Вы находитесь на странице: 1из 434

Unit 3 Table of Contents MATERNAL & CHILD NURSING Outlin

Section I. Anatomy & Physiology

  • 1. Reproductive System

 

a.

Female Reproductive System

 

1)

External Genitalia

2)

Internal Genitalia

3)

Types of Pelvic Ligaments

 

b.

Male Reproductive System

 

1)

External & Internal Features

  • 2. Mammary Glands

  • 3. Reproductive Hormones

 

a.

Female Reproductive Hormones

b.

Other Reproductive Hormones

  • 4. Menstruation

 
 

a.

Menstrual Changes

b.

Menstrual Cycle

c.

Ovarian Cycle

d.

Endometrial / Uterine Cycle

e.

Menstrual Disorders

  • 5. Family Planning

 
 

a.

Natural Conception

b.

Barrier Methods

c.

Pharmacological Methods

d.

Birth Control Summary

Section II. Antepartal Period

  • 1. Assessment of Prenatal Risk Factors

  • 2. Physiological Changes in Pregnancy

 

a.

Physiological Changes

b.

Antepartum Health Promotion

  • 3. Fertilization to Conception

 
 

a.

Fertilization

1

  • b. Origin of Body Tissues

  • 4. Fetal Development

    • a. Measuring Age of Gestation

    • 5. Maternal & Fetal Diagnostic Tests

    • 6. Electronic Fetal Monitoring

  • 7. Laboratory Studies

    • 8. Other Gynecological Procedures

  • 9. Three Common Pregnancy Signs

    • 10. Discomfort Signs of Pregnancy

    • 11. Psychological Changes in Pregnancy

      • a. Maternal Changes in Pregnancy

      • b. Paternal Adaptations in Pregnancy

  • Section III. Antepartal Complications

    • 1. Abortion

    • 2. Ectopic Pregnancy

    • 3. H-mole

    • 4. Incompetent Cervix

    • 5. Diabetes Mellitus of Pregnancy

    • 6. PIH (Pregnancy Induced Hypertension)

    • 7. Bleeding Disorders in Pregnancy ( Table of Comparison)

      • a. Placenta Previa

    b. Abruptio Placenta

    • 8. Vena Cava Syndrome

    • 9. Diseminated Intravascular Coagulation

      • 10. Hyperemesis Gravidarum

    Section IV. Intrapartum Care

    • 1. Five Factors Affecting Labor (Table of Mechanics of Labor)

    2

     

    a.

    Passageway

     

    1.

    Types of Pelvis

    2.

    Pelvic Measurements

     

    b.

    Passenger

     

    1.

    Fetal Attitude

    2.

    Fetal Lie

    3.

    Fetal presentation

    4.

    Fetal Position

     

    c.

    Power

     

    1.

    Three Phases of Contraction

    2.

    Characteristics of Contractions

     

    d.

    Placental Factors

    e.

    Psyche

    • 2. Labor

     

    a.

    Signs of Impending Labor

    b.

    Comparison of True & False Labor

    c.

    Stages of Labor

     

    1.

    Stations of Presenting Part

     

    d.

    Nursing Considerations during Labor & Delivery

    e.

    Nursing Care during labor

    f.

    Assessing Fetal Heart Rate

    g.

    Cardinal Mechanisms / Movements of Labor

    • 4. Anesthezia

    • 5. Obstetrical Procedures

     
     

    a.

    Preterm Labor

    b.

    PROM (Premature Rupture of the Membranes)

    c.

    Prolapse Cord

    d.

    Dystocia

    e.

    Infection

    3

    • f. Precipitate Delivery

    • g. Uterine Rupture

    • h. Amniotic Fluid Embolism

    Section V.

    Complications of Labor & Delivery

    • a. Preterm Labor

    • b. PROM ( Premature Rupture of the Membranes)

    • c. Prolapsed Umbilical Cord

    • d. Dystocia

    • e. Infection

    • f. Precipitate Delivery

    • g. Uterine rupture

    • h. Amniotic Fluid embolism

    Section VI. Postpartum

    • 1. Postpartum Biophysical changes

      • a. Lochia

      • b. Uterus

      • c. Uterine Involution

      • d. Breast

      • e. GI Tract

  • 2. Post Partum Discomforts

    • a. Perineal discomforts

    • b. Episiotomy

    • c. Breast Discomforts

  • 4

    3.

    Post partum Discharge Teachings

    • a. Breast feedings

    b.Burping & Feeding

    • c. Psychological Adaptations

    SECTION VII. Neonatal Care

    • 1. Initial Physical Examination & Care of the Newborn

      • a. Assessment

      • b. Implementation

      • c. Vital Signs

      • d. Body Measurement

  • 2. Head to Toe Newborn Assessment

  • 3. Gestational Assessment

  • 4. Newborn Reflexes

  • 5. Basic Teaching Needs of New Parents

  • 6. Preterm Neonates

  • 7. Post term Neonates

  • 8. Other Newborn Abnormalities

    • a. RDS (Respiratory Distress Syndrome)

    • b. Hemolytic Disease

    • c. Hyperbilirubinemia

    • d. Erythroblastosis Fetalis

    • e. The Newborn of Addicted Mothers

    • f. SGA (Small Gestational Age)

    • g. Nervous System Anomalies

      • 1. Spina Bifida

      • 2. Meningocele

      • 3. Myelomeningocele

  • 5

    Unit 3 MATERNAL AND CHILD HEALTH NURSING

    Section I

    ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM

    Unit 3 MATERNAL AND CHILD HEALTH NURSING Section I ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE

    6

    I.a External Genitalia (Vulva/Pudendum)

    MONS PUBIS -Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair just
    MONS PUBIS
    -Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair just before puberty
    It is where the pubic hair grows.
    I.a External Genitalia (Vulva/Pudendum) MONS PUBIS -Soft fatty tissue, lies directly over symphysis pubis & becomes

    LABIA MAJORA

    -W/ hair outside but smooth inside fatty skin folds from MONS PUBIS to PERINEUM and protects the labia minora , urinary meatus & vagina

    I.a External Genitalia (Vulva/Pudendum) MONS PUBIS -Soft fatty tissue, lies directly over symphysis pubis & becomes
    I.a External Genitalia (Vulva/Pudendum) MONS PUBIS -Soft fatty tissue, lies directly over symphysis pubis & becomes

    LABIA MINORA

    -Thin, pink, smooth, hairless, extremely sensitive to pressure, touch and

    temperature. The glands of labia minora lubricate the vulva. It is formed by the

    frenulum and the prepuce of the clitoris

    which is also very sensitive because it has rich nerve supply.

