MATERNITY NURSING L E C T U R E  ( Arellano University)  ARLENE D. LATORRE R.N. MAN
Requirements <ul><li>Pilliterri Maternal and Child Nursing ( 2 volumes) – to be checked </li></ul><ul><li>OB notebook </li...
 
 
<ul><li>TRENDS IN MATERNAL AND CHILD CARE </li></ul><ul><li>FAMILIES ARE SMALLER IN SIZE THAN IN PREVIOUS DECADES </li></u...
FEMALE REPRODUCTIVE SYSTEM : EXTERNAL STRUCTURES  ( VULVA/ PUDENDUM) A.  MONS PUBIS OR MONS VENERIS = PAD OF FAT OVER THE ...
 
 
C.  LABIA MINORA = THINNER, LENGTHWISE FOLDS OF HAIRLESS SKIN, ENCIRCLING THE CLITORIS ANTERIORLY ( PREPUCE ) AND UNITE PO...
E.  GLANS CLITORIS = SMALL ERECTILE STRUCTURE; CONTAINS  NERVE ENDINGS,  SENSITIVE TO TEMPERATURE AND TOUCH . IT IS THE  S...
F .  URETHRAL MEATUS = THE EXTERNAL OPENING OF THE URETHRA. SLIGHTLY BEHIND AND TO THE SIDE  ARE THE OPENINGS   OF THE  SK...
 
 
H.  VAGINAL ORIFICE / INTROITUS = EXTERNAL OPENING OF THE VAGINA, COVERED BY A THIN MEMBRANE ( HYMEN) IN VIRGINS.LOCATED L...
 
<ul><li>I.  FOURCHETTE   </li></ul><ul><ul><li>= THIN FOLD OF TISSUE FORMED BY MERGING OF THE LABIA MAJORA AND LABIA MINOR...
<ul><li>INTERNAL STRUCTURES : </li></ul><ul><li>VAGINA </li></ul><ul><li>HOLLOW MEMBRANOUS & MUSCULAR CANAL, 3-4 INCHES LO...
**  DODERLIEN’S BACILLUS  MAINTAINS THE NORMAL FLORA OF THE VAGINA, WHICH MAKES THE pH OF VAGINA ACIDIC, DETRIMENTAL TO TH...
 
VAGINA <ul><li>Functions: </li></ul><ul><ul><li>Organ of copulation </li></ul></ul><ul><ul><li>Discharges menstrual flow <...
<ul><li>RUGAE  – TRANSVERSE FOLDS OF SKIN IN THE VAGINAL WALL THAT IS ABSENT IN CHILDHOOD, APPEAR AFTER PUBERTY & DISAPPEA...
B.   UTERUS = HOLLOW, MUSCULAR PEAR SHAPED ORGAN LOCATED IN THE PELVIS, WEIGHING 50-60 g IN A NON-PREGNAT WOMAN. HELD IN P...
<ul><li>DURING PUBERTY, IT INCREASES IN SIZE & REACHES ITS MAXIMUM SIZE AT 17 YRS OLD </li></ul><ul><li>FUNCTONS: </li></u...
 
 
 
DIVISIONS OF THE UTERUS 1. CERVIX   = LOWER PORTION CALLED THE NECK a.  EXTERNAL CERVICAL OS  = DISTAL  OPENING TO THE VAG...
<ul><li>= MOST VASCULAR PORTION </li></ul><ul><li>=  NORMAL IMPLANTATION SITE </li></ul><ul><li>3.   CORPUS –  BODY OF THE...
<ul><li>= MOST VASCULAR PORTION </li></ul><ul><li>=  NORMAL IMPLANTATION SITE </li></ul><ul><li>3.   CORPUS –  BODY OF THE...
2.  MYOMETRIUM = MIDDLE LAYER , EXPELS FETUS DURING BIRTH PROCESS THEN CONTRACTS AROUND BLOOD VESSELS TO PREVENT HEMORRHAG...
<ul><li>GLANDULAR LAYER  – PEELS OFF DURING MENSTRUATION & THICKENS DURING THE PROLIFERATIVE & SECRETORY PHASE </li></ul><...
UTERINE LIGAMENTS : 1.BROAD LIGAMENT  – SUPPORTS THE SIDES OF THE UTERUS & ASSISTS IN HOLDING THE UTERUS IN ITS NORMAL  AN...
 
 
 
 
2. CARDINAL LIGAMENT  – LOWER PORTION OF THE BROAD LIGAMENT. IT IS THE MAIN SUPPORT OF THE UTERUS.DAMAGE TO THIS LIGAMENT ...
 
3.  UTEROSACRAL LIGAMENT  – CONNECTS UTERUS TO THE SACRUM 4.  ANTERIOR LIGAMENT  – PROVIDES SUPPORT TO THE UTERUS IN CONNE...
C.  FALLOPIAN TUBES / OVIDUCTS / UTERINE   TUBES = TWO SLENDER MUSCULAR TUBES WHICH ARISES FROM EACH OF THE UPPER CORNER O...
 
 
PARTS: 1. INTERSTITIAL  =( 1cm) LIES WITHIN THE  UTERINE WALL. IT HAS THE SMALLEST LUMEN. 2.  ISTHMU S  =( 2cm)  PORTION C...
<ul><li>FUNCTION: </li></ul><ul><ul><li>TRANSPORT OVUM FROM OVARY TO THE UTERUS </li></ul></ul><ul><ul><li>SITE OF FERTILI...
D.  OVARIES   = ALMOND SHAPED ORGANS LOCATED ON EITHER SIDE OF THE UTERUS. BEFORE PUBERTY, THE OVARIES ARE SMOOTH, FLAT & ...
OVARIES <ul><li>Function </li></ul><ul><ul><li>Oogenesis </li></ul></ul><ul><ul><li>Ovulation </li></ul></ul><ul><ul><li>H...
 
<ul><li>LAYERS OF THE OVARY : </li></ul><ul><li>TUNICA   ALBUGINEA </li></ul><ul><li>-  THE OUTERMOST  PROTECTIVE   LAYER ...
FOLLICLES, CORPUS LUTEUM & CORPUS ALBICANS. - two months intrauterine = 600,000 oogonia - 5 months intrauterine = 6,800,00...
<ul><li>  THE MAMMARY GLANDS </li></ul><ul><li>STRUCTURES: </li></ul><ul><li>LOBES  =EACH BREAST CONSISTS OF 15-20 LOBES F...
 
3.ACINAR CELLS  – MILK SECRETING CELLS THAT IS STIMULATED BY PROLACTIN  4.LACTIFEROUS DUCTS  = MILK RESERVOIR – WHICH OPEN...
PHYSIOLOGY OF MILK PRODUCTION ** THE  PRODUCTION OF BREAST MILK IS NOT ACHIEVED DURING PREGNACY BECAUSE OF THE PREDOMINANC...
** AS THE INFANT SUCKS, THE PPG IS STIMULATED TO RELEASE THE HORMONE  OXYTOCIN  CAUSING THE COLLECTING SINUSES OF THE MAMM...
<ul><li>HORMONES THAT INFLUENCE THE MAMMARY GLANDS: </li></ul><ul><ul><li>ESTROGEN  – STIMULATES THE DEVELOPMENT OF THE DU...
MALE REPRODUCTIVE SYSTEM: ANDROLOGY <ul><li>B.  Penis :  the male organ of copulation; a cylindrical shaft consisting of: ...
 
<ul><li>INTERNAL STRUCTURES : </li></ul><ul><li>TESTES </li></ul><ul><ul><li>= TWO OVOID SHAPED BODY THAT LIE INSIDE THE S...
= EACH LOBULE CONTAINS INTERSTITIAL CELLS (  LEYDIG’S CELLS ) AND SEMINIFEROUS TUBULES =  SEMINIFEROUS TUBULES  PRODUCE SP...
 
<ul><li>FUNCTIONS OF THE TESTES : </li></ul><ul><li>SPERMATOGENESIS </li></ul><ul><li>= PROCESS BY WHICH THE SPERMATOCYTES...
b.   FSH   = FOLLICLE STIMULATING HORMONE = CAUSES RAPID SPERM PRODUCTION BY THE TUBULE c.  ICSH  – INTERSTITIAL CELL STIM...
Male
MALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures </li></ul><ul><ul><li>1.  Epididymis :  serves as reservoir for s...
MALE REPRODUCTIVE SYSTEM: 4.  Ejaculatory duct :  the canal formed by the union of the vas deferens and the excretory duct...
SEMINAL FLUID / SEMEN : = A GRAYISH WHITISH SUBSTANCE CONTAINING SPERMATOZOA AND FRUCTOSE RICH SUBSTANCES. = AT THE TIME O...
<ul><ul><li>During ejaculation, semen receives contributions of fluid from  </li></ul></ul><ul><ul><li>Prostate gland (60%...
Spermatogenesis <ul><li>Testes </li></ul><ul><li>Contain Leydig cells  produces testosterone </li></ul><ul><li>Testosteron...
Sperm Pathway <ul><li>Testes  ---produces sperms </li></ul><ul><li>Epididymis  conducts sperm to Vas deferens  </li></ul><...
ANALOGOUS STRUCTURE <ul><li>Female Male </li></ul><ul><li>Glans Clitoris Glans penis </li></ul><ul><li>Labia majora Scrotu...
<ul><li>PUBERTAL DEVELOPMENT : </li></ul><ul><li>Puberty  =is the stage of life IN which the secondary sex characteristics...
SEQUENTIAL ORDER OF PUBERTAL CHANGES IN GIRLS : 1. GROWTH SPURT 2. INCREASE IN THE TRANSVERSE DIAMETER OF THE PELVIS 3. BR...
<ul><li>SEQUENTIAL ORDER OF PUBERTAL CHANGES IN BOYS : </li></ul><ul><li>INCREASE IN WEIGHT </li></ul><ul><li>2. GROWTH OF...
<ul><li>CLIMACTERIC PERIOD  (AGE 50 YEARS) </li></ul><ul><li>ATROPHY OF GENITALS GRADUALLY OCCURS </li></ul><ul><li>PUBIC ...
MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE = EPISODIC UTERINE BLEEDING IN RESPONSE TO HORMONAL CHANGES = PERIODIC SERIES ...
Basis for menstrual cycle is 6-12 month graphing. Menarche  – first menstrual period that occurs typically at age 12 but m...
<ul><li>MENSTRUATION  = PERIODIC, SLOUGHING OFF OF THE ENDOMETRIUM WHICH OCCURS EVERY 28 DAYS BUT COULD BE ANYWHERE FROM 2...
<ul><li>BODY STUCTURES INVOLVED IN   MENSTRUATION ; </li></ul><ul><li>HYPOTHALAMUS   – ultimate initiator of menstrual cyc...
<ul><li>PITUITARY HORMONES  ( GONADOTROPIC HORMONES) WHICH REGULATE MENSTRUAL CYCLIC ACTIVITIES : </li></ul><ul><li>FOLLIC...
<ul><li>Diseases of the hypothalamus causing a deficiency of this releasing factor can result in delayed puberty. Diseases...
PHASES OF THE MENSTRUAL CYCLE 1. PROLIFERATIVE/ FOLLICULAR/ ESTROGENIC/PREOVULATORY/POST MENSTRUAL 2. SECRETORY/ LUTEAL/ P...
The uterine cycle <ul><li>Consists of the ff phases </li></ul><ul><li>Menstrual phase </li></ul><ul><li>Proliferative phas...
Uterine Cycle :  Menstrual phase <ul><li>Day 1- day 5 </li></ul><ul><li>First day of bleeding is the first day of cycle </...
Uterine cycle :   proliferative Phase ( estrogenic, follicular  ) <ul><li>Day 6- day 14 of a 28 day cycle </li></ul><ul><l...
Uterine cycle :  Secretory phase <ul><li>Day 15- day 28 </li></ul><ul><li>Endometrium becomes thicker and glands secrete n...
12345678910111213141516171819202122232425262728 Uterine phase Ovarian phase Menstrual phase Proliferative phase Secretory ...
Uterine cycle :  Ischemic phase <ul><li>If fertilization does not occur, the corpus luteum shrivels as its life span is on...
 
OVARIAN cycle Consists of three phases 1. Pre-ovulatory :  follicular phase 2. Ovulatory phase 3. Post-ovulatory :  Luteal...
Ovarian Cycle; preovulatory/follicular <ul><li>Variable in length: day 6- day 13 </li></ul><ul><li>Dominant follicle matur...
Ovarian cycle: Ovulatory phase <ul><li>Day 14 </li></ul><ul><li>Rupture of the graafian follicle releasing the secondary o...
OVARIAN cycle: Post-ovulatory: luteal phase <ul><li>Day 15- day 28 </li></ul><ul><li>MOST CONSTANT 14 days after  ovulatio...
<ul><li>SIGNS OF OVULATION </li></ul><ul><li>MITTLESCHMERZ  = A CERTAIN DEGREE OF PAIN FELT AT THE LOWER LEFT OR RIGHT ILI...
<ul><li>3.  The distensible quality of the cervical mucus wherein   it becomes   profuse and thin and can be pulled into l...
 
4.  Cervical Changes <ul><li>Ferning or arborization of cervical mucus  </li></ul><ul><li>At the height of estrogen stimul...
5.  Basal Body Temperature <ul><li>Involves taking the temperature every morning BEFORE the woman gets out of bed and reco...
6. MOOD CHANGES DUE TO HORMONAL CHANGES 7. BREAST CHANGES AND ENLARGEMENT AND NIPPLES BECOME ERECT 8. INCREASED LIBIDO
<ul><li>FUNCTIONS OF ESTROGEN : </li></ul><ul><li>ASSISTS WITH THE MATURATION OF THE PRIMARY FOLLICLE  </li></ul><ul><li>2...
6. INCREASES  CONTRACTIONS OF THE FALLOPIAN TUBES 7. INCREASES QUANTITY AND  PH OF CERVICAL MUCUS CAUSING IT TO BECOME THI...
<ul><li>FUNCTIONS OF PROGESTERONE : </li></ul><ul><li>INCREASES BBT( THERMOGENIC EFFECT) </li></ul><ul><li>2. PREPARES THE...
<ul><li>CAUSES SECRETORY CHANGES IN THE ENDOMETRIUM IN PREPARATION FOR IMPLANTATION  </li></ul>
<ul><li>  FUNCTIONS OF PITUITARY HORMONES </li></ul><ul><li>FOLLICLE STIMULATING HORMONE  (FSH) </li></ul><ul><li>= STIMUL...
Menstrual disorders 1.  Dysmenorrhea  – painful menstruation 2.  POLYMENORRHEA  = TOO FREQUENT MENSTRUATION OCCURING AT IN...
<ul><li>SEXUAL RESPONSE CYCLE </li></ul><ul><li>EXCITEMENT PHASE  = OCCURS WITH PHYSICAL, PSYCHOLOGICAL  ( SIGHT, SOUND, E...
2.  PLATEAU PHASE  = NIPPLES BECOME FURTHER ENGORGED. IN MEN, VASOCONGESTION LEADS TO FULL DISTENTION OF THE PENIS, FLUSHI...
4.  RESOLUTION PHASE  = GENERALLY TAKES APPROXIMATELY 30 MINUTES FOR BOTH MEN & WOMEN , GENERAL MUSCLE RELAXATION OCCURS, ...
<ul><li>  FETAL DEVELOPMENT </li></ul><ul><li>OVUM : </li></ul><ul><li>IT IS THE FEMALE SEX CELL OR FEMALE GAMETE. </li></...
  ** OVUM CAN STAY VIABLE & IS CAPABLE OF BEING FERTILIZED FOR  12-24 HOURS  AFTER OVULATION BUT CAN LIVE UP TO 3-4 DAYS. ...
<ul><li>** ONLY ONE SPERMATOZOON IS ABLE TO PENETRATE THE CELL MEMBRANE OF THE OVUM AFTERWHICH THE OVUM BECOMES IMPERVIOUS...
 
** HAS 3 PARTS :  HEAD  THAT CONTAIN CHROMATIN MATERIALS;  NECK  OR MID PIECE THAT PROVIDE ENERGY &  TAIL  THAT IS RESPONS...
Insemination <ul><li>Deposition of the sperm in the female internal organs which occur during sexual intercourse </li></ul...
<ul><li>FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION) </li></ul><ul><li>= IT IS THE UNION OF A MATURED EGG AND A ...
** When the sperm cell reaches the uterus, it removes its protective covering, a process called “  CAPACITATION” , the out...
** once the sperm cell has entered the ovum & their nucleus has fused together,  fertilization is completed .  ** the plas...
** REPRODUCTIVE CELLS, DURING GAMETOGENESIS DIVIDE BY  MEIOSIS  (  HAPLOID NUMBER OF DAUGHTER CELLS )  THEREFORE THEY CONT...
** ( BODY CELLS OR SOMATIC CELLS HAVE 46 CHROMOSOMES BEC THEY DIVIDE VIA MITOSIS)  ** SPERMS  HAVE 23 CHROMOSOMES = 22 AUT...
<ul><li>Genes – basic units of heredity that detrmine both the physical and cognititve characteristics of people </li></ul...
<ul><li>Ex: </li></ul><ul><li>46XX5p- = female with 46 chromosomes but with the short arm of chromosome 5 missing( cru de ...
ZYGOTE : - IS THE FIRST CELL FORMED FROM THE FERTILIZATION OF SPERM & OVUM. - IT CONTAINS 46 CHROMOSOMES: 44 AUTOSOMES & E...
 
 
- WHEN THERE ARE ALREADY 16 OR MORE BLASTOMERES, THE ZYGOTE IS TERMED  “ MORULA ”( MORUS – MULBERRY) - WHEN IT REACHES THE...
 
<ul><li>The trophoderm layer gives rise to the placenta, fetal membranes, umbilical cord and amniotic fluid </li></ul><ul>...
TROPHOBLASTS OR THE OUTER CELLS: AT ABOUT 3 WEEKS, THE TROPHOBLAST CELLS  DIFFERENTIATE INTO TWO DISTINCT LAYERS: 1.CYTOTR...
1.HCG:  HUMAN CHORIONIC GONADOTROPIN - FIRST HORMONE TO APPEAR IN PREGNANCY WHICH  SERVES AS THE BASIS FOR PREGNANCY TESTI...
<ul><li>2.  Human placental lactogen   </li></ul><ul><li>makes sufficient amount of protein, glucose, and minerals  </li><...
<ul><li>3. Estrogen   </li></ul><ul><li>-  stimulates development of uterine  and breast  tissues  in the mother </li></ul...
<ul><li>4.  Progesterone   </li></ul><ul><li>- after 11 weeks of pregnancy, placenta takes over the production of progeste...
ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS
- At the time of implantation, the blastocyst already has differentiated at which two separate cavities appear in the inne...
- THE BLASTOCELE OR EMBRYONIC DISC GIVES RISE TO THE THREE PRIMARY GERM LAYERS:  ECTODERM, MESODERM, ENDODERM.
  PRIMARY GERM LAYERS TISSUE LAYER    BODY PORTIONS FORMED ECTODERM NERVOUS SYSTEM, SKIN, HAIR  ( OUTER LAYER)  NAILS, SEN...
ENDODERM / ENTODERM LINING OF THE GI TRACT,  ( INNER LAYER) RESPIRATORY TRACT, TONSILS, PARATHYROID, THYROID, THYMUS GLAND...
<ul><li>FETAL MEMBRANES : - </li></ul><ul><li>= this enclose the fetus & the amniotic fluid. They also protect the fetus a...
2.   AMNIOTIC MEMBRANE  –( INNER FETAL MEMBRANE)  = IT IS A SMOOTH, THIN, TOUGH & TRANSLUCENT MEMBRANE DIRECTLY ENCLOSING ...
 
 
IMPLANTATION/NIDATION - THE BLASTOCYST REMAINS FREE FLOATING IN THE UTERINE CAVITY FOR 3-5 DAYS & IMPLANTS IN THE ENDOMETR...
<ul><li>IMPLANTATION IS AN IMPORTANT STEP IN PREGNANCY BECAUSE AS MANY AS 50% of zygotes never achieve it. </li></ul>
<ul><li>DECIDUA: </li></ul><ul><li>- AFTER IMPLANTATION, THE ENDOMETRIUM IS NOW REFERRED TO AS THE  DECIDUA . </li></ul><u...
 
AMNIOTIC FLUID : - 500 ML TO 1200 ML AT TERM; AVERAGE 1000 ML; replaced approximately every 3 hours - 99% WATER & 1% SOLID...
AMNIOTIC FLUID <ul><li>fetus contributes to the fluid through urine excretion and absorbs from it by swallowing </li></ul>...
<ul><li>ABNORMAL AMNIOTIC COLORS : </li></ul><ul><li>GREEN TINGES OR MECONIUM STAINED IN A NON BREECH PRESENTATION – SIGNI...
<ul><li>FUNCTIONS OF AMNIOTIC FLUID : </li></ul><ul><li>PROTECTS THE FETUS FROM TRAUMA, BLOWS & PRESSURE </li></ul><ul><li...
UMBILICAL CORD / FUNIS -STRUCTURE THAT CONNECTS THE FETUS TO THE PLACENTA -  MAIN FUNCTION IS TO  CARRY   O2 & NUTRIENTS F...
- 2 arteries carry deoxygenated blood from the fetus to the placenta - 1 vein  carries oxygenated blood to the fetus, alon...
** UMBILICAL CORD ORIGINATES FROM THE YOLK SAC & UMBILICAL VESICLES.  ** WHARTON’S JELLY – GELATINOUS SUBSTANCE THAT COVER...
 
<ul><li>CORD INSERTION : </li></ul><ul><li>*1.  CENTRAL INSERTION  – NORMALLY, THE CORD IS INSERTED AT THE CENTER OF THE F...
<ul><li>*2.  LATERAL INSERTION  – WHEN THE CORD IS INSERTED AWAY FROM THE CENTER OF THE PLACENTA BUT NOT AT ITS EDGES. </l...
3. Velamentous insertion of the cord <ul><li>The cord, instead of entering the placenta directly, separates into small ves...
* 4. Battledore insertion <ul><li>The cord is inserted marginally rather than centrally </li></ul><ul><li>The cord is inse...
 
Cord Abnormalities <ul><li>Knots of the Cord  – fetal movements may cause knots in the cord which could lead to perinatal ...
Umbilical knot
THE PLACENTA IS FORMED FROM THE  CHORIONIC VILLI  AND  DECIDUA BASALIS . ** ITS GROWTH PARALLELS THAT OF THE FETUS, GROWIN...
<ul><li>Placenta - membranous vascular organ connecting the fetus to the mother, supplies the fetus with oxygen and food a...
<ul><li>2 sides of placenta: </li></ul><ul><li>1.maternal side which is irregular and is divided into subdivisions called ...
 
FUNCTIONS OF THE PLACENTA 1.  RESPIRATORY SYSTEM  = EXCHANGE OF GASES TAKES PLACE IN THE PLACENTA, NOT IN THE FETAL LUNG  ...
4.  CIRCULATORY SYSTEM  = FETO PLACENTAL CIRCULATION IS ESTABLISHED BY SELECTIVE OSMOSIS 5.  PROTECTIVE BARRIER  = INHIBIT...
 
 
Anomalies of the placenta and cord <ul><li>Placenta  </li></ul><ul><li>Weighs approximately 500 g and is 15 – 20 cm in dia...
Placenta succenturiata <ul><li>Placenta has 1 or more accessory lobes connected to the main placenta by blood vessels </li...
Placenta circumvallata <ul><li>Ordinarily, chorion membrane begins at the edge of the placenta; no chorion covers the feta...
Abnormal Placental Implantation <ul><li>Placenta Acreta –  invasion of the placenta deep into the endometrium </li></ul><u...
The Growing Fetus
<ul><li>STAGES OF   FETAL GROWTH AND DEVELOPMENT </li></ul><ul><li>PRE-EMBRYONIC or GERMINAL STAGE   = FIRST 2 WEEKS  BEGI...
NORMAL FETAL DEVELOPMENT ( measurement done at end of the lunar month) 4 WEEKS   FORM OF EMBRYONIC DISC,      NOT CLEARLY ...
8 WEEKS   ORGANOGENESIS IS COMPLETE, HEART    BEATS RHYTHMICALLY, , FACIAL FEATURES   ARE DISCERNABLE,EXTREMITIES HAVE    ...
12 WEEKS   NAIL BEDS FORMING ON FINGERS & TOES,   BONE OSSIFICATION BEGINS, TOOTH BUDS   PRESENT, SEX DISTINGUISHABLE BY  ...
20 WEEKS QUICKENING FELT BY A PRIMAGRAVIDA,    ANTIBODY PRODUCTION IS POSSIBLE,    HAIR FORMS INCLUDING EYEBROWS &    HAIR...
 
24 WEEKS PASSIVE ANTIBODY TRANSFER FROM  MOTHER TO FETUS BEGINS .INFANTS  BORN BEFORE ANTIBODY  . TRANSFER HAS TAKEN PLACE...
28 WEEKS     LUNG ALVEOLI BEGINS TO MATURE;  SURFACTANT  PRESENT IN AMNIOTIC  FLUID;  TESTES BEGIN TO DESCEND;BLOOD  VESSE...
36 WEEKS ADDITIONAL AMOUNTS OF SUBCATANEOUS    FATS ARE DEPOSITED ;  SOLE OF THE FOOT  HAS ONLY ONE OR TWO CRISSCROSS  CRE...
** THE DURATION OF A NORMAL PREGNANCY  IS 266 – 280 DAYS OR 38-42 WEEKS ( AVERAGE IS 40 WEEKS) ; OR 9 CALENDAR MONTHS OR 1...
Psychological Tasks of Pregnancy
PATERNAL REACTIONS TO PREGNANCY : A.  FIRST TRIMESTER  = AMBIVALENCE  & ANXIETY ABOUT ROLE CHANGE; CONCERN FOR IDENTIFICAT...
<ul><li>SIGNS & SYMPTOMS OF PREGNANCY : </li></ul><ul><li>PRESUMPTIVE SIGNS :  ( SUBJECTIVE SIGNS –  SUGGESTIVE  OF PREGNA...
SKIN <ul><li>Pink or reddish abdominal streaks ( striae   gravidarum ) which is caused by stretching of the skin </li></ul...
CHLOASMA LINEA NIGRA STRIAE GRAVIDARUM STRIAE ALBICANTES
<ul><li>PROBABLE SIGNS : ( OBJECTIVE SIGNS) </li></ul><ul><li>CHADWICK’S  SIGN  – PURPLISH DISCOLORATION OF THE VAGINA DUE...
<ul><li>POSITIVE SIGNS OF PREGNANCY : </li></ul><ul><li>( DEFINITELY PREGNANT) </li></ul><ul><li>PRESENCE OF FETAL HEART T...
SYSTEMIC CHANGES: CIRCULATORY / CARDIOVASCULAR : ** BEGINNING THE END OF THE FIRST TRIMESTER, THERE IS A GRADUAL INCREASE ...
CONSENQUENCES OF INCREASED CARDIAC VOLUME: **  EASY FATIGABILITY  & SOB DUE TO INCREASED WORKLOAD OF THE HEART MX: REST **...
** PALPITATIONS DUE  TO INCREASED PRESSURE ON THE DIAGPHRAGM  ** EDEMA OF LOWER EXTERMITIES OCCURS DUE TO POOR CIRCULATION...
** VARICOSITIES COULD OCCUR DUE TO PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS OF THE LE MX: > DO NOT CROSS LEGS WH...
** VARICOSITIES OF THE VULVA &  RECTUM MX:  > SIDE LYING POSITION WITH HIPS ELEVATED ON PILLOWS > MODIFIED KNEE CHEST POSI...
IMPLICATION : PREGNANT WOMEN SHOULD NOT BE MASSAGED SINCE BLOOD CLOTS CAN BE RELEASED & CAUSE THROMBOEMBOLISM. ** DURING D...
**  SUPINE HYPOTENSION SYNDROME   OR VENA CAVA SYNDROME  = THE WEIGHT OF THE GRAVID UTERUS PRESSES ON THE VENA CAVA OBSTRU...
RESPIRATORY SYSTEM : ** SLIGHT DYSPNEA MAY OCCUR UNTIL LIGHTENING CAUSED BY INCREASED O2 CONSUMPTION & PRODUCTION OF CO2 G...
HYPEREMESIS GRAVIDARUM   ( PERNICIOUS   VOMITING ) = EXCESSIVE NAUSEA & VOMITING WHICH PERSISTS BEYOND 3 MONTHS THAT COULD...
<ul><li>CONSTIPATION  = DUE TO DISPLACEMENT OF THE STOMACH & INTESTINES AND  DUE TO INCREASED PROGESTERONE DURING PREGNANC...
HEARTBURN  = REFLUX OF STOMACH CONTENT INTO THE ESOPHAGUS DUE TO INCREASED PROGESTERONE WHICH DECREASES GASTRIC MOTILITY M...
PICA  = **ABNORMAL CRAVING FOR NON NUTRITIOUS SUBSTANCES. THE MOST COMMON IS CRAVING FOR ICE CUBES. THERE COULD ALSO BE CR...
MUSCULOSKELETAL SYSTEM   GRADUAL SOFTENING OF PELVIC LIGAMENTS AND JOINTS TO FACILITATE PASSAGE OF THE BABY. ( RELAXIN) LO...
MANAGEMENT: **FREQUENT REST PERIODS WITH FEET ELEVATED **WEAR WARM, COMFORTABLE CLOTHING **INCREASE CALCIUM INTAKE (CALCIU...
Discomforts associated with pregnancy  1. First trimester <ul><li>Nausea and vomiting (“morning sickness”) related to alte...
<ul><li>Breast soreness due to hormonal changes; suggest wearing a well-fitting, supportive brassiere </li></ul><ul><li>He...
Second and third trimester <ul><li>Heartburn may be related to tension and vomiting in early pregnancy, progesterone-induc...
<ul><li>Constipation related to progesterone-induced hypoperistalsis, compression/displacement of the bowel by the enlargi...
<ul><li>Uterine contractions (Braxton-Hicks) due to tension on the round ligaments as a result of displacement of the uter...
<ul><li>Leg cramps related to pressure on the nerves supplying the lower extremities aggravated by poor peripheral circula...
<ul><li>Varicosities of extremities or vulva related to uterine compression of venous return, increased vein wall distensi...
MLNG CELESTE, RN, MD
c.  THE PSYCHOLOGICAL TASKS OF PREGNANCY <ul><li>First trimester  – ACCEPTING THE PREGNANCY”I am pregnant” </li></ul><ul><...
Second trimester <ul><li>ACCEPTING THE BABY as a separate individual </li></ul><ul><li>“  I am going to have a baby” </li>...
Third trimester <ul><li>PREPARING FOR DELIVERY AND PARENTHOOD “ I am going to be a mother” </li></ul><ul><li>possible new ...
PATERNAL REACTIONS TO PREGNANCY : A.  FIRST TRIMESTER  = AMBIVALENCE  & ANXIETY ABOUT ROLE CHANGE; CONCERN FOR IDENTIFICAT...
<ul><li>PRENATAL CARE ( ANTEPARTUM CARE) </li></ul><ul><li>-  Refers to the health care given to a woman & her family duri...
COMPONENTS OF PRE NATAL VISIT 1. PRE -   CONSULTATION PHASE: History Taking PERSONAL DATA: AGE, SEX, CIVIL STATUS, WEIGHT,...
OBSTETRICAL DATA : MENSTRUAL HISTORY : INCLUDES MENARCHE, LENGTH & REGULARITY OF MENSES, INTERVAL BETWEEN PERIODS, AMOUNT ...
T =  NUMBER OF FULL TERM BIRTHS P =  NUMBER OF PREMATURE BIRTHS A =  NUMBER OF ABORTIONS L =  NUMBER OF LIVING CHILDREN M ...
NULLIPARA  – A WOMAN WHO HAS NEVER DELIVERED A FETUS THAT REACHED THE AGE OF VIABILITY. SUCH WOMAN MAY OR MAY NOT HAVE BEE...
EX: Utilize the GTPAL system to classify a woman who is currently 8 months pregnant. This is her fourth pregnancy. She del...
<ul><li>EX:  A nurse is collecting the data during an admission assessment of Manilyn, a client who is pregnant with twins...
<ul><li>A woman who has had term twins, then 1 preterm infant & is now pregnant again is classified as: </li></ul><ul><li>...
DEFINITION OF TERMS <ul><li>Term infant  – an infant born between 38 and 42 weeks of gestation </li></ul><ul><li>Preterm  ...
DEFINITION OF TERMS <ul><li>Stillbirth  – infant born without signs of life </li></ul><ul><li>Early neonatal Death  – deat...
MATERNAL MORTALITY RATE  – NUMBER OF DEATHS THAT OCCURRED DUE TO COMPLICATIONS OF PREGNANCY, LABOR & PUERPERIUM PER 10,000...
<ul><li>2.   CONSULTATION PHASE : Physical assessment 1. Initial visit –  complete physical exam *Weight, Height & VS are ...
Laboratory screening <ul><li>Initially and at routine visits, urine dipstick for glucose, protein (pregnancy induced hyper...
Laboratory Tests <ul><li>Urinalysis </li></ul><ul><ul><li>1.Collect urinary specimen by midstream or clean catch technique...
<ul><li>Blood Tests </li></ul><ul><li>Hematocrit & Hemoglobin –  count at initial clinic visit & repeated at 28-32 weeks t...
<ul><li>VDRL and Kahn & Wassaerman test to detect Syphilis </li></ul><ul><li>Gonorrhea Culture </li></ul><ul><li>Rubella A...
Assessment of Fetal Growth Assessing fetal well-being <ul><ul><li>Fetal movement </li></ul></ul><ul><ul><li>Fetal heart ra...
Fetal movement <ul><li>Fetal movement that can be felt by the mother : QUICKENING begins  at approximately 18 – 20 weeks o...
7. Fetal kick Count or Fetal  movement <ul><li>Is a daily recording of fetal movements to assess active & passive fetal st...
Nonstress Test ( NST) <ul><li>Measures the response of fetal heart rate to fetal movement </li></ul><ul><li>Determines fet...
<ul><li>An external ultrasound transducer and the tocodynamometer are applied to the mother and  a tracing of at least 20 ...
<ul><li>RESULTS OF NST: </li></ul><ul><li>REACTIVE NONSTRESS  TEST:Normal/Negative </li></ul><ul><li>- indicates a  health...
Contraction Stress Test  (CST)or  Oxytocin Challenge Test  ( OCT) Nipple Stimulation Test ( NST) <ul><li>Assesses placenta...
<ul><li>External fetal monitor is applied to the mother, and a 20 to 30 minute baseline strip is recorded. </li></ul><ul><...
<ul><li>RESULTS OF CST: </li></ul><ul><li>NEGATIVE CST/ NORMAL </li></ul><ul><li>- no late or variable decelerations of FH...
 
Fetal Heart Rate Patterns Indicative of… Intervention Tachycardia (>160 bpm) <ul><li>Maternal or fetal infection </li></ul...
<ul><ul><ul><li>Variability  – beat-to-beat fluctuations; measured by internal EFM only </li></ul></ul></ul><ul><li>a.  No...
<ul><ul><ul><li>Periodic changes </li></ul></ul></ul><ul><li>1.  Accelerations  – rise above baseline followed by a return...
<ul><li>before, during, or after contraction; indicative of cord compression, which may be relieved by change in mother’s ...
Fetal heart rate <ul><li>FHR should be  120-160 </li></ul><ul><li>beats per minute </li></ul><ul><li>Can be heard with a  ...
LOCATING FETAL HEART SOUNDS BY FETAL POSITION FHT – heard best at the FETAL BACK
Ultrasound <ul><li>Response of sound waves against objects </li></ul><ul><li>Allows visualization of the uterine content <...
<ul><li>Diagnose pregnancy as early as 6 weeks </li></ul><ul><li>Confirm the presence, size and location of the placenta a...
<ul><li>Can assess fetal age by getting the fetal crown –to- rump measurement </li></ul>
<ul><li>Nursing Interventions : </li></ul><ul><li>Pre-procedure: </li></ul><ul><li>Drink 1 glass of water every 15 minutes...
Bi parietal Diameter <ul><li>Ultrasound is used to predict fetal maturity by measuring the biparietal diameter ( side to s...
Amniocentesis <ul><li>–  amniotic fluid is aspirated by a needle inserted through the abdominal and uterine walls; indicat...
 
<ul><li>Prior to the procedure, the patient’s bladder should be emptied if AOG is more than 20 weeks  </li></ul><ul><li>Po...
Chorionic villus sampling (CVS ) <ul><li>–   transcervical aspiration of chorionic villi that  allows for first trimester ...
Estriol levels <ul><li>–   serial 24-h maternal urine samples or serum specimens to determine fetoplacental status; fallin...
Percutaneous umbilical blood sampling (PUBS)Cordocentesis/Funicentesis <ul><li>–   second- and third-trimester method to a...
Lecithin/ Sphingomyelin ratio (2:1) <ul><li>–  important components of surfactant, a phosphoprotein that the alveoli begin...
Biophysical profile (BPS) <ul><li>Assesses 4 to 6 parameters (fetal breathing movement, fetal body movement, fetal tone, a...
<ul><li>Criteria in BPS: </li></ul><ul><li>1. Fetal Breathing Movements ( FBM) </li></ul><ul><ul><li>Normal: At least one ...
<ul><li>4. Amniotic fluid volume  </li></ul><ul><li>Normal: a pocket of amniotic fluid measuring more than 1 cm in vertica...
Placental Grading <ul><li>Determines the amount of calcium deposits on the base of the placenta </li></ul><ul><li>0 = 12 t...
Amniotic Fluid Volume Assessment
F. Maternal Serum  Alphafetoprotein <ul><li>Involves drawing a small amount of  BLOOD  from the mother to check for the le...
<ul><li>TESTS DONE: </li></ul><ul><li>Between 16-18 weeks </li></ul><ul><ul><li>Maternal serum Alphafetoprotein </li></ul>...
BASELINE   VITAL SIGNS  = TEMPERATURE, PULSE AND RESPIRATORY RATES ARE IMPORTANT ESPECIALLY DURING THE INITIAL PHASE OF TH...
WEIGHT *DURING THE FIRST TRIMESTER, WEIGHT GAIN OF 1.5-3LBS.( 1lb per month or 0.4 kg) *ON THE 2 ND  AND 3 RD  TRIMESTERS,...
<ul><li>Women who are underweight coming to pregnancy should gain slightly more weight than the average woman ( 0.5kg/mo o...
DISTRIBUTION OF WEIGHT GAIN DURING PREGNANCY: FETUS 7 LBS PLACENTA 1 LB AMNIOTIC FLUID 11/2 LBS INCREASED WT. OF UTERUS 2 ...
3.POST – CONSULTATION PHASE  = HEALTH TEACHINGS <ul><li>Schedule of clinic visits </li></ul><ul><li>Bathing </li></ul><ul>...
<ul><li>PRENATAL CARE: </li></ul><ul><li>SCHEDULE OF PRENATAL VISIT : </li></ul><ul><li>A.   ONCE   EVERY 4 WEEKS , UP TO ...
BATHING : DUE TO INCREASED PERSPIRATION , THE PREGNANT WOMAN IS ENCOURAGED TO HAVE A DAILY BATH TO KEEP HER FRESH & CLEAN....
<ul><li>PERINEAL HYGIENE: </li></ul><ul><li>DOUCHING  IS CONTRAINDICATED DURING PREGNANCY BECAUSE THE FORCE OF THE IRRIGAT...
BREAST CARE : 1. WELL FITTING & LARGER SIZED BRASSIERE ( WIDE STRAPS & DEEP CUPS TO PREVENT LOSS OF BREAST TONE.) 2. WASH ...
<ul><li>Dental Care: </li></ul><ul><li>Gingival tissue tend to hypertrophy during pregnancy. </li></ul><ul><li>Routine che...
** TERATOGENICITY OF CIGARETTES  = ( associated w/ infertility in women) CAUSES VASOCONSTRICTION LEADING TO DECREASED BLOO...
**   EMPLOYMENT   = AS LONG AS THE JOB DOES NOT ENTAIL HANDLING TOXIC SUBSTANCES OR LIFTING HEAVY OBJECTS , OR EXCESSIVE E...
**  TRAVELLING  =  NO TRAVEL RESTRICTIONS  BUT POSTPONE A TRIP DURING THE LAST TRIMESTER. ON LONG RIDES , 15-20 MINUTE RES...
** TERATOGENICITY OF ALCOHOL  = ALCOHOL HAS NOW BEEN FIRMLY ISOLATED AS A TERATOGEN. FETUSES CANNOT REMOVE THE BREAKDOWN P...
. ** DRUGS = DANGEROUS TO FETUS ESPECIALLY DURING THE FIRST TRIMESTER WHEN THE PLACENTAL BARRIER IS STILL INCOMPLETE AND T...
Drugs  Teratogenic Effects Androgen, Estrogen  -  Musculinization of female infants Progesterone   Thalidomide  - Phocomel...
<ul><li>SEXUAL RELATIONS :  CHANGES IN SEXUAL DESIRE : </li></ul><ul><li>FIRST TRIMESTER  = SEXUAL DESIRE IS  DECREASED  A...
** SEXUAL INTERCOURSE IS ALLOWED UNTIL THE LAST 6 WEEKS OF PREGNANCY ( BECAUSE IT HAS BEEN FOUND OUT THAT THERE IS INCREAS...
** SEXUAL INTERCOURSE  SHOULD BE DONE WITH THE WOMAN IN A COMFORTABLE POSITION: 1. SIDE LYING 2. WOMAN SUPERIOR – WOMAN ON...
<ul><li>**  Hyperthermia  – detrimental to growth because it interferes with cell metabolism.  </li></ul><ul><li>Pregnant ...
Teratogenic Maternal stress <ul><li>An emotionally disturbed pregnancy, one filled with emotional worry or anxiety beyond ...
TT IMMUNIZATION : > TT1 GIVEN ANYTIME DURING PREGNANCY  > TT2 ONE MONTH AFTER TT1 ( 3 YEARS PROTECTION) > TT3 SIX MONTHS A...
Nutrition in Pregnancy : <ul><li>Nutritional Teaching for the pregnant client should emphasize : </li></ul><ul><li>Eating ...
<ul><li>2. Recommended Daily Allowance (RDA) for Pregnancy and Lactation </li></ul><ul><li>!.  Energy Requirement for Preg...
NUTRITION  = MOST IMPORTANT ASPECT OF POST CONSULTATION FOOD SOURCES : **  PROTEIN RICH FOODS  = MEAT, FISH, EGGS, MILK, P...
**VITAMIN C= TOMATOES, GUAVA, PAPAYA **VITAMIN B= PROTEIN RICH FOODS **CALCIUM/PHOSPHORUS=MILK, CHEESE ** I RON = ESPECIAL...
IRON SHOULD BE GIVEN AFTER MEALS BECAUSE IT IS IRRITATING TO THE GASTRIC MUCOSA. SOURCES: LIVER AND OTHER INTERNAL ORGANS,...
**  FOLIC ACID   – TO PREVENT NEURAL TUBE DEFECTS ( SPINA BIFIDA, MENINGOCOELE ) SOURCES: ** GREEN LEAFY VEGETABLES ** FRU...
NUTRITIONAL REQUIREMENTS <ul><li>Calories  – 300 kcal/d; may need adjustment for prepregnant under/overweight </li></ul><u...
<ul><li>e.  Iron  – to a total of 30 mg/d of elemental iron; usually requires supplement </li></ul><ul><li>f.  Calcium  to...
** THE PROVISION OF  PRENATAL CARE  IS THE PRIMARY FACTOR IN THE IMPROVEMENT OF MATERNAL MORBIDITY & MORTALITY STATISTICS....
<ul><li>  IMPORTANT ESTIMATES </li></ul><ul><li>NAEGELE’S RULE  = CALCULATION OF EXPECTED DATE OF CONFINEMENT ( EDC ) </li...
EDC LAST MENSTRUAL PERIOD   ( LMP ) – counted from  first day of the last menses
AOG <ul><li>COMPUTATION OF AGE OF GESTATION </li></ul><ul><li>Example:  LMP: January 1, 2007 </li></ul><ul><li>Date of con...
2.  MC DONALD’S RULE  = ( ESTIMATION OF AOG IN MONTHS & WEEKS BY FUNDIC HEIGHT MEASUREMENT)=  FORMULA : FUNDIC HEIGHT IN C...
Fundic Height <ul><li>McDonald’s Rule – determines during midpregnancy, that the fetus is growing in utero by measuring th...
Measuring Fundic Height
<ul><li>Measure from the notch of the symphysis pubis to over the top of the uterine fundus as the woman lies supine. </li...
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  • Common Sites 0f Endometriosis Formation
  • O B Lec Arellano

    1. 1. MATERNITY NURSING L E C T U R E ( Arellano University) ARLENE D. LATORRE R.N. MAN
    2. 2. Requirements <ul><li>Pilliterri Maternal and Child Nursing ( 2 volumes) – to be checked </li></ul><ul><li>OB notebook </li></ul><ul><li>Nurse’s dictionary </li></ul><ul><li>Project in Maternity Nursing </li></ul><ul><li>Quizzes ( short and long)20% </li></ul><ul><li>Mastery Exams 30% </li></ul><ul><li>Major exam 40% </li></ul>
    3. 5. <ul><li>TRENDS IN MATERNAL AND CHILD CARE </li></ul><ul><li>FAMILIES ARE SMALLER IN SIZE THAN IN PREVIOUS DECADES </li></ul><ul><li>SINGLE PARENTS ARE INCREASING IN NUMBER </li></ul><ul><li>AN INCREASING NUMBER OF MOTHERS ARE WORKING OUTSIDE THE HOME </li></ul><ul><li>FAMILIES ARE MORE MOBILE THAN PREVIOUSLY </li></ul><ul><li>ABUSE IS MORE COMMON THAN EVER BEFORE </li></ul><ul><li>FAMILIES ARE MORE HEALTH CONSCIOUS THAN EVER BEFORE </li></ul>
    4. 6. FEMALE REPRODUCTIVE SYSTEM : EXTERNAL STRUCTURES ( VULVA/ PUDENDUM) A. MONS PUBIS OR MONS VENERIS = PAD OF FAT OVER THE SYMPHYSIS PUBIS. HAIRLESS & SMOOTH IN CHILDHOOD, IT IS COVERED BY DARK & CURLY HAIR CALLED ESCUTCHEON AFTER PUBERTY. HAIR PATTERN IS TRIANGULAR WITH BASE UP. B. LABIA MAJORA = LENGTHWISE, TWO THICK FOLDS OF FATTY SKIN EXTENDING FROM THE MONS TO THE PERINEUM THAT PROTECTS THE LABIA MINORA, URINARY MEATUS AND VAGINAL MUCOSA.
    5. 9. C. LABIA MINORA = THINNER, LENGTHWISE FOLDS OF HAIRLESS SKIN, ENCIRCLING THE CLITORIS ANTERIORLY ( PREPUCE ) AND UNITE POSTERIORLY ( FOURCHETTE ) .BELOW THE PREPUCE IS CALLED FRENULUM. HIGHLY SENSITIVE TO MANIPULATION AND TRAUMA, THE REASON WHY IT IS OFTEN TORN DURING DELIVERY. D. VESTIBULE = TRIANGULAR SPACE LOCATED BETWEEN THE LABIA MINORA CONTAINING VAGINAL INTROITUS, URETHRAL MEATUS BARTHOLIN’S & SKENE’S GLANDS
    6. 10. E. GLANS CLITORIS = SMALL ERECTILE STRUCTURE; CONTAINS NERVE ENDINGS, SENSITIVE TO TEMPERATURE AND TOUCH . IT IS THE SEAT OF SEXUAL AROUSAL AND EXCITEMENT IN FEMALES . IT IS THE MOST SENSITIVE PART OF A WOMAN’S BODY . IT IS ALSO THE STRUCTURE THAT GUIDES THE NURSE TO THE URINARY MEATUS.
    7. 11. F . URETHRAL MEATUS = THE EXTERNAL OPENING OF THE URETHRA. SLIGHTLY BEHIND AND TO THE SIDE ARE THE OPENINGS OF THE SKENE’S GLANDS ( PARAURETHRAL GLANDS ); THE SECRETIONS OF WHICH HELP TO LUBRICATE THE EXTERNAL GENITALIA. THE SHORTNESS OF THE FEMALE URETHRA MAKES WOMEN MORE SUSCEPTIBLE TO UTI THAN MEN. G . HYMEN . = A TOUGH BUT ELASTIC SEMICIRCLE OF TISSUE THAT COVERS THE OPENING TO THE VAGINA. THE REMNANT OF HYMEN IS CALLED CARUNCULAE MYRTIFORMIS.
    8. 14. H. VAGINAL ORIFICE / INTROITUS = EXTERNAL OPENING OF THE VAGINA, COVERED BY A THIN MEMBRANE ( HYMEN) IN VIRGINS.LOCATED LATERAL TO THE VAGINAL OPENING ON BOTH SIDES ARE THE BARTHOLIN’S GLANDS ( VULVOVAGINAL GLANDS ). IT LUBRICATES THE EXTERNAL VULVA DURING COITUS AND THE ALKALINE PH OF THEIR SECRETION HELPS TO IMPROVE SPERM SURVIVAL IN THE VAGINA. THE GRAFENBERG OR G-SPOT IS A VERY SENSITIVE AREA LOCATED AT THE INNER ANTERIOR ASPECT OF THE VAGINA.
    9. 16. <ul><li>I. FOURCHETTE </li></ul><ul><ul><li>= THIN FOLD OF TISSUE FORMED BY MERGING OF THE LABIA MAJORA AND LABIA MINORA BELOW THE VAGINAL ORIFICE. </li></ul></ul><ul><ul><li>J. PERINEUM </li></ul></ul><ul><ul><li>= MUSCULAR SKIN COVERED AREA BETWEEN VAGINAL OPENING AND ANUS. </li></ul></ul>
    10. 17. <ul><li>INTERNAL STRUCTURES : </li></ul><ul><li>VAGINA </li></ul><ul><li>HOLLOW MEMBRANOUS & MUSCULAR CANAL, 3-4 INCHES LONG,DILATABLE, CONTAINS RUGAE (WHICH PERMITS CONSIDERABLE STRETCHING WITHOUT TEARING).IT IS LOCATED IN FRONT OF THE RECTUM & BEHIND THE BLADDER. </li></ul><ul><ul><li>= PASSAGEWAY OF MENSTRUATION </li></ul></ul><ul><ul><li>= PASSAGEWAY OF FETUS </li></ul></ul><ul><ul><li>= ORGAN OF COPULATION </li></ul></ul><ul><ul><li>= SEMEN DEPOSITORY </li></ul></ul>
    11. 18. ** DODERLIEN’S BACILLUS MAINTAINS THE NORMAL FLORA OF THE VAGINA, WHICH MAKES THE pH OF VAGINA ACIDIC, DETRIMENTAL TO THE GROWTH OF PATHOLOGIC BACTERIA.
    12. 20. VAGINA <ul><li>Functions: </li></ul><ul><ul><li>Organ of copulation </li></ul></ul><ul><ul><li>Discharges menstrual flow </li></ul></ul><ul><ul><li>Birth canal </li></ul></ul>pH 4-5 : acidic
    13. 21. <ul><li>RUGAE – TRANSVERSE FOLDS OF SKIN IN THE VAGINAL WALL THAT IS ABSENT IN CHILDHOOD, APPEAR AFTER PUBERTY & DISAPPEARS AT MENOPAUSE. </li></ul><ul><li>FORNIX-FORNICES= THE CERVIX PROJECTS TO THE VAGINA FORMING FOUR RECESSES OR DEPRESSION AROUND ITS UPPER PORTION CALLED FORNICES: ANTERIOR FORNIX, LATERAL FORNICES, POSTERIOR FORNIX. </li></ul>
    14. 22. B. UTERUS = HOLLOW, MUSCULAR PEAR SHAPED ORGAN LOCATED IN THE PELVIS, WEIGHING 50-60 g IN A NON-PREGNAT WOMAN. HELD IN PLACE BY BROAD LIGAMENTS. ABUNDANT BLOOD SUPPLY COMES FROM UTERINE AND OVARIAN ARTERIES.
    15. 23. <ul><li>DURING PUBERTY, IT INCREASES IN SIZE & REACHES ITS MAXIMUM SIZE AT 17 YRS OLD </li></ul><ul><li>FUNCTONS: </li></ul><ul><li>a. ORGAN OF IMPLANTATION ( NIDATION) </li></ul><ul><li>AND MENSTRUATION </li></ul><ul><li>b. RECEIVES THE OVA FROM THE FALLOPIAN TUBE </li></ul><ul><li>c. FURNISHES PROTECTION FOR A GROWING FETUS </li></ul>
    16. 27. DIVISIONS OF THE UTERUS 1. CERVIX = LOWER PORTION CALLED THE NECK a. EXTERNAL CERVICAL OS = DISTAL OPENING TO THE VAGINA b. CERVICAL CANAL = THE CAVITY c. INTERNAL CERVICAL OS = OPENING TO THE UTERUS 2. FUNDUS = UPPERMOST CONVEX PORTION AND CAN BE PALPATED TO DETERMINE UTERINE GROWTH DURING PREGNANCY , TO ASSESS UTERINE CONTRACTIONS DURING LABOR,& INVOLUTION DURING THE POSTPARTUM PERIOD
    17. 28. <ul><li>= MOST VASCULAR PORTION </li></ul><ul><li>= NORMAL IMPLANTATION SITE </li></ul><ul><li>3. CORPUS – BODY OF THE UTERUS WHICH MAKES UP 2/3 OF THE SAID ORGAN. HOUSES THE FETUS DURING PREGNANCY </li></ul><ul><li>4. CORNUA – THE UPPER PORTION WHERE THE FALLOPIAN TUBES ARE ATTACHED. </li></ul><ul><li>LAYERS : </li></ul><ul><li>1. PERIMETRIUM </li></ul><ul><ul><li>= OUTERMOST LAYER, IT IS ATTACHED TO THE BROAD LIGAMENTS & OFFER ADDED SUPPORT TO THE UTERUS </li></ul></ul>
    18. 29. <ul><li>= MOST VASCULAR PORTION </li></ul><ul><li>= NORMAL IMPLANTATION SITE </li></ul><ul><li>3. CORPUS – BODY OF THE UTERUS WHICH MAKES UP 2/3 OF THE SAID ORGAN. HOUSES THE FETUS DURING PREGNANCY </li></ul><ul><li>4. CORNUA – THE UPPER PORTION WHERE THE FALLOPIAN TUBES ARE ATTACHED. </li></ul><ul><li>LAYERS : </li></ul><ul><li>1. PERIMETRIUM </li></ul><ul><ul><li>= OUTERMOST LAYER, IT IS ATTACHED TO THE BROAD LIGAMENTS & OFFER ADDED SUPPORT TO THE UTERUS </li></ul></ul>
    19. 30. 2. MYOMETRIUM = MIDDLE LAYER , EXPELS FETUS DURING BIRTH PROCESS THEN CONTRACTS AROUND BLOOD VESSELS TO PREVENT HEMORRHAGE (OXYTOCIN SITE) 3. ENDOMETRIUM = INNERMOST LAYER; THIS LAYER UNDERGO CHANGES IN RESPONSE TO THE HORMONES AT VARIOUS PHASES OF THE MENSTRUAL CYCLE & DURING PREGNANCY; IT CONSISTS OF TWO LAYERS:
    20. 31. <ul><li>GLANDULAR LAYER – PEELS OFF DURING MENSTRUATION & THICKENS DURING THE PROLIFERATIVE & SECRETORY PHASE </li></ul><ul><li>BASAL LAYER – LAYER ADJACENT TO THE MYOMETRIUM & GIVES RISE TO THE NEW ENDOMETRIUM AFTER MENSTRUATION & DELIVERY. </li></ul>
    21. 32. UTERINE LIGAMENTS : 1.BROAD LIGAMENT – SUPPORTS THE SIDES OF THE UTERUS & ASSISTS IN HOLDING THE UTERUS IN ITS NORMAL ANTEVERSION AND ANTEFLEXION POSITION.
    22. 37. 2. CARDINAL LIGAMENT – LOWER PORTION OF THE BROAD LIGAMENT. IT IS THE MAIN SUPPORT OF THE UTERUS.DAMAGE TO THIS LIGAMENT WILL RESULT TO UTERINE PROLAPSE .
    23. 39. 3. UTEROSACRAL LIGAMENT – CONNECTS UTERUS TO THE SACRUM 4. ANTERIOR LIGAMENT – PROVIDES SUPPORT TO THE UTERUS IN CONNECTION WITH THE BLADDER. OVERSTRETCHING OF THIS LIGAMENT WILL LEAD TO HERNIATION OF THE BLADDER TO THE VAGINA ( CYSTOCELE). 5. POSTERIOR LIGAMENT – FORMS THE CUL-DE-SAC OF DOUGLAS. DAMAGE TO THIS LIGAMENT WILL LEAD TO HERNIATION OF THE RECTUM TO THE VAGINA. ( RECTOCELE )
    24. 40. C. FALLOPIAN TUBES / OVIDUCTS / UTERINE TUBES = TWO SLENDER MUSCULAR TUBES WHICH ARISES FROM EACH OF THE UPPER CORNER OF THE UTERINE BODY AND EXTEND OUTWARD. PROVIDES A PLACE FOR FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION) OF OVA BY THE SPERM.
    25. 43. PARTS: 1. INTERSTITIAL =( 1cm) LIES WITHIN THE UTERINE WALL. IT HAS THE SMALLEST LUMEN. 2. ISTHMU S =( 2cm) PORTION CUT OR SEALED DURING TUBAL LIGATION .( BTL) 3. AMPULLA =( 5cm) LONGEST PORTION, EXACT SITE OF FERTILIZATION ( DISTAL 3 RD , OUTER 3 RD ) 4. INFUNDIBULUM =MOST DISTAL PORTION; RIM OF THE FUNNEL IS COVERED BY FIMBRAE THAT HELPS GUIDE THE OVA INTO THE FALLOPIAN TUBE.
    26. 44. <ul><li>FUNCTION: </li></ul><ul><ul><li>TRANSPORT OVUM FROM OVARY TO THE UTERUS </li></ul></ul><ul><ul><li>SITE OF FERTILIZATION </li></ul></ul>
    27. 45. D. OVARIES = ALMOND SHAPED ORGANS LOCATED ON EITHER SIDE OF THE UTERUS. BEFORE PUBERTY, THE OVARIES ARE SMOOTH, FLAT & OVOID ORGANS. AFTER OVULATIONS, THEY ASSUME A NODULAR & PITTED APPEARANCE. FUNCTIONS: = RESPONSIBLE FOR THE PRODUCTION, MATURATION AND DISCHARGE OF OVA AND SECRETION OF ESTROGEN AND PROGESTERONE = ORGAN OF OVULATION
    28. 46. OVARIES <ul><li>Function </li></ul><ul><ul><li>Oogenesis </li></ul></ul><ul><ul><li>Ovulation </li></ul></ul><ul><ul><li>Hormone production – estrogen & progesterone </li></ul></ul>
    29. 48. <ul><li>LAYERS OF THE OVARY : </li></ul><ul><li>TUNICA ALBUGINEA </li></ul><ul><li>- THE OUTERMOST PROTECTIVE LAYER SURROUNDED BY A SINGLE LAYER OF CUBOIDAL EPITHELIUM . </li></ul><ul><li>2. CORTEX </li></ul><ul><li>- THE FUNCTIONAL LAYER WHICH IS THE SITE OF OVUM FORMATION & MATURATION. IT CONTAINS THE PRIMORDIAL FOLLICLES, GRAAFIAN </li></ul>
    30. 49. FOLLICLES, CORPUS LUTEUM & CORPUS ALBICANS. - two months intrauterine = 600,000 oogonia - 5 months intrauterine = 6,800,000 - at birth = 2 million oocytes - prepuberty / childhood = 300,000 to 400,000 - 36 years old = 30,000 to 40,000 - menopause = absent 3. MEDULLA - LAYER WHICH CONTAINS THE BLOOD VESSELS, LYMPHATICS, NERVES & MUSCLE FIBERS.
    31. 50. <ul><li> THE MAMMARY GLANDS </li></ul><ul><li>STRUCTURES: </li></ul><ul><li>LOBES =EACH BREAST CONSISTS OF 15-20 LOBES FOUND IN EACH BREAST WHICH ARE SUBDIVIDED INTO LOBULES </li></ul><ul><li>LOBULES – COMPOSED OF CLUSTERS OF ACINAR CELLS ( RESPONSIBLE FOR MILK PRODUCTION) </li></ul>THE FEMALE BREASTS ARE ACCESSORY ORGANS OF REPRODUCTION MEANT TO PROVIDE THE INFANT WITH THE MOST IDEAL NOURISHMENT AFTER BIRTH.
    32. 52. 3.ACINAR CELLS – MILK SECRETING CELLS THAT IS STIMULATED BY PROLACTIN 4.LACTIFEROUS DUCTS = MILK RESERVOIR – WHICH OPEN TO THE NIPPLE. 5. AREOLA = DARK PIGMENTED PART AROUND THE NIPPLE 6 . MONTGOMERY TUBERCLE = SECRETES FATTY SUBSTANCE TO LUBRICATE NIPPLES 7 . NIPPLE = ELEVATED PART OF THE BREASTS CONTAINING 15-20 OPENINGS FROM THE LACTIFEROUS DUCTS 8 . COOPER’S LIGAMENT = PROVIDES SUPPORT TO THE MAMMARY GLAND
    33. 53. PHYSIOLOGY OF MILK PRODUCTION ** THE PRODUCTION OF BREAST MILK IS NOT ACHIEVED DURING PREGNACY BECAUSE OF THE PREDOMINANCE OF ESTROGEN & PROGESTERONE. ** IMMEDIATELY AFTER THE DELIVERY OF THE PLACENTA, THERE IS MARKED DECREASE OF BOTH ESTROGEN & PROGESTERONE W/C SERVES AS A STIMULUS FOR THE APG TO PRODUCE PROLACTIN . ** PROLACTIN ACTS ON THE ACINI CELLS TO STIMULATE PRODUCTION OF MILK & ARE THEN STORED IN THE LACTIFEROUS DUCTS.
    34. 54. ** AS THE INFANT SUCKS, THE PPG IS STIMULATED TO RELEASE THE HORMONE OXYTOCIN CAUSING THE COLLECTING SINUSES OF THE MAMMARY GLANDS TO CONTRACT, FORCING MILK FORWARD THROUGH THE NIPPLES CALLED “ LET DOWN REFLEX ” OR “ MILK EJECTION REFLEX ” .
    35. 55. <ul><li>HORMONES THAT INFLUENCE THE MAMMARY GLANDS: </li></ul><ul><ul><li>ESTROGEN – STIMULATES THE DEVELOPMENT OF THE DUCTILE STRUCTURES OF THE BREST </li></ul></ul><ul><ul><li>PROGESTERONE – STIMULATES THE DEVELOPMENT OF THE ACINAR CELLS </li></ul></ul><ul><ul><li>HUMAN PLACENTAL LACTOGEN – PROMOTES BREAST DEVELOPMENT DURING PREGNANCY </li></ul></ul><ul><ul><li>OXYTOCIN – LET DOWN REFLEX </li></ul></ul><ul><ul><li>PROLACTIN – STIMULATE MILK PRODUCTION </li></ul></ul>
    36. 56. MALE REPRODUCTIVE SYSTEM: ANDROLOGY <ul><li>B. Penis : the male organ of copulation; a cylindrical shaft consisting of: </li></ul><ul><ul><li>a. corpora cavernosa - t wo lateral columns of erectile tissue </li></ul></ul><ul><ul><li>b. corpus spongiosum - encases the urethra </li></ul></ul><ul><ul><li>Parts: 1. The glans penis , a cone-shaped expansion of the corpus spongiosum that is highly sensitive in males. </li></ul></ul><ul><ul><li> 2. Shaft or body </li></ul></ul><ul><ul><li> 3. Prepuce or Foreskin – retractable skin covering the glans & removed during circumcision. Unretractable or tight foreskin is called PHIMOSIS. </li></ul></ul><ul><ul><ul><li>- Erection is stimulated by parasympathetic nerve </li></ul></ul></ul><ul><ul><ul><li>C. Scrotum : a pouch hanging below the penis that contains the testes . </li></ul></ul></ul>
    37. 58. <ul><li>INTERNAL STRUCTURES : </li></ul><ul><li>TESTES </li></ul><ul><ul><li>= TWO OVOID SHAPED BODY THAT LIE INSIDE THE SCROTUM </li></ul></ul><ul><ul><li>= ENCASED BY A PROTECTIVE WHITE FIBROUS CAPSULE AND COMPRISES A NUMBER OF LOBULES </li></ul></ul>
    38. 59. = EACH LOBULE CONTAINS INTERSTITIAL CELLS ( LEYDIG’S CELLS ) AND SEMINIFEROUS TUBULES = SEMINIFEROUS TUBULES PRODUCE SPERMATOZOA = LEYDIG’S CELLS PRODUCE THE HORMONE TESTOSTERONE
    39. 61. <ul><li>FUNCTIONS OF THE TESTES : </li></ul><ul><li>SPERMATOGENESIS </li></ul><ul><li>= PROCESS BY WHICH THE SPERMATOCYTES ARE DEVELOPED INTO MATURE SPERMATOZOA </li></ul><ul><li>2. HORMONE PRODUCTION </li></ul><ul><li>a. T ESTOSTERONE = AN ANDROGEN OR MUSCULINIZING HORMONE RESPONSIBLE FOR </li></ul><ul><li>** GROWTH & DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS </li></ul>
    40. 62. b. FSH = FOLLICLE STIMULATING HORMONE = CAUSES RAPID SPERM PRODUCTION BY THE TUBULE c. ICSH – INTERSTITIAL CELL STIMULATING HORMONE = STIMULATES LEYDIG’S CELLS TO INCREASE TESTOSTERONE PRODUCTION
    41. 63. Male
    42. 64. MALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures </li></ul><ul><ul><li>1. Epididymis : serves as reservoir for sperm storage and maturation. Approximately 20 ft. it takes 12-20 days for the sperm to travel the length of Epididymis. </li></ul></ul><ul><ul><li>A total of 64 days before they reach maturity. </li></ul></ul><ul><ul><li>(“Treatment= 2 months” ). </li></ul></ul><ul><ul><ul><li>Aspermia - (absence of sperm) </li></ul></ul></ul><ul><ul><ul><li>Oligospermia- if < 20 million sperm/ ml </li></ul></ul></ul><ul><ul><li>2. Vas deferens : a duct extending from epididymis to the ejaculatory duct and seminal vesicle, providing a passageway for sperm. </li></ul></ul><ul><ul><ul><li>Varicocele- varicosity of internal spermatic cord </li></ul></ul></ul><ul><ul><ul><li>Vasectomy (male birth control) </li></ul></ul></ul><ul><ul><li>3. Seminal vesicle : are two convoluted pouches that lie along the lower portion of the bladder and empty into the urethra by the way of ejaculatory ducts </li></ul></ul>
    43. 65. MALE REPRODUCTIVE SYSTEM: 4. Ejaculatory duct : the canal formed by the union of the vas deferens and the excretory duct of the seminal vesicle, which enters the urethra at the prostate gland. 5. Prostate Gland : located just below the urinary bladder. Secretes alkaline and most of the seminal fluid. 6. Bulbourethral glands or Cowper’s Gland : adds alkaline fluid to the semen. Counterpart of the Bartholin’s glands in females. 7. Urethra : the passageway for both urine and semen, extending from the bladder to the urethral meatus . (8 inches in long)
    44. 66. SEMINAL FLUID / SEMEN : = A GRAYISH WHITISH SUBSTANCE CONTAINING SPERMATOZOA AND FRUCTOSE RICH SUBSTANCES. = AT THE TIME OF EJACULATION, APPROXIMATELY 3-5 ML OF SEMEN IS SECRETED WITH ABOUT 100 MILLION SPERMATOZOA PER ML, OR ABOUT 250-500 MILLION SPERMATOZOA AT EACH EJACULATION. IF THE SPERM COUNT DROPS TO LESS THAN 20 MILLION PER ML OF SEMEN, THE RATE IS CONSIDERED INFERTILE .
    45. 67. <ul><ul><li>During ejaculation, semen receives contributions of fluid from </li></ul></ul><ul><ul><li>Prostate gland (60%) </li></ul></ul><ul><ul><li>Seminal vesicle (30%) </li></ul></ul><ul><ul><li>Epididymis ( 5%) </li></ul></ul><ul><ul><li>Bulbourethral gland (5%) </li></ul></ul>
    46. 68. Spermatogenesis <ul><li>Testes </li></ul><ul><li>Contain Leydig cells produces testosterone </li></ul><ul><li>Testosterone </li></ul><ul><li>Stimulates </li></ul><ul><li>APG secrete FSH & LH </li></ul><ul><ul><ul><ul><ul><li>stimulates seminiferous tubules to produce spermatozoa </li></ul></ul></ul></ul></ul>ALERT: it takes 64 days for sperm to reach maturity
    47. 69. Sperm Pathway <ul><li>Testes ---produces sperms </li></ul><ul><li>Epididymis conducts sperm to Vas deferens </li></ul><ul><li>Seminal vesicles ( secretion of fructose & protein) </li></ul><ul><li>Ejaculatory duct </li></ul><ul><li>Urethra ( 8 inches) ( cowper’s gland secretes alkaline fluid) </li></ul><ul><li>OUT </li></ul>
    48. 70. ANALOGOUS STRUCTURE <ul><li>Female Male </li></ul><ul><li>Glans Clitoris Glans penis </li></ul><ul><li>Labia majora Scrotum </li></ul><ul><li>Vagina Penis </li></ul><ul><li>Ovaries Testes </li></ul><ul><li>Fallopian tubes Vas deferens </li></ul><ul><li>Skene’s glands Prostate glands </li></ul><ul><li>Bartholin’s glands Cowper’s glands </li></ul><ul><li>Ovum Spermatozoa </li></ul>
    49. 71. <ul><li>PUBERTAL DEVELOPMENT : </li></ul><ul><li>Puberty =is the stage of life IN which the secondary sex characteristics changes; = stage when the reproductive organs become functional. </li></ul><ul><li>Girls - age 9 to12 years </li></ul><ul><li>Theory: must reach a critical weight of approx. 95lbs (43kg) </li></ul><ul><li>Boys - age 12 to 14 years </li></ul><ul><ul><li>The role of Androgen- hormones responsible for : </li></ul></ul><ul><ul><ul><li>Muscular development </li></ul></ul></ul><ul><ul><ul><li>Physical growth </li></ul></ul></ul><ul><ul><ul><li>Increase sebaceous gland secretion (acne) </li></ul></ul></ul><ul><ul><li>“ Testosterone -1° androgenic hormone” </li></ul></ul><ul><ul><li>In girls, testosterone influences the development of </li></ul></ul><ul><ul><li>labia majora, clitoris, and axillary & pubic hair latter termed as (adrenarche) </li></ul></ul>
    50. 72. SEQUENTIAL ORDER OF PUBERTAL CHANGES IN GIRLS : 1. GROWTH SPURT 2. INCREASE IN THE TRANSVERSE DIAMETER OF THE PELVIS 3. BREAST DEVELOPMENT (THELARCHE) 4. GROWTH OF PUBIC HAIR 5. ONSET OF MENSTRUATION (MENARCHE) 6. GROWTH OF AXILLARY HAIR(ADRENARCHE) 7. VAGINAL SECRETIONS
    51. 73. <ul><li>SEQUENTIAL ORDER OF PUBERTAL CHANGES IN BOYS : </li></ul><ul><li>INCREASE IN WEIGHT </li></ul><ul><li>2. GROWTH OF TESTES </li></ul><ul><li>3. GROWTH OF FACE, AXILLARY & PUBIC HAIR </li></ul><ul><li>4. VOICE CHANGES </li></ul><ul><li>5. PENILE GROWTH </li></ul><ul><li>6. INCREASE IN HEIGHT </li></ul><ul><li>7. SPERMATOGENESIS </li></ul>
    52. 74. <ul><li>CLIMACTERIC PERIOD (AGE 50 YEARS) </li></ul><ul><li>ATROPHY OF GENITALS GRADUALLY OCCURS </li></ul><ul><li>PUBIC HAIR THINS </li></ul><ul><li>PENIS BECOMES FLABBY </li></ul>
    53. 75. MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE = EPISODIC UTERINE BLEEDING IN RESPONSE TO HORMONAL CHANGES = PERIODIC SERIES OF CHANGES THAT RECUR IN THE UTERUS AND ASSOCIATED ORGANS BEGINNING AT PUBERTY AND ENDING AT MENOPAUSE = TAKEN FROM THE FIRST DAY OF MENSTRUATION TO THE FIRST DAY OF THE NEXT MENSTRUATION
    54. 76. Basis for menstrual cycle is 6-12 month graphing. Menarche – first menstrual period that occurs typically at age 12 but may occur as early as 9 or as late as 17. Thelarche – is the development of the breast buds that occur at puberty. Adrenarche – is the development of pubic & axillary hair due to androgen stimulation.
    55. 77. <ul><li>MENSTRUATION = PERIODIC, SLOUGHING OFF OF THE ENDOMETRIUM WHICH OCCURS EVERY 28 DAYS BUT COULD BE ANYWHERE FROM 25 TO 35 DAYS & LASTS FOR 3-5 DAYS. </li></ul><ul><li>Characteristic of Menstrual Blood: </li></ul><ul><li>Does not appear to clot </li></ul><ul><li>Dark red as that of venous blood </li></ul><ul><li>Offensiveness ( Fleshy stale odor) </li></ul>
    56. 78. <ul><li>BODY STUCTURES INVOLVED IN MENSTRUATION ; </li></ul><ul><li>HYPOTHALAMUS – ultimate initiator of menstrual cycle. Secretes GnRH. Releases FSHRF during the first half of the cycle & LHRF during the second half of the cycle. </li></ul><ul><li>2. ANTERIOR PITUITARY GLAND – releases the gonadotropin hormones (GH) FSH & LH </li></ul><ul><li>3. OVARIES - site of ovulation & releases estrogen & progesterone. </li></ul><ul><li>4. UTERUS – the organ from which menstrual discharge is formed. The changes in the uterine endometrium are due to ovarian hormones </li></ul>
    57. 79. <ul><li>PITUITARY HORMONES ( GONADOTROPIC HORMONES) WHICH REGULATE MENSTRUAL CYCLIC ACTIVITIES : </li></ul><ul><li>FOLLICLE STIMULATING HORMONE ( FSH) </li></ul><ul><li>2. LUTEINIZING HORMONE ( LH ) </li></ul><ul><li>OVARIAN HORMONES WHICH REGULATE MENSTRUAL CYCLE ACTIVITIES : </li></ul><ul><li>ESTROGEN – hormone of women ; produced by the graafian follicle </li></ul><ul><li>2. PROGESTERONE – hormone of mothers ; produced by the corpus luteum </li></ul>
    58. 80. <ul><li>Diseases of the hypothalamus causing a deficiency of this releasing factor can result in delayed puberty. Diseases causing early activation of the GnRH can lead to abnormally early sexual development or precocious puberty </li></ul>
    59. 81. PHASES OF THE MENSTRUAL CYCLE 1. PROLIFERATIVE/ FOLLICULAR/ ESTROGENIC/PREOVULATORY/POST MENSTRUAL 2. SECRETORY/ LUTEAL/ PROGESTATIONAL POST OVULATORY 3. PREMENSTRUAL OR ISCHEMIC PHASE 4. MENSTRUAL PHASE
    60. 82. The uterine cycle <ul><li>Consists of the ff phases </li></ul><ul><li>Menstrual phase </li></ul><ul><li>Proliferative phase </li></ul><ul><li>Secretory phase </li></ul><ul><li>Ischemic phase </li></ul>
    61. 83. Uterine Cycle : Menstrual phase <ul><li>Day 1- day 5 </li></ul><ul><li>First day of bleeding is the first day of cycle </li></ul><ul><li>Stratum functionale is shed </li></ul><ul><li>Total blood loss during menses range from 30-80 ml. 60 ml average! </li></ul><ul><li>More than 80ml blood loss is considered excessive- need for iron supplements </li></ul><ul><li>Ave daily loss of iron is 0.5 to 1mg </li></ul>
    62. 84. Uterine cycle : proliferative Phase ( estrogenic, follicular ) <ul><li>Day 6- day 14 of a 28 day cycle </li></ul><ul><li>The very low estrogen level during menstruation stimulates hypothalamus to secrete FSHRF, which in turn stimulates the APG to secrete FSH </li></ul><ul><li>Estrogen is lowest on the 3 rd day of the menstrual cycle & highest a day before ovulation </li></ul>
    63. 85. Uterine cycle : Secretory phase <ul><li>Day 15- day 28 </li></ul><ul><li>Endometrium becomes thicker and glands secrete nutrients </li></ul><ul><li>Uterus is prepared for implantation </li></ul><ul><li>Due to progesterone </li></ul><ul><li>If no fertilization  constriction vessels  menstruation </li></ul>
    64. 86. 12345678910111213141516171819202122232425262728 Uterine phase Ovarian phase Menstrual phase Proliferative phase Secretory phase Follicular phase Luteal phase Ovulatory Phase Ischemic
    65. 87. Uterine cycle : Ischemic phase <ul><li>If fertilization does not occur, the corpus luteum shrivels as its life span is only 8-10 days from date of ovulation. On the 26 th day of a 28 day cycle, if pregnancy has not occurred, the corpus luteum begins to degenerate and becomes corpus albicans . Two days after, menstruation occurs </li></ul>
    66. 89. OVARIAN cycle Consists of three phases 1. Pre-ovulatory : follicular phase 2. Ovulatory phase 3. Post-ovulatory : Luteal phase
    67. 90. Ovarian Cycle; preovulatory/follicular <ul><li>Variable in length: day 6- day 13 </li></ul><ul><li>Dominant follicle matures and becomes graafian follicle with primary oocyte </li></ul><ul><li>FSH increases initially then decreases because of estrogen increase </li></ul>
    68. 91. Ovarian cycle: Ovulatory phase <ul><li>Day 14 </li></ul><ul><li>Rupture of the graafian follicle releasing the secondary oocyte </li></ul><ul><li>Due to the LH surge </li></ul><ul><li>MITTELSCHMERZ- pain during rupture of follicle </li></ul>
    69. 92. OVARIAN cycle: Post-ovulatory: luteal phase <ul><li>Day 15- day 28 </li></ul><ul><li>MOST CONSTANT 14 days after ovulation </li></ul><ul><li>Corpus luteum secretes Progesterone </li></ul><ul><li>If no fertilization happens, corpus luteum will become corpus albicans then degenerate </li></ul><ul><li>Decreased estrogen and progesterone </li></ul>
    70. 93. <ul><li>SIGNS OF OVULATION </li></ul><ul><li>MITTLESCHMERZ = A CERTAIN DEGREE OF PAIN FELT AT THE LOWER LEFT OR RIGHT ILIAC </li></ul><ul><li>2. CERVICAL MUCUS METHOD OR BILLING’S METHOD = CHANGES IN CERVICAL MUCUS SECRETIONS TO CLEAR, ELASTIC & WATERY ( MOST RELIABLE SIGN). </li></ul>
    71. 94. <ul><li>3. The distensible quality of the cervical mucus wherein it becomes profuse and thin and can be pulled into long strands & suspended like in two glass slides is called SPINNBARKEIT . </li></ul><ul><li>Spinnbarkeit test – does not indicate the exact time of ovulation but signals that a woman is nearing ovulation. This sign is characterized by cervical mucus that is thin, watery and transparent, abundant and highly stretchable . When dried and viewed under the microscope, the mucus reveals a fern pattern . The fern pattern is due to elevated levels of sodium chloride. </li></ul>
    72. 96. 4. Cervical Changes <ul><li>Ferning or arborization of cervical mucus </li></ul><ul><li>At the height of estrogen stimulation just before ovulation </li></ul><ul><li>Ferning - due to crystallization of sodium chloride on mucus fibers </li></ul>
    73. 97. 5. Basal Body Temperature <ul><li>Involves taking the temperature every morning BEFORE the woman gets out of bed and recording it </li></ul><ul><li>The temperature drops slightly 24 hours before ovulation, then rises to about half a degree higher than normal and remains thus for up to three days: UNSAFE period! </li></ul><ul><li>Not a very efficient method unless combined with calendar and mucus methods </li></ul>
    74. 98. 6. MOOD CHANGES DUE TO HORMONAL CHANGES 7. BREAST CHANGES AND ENLARGEMENT AND NIPPLES BECOME ERECT 8. INCREASED LIBIDO
    75. 99. <ul><li>FUNCTIONS OF ESTROGEN : </li></ul><ul><li>ASSISTS WITH THE MATURATION OF THE PRIMARY FOLLICLE </li></ul><ul><li>2. CAUSES THICKENING OF THE ENDOMETRIUM, STIMULATES GROWTH OF VAGINA & UTERUS </li></ul><ul><li>3. RESPONSIBLE FOR THE DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS ( BREAST DEVELOPMENT) </li></ul><ul><li>4. INHIBITS FSH PRODUCTION </li></ul><ul><li>5. INCREASES CONTRACTIONS OF THE MYOMETRIUM </li></ul>
    76. 100. 6. INCREASES CONTRACTIONS OF THE FALLOPIAN TUBES 7. INCREASES QUANTITY AND PH OF CERVICAL MUCUS CAUSING IT TO BECOME THIN & WATERY & CAN BE STRETCHED TO A DISTANCE OF 10-13CM ( SPINNBARKHEIT TEST OF ELASTICITY ) 8. STIMULATES UTERINE CONTRACTIONS
    77. 101. <ul><li>FUNCTIONS OF PROGESTERONE : </li></ul><ul><li>INCREASES BBT( THERMOGENIC EFFECT) </li></ul><ul><li>2. PREPARES THE ENDOMETRIUM FOR IMPLANTATION BY INCREASING GLYCOGEN, ARTERIAL BLOOD, SECRETORY GLANDS, AMINO ACIDS AND WATER. </li></ul><ul><li>3. MAINTAINS PREGNACY BY INHIBITING UTERINE CONTRACTIONS </li></ul><ul><li>4. INHIBITS THE PRODUCTION OF LH </li></ul><ul><li>5. PROMOTES GROWTH OF THE ACINI CELLS OF THE BREASTS </li></ul>
    78. 102. <ul><li>CAUSES SECRETORY CHANGES IN THE ENDOMETRIUM IN PREPARATION FOR IMPLANTATION </li></ul>
    79. 103. <ul><li> FUNCTIONS OF PITUITARY HORMONES </li></ul><ul><li>FOLLICLE STIMULATING HORMONE (FSH) </li></ul><ul><li>= STIMULATES THE DEVELOPMENT OF GRAAFIAN FOLLICLE & THE OVUM </li></ul><ul><li>= MAKES THE OVUM MATURE </li></ul><ul><li>2. LUTEINIZING HORMONE ( LH) </li></ul><ul><li>= STIMULATES OVULATION AND DEVELOPMENT OF CORPUS LUTEUM </li></ul>
    80. 104. Menstrual disorders 1. Dysmenorrhea – painful menstruation 2. POLYMENORRHEA = TOO FREQUENT MENSTRUATION OCCURING AT INTERVALS OF LESS THAN THREE WEEKS 3. MENORRHAGIA = EXCESSIVE MENSTRUAL BLEEDING 4. METRORRHAGIA = BLEEDING BETWEEN PERIODS; INTERCYCLIC BLEEDING 5. HYPOMENORRHEA = ABNORMALLY SHORT MENSTRUATION 6. HYPERMENORRHEA = ABNORMALLY LONG MENSTRUATION 7. AMENORRHEA – absence of menses 8 . OLIGOMENORRHEA – decreased menstrual flow
    81. 105. <ul><li>SEXUAL RESPONSE CYCLE </li></ul><ul><li>EXCITEMENT PHASE = OCCURS WITH PHYSICAL, PSYCHOLOGICAL ( SIGHT, SOUND, EMOTION OR THOUGHT) STIMULATION THAT CAUSES PARASYMPATHETIC NERVE STIMULATION </li></ul><ul><ul><li>= VAGINAL LUBRICATION OCCURS, ARTERIAL DILATION & VENOUS CONSTRICTION IN THE GENITAL AREA, OVERALL MUSCLE TENSION INCREASES. IN MEN, ERECTION INCREASES, CR,RR,BP INCREASES </li></ul></ul>
    82. 106. 2. PLATEAU PHASE = NIPPLES BECOME FURTHER ENGORGED. IN MEN, VASOCONGESTION LEADS TO FULL DISTENTION OF THE PENIS, FLUSHING OCCURS “SEX FLUSH”, BREATHING BECOMES DEEPER, CR,RR & BP INCREASE MARKEDLY 3. ORGASMIC PHASE = SHORTEST STAGE IN THE SEXUAL RESPONSE CYCLE, STRONG MUSCULAR CONTRACTIONSBOTH VOLUNTARY & INVOLUNTARY IN MANY PARTS OF THE BODY, RR,CR DOUBLES AND BP INCREASING AS MUCH AS 1/3 ABOVE NORMAL.
    83. 107. 4. RESOLUTION PHASE = GENERALLY TAKES APPROXIMATELY 30 MINUTES FOR BOTH MEN & WOMEN , GENERAL MUSCLE RELAXATION OCCURS, EXTERNAL & INTERNAL ORGANS TO UNAROUSED STATE. ** REFRACTORY PHASE IN MEN
    84. 108. <ul><li> FETAL DEVELOPMENT </li></ul><ul><li>OVUM : </li></ul><ul><li>IT IS THE FEMALE SEX CELL OR FEMALE GAMETE. </li></ul><ul><li>REGULARLY RELEASED BY THE OVARY BY OVULATION </li></ul><ul><li>ONLY ONE OVUM REACHES MATURITY EVERY MONTH </li></ul><ul><li>4. OVUM HAS 2 LAYERS OF PROTECTIVE COVERING ; A RING OF FLUID CALLED“ ZONA PELLUCIDA ”, & A CIRCLE OF CELLS CALLED “ CORONA RADIATA ” </li></ul><ul><li>= these structures increase the bulk of the ovum, facilitating its migration to the uterus. </li></ul>** MATUR
    85. 109. ** OVUM CAN STAY VIABLE & IS CAPABLE OF BEING FERTILIZED FOR 12-24 HOURS AFTER OVULATION BUT CAN LIVE UP TO 3-4 DAYS. ** MATUR
    86. 110. <ul><li>** ONLY ONE SPERMATOZOON IS ABLE TO PENETRATE THE CELL MEMBRANE OF THE OVUM AFTERWHICH THE OVUM BECOMES IMPERVIOUS TO OTHER SPEMATOZOA. </li></ul><ul><li>2 KINDS OF SPERM CELL: </li></ul><ul><li>GYNOSPERM – X CARRYING SPERM CELL. It has a large oval head, lesser in number than androsperms & thrive better in acidic environment. </li></ul><ul><li>ADROSPERM – Y CARRYING CELL. It has a small head & thrive better in alkaline environment </li></ul>
    87. 112. ** HAS 3 PARTS : HEAD THAT CONTAIN CHROMATIN MATERIALS; NECK OR MID PIECE THAT PROVIDE ENERGY & TAIL THAT IS RESPONSIBLE FOR ITS MOTILITY. **SPERMATOZOA DEPOSITED IN THE VAGINA REACHES THE WAITING EGG IN THE FALLOPIAN TUBE IN ABOUT 5 MINUTES ** THE FUNCTIONAL LIFE OF SPERMATOZOA IS 48-72 HRS (OR 3 TO 4 DAYS AFTER EJACULATION) BUT CAN STAY ALIVE IN THE VAGINA FOR 5 -7 DAYS. SPERM CELL : .
    88. 113. Insemination <ul><li>Deposition of the sperm in the female internal organs which occur during sexual intercourse </li></ul><ul><li>Although millions of sperms are deposited in the vagina, only a few reach the uterus because many of them are immobilized by the acidic vaginal environment </li></ul>
    89. 114. <ul><li>FERTILIZATION ( CONCEPTION, FECUNDATION, IMPREGNATION) </li></ul><ul><li>= IT IS THE UNION OF A MATURED EGG AND A SPERM & THE PRODUCT IS CALLED A CONCEPTUS OR ZYGOTE . </li></ul><ul><li>=IT OCCURS AT THE DISTAL 3 RD OF THE FALLOPIAN TUBE – THE AMPULLA </li></ul><ul><li>Before fertilization can happen, two things must occur: </li></ul><ul><li>Ovulation </li></ul><ul><li>Insemination </li></ul>
    90. 115. ** When the sperm cell reaches the uterus, it removes its protective covering, a process called “ CAPACITATION” , the outer covering at the head of the sperm cell disappears & tiny holes appear on it. ** when it meets the ovum in the fallopian tube it secretes the enzymes HYALURONIDASE through the holes in its head which dissolves the outermost covering of the egg cell, the corona radiata (a process called “ ACROSOME REACTION ”.) ** when radiata is dissolved, the sperm will again secrete another enzyme called ACROSIN to dissolve a portion of the zona pellucida & will enter the ovum.
    91. 116. ** once the sperm cell has entered the ovum & their nucleus has fused together, fertilization is completed . ** the plasma membrane of the ovum will undergo structural changes to prevent POLYSPERMY ( or other sperms cells entering the ovum) ** the hereditary traits & characteristics of a person are found in the cell’s nucleus in the form of chromosomes. Each strand of chromosome is made up of thousands of genes that are composed of protein substances called deoxyribose nucleic acid (DNA) & ribonucleic acid (RNA)
    92. 117. ** REPRODUCTIVE CELLS, DURING GAMETOGENESIS DIVIDE BY MEIOSIS ( HAPLOID NUMBER OF DAUGHTER CELLS ) THEREFORE THEY CONTAIN ONLY 23 CHROMOSOMES). = 22 pairs of autosomes = 1 pair of sex chromosomes
    93. 118. ** ( BODY CELLS OR SOMATIC CELLS HAVE 46 CHROMOSOMES BEC THEY DIVIDE VIA MITOSIS) ** SPERMS HAVE 23 CHROMOSOMES = 22 AUTOSOMES & 1 X SEX CHROMOSOME OR 1 Y SEX CHROMOSOME. ** THE UNION OF AN X CARRYING SPERM (GYNOSPERM) & A MATURE OVUM RESULTS IN A BABY GIRL (XX) ** THE UNION OF A Y CARRYING SPERM(ANDROSPERM) & A MATURE OVUM RESULTS IN A BABY BOY (XY) ** ONLY FATHERS CAN DETERMINE THE SEX OF THEIR CHILDREN ** SEX OF A CHILD IS DETERMINED AT THE TIME OF FERTILIZATION.
    94. 119. <ul><li>Genes – basic units of heredity that detrmine both the physical and cognititve characteristics of people </li></ul><ul><li>Phenotype – refers to his or her outward appearance or the expression of the genes </li></ul><ul><li>Genotype – refers to his or her actual gene composition </li></ul><ul><li>Genome – complete set of genes present </li></ul><ul><ul><li>46XX or 46XY </li></ul></ul>
    95. 120. <ul><li>Ex: </li></ul><ul><li>46XX5p- = female with 46 chromosomes but with the short arm of chromosome 5 missing( cru de chat syndrome) </li></ul><ul><li>47XX21 or 47 XY21 – person has an extra chromosome21 ( Trisomy 21 or Down’s syndrome) </li></ul>
    96. 121. ZYGOTE : - IS THE FIRST CELL FORMED FROM THE FERTILIZATION OF SPERM & OVUM. - IT CONTAINS 46 CHROMOSOMES: 44 AUTOSOMES & EITHER XX CHROMOSOMES IF THE OFFSPRING IS A FEMALE, OR XY CHROMOSOME, IF THE OFFSPRING IS A MALE. - IT JOURNEYS FROM THE FALLOPIAN TUBE TO THE UTERUS FOR 3-5 DAYS - 16 HOURS AFTER FERTILIZATION, IT UNDERGOES ITS FIRST CELL DIVISION ,” BLASTOMERE”
    97. 124. - WHEN THERE ARE ALREADY 16 OR MORE BLASTOMERES, THE ZYGOTE IS TERMED “ MORULA ”( MORUS – MULBERRY) - WHEN IT REACHES THE UTERUS IT IS TRANSFORMED INTO A “ BLASTOCYST ” – A BALL LIKE STRUCTURE COMPOSED OF AN INNER CELL MASS , CALLED EMBRYONIC DISC OR BLASTOCELE & AN OUTER LAYER OF RAPIDLY DEVELOPING CELLS CALLED TROPHOBLASTS OR TROPHODERM. FLUID FILLS THE SPACES FOUND WITHIN THE CELLS. -
    98. 126. <ul><li>The trophoderm layer gives rise to the placenta, fetal membranes, umbilical cord and amniotic fluid </li></ul><ul><li>The important functions of the trophoblasts are to: </li></ul><ul><li>1) absorb nutrients from the endometrium </li></ul><ul><li>2.) secrete a hormone called “ Human Chorionic Gonadotropin ” necessary in prolonging the life of the corpus luteum. </li></ul>
    99. 127. TROPHOBLASTS OR THE OUTER CELLS: AT ABOUT 3 WEEKS, THE TROPHOBLAST CELLS DIFFERENTIATE INTO TWO DISTINCT LAYERS: 1.CYTOTROPHOBLAST OR LANGHAN’S LAYER : - INNER LAYER THAT PROTECTS THE FETUS AGAINST SYPHILIS UNTIL THE 2 ND TRIMESTER. 2. SYNCYTIOTROPHOBLAST OR SYNCYTIAL LAYER : - OUTER LAYER THAT PRODUCES THE HORMONES 1. HUMAN CHORIONIC GONADOTROPIN (HCG), 2.HUMAN PLACENTAL LACTOGEN (HPL). 3.ESTROGEN & 4.PROGESTERONE.
    100. 128. 1.HCG: HUMAN CHORIONIC GONADOTROPIN - FIRST HORMONE TO APPEAR IN PREGNANCY WHICH SERVES AS THE BASIS FOR PREGNANCY TESTING - SECRETED BY TROPHOBLASTS DURING EARLY PREGNANCY - PREVENTS INVOLUTION OF THE CORPUS LUTEUM, STIMULATES IT TO CONTINUE PRODUCING PROGESTERONE AND ESTROGEN FOR 11-12 WEEKS - 8 – 10 DAYS AFTER FERTILZATION, HCG IS PRESENT IN THE MATERNAL BLOOD - FEW DAYS AFTER MISSED MENSES (+) IN THE URINE
    101. 129. <ul><li>2. Human placental lactogen </li></ul><ul><li>makes sufficient amount of protein, glucose, and minerals </li></ul><ul><li>an insulin antagonist (maternal metabolism of glucose) </li></ul><ul><li>- ensures that the mother’s body is prepared for lactation </li></ul>
    102. 130. <ul><li>3. Estrogen </li></ul><ul><li>- stimulates development of uterine and breast tissues in the mother </li></ul><ul><li>- increases vascularity and vasodilation in the villous capillaries </li></ul>
    103. 131. <ul><li>4. Progesterone </li></ul><ul><li>- after 11 weeks of pregnancy, placenta takes over the production of progesterone from the corpus luteum </li></ul><ul><li>- it is a smooth muscle relaxant, prevents uterine contraction by decreasing its contractility </li></ul><ul><li>- also maintains the endometrium </li></ul>
    104. 132. ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS
    105. 133. - At the time of implantation, the blastocyst already has differentiated at which two separate cavities appear in the inner structure.1. a large one, the Amniotic cavity which is lined with ECTODERM cells 2. a smaller cavity, the yolk sac, lined with ENDODERM cells ( provides fetal RBC until the embryo’s hematopoietic system matures on the 12 th week after which it atrophies) - Between the amniotic cavity and the yolk sac, a third layer of cells, the MESODERM forms . The embryo will begin to develop at the point where the three cell layers ( ECTODERM, MESODERM, ENDODERM) meet called embryonic shield.
    106. 134. - THE BLASTOCELE OR EMBRYONIC DISC GIVES RISE TO THE THREE PRIMARY GERM LAYERS: ECTODERM, MESODERM, ENDODERM.
    107. 135. PRIMARY GERM LAYERS TISSUE LAYER BODY PORTIONS FORMED ECTODERM NERVOUS SYSTEM, SKIN, HAIR ( OUTER LAYER) NAILS, SENSE ORGANS, MUCUS MEMBRANES OF NOSE & MOUTH MESODERM CONNECTIVE TISSUE, BONES, ( MIDDLE LAYER) CARTILAGE, MUSCLES, TENDONS, KIDNEYS, URETERS, REPRODUCTIVE SYSTEM, HEART, CIRCULATORY SYSTEM, BLOOD CELLS
    108. 136. ENDODERM / ENTODERM LINING OF THE GI TRACT, ( INNER LAYER) RESPIRATORY TRACT, TONSILS, PARATHYROID, THYROID, THYMUS GLANDS, BLADDER, URETHRA
    109. 137. <ul><li>FETAL MEMBRANES : - </li></ul><ul><li>= this enclose the fetus & the amniotic fluid. They also protect the fetus against ascending bacterial infection. Once the integrity of the membranes are destroyed, the woman is prone to develop infection. </li></ul><ul><li>CHORIONIC MEMBRANE – ( OUTER MEMBRANE) = TOGETHER WITH THE DECIDUA BASALIS GIVES RISE TO THE PLACENTA . IT CONTAINS 15-20 COTYLEDONS . </li></ul>
    110. 138. 2. AMNIOTIC MEMBRANE –( INNER FETAL MEMBRANE) = IT IS A SMOOTH, THIN, TOUGH & TRANSLUCENT MEMBRANE DIRECTLY ENCLOSING THE FETUS & THE AMNIOTIC FLUID. IT IS CONTINUOUS WITH THE UMBILICAL CORD & COVER THE FETAL SURFACE OF THE PLACENTA & UMBILICAL CORD. = AMNION & CHORION DOES NOT CONTAIN NERVE ENDINGS
    111. 141. IMPLANTATION/NIDATION - THE BLASTOCYST REMAINS FREE FLOATING IN THE UTERINE CAVITY FOR 3-5 DAYS & IMPLANTS IN THE ENDOMETRIUM 6-7 ( 8-10 ) DAYS AFTER FERTILIZATION. - AS IT ATTACHES ITSELF TO THE WALL OF THE UTERUS ( APPOSITION ), ITS TROPHOBLAST CELLS RELEASE ENZYMES ALLOWING IT TO BURROW DEEP & THEN ATTACHES INTO THE ENDOMETRIUM ( ADHESION ) RESULTING IN RUPTURE OF VESSELS & BLEEDING AT THE IMPLANTATION SITE. “ IMPLANTATION BLEEDING ”. AFTERWHICH IT SETTLES DOWN INTO ITS SOFT FOLDS ( INVASION) IMPLANTA
    112. 142. <ul><li>IMPLANTATION IS AN IMPORTANT STEP IN PREGNANCY BECAUSE AS MANY AS 50% of zygotes never achieve it. </li></ul>
    113. 143. <ul><li>DECIDUA: </li></ul><ul><li>- AFTER IMPLANTATION, THE ENDOMETRIUM IS NOW REFERRED TO AS THE DECIDUA . </li></ul><ul><li>LAYERS: </li></ul><ul><li>DECIDUA BASALIS – LAYER WHERE IMPLANTATION TAKES PLACE. IT WILL LATER ON FORM THE MATERNAL SIDE OF THE PLACENTA. </li></ul><ul><li>DECIDUA CAPSULARIS – LAYER WHICH ENCLOSES, ENVELOPES THE BLASTOCYST & BECOMES THE BAG OF WATER. </li></ul><ul><li>. DECIDUA VERA – REMAINING LAYER </li></ul>
    114. 145. AMNIOTIC FLUID : - 500 ML TO 1200 ML AT TERM; AVERAGE 1000 ML; replaced approximately every 3 hours - 99% WATER & 1% SOLID PARTICLES CONTAINING ALBUMIN, UREA, URIC ACID, CREATININE, LECITHIN, SPHINGOMYELIN, BILIRUBIN & VERNIX CASEOSA. - SHOULD BE CLEAR, COLORLESS TO STRAW COLORED WITH TINY SPECKS OF VERNIX CASEOSA. - AMNIOTIC FLUID VOLUME INCREASES DURING PREGNANCY & PEAKS APPROXIMATELY 2 WEEKS BEFORE EDC
    115. 146. AMNIOTIC FLUID <ul><li>fetus contributes to the fluid through urine excretion and absorbs from it by swallowing </li></ul><ul><li>Hydramnios or polydydaramnios (> 2000 ml)- </li></ul><ul><li>Oligohydramnios (< 500) ml indicates disturbance in kidney function </li></ul>
    116. 147. <ul><li>ABNORMAL AMNIOTIC COLORS : </li></ul><ul><li>GREEN TINGES OR MECONIUM STAINED IN A NON BREECH PRESENTATION – SIGNIFIES FETAL DISTRESS </li></ul><ul><li>2. GOLD OR YELLOW – SIGNIFIES HEMOLYTIC DISEASE SUCH AS Rh OR ABO INCOMPATIBILITY </li></ul><ul><li>3. GRAY – INDICATES INFECTION </li></ul><ul><li>4. PINK – SIGNIFIES BLEEDING </li></ul>
    117. 148. <ul><li>FUNCTIONS OF AMNIOTIC FLUID : </li></ul><ul><li>PROTECTS THE FETUS FROM TRAUMA, BLOWS & PRESSURE </li></ul><ul><li>2. ALLOWS FREEDOM OF MOVEMENT WHICH PERMITS SYMMETRICAL GROWTH & DEVELOPMENT </li></ul><ul><li>3.MAINTAINS A CONSTANT TEMPERATURE. </li></ul><ul><li>4. SOURCE OF ORAL FLUID INTRAUTERINE. </li></ul><ul><li>5. AIDS IN DIAGNOSIS OF MATERNAL & FETAL COMPLICATIONS. </li></ul><ul><li>6. AIDS IN FETAL DESCENT DURING LABOR BY PROVIDING LUBRICATION IN THE BIRTH CANAL. </li></ul>
    118. 149. UMBILICAL CORD / FUNIS -STRUCTURE THAT CONNECTS THE FETUS TO THE PLACENTA - MAIN FUNCTION IS TO CARRY O2 & NUTRIENTS FROM THE PLACENTA TO THE FETUS & RETURN THE UNOXYGENATED BLOOD & FETAL WASTE PRODUCTS TO THE PLACENTA. - 50 -55 CMS LONG. APPEARS DULL WHITE,MOIST & COVERED BY AMNION. - COMPOSED OF 2 ARTERIES & 1 VEIN ( AVA ) - IF ONLY TWO BLOOD VESSELS, SUSPECT RENAL AND CARDIAC ANOMALIES.
    119. 150. - 2 arteries carry deoxygenated blood from the fetus to the placenta - 1 vein carries oxygenated blood to the fetus, along with nutrients, hormones etc
    120. 151. ** UMBILICAL CORD ORIGINATES FROM THE YOLK SAC & UMBILICAL VESICLES. ** WHARTON’S JELLY – GELATINOUS SUBSTANCE THAT COVERS THE UMBILICAL CORD TO PREVENT TRAUMA TO THE CORD.
    121. 153. <ul><li>CORD INSERTION : </li></ul><ul><li>*1. CENTRAL INSERTION – NORMALLY, THE CORD IS INSERTED AT THE CENTER OF THE FETAL SURFACE OF THE PLACENTA. </li></ul>
    122. 154. <ul><li>*2. LATERAL INSERTION – WHEN THE CORD IS INSERTED AWAY FROM THE CENTER OF THE PLACENTA BUT NOT AT ITS EDGES. </li></ul>
    123. 155. 3. Velamentous insertion of the cord <ul><li>The cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion </li></ul><ul><li>May be found in multiple gestation </li></ul><ul><li>May be associated with fetal anomalies </li></ul>MLNG CELESTE, RN, MD
    124. 156. * 4. Battledore insertion <ul><li>The cord is inserted marginally rather than centrally </li></ul><ul><li>The cord is inserted at the edge of the placenta </li></ul>
    125. 158. Cord Abnormalities <ul><li>Knots of the Cord – fetal movements may cause knots in the cord which could lead to perinatal loss. Its incidence is high in monoamniotic twinning. Normal false knots results from kinking to accommodate cord length. </li></ul><ul><li>Loops of the Cord- the cord may coil around the fetal body and neck. When cord coil is in the neck, it is called nuchal cord . </li></ul>
    126. 159. Umbilical knot
    127. 160. THE PLACENTA IS FORMED FROM THE CHORIONIC VILLI AND DECIDUA BASALIS . ** ITS GROWTH PARALLELS THAT OF THE FETUS, GROWING FROM A FEW IDENTIFIABLE CELLS AT THE BEGINNING OF PREGNANCY TO AN ORGAN 15 TO 20 CM IN DIAMETER. IT COVERS ABOUT HALF OF THE SURFACE OF THE INTERNAL UTERUS * IT REACHES MATURITY AT 8 WEEKS AND BECOMES FUNCTIONAL AT 12 WEEKS GESTATION ( 3 MONTHS) AND CONTINUE TO FUNCTION EFFECTIVELY UNTIL THE 40 TO 41ST WEEK.. IT BEGINS TO DEGENERATE AFTER THE 42ND WEEK MAKING IT DANGEROUS FOR THE FETUS TO REMAIN IN UTERO BEYOND 42 WEEKS GESTATION. * DEVELOPMENT IS STIMULATED BY PROGESTERONE SECRETED BY THE CORPUS LUTEUM PLACENTA
    128. 161. <ul><li>Placenta - membranous vascular organ connecting the fetus to the mother, supplies the fetus with oxygen and food and transports waste product out of fetal system </li></ul><ul><li>- development is stimulated by progesterone secreted by corpus luteum </li></ul><ul><li>( 3 rd wk after fertilization) </li></ul><ul><li>- fully functional by the 12 th week </li></ul>
    129. 162. <ul><li>2 sides of placenta: </li></ul><ul><li>1.maternal side which is irregular and is divided into subdivisions called cotyledons </li></ul><ul><li>2. fetal side covered by amnion, so it is smooth and shiny </li></ul>
    130. 164. FUNCTIONS OF THE PLACENTA 1. RESPIRATORY SYSTEM = EXCHANGE OF GASES TAKES PLACE IN THE PLACENTA, NOT IN THE FETAL LUNG 2. RENAL SYSTEM = WASTE PRODUCTS ARE BEING EXCRETED THROUGH THE PLACENTA NOTE: IT IS THE MOTHER’S LIVER WHICH DETOXIFIES THE FETAL WASTE PRODUCTS 3. GASTROINTESTINAL SYSTEM = NUTRIENTS PASS TO THE FETUS VIA THE PLACENTA BY DIFFUSION THROUGH THE PLACENTAL TISSUES.
    131. 165. 4. CIRCULATORY SYSTEM = FETO PLACENTAL CIRCULATION IS ESTABLISHED BY SELECTIVE OSMOSIS 5. PROTECTIVE BARRIER = INHIBITS PASSAGE OF CERTAIN BACTERIA & LARGE MOLECULES ** PROVIDES MATERNAL IMMUNOGLOBULIN G ( IG G) THAT GIVES FETUS PASSIVE IMMUNITY TO CERTAIN DISEASES FOR THE FIRST FEW MONTHS AFTER BIRTH. 6. ENDOCRINE SYSTEM = PRODUCES HORMONES HCG, HPL ( HUMAN PLACENTAL LACTOGEN “ CHORIONIC SOMATOMAMMOTROPIN”, ESTROGEN , PROGESTERONE, RELAXIN
    132. 168. Anomalies of the placenta and cord <ul><li>Placenta </li></ul><ul><li>Weighs approximately 500 g and is 15 – 20 cm in diameter, 1.5 – 3 cm thick </li></ul><ul><li>Weight is 1/6 of the fetus </li></ul><ul><li>Maternal and fetal sides </li></ul><ul><li>Umbilical cord </li></ul><ul><li>length:55 cm at term </li></ul><ul><li>1 vein (carries oxygenated blood to the fetus) </li></ul><ul><li>2 arteries (carry deoxygenated blood from fetus to placenta) </li></ul><ul><li>Wharton’s jelly, gelatinous substance </li></ul><ul><li>Cord extends from the fetal surface of the placenta to the fetal umbilicus </li></ul>
    133. 169. Placenta succenturiata <ul><li>Placenta has 1 or more accessory lobes connected to the main placenta by blood vessels </li></ul>
    134. 170. Placenta circumvallata <ul><li>Ordinarily, chorion membrane begins at the edge of the placenta; no chorion covers the fetal side of the placenta </li></ul><ul><li>This kind- the fetal side of the placenta is covered with chorion </li></ul>
    135. 171. Abnormal Placental Implantation <ul><li>Placenta Acreta – invasion of the placenta deep into the endometrium </li></ul><ul><li>Placeta increta- invasion of the placenta into the myometrium </li></ul><ul><li>Placenta percreta – penetration of the placenta through the myometrium to the serosa </li></ul><ul><li>Vasa previa – placental vessels crossing the cervical os </li></ul>
    136. 172. The Growing Fetus
    137. 173. <ul><li>STAGES OF FETAL GROWTH AND DEVELOPMENT </li></ul><ul><li>PRE-EMBRYONIC or GERMINAL STAGE = FIRST 2 WEEKS BEGINNING WITH FERTILIZATION ( ZYGOTE ) </li></ul><ul><li>B. EMBRYONIC = WEEKS 2-8, CONSIDERED THE MOST CRITICAL IN FETAL STAGE BECAUSE OF ORGANOGENESIS. </li></ul><ul><li>( EMBRYO ) </li></ul><ul><li>C. FETAL = WEEKS 8 TO BIRTH ( FETUS) </li></ul>
    138. 174. NORMAL FETAL DEVELOPMENT ( measurement done at end of the lunar month) 4 WEEKS FORM OF EMBRYONIC DISC, NOT CLEARLY DEFINED FEATURES, SPINAL CORD IS FORMED; RUDIMEN TARY HEART APPEARS AS A PROMINENT BULGE ON THE ANTERIOR SURFACE, ARMS & LEGS BUD LIKE STRUCTURES, RUDIMENTARY EYES, EARS, & NOSE ARE DISCERNABLE L = 0.75 to 1 cm W= 400 mg
    139. 175. 8 WEEKS ORGANOGENESIS IS COMPLETE, HEART BEATS RHYTHMICALLY, , FACIAL FEATURES ARE DISCERNABLE,EXTREMITIES HAVE DEVELOPED,, EXTERNAL GENITALIA PRESENT BUT SEX IS NOT DISTINGUISHABLE PRIMITIVE TAIL IS REGRESSING, ABDOMEN APPEARS LARGE AS FETAL INTESTINES GROWS RAPIDLY,EYES MOVE FROM FACE TO FRONT SONOGRAM SHOWS GESTATIONAL SAC ( DIAGNOSTIC OF PREGNANCY) L= 2.5 cm ( 1 inch) W=20g
    140. 176. 12 WEEKS NAIL BEDS FORMING ON FINGERS & TOES, BONE OSSIFICATION BEGINS, TOOTH BUDS PRESENT, SEX DISTINGUISHABLE BY OUTWARD APPEARANCE, KIDNEYS SECRETE, HEARTBEAT AUDIBLE BY A DOPPLER 16 WEEKS FETAL HEART SOUNDS AUDIBLE VIA FETOSCOPE , LANUGO IS WELL FORMED, LIVER & PANCREAS FUNCTIONING, FETUS SWALLOWS AMNIOTIC FLUID SHOWING AN INTACT BUT UNCOORDINATED SWALLOWING REFLEX, SEX CAN BE DETERMINED BY ULTRASOUND; QUICKENING FELT BY A MULTIGRAVIDA L=7 TO 8 CM w- 45G L-10 TO 17CM W-55 TO 120 G
    141. 177. 20 WEEKS QUICKENING FELT BY A PRIMAGRAVIDA, ANTIBODY PRODUCTION IS POSSIBLE, HAIR FORMS INCLUDING EYEBROWS & HAIR ON HEAD, MECONIUM PRESENT IN UPPER INTESTINE, BROWN FAT ( AIDS IN TEMPERATURE REGULATION AT BIRTH) BEGINS TO BE FORMED BEHIND THE KIDNEYS, STERNUM, & POSTERIOR NECK, FETAL HEART AUDIBLE VIA STETHOSCOPE, VERNIX CASEOSA BEGINS TO FORM, DEFINITE SLEEPING PATTERNS ARE DISTINGUISHABLE ( WILL GUIDE SLEEP/WAKE PATTERNS THROUGHOUT LIFE L= 25 CMS W= 223g
    142. 179. 24 WEEKS PASSIVE ANTIBODY TRANSFER FROM MOTHER TO FETUS BEGINS .INFANTS BORN BEFORE ANTIBODY . TRANSFER HAS TAKEN PLACE HAVE NO NATURAL IMMUNITY & NEED MORE THAN THE USUAL PROTECTION AGAINST INFECTIOUS DISEASE IN THE NEWBORN UNTIL THE INFANT’S OWN STORE OF IG’S CAN BUILD UP; MECONIUM IS PRESENT IN THE RECTUM; ACTIVE PRODUCTION OF LUNG SURFACTANT BEGINS; EYEBROWS & EYELASHES WELL DEFINED; EYELIDS NOW OPEN; PUPILS REACTIVE TO LIGHT; HEARS IN RESPONSE TO SUDDEN SOUND. L = 28 TO 36 CMS W= 550g
    143. 180. 28 WEEKS LUNG ALVEOLI BEGINS TO MATURE; SURFACTANT PRESENT IN AMNIOTIC FLUID; TESTES BEGIN TO DESCEND;BLOOD VESSELS OF THE RETINA ARE THIN & EXTREMELY SUSCEPTIBLE TO DAMAGE ( an imp. consideration when caring for preterm infants who need oxygen) 32 SUBCUTANEOUS FAT BEGINS TO BE DEPOSITED ( THE FORMER “ STRINGY” OLD MAN APPEARANCE IS LOST); FETUS IS AWARE OF SOUNDS OUTSIDE THE MOTHERS BODY; ACTIVE MORO REFLEX PRESENT, BIRTH POSITION( VERTEX OR BREECH) MAY BE ASSUMED; IRON STORES THAT PROVIDE IRON FOR THE TIME THAT THE NEONATE WILL INGEST ONLY MILK AFTER BIRTH ARE BEGINNING TO BE DEVELOPED; FINGERNAILS GROW TO REACH END OF FINGERTIPS. weeks
    144. 181. 36 WEEKS ADDITIONAL AMOUNTS OF SUBCATANEOUS FATS ARE DEPOSITED ; SOLE OF THE FOOT HAS ONLY ONE OR TWO CRISSCROSS CREASES; LANUGO BEGINS TO DIMINISH; MOST BABIES TURN INTO A VERTEX OR HEAD-DOWN PRESENTATION DURING THIS MONTH 40 WEEKS FETUS KICKS ACTIVELY CAUSING DISCOMFORT TO THE MOTHER; VERNIX CASEOSA IS FULLY FORMED; ** IN PRIMIPARAS, THE FETUS OFTEN SINKS INTO THE BIRTH CANAL DURING THE LAST TWO WEEKS ( UP TO 4 WEEKS), GIVING THE MOTHER A FEELING THAT HER LOAD IS BEING LIGHTENED. THIS IS TERMED LIGHTENING . IT IS A FETAL ANNOUNCEMENT THAT THE THIRD TRIMESTER OF PREGNANCY HAS ENDED AND BIRTH IS AT HAND.** L-48 to 52 cm W-3,000g -7 to 7.5 lbs
    145. 182. ** THE DURATION OF A NORMAL PREGNANCY IS 266 – 280 DAYS OR 38-42 WEEKS ( AVERAGE IS 40 WEEKS) ; OR 9 CALENDAR MONTHS OR 10 LUNAR MONTHS. ** BOTH OVULATION & GESTATIONAL AGE ARE ALSO SOMETIMES MEASURED IN LUNAR MONTHS ( 4 WEEK PERIODS) OR IN TRIMESTERS ( 3 MONTH PERIOD) RATHER THAN IN WEEKS. IN LUNAR MONTHS, A PREGNANCY IS 10 MONTHS ( 40 WEEKS OR 280 DAYS) LONG; A FETUS GROWS IN UTERO 9.5 LUNAR MONTHS OR THREE FULL TRIMESTERS ( 38 WEEKS OR 266 DAYS)
    146. 183. Psychological Tasks of Pregnancy
    147. 184. PATERNAL REACTIONS TO PREGNANCY : A. FIRST TRIMESTER = AMBIVALENCE & ANXIETY ABOUT ROLE CHANGE; CONCERN FOR IDENTIFICATION WITH MOTHER’S DISCOMFORTS ( COUVADE SYNDROME ) B. SECOND TRIMESTER = INCREASED CONFIDENCE & INTEREST IN MOTHER’S CARE; DIFFICULTY RELATING TO FETUS; “ JEALOUSY ”
    148. 185. <ul><li>SIGNS & SYMPTOMS OF PREGNANCY : </li></ul><ul><li>PRESUMPTIVE SIGNS : ( SUBJECTIVE SIGNS – SUGGESTIVE OF PREGNANCY) </li></ul><ul><li>AMENORRHEA of more than 10 days </li></ul><ul><li>2. MORNING SICKNESS ( NAUSEA & VOMITING) </li></ul><ul><li>4. URINARY FREQUENCY </li></ul><ul><li>5. STRIAE GRAVIDARUM </li></ul><ul><li>6. CHLOASMA, MELASMA OR “ MASK OF PREGNANCY” 8. QUICKENING </li></ul><ul><li>7. LINEA NIGRA 9. LEUKORRHEA </li></ul>
    149. 186. SKIN <ul><li>Pink or reddish abdominal streaks ( striae gravidarum ) which is caused by stretching of the skin </li></ul><ul><li>Chloasma or “mask of pregnancy -Increased pigmentation can occur on the face as blotchy brown areas on the forehead an cheeks </li></ul><ul><li>linea nigra – on the abdomen as dark line from the symphysis pubis </li></ul><ul><li>Minute vascular spiders may occur </li></ul><ul><li>The umbilicus is pushed outward, and by about the seventh month its depression disappears and becomes a darkened area on the abdominal wall </li></ul><ul><li>Sweat and sebaceous glands are more active </li></ul>
    150. 187. CHLOASMA LINEA NIGRA STRIAE GRAVIDARUM STRIAE ALBICANTES
    151. 188. <ul><li>PROBABLE SIGNS : ( OBJECTIVE SIGNS) </li></ul><ul><li>CHADWICK’S SIGN – PURPLISH DISCOLORATION OF THE VAGINA DUE TO HIGH VASCULARITY IN THE AREA. </li></ul><ul><li>2. GOODEL’S SIGN – SOFTENING OF THE CERVIX </li></ul><ul><li>3. HEGAR’S SIGN – SOFTENING OF THE LOWER UTERINE SEGMENT. </li></ul><ul><li>4. BALLOTEMENT – BOUNCING OF THE BABY WHEN TAPPED BY AN EXAMINING FINGER. </li></ul><ul><li>5. BRAXTON HICK’S – PAINLESS UTERINE CONTRACTIONS </li></ul><ul><li>6. (+) POSITIVE PREGNANCY TEST </li></ul><ul><li>7. Uterine enlargement </li></ul>
    152. 189. <ul><li>POSITIVE SIGNS OF PREGNANCY : </li></ul><ul><li>( DEFINITELY PREGNANT) </li></ul><ul><li>PRESENCE OF FETAL HEART TONE- audible bet. 17-20 wks gestation with the use of ordinary stet audible by doppler at 8 to 10 weeks </li></ul><ul><li>2. FETAL OUTLINE BY XRAY / ULTRASOUND – may be detected as early as the 6 th wk AOG although usually done at 16-18 wks </li></ul><ul><li>3. FETAL MOVEMENT FELT BY EXAMINER – after 16 wks but usually about 5 th month </li></ul>
    153. 190. SYSTEMIC CHANGES: CIRCULATORY / CARDIOVASCULAR : ** BEGINNING THE END OF THE FIRST TRIMESTER, THERE IS A GRADUAL INCREASE OF ABOUT 30%-50% IN TOTAL CARDIAC VOLUME. THIS CAUSES A DROP IN HgB & HcT VALUES SINCE THE INCREASE IS ONLY IN PLASMA .” PHYSIOLOGIC ANEMIA OF PREGNANCY” Mx : iron supplement
    154. 191. CONSENQUENCES OF INCREASED CARDIAC VOLUME: ** EASY FATIGABILITY & SOB DUE TO INCREASED WORKLOAD OF THE HEART MX: REST ** SLIGHT HYPERTHOPHY OF THE HEART CAUSING IT TO BE DISPLACED TO THE LEFT ** SYSTOLIC MURMURS DUE TO LOWERED BLOOD VISCOSITY ** NOSEBLEEDS MAY OCCUR DUE TO MARKED CONGESTION OF THE NASOPHARYNX
    155. 192. ** PALPITATIONS DUE TO INCREASED PRESSURE ON THE DIAGPHRAGM ** EDEMA OF LOWER EXTERMITIES OCCURS DUE TO POOR CIRCULATION RESULTING FROM PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS MX; > RAISE LEGS ABOVE HIP LEVEL > AVOID PROLONGED STANDING & SITTING NOTE: EDEMA OF THE LE IS NOT A SIGN OF TOXEMIA.
    156. 193. ** VARICOSITIES COULD OCCUR DUE TO PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS OF THE LE MX: > DO NOT CROSS LEGS WHEN SITTING > WEAR SUPPORT HOSE TO PROMOTE VENOUS FLOW THUS PREVENTING STASIS IN THE LOWER EXTREMITIES > AVOID USE OF KNEE HIGH SOCKS
    157. 194. ** VARICOSITIES OF THE VULVA & RECTUM MX: > SIDE LYING POSITION WITH HIPS ELEVATED ON PILLOWS > MODIFIED KNEE CHEST POSITION ** THERE IS INCREASED CIRCULATING FIBRINOGEN ( CLOTTING FACTOR) THAT IS WHY PREGNANT WOMEN ARE NORMALLY SAFEGUARDED AGAINST UNDUE BLEEDING. HOWEVER THIS ALSO PREDISPOSES THEM TO CLOT FORMATION ( THROMBI)
    158. 195. IMPLICATION : PREGNANT WOMEN SHOULD NOT BE MASSAGED SINCE BLOOD CLOTS CAN BE RELEASED & CAUSE THROMBOEMBOLISM. ** DURING DELIVERY, THE ALLOWABLE BLOOD LOSS IS 250-450 ML (MAXIMUM 500 ML) FOR A SINGLE FETUS, 1000 ML FOR VAGINAL DELIVERY OF TWINS OR CESARIAN SECTION.
    159. 196. ** SUPINE HYPOTENSION SYNDROME OR VENA CAVA SYNDROME = THE WEIGHT OF THE GRAVID UTERUS PRESSES ON THE VENA CAVA OBSTRUCTING BLOOD FLOW. THE WOMAN EXPERIENCES LIGHTHEADEDNESS , FAINTNESS & HEART PALPITATIONS . MX: LEFT SIDE LYING OR LEFT LATERAL SO AS NOT TO COMPRESS THE VENA CAVA. NO SUPINE POSITION AFTER 20 WEEKS AOG
    160. 197. RESPIRATORY SYSTEM : ** SLIGHT DYSPNEA MAY OCCUR UNTIL LIGHTENING CAUSED BY INCREASED O2 CONSUMPTION & PRODUCTION OF CO2 GASTROINTESTINAL SYSTEM : ** MORNING SICKNESS MX: EAT DRY CRACKERS 30 MINUTES BEFORE ARISING IN THE MORNING. AVOID SPICY, FATTY FOODS
    161. 198. HYPEREMESIS GRAVIDARUM ( PERNICIOUS VOMITING ) = EXCESSIVE NAUSEA & VOMITING WHICH PERSISTS BEYOND 3 MONTHS THAT COULD RESULT TO DEHYDRATION, STARVATION, MALNUTRITION AND F & E IMBALANCE MX: 3000 ML f Ringer’s Lactate with added Vit B IN 24 HOURS IS THE PRIORITY OF TREATMENT > REST > ANTI- EMETICS (EX. PLASIL, REGLAN ) - Cause is unknown but women with the disorder may have increased thyroid function d/t the thyroid stimulating properties of HCG
    162. 199. <ul><li>CONSTIPATION = DUE TO DISPLACEMENT OF THE STOMACH & INTESTINES AND DUE TO INCREASED PROGESTERONE DURING PREGNANCY ( DECREASED PERISTALSIS </li></ul><ul><li>MX: </li></ul><ul><li>> INCREASE FLUID INTAKE </li></ul><ul><li>> HI - FIBER DIET </li></ul><ul><li>ESTABLISH REGULAR ELIMINATION PATTERN </li></ul><ul><li>EXERCISE </li></ul><ul><li>> MINERAL OIL SHOULD NOT BE USED BECAUSE IT INTERFERES WITH ABSORPTION OF FAT SOLUBLE VITAMINS ( ADEK) </li></ul>
    163. 200. HEARTBURN = REFLUX OF STOMACH CONTENT INTO THE ESOPHAGUS DUE TO INCREASED PROGESTERONE WHICH DECREASES GASTRIC MOTILITY MX: > PATS OF BUTTER BEFORE MEALS > AVOID FRIED, FATTY FOODS > BEND AT THE KNEES NOT AT THE WAIST > TAKE ANTACIDS EX. MILK OF MAGNESIA BUT NEVER SODIUM NHCO3 ( ALKA SELTZER OR BAKING SODA) BECAUSE IT PROMOTES FLUID RETENTION. > DON’T LIE DOWN AFTER EATING
    164. 201. PICA = **ABNORMAL CRAVING FOR NON NUTRITIOUS SUBSTANCES. THE MOST COMMON IS CRAVING FOR ICE CUBES. THERE COULD ALSO BE CRAVING FOR PAPER, ETC., **OFTEN ACCOMPANIES IRON DEFICIENCY ANEMIA **ENCOURAGE TO TAKE IRON SUPPLEMENTS
    165. 202. MUSCULOSKELETAL SYSTEM GRADUAL SOFTENING OF PELVIC LIGAMENTS AND JOINTS TO FACILITATE PASSAGE OF THE BABY. ( RELAXIN) LORDOSIS = FORWARD CURVATURE OF THE LUMBER SPINE . “THE PRIDE OF PREGNANCY ” LEG CRAMPS – ALSO KNOWN AS “CHARLEY HORSE” MAY OCCUR FROM AN IMBALANCE OF CALCIUM / PHOSPHORUS RATIO IN THE BODY AND FROM PRESSURE OF THE UTERUS ON LOWER EXTREMITIES; FATIGUE; CHILLS BACK PAINS – RELIEVED BY WEARING LOW HEELED SHOES
    166. 203. MANAGEMENT: **FREQUENT REST PERIODS WITH FEET ELEVATED **WEAR WARM, COMFORTABLE CLOTHING **INCREASE CALCIUM INTAKE (CALCIUM TABLETS AND DIET) **DO NOT MASSAGE= BLOOD CLOTS CAN CAUSE EMBOLISM
    167. 204. Discomforts associated with pregnancy 1. First trimester <ul><li>Nausea and vomiting (“morning sickness”) related to altered hormone levels and metabolic changes; advise small snacks of dry crackers before arising, small feedings of bland food, milk </li></ul><ul><li>Urinary frequency and urgency without dysuria; fluid intake should not be restricted </li></ul><ul><li>Increased vaginal discharge; manage with good hygiene (but no douching) and loose-fitting cotton underwear; report signs or symptoms of vaginitis </li></ul>
    168. 205. <ul><li>Breast soreness due to hormonal changes; suggest wearing a well-fitting, supportive brassiere </li></ul><ul><li>Headache due to tension from emotional and physical stresses at any time during pregnancy; provide reassurance, suggest relaxation techniques; inform patient to report persistent and/or severe episodes </li></ul>