Process of fertilization

*Fertilization must occur within 24-48 hours after ovulation

*The fertile period is 48-72 hours

*Implantation begins 7-10 dyas after fertilization

Process of fertilization

* Fertilization usually occurs in the upper 1/3 of the fallopian tubes (called the ampula)

*Implantation usually occurs ih the upper portion of the uterus a few days following fertilization

*Implantation is complete in 14-15 days

Process in steps of fertilization

* chromosomes fuse and form a zygote

*In 3-4 days has made its way into the uterus, it is now 16-64 cells and is called a morula

Corpus luteum continues to secrete estrogen and progesterone because of HCG produced by thrphoblast cell, this causes the endometrium to grow, it is called the decidua

*On ultrasound there is visualization of pregnancy at 5-6 weeks

* What hormones is sensed in the pregnancy test?

HCG

Placenta

During pregnancy, the endometrium of the uterus is called the decidua.

Description of normal placenta in size and appearance

2 parts, maternal portions, deciduas basalis and its circulation, irregular looking segments called cotlyedons.

* Fetal portion consists of chorionic villi and surface covered by the aminion

* Placenta has acheived full thickness by 20 weeks gestation or 4 months

Description of normal placenta in size and appearance

(cont'd)

* It is 6-10" in diameter

*It is 1" thick

*Normally the shape of the pancake

*Maternal side is reddish, meat liver colored is called {Dirty Duncan}

*Fetal side is shiny called {Shiny Shultz}

Fetal Characteristics in Utero

1st month

{0-4 weeks}

embryo stage

*Heart beat day 24

*From conception to end of the 7th week this is called the embryonic stage

*  FHR is rapid in early development 160-170 bpm

*As fetus matures HR decreases to 110-160 bpm, normal baseline

2nd month

{4-8 weeks}

* organogensis complete {organs are been formed}

* Differentation of three germ layer inot specific tissues

*7th week, rapidly growing intestines hernaited our of small abdominal cavity into umblical cord

3rd month

(9-12 weeks)

* week 9 until birth is called the fetal period

*Spontaneous respirations noted

*fetal movemnt at 13-16 weeks, not felt by mom till 17-20 weeks

*toothbuds

4th month

{13-16 weeks}

* kidneys secrete urine

*meconium (mucus that accumualtes in fetal gut)

*Lanugo-->downy hair on body

5th month

{17-20 weeks}

* movement perceived- quickenening {feeling of movement}

*sleep/active periods, regular schedule of sucking, kicking and sleeping.

*brown fat deposited

*skin covered by vernix caseosa

6th month

(21-24 weeks)

* lungs mature- surfactant secretion begins, full maturity not until 36 weeks

*eyes open and are completely formed

*can hear and respond to sound

*fetus is viable around 24 weeks

7th month

(25-28 weeks)

* lecithin/sphinogomyelin ratio

*increased chance of survival

*lungs are capable of breathing air

8th month

(29-32 weeks)

* suck/swallow

* fat deposited for thermoregulation

*FE stores

*limbs are getting a little chubbier

*32 weeks survival is usual

9th month

(33-36 weeks)

* digestive enzymes present

* firm grasps

*lungs are mature

10th month

(36-40 weeks)

* hemoglobin starts to change

*fingernails over fingers

*sleep wake cycle is fiarly definite

Teratogens in the fetal development period

* the embryonic stage the embryo is very vulnerable to teratogens.

*brain can be affected during the entire pregnancy

1. drugs, x-ray, viral/baterial assault, and environmental can affect the fetus

Fetal Circulation

* Ductus Venosus: {venosus is a shunt that connects a vein to vein}.

Umblical cord carries oxygen rich blood to underside of liver to ductous venousus, inferior umblical vein en route to the right side of the heart.

