Gh

1. 1
Fertilization, Implantation and early
Development of the embryo
Lecture 3
3/10/2006

2. 2
Placenta
 Remarkable organ originating from trophoblast layer
of fertilized ovum.
Placental functions
 Transport
 Respiratory
 Nutrient function
 Hormone production
 Storage
 Barrier function (molecular as heparin, syphilis,
toxoplasma

3. 3
Abnormalities In Placenta
– Placenta Marginata: disorder of placental
attachment, mild type of abruption in which
slight separation occurs at the edge of
placenta in region of marginal sinus of mother.
– Placenta circumvallata: opaque ring seen on
fetal surface, its formed by doubling edge.
– Placenta membranacea: covered all of the
fetus.
– Placenta Accretta, increta, percreta

4. 4
Fetus
 Rate of growth development under control of
genetic control and nutrient in body
 Size
--5th wk- sac
--12th wk-30gm
--28th wk-1100gm
--Full term-50cm (2700-3600 gm)

5. 5
Fetal Circulation
 During intra uterine life of fetal, respiratory system is
not functioning because oxygenation of blood is
occurring in placenta, therefore 4-temporary structures
in fetal circulation, these are
 Ductus Venous: runs from umbilical vein to the vena
cava, it carries oxygenated blood to the heart
 Foramen Ovale: allows blood to flow from Rt atrium
directly to Lf atrium (bypass Rt ventricle and fetal
lungs).
 Ductus Arterioses: communicating duct from
pulmonary artery to descending arch of aorta, it carries
deoxygenated blood.
 Hypo gastric arteries: branching from internal iliac
arteries to enter the umbilical cord as umbilical arteries

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7. 7
Summary of fetal circulation
– O2 blood enters fetus via umbilical vein
– Umbilical vein goes straight to liver ,however most of blood go to Ductus
venous to inferior vena cava
– Inferior vena cava carrying co2 blood from lower parts of fetus
– Inferior vena cava empties its blood into Rt atrium
– Main volume of blood passes straight to Lt atrium via foramen Ovale.
– From Lf atrium blood passes to Lt ventricle and out into aorta to supply
brain and upper limbs
– Co2 blood returned from upper part of body via superior vena cava
– From superior vena cava blood travels through Rt atrium and ventricle
to enter pulmonary artery
– Most of the blood bypasses through Ductus Arterioses straight to
descending arch of aorta
– Main volume of blood diverted through hypo gastric arteries to cord and
then to placenta as umbilical arteries for replenishment.

8. 8
Changes after birth
 After clamping umbilical cord and take first
deep breath as a result of stimuli like
-Infant’s thorax first compressed and rapidly re
expands during delivery
-Cold of external environment
-Bright lights
-Noises
-Pressure on infant’s body and sensation of
weight

9. 9

10. 10
Amniotic Fluid (liquor)
 Allows growth and free movement of fetus
 Equalizes pressure and protect fetus from injury
 Maintains temperature and provides small
amounts of nutrients
 In labour protects placenta and umbilical cord
from pressure of uterine contractions
 Aids effacement of cervix and dilatation of
uterine os.

11. 11
Abnormalities
 Polyhydraminus: exceeds 1500 ml (e.g.
encephalopathy)
 Oligohydraminus: less than 300 ml (e.g. fetus
unable to pass urine)
 Meconium: in case of fetal distress

12. 12
Umbilical Cord
 Length 15-120 cm (average 50cm) sufficient
to allow delivery of baby without traction to
placenta occur.
 -Transmits umbilical blood vessels
 -Two arteries from internal iliac artery, un
oxygenated blood and one vein from Ductus
venosus having oxygenated blood.

13. 13
Abnormalities
 Less than 40 cm short cord
 Very long cord may wrapped around neck or
body of fetus or become knotted
 True knots result occlusion of blood vessels
 False knots

14. 14
Fetal Membranes (amniotic Sac)
 Function
 keep amniotic fluid
 Asses in formation of fluid
 Protection
 Asses material exchange.

15. 15
Terminology
 Para- number of births after 20 weeks
gestation regardless of whether the infants
were born alive or dead,twins are
considered a single para
 Primagravida- woman pregnant for the first
time
 Mulrigravida- woman who is in her second or
more pregnancy

16. 16
Terminology
 Gravida-any pregnancy, regardless of
duration
 Nulligravida- a woman who has never
been pregnant
 Primapara-woman who has not given
birth at more than 20weeks gestation
 Multipara-woman who has given birth
two or more times at more than 20
weeks gestation

17. 17
Trimesters & length of
pregnancy
 Average Pregnancy
lasts 280 days-40
weeks and is divided
into trimesters
– 1st trimester 0-
3months(13WK)
– 2ndTrimester 3-6
months(26WK)
– 3rdTrimester-6-9
months(39WK)
– 10 lunar months
– 9 calendar months

18. 18
Profile of previous obstetric
history
 GTPALM
 G=gravida
 T=term
 P=premature
births
 A=abortions
 L= number of
living children
 M= multiple births

19. 19
GTPALM
 A lady who is pregnant has 3 children
and a history of 1 miscarriage (abortion).
 This would be written as follows
– G T P A l M
– 5-3-0-1-3-0

20. 20
 Other institutions use only 2
letters
– P & G to indicate PARA and Gravida
– A woman pregnant for the first time
would be
P0, G1
A woman is pregnant has 4 children
and has a history of 2 abortions
 P4, G 7

21. 21
DETERMINATION OF DATE OF
BIRTH
 Nagele’s rule
 1st day LMP - 3
months + seven
days
 LMP Oct 10th2003
 -3mts July 10th
 +7 days
 EDD= July 17th 2004

22. 22
Pre-natal care
 Improved pre-natal care has dramatically reduced
infant and maternal mortality
 Detecting potential problems early leads to prompt
assessment and treatment
 Preventative measures such as adequate
nutrition, proper exercise, assessment of
pregnancy and a planned regimen of care are
essential
 A pregnant woman should seek health care as
soon as she suspects she is pregnant

23. 23
The initial pre-natal visit
 The initial visit will include
the following data
collection
– Health history
– Past medical history
– Genetic disorders
– Obstetric history
– Personal & social
history
– Physical assessment

24. 24
Take health history
 last period started on
 menstrual cycles are regular and how long they
usually last;
 details about any gynecological problems
 details about any previous pregnancies.
 medical history, including chronic conditions and
medications used to treat them, drug allergies,
psychiatric problems, and any past surgeries or
hospitalizations
 ask about activities such as smoking, drinking,
and drug use that could affect pregnancy.

25. 25
Take family health history
ask if any of relatives or
baby's father or his relatives
have had any chronic or
serious diseases

26. 26
Do a genetic and birth defect
history
 ask if you, the baby's father, or anyone else
in the family has a chromosomal or genetic
disorder or was born with a structural birth
defect.
 know about all the medications and
nutritional supplements you've taken since
your last period
 any exposures to potential toxins

27. 27
Pre-natal visits
 At each pre-natal visit the nurse
collects the following data
– Weight
– Urine for glucose & protein
– Vital signs
– Doppler of the fetal heart beat
– Leopold’s maneuvers to
determine presentation of the
fetus
– Assessment of fundal height

28. 28
Signs of pregnancy
(table9.2),P.223
– Presumptive signs-these signs
suggest pregnancy
– Probable signs-indicate that the woman
is most likely pregnant
– Positive signs- definite evidence that a
woman is pregnant

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30. 30

31. 31

32. 32
Signs of pregnancy
Presumptive
Amenorrhea
Nausea &
vomiting
Urinary
frequency
Quickening
Uterine
enlargement
Pigmentation
changes
Probable
Goodell’s
Hegar’s
Chadwick's sign,
ballottement
braxton hicks
contractions
+preg test
Positive
Fetal heart
sounds,
Outline &
move on
ultrasound

33. 33
How do pregnancy tests work?
 All pregnancy tests look for a special
hormone in the urine or blood that is only
present when a woman is pregnant. This
hormone, human chorionic gonadotropin
(hCG), is also called the pregnancy
hormone.

34. 34
What's the difference between a urine
and a blood pregnancy test?
 Blood tests can pick up hCG earlier in a
pregnancy than urine tests can.
-Blood tests can tell if you are pregnant about 6 to
8 days after you ovulate (or release an egg from
an ovary).
-Urine tests can determine pregnancy about 2
weeks after ovulation. Some more sensitive urine
tests can tell if you are pregnant as one day after
you miss a menstrual period.

35. 35
Counsel and let woman know
what's coming
 eat well
 weight gain
 Discomfort of early pregnancy
 symptoms that require immediate
attention

36. 36
Nursing Diagnosis
 Health-seeking behaviors related to
interest in maintaining optimal health during
pregnancy
 Anxiety related to minor symptoms of
pregnancy
 Risk for fluid volume deficient related to
nausea and vomiting
 Constipation related to reduced peristalsis
during pregnancy

37. 37
Nursing Diagnosis-Cont.
 Disturbed body image R/T change of
appearance with pregnancy
 Risk for ineffective sexuality patterns
R/t fear of harming fetus during pregnancy.
 Disturbed sleep pattern R/t frequent need
to empty bladder during night
 Fatigue R/t metabolic changes of
pregnancy.

38. 38
Danger signs during pregnancy
 Headache –visual disturbances, or dizziness
 Increase in systolic BP 30mmHg or more
 Increase in diastolic blood pressure 15mmHg
 Epigastric pain
 Burning on urination or backache
 Abnormal fatigue and nervousness
 Anginal pain, shortness of breath
 Muscular irritability, confusion, seizures
 Vaginal bleeding or fluid leaking from the vagina