Reproductive System: Amenorrhea and Premenstrual Issues

Reproductive System Concerns

• Amenorrhea means the absence of menstrual flow, indicating possible health issues or pregnancy.
• Conditions to evaluate include absence of menarche, secondary sex characteristics by age 13, or absence of menses by age 15, regardless of growth.
• Absence of menstruation within 5 years of breast development or cessation of menses for 6+ months is also key.
• Early menstruation may occur with moderate obesity (20-30% above ideal weight); delayed onset (by 18) may happen due to malnutrition, or strenuous exercise.
• Amenorrhea causes include pregnancy, anatomic abnormalities, endocrine dysfunction, chronic diseases such as type 1 diabetes, medications like phenytoin, drug/alcohol use, or oral contraceptives.
• Premenstrual pain and discomfort include dysmenorrhea, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and clustered symptoms before menstruation.
• Dysmenorrhea is a common gynecologic issue involving pain during or before menstruation.
• Primary dysmenorrhea is linked to the ovulatory cycle, lacks known pathology, and manifests before age 20.
• It arises from the rise of prostaglandins during menses.
• Excessive PGF2a increases uterine contractions and causes vasospasm of arterioles, leading to ischemia and lower abdominal cramps.
• Symptoms of dysmenorrhea are systemic responses to PGF2a: backache, weakness, diaphoresis, GI symptoms, and CNS symptoms (dizziness, syncope, headache, poor concentration).
• Secondary dysmenorrhea, menstrual pain developing after primary dysmenorrhea, typically occurs after age 25, and may indicate a pelvic pathology (adenomyosis, endometriosis, pelvic inflammatory disease, endometrial polyps, or myomas).

Conception and Fetal Development

• Conception means union of a single egg and sperm.
• Fertilization happens in the uterine tube within 24 hours of ovulation. The zygote is the first cell of a new individual.
• Implantation occurs 6-10 days after conception.
• Germinal stage is 0-2 weeks.
• Embryonic stage is 3-8 weeks.
• Fetal stage is from 9 weeks to birth.
• The embryonic period of development is most critical, occurring from day 15 through the 8th week.

Chemical Teratogens

• Alcohol may lead to growth restriction, cognitive impairment, microcephaly, and malformations of the face/trunk.
• Anticoagulants may cause skeletal abnormalities, broad hands with short fingers, nasal hypoplasia, and eye/neck/CNS anomalies.
• Chemotherapeutic agents may cause major anomalies throughout the body.
• Cocaine may cause cardiac/central nervous system anomalies, and growth restriction.
• Lithium may cause heart anomalies.
• Dilantin may cause cognitive impairment, poor growth, microcephaly, dysmorphic face, and digit/nail hypoplasia.
• Accutane may cause craniofacial defects, cleft palate, ear/eye deformities, and nervous system defects.

Embryo and Fetus

• Pregnancy lasts 280 days/40 weeks, calculated from the first day of the last menstrual period (LMP).
• Membranes that surround the developing embryo/fetus include the chorion and amnion.
• Amniotic fluid is fetal lung liquid and urine, aiding thermoregulation, oral fluid, waste repository, fluid/electrolyte homeostasis, cushioning, musculoskeletal development, antibacterial factors, and auditory stimulation; volume is significant.
• Oligohydramnios is less than 300 mL.
• Polyhydramnios is more than 2 liters.

Embryo Development

• The umbilical cord contains vessels: 2 arteries carrying high CO2 blood and waste away from the fetus, and 1 vein carrying freshly oxygenated and nutrient-rich blood back to the fetus.
• Wharton's jelly surrounds vessels to prevent compression.
• Nuchal cord occurs when the cord wraps around the baby's neck.
• A true knot is a knot in the umbilical cord.
• The placenta is complete by week 12, growing wider and covering half of the uterine surface by week 20.

Placenta Function- Endocrine

• Produces 4 hormones: human chorionic gonadotropin (HcG), which is the basis for pregnancy and results in a positive pregnancy test.
• Human chorionic somatomammotropin (hCS), progesterone, and estriol (one of the main estrogens).
• Estriol stimulates uterine growth and uteroplacental blood flow.

Placenta Function- Metabolic

• Provides respiration (O2 to fetus, CO2 out), nutrition, and excretion/storage.
• Circulatory effects depend on maternal blood pressure.
• If maternal hypotension occurs, there is less blood flow to the baby and FHR drops.

