Untitled Quiz

Istanbul Gelisim University

• Istanbul Gelisim University is focused on ecological, economic, and social sustainability.

Department of Nursing

• Course: Women's Health and Diseases Nursing
• Lecturer: N. Alper Sahbaz, MD

Course Information

• Credits: 8 Credit / 9 ECTS
• Link: https://gbs.gelisim.edu.tr/en/lesson-details-17-319-12715-2
• Week: 17

What We Will Learn This Week

• Prenatal care including monitoring and examining pregnant women
• Training and consulting for pregnant women and their families

Commencing of Pregnancy

• The uterine lining (endometrium) thickens to receive a fertilized egg.
• If not fertilized, the lining is shed as menstruation.

Stages of Early Embryo Development

• Around the seventh or ninth day after conception, the blastocyst implants in the uterine lining (implantation).
• Protective covering (amnion) forms around the organism, containing amniotic fluid.
• A yolk sac develops, producing blood cells.
• Ovaries produce high levels of progesterone during pregnancy.

Stages of Early Embryo Development

• Germinal period: First 2 weeks after conception.
• Embryonic period: Weeks 2-8
• Fetal period: Week 8 onwards

Twins

• Fraternal twins: Two different eggs fertilized by different sperms.
• Identical twins: Single egg fertilized by one sperm that splits.

Fetal Growth Chart

• Timing of potential air pollution risks related to fetal development (detailed chart included)

Layers of Embryonic Development

• Yolk sac: Lined with endoderm, provides nutrients early in development.
• Amniotic cavity: Fluid-filled space, supports fetus.
• Endoderm: Forms digestive system, liver, pancreas, and lungs.
• Mesoderm: Creates circulatory, lung, skeletal, and muscular systems.
• Ectoderm: Becomes hair, nails, skin, and nervous system

Week 4

• Nerve growth begins.
• Sheet of embryo cells form the neural tube (spinal cord and brain regions).

Week 5 & 6

• Embryo reaches the size of a raisin.
• Ear development.
• Neural tube develops into a complex brain.
• Placenta begins to function, supplying oxygen and nutrients.
• Spinal cord grows rapidly.

Week 7

• Embryo's hands and feet take shape (fingers start to separate).
• Embryonic tail mostly disappears.
• The heart develops chambers and beats at 150 beats per minute (about twice that of an adult).
• Facial features are visible (mouth, tongue), eyes develop retina and lens.
• Major muscles are formed; beginning movement practice.
• Blood cells are produced in the liver, not the yolk sac.

Week 8

• The embryo becomes a fetus.
• Amniotic sac with fluid protects the fetus.
• Arms and legs have lengthened.
• The head appears large compared to the body, as brain growth is rapid.
• Brain waves are measurable.
• Teeth and larynx begin to develop.
• Veins visible through thin skin.
• Ears begin to develop.

Week 9

• Fetus is constantly moving.
• Organs, muscles, and nerves are fully functional.
• Fingers and toes develop from paddle-like shapes.
• Touch pads appear on fingers

Week 10

• Fetus weighs 7-8 gr and resembles a newborn.
• Eyelids fused shut.
• Wrists, ankles, fingers, and toes clearly formed.
• Sex of the fetus less clear during the 10th week.

Week 11

• Vital organs (liver, kidneys, intestines, brain, lungs) are fully formed and functioning (beginning to function)
• Head is now about half the length of entire body.
• Fetus is about 5cm and weighs less than 14 gr

Week 12 (First Trimester End)

• Vocal chords are complete.
• Fetus can cry silently.
• Brain fully formed.
• Fetus may suck its thumb.
• Eyelids cover eyes to protect optical nerves.
• Hair, nails, and kidneys develop.

Changes in Uterus

• Uterine blood flow increases significantly.
• Blood flow may be 500-750 cc/minute.
• Hemorrhage is a key cause in maternal death.