    I.a External Genitalia (Vulva/Pudendum) MONS PUBIS -Soft fatty tissue, lies directly over symphysis pubis & becomes

    Covers and protects VESTIBULE

    VAGINAL INTROITUS CLITORIS URETHRAL MEATUS TWO GLANDS THAT LUBRICATE DURING SEX -Entrance of urethra, opens approximately
    VAGINAL INTROITUS
    CLITORIS
    URETHRAL MEATUS
    TWO GLANDS THAT LUBRICATE DURING SEX
    -Entrance of urethra,
    opens approximately
    1cm below clitoris
     1. SKENES GLANDS (Paraurethral Glands): lubricates the
    external genitalia
     2. Bartholins Gland (Vulvovaginal Glands): alkaline in ph,
    helps improve sperm survival
     Doderleins Bacillus: causes the vaginal ph to be acidic, which
    forms lactic acid
    Hymen: the elastic tissue, symbolizes virginity. Thorn &
    bloody during forced sexual act
     RUGAE: thick folds of membranous stratified epitheliums on
    the internal wall of the vagina, capable of stretching during the
    birth process, to accommodate the delivery of the fetus.
    -Composed of glans &
    shaft that is partially
    covered by prepuce
    -GLANS is small and
    round and is filled w/
    many nerve endings and
    rich blood supply
    -SHAFT is a cord
    connecting the glans to
    the pubic bone; w/in it is
    the major blood supply
    of clitoris

    7

    Figure 1-a Internal Structure

    Ib. Internal Genitalia

    Figure 1-a Internal Structure Ib. Internal Genitalia (Figure 1-a) ORGAN FUNCTIONS STRUCTURE NOTES Uterus Divisions of

    (Figure 1-a)

     
     

    ORGAN

    FUNCTIONS

     

    STRUCTURE

    NOTES

    Uterus

     

    Divisions of the uterus

     

    Layers of the Uterus:

    Pear

    shape

    muscular

    I. Cervix : lowest portion , 1/3 of the

    1.

    Endometrium:

    organ

    which

    has

    total uterus

    inner layer, most

    three(3)

     

    main

    External Os: where the nurse obtain

    vascular, SHED

    functions

     

    the Pap Smear

    to

    the

    DURING

    1.

    receive

    the

    ova

    SQUAMOCOLUMNAR JUNCTION

    MENSTRUATION.TH

    from

    the

    fallopian

    cells. This is where the cerclage is

    E NON-PREGNANT

    tube

    done for incompetent cervix. Namely:

    UTERUS

    2.

    provide a place for

    A. Shirodkar Barter Suture- permanent

    2.

    Myometrium:

    implantation

    of

    the

    closure of the internal cervical os,

    LARGEST PORTION

     

    ova

    until the 38 th week after which is

    EXPELS THE FETUS

    3.

    Nourishment

    for

    separated – TREATMENT FOR

    uterus, the portion that is cut when the

    DURING THE BIRTH

    fetal growth.

     

    INCOMPETENT CERVIX and

    PROCESS. The part

     

    PREVIOUS ABORTION. B. Mc Donalds or Purse String Cerclage of the external os: usually

    that contracts during hemorrhage. Prevents hemorrhage.

    Normal spontaneous delivery will be

    1.

    Perimetrium:

    done for the patient. II. Isthmus: shortest portion of the

    Outer most layer. Aids for support & added strength.

    fetus

    is

    delivered

    during cesarean

     

    birth. III. Fundus: Upper segment, this is the most vascular, the portion also where palpation is done. Also touching it by the tip of the fingers during contraction is the best method to determine the

    intensity of contractions during labor.

    8

       

    Bandl’s Ring ( Pathological Retraction

     

    Ring): seen in Prolonged Labor or Dystocia

    Fallopian

    Site of fertilization of

    4 Parts of the Fallopian tubes

     

    Fallopian

     

    tubes

    tubes

    the ovum with perm

    • 1. Interstitial : lies within the uterine

    transport the ova from

    wall

    the ovaries

    to

    the

    • 2. Isthmus: the portion that is cut or

    uterus.

    sealed in TUBAL LIGATION ( site for sterilization)

    • 3. Ampulla: where fertilization

    occurs , this is also the LONGEST

    portion, frequent site for ectopic pregnancy.

    • 4. Infundibular: covered by the

    Fimbriae cells that help guide the ova

    to the Fallopian Tube.

     

    Ovaries

    Ovulation (the release of an ovum); Steroid

    Pair of follicle containing organs on the other side of the uterus

    The ovaries lie in the upper pelvic cavity.

    hormone production

    Ovaries: 4 by 2 cm in diameter, 1.5 cm thick. Responsible for

     

    the

    production,

    Maturation,

    and

    discharge of ova Secretion of estrogen and progesterone Cortex of the Ovaries; developing

    and graafian follicles are found here.

    Vagina

    Organ

    for

    coitus;

    Tube extending from the introitus to

    Fibromuscular

     

    organ

    Birth canal; Conduit

    cervix

    lined

    with

    mucus

    for menstrual flow.

    membrane

    I c. Types of Pelvic Ligaments

    • 1. Round: remain lax during non-pregnancy & become HYPERTROPHIED & elongated during pregnancy.

    • 2. Cardinal: chief uterine supports

    • 3. Broad ligaments: drapes over the fallopian tubes, uterus & ovaries

    9

    I. B MALE REPRODUCTIVE SYSTEM External Features : 2 Erectile Tissues in the penis: a. Corpus

    I. B

    MALE REPRODUCTIVE SYSTEM

    External Features:

    2 Erectile Tissues in the penis:

    • a. Corpus cavernosa

    • b. corpus spongiosum

    Internal Features:

    Epididymis: totals 20 ft. WHERE SPERMS ARE STORED

    Vas / Ductus Deferens:

    carries the sperm to the inguinal canal

    Seminal Gland / Vesicle: Secretes SEMEN

    Prostrate Gland: secretes SEMEN also.

    Cowpers Gland/ Bulbo-urethral: secretes also semen

    SEMEN sources:

    1. prostrate gland

    :

    60%

    • 2. 30%

    Seminal vesicles

    :

    • 3. 5%

    Epididymis

    :

    • 4. 5%

    Cowpers

    :

    10

    Accessory Structures

    Accessory Structures Figure 1-b Mammary Glands III. Mammary Glands MAMMARY GLANDS -2 mammary glands located on

    Figure 1-b Mammary Glands

    III. Mammary Glands

    MAMMARY GLANDS -2 mammary glands located on each side of chest wall -Each breast 15-20 lobes
    MAMMARY GLANDS
    -2 mammary glands located on each side of chest wall
    -Each breast 15-20 lobes containing clusters of ALVEOLI
    ACINI
    DUCTULES
    NIPPLES
    -Saclike end of
    the glandular
    system
    -Lined both w/
    epithelial cells
    that secrete
    colostrum( whic
    h is rich in IgA)
    & milk & w/
    muscles that
    expel milk
    -Exit alveoli & join
    to form larger canals
    LACTIFEROUS
    DUCTS
    -During lactation,
    milk flows to the
    alveoli and then thru
    the duct system
    further going to the
    balloon like storage
    sacs called
    LACTIFEROUS
    SINUSES
    -Sinuses merge into
    openings on nipple

    11

    IV. Female Reproductive Hormones

    HORMONES

    IV. Female Reproductive Hormones HORMONES Estrogen -Produce from ovaries, adrenal cortex, and placenta -Assists in maturation
    IV. Female Reproductive Hormones HORMONES Estrogen -Produce from ovaries, adrenal cortex, and placenta -Assists in maturation
    IV. Female Reproductive Hormones HORMONES Estrogen -Produce from ovaries, adrenal cortex, and placenta -Assists in maturation
    IV. Female Reproductive Hormones HORMONES Estrogen -Produce from ovaries, adrenal cortex, and placenta -Assists in maturation

    Estrogen

    -Produce from ovaries, adrenal cortex, and

    placenta -Assists in maturation of Graafian follicle -Stimulates thickening of endometrium.

    Other functions

    a.Contracts

    smooth

     

    muscles Inhibits the

    secretion of FSH

    b.

    Responsible

    for

    the

    increase

    vaginal

    secretion in the vagina (LEUKORRHEA)

    c.

    Thickens

    the

    endometrium

    d.

    SUPPRESSES THE FSH & Prolactin

    e.

    Responsible for the

    dev’t of 2ndary sex characteristics in females

    f.

    Stimulates

    uterine

    contractions & smuscular peristalsis of the fallopian tubes for the passage of the ovum to the uterus.

    g.

    Mildly increases Na & water reabsorption

    h.

    Stimulates LH

    secretion

    &

    responsible for the production of cervical mucus associated in ferning & spinnbarkeit

    IV. Female Reproductive Hormones HORMONES Estrogen -Produce from ovaries, adrenal cortex, and placenta -Assists in maturation
     

    Lutenizing

       

    Follicle Stimulating

    Hormone

    Hormone

    -When follicle is

    *Stimulates

    ripe and mature,

    Graafian follicle to mature and resulting in increase levels of estrogen

    triggers follicular rupture and release of ovum -Peaks at 16-18

     

    hours before ovulation. -stimulates ovulation & development of corpus luteum

    Progesterone

    *Produce from corpus

    luteum, placenta -Secretes thick/viscous cervical secretions.

    A.

    Preparation of the

    uterus to receive a fertilized ovum

    B.

    Decrease uterine motility/

    contractility during

    pregnancy

     

    C.

    Increases basal

    metabolism

     

    D.

    Enhances

    placental growth

    E.

    Stimulates

    the

    dev’t of acini cells

    in

    the

    breast(major cells

    for breast milk) Increase

    the

    endometriums

    supply

    of

    glycogen, oxygen & amino acids for maintaining pregnancy

    LUTENIZING HORMONE AND ESTROGEN peak immediately before ovulation

    Most women ovulate two weeks before the beginning of the next period.

    12

    IV a. Other Reproductive Hormones

    1. Lactogenic Hormone (Prolactin) -Stimulates lactation

    2. Melanocyte Stimulating Hormone

    -Responsible for the linea nigra & chloasma in pregnancy

    -Secreted by the anterior pituitary hormone MELANOTROPIN -Will end on the 2 nd month of pregnancy 3. Human Chorionic Gonadotropin -Increases in nausea and vomiting Responsible for Hyperemesis Gravidarum

    V. MENSTRUATION

    Menarche: 1 st menstrual period, usually age 12, but may begin as early as 9. Menopause: cessation of menstrual cycle that occurs normally from 40 & 55 y.o.

    Menstrual Cycle:

    • 1. Menstrual Phase ( 1 – 14 days)

    -Corpus luteum dies. -Progesterone & Estrogen vanishes- triggers/stimulate the production of FSH. -Endometrium degenerated/ sheds- menstruation occurs.

    Sexual intercourse during menstruation is not harmful.

    • 2. Proliferative Phase- Estrogen Phase ( 6 – 14 days)

    Graafian Follicle: Estrogen

    Anterior Pituitary Gland

    Anterior Pituitary Gland secretes FSH stimulates the development of the Graafian

    secretes FSH

    stimulates the development of the Graafian

    follicle

    ovulation

    follicle ovulation (secretes Estrogen) suppresses FSH & stimulates LH Increase Estrogen kills/decreases FSH LH stimulates

    (secretes Estrogen)

    follicle ovulation (secretes Estrogen) suppresses FSH & stimulates LH Increase Estrogen kills/decreases FSH LH stimulates

    suppresses FSH & stimulates LH

    Increase Estrogen kills/decreases FSH

    LH stimulates

    follicle ovulation (secretes Estrogen) suppresses FSH & stimulates LH Increase Estrogen kills/decreases FSH LH stimulates
    • 3. Secretory Phase (15 to 21 days) Progesterone Phase (Corpus Luteum: Progesterone) Other Books it is called: Luteal Phase After Ovulation-----release of mature ovum from the Graafian follicle-----Graafian Follicles die and replaced by Corpus Luteum-----secretes progesterone Functions of Progesterone:

    • 4. Pre-Menstrual Phase (22 days to 28 days) -If fertilization does not occur, corpus luteum begins to die -Progesterone & Estrogen decreases -Endometrium degenerates -Menstruation stops during pregnancy because there is decrease secretion of hormones by the ovary.

    13

    OVARIAN CYCLE

    (ACORDING TO HORMONAL ACTIVITY)

     

    0

    7

    14

    21

    28

    DEVELOPING FOLLICLES

     

    OVULATION

    CORPUS LUTEUM

     

    LUTEAL

     

    REGRESSION

    FOLLICULAR PHASE LUTEAL PHASE

    FOLLICULAR PHASE

    FOLLICULAR PHASE LUTEAL PHASE
    FOLLICULAR PHASE LUTEAL PHASE

    LUTEAL PHASE

    FOLLICULAR PHASE LUTEAL PHASE
     

    Ovarian follicles mature under influence

    -mittelshmerz

    -cervical changes

    -increase BBT

     

    of FSH and estrogen

    LH surge causes ovulation

    ENDOMETRIAL/UTERINE CYCLE

    (Described by varying thickness of the endometrium)

    (Figure 1-c)

    MENSTRUAL

     

    PROLEFERATIVE

     

    SECRETORY

    PHASE

    PHASE

    PHASE

    -Menstruation

    -Formation of corpus

    -Decrease estrogen

    -Hypothalamus

    -Hypothalamus stops

    luteum

    -Decrease

    secretes FSH

    -Increase

    progesterone

    -APG (anterior

    progesterone

    pituitary gland) secretes FSH -Maturation of Graafian follicle -Increased estrogen

    -NO FERTILIZATION; corpus luteum degenerates 10 days after ovulation -WITH

     

    FSH & starts LH -APG stops FSH & starts LH secretion

    FERTILIZATION; concepts produces HCG that sustains

     

    life corpus luteum; progesterone level is maintained at high level -Progesterone level decreases -Corpus albicans Sloughing off of endometrial lining

    PRE- MENSTRUAL PHASE -endometrium degenerates
    PRE-
    MENSTRUAL
    PHASE
    -endometrium
    degenerates

    14

    Figure 1-c Menstrual Cycle V. a Menstrual Disorders 15

    Figure 1-c Menstrual Cycle

    V. a Menstrual Disorders

    15

    BASAL

    Premenstrual

    Amenorrhea

    Menorrhagi

    Metrorrhagia

    BODY

    Syndrome

    a

    TEMPER

    ATURECE

    RVICAL

    MUCUS

    METHOD

    SYMPOT

    HERMAL

    METHOD

    MITTELSC

    HMERZCOI

    TUS

    INTERRUP

    TS-

    Excessive or

    prolonged

    bleeding-

    Irregular

    bleeding in

    between

    periods

    Primary-

    Dysmenorrh

    eal

    VI.