Fetal Circulation

{cont'd}

Fetal Circulation

{cont'd}

Developmental Tasks of Pregnancy

1st trimester

to accept the biologic fact of pregnancy. The woman needs to be able to state. " I am pregnant"

nursing implications

encourage parent to express feelings about pregnancy.

assimialte to pregnancy state

Developmental Tasks of Pregnancy

2nd trimester

13-26 weeks

To accept the growing fetus as distinct from herself.  The woman can now state "i am going ot have a baby"

nursing implications

measure lvl of acceptance of baby

Developmental Task of Pregnancy

3rd trimester

23-40 weeks

To prepare realsitically for the coming of the coming of the child and prepare to relinquish it.  The woman expresses the thought that "I am going to be parent"

nursing interventions

Look at their birthing plant

want pain meds, epidural

1st signs of labor

lots of education

Imbliviance-indifferece, not wanting to be pregnant.

narcissim-lashing out and into their themselves.  Very concerned out of their appearance.

emotionability-up and down. Easily upset

Couvade- men get the same sickness as woman

Nutritional needs and problems during pregnancy

nutritional assessment and suggested weight gain

300 extra calories women need.

women below 18.5 are extremely thin

If above 35, they are 15 punds

average 25-35 pds

multiple pregnancy- 1pound per week for the rest of the pregnancy

Nutritional Guidance

Special nutritional needs during pregnancy

breast weighs-->1 1/2 pounds

fetus-->7 1/2 pounds

uterus-->2 1/2 pounds

placenta-->1 1/2 pounds

aminiotic-->2 pounds

body fluid-->4 pounds

adolescent nutritional needs

2800 calories

get WIC program

refer to dietician

The pregnant vegetarian

Give vitamin B-12

Get calcium from green veggies, orange juice

extra folic acid and prenatal vitamin

Milk allergic pregnant patients

Can eat cheese.  Find different source of calcium

Green leafy vegetables

The overweight pregnant patient

Big concern

Diabetes & hypertension at risk

Non-nutritive substance during pregnancy

a. alcohol

b. drugs

c. caffeine

d. tobacco

e. pica-{nutrition deficiency}

avoid aspartame

Inadequate nutrional habits

not enough calorie intake

too much caffeine

skip meals

fast foods{gives coronary disease}

Cultural aspects of nutrition during pregnancy

Eat only certain types of meat

Vegetarian & incomplete protein consumption

Eat higher fat meals

eat high carbohydrates

calories-->2500

protein-->60 grams

fat-->10% linoleic acid{essential found in veggie}

ca-->1200 mg

Feh-->30 mg{necessary to build hemoglobin}

Vitamin A-->800 units

Vitamin C-->85 mg

vitamin D-->5 units

vitamin B "folic acid"-->600 units

vitamin e-->15 mg

have increase in blood volume

increase of fluid to  8-10 cups of H2o a day

General guidelines for Good nutrition during pregnancy

a. assess first-don't chge everything

b. do not excessively reduce sodium

c. milk is a poor source of iron {important protein & calcium}

d. extra fluids (8-10 glasses/day)important

Para

Primigravada

Primi para

Multi gravida

multi-para

nulli-gravida

nulli-para

GTPAL

Gravida

Term

Preterm infants

A spontaneous/induced abortions

L# of living children

Duration of Pregnancy

The usual length of pregnancy is 9 1/4 calendar month  {10 lunar months}

first trimester: 0-12 weeks{mths 1-3}

2nd trimester: 13-26 weeks {mths 4-6}

3rd trimester: 27-40 weeks {mths 7-9}

Presumptive signs and subjective signs

a. amenorrhea          e.fatigue

b. nausea/vomiting       f. weight change

c. breast sensitivity       g. quickening

d. frequency/urgency       h. appetite increase

Probable signs/objective signs

(a better indicator of pregnancy)

abdominal changes/uterine growth

16 weeks-->fundus 1/2 way between umblicous and symphysis pubis

20 weeks-->at umblicus

36 weeks-->at xyphoid process

other signs of uterine growth: tumors

Probable signs/objective signs

(a better indicator of pregnancy)

Fetal outline

palpate or actual see the baby

Probable signs/objective signs

(a better indicator of pregnancy)

Uterine/Vaginal/Cervical Changes

The pregnant uterus increases in weight from 2 ounces to about 2 pounds.Changes in size, shape, and consistency which take place in the uterus during the first three months of pregnancy may help the provider to make a tentative diagnosis of pregnancy

* Positional and muscular changes

Hegars sign

(Uterus)

Chadwick's sign

(vaginal and cervical changes)

Goodells Sign

(cervical changes)

Feels soft and plaible instead of firm.