Diagnosis of Pregnancy

• Pregnancy tests detect human chorionic gonadotropin (hCG) being the earliest biochemical marker.
• Many available tests can detect pregnancy 7-8 days before expected menses using serum, urine, or quantitative serum testing.

Fetal Characteristics

• The fetal heart is completely developed by the end of week 8.
• It contains a special circulatory pathway (ductus arteriosus, ductus venosus, foramen ovale).
• In fetal hemoglobin, there is a high oxygen affinity and 20-30% more oxygen than maternal hemoglobin.
• Fetal heart rate is approximately 110-160 beats/min, resulting in increased cardiac output.
• Pulmonary surfactants show at 32 weeks, and help baby breathe.
• Artificial surfactant will be given if baby is born before 30 weeks.
• The L/S ratio is used to determine fetal lung maturity where lecithin and sphingomyelin are the pulmonary phospholipids.
• The fetus swallows amniotic fluid starting in the 5th month.
• Meconium is the first fetal/newborn stool within 24 hours following birth. If the amniotic fluid is brown, meconium has occurred in utero.
• Vitamin K is produced by intestinal bacteria in adults. The gut of the infant is sterile at birth, hence the need for the vitamin K.
• Glycogen can be stored in the fetal liver and coagulation factors can be synthesized in the fetal liver due to lack of vitamin K.
• Urine makes up most of amniotic fluid. Oligohydramnios indicates renal malfunction of the infant.
• Sucking is present at week 12.
• Fetal senses are taste by 16 weeks, sound by 24 weeks, and sight by 26 weeks

Endocrine Development

• Insulin is produced by week 20.
• Maternal hyperglycemia can produce infant hyperglycemia.

Reproductive System

• Fetal sex can be determined via sonogram at 12 weeks.

Musculoskeletal Development

• Movements become strong enough to be felt at 20 weeks, or as early as 16 weeks, being "quickening."

Integumentary System

• Vernix is a cheesy material that protects the skin, should not be rubbed off, is antibacterial, and will gradually soak into the skin.
• Lanugo is soft, fine hair covering a fetus that falls off in a few weeks.

Multifetal Pregnancies

• It is about 1 in every 43 births are twins.
• Dizygotic are the fertilization of two ova, with two implantations and fraternal twins that are with same or different sex.
• Increases in frequency with maternal age (peaking at 37 years), parity, and the use of assistive reproductive therapy (ART). There are two placentas and two chorions.
• Monozygotic develops from one fertilized ovum that divides, and is about 0.4% pregnancies being the same/identical sex.
• Monochronic means one placenta for both twins.
• Monoamniotic means one sac of fluid.
• Dichroic, diamniotic: most common, least risk

Other Influences

• Influences on fetal growth and development include complex genetic and environmental factor interactions
• Parental genetics play a major role.
• Many congenital anomalies/disorders are a result of chromosomal abnormalities
• For environment, health of placenta and mother, nutritional status, maternal age; drug, chemicals and hormones
• Teratogen effects depend on timing of exposure in pregnancy, and mostly affect during embryonic period (3-8 weeks).

Anatomy and Physiology of Pregnancy/ Pregnancy Adaptations

• Maternal changes are multisystemic and caused by hormones/mechanical pressures
• Changes protect normal functioning, meet metabolic needs, and provide for fetal growth.
• Maternal blood volume increases by 40-45%, and cardiac output increase with blood pressure.
• Heart rate increases to 15-20 beats/min by 32 weeks
• Physiologic anemia is a result of increased plasma volume.
• Pregnancy is a hypercoagulable state (increased risk for thromboembolic disease).
• The respiratory rate remains unchanged, but tidal volume and minute ventilation increase by 30-50%.
• Decreased muscle tone contributes to heartburn/constipation.
• Dilation of renal pelvis and ureters raises risk of urinary tract infection
• Hormones maintain pregnancy.
• Home pregnancy testing accuracy depends on following instructions correctly
• Pregnancy diagnosis is based on presumptive (subjective), probable (objective), and positive signs.
• As the uterus enlarges the degree to which abdominal enlargement is observed is influenced by shape and parity
• Uterus palpates symphysis pubis around 12th week, and umbilicus around 20th week. At 38th week, Xiphoid. 38th-40th due to lightening (dropping of the fetus in the pelvis)
• Non-pregnant Uterine Weight= 4-70 g while pregnant is 1,200. Weight 10 ml and 5l