Distribution of Blood Flow

• Pie chart showing distribution of blood flow in myometrium, endometrium, and placenta

Cardiovascular Changes

• Heart rate increases (5-15%)
• Stroke volume increases (25-30%)
• Cardiac output increases (35-50%)

Cardiovascular Changes (During Labor)

• Early first stage: 15-20% increase in cardiac output.
• Late first stage: 30-35% increase in cardiac output.
• Second stage: 35-40% increase in cardiac output.

Pulmonary Function Alterations

• Inspiratory reserve volume: No change
• Tidal volume: Increased
• Expiratory reserve volume: Decreased
• Residual volume: Decreased

Pulmonary Function Alterations

• Inspiratory capacity (IRV + TV): Increased
• Vital capacity (IRV + TV + ERV): Unchanged
• Functional residual capacity (ERV + RV): Decreased
• Total lung capacity (IRV + TV + ERV + RV): Decreased

Hematologic Alterations in Pregnancy

• Blood volume: 30-50% increase
• Plasma volume: 50% increase
• Red blood cell number: 30% increase

Principal Causes of Anemia in Pregnancy

• Iron deficiency: RBC indices, serum ferritin
• Hemodilution: RBC indices
• Folate deficiency: RBC indices, serum folate
• B 12 deficiency: RBC indices, serum folate
• Hemoglobinopathy: Hgb electrophoresis

Coagulation Changes in Pregnancy

• Enhanced hepatic synthesis of factors I, II, VII, VIII, IX, and X.
• Placenta produces factor III (tissue thromboplastin).
• Platelets are more readily aggregated.

Gastrointestinal Alterations in Pregnancy

• Increased intra-abdominal pressure: Hiatal hernia
• Delayed colonic emptying: Constipation

Renal Function Alterations in Pregnancy

• Renal blood flow increases 30-40%.
• GFR (creatinine clearance) increases.
• Serum BUN, creatinine, and uric acid decrease.

Increased Risk of Pyelonephritis in Pregnancy

• Progesterone inhibits ureteral peristalsis.
• Mechanical compression by the gravid uterus.
• Complications include preterm labor, sepsis, and ARDS.

Increased Risk of Nephrolithiasis in Pregnancy

• Elevated calcium in urine.
• Urinary stasis.
• Most common stones: Calcium oxalate, Struvite.

Quality throughout the Continuum of Care

• Focus on quality care for every pregnant woman and newborn.
• Person-centered approach: Reducing mortality/morbidity; respectful care; optimized service delivery

Women's Views

• Healthy pregnancy for the mother and baby.
• Physical and sociocultural normalcy during pregnancy.
• Positive transition to labor and birth.
• Positive motherhood (self-esteem, competence, autonomy).

Dietary Interventions

• Daily oral iron and folic acid supplementation (30-60mg elemental iron, 400µg folic acid).
• Intermittent supplementation (120mg elemental iron, 2800µg folic acid).
• Calcium supplementation(1.5-2.0 g oral elemental calcium)
• Vitamin A supplementation (only in areas with severe deficiency).

Nutritional Interventions-2

• Zinc supplementation: Recommended in rigorous research.
• Multiple micronutrient, Vitamin B6, Vitamin E, and Vitamin C supplementation: Not recommended.

Maternal Assessment

• Full blood count testing is recommended for diagnosing anemia.
• Midstream urine culture is the method for diagnosing asymptomatic bacteriuria.
• Clinical enquiry about IPV should be considered at antenatal visits.

Maternal Assessment -2

• If hyperglycemia is detected (any time during pregnancy) classify it as gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, following WHO criteria.
• Health care providers are to screen all pregnant women about tobacco use (past and present), exposure to second hand smoke and their alcohol or substance use, at every antenatal visit possible.
• In high-prevalence HIV settings, provider initiated testing and counseling (PITC) should be routine.

Fetal Assessment

• Daily fetal movement counting (e.g., count-to-ten kick charts) is only recommended in research settings.
• Abdominal palpation for fetal growth or symphysis-fundal height is not recommended in this study.
• Antenatal cardiotocography (CTG) and routine antenatal Doppler ultrasound examination are not recommended.
• One ultrasound to estimate gestational age at or before 24 weeks is recommended.