    FAMIL

     

    Y

    PLAN

    NING

    AND

    CONT

    RACE

    PTION

    Family

    Planning

    Methods

     

    The

    mos

    t

    imp

    orta

    nt

    topi

    c

    in

    a

    Pren

    atal

    16

    MALE CONDOMIUD*

     

    * Measured by taking &

    In Basal body temperature

    * Uses the appearance,

    cervical mucus is yellowish,

    Requires withdrawal of the penis

    recording e temperature rally

    characteristics and amount of

    from the vagina before

    Relies

    rectally each morning before

    cervical mucus to identify

    on abstinence from intercourse during fertile period-Edema of lower extremities- Primary- -Flexible device inserted into the uterine cavity -It alters uterine transport of the sperm so fertilization don’t occur

    waking after at least 3 hours of sleep * Drops before ovulation and rises 0.2 F-0.8 F

    method the patient should take her temperature every morning upon awakening and prior to any

    ovulation Ovulatory: cervical mucus is clear and abundant Pre-ovulatory / post ovulatory:

    less abundant, and sticky (inhibit sperm motility)

    DANGER SIGNS TO REPORT:

     

    activity to avoid the temperature

    .

    Late or missed menstrual period -Severe abdominal pain

    -

    being influenced by other factors.

    -Fever and chills

    -

    Foul vaginal discharge

     

    -Spotting, bleeding, or heavy menstrual periods

     

    -

    Spontaneous expulsion occur in 2%-10% of users in the first year

    -

    Rubber sheath that fits over the erect penis and prevents sperm from entering the vagina

     

    -

    Long polyurethane sheath that is inserted manually into vagina with a flexible internal ring extending to cover the perineum

    -

    Lubricated with a spermicide (non-oxynol-

     

    9)

    -

    It can be inserted up to 8 hrs before intercourse

     

    B. Barrier Methods

     

    FEMALE CONDOM (VAGINAL POUCH)

     

    ejaculation

    -

    Abdominal bloating

     

    -

    Weight gain

    Headache -Breast tenderness

    -

    -

    Depression

    -

    Crying

    -

    Loss of concentration

     

    No known cause

    -

    Secondary-

    May

    be

    caused

    by

    *

    Cou

    ple

    mak

    es

    use

    of

    com

    binat

    ion

    of

    cale

    ndar,

    BBT

    , and

    cervi

    cal

    muc

    us

    meth

    od to

    deter

    mine

    fertil

    e

    perio

    d

    17

    tumor/inflammatory conditions

    * Between menstrual cycles, some women experience pain

    when the ovary releases egg

    Figure 1-d Condom

    C

    E

    NCLEX TIPS!!

    R The female condom during sex

    V

    Figure 1-d

    I

    During sex the penis is inserted into the center of the open ring at the opening of the vagina. Until both

    C

    partners are familiar with the Reality condom, the penis should be guided by hand into the open ring.

    A Otherwise there is the chance that the penis will be inserted outside the condom into the vagina, thus

    L

    defeating the condom's purpose. Use of the male condom with the female condom is not recommended,

    because rubbing the latex male condom against the polyurethane female condom creates friction that may

    C

    make intercourse difficult.

    A

    P Removing the female condom

    D

    The female condom should be removed following intercourse and before standing up. To remove, squeeze

    I

    and twist the outer ring to ensure that semen remains inside the condom. Gently pull the condom from the

    A vagina. Discard in the trash. Do not attempt to flush the condom down the toilet, as it may clog the toilet or

    P sewer lines. Do not reuse.

    H

    R

    A Important points to remember when using the female condom

    G - The female condom works only if you use it every time you have sex.

    M

    - Use a new condom each time you have sexual intercourse. Do not reuse the female condom.

    ( - You can still become pregnant and transmit or acquire a sexually transmitted disease while using the

    F

    female condom. The risk is less than if you do not use the condom, but there still is a slight risk.

    i

    - Although the Reality condom is prelubricated, it also comes with a tube of lubricant in the package. You

    g

    may wish to add a few drops of lubricant to the opening of the condom or to the penis. Lubricants reduce

    u

    friction and noise those results from friction.

    r - Remove tampons before inserting the female condom.

    e - Use caution to avoid tearing the female condom with a sharp fingernail, ring, or other jewelry when

    • 1 inserting and removing the condom.

    -

    e

    )

    C

    E

    R

    V

    I

    C

    A

    L

    C

    A

    P

    V

    S

    D

    I

    A

    18

    P

    H

    R

    A

    G

    M

    C

     

    Not necessary for

    USAGE

    Small rubber plastic that fits

    Flexible ring covered with dome shape

    repeated coitusUse

    snugly over cervix

    rubber cap

    every coitusContinuous protection 24 hours regardless of the number of times of sexual intercourseOn two hours prior to sexual intercourse and in place for 6 hours after80% with typical use SPERMICIDE

    NULLIPARA=80%

    MLTIPARA=60%

    DESCRIPTION

    F

    it SIDE EFFECTS

    t

    e

    d

    b

    y

    h

    e

    a

    lt

    h

    p

    r

    o

    v

    i

    d

    e

    r

    S

    a

    19

    m

    e

    ,

    r

    e

    f

    it

    t

    e

    d

    a

    f

    t

    e

    r

    b

    i

    r

    t

    h

    a

    n

    d

    w

    e

    i

    g

    h

    t

    l

    o

    s

    s

    o

    f

    1

    5

    l

    b

    s

    C

    y

    s

    ti

    ti

    s

    ,

    c

    r

    a

    m

    p

    s

    ,

    r

    e

    c

    t

    a

    l

    p

    r

    o

    l

    a

    p

    s

    e

    d

    H

    O

    W

    T

    O

    I

    N

    S

    E

    R

    T

    T

    o

    x

    i

    c

    S

    h

    o

    c

    k

    s

    y

    n

    d

    r

    o

    m

    e

    (

    T

    S

    S

    )

    E

    F

    F

    E

    C

    T

    I

    V

    I

    T

    Y

     

    Cervicitis

    Not longer than 48 hours

    Not longer than 24 hours

    DURATION

    A diaphragm should be left in the vagina

     

    6-8 hours after sexual intercourse.

    Diaphragm: should remain in place 6-8 hours after sex & maybe left for 24 hours.

    ALWAYS CHECK FOR TEARS & HOLES!!!

