Women's Health and Diseases Nursing - Week 17

Istanbul Gelisim University

• Istanbul Gelisim University is dedicated to ecological, economic, and social sustainability.
• Website and social media links are provided.

Department of Nursing

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

Course Information

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

What to Learn This Week

• Formation of the human reproductive physiology and pregnancy

Embryo Implantation

• Illustrated stages of human embryo development (zygote, cleavage stages, morula, blastocyst, implantation).
• Stages include fusion of egg and sperm pronuclei (fertilization) and ovum.
• Features of the reproductive organs (uterus, fallopian tube, ovaries, vagina, cervix).

Early Pregnancy Signs

• Common early pregnancy signs are listed as symptoms.
• Signs include headache, nausea, vomiting, bloating, missed period, spotting, elevated temperature, swollen/tender breasts, mood swings, flatulence, frequent urination, fatigue, food cravings, crying, low back pain and constipation.

Learning Objectives

• Determining gravidity and parity using two- and five-digit systems.
• Describing different types of pregnancy tests, including timing and interpretation.
• Explaining expected maternal anatomic and physiologic adaptations to pregnancy.
• Differentiating presumptive, probable, and positive signs of pregnancy.
• Identifying maternal hormones during pregnancy, their target organs, and effects.

Naegele's Rule

• A formula for calculating the estimated due date (EDC).
• Begin with the first day of the last menstrual period (LMP).
• Subtract three months.
• Add 7 days.
• Add one year.

Naegele's Rule Questions

• Questions related to calculating due dates based on the LMP using Naegele's rule (three examples provided).

Important Terms: Gravidity

• Gravida: A woman who is pregnant.
• Gravidity encompasses pregnancy regardless of outcome.
• Multigravida: A woman who has had two or more pregnancies.
• Nulligravida: A woman who has never been pregnant.
• Viability: Ability of a fetus to survive outside the womb (24+ weeks gestation).

Important Terms: Parity

• Parity: Number of pregnancies in which a fetus/fetuses have reached viability, not the number of fetuses born.
• Nullipara: A woman who has not completed a pregnancy to the stage of fetal viability.
• Primipara: A woman who has completed one pregnancy to 24 weeks of gestation.
• Multipara: A woman who has completed two or more pregnancies to 24 weeks of gestation or more.

Important Terms: Gestational Age of Pregnancy

• Preterm: Pregnancy that reaches 24 weeks but ends before 37 weeks of gestation.
• Late preterm: Pregnancy between 34-0 to 36-6 weeks of gestation.
• Early term: Pregnancy between 37-0 to 38-6 weeks of gestation.
• Full term: Pregnancy between 39-0 to 40-6 weeks of gestation.
• Late term: Pregnancy between 41-0 to 41-6 weeks of gestation.
• Post term: Pregnancy that reaches 42 weeks and beyond.
• Gestational age chart is provided in weeks.

Anatomy and Physiology of Pregnancy

• Human chorionic gonadotropin (hCG) - earliest biochemical marker for pregnancy; production begins at implantation.
• hCG levels increase in urine until reaching a peak (60-70 days of gestation).
• High hCG levels may indicate abnormal or multiple gestations.
• Abnormal hCG increase/decrease can indicate miscarriage or ectopic pregnancy.

Adaptations to Pregnancy

• Reproductive system and breasts: Uterine growth (size comparisons), breast changes during pregnancy, and the timeline.
• Diagnosis of pregnancy: Explains probable signs of pregnancy using bimanual examination (Hegar's and Goodell's signs).
• Uteroplacental Blood Flow: Maternal blood flow to the uterus and placental perfusion increase during pregnancy; blood flow details for the vascular system.
• Ballottement: Passive movement of the unengaged fetus, detected by vaginal exam (16-18 weeks).
• Breast changes: Breast changes (fullness, sensitivity, tingling, heaviness) and pigmentation changes in nipples and areolae. Lactogenesis (colostrum).
• Cardiovascular system: Slight cardiac enlargement, diaphragm displacement, and increased pulse rate (10-15 beats/min).
• Blood Pressure: Diastolic blood pressure generally remains constant, then gradually decreasing (widespread decrease).
• Blood volume and composition: Changes in blood volume (plasma, RBCs), increased total white blood cells, and timing of total white blood cell count increase in pregnancy.
• Cardiac Output: Cardiac output increases (30-50%) over non-pregnant rate. Circulation time slightly decreases.
• Respiratory system: Oxygen requirements increase; upper respiratory tract becomes more vascular.
• Pulmonary function: Pregnant women may experience dyspnea; chest wall and diaphragm changes.
• Basal metabolic rate: Metabolic rate increase and varies considerably; heat intolerance, fatigue experienced by expectant mothers.
• Renal system: Changes to renal pelves and ureters. Glucose in pregnancy urine content. Urinary frequency, bladder irritability, and nocturia. Bladder capacity increase to 1500 ml.
• Fluid and electrolyte balance: Pooling of fluid in legs, edema, and dependent edema - no treatment needed. Glucose reabsorption impaired in pregnant women. Proteinuria is unusual but can occur during labor or birth.
• Integumentary system: Chloasma (facial mask), linea nigra, striae gravidarum, and Vascular Spiders (angiomas), Palmar erythema, cholestasis of pregnancy, and epulis, hirsutism.
• Musculoskeletal system: Walking difficulties, waddling gait, ligamentous laxity and muscular/spinal changes.
• Neurologic system: Edema affecting peripheral nerves, carpal tunnel syndrome, headaches, syncope (fainting), hypocalcemia, muscle cramps, tetany (muscle spasms).

Adaptations to Pregnancy: Gastrointestinal System

• Appetite and Nausea (Morning sickness): Changes in appetite (pica), excessive salivation (ptyalism); nausea and vomiting of pregnancy subsides by third trimester.
• Mouth, Esophagus, Stomach, and Intestines: Pica, non-food substance cravings, vomiting, indigestion (pyrosis), constipation, hemorrhoids, and their symptoms.

Adaptations to Pregnancy: Pituitary and Placental Hormones

• Roles of hormones (progesterone for muscle relaxation, maintaining pregnancy; estrogen for breast and uterine changes; and oxytocin for milk production and uterine contractions during labor).

Multiple Choice Questions

• Questions related to hormones, the definition of gravidity and multipara, due date calculation, probable signs of pregnancy (Hegar and Goodell's signs), uterus size in gestation, and the definition of ballottement in pregnancy.