Looks like a donut

shortening-->cervix becomes more elastic in preparation for effacement and dilation which will occur during the first stage of labor

secretion--> cervical glands secrete a thick mucous which acts as a plug in the cervical canal. Called the "mucous plug". Discharge of plug is signs of labor

Positive pregnancy tests

Human chorionic gonadotropin

 psychotropic meds--> give false positive test with urine test

shape-->oblong in shape; large hen egg

uterine wall-->hyperdectodomy{stretches enlargement of preexisting muscles}

contraction--> Braxton Hicks-->20 weeks-preparation for delviery. Hard tight then relax

Vaginal Changes

Ph lowers to 4.5 acidic

White vaginal discharge, loosening of connective tissue

raises vascularity-->pink->purple

cardian-->yeast infection

swelling of the uvula area

Quickening and Ballotment

Happens to 16-20 weeks

Tap the uterine bounce around in amniotic fluid

Breast changes

six weeks

during gestation period, these alveolar cells secrete a thin yellowish fluid called colostrum.

colostrum, the forerunner of breast milk contains proteins, fats, sugar,and water

Breast changes occur early early in pregnancy and are considered a presumptive symptom

color changes of areola, Montgomery tubercules--> enlarge and become prominent

skin changes

a. straie gravidarum-->stretch marks

b. Choasma gravidarum-->pregnancy mask

c. Linea nigra--> line pregnancy

Endocrine system changes

Pregnancy hormones--> and increase of estrogen and progesterone by the corpus luteum until 3rd pregnancy

11 weeks gestation the placneta produces 100% of the hormones for pregnancy

Hormones of Pregnancy

Progesterone-->priamry action to keep the myometrium from contracting

estrogen-->primary female hormone produced by ovaries and placenta, resposnible for sex characteristics

HCG-->keeps the corups luteum producing progesterone until placenta takes over

Hormones of Pregnancy

(cont'd)

hPL-->increases amount of free fatty acid available for maternal needs

Relaxin--> a hormone that softens the articulations in the pelvis

Cardiovascular system changes

Blood volume --> the total vloume increases 40-60% and peaks at 28 weeks

This increase in blood volume, particularly plasma, which accompanies pregnancy results in a pseudo-anemia.

The pregnant woman requires an additional 30 mg iron/day

Schedule of continuing prenatal visits for an uncomplicated pregnancy

Every 4 weeks through 32 weeks

Every 2 weeks through 36 weeks

Every week through 40 weeks

Nutritional Assessment and Suggested Weight Gain

Normal BMi-->25-35

Underweight-->27-39

overweight-->15-25

obese-->15

Gravida

Discomforts during Pregnancy

Heartburn-->Lowers Gastric motility & increase pressure of uterus

Constipation-->lower perstitalis, pressure of growing uterus

leg cramps-->raises phosphorus-->

Morning Sickness-->raises HCG lvls, lowers gastric motility

Discomforts during Pregnancy

(cont'd)

Varicose Veins-->raises pressure of uterus on lower extremities

Hemorrhoids-->raises pressure causing pelvic congestion

Dyspnea-->raises pressure uterus/diaphragm

Vaginal discharge-->raises cervical and vaginal secretions

Discomforts during Pregnancy

(cont'd)

NAsal stuffiness-->raises estrogen lvls

fatigue-->rapidgrowth of fetus; BMR lowered

Fainteness-->postural hypotension

ankle edema-->lowers circulation; prolonged standing

Backache-->changing center of gravity

Frequency-->raises pressure on bladder

Danger signs of pregnancy to be taught by RN at prenatal visists

a. headache       b. visual changes

c.increased temperature     d. vomiting

e. chest pain       f. abdominal pain

g.vaginal bleeding   h. ROM

i. decreased fetal movement

Sexual activity during pregnancy

1. vaginal bleeding

2. suspects bag is broken

3. backache often after orgasm

4.