SAS 1
Primary Goal of Maternal and Child Health Nursing
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The promotion and maintenance of optimal family health to ensure cycles of optimal childbearing
and childrearing.
Philosophy of Maternal and Child Health Nursing:
 Family – centered – assessment data must include family and individual assessment.
 Community – centered – health of families depends on influences the health of communities
 Evidence – based – provide a foundation for nursing care, studies, conducts, and etc.
Maternal and Child Health Goals and Standards
Global Health Goals
 UN and WHO established Millennium Health Goals in 2000 to improve health world
wide
MILLENNIUM DEVELOPMENT GOALS – 8 goals; created by UN in 2000; to eradicate poverty,
hunger, illiteracy, and disease, expired in 2015.
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Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development
SUSTAINABLE DEVELOPMENT GOALS – 17 goals; created by UN in 2015 for year 2030; aims to
transform our world and improve people’s lives and prosperity on a healthy planet.
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No poverty
No hunger
Good health and well-being
Quality education
Gender equality
Clean water and sanitation
Affordable and clean energy
Decent work and economic growth
Industry innovation and infrastructure
Reduced inequalities
Sustainable cities and communities
Responsible consumption and production
Climate action
Life below water
Life of land
Peace, justice and strong institutions
Partnerships for the goals
THEORIES RELATED TO MATERNAL AND CHILD HEALTH NURSING
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Callista Roy – Adaptation Theory
 nurses’ role is to help patient adapt to change caused by illnesses or other stressors
Dorothea Orem – Self- Care Theory
 involves examining the patient’s ability for self – care
Patricia Benner – Novice – Expert Model
 describes nurse’s move from novice to expert
Scope of Nursing Practice - PHILIPPINE NURSING ACT OF 2002 – RA 9173
6 COMPETENCIES NECESSARY FOR QUALITY CARE
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Patient – centered care
Teamwork & collaboration
Evidence – based practice
Quality Improvement
Safety
Informatics
DEFINITIONS OF FAMILY
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A group of people related by blood, marriage, or adoption living together
Two or more people who live in the same household, share a common emotional bond, and
perform certain interrelated social tasks.
INFLUENCES OF FAMILY ON ITS MEMBERS
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Provides long lasting emotional ties
Provides a depth of support
Determines how members relate to people
Influences what moral values members follow
Molds the members’ basic perspectives on the present and future
BASIC FAMILY TYPES
1. Family orientation
 Refers to the family in which a person is raised
 The family one is born into (e.g., oneself, mother, father, and siblings)
2. Family of procreation
 the family that we create by getting married and having children
 the family one establishes (e.g., oneself, spouse, and children)
RECOGNIZED FAMILY STRUCTURES
Childfree / Childless family – 2 people living together without children
Cohabitation family- unmarried couples with children that live together
Nuclear family – composed of the parents and children
Extended family – nuclear family with other relatives
Single parent family – single mother/father and child/ren
Blended family – a divorced or widowed person with children marries someone who also has
children
7. Dyad family – a newly married / or single couples living together living together as a dyad for
companionship and financial security
8. Binuclear family – a family created by divorce or separation when the child is raised in two
families
9. Communal family – a group of people who chose to live together as an extended family;
motivated by religious values
10. LGBT family – individuals of the same sex live together as partners for companionship, financial
security, and sexual fulfillment
11. Foster family – people who officially take a child into their family for a period of time, without
becoming the child's legal parents
12. Adoptive family - a family who has welcomed a child born to another into their family and legally
adopted that child as their own.
13. Polygamous family – marriage with multiple spouses
 Polygyny – man with several wives
 Polyandry – woman with several husbands
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UNIVERSAL CHARACTERISTICS OF A FAMILY
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Small social system
Performs certain basic functions
Has structure
Has its own cultural values and roles
Moves through stages in the life cycle
8 FAMILY TASKS
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Physical maintenance
Socialization of family members
Allocation of resources
Maintenance of order
Division of labor
Reproduction, recruitment and release of family members
Placement of members into the larger society
Maintenance of motivation and morale
FAMILY LIFE CYCLES
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VIII.
Marriage
The early childbearing family
Family with a pre-school child
Family with a school-age child
Family with an adolescent
Launching stage family
Family of middle years
Family in retirement or old age
BOOMERANG GENERATION – young adults return home to live with parents after college until they
can afford their own apartment or form a new relationship
SANDWICH FAMILY – a family that is squeezed into taking care of both aging parents and a
returning young adult
EMPTY NEST SYNDROME – a feeling of boredom or grief and loneliness parents may feel when
their children leave home for the first time
GENOGRAM – diagram that details family structure, provides family history and the roles of various
family members over time. Provides a basis for discussion and analysis of family interaction.
ECOMAP – to document the fit of a family in their community; a diagram of family and community
relationships
FAMILY APGAR – a screening tool of the family environment
SAS 2
OBSTETRICS – branch of medicine that deals with the care of women during pregnancy, labor, and
the period of recovery following childbirth; OBSTARE = to keep watch
GYNECOLOGY – study of the female reproductive organ and diseases affecting it
ANDROLOGY – study of the male reproductive organ
PEDIATRICS – branch of medical science in children and their illnesses; PAIS = child
NEONATOLOGY – the branch of medicine concerned with the development and disorders of
newborn babies
SEXUAL HEALTH – not just an absence of disease, dysfunction, or infirmity but a condition of
physical, emotional and psychological well-being
GONAD – a body organ that produces the cells necessary for reproduction (e.g., ovary, testes)
WOLFFIAN DUCTS (MESONEPHRIC) - are the progenitors of the epididymis, vas deferens, and
seminal vesicles in males
MÜLLERIAN DUCTS (PARAMESONEPHRIC) - become the fallopian tubes, uterus, and part of the
vagina in females
ADRENARCHE – awakening of the adrenal glands
ANDROGENS – hormones produced by the adrenal glands; testes in males and ovaries in females
THELARCHE – beginning of breast development. Starts 1 -2 years before menstruation
MENARCHE – the beginning of menstruation
SCROTUM – pouch that holds the testis; left scrotum is larger and lower due to longer spermatic cord
CREMASTER MUSCLE – responsible for contraction of the scrotum
MIDLINE SEPTUM – separates each sac; each compartment contains a testis, its epididymis and a
part of the spermatic cord
LEYDIG’S CELLS – the primary source of testosterone or androgens in males.
CORPUS SPONGIOSUM – contains the urethra which serves as a passage for both sperm and urine
PENILE ARTERY – supplies blood to the penis
GLANS – bulging, sensitive ridge of tissue at the end of the distal end of the penis; similar to clitoris
PREPUCE/FORESKIN – retractable casing of skin, protects the glans
PHIMOSIS – condition in which the prepuce is too tight that it interferes with the flow of urine
EPIDIDYMIS – a tightly coiled tube responsible for conducting sperm from the tubule to the vas
deferens; storage of immature sperm
ASPERMIA – absence of sperm
OLIGOSPERMIA – fewer than 20 million sperm per milliliter
VAS DEFERENS – an additional hollow tube surrounded by arteries and protected by thick fibrous
coating, which altogether, are referred to as the spermatic cord; site severed during vasectomy
PROSTATE GLAND – secretes a thin, alkaline fluid that protects the sperm by increasing the
naturally low pH level of the urethra
BULBOURETHRAL GLAND – supply one more source of alkaline fluid to help ensure the safe
passage of spermatozoa
SEMEN – 60% prostate gland; 30% seminal vesicles; 5% epididymis; 5% bulbourethral glands
URETHRA - duct that transmits urine from the bladder to the exterior of the body during urination
MONS PUBIS – pad of adipose tissue located over the symphysis pubis – the pubic bone joint;
protects the junction of the pubic bone from trauma
LABIA MAJORA – 2 folds of adipose tissue covered by loose connective tissue and epithelium;
protects the external genitalia and inner vulva structures
LABIA MINORA – 2 flat hairless, reddish folds of connective tissue; located between labia majora;
protects and obscures the vestibule, urinary meatus and vaginal os
FOURCHETTE - torn during childbirth and site of episiotomy
VESTIBULE – contains openings to the urethra, vagina, skene’s glands and Bartholin glands
GLANS CLITORIS – rounded organ of erectile tissue; site of sexual arousal and orgasm in females
SKENE’S GLANDS – located on each side of the urinary meatus; produce alkaline mucus for
lubrication and protection
BARTHOLIN GLANDS – located each side of the vaginal opening; secrete alkaline substance to
lubricate the vaginal orifice and neutralize the acidity of the vagina; site of Bartholin’s cyst
(Bartholinitis)
PERINEAL MUSCLE – located posterior to the fourchette; muscular area stretched during childbirth
HYMEN – tough but elastic tissue that covers the vagina
IMPERFORATE HYMEN – hymen so complete it does not allow passage of menstrual blood from the
vagina or for sexual relation until it is surgically incised.