    Contraindicated for: Frequent UTI, Prolapsed Cord & Retroverted Uterus, cystocele & rectocele, acute

    C. Pharmacologic methods

    cervicitis

    Figure 1-e Diaphragm

    Oral Contraceptive Pill : synthetic estrogen combined with small amounts of synthetic progesterone-

    preventing ovulation by stopping FSH & LH.

    • - Stops LH & FSH

    STOP IF WITH THE FF: (ACHES)

    • - A- abdominal pain, C- Chest pain, H- Headaches, E- eye problems & S-severe leg cramps

    • - ATTN: Severe Headaches maybe an indication of Hypertension!!!!

    CONTRAINDICATED:

    1 Thromboembolism

    2 CVA, HPN, smoking & diabetics,DIC, hyperviscosity

    Contraindicated for DIABETICS. The best for diabetics are Barrier Contraceptives--Condom &

    Diaphragm

    Examples: Demulen (Ethinyl Estradiol Ethylnodiol ) a monophasic oral contraceptive agent.

    If the patient forgets to take 2 tablets for the next 2 days, she should take 2 tablets NEXT 2 DAYS!!!

    And use another contraceptive method for the rest of the cycle.

    If she misses 3 or more, she should discard the remaining tablets & use another contraceptive

    method for the rest of the cycle.

    ORAL CONTRCEPTIVESMINIPILLSSUBDERMAL IMPLANTSSUBCUTANEOUS INJECTIONSUse to

    prevent conception by inhibiting ovulation (inhibits release of FSH and LH)

    Causes atrophic changes in the endometrium to prevent implantation of egg

    Causes thickening of cervical mucus to inhibit sperm travel

    Under ideal conditions the sperm can reach the ovum 1 to 5 minutes after ejaculation.

    Combined estrogen and progesterone preparation in tablet form and are taken daily with combinations of

    hormones

    22

    Oral contraceptives prevent pregnancy by suppressing FSH (follicle stimulating hormone) and LH

    (leutenizing hormone) release from the pituitary gland thereby blocking ovulation.Pills contain progestin but no

    estrogen

    Pills must be taken each day and preferably same time each day to achieve maximal effectiveness

    Thins and atrophy endometrium and thickens cervical mucous

    ADVANTAGE: can be use immediately postpartum if client is not breastfeeding and 6 weeks if breastfeeding

    Women taking the minipill have a higher incidence of tubal and ectopic pregnancies, possibly because

    progestin slows ovum transport through the fallopian tubes. Endometriosis, female hypogonadism, and

    premenstrual syndrome aren't associated with progestin-only oral contraceptives.Six soft sillastic rods filled

    with synthetic progesterone implanted into the woman’s arm

    Progesterone leaks into the blood stream, inhibiting implantation into endometrium

    Norplant

    Inserted subdermally into the midportion of the upper arm about 8-10cm above the elbow crease. 6 implantable

    capsules are inserted at one timeMedroxyprogesterone (DMPA or DEPOVERA)

    Birth Control Summary Table

    BIRTH CONTROL METHODADVANTAGERISKS OR POSSIBLE PROBLEMS

    Spermicides: chemicals in the form of

    foams, creams, jellies, films, or

    • Available over the counter • Only partially effective

    • Can be used with other

    against sexually transmitted

    suppositories that are inserted into the

    methods to improve

    disease (STD) transmission

    vagina to kill sperm before they can enter

    effectiveness

    • Possible allergies or irritation

    the uterus; typical use effectiveness: 70%

    • Not effective against STD transmission• ReusableCervical Cap:

    thimble-shaped latex cap inserted into vagina over cervix to prevent sperm from entering uterus; used with spermicide; typical use effectiveness: 82%• Not effective against STD transmission• ReusableCondom: male condom is a sheath of latex or animal tissue placed on erect penis; female condom is a plastic sac with a ring on each end inserted into the vagina; both may be used with a spermicide; typical use effectiveness: 84% (male) 79% (female) • Needs to be fitted by a health care professional • Difficult to fit women with an unusual cervix size • Difficult for some women to insert

    • Effective against STD

    transmission

    • Possible allergies to latex or

    spermicide

    • Available over the counter • Lessens sensation

    • Can be used with other

    methods to further protect

    against STD

    • May break during intercourse

    .Avoid using petroleum jelly of

    oil base products; it can

    cause INCREASE FRICTION

    which will lead to TEARING

    OF THE LATEX CONDOM.

    • Can last for one to two years

    CERVICAL CAP: can be retained upto 48

    hours. It does not leak. Cannot be re-applied

    again after use. May use spermicide before

    use.

    23

    • Needs to be fitted by a health care professional • Increased risk of bladder infection • Possible allergies to latex or spermicide

    • Can last for one to two years

    Birth Control Pill: prescription drug

    containing female hormones; one pill taken

    daily prevents ovaries from releasing eggs

    • More regular periods

    • No action required prior

    to sexual intercourse,

    • Not effective against STD

    transmission

    Rare but dangerous

    and/or thickens cervical mucus to prevent

    permits sexual

    complications, including

    sperm from reaching egg; typical use

    spontaneity

    blood clotting and

    effectiveness: 94%Diaphragm: shallow

    Some protection against

    hypertension, particularly in

    latex cup with flexible rim inserted into

    ovarian and endometrial

    women over 35 years who

    vagina over cervix to prevent sperm from

    cancer, noncancerous

    smoke

    entering uterus; used with spermicide;

    typical use effectiveness: 82%

    breast tumors, ovarian

    cysts

    • Must be taken daily

    Hormonal Implant (Norplant): six small

    • Protects against

    • Not effective against STD

    capsules inserted by a health care

    pregnancy for up to five

    transmission

    professional under the skin of upper arm

    years

    • Possible scarring or, rarely,

    that deliver small amounts of hormone to

    • No action required prior

    infection at insertion site

    prevent ovaries from releasing egg; typical

    to sexual intercourse,

    • Side effects include irregular

    use effectiveness: 99%

    permits sexual

    bleeding, headaches, nausea,

    spontaneity

    depression

    Can be used while breast-

    feeding beginning six

    weeks after delivering

    baby

    • Not effective against STD transmission• Effective one to six years, depending on type

    usedHormonal Injection (Depo- Provera): injection given by a health care professional in the arm or

    buttock every 12 weeks to prevent ovaries from releasing an egg and/or thicken cervical mucus to keep sperm from reaching an egg; typical use effectiveness: 99%

    • May cause spotting between periods and

    longer, heavier periods

    Increased risk of pelvic inflammatory

    disorder(PID) within first four months

    after insertion

    • Rare risk of uterine perforation

    • No action required prior to sexual intercourse, permits sexual spontaneity

    • Protects against

    pregnancy for 12 weeks

    • No action required prior

    to sexual intercourse,

    permits sexual

    spontaneity

    Can be used while breast-

    • Not effective against STD

    transmission

    • Side effects include irregular

    bleeding, weight gain,

    headaches, depression,

    abdominal pain

    • Side effects do not reverse

    feeding beginning six

    weeks after delivering

    baby

    • Protects against cancer of

    the uterine lining and iron

    deficiency anemia

    until medication wears off

    • May cause delay in becoming

    pregnant after injections are

    stopped

    • Not effective against STD

    • Permanent protection

    • Not effective against STD

    transmissionNatural Family Planning:

    from pregnancy

    transmission

    techniques, including checking body

    • No action required prior

    • Reactions to surgery may

    24

    temperature or cervical mucus daily or

    to sexual intercourse,

    include infection, bleeding,

    recording menstrual cycles on a calendar, to

    permits sexual

    injury to intestine, reaction to

    determine the days when body is most

    spontaneity

    anesthesia

    fertile; typical use effectiveness: 81%• No

    • Increased chance of ectopic

    medical or hormonal side effects• Not

    pregnancy

    effective against STD transmission•

    • Irreversible

    Permanent protection from pregnancyTubal

    Ligation: surgical procedure to permanently

    block woman's Fallopian tubes to prevent

    eggs from reaching sperm; typical use

    effectiveness: 99%Intrauterine Device

    (IUD): small device inserted by a health

    care professional into the uterus; prevents

    eggs from being fertilized and/or implanting

    in uterus; typical use effectiveness: 96%

    • Requires strict recordkeeping

    • Illness or lack of sleep may affect body

    temperature

    • Vaginal infections and douches may affect

    cervical mucus

    • Requires abstinence from sexual

    intercourse or alternative contraception

    during fertile days

    • Inexpensive • Accepted by most religions • Reactions to surgery may include infection, blood clot near testes, bruising, swelling, or tenderness of scrotum • Irreversible

    • No action required prior to sexual

    intercourse, permits sexual spontaneity

    Tubal ligation: isthmus part in the

    fallopian tube is the usual part being

    lighted.

    Intra-uterine Devices (IUD)- a

    small plastic object is inserted into the

    uterus where it remains in place. It

    interferes with the ability of the ovum to

    develop as it transverses the fallopian

    tube.

    Most Frequent Side Effect:

    a. Excessive Menstrual flow

    (menorrhagia)

    b. Spontaneous

    Expulsion of the device: Myometrium

    irritability c. Cramping & fever

    Contraindications:

    1. History of PID: a woman using IUD

    has 50% chance of getting PID.

    2.

    Ectopic Pregnancy, AIDS

    Never use / give IUD to NULLIPAROUS

    25

    WOMEN!!!

       

    Return to the clinic for evaluation after

    her 1 st menses!!!

    Figure

    Intra uterine device

    (IUD)

    Vasectomy: surgical procedure to permanently block the male's vas deferens to prevent sperm from reaching eggs; typical use effectiveness: 99%

    Section II Antepartum Period

    • I. Assessment of Risk Factors in the Prenatal Period

    Age of Pregnant Women -17 below: Have a higher incidence of

    • 1. Prematurity

    • 2. Pregnancy Induced Hypertension

    • 3. Cephalopelvic Disproportion

    Women over 35 years old are at Risk for:

    • 1. Chromosomal Disorders in infants

    • 2. PIH

    • 3. Cesarean Delivery

    Primigravida - 1st time Pregnancy

    Primipara - 1 st delivery of a live infant,

    Nulligravida - never been pregnant

    Infections: Use TORCH

    T

    -

    Toxoplasmosis

    O

    -

    Other infections

    R

    -

    Rubella

    C

    -

    Cytomegalovirus

    H

    -

    Herpes

    • A. Toxoplasmosis (protozoa)

    Produces symptoms of acute, flu-like infection in mother

    Transmitted through raw meat or handling cat litter of infected cats

    Spontaneous abortion likely to occur early in pregnancy

    • B. Rubella

    Extremely teratogenic in first trimester

    Causes congenital defects of eyes, heart, ears, and brain

    26

    Women with low rubella titers should be vaccinated at least 3 months before becoming pregnant or following

    a delivery

    NOTE: Any woman in the first trimester of pregnancy is at risk if exposed to rubella. Congenital Fetal defects

    often results from such an infection.

    • C. Cytomegalovirus (CMV)

    .Produces flu-like or mononucleosis-like symptoms in the mother

    Transmitted through the respiratory or sexual route

    May cause fetal death, retardation, heart defects, deafness

    No effective treatment available

    • D. Herpes Simples

    Affects the external genitalia, vagina, and cervix

    Causes draining, painful vesicles

    Delivery of the fetus is usually by cesarean section active lesions are present in the vagina; delivery may be

    performed vaginally if the lesions are in the anal, perineal, or inner thigh area (strict precautions are

    necessary to protect the fetus during delivery)

    No vaginal examinations are done in the presence of active vaginal herpetic lesions

    Maintain CONTACT isolation procedures during hospitalization if the disease is active

    Neonate and mother may be separated during the active period, or other special precautionary measures

    may be used to avoid transmission to neonate

    Teratogenic Drugs: BASA-O(code)

    B - Barbiturates

    A - Anti-malarial

    S

    -

    Salicylates

    A - Anesthetic

    O - Oral hypoglycemics

    Substance Abuse:

    Alcohol: causes learning disabilities, Mongolism, fetal alcohol syndrome

    Nicotine: increases vasoconstriction, retardation, SGA (small gestational age), low birth weight

    Heroin addict: babies are born with an EXAGGERATED/ HYPERACTIVE CNS / REFLEXES or

    CNS IRRITABILITY.

    Coccaine: The effect of cocaine in a labor and the fetus is preterm labor thus increased uterine

    contractions, intrauterine growth retardation and the potential for a sick, addicted infant

    II. Physiological Changes in Pregnancy

    Increases during pregnancy

     

    demand

    Increase Heart Rate for 10-15 beats/minute

    Increase

    Cardiac

    Output for

    20%

    -

    30% during

    1 st

    Increase secretion of sugar (Glycosuria)

    INCREASE PLAMA VOLUME

    Increase Urinary Frequency due to pressure to bladder.

    2 nd

    trimester to meet

    increase tissue

    27

    Increase normal dependent Edema (bilateral or ankle edema) normal for 36 weeks gestation.

    Decreases during pregnancy

    Decrease (slightly of blood pressure) in the 2 nd trimester due to decrease peripheral resistance

    Decrease Hemoglobin & Hematocrit because of Iron Deficiency (Pseudo- ANEMIA)

    Decrease gastrointestinal motility & peristalsis due to displacement of the intestine & compression

    of the stomach. ---leading to CONSTIPATION.

    Decrease Urine Specific gravity: a result of increase Urinary Output.

    Others:

    Chloasma : Mask of pregnancy

    Leukorrhea: whitish vaginal discharge without signs of inflammation & itching.

    Operculum: formation of mucus plug in CERVIX to seal out bacteria.

    Lordosis: the Pride of Pregnancy

    Relaxin: responsible hormone for the softening of the pelvic cartilages. Produce by the corpus luteum,

    contributes to the waddling gait typically noted in pregnancy.

    Normal delivery blood loss: 300 – 400 ml of blood

    Cesarean Section: 800 – 1000 ml

    II a. Antepartum Health Promotion

    Prenatal Visit

    Schedule of visit if with no complications:

    • a. Every 4 weeks, up to 32 weeks

    • b. Every 2 weeks, from 32-36 weeks (more frequently if problems exist)

    • c. Every week from 36-40 weeks

    Classifications of Pregnancy

    GRAVIDA – number of times pregnant, regardless of duration, including present pregnancy.

    PRIMIGRAVIDA – pregnant for the first time.

    It's important for the nurse to distinguish between a client who's having her first baby and one who has already

    had a baby. For the client who's pregnant for the first time, quickening occurs around 20 to 22 weeks. Women

    who have had children will feel quickening earlier, usually around 18 to 20 weeks, because they recognize the

    sensations.

    MULTIGRAVIDA – pregnant for second or subsequent time.

    PARA – number of pregnancies that lasted more than 20 weeks.

    NULLIPARA – a woman who has not given birth to a baby beyond 20 weeks gestation.

    PRIMIPARA – a woman who has given birth to one baby more than 20 weeks gestation.

    MULTIPARA – a woman who has had two or more births at more than 20 weeks gestation.

    Note: Twins or triplets counted as 1 para.

    PRETERM – newborn born before 37 weeks of gestation.

    TERM – newborn born after 37 weeks to 40 weeks of gestation.

    POST-TERM – newborn born after 40 weeks of gestation.

    Parity (TPAL)

    T

    -

    Number of terms births,

    P

    -

    Number of premature births,

    A - Number of Abortions,

    28

    • L - Number of living children

    NUTRITION

    1 st Trimester: 2 –4 lbs gain / 30-35 calories/kg/day

    2 nd trimester: 1 lb per week / 200 calories/kg/day

    3 rd trimester: 1 lb per week/ 200 calories/kg/day

    Pregnant Women needs 300 extra calories PER DAY for adequate nutrition.

    A diet of 2500 calories per day

    An increase of about 500 calories per day is needed during LACTATION.

    Iron Deficiency Anemia is a result of PICA.

    Different types of Exercises

    Pelvic Floor Contractions (Kegel’s Exercise): Promotes perineal healing, increase sexual

    responsiveness, press stress incontinence. Done 50-100 times. Examples: Tightening &

    strengthening the muscles of the Vagina, rectum, perineum & then relax after. Efficient for

    Urinary Frequency & Hemorrhoids. Increase elasticity of the Pubococcygeus muscle.

    Abdominal muscle Contractions: prevent constipation in pregnancy, done in standing or lying position,

    strengthening the abdominal muscles.

    Pelvic Rocking:

    Relieves backache during pregnancy, done by tightening the buttocks & flattens the

    lower back against the floor for one minute.

    DIFFERENT TYPES OF BREATHING TECHNIQUES

    • A. Abdominal breathing ( during latent phase of Stage 1 Labor)

    • 1. Used until labor is more advanced

    • 2. The abdomen moves outward during inhalation and downward during exhalation

    • 3. The rate remains slow, with approximately six to nine breaths per minute

    • B. Pant-pant-blow( during Transitional Phase of Stage 1 Labor)

    • 1. Used in advanced labor

    • 2. A more rapid pattern, consisting of two short blows from the mouth followed by a longer blow

    • 3. All exhalations are a blowing motion

    III. Fertilization to Conception

    Fertilization: the union of the ovum & sperm.

    determination.

    The start

    of Mitotic cell division

    & fetal sex

    > Primary oocyte (immature ovum) contains Diploid number of chromosomes (46).

    > One oocyte contains a haploid (23) number of chromosomes after division.

    > Gamete (mature ovum): is a cell or ovum that has undergone Maturation & will be ready for

    fertilization.

    > One gamete carries 23 chromosomes.

    > A sperm carries 2 types of sex chromosomes. X & Y.

    > 400 million sperm cells in one ejaculation.

    > Functional Life of spermatozoa is 48 hours

    > XX= female, XY= male.

    29

    Figure 1-F Morula

    Process of Fertilization:

    After ovulation ovum will be expelled from the Graafian follicles ovum will be surrounded by Zona

    Figure 1-F Morula Process of Fertilization : After ovulation ovum will be expelled from the Graafian
    Figure 1-F Morula Process of Fertilization : After ovulation ovum will be expelled from the Graafian

    Pellucida (mucopolysaccharide fluid) & a circle of cells (Corona Radiata) which increases the bulk of the

    Ovum

    Ovum expelled from the Fallopian Tube by the Fimbriae (infundibulum). Sperms move by flagella &

    expelled from the Fallopian Tube by the Fimbriae (infundibulum). Sperms move by flagella &

    Penetrate

    the & dissolve the cell wall of the ovum by releasing a proteolytic enzyme

    (Hyaluronidase) After penetration Fusion will result to Zygote. Zygote migrate for 4 days in the

    Figure 1-F Morula Process of Fertilization : After ovulation ovum will be expelled from the Graafian

    body of the uterus (Mitosis will take place-Cleavage formation will begin)

    Figure 1-F Morula Process of Fertilization : After ovulation ovum will be expelled from the Graafian

    After 16-50 cell formation from

    mitosis, a mulberry & Bumpy appearance will follow morula (figure 1-F) ---after 3-4 days, the structure will

    be ball like in appearance which will be called Blastocyst. Cells in the outer ring are called Trophoblast (later it

    forms the placenta, responsible for the dev’t of placenta & fetal membrane; Cells in the inner ring are called

    Erythroblas t cells (which will be the embryo).

    Terms to remember:

    Ovum: From ovulation to fertilization

    Zygote: From fertilization to implantation

    Embryo: From implantation to 5-8 weeks.

    Fetus: From 5-8 weeks until term

    The ovum is said to be viable for 24-36 hours.

    Sodium Bicarbonate- the frequent medication to alter the vaginal ph, decrease the acidity of the

    vagina so as to INCREASE THE MOTILITY OF THE SPERM.

    Figure 1-G Fetal Membranes

    Fetal Membranes: membranes that surround the fetus, & give the placenta the shiny appearance.

    (Figure 1-G)

    2 Layers:

    • a. Amnion: shiny membrane on the 2 nd week of Embryonic Development & encloses the Amniotic

    Cavity

    • b. Chorion: Outer membrane that supports the sac of the amniotic fluid.

    Chorionic Villi: finger like projections from the chorion. This is the place where gases, nutrients and

    waste products between the maternal & fetal blood takes place.

    Amniotic Fluid: surrounds the embryo, contains fetal urine, lanugo from fetal skin & epithelial cells.

    Ph is 7. 2.

    Specific Gravity: 1.005 – 1.025

    Normal Amount:

    500 – 1000 ml.

    Oligohydramnios-

    less than 300 ml.

    Polyhydramnios-

    more than 2000 ml. observe for Down syndrome & congenital defects

    Functions of Amniotic Fluid:

    • a. Protects the fetus from changes in the temperature & cushion against injury.

    • b. Protects the umbilical cord from pressure, the fetus drinks & breaths the fluid

    into the lungs.

    Amniotic Fluid Colors: Normal color: transparent, clear, with white tiny specks

    Dark amber or yellow: Ominous sign of presence of Bilirubin, hemolytic disease

    Port Wine Colored: Abruptio Placenta

    Greenish: Meconium Stained / FETAL DISTRESS: always go for Cesarian Section! Also if ph is

    less than 7.2

    If with odor: deliver within 24 hours, may indicate infection.

    30

    Umbilical Cord: 21 inches in length & 2 cm in thick

    ness, circulatory communication of the fetus to the

    mother. CONTAINS 2 ARTERIES & 1 VEIN. Covered by a gelatinous mucopolysaccharide called

    Whartons jelly.

    Implantation occurs at the end of the 1st week after fertilization, when the blastocyst attaches to the

    endometrium. During the 2nd week (14 days after implantation), implantation progresses and two germ layers,

    cavities, and cell layers develop. During the 3rd week of development (21 days after implantation), the

    embryonic disk evolves into three layers, and three new structures — the primitive streak, notochord, and

    allantois — form. Early during the 4th week (28 days after implantation), cellular differentiation and

    organization occur.

    Figure 1-H Fertilization Cycle

    Table Summary from Fertilization to Implantation (Figure 1-H)

    PRE-FERTILIZATION

     

    ACTIVITIES

    Ovum moves to amulla of

    fallopian tubes

     

    Capacitation

    Acrosome reaction

     

    Tissue Layer

    ECTODERM

    Mesoderm

    Endoderm

     

    CONCEPTION

     

    Zona reaction

    Zygote (fertilized ovum;

     
     

    about 24-48 hrs, divides;

     

    cleavage divides, travels to

    the uterus

    Umbilical Cord : 21 inches in length & 2 cm in thick ness, circulatory communication of
    Umbilical Cord : 21 inches in length & 2 cm in thick ness, circulatory communication of
     

    IMPLANTATION

    Morula (after 3-4

    days implantation)

    Blastocyst

    (trophoblast;

    embryolast)

    Implants complete

    w/n 7-10 days

    III.a ORIGIN OF BODY TISSUE

    Body Portion Formed

    Nervous system, mucus membranes, anus & mouth

    Connective Tissue, Reproductive, circulatory & upper

    Urinary system, bones, cartillage

    lining of the GI tract, Respiratory Tract, bladder & urethra

    MULTIPLE PREGNANCIES

    Double ovum

    Dizygotic/fraternal twins

    Ova from same or different ovaries

    Same or different sex

    2 placentas but maybe fused

    2 chorions & 2 amnions

    Single Ovum

    Monozygotic/identical twins

    union of a single ovum & a single sperm

    same sex one placenta

    one chorion & 2 amnions

    Genetics:

    Phenotype: Individual’s outward appearance

    Genotype:

    Individuals Genetic Make up

    Karyotype: Pictorial analysis of individual’s chromosomes

    Serotype:

    antigenic character “ABO”

    31

    Genetic Disorders:

    Autosomal Recessive Disorders: both men & women are at equal risk because the DEFECTIVE GENE

    is an AUTOSOME: one of 22 pairs of non-sex chromosomes. Offspring of each pregnancy

    has a 25% chance of being affected and 50% chance of being a carrier.

    Examples are: PKU ( phenylketenuria) , Tay - Sachs Disease, Cystic Fibrosis, Thallasemia,

    and Sickle Cell Anemia

    Autosomal Dominant: an affected offspring has an affected parent.

    Examples are: Huntinton’s Chorea and Marfan’s Syndrome (Arachnodactyly)

    X-linked dominant/Recessive Disorders: abnormal gene is found on the X chromosome because men

    have only one X chromosome, they always express the disorder.

    Examples are: Hemophillia and Duchenne Muscular Dystrophy

    IV. FETAL DEVELOPMENT

    Figure 1- H2 Fetal Development

     

    Placen

    Embryo is 4-5 mm length

     

    tal

    Trophoblasts embedded in deciduas

    transp

    Foundations for nervous system, genitourinary system, skin, bones, and

    ort of

    substa

    lungs are formed

    Rudiments of eyes, ears, nose appear

    nces

    Cardiovascular system functioning, heart beginning to beat, beginning of heart circulation.

    Placenta dev’t.

    ( 5

    weeks

    )

    The

     

    fetus is 27-31 mm

     

    and weighs

    2-4

    grams

     

    Fetus s

     
     

    markedly bent

     

    Head

     
     

    is

    disproportionately

     

    large due to brain

    development

     

    Center

     
     

    s of bone begin to

    ossify

     

    Gangli

     
     

    onic cells

    (5 th

    to

    12

    th weeks)

    Placenta and meconium

     

    32

    are present, with facial features

    • 1 mo/ 4 weeks

    • 3 mos./9-12 wks

    CVS done (8 12 weeks) every organ present, Head greatly enlarged

    Average length is 50-55 mm and weighs 45 gms.

    Fingers and toes are distinct.

    • 2 mo/ 5-8 weeks

    Placenta is complete.

    Rudimentary kidneys secrete urine.

    Fetal circulation is complete.

    External genitalia show definite characteristics.

    Ganglionic cells

    SEX IS VISUALLY RECOGNIZABLE. Heart is audible in a Doppler ( 11 th week)

     

    Fetus swallows. With nails. Kidneys able to secrete.

    mos. /13-16 weeks

    • 4 94-140 mm length and weighs 97-200 gms.

     

    Head is erected, lower limbs are well developed.

    Heartbeat is present

    Nasal septum and palate close

    Fingerprints are set

    LANUGO APPEARS IN THE BODY

    8

    Fetus is 150-190 mm. In length and weighs approximately 260-460

    mos. /

    gms.

    30-34

    Lanugo covers entire body.

    weeks

    Eyebrows and scalp hair is present.

    Lengt

    Heart sounds are perceptible by auscultation.

    Vernix caseosa covers skin.

    h

    Heartbeat can be

    heard in the fetoscope ( 18 weeks—20 weeks). Liver is already

    280-

    functioning.

    320

    Quickening felt by a mother. Skeleton begins to develop.

    mm.

    weigh

    Brown Fats begin to form. Heart sounds in the stethoscope

    Can be heard ( 17- 20 weeks)

    t

    NOTE: There is a placental barrier to syphilis until the 18 th week of pregnancy.

    • 1700- If the mother is treated before 18 th week, the baby will most likely not be
      2500 affected.

    gms.7

    mos. /

    26-29

    weeks

    Lengt

    h

    250-

    275;

    weigh

    t 910-

    1500

    gms.2

    33

    pancreas

    1-25

    WEE

    KS…

    OLD

    MAN

    ’s

    FACE

    5

    mos. /

    17-20

    weeks

    Toenails

    become

    visible

    Steady

    weight

    gain occurs

     

    Vigorous

     

    fetal

    movement occurs.

    LANUGO DISAPPEARS

    are fully developed.

     

     

    Aware

    of

    sounds

    outside

    the

     

    body.

     

    Assum

    es

    the

    deliver

    y

    positio

    n.

    Increa

    sed

    chance

    of

    surviv