Basic Concepts

• Fertilization – also known

as conception,
impregnation or
fecundation
- a union of
ovum and spermatozoa
• Implantation – contact between the growing
structure and the uterine endometrium
- occurs approximately 8 to 10 days
after fertilization
• Human Chorionic Gonadotropin

- first hormone produced

- Found in maternal blood and urine as early as
the first missed menstrual period through about
100th day of pregnancy.
- Testing after birth used as proof of the placental
tissue has been delivered.
• Estrogen

- Primarily Estriol a second product of the

syncytial cells of the placenta
- “Hormone of women”
- Mammary gland development for
lactation
- Stimulates uterine growth for the
developing fetus
• Progesterone

- “Hormone of mothers”
- Maintains endometrial lining of the
uterus
- Reduce the contractility of uterine
musculature, preventing premature
labor
• Placenta

- Arises out of trophoblast tissue

- Serves as fetal lungs, kidneys and GI tract and as a
separate endocrine organ throughout pregnancy
- Cotyledons are the approximately 15-25
• Umbilical Cord

- Formed from fetal

membranes the (amnion
and chorion) and
provides a circulatory
pathway that connects
the embryo to the
chorionic villi of the
placenta
• Transport oxygen and
nutrients to the fetus
from the placenta and
to return waste
products from the
fetus to the placenta
• Contains one vein and two arteries surrounded
with Wharton’s jelly that gives the cord body
and prevents pressure on the vein and arteries.

• 53cm in length and 2cm thick.

• Abnormalities in the umbilical cord is

accompanied with congenital anomalies in the
kidney and heart.
• Amniotic membrane and amniotic fluid

- Chorionic membrane is the

outermost fetal membrane
- Amniotic membrane second
membrane lining the chorionic
membrane and produces
amniotic fluid
- Do not have nerve supply
- Amniotic fluid volume ranges
from 800 to 1,200 mL.
- Amniotic fluid is slightly
alkaline
• Milestones of Fetal Growth and
Development
 End of 4th Gestational
week
- Spinal cord is formed and
fused in midpoint
- Development of eyes,
ears and nose
 End of 8th week

- Organogenesis (three germ tissue layers of the embryo,

which are the ectoderm, endoderm, and mesoderm, develop
into the internal organs of the organism) complete
- Arms and legs develop
- Facial features discernible
- Heart with septum and valves is beating rhythmically
- External genitalia are present but sex is not distinguishable
 End of 12th Week

- Babinski reflex present

- Sex is distinguishable by outward appearance
- Heartbeat is audible through Doppler
 End of 16th Week

- Fetal heart sounds are audible with an ordinary

stethoscope
- Sex can be determined by ultrasound
 End of 20th Week

- Spontaneous fetal movement can be

sensed by mother
- Hair forms ( head and eyebrows)
- Vernix Caseosa and brown fat formed
 End of 24th Week

- Meconium is present as far as the rectum

- Active production of lung surfactant
- Hearing can be demonstrated by response to
sudden sound
 End of 28th week
- Testes begin to descend into the scrotal sac from
the lower abdominal cavity

 End of 32nd week

- Active moro reflex present
- Fetus responds to sound outside mother’s body
- Fingernails grow to reach the end fingertips
End of 36th Week
- Most babies turn into vertex presentation

 End of 40th Week

- Fingernails extend over the fingertips
- Hemoglobin conversion to adult hemoglobin
about 20%
- Term
• Nagele’s Rule

EDC –estimated date of confinement

EDB- estimated date of birth
EDD- estimated date of delivery

- To calculate the date of birth by this rule, count

backward 3 calendar months from the last
menstrual period and add 7 days.
• Positive Signs of
Pregnancy

 Sonographic evidence
of fetal outline
 Fetal heart audible
 Fetal movement felt
• Age of viability – earliest age
at which fetuses could survive
if they were born at that time,
generally accepted as 24 weeks
or fetuses weighing more than
400 grams.
• First-trimester bleeding

 Abortion
 Ectopic Pregnancy - implantation occurs
outside the uterine cavity
• Some ectopic pregnancy spontaneously
end and then are reabsorbed, requiring
no treatment.

• Ectopic pregnancy diagnosed before it

ruptures: treated with methotrexate
(block the body's production of folat),
leucovorin (works by replacing folate in
the body), mifepristone
 • 2nd Trimester Bleeding

 Gestational Trophoblastic Disease ( H. Mole)

 Hydatidiform mole, or molar
pregnancy, results from too much
production of the tissue that is
supposed to develop into the
placenta.
Treatment:

• Suction curettage (D and C) may be performed.

• A hysterectomy may be an option for older women who do
not wish to become pregnant in the future.
• After treatment, serum HCG level will be followed. It is
important to avoid pregnancy and to use a reliable
contraceptive for 6 - 12 months after treatment for a molar
pregnancy. This allows for accurate testing to be sure that the
abnormal tissue does not grow back. Women who get
pregnant too soon after a molar pregnancy have a high risk of
having another molar pregnancy.
• 3rd Trimester Bleeding

 Low implantation of placenta

 Painless bleeding
 The main symptom of placenta
previa is sudden bleeding from the
vagina.
 Bleeding may be severe and life
threatening. It may stop on its own
but can start again days or weeks
later.
 Labor sometimes starts within
several days of the heavy bleeding.
Nearly all women with placenta previa need a C-
section. If the placenta covers all or part of the
cervix, a vaginal delivery can cause severe
bleeding. This can be deadly to both the mother
and baby.
 Reducing activities
 Bed rest
 Pelvic rest, which means no sex, no douching
and internal examination.
Premature Separation of the Placenta
• Labor occurs
before the
end of 37
week of
gestation
Pregnancy- Induced Hypertension (PIH)

 A condition in which vasospasm occurs in

both small and large arteries.
 Gestational hypertension

Elevated blood pressure 140/90 mmHg but has

no proteinuria or edema.

No drug therapy is necessary

a.Mild Preeclampsia

- BP 140/90 mmHg taken two occasions at least 6 hours

apart
- Systole greater than 30mmHg and diastole greater
than 15mmHg above prepregnant value
- Proteinuria 1+ or 2+ on random sample
- Edema
b. Severe preeclampsia
- Blood pressure has risen to 160 mmHg systole and 110mmHg
diastole or above at least two occasions 6 hours apart at bed
rest or diastole is 30mmHg above her pre-pregnancy level.
- Marked proteinuria
- 3+ or 4+ on random urine sample in a 24-hour urine sample
- Extensive edema
c. Eclampsia

- Most severe classification of PIH

- Causes cerebral edema that leads to seizure
or coma
- Complications: cerebral hemorrhage,
circulatory collapse, or renal failure
- Eclamptic seizure ( tonic- clonic)
 Priority care during
seizure is PATENT
AIRWAY.