OVARIES – size and shape of almonds; produce, mature and discharge egg cells; produce estrogen
and progesterone and initiate and regulate menstrual cycle; organ of ovulation, oogenesis, and
hormone production
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TUNICA ALBUGINEA – protective layer of epithelium
CORTEX – filled with ovarian and graafian follicle
MEDULLA – contains nerves, blood vessels, lymphatics
FALLOPIAN TUBES/OVIDUCTS/UTERINE DUCTS – convey the ovum from the ovaries to the
uterus and to provide a place for fertilization of the ovum by the sperm
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INTERSTITIAL – most proximal; lies within uterine walls; most dangerous site for ectopic
pregnancy
ISTHMUS – next distal portion; extremely narrow; site for bilateral tubal ligation
AMPULLA – 3rd and longest portion; site of fertilization
INFUNDIBULLUM – most distal; rim is covered in fimbriae, that helps guide the ovum into the
fallopian tube.
UTERUS – hollow. Muscular, pear-shaped organ located in the lower pelvis
- CORPUS – uppermost part and forms the bulk of the organ
 FUNDUS – uppermost part of the corpus
ISTHMUS – short segment between the body and the cervix; incision area for cesarean birth; the
lower uterine segment during pregnancy
CERVIX
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lowest portion of the uterus
its central cavity is termed cervical canal
opening of the canal at the junction of the cervix and isthmus is the internal cervical os
the distal opening to the vagina is the external cervical os
the level of the external os is at the level of the ischial spines
ENDOMETRIUM – inner layer of mucous membrane; innermost layer
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composed of 3 layers; compact; spongy and basal
basal layer is unaffected by hormones
compact and spongy are sloughed off during menses; greatly affects by hormones
MYOMETRIUM – middle layer of muscle fibers; 3 interwoven layers of smooth muscles arranged in
longitudinal, transverse and oblique directions; provides strength to the organ during contractions
PERIMETRIUM – an outer layer of connective tissue that provides support
MACKENRODT LIGAMENTS
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main support of the uterus; damage to this ligament results to uterine prolapse - occurs when
pelvic floor muscles and ligaments stretch and weaken until they no longer provide enough
support for the uterus
PERITONEAL LIGAMENTS – the sides of the uterus and assists in holding the uterus in propped
forward
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RIGHT LIGAMENT - connects the uterus to the labia majora and gives stability to the uterus
ANTERIOR LIGAMENT
 provides support to the uterus in connection with the bladder
 CYSTOCELE – herniation of the bladder to the vagina due to overstretching
POSTERIOR LIGAMENT
 forms the cul – de – sac or pouch of Douglas
 RECTOCELE – herniation of the rectum to the vagina due to damage
VAGINA
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hollow and musculo-membranous
rigae makes the vagina elastic and expand during childbirth
from the cervix of the uterus to the external vulva
organ of intercourse and birth canal
FORNICES – recesses at the cervical end of the vagina; posterior, anterior and lateral
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POSTERIOR FORNIX – site where the semen pools after intercourse
Lined with stratified squamous epithelium similar to the cervix
DODERLEIN’S BACILLUS – provides some sort of protection in the vagina against certain
potentially harmful bacteria.
BULBOCAVERNOUS MUSCLE – acts as a voluntary sphincter
MAMMARY GLANDS – located anterior to the pectoralis major muscle; divided into 15 – 20 lobes
divided in lobules
LOBULES – clusters of acinar cells/acini – sac like terminal parts of the gland emptying through a
narrow lumen of duct lined with epithelial cells that secretes milk and colostrum - is the first milk your
body produces during pregnancy.
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MYOEPITHELIUM – contracts to expel milk from the acini into the lactiferous or milk ducts
towards the nipple
LACTIFEROUS SINUSES/AMPULLA – serves as milk reservoirs; located posterior to the nipple
AREOLA
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MONTGOMERY’S TUBERCLES – sebaceous glands that makes the areola appear rough
Stimulation leads the anterior pituitary glands to secrete oxytocin, which makes the
myoepithelium to contract, pushing milk forward to the nipples (letdown reflex / milk ejection
reflex)
Increase in progesterone and estrogen, 3 – 4 days before menses increase vascularity of the
breasts, induce growth of ducts and acini, promotes H2O retention, resulting in breast swelling,
tenderness and discomfort.
After menses, regression occurs and H2O is lost and reaches minimal alteration levels 5 – 7
days after menses.
BREAST SELF – EXAMINATION – best done after menses
ESTROGEN – development of the ductile structure of the breast
PROGESTERONE – development of the acinar structures of the breast
HUMAN PLACENTAL LACTOGEN (HPL) – breast development during pregnancy
OXYTOCIN – let down reflex or milk ejection reflex
PROLACTIN – directly stimulates milk production
FALSE PELVIS – upper half that supports the uterus during late months of pregnancy and aids in
directing fetus into the true pelvis for birth
TRUE PELVIS – inlet, pelvic cavity, outlet
LINEA TERMINALIS – imaginary line that divides pelvis into true and false pelvises
SAS 3
CHARACTERISTICS OF A NORMAL MENSTRUAL CYCLE
- Beginning
o MENARCHE – first occurrence of menstruation
o Average age: 12.4 years old
o Average range: 9 – 17 years old
- INTERVAL BETWEEN CYCLES
o Average: 28 days
o 23 – 35 days is unusual
- DURATION OF MENSTRUAL FLOW
o Average: 4 – 6 days
o 2 – 9 days is abnormal
- AMOUNT OF MENSTRUAL FLOW
o Average: 30 – 80 mL per menstrual period
o Saturation of pad in less than 1 hour is abnormal bleeding
- COLOR OF MENSTRUAL FLOW
o Dark red; combination of blood mucus and endometrial cells
- ODOR
o Similar to marigolds
MENSTRUAL CYCLE
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Definition: episodic uterine bleeding in response to the cyclic hormonal changes
Purpose: to bring an ovum to maturity and renew uterine tissue bed that is responsible
for the growth of the fertilized ovum. Release is triggered by FSH, ovaries in females
excrete a high level of estrogen
HYPOTHALAMUS
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Releases of GnRH (aka LHRH) to initiate the menstrual cycle
GnRH stimulates pituitary glands to send gonadotrophic hormone to the ovaries to produce
estrogen
↑ estrogen, release of GnRH is repressed and no further menstrual cycles will occur
GNrH – Gonadotropin – Releasing Hormone
LHRH – Luteinizing hormone – releasing hormone
PITUITARY GLAND
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Under the influence of GnRH
Anterior lobe of pituitary gland (adenohypophysis) produces two hormones:
 Follicle – stimulating hormone (FSH)
 Is a hormone active early in the cycle that is responsible for maturation of the
ovum
 Luteinizing hormone (LH)
 Responsible for ovulation, or release of mature egg from the ovary
 Stimulates growth of the uterine lining during the second half of the menstrual
cycle
 Is a hormone that becomes most active at the midpoint of the cycle
FSH and LH are called gonadotropic hormones because they cause growth (trophy) in the
gonads (ovaries).
OVARIAN CYCLE
A. PROLIFERATIVE PHASE – day 1 – 14 of a 28-day menstrual cycle
 Oocytes are activated by FSH to begin grow and mature
 As oocyte grow, its cells produce a clear fluid called follicular fluid – contains a high
degree of estrogen and progesterone.
 As the follicle surrounding oocyte grows, it is propelled toward the surface of the ovary
as a clear blister called Graafian follicle - a mature fluid-filled cavity presents inside
the ovary which contains the female gamete/ovum.
 ↑ LH, prostaglandins are released and the graafian follicle ruptures (ovulation)
 Happens on the 14th day before the onset of the next cycle
OOCYTE – immature female egg
OVUM – mature female egg
ESTROGEN – menstruation hormone
PROGESTERONE – pregnancy hormone
B. LUTEAL PHASE – day 15 – 28
 Ovum and follicular fluid have been discharged from the ovary and ↓ FSH
 ↑ LH, directs the follicle cells left behind in the ovary to produce a lutein – a bright –
yellow fluid high in progesterone
 With lutein production, the follicle is renamed a corpus luteum - responsible for the
production of the hormone progesterone during early pregnancy.
 If conception does occur, fertilized ovum implants on the endometrium of the uterus.
Corpus luteum remains for 16 – 20 weeks of the pregnancy.
 If conception does not occur, unfertilized ovum atrophies after 4 – 5 days. Corpus
luteum remains for only 8 – 10 days, and as it regresses, it gradually replaced by
corpus albicans – regressed form of corpus luteum.
 Body temperature drops slightly due to low levels of progesterone and remains for
approximately 24 hours until progesterone level again decreases.
UTERINE CYCLE
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The uterus also changes monthly as a result of stimulation from the estrogen and
progesterone produced by the ovaries
A. PROLIFERATIVE PHASE – day 4 or 5 - 14
 Immediately after menstrual flow, the endometrium is one cell layer in depth.
 Ovaries begins to produce estrogen and the endometrium beings to proliferate.
 Due to rapid growth, it increases the thickness of the endometrium eightfold.
 Also known as estrogenic, follicular, or postmenstrual phase
B. SECRETORY PHASE – day 14 – 24
 After ovulation, the formation of progesterone in the corpus luteum causes the gland of
the uterine endometrium to become corkscrew or twist in appearance.
 The capillaries of the endometrium increase in amount of rich, spongy velvet.
 Also known as pregestational, luteal, premenstrual, or secretory phase
C. ISCHEMIC PHASE – day 24 – 28
 If fertilization does not occur, the corpus luteum regresses after 8 -10 days
 Production of progesterone and estrogen decreases
 The endometrium begins to degenerate
 Capillaries rupture and the endometrium sloughs off
D. MENSTRUAL PHASE – 1st day of menstrual flow to 5 days
 Menstrual flow is composed of blood from the ruptured capillaries, mucin from the gland
(protein), fragments of endometrial tissue, microscopic, atrophied, and unfertilized ovum
OVULATION TESTS
A.
B.
FERN TEST – arborization or ferning
↑ Estrogen = fern like pattern forms
↑ Progesterone = pattern no longer discernible
SPINNBARKEIT TEST
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↑ Estrogen = cervical mucus stretches into long strands
MENSTRUAL DISORDERS
DYSMENORRHEA - painful menstruation
MENORRHAGIA – abnormally heavy menstrual flow
METRORRHAGIA – bleeding between menstrual periods
AMENORRHEA – absence of menstrual flow
MENOPAUSE – cessation of menstrual cycle
 Age range: 40 – 55 years old
 Mean average: 51. 3 years old
 Female smokers tend to have earlier menopause
PERIMENOPAUSAL – used to denote the period during which menopausal changes occur
POSTMENOPAUSAL – describes the time of like following the final menses
SIGNS AND SYMPTOMS OF MENOPAUSE
 Periods of amenorrhea
 Hot flashes – can be accompanied by heart palpitations and can occur up to 20 – 30
episodes a day; sip cold drink or use a hand fan
 Vaginal dryness leading to dyspareunia – painful intercourse; use lubrication jelly
such as KY jelly before intercourse
 Osteoporosis – lack of bone mineral density
 Urinary incontinence – practice Kegel exercise to help strengthen bladder supports
SAS 4
GENETIC REPLACEMENT THEORY - is an experimental technique that uses genes to treat or prevent
disease
GENE EDITING
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DNA is inserted, deleted, modified or replaced in the genome of a living organism targets the
insertions of site - specific locations
GENETIC DISORDERS
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Inherited or genetic disorders are can be passed from one generation to the next due to disorders
in the gene or chromosome structure
May occur in the ovum and a sperm fuse or even in the meiotic division phase of the gametes
50% of 1st trimester spontaneous miscarriages
GENETICS – the study of genes and heredity
CYTOGENETICS - the study of chromosomes by light microscopy and the method by which
chromosomal aberrations are identified
MENDELIAN INHERTIANCE
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Discovered by GREGOR MENDEL – describes the principle of generic inheritance
When dominant gene is paired with non-dominant (recessive) ones, the dominant genes are
always expressed in preference to the recessive genes.
HOMOZYGOUS – two identical copies
HETEROZYGOUS – two different alleles
GENES
 Are the basic units of heredity that determine both physical and cognitive characteristics of
people
 Basic unit of genetic information
 Determines the inherited characters
 Are composed of segments of DNA, which are woven into strands in the nucleus of all body cells
to form chromosome
ALLELES – Are the two like genes on autosomes
PHENOTYPES – Refers to a person’s outward appearance or the expression of genes
GENOTYPE – Refers to a person’s actual gene composition
GENOME
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Is the complete set of genes present (about 50,000 – 100,000)
The collection of genetic information
CHROMOSOME – Storage unit of genes
DNA - A nucleic acid that contains the genetic instructions specifying the biological development of all
cellular forms of life
DOMINANT – allele is expressed even if it is paired with a recessive gene
RECESSIVE – allele only visible when paired with another recessive allele
AUTOSOMAL RECESSIVE – disease does not occur unless 2 genes for the disease are present
AUTOSOMAL DOMINANT – either a person has 2 unhealthy genes
X – LINKED DOMINANT – genes are located on and transmitted only by the female sex chromosome
(X CHROMOSOME)
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ALPORT’S SYNDROME – progressive kidney failure disorder
X – LINKED RECESSIVE – only males have the disorder
MULTIFACTORIAL INHERITANCE
 from multiple gene combinations plus environmental factors
 heart disease, diabetes mellitus, cleft palate, neural tube defects, pyloric stenosis
CHROMOSOMAL ABNORMALITIES (CYTOGENIC DISORDERS)
 abnormalities due to fault in the number / structure of chromosome which results in
missing or distorted genes
 when chromosomes are photographed and displayed, the resulting arrangement is
termed a KARYOTYPE - an individual's complete set of chromosomes
FLOURESCENT IN SITU HYBRIDIZATION (FISH) – the number of chromosomes and specific parts
of chromosomes can be identified by karyotyping or by this process
NONDISJUNCTION
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uneven division; resulting 1 sperm/ovum having 24 & the other 22
If fused with a normal sperm/ovum, the zygote will have 47 or 25 chromosomes
DOWN SYNDROME (TRISOMY 21) – presence of all or a portion of a third chromosome 21.
TURNER SYNDROME – a condition that affects only females, results when one of the X
chromosomes (sex chromosomes) is missing or partially missing
KLINEFELTER SYNDROME – where boys and men are born with an extra X chromosome.
DELETION ABNORMALITIES
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Chromosome disorder in which part of the chromosome breaks during cell division, causing the
affected person to have the normal amount of chromosome +/- an extra portion of a chromosome
e.g., 45.75 or 47.5
 CRI-DU-CHAT SYNDROME (46XY5q-) – 1 portion of chromosome 5 is missing
TRANSLOCATION ABNORMALITIES
 A child gains an additional chromosome through another route
 Down Syndrome (Trisomy 21)
MOSAICISM
 when the nondisjunction disorder occurs after fertilization of the ovum, as the structure begins
mitotic cell division
 Occurs when a person has two or more genetically different sets of cells in his or her body
ISOCHROMOSOME
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Chromosome accidentally divides not by a vertical separation but by a horizontal one, a new
chromosome with mismatched long and short arms can result.
Turner’s Syndrome
GENETIC COUNSELING - the giving of advice to prospective parents concerning the chances of
genetic disorders in a future child
MATERNAL SERUM SCREENING
A. ALPHAFETOPRIOTEIN (AFP)
- secreted by the fetal liver peaks in maternal serum between 13 and 32 weeks; level
is elevated with fetal spinal cord disease
- decreased with fetal chromosomal disorder like Trisomy 21
B. CHORIONIC VILLI SAMPLING – involves retrieval and analysis of chorionic villi from the
growing placenta for chromosome or DNA analysis
C. AMNIOCENTESIS – withdrawal of AF through the abdominal wall for analysis at the 14 th to
16th week
D. PERCUTANEOUS UMBILICAL BLOOD SAMPLING / CORDOCENTESIS – is the removal
of fetal cord blood at 17 weeks using amniocentesis methods
CHROMOSOMAL ABNORMALITIES
PATAU SYNDROME (TRISOMY 13) – 47xy13+ or 47XY13-
Extra chromosome 13, severely cognitively challenged
Midline body disorders like cleft lip/palate, heart defects, abnormal genitalia,
microcephaly, microphthalmia, low-set ears
Most do not survive beyond early childhood
EDWARD’S SYNDROME (TRISOMY 18) – 47XX18+ or 47XY18+
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Have 3 copies of chromosome 18
Severely cognitively challenged, SGA, low-set ears, small jaw, congenital heart
defects, misshapen fingers and toes, rocker-bottom feet
Do not survive beyond early infancy
CRI – DU – CHAT SYNDROME (5p-) – 46XX5p- or 45XY5p-
Result of missing portion of chromosome 5
Abnormal cry, small head, wide-set eyes, downward slant to the palpebral fissure,
severely cognitively challenged
TURNER SYNDROME (MONOSOMY X) – 45XO AKA GONADAL DYSGENESIS
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Only 1 functional X chromosome
Short in stature
Streak ovaries, sterile and secondary sex characteristics except for pubic hair, do not
develop during puberty
Hairline at the nape of the neck is low-set
Webbed and short neck
Newborn may have edema of the hands and feet and anomalies like coarctation of
the Aorta and kidney disorders
Learning disabilities
Human growth hormone and estrogen therapy may cause appearance of sex
characteristics
KLINEFELTER SYNDROME – 47XXY
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Males with extra X chromosome
No development of secondary sex characteristics during puberty; small testes with
ineffective sperm, gynecomastia, increased risk for breast CA
FRAGILE X SYNDROME (FXS) – 46XY23q-
Most common cause of cognitive challenge in males X-linked -1 long arm X
chromosome is defective
Before puberty, boys demonstrate maladaptive behaviors like hyperactivity or autism,
reduced intellectual functioning with marked deficits in speech and arithmetic
Large head, long face with high forehead, prominent lower jaw, large, protruding ears,
hyper extensive joints, cardiac disorders
After puberty, large testicles
Fertile
DOWN SYNDROME (TRISOMY 21) – 47XY21+ or 47XX231+
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Most frequently occurring chromosomal abnormality (1 in 800 pregnancies)
Broad and flat nose
Eyelids have extra fold of tissue at the inner canthus (epicanthal fold)
Palpebral fissure tends to slant upward
Iris may have white specks called BRUSHFIELD SPOTS
Tongue may protrude since oral cavity is small
Back of the head is flat
Poor muscle tone
Cognitively challenged to some degree (50 – 70%)
Short neck, extra pad of fat at the base of the head causes puppy’s neck
SAS 5
CULTURE – a set of traditions a specific social group uses and transmits to the next generation
DIVERSITY – a mixture or variety of sociodemographic groups, experiences, and beliefs
TRANSCULTURAL NURSING – care guided by cultural aspects and respects individual differences
CULTURE-SPECIFIC VALUES – norms and patterns of behavior unique to one particular culture
ETHNICITY – refers to a cultural group into which the person is born; sometimes used in a narrower
context to mean only RACE
RACE – refers to a category of people who share a socially recognized physical characteristic; refer
to a group of people who share the same ANCESTRY
STEREOTYPE – a wide held but fixed and oversimplified image or idea of a particular type of person
or thing
PREJUDICE – preconceived opinion that is not based on reason or actual experience
DISCRIMINATION – the unjust or prejudicial treatment of different categories of people or things,
especially on the grounds of race, age or sex
SEX – biological, based on reproductive organs; may be male, female or intersex
SEX ROLE – biological function, which a male or female assumes because of the basic
physiological or anatomical differences between the sexes
GENDER – masculinity or femininity; refers to the social attributes and opportunities associated
with being male and female
GENDER IDENTITIY – refers to a person’s deeply felt internal and individual experiences of
gender, which may or may not correspond with the sex assigned at birth
HETEROSEXUAL – finds sexual fulfillment with someone of the opposite sex
HOMOSEXUAL – finds sexual fulfillment with someone of the same sex
GAY – male individuals attracted to male partners
LESBIAN – female individuals attracted to female partners
ASEXUAL – someone who does not experience or feel sexual attraction
INTERSEX – someone who is born with a reproductive organ that does not fit the typical female or
male definitions
QUEER – umbrella term; does not categorize sex, sexuality or gender
CROSS DRESSING / TRANSVESTISM – act of wearing items of clothing commonly associated with
the opposite sex within a particular society
MSM – men who have sex with men
WSW – women who have sex with women
BISEXUAL – an individual attracted to both men and women
CISGENDER – when individuals feel that their gender and their sex match
TRANSGENDER – when individuals feel that their gender and their sex do not match
GENDER EXPRESSION – way in which a person acts to communicate gender within a given culture
through clothing, communication, pattern and interests
SEXUALITY – totality of being; the sum of a person’s sexual behaviors and tendencies, and the
strength of such tendencies, it begins at birth and lasts a life time
SEX – never changing, biologically determined
GENDER – ever changing, socially, culturally determined
SAS 6
FERTILIZATION
-
-
the beginning of pregnancy
union of the ovum and spermatozoon
sperm is functional for 48 - 72 hours
critical time for intercourse is about 72 hours (48 hours before ovulation + 24hours)
mature ovum is surrounded by the zona pellucida (ring of mucopolysaccharide fluid) and
corona radiata (circle of cells), both serve to increase the bulk of the ovum and as buffers
against injury
ejaculation of 2.5 ml of semen contains 50 – 200M sperm
during ovulation, cervical mucus is thin making the sperm able to penetrate it
CAPACITATION – changes in the plasma membrane of the sperm head which reveals the spermbinding receptor sites
HYALURONIDASE – released by the sperm and dissolves the protective corona radiata
HYDATIDIFORM MOLE – multiple sperm enter leading to abnormal growth
-
after entry, chromosomal material fuse forming a ZYGOTE
mitosis begins within 24 hours
when zygote reaches the body of the uterus, it is bumpy in appearance called MORULA
a BLASTOCYTE then attaches to the endometrium
IMPLANTATION / NIDATION – contact between the blastocyte and the endometrium occurs 8 -10
days after fertilization
3 PHASES OF IMPLANTATION
-
-
 APPOSITION – blastocyte brushes against the endometrium (secretory phase of MC)
 ADHESION – blastocyte attaches to the surface of the endometrium
 INVASION – blastocyte settles down into the soft folds of the endometrium receiving
nourishment of glycogen – mucoprotein from the endometrial gland
Invasion is possible since trophoblast cells produce proteolytic enzymes - involved in
rebuilding of the endometrium and play an important role in the process of implantation
and placental development.
Establishes a communication network with the blood system of the endometrium
Occasionally, vaginal spotting occurs with implantation because capillaries are ruptures by the
implanting cells
ONCE IMPLANTED, ZYGOTE IS AN EMBRYO
THE DECIDUA
 Corpus luteum in the ovary continue to function with the influence of HCG secreted by
the trophoblast cells
ENDOCRINE FUNCTIONS:
-
PROLACTIN – promotes milk production
RELAXIN – peptide hormones that relaxes CT of symphysis pubis and pelvic ligaments,
promotes cervical dilation
PROSTAGLANDINS – potent, hormone-like fatty acid
Endometrium continues to grow in thickness and vascularity and is termed DECIDUA
PARTS OF THE DECIDUA
-
DECIDUA BASALIS – lies directly under the embryo
DECIDUA CAPSULARIS – portion that stretches or encapsulates the surface of the
trophoblast
DECIDUA VERA – the remaining portion of the uterine lining
CHORIONIC VILLI
 On the 11th – 12th day, miniature villi or probing fingers called chorionic villi reach out
to the endometrium
 Chorionic villi have a center core of loose connective tissue surrounded by a double
layer of trophoblast cells
 Center core of chorionic villi contains fetal capillaries
2 OUTER PORTION LAYERS
-
-
SYNCYTIOTROPHOBLAST
 Outer layer or syncytial layer
 Produce HCG, somatomammotropin (human placental lactogen) hormone, estrogen
and progesterone
CYTOTROPHOBLAST / LANGHANS LAYER
 Inner layer, present at 12 days gestation
 This layer disappears between 20 – 24th week
PLACENTA - Latin for pancake
-
Serves as fetal lungs, kidneys, GIT, a separate endocrine organ throughout the pregnancy
Covers half the surface area of the internal uterus
FETAL CIRCULATION
-
-
12th day of gestation – maternal blood begins to collect at the intervillous spaces of the uterine
endometrium surrounding the chorionic villi
3rd week – O2 and nutrients like glucose amino acids, fatty acids, minerals, vitamins and water
diffuse from the maternal blood through the layers of the chorionic villi to the capillaries and are
transported to the developing embryo
No direct exchange of blood between embryo and mother, only by selective osmosis
through the chorionic villi
Almost all drugs and alcohol perfuse across the placenta
COTYLEDONS – 30 mature placenta segments which makes the maternal side rough and uneven
BRAXTON HICKS – contractions that are barely noticeable; aid in maintaining pressure in the
intervillous spaces by closing off the veins during contractions
UTERINE PERFUSION AND PLACENTAL CIRCULATION
-
Efficient when the woman lies on her left side listing the uterus away from the inferior vena
cava, preventing blood from being trapped in her lower extremities
PLACENTA WEIGHT - AT TERM: 400g – 600g (1lb), 1/6 of baby’s weight
FUNCTION OF PLACENTA
ENDOCRINE FUNCTION
-
-
-
-
HUMAN CHORIONIC GONADOTROPHIN
 ensure that the corpus luteum continues to produce E/P
 suppresses maternal immunologic response to prevent/rejection of placental tissue
 if fetus is male, it influences testes to produce testosterone
 8th week – outer layer of placenta begins to produce P so CL is no longer needed and
HCG levels decrease
 Present in blood and urine
ESTROGEN
 Contributes to mammary gland development
 Stimulates uterine growth to accommodate growing fetus
PROGESTERONE
 Maintains endometrial lining
 Reduce contractility of uterine muscles preventing premature labor
 After placental synthesis on the 12th week, progesterone rises progressively
HUMAN PLACENTAL LACTOGEN (HUMAN CHORIONIC SOMATOMAMMOTROPIN)
 Growth promoting and lactogenic (milk-producing)
 Promotes mammary gland growth
 Regulates maternal glucose, protein and fat levels so that adequate amounts are
always available to the fetus
 Present in maternal serum and urine
UMBILICAL CORD
-
It provides a circulatory pathway that connects the embryo to the CV of the placenta
Transports O2 and nutrients to the fetus from the placenta and to return waste products to the
placenta
Outer surface is covered with amniotic membrane
2 arteries, 1 vein
1 vein, 1 artery – anomalies of the kidney and heart
No nerve supplies
PLACENTAL MEMBRANES
A. AMNIOTIC MEMBRANE
- Chorionic villi become smooth chorion
- Smooth chorion becomes chorionic membrane – outermost fetal membrane which
supports the sac that contain amniotic fluid
- Inner layer becomes the amniotic membrane or amnion
- Covers the fetal surface making it shiny
FUNCTIONS
-
Supports and produces amniotic fluid
Produces phospholipids that initiate formation of prostaglandins that initiate labor by producing
contractions
B. AMNIOTIC FLUID
- Fetus continually swallows AF, from the intestine, to the bloodstream, to the umbilical arteries
to the placenta
- Volume at term: 800 – 1200mL
- Slightly alkaline: pH 7.2
- If unable to swallow:
 ESOPHAGEAL ATRESIA - a birth defect in which part of a baby's esophagus does
not develop properly
 ANACEPHALY - a serious birth defect in which a baby is born without parts of the
brain and skull.
HYDRAMNIOS occurs, a condition that occurs when too much amniotic fluid builds up during
pregnancy. (>2000 mL AF or > 8cm pockets of fluid in ultrasound)
OLIGOHYDRAMNIOS – reduction in the amount of AF maybe be due to kidney disturbance (<300 ml
or > 1 cm no pocket on UTZ)
FUNCTIONS
-
Shields fetus from pressure or blow to the abdomen
Regulates temperature
Aids in muscular development since it allows fetus to move freely
Protects umbilical cord from pressure thus protecting the fetal 02 supply
STEM CELLS
 First 4 days of life – TOTIPOTENT STEM CELLS – have the potential to form a complete
human being
 Next 4 days, cells begin to differentiate and slated to become specific body cells called
PLURIPOTENT STEM CELLS - have the ability to undergo self-renewal and to give rise to
all cells of the tissues of the body.
 Next few days, MULTIPOTENT CELLS - have the capacity to self-renew by dividing and to
develop into multiple specialized cell types present in a specific tissue or organ.
PRIMARY GERM LAYERS
-
At implantation, blastocyte has differentiated with 2 separate cavities appear in the inner
structure:
 AMNIOTIC CAVITY – large cavity, lined with the ectoderm
 YOLK SAC – smaller cavity, lined with entoderm cells
YOLK SAC
-
supply nourishment only until implantation
After implantation, it serves as a source of RBCs until the hematopoietic system is mature
enough to take over, then it atrophies
-
Between the amniotic cavity and the yolk sac, a 3 rd layer of primary cells, the MESODERM,
forms.