Preventive Measures

• 7-day antibiotic regimen for asymptomatic bacteriuria (ASB).
• Antibiotic prophylaxis for recurrent urinary tract infections (UTIs) in research settings only.
• Antenatal prophylaxis with anti-D immunoglobulin for Rh-negative pregnant women.
• Anthelminthic treatment in endemic areas
• Vaccination for tetanus.

Rh D Alloimmunization

• If a mother is Rh-negative but fetus is Rh-positive, the mother can develop anti-Rh antibodies which could affect future pregnancies.

Prevenve Measures-2

• Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP)
• Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)

Common Physiological Symptoms

• Ginger, chamomile, Vitamin B6 or acupuncture for nausea, from the options provided, and recommended.
• Dietary advice and lifestyle modifications for heartburn.
• Magnesium, calcium or non-pharmacological options for leg cramps.
• Regular exercise for low back and pelvic pain.
• Wheat bran/fiber supplements for constipation.
• Non-pharmacological options (compression stockings, elevation) for varicose veins and edema

Antenatal Care Models

• Eight antenatal care visits are recommended for improved perinatal outcomes.

2016 WHO Antenatal Care Model

• Detailed model describing visit timelines regarding care given during the antenatal period.

Quality Antenatal Care

• Regular contact supports a positive pregnancy experience.
• All women should have eight contacts throughout the pregnancy.

External Fetal Heart Rate Monitoring

• Ultrasound transducer detects fetal heart sounds.
• The rate and pattern of the fetal heart are displayed and printed.
• Uterine contractions are monitored along with the fetal heart rate using a tocodynamometer.

Physiological CTG Interpretation - Baseline Heart Rate

• Normal Baseline heart rate is between 110-160 bpm.
• Tachycardia: Heart rate > 160 bpm for 10 minutes or more.
• Bradycardia: Heart rate < 110 bpm for 10 minutes or more.

Physiological CTG Interpretation - Baseline Variability (BLV)

• Normal: Band width 5-25 bpm.
• Reduced BLV: < 5 for 50+ or 3+ minutes during decels.
• Increased BLV(saltatory): 25 + for 30 + minutes.
• Sinusoidal: Regular, smooth, undulating signals at 5-15 bpm with no accels.
• Pseudo-sinusoidal: Resembles sinusoidal + more jagged pattern.

Physiological CTG Interpretation – Decelerations (15+ bpm for 15+ secs)

• Early decelerations: Gradual decline coinciding with contractions.
• Variable decelerations: V-shaped decline, rapid drop and recovery.
• Late decelerations: Gradual decline that is after contractions; indicate hypoxia.
• Prolonged deceleration: Decels lasting 3 minutes or longer.

Physiology of Hypoxia in Labour

• Acute hypoxia: Prolonged decelerations (5+ minutes). Causes: Accidents, iatrogenic, hyperstimulation. Management: 3-minute rule, emergency alarm, diagnosis, preparation for delivery, aim for delivery in 12-15 minutes for prolonged decels.

• Subacute hypoxia: Fetus remains in prolonged decelerations, often caused by hyperstimulation. Management: Stop uterotonics, avoid supine, fluids, consider tocolytics, expedite delivery if it persists.

• Gradually evolving hypoxia (Stages 1-4): Hypoxic stress, loss of acceleration, exaggerated response, and redistribution to vital organs.

• Gradually evolving hypoxia (Stages 5 & 6): Further redistribution, vasoconstriction, terminal heart failure, unstable pulse rate decline, 'step ladder' pattern leading towards death.

• Chronic hypoxia: Antenatal type, presenting with low baseline heart rate at the end of the normal pulse rate, reduced variability and shallow decels. Requires surgical intervention if necessary.

Questions and Answers

• (Multiple Choice Questions about pregnancy stages, hormones, fetal development, and related topics are included.)