
• Implantation
• Gave birth and then produce the female sex
hormones.
• The female reproductive system includes the
ovaries, Fallopian tubes, uterus, vagina,
accessory glands, and external genital organs.

56. Physiology
• The female sexual response includes arousal and
orgasm, but there is no ejaculation.
• A woman may pregnant without having an
orgasm.
• FSH, LH, estrogen, and progesterone have major
role
• At puberty, the ovaries and uterus are mature
enough
• Then respond to hormonal stimulation, certain
stimuli cause the hypothalamus to start secreting
gonadotropin-releasing hormone.

57. Physiology
• Hormone blood AP FSH and
LH ovaries and uterus and the
monthly cycles begin.
• A woman's reproductive cycles starts
from menarche and ends at menopause.

58. Physiology
• Menopause occurs when a woman's
reproductive cycles stop.
• Decreased levels of ovarian hormones and
increased levels of pituitary FSH, LH
• The changing hormone levels are responsible
for the symptoms associated with menopause

59. Physiological Stages
• Neonatal period: birth---4 weeks
• Childhood: 4 weeks----12 years
• Puberty: 12 years---18 years
• Sexual maturation: 18 year---50 year
• Perimenopause: (40 years)----1 year post
menopause
• Postmenopause

60. Menstruation
Cyclic endometrium sheds and bleeds due to cyclic
ovulation
1. Endometrium is sloughed (progesterone withdrawal)
2. Nonclotting menstrual blood mainly comes from
artery (75%)
3. Interval: 24-35 days (28 days). duration: 2-6 days.
4. the first day of menstrual bleeding is consideredy by
day 1
5. Shedding: 30-50 ml

61. Central reproductive hormones
Neuroendocrine regulation
1.Gonadotropin-releasing hormone, GnRH
2. Chemical structure
(pro)Glu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-
NH2
2)Synthesize and transport

62. Central reproductive hormones
3)Regulation of GnRH
Hypothalamus-----Gonadotrophin hormone----
Pituitary (FSH, LH)------Ovary (Estrogen and
progesterone)

63. Central reproductive hormones
2. Gonadotropins
1) Composition (glycoprotein): FSH, LH
2) Synthesize and transport
Gonadotrophin----Blood circulation----Ovary

64. The Ovarian cycle
Function of ovary
1.Reproduction
 Development and maturation of follicle;
ovulation
2.Endocrine
 Estrogens, progesterone, testosterone

65. The Ovarian cycle
1. The development and maturation of follicle
1)Primordial follicle: before meiosis
2)Preantral follicle: zona pellucida, granulosa cells
(FSH receptor)
3)Antral follicle: granulosa cells (LH receptor), E↑
4)Mature follicle: E↑,P↑
Theca externa, theca interna, granulosa, follicular
antrum, mound, radiate coronal
5)Follicular phase: day 1 to follicle mature (14 days)

66. The Ovarian cycle
2. Ovulation
1) First meiosis completed → collagen decomposed →
oocyte ovulated
1) Regulation
a) LH/FSH peak
E2↑(mature follicle) → GnRH ↑ (hypothalamus) →
LH/FSH peak (positive feedback)
b) P cooperation
LH ↑ → P ↑(follicle luteinized before ovulation)
→positive feedback

67. The Ovarian cycle
3. Corpus luteum
1) follicle luteinized after ovulation: luteal cells
2) LH → VEGF → corpus hemorrhagicum
3) Regression
non fertilized → corpus albicans
4) Luteal phase
Ovulation to day 1

68. The Ovarian cycle
Sex hormones secreted by ovary
1. Composition
Estrogen, progesterone, testosterone
2. Chemical structure
Steroid hormone
3. Synthesis
Cholesterol→pregnenolone→androstenedione→
testosterone→estradiol

69. The Ovarian cycle
4. Metabolism: liver
5. Cyclic change of E and P in ovary
1) Estrogen
a) E↑(day 7) → E peak (pre-ovulate) → E↓ →
E↑ (1 day after ovulate) →E peak (day 7-8)
→ E↓
b) theca interna cells (LH receptor) →
testosterone
c) Granulosa (FSH receptor) → estrogen

70. The Ovarian cycle
2) Progesterone
P↑ (after ovulation) → P peak (day 7-8) → P↓

71. The endometral cycle
Proliferative phase
1.E↑(mitogen)→ stroma thickens and glands
become elongated → proliferative
endometrium
2.Duration: 2 weeks
3.Thickness: 0.5mm → 5mm

72. The endometrial cycle
Secretory phase
1. P↑(differentiation) → secretory endometrium
2. Features
stroma becomes loose and edematous
 Blood vessels entering the endometrium become
thickened and twisted
 Glands become tortuous and contain secretory
material within the lumina
3. Duration: 2 weeks
4. Thickness: 5-6mm

73. Change of Other genital organs
Cervix
 Endocervical glands (E↑)→ mucus(thin,clear, watery)
→ maximal (ovulation)
 Endocervical glands (P↑)→ mucus(thick, opaque,
tenacious)
Vagina
 Vaginal mucosa (E↑)→ thickening and secretory
changes
 Vaginal mucosa (P↑) → secrete↓

74. The menstrual cycle
phase
Name of phase Days
1. Menstrual -low level of EP 1-4
2. Follicular phase (also known as proliferative
phase)- High level of FSH, E
5-13
Ovulation (not a phase, but an event dividing
phases)- high level FSH, E,LH
14
3. Luteal phase (also known as secretory phase)-
high level of P , mild level E
15-26
4. Ischemic phase (some sources group this with
secretory phase)
27-28

76. Summary
• The monthly ovarian cycle begins with the follicle
development during the follicular phase,
• Continues with ovulation during the ovulatory phase,
and conclude with the development and regression of
the corpus luteum during the luteal phase.
• The uterine cycle takes place simultaneously with the
ovarian cycle.
• The uterine cycle begins with menstruation during the
menstrual phase,
• Continues with repair of the endometrium during the
proliferative phase, and
• Ends with the growth of glands and blood vessels
during the secretory phase.