Uterus Changes

• Hegar sign is the softening of the lower uterine segment.
• Causes uterine anteflexion (urinary frequency in the first 3 months of pregnancy)
• Blood flow depends on the mother.
• The rate of blood flow is 450-650 ml per min.
• Braxton Hicks contractions enhance blood flow and are irregular/painless, that stops with exercise and dont cause cervical change.
• Goodell sign is the softening of the cervix.
• Friability: slight bleeding after intercourse
• Chadwick sign: bluish mucus, leukorrhea and lower Ph. Blood flow increases.
• No ovulation means estrogen and progesterone decreases FSH
• Pregnancy bleeding 6-12 after implantation and amenhorrea
• Hormones causes sensitivity with stretch marks and vascularity
• Milk ducts growth produces colostrum first.
• Maternal oxygen consumption increases by 20-40%
• Structural Adaptations
• Asculatory changes and elevated
• Prevent DVT socks

Cardiovascular Adaptations

• Includes a 40-50% Blood Volume Increase with blood flow to uterus.
• Increase in red blood cell plasma volume happens faster than RBC production meaning physiological anemia.
• Hgb 12-16 and HCT is 37-47- HCB low and HCT during trimesters 1 and 3- lower if in the first two
• Hypercoagulable state, and prevent thromboembolism by walking
• Heart rate increases, systolic decreases and blood pressure
• Cardiac output increases, 30-5 per cent
• Taste in 16/24 weeks-26 weeks/note doesnt

Respiratory Adaptations

• Maternal consumption by between 40/40 • Chest breathing replaces abdominal Dyspnea • Rate uncharge /alvoea hyper • alkalosis transports and releases from the mother. • Peaks by 9 is a lot of cravings are non-food cravings

Gastrointestinal Adaptations

• Pica-non food eatings and excessive salivation (PTYALISSMM)
• Relaxes and more reabsorbed
• Dystendded leading stone

Renal/Integumentary Adaptations

• Increases body watre aslo
• Increases GFR/demands more product
• Hypersensitivity of the skin, pituitary hormones
• Linear Nigera and strea on hands

Musculoskeletal/Neurological Adaptations

• Noticeable changes in posture
• Contradiction headaches and emotional
• Sleep change: caparol
• Essential for pregnancy and recovery •

Fetal Growth Factors

• Complex interactions and the genetics
• Anomlaies are the result of anomalies and environmental The most dangerous 3-8 weeks
• Multistetmetic with a high pressure.

Key Nursing Points For Pregnancy

Maternal Anatomic and physiological adaptations

• Protect the woman's normal functioning, meet the metabolic demands that pregnancy imposes, and provide for fetal developmental and growth needs • increased by blood increase to prevent pregos
• Is a state! Increased to

Pregnancy Symptoms

• Are subjective, objective, and have positive results!

Pregnancy Term Terminoloy

• Gravia-paritity and pregnancy, regardless of duration
• Nullparous- never completes less gestation.

Gestation Duration

9 calendar months, 10 lunar months 40 weeks or 280 days Trimesters- 1-13 is the first term.

Pregnancy Phase

Accepting, recognizing, establishing relationships, and then there are changes!

Care

• Promote the fetus
• Provide inter profesional team, centering pregnancy and a lot of cost.

Initial Testing

• Pop smear if over 21, urine and cbs in the labs •
• Tradoitonal schedule as follows
• 1 tri, 96, 29-30 is every 2, and then delivery week is high •
• Initial: prenatal
• Risk assessment-review systems and tests. • Follow assessment, lmp and testing from the heart/babies. • •

Labour Signs

• Can affect babies =preeclamips o posture and more care

Nutrition

• The most development • the less intake means defects • BMI is what helps with more sustainence • underweight needs pounds • single/double

Macros

• Essential: meat/carbs/proteins for growth • minerals increase

Calcium

• same amount, leeg and pescato Risks increase for preterm /SGA •

Pregos Issues

•No type-caffiene is minimal.

Planning

•Emphasize and cultural needs

Weight Changes

• know the range!

Foods

• avoid -vomit , intake for fibe

Modicatons

• increased risks. • the 4 things to care for and do this

• Low at seafood.

5P's Labor

•What are the 5ps?

• P and p

Fetal Factors

• Fontels • posterior and extended • types

Attitude of the Baby Is Super Important

• Cephalic • B • not well will. •shoulder

Lye Fetal

•Vert and trans

Atidue- Flexion

•head is to the chest •the long axis •ROA

0 Is Level Station

• negative is up and pushing • contractions • vaginal tissue assessment

Overview of amenorrhea and premenstrual pain/discomfort. Amenorrhea, or the absence of menstrual flow, can indicate health issues. Premenstrual issues include dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD).