CARE OF MOTHER, CHILD AND ADOLESCENTS (BSN2) - Prelims-Midterms PDF

CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 5. Care in a variety of hospital and home care settings M1 : INTRODUCTION TO MATERNAL AND CHILD...

CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 5. Care in a variety of hospital and home care settings M1 : INTRODUCTION TO MATERNAL AND CHILD PHILOSOPHY OF MCN NURSING 1. Family centered; assessment should always include the family as well as an individual Lesson 1 : Overview of Maternal 2. Community centered; the health of and Child Nursing families is both affected by and influences the health of communities Maternal and Child Nursing 3. Evidence based; critical knowledge The nursing specialty that deals with the increases care of women throughout their pregnancy 4. A challenging role for nurses and a and childbirth and the care of their newborn major factor in keeping families well children” (National Center for Biotechnology and optimally functioning Information, 2006) An MCN Nurse: ROLES Three subordinate terms in the CINAHL 1. Considers the family as a whole and subject headings hierarchy: as a partner in care 1. Obstetric nursing (“care of normal, 2. Serves as an advocate to protect the uncomplicated pregnancies only”), right of all family members , 2. Perinatal nursing (“nursing care of including the fetus childbearing families who are at risk 3. Demonstrate a high degree of for increased maternal, fetal, or independent nursing functions neonatal mortality”), and because teaching and counseling 3. Pediatric nursing are major interventions 4. Promotes health and disease PRIMARY GOAL prevention because these protect The promotion and maintenance of optimal the health of the next generation family health to ensure cycles of optimal 5. Serves as important resource for childbearing and childrearing families during childbearing and childrearing as these can be SCOPE OF PRACTICE extremely stressful times in a life 1. Preconception health care cycle 2. Care of women during the trimesters 6. Respects personal, cultural, and of pregnancy and the puerperium ( 6 spiritual attitudes and beliefs weeks after childbirth) influence the meaning 3. Care of the infants during the 7. Encourages developmental perinatal period ( the time span stimulation during both health and beginning at 20 weeks of pregnancy illness so children can reach their to 4 weeks after birth) ultimate capacity in adult life 4. Care of children form birth through 8. Assesses families for strengths as late adolescence well as specific needs or challenges CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 9. Encourages family bonding through Target 7.C: Halve, by 2015, the rooming-in and family visiting in proportion of people without maternal and child healthcare facility sustainable access to safe drinking 10. Encourages early hospital discharge water and basic sanitation options to reunite families as soon Goal 8: Develop a global partnership as possible in order to create a for development seamless, helpful transition process Target 8.E: In cooperation with 11. Encourages families to reach out to pharmaceutical companies, provide their community so the family can access to affordable essential drugs develop a wealth of support people in developing countries. Health-related Millennium Development SUSTAINABLE DEVELOPMENT GOALS Goals and Targets (SDGs) Goal 1: Eradicate poverty and The Sustainable Development Goals hunger (SDGs) are a collection of 17 global goals Target 1.C: Halve, between 1990 set by the United Nations General Assembly and 2015, the proportion of people in 2015 for the year 2030. The SDGs are who suffer from hunger. part of Resolution 70/1 of the United Goal 4: Reduce child mortality Nations General Assembly, the 2030 Target 4.A: Reduce by two-thirds, Agenda. between 1990 and 2015, the The 17 SDGs are broader and more under-five mortality rate. ambitious than the MDGs, presenting an Goal 5: Improve maternal health agenda that is relevant to all people in all Target 5.A: Reduce by three countries to ensure that "no one is left quarters, between 1990 and 2015, behind." The new agenda requires that all 3 the maternal mortality ratio. dimensions of sustainable development – Target 5.B: Achieve, by 2015, economic, social and environmental – are universal access to reproductive addressed in an integrated manner. health. SDG 3: Ensure healthy lives and Goal 6: Combat HIV/AIDS, malaria promote wellbeing for all at all ages. and other diseases - 3.1 By 2030, reduce the Target 6.A: Have halted by 2015 global maternal mortality and begun to reverse the spread of ratio to less than 70 per 100 HIV/AIDS. 000 live births. Target 6.B: Achieve, by 2010, - 3.2 By 2030, end preventable universal access to treatment for deaths of newborns and HIV/AIDS for all those who need it. children under 5 years of Target 6.C: Have halted by 2015 age, with all countries aiming and begun to reverse the incidence to reduce neonatal mortality of malaria and other major diseases. to at least as low as 12 per Goal 7: Ensure environmental 1000 live births and under-5 sustainability mortality to at least as low as 25 per 1000 live births CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - 3.3 By 2030, end the and illnesses from hazardous epidemics of AIDS, chemicals and air, water and tuberculosis, malaria and soil pollution and neglected tropical diseases contamination. and combat hepatitis, - 3.a Strengthen the water-borne diseases and implementation of the WHO other communicable Framework Convention on diseases. Tobacco Control in all - 3.4 By 2030, reduce by one countries, as appropriate. third premature mortality - 3.b Support the research and from non-communicable development of vaccines and diseases through prevention medicines for the and treatment and promote communicable and mental health and well-being non-communicable diseases - 3.5 Strengthen the that primarily affect prevention and treatment of developing countries, provide substance abuse, including access to affordable narcotic drug abuse and essential medicines and harmful use of alcohol. vaccines, to protect public - 3.6 By 2020, halve the health, and, in particular, number of global deaths and provide access to medicines injuries from road traffic for all. accidents. - 3.c Substantially increase - 3.7 By 2030, ensure health financing and the universal access to sexual recruitment, development, and reproductive health-care training and retention of the services, including for family health workforce in planning, information and developing countries, education, and the especially in least developed integration of reproductive countries and small island health into national strategies developing States. and programmes. - 3.d Strengthen the capacity - 3.8 Achieve universal health of all countries, in particular coverage, including financial developing countries, for risk protection, access to early warning, risk reduction quality essential health-care and management of national services and access to safe, and global health risks. effective, quality and affordable essential PHILIPPINE HEALTH GOALS medicines and vaccines for NATIONAL SAFE MOTHERHOOD all. PROGRAM - 3.9 By 2030, substantially Vision - For Filipino women to have reduce the number of deaths full access to health services CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 towards making their pregnancy and delivery safe Lesson 2 : Maternal and Child Mission - Guided by the Department Nursing Initiatives In the of Health FOURmula One Plus Philippines thrust and the Universal Health Care Frame, the National Safe Motherhood Program is committed NATIONAL SAFE MOTHERHOOD to provide rational and responsive PROGRAM policy direction to its local government partners in the delivery Program Components of quality maternal and newborn Component A: Local Delivery of the health services with integrity and Maternal–Newborn Service Package accountability using proven and This component supports LGUs in innovative approaches establishing and mobilizing the service Objectives - The Program delivery network of public and private contributes to the national goal of providers to enable them to deliver the improving women’s health and integrated maternal-newborn service well-being by: Collaborating with package. In each province and city, the Local Government Units in following shall continue to be undertaken: establishing sustainable, cost-effective approach of delivering 1. Establishment of critical capacities to health services that ensure access provide quality maternal-newborn of disadvantaged women to services through the organization acceptable and high quality maternal and operation of a network of and newborn health services and Service Delivery Teams consisting enable them to safely give birth in of: health facilities near their homes a. Barangay Health Workers Establishing core knowledge base b. BEmONC Teams composed of and support systems that facilitate Doctors, Nurses and Midwives the delivery of quality maternal and newborn health services in the 2. In collaboration with the Centers for country. health Development and relevant national offices: Establishment of Reliable Sustainable Support Systems for Maternal- Newborn Service Delivery through such initiatives as: a. Establishment of Safe Blood Supply Network with support from the National Voluntary Blood Program b. Behavior Change Interventions in collaboration with the Health Promotion and Communication Service CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 c. Sustainable financing of maternal - c. Annual Program Implementation newborn services and commodities Reviews with Provincial Health through locally initiated revenue Officers and Regional Coordinators generation and retention activities including PhilHealth accreditation POLICIES AND LAWS and enrolment. Republic Act No. 10354: Component B: National Capacity to Responsible Parenthood and Sustain Maternal-Newborn Services Reproductive Health Law (RPRH 1. Operational and Regulatory Act of 2012) Guidelines 1. Administrative Order 2008-0029: a. Identification and profiling of current Implementing Health Reforms to FP users and identification of Rapidly Reduce Maternal and potential FP clients and those with Neonatal Mortality unmet need for FP (permanent or 2. Department Order 2009-0084: temporary methods) Guidelines Governing the Payment b. Mainstreaming FP in the regions of Training Fees relative to the with high unmet need for FP Attendance of Health Workers to c. Development and dissemination of Basic Emergency Obstetric and Information, Education Newborn Care Skills