Development continues until the 3 germ layers meet at a point called EMBYRONIC SHIELD
Each germ layer develops into specific body systems
-
EMBRYONIC PRIMARY GERM LAYERS
-
ECTODERM – forms the exoskeleton
 CNS (brain and spinal cord)
 Peripheral Nervous System
 Skin, hair, nails
 Sebaceous glands
 Sense organs
 Mucous membranes of anus, mouth and nose
 Tooth enamel
 Mammary glands
-
MESODERM – develops into organs
 Supporting structures (connective tissues, bones, cartilage, muscle, ligaments, and
tendons)
 Dentin of the teeth
 Upper portion of the urinary system (kidneys and ureters)
 Reproductive system
 Heart
 Circulatory system
 Blood cells
 Lymph vessels
-
ENTODERM – forms the inner lining of the organs
 Lining of the pericardial, pleural and peritoneal cavities
 Lining of the gastrointestinal tract, respiratory tract, tonsils, parathyroid
 Thyroid, thymus glands
 Lower urinary system (bladder and urethra)
SAS 7
1st TRIMESTER: ACCEPTING THE PREGNANCY




Task: accept the reality of the pregnancy
Maladaptation: Denial
AMBIVALENCE – combination of pleasure and anxiety
SONOGRAM – seeing the fetal outline on screen may promote acceptance
2nd TRIMESTER: ACCEPTING THE BABY




Task: accepting the reality of having a baby
QUICKENING – 1st moment the woman feels fetal movement, proof of child’s existence
Mother starts to imagine, role-play, fantasize
A good way to measure acceptance is how well she follows prenatal instructions
3rd TRIMESTER: PREPARING FOR PARENTHOOD
-
Nest Building
Interested in attending prenatal and childbirth classes
EMOTIONAL RESPONSES TO PREGNANCY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Ambivalence - combination of pleasure and anxiety
Grief
Narcissism
Introversion vs Extroversion
Body image and boundary
Stress
Couvade Syndrome
Emotional lability
Changes in sexual desire
Changes in the expectant family
PRESUMPTIVE SIGNS OF PREGNANCY
-
Least indicative of pregnancy and individually may be symptoms of other conditions
Subjective
- Amenorrhea – absence of menstrual cycle
- Nausea and vomiting
- Breast changes: tingling, darkening, enlargement
- Urinary frequency
- Fatigue – due to increase in estrogen
- Skin changes:
 Chloasma – a pigmentation disorder of the skin characterized by darker skin
patches that primarily affect the face and other sun-exposed areas.
 Linea nigra – line of dark pigment on the abdomen
 Striae gravidarum – red streaks on abdomen
- Diaphoresis - excessive, abnormal sweating
- Leukorrhea – a thick, whitish, yellowish or greenish vaginal discharge
- Weight gain
- Quickening – fluttering sensation, mother’s perception of fetal movement
 18 – 20th week for primipara
 14 – 16th week for multipara
PROBABLE SIGNS
-
Can be documented by the examiner
Objective
More reliable but still not positive or true diagnostic finding
- Uterine enlargement
- Goodell’s Sign – softening of the cervix
-
Hegar’s Sign – softening of the lower uterine segment
Chadwick’s Sign – bluish discoloration of the cervix, vagina and perineum
McDonald’s Sign – ease in flexing the body of the uterus against the cervix
Braxton – Hicks contractions – painless and irregular, relieved by walking
Ballottement – fetal rebound against examination
Positive pregnancy test: (+) HCG
POSTIVE SIGNS OF PREGNANCY
-
Fetal parts on palpation by examiner
Fetal skeleton on X-ray (safe from 16 weeks)
Fetal outline on ultrasonography
Fetal Heart Tone is audible
- Normal range: 120 -150 bpm
- FUNIC souffle – sound of blood in the cord
- Uterine souffle – NOT a diagnostic sign
STUFFINESS – nasal congestion due to increased estrogen levels
PSEUDOANEMIA - Pallor of the skin and mucous membranes without the blood signs of anemia
HYPERPTYALISM - overproduction of saliva
HYPEREMESIS GRAVIDARUM - extreme, persistent nausea and vomiting during pregnancy
DANGER SIGNS OF PREGNANCY
-
Vaginal bleeding
Persistent vomiting
Chills and fever
Sudden escape of clear fluid from the vagina
Abdominal or chest pain
PREGNANCY – INDUCED HYPERTENSION (PIH)
-
Rapid weight gain (over 2lbs/wk in the 2nd trimester, 1lb/wk in the 3rd trimester)
Swelling of the face or fingers
Flashes of light or dots before the eyes
Dimness or blurring of vision
Severe, continuous headache
Decreased urine output
INCREASE OR DECREASE IN FETAL MOVEMENT – fetus lacks oxygen
PREPARING FOR LABOR
 LIGHTENING
 settling of the fetal head into the inlet of the true pelvis
 SHOW
 the release of the cervical plug (operculum) that formed during pregnancy
 RUPTURE OF THE MEMBRANES
 A sudden gush of clear fluid (amniotic fluid) from the vagina indicates rupture of the
membranes
 EXCESS ENERGY
 Feeling extremely energetic is a sign of labor important for women to recognize. It
occurs as part of the body’s physiologic preparation for labor
 UTERINE CONTRACTIONS
 True labor contractions usually start in the back and sweep forward across the
abdomen like the tightening of a band. They gradually increase in frequency and
intensity
SAS 8
ASSESSING FETAL WELL – BEING
QUICKENING – felt by the mother at 18 – 20 weeks and peaks at 28 – 38 weeks
SANDOVSKY METHOD
-
Mother lies in a left recumbent position after a meal and record how many fetal movements
she feels for 1 hour
If <10 movements per hour, repeat for another hour
If 10 for 2 hours, notify physician
CARDIFF METHOD (COUNT-TO-TEN/FETAL KICK COUNT)
-
Mother records time interval it takes to feel 10 movements (usually within 60 seconds)
Done at the same time daily, preferably after breakfast (most active), lie on left side after
stimulating activity like walking
Warning: > 1 hour for 10 FM or <10 FM in 12 hours
Alarm: weaker movements < 3 FM in 12 hours
FETAL HEART RATE: 120 – 160 bpm
1. RHYTHM STRIP TESTING
 test for good baseline rate and presence of long- and short-term variability
 SEMI-FOWLERS’S POSITION – to prevent supine hypertension and for comfort
 External fetal heart rate and uterine contraction monitors are attached abdominally
 TOCOTRANSDUCER – over fundus measure contractions and fetal movement
 ULTRASOUND – over abdominal site where FHR is distinct
 FHR is recorded for 20 minutes
 BASELINE READING – average rate of fetal heartbeat per minute
SHORT-TERM VARIABILITY (BEAT-TO-BEAT VARIABILITY)
 Small changes in rate from second to second if fetal parasympathetic NS receives adequate
O2 and nutrients
LONG-TERM VARIABILITY
 Differences in heart rate over the 20-minute period
2. NON-STRESS TESTING (NST)
 Measures the response of the FHR to fetal movement
 SEMI-FOWLERS’S POSITION – to prevent supine hypertension and for comfort
 External fetal heart rate and uterine contraction monitors are attached abdominally
 TOCOTRANSDUCER – over fundus measure contractions and fetal movement
 ULTRASOUND – over abdominal site where FHR is distinct
 With fetal movement, FHR increases 15 bpm and remain elevated for 15 seconds It
should decrease as fetus quiets
 No increase in beats, poor O2 perfusion is suggested
 NST is done for 10 – 20 minutes
REACTIVE (NORMAL)
-
2 accelerations of FHR (by 15 beats or more) lasting for 15 seconds occur after movement
within the chosen time period
NON-REACTIVE
-
No acceleration with the fetal movement, no movement, low short-term FHR variability (<6
bpm) throughout the testing period
20 minutes without fetal movement – sleeping fetus; give CHO snack or stimulate by a loud
sound
If not responsive after 1 hour, contraction stress testing
3. VIBROACOUSTIC STIMULATION
 A specially-designed acoustic stimulator is applied to the mother’s abdomen to produce
a sharp sound 80 decibels at a frequency of 80 Hz, to startle and wake the fetus
 In a NST with no acceleration within 5 minutes, a single 1-2 second sound stimulation is
applied to the lower abdomen (may be repeated at the end of 10 minutes if no
movement)
4. CONTRACTION STRESS TESTING
 FHR is analyzed in conjunction with contractions (achieved by nipple stimulation to
release oxytocin)
 Baseline FHR is obtained then mother rolls nipple until contraction begins, recorded by
a uterine monitor
 3 contractions lasting for 40 seconds or more in a 10-minute window
RESULTS
-
Normal – no FHR decelerations with the contractions
Abnormal – (+) -50% more of contractions cause late decelerations (dip in FHR towards end
of contraction and continues after the contraction)
3 TYPES OF DECELERATIONS
-
EARLY DECELERATION – begins on or after onset of contraction and ends when contraction
ends; due to head compression during labor
LATE DECELERATION – begin after onset and peak of uterine contraction and ends after
contraction; due to uteroplacental insufficiency
VARIABLE DECELERATION – u, w, or v shape, unrelated to contraction, due to cord
compression
5. ULTRASONOGRAPHY
 Ask mother to drink a full glass of water every 15 minutes beginning 90 minutes before
the procedure and should not void before the procedure
PURPOSE
- Diagnose a pregnancy
- Confirm presence, location, size of placenta and amniotic fluid
- Establish fetal growth and rule out abnormalities
- Establish sex, presentation, and position of fetus
- Predict maturity via the measurement of the biparietal diameter of the head
- Discover complications of pregnancy
6. BIPARIETAL DIAMETER
- Side to side measurement of the fetal head via ultrasound
- If 8.5 cm greater, infant will weight more than 2500g (5.5lbs)
- Diameter of 8.5 cm indicates fetal age of 40 weeks
- Head circumference of 34.5 mc indicates 40-week fetus
- Femoral length
7. HAASE’S RULE
- Determines length of fetus in cm
8. DOPPLER UMBILICAL VELOCIMETRY
- Measures velocity at which RBCs in the blood volume are flowing
- Helps determine vascular resistance in women with diabetes and hypertension and
whether placental insufficiency occurred
9. PLACENTAL GRADING
- Based on the amount of Ca deposits in the base of the placenta via UTZ
10. AMNIOTIC FLUID ASSESSMENT
- Decrease in amniotic fluid, risk of cord compression
11. ELECTROCARDIOGRAPHY
- May be recorded as early as 11th week of pregnancy
12. MAGNETIC RESONANCE IMAGING
- To diagnose complications like ectopic pregnancy
13. MATERNAL SERUM ALPHA-FETOPROTEIN
- checks the level of alpha-fetoprotein produced by your baby as a way to assess your
little one's risk of a neural tube defect or a chromosomal abnormality.
14. TRIPLE SCREENING
- Analysis of 3 indicators; MSAFP, unconjugated estriol, and HCG
15. CHORIONIC VILLI SAMPLING
- Biopsy and chromosomal analysis of CV
- COELOCENTESIS – transvaginal aspiration of fluid from the extraembryonic cavity
16. AMNIOCENTESIS
- Aspiration of amniotic fluid from the uterus for analysis
- If mother is Rh(-), Rhlg or RhoGAM is administered within 72 hours to prevent fetal
isoimmunization
- COLOR:
 Strong yellow – suggest blood incompatibility
 Green – meconium staining, suggesting fetal distress
- LECITHIN/SPHINGOMYELIN RATIO
- PHOSPHATIDYGLYCEROL & DESATURATED PHOSPHATIDYCHOLINE
 Present only in mature lung function (35 – 35 weeks)
- BILIRUBIN DETERMINATION
 Done if blood incompatibility is suspected
 Sample must be blood-free to avoid false-positive results
- CHROMOSOME ANALYSIS
 To detect chromosomal diseases
 Fetal skin cells present in AF may be cultured and stained for karyotyping
- FETAL FIBRONECTIN
 Detected if there is damage in fetal membranes
- INBORN ERRORS OF METABOLISM
- ALPHA-FETOPROTEIN
 Present if fetus has an open body defect causing leakage of AFP into the AF
- ACETYLCHOLINETERASE
 Present in AF if neural tube defect is present
17. SHAKE TEST
- If bubbly, the ratio is mature
18. PERCUTANEOUS UMBILICAL BLOOD SAMPLING / CORDOCENTESIS / FUNICENTESIS
- Aspiration of blood from umbilical vein for testing
- CBC, direct COOMB’S test, blood gases, karyotyping is done
 KLEIHAUER-BETKE TEST – to ensure that the blood is fetal blood
19. AMNIOSCOPY
- Visual inspection of the AF through the cervix and membranes with an amnio scope
- To detect meconium staining
20. FETOSCOPY
- Fetus is visualized by a fetoscope
- Confirm intactness of the spinal column
- obtain biopsy samples of the fetal tissue and fetal blood samples
- perform elemental surgery (shunt for hydrocephalus)
- AMNIONITIS – infection of the amniotic fluid
21. BIOPHYSICAL PROFILE
- Also known as FETAL APGAR
- Fetal reactivity, fetal breathing movements, fetal body movements, fetal tone, amniotic
fluid volume
- Fetal heart and breathing record measures CNS function
SAS 9
OVULATION AGE – measured from the time of ovulation
LENGTH OF PREGNANCY – from the 1st day of LMP is the gestational age
OVULATION AGE AND GESTATIONAL AGE – measured in lunar months (4-week periods) or
trimesters (3-month periods)
PREGNANCY – 10 lunar months (40 weeks or 280 days); fetus grows in utero for 9.5 lunar months or
3 full trimesters (38 weeks or 266 days)
4th GESTATIONAL WEEK
-
Length: 0.75 – 1 cm
Weight: 400 mg
Spinal cord formed and fused
Lateral wing forming body are folded toward to fuse at midpoint
Head holds forward, prominent, 1/3 of entire structure
Back is bent so head almost touches tip of tail
Rudimentary heart bulges on anterior surface
Arm and leg buds
Rudimentary eyes, ears, nose are discernible
8th GESTATIONAL WEEK
-
Length: 1 inch
Weight: 20 g
Organogenesis complete
Heart with septum and valves, beats
Discernible facial features
Arms and legs developed
External genitalia present but undiscernible
Primitive tail regressing
Abdomen is large due to rapid growing fetal intestines
Ultrasound shows gestational sac
12th GESTATIONAL WEEK
-
Length: 7 – 8 cm
Weight: 45 g
Nail beds on fingers and toes forming
Spontaneous movements possible but too faint to be felt
Bone ossification centers forming
Tooth buds present
Sex distinguishable by outward appearance
Kidney secretion begins but urine not yet evident in the amniotic fluid
Heartbeat audibles through doppler technology
Reflexes present like Babinski reflex
16th GESTATIONAL WEEK
-
Length: 10 – 17 cm
Weight: 55 – 120 g
Fetal heart sounds audible with ordinary stethoscope
Lanugo is well formed
Liver and pancreas functioning
Active swallowing of amniotic fluid demonstrating intact though uncoordinated
swallowing reflex
Urine is present in amniotic fluid
Sex can be determined by ultrasound
20th GESTATIONAL WEEK
-
Length: 25 cm
Weight: 223 g
Spontaneous movements felt by the mother
Antibody production possible
Hair forms, including eyebrows and hair on the head
Meconium present in the upper intestine
Brown fat
Vernix caseosa begins to form
Definite sleep/wake patterns
24th GESTATIONAL WEEK
-
Length: 28 – 35 cm
Weight: 550 g
Passive ab transfer
Meconium is present as far as the rectum
Active production of lung surfactants begins
Eyebrows and eyelashes well – defined
Eyelids now open
Pupils capable of reacting to light
Hearing can be demonstrated by response to sudden sound
28th GESTATIONAL WEK
-
Length: 35 – 38 cm
Weight: 1,200 g
Lung alveoli begin to mature, surfactant present in amniotic fluid
Testes begin to descend in scrotal sac from the lower abdominal cavity
Blood volume of retina are thin and susceptible to damage from high O2
32th GESTATIONAL WEEK
-
Length: 38 – 43 cm
Weight: 1,600 g
Subcutaneous fat begins to be deposited
Fetus responds by movement to sound outside mother’s body
Active Moro reflex
Birth position is assumed
Iron stores beginning to be developed
Fingernails grow to reach end of fingertips
36th GESTATIONAL WEEK
-
Length: 42 – 48 cm
Weight: 1,800 g – 2,700 g (5 - 6 lbs.)
Body stores of glycogen, irons and carbohydrates and calcium are deposited
Additional amount of subcutaneous fat is deposited
Sole of foot has only 1 or 2 crisscross creases
Lanugo begins to diminish
Most babies turn into a vertex or head-down position during this month
40th GESTATIONAL WEEK
-
Length: 48 – 52 cm (crown to rump, 35 – 37 cm)
Weight: 3,000g (7 – 7.5 lbs.)
Fetus kicks actively causing discomfort
Fetal hemoglobin begins conversion to adult hemoglobin
FETOPLACENTAL CIRCULATION
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
12th day – maternal blood collects in the intervillous spaces of the endometrium
surrounding the chorionic villi
3rd week – fetal blood beings t exchange nutrients with maternal blood by osmosis
O2 blood from placenta enters umbilical vein
Ductus Venosus (supplies liver)
Inferior vena cava
Right atrium
Foramen ovale
Left atrium
Left ventricle
Aorta
SHUNTS OR BYPASSES





FORAMEN OVALE – between right and left atrium
DOCTUS VENOSUS – bypasses the liver
DUCTUS ARTERIOSUS – bypasses the lungs
UMBILICAL VEIN – carries oxygenated blood and nutrients to fetus
UMBILICAL ARTERIES – carries carbon dioxide and other wastes from fetus to maternal
circulation
 Pressure is higher on the Right side of the heart before birth
SAS 10
TERATOGEN
 any factor, chemical or physical that adversely affects the fertilized ovum, embryo or fetus
TIMING OF THE INSULT
 before implantation, zygote is destroyed or unaffected
 during organogenesis, very vulnerable
 3rd trimester, the harm decreases
SYPHILIS AND TOXOPLASMOSIS – affects fetus throughout the pregnancy
LEAD – has affinity for nervous tissues
THALIDOMIDE – causes limb defects
TETRACYCLINE – causes tooth enamel and bone deformities
TERATOGENIC MATERIAL INFECTIONS
-
Involves STI or systemic infections
Viral, bacterial or protozoan
Most cause relatively mild, flulike symptoms in a woman but more serious effects on a fetus
TORCH INFECTIONS
-
Toxoplasmosis
Other infections like syphilis, Hepatitis B virus and HIV
Rubella
Cytomegalovirus
Herpes simplex virus
TORCH SCREEN
-
Immunologic tests on the pregnant woman – to identify fetal risk factors
Immunologic test on new born – to detect if antibodies vs the teratogens are present
Negative result = normal
Positive IgM abs = recent or current infection
Positive IgG = maternal abs crossed placenta
TOXOPLASMOSIS
-
an infectious disease caused by a parasite that spreads from animals to humans.
INFANTS
-
CNS damage
Hydrocephalus
Microcephaly
Intracerebral calcification
Retinal deformities
MEDICATION
-
SULFONAMIDES – increase bilirubin levels in the newborn; does not prevent deformities
PYRIMETHAMINE – anti-protozoal drug also anti-folic acid
FOLIC ACID
SPIRAMYCIN – experimental use
RUBELLA
-
a contagious viral infection best known by its distinctive red rash. Also called German measles.
DIAGNOSTICS
-
Rubella titer is obtained on 1st prenatal visit
Immunization cannot be done during pregnancy; wait for 3 months before getting pregnant
MATERNAL
-
mild rash
mild systemic illness
CONGENITAL RUBELLA: fetal damage from maternal infection
-
deafness
mental and motor challenges
cataracts
cardiac defects (PDA, pulmonary stenosis)
restricted intrauterine growth (SGA)
thrombocytopenic purpura
dental and facial clefts
CYTOMEGALOVIRUS
-
a member of the herpes virus family; droplet transmission
DIAGNOSTICS
-
isolation of CMV antibodies from the mother or the infant’s blood serum
TREATMENT
-
no treatment or vaccine available
FETAL SYMPTOMS
-
neurological damage (hydrocephalus, microcephaly, spasticity
eye damage (optic atrophy, chorioretinitis)
deafness
chronic liver disease
skin covered with large Petechiae (blueberry-muffin lesions)
HERPES SIMPLEX VIRUS (GENITAL HERPES INFECTION)
-
a common sexually transmitted infection caused by the herpes simplex virus (HSV)
DIAGNOSTICS
-
1st episode genital herpes infection is systemic and crosses the placenta to the fetus
1st trimester infection: severe congenital anomalies or spontaneous miscarriage
2nd or 3rd trimester: high incidence of premature birth, intrauterine growth restriction (IUGR),
continuing infection of the newborn at birth
If reoccurrence, the mother’s antibodies to the virus in her system prevents the spread of the
virus to the fetus across the placenta
If genital lesions are present at birth, cesarean is recommended to avoid direct exposure
MEDICATION
-
IV ACYCLOVIR or ORAL ACYCLOVIR (ZOVIRAX)
SYPHILIS
-
a chronic bacterial infection that can be transmitted through sexual contact
DIAGNOSTICS
-
if detected in 1st trimester and treated with antibiotics, fetus is rarely affected
If detected beyond 18th week, deafness, cognitive challenge, osteochondritis and fetal death are
possible
CONGENITAL SYPHILIS: congenital anomalies, extreme rhinitis (sniffles), characteristic
syphilis rash, Hutchinson teeth
MEDICATION
-
BENZATHINE PENICILLIN
ZIKA VIRUS
-
Spreads through infected mosquito bites – Aedes aegypti
Can be passed from pregnant mother to fetus
Transmitted through mosquito bites, body fluids like blood and semen
DIAGNOSTICS
-
Infection during pregnancy can cause a birth defect called microcephaly and other severe fetal
brain defects
PREVENTION
-
Avoid traveling to areas with Zika
Use safe sex practices like condoms
Avoid intercourse with someone who has traveled to a Zika risk area
SAS 11
PROSTAGLANDIN THEORY
-
Initiation of labor is a result from the release of ARACHIDONIC ACIDS produced by STEROID
ACTION on lipid precursors.
Arachidonic acids are said to increase prostaglandin synthesis which in turn causes
uterine contractions
OXYTOCIN THEORY
-
-
Pressure on the cervix stimulates the hypophysis to release oxytocin from the maternal
posterior pituitary gland. As pregnancy advances, the uterus becomes more sensitive to
oxytocin.
Presence of oxytocin causes the initiation of contraction of the smooth muscles of the
body.
UTERINE STRETCH THEORY
-
The idea is based on the concept that any hollow body organ when stretched to its capacity
will inevitably contact to expel its contents.
Uterus is compared to a balloon of which is=f the point of elasticity is met, it will burst thus
labor process occurs.
PLACENTAL DEGENERATION THEORY
-
Because of decreased blood supply and functional capacity, the uterus starts to contract
PROGESTERONE DEPRIVATION THEORY
-
Decreased amount of progesterone initiates uterine motility
PREMONITORY SIGNS OF LABOR
1.
2.
3.
4.
5.
Lightening
Increased level of activity
Braxton Hicks Contractions
Ripening of the Cervix
Slight loss of weight
FALSE CONTRACTIONS
1.
2.
3.
4.
5.
Begin and remain irregular
Felt 1st abdominally and remain confined to the abdomen and groin
Often disappear with ambulation and sleep
Do not increase in duration, frequency and intensity
Do not achieve cervical dilation
TRUE CONTRACTIONS
1.
2.
3.
4.
5.
Begin irregularly but become regular and predictable
Felt 1st in the lower back and sweep around to the abdomen in a wave
Continue no matter what the woman’s level of activity
Increase in duration, frequency and intensity
Achieve cervical dilation
SIGNS OF TRUE LABOR
1. Uterine contractions
2. Show
3. Rupture of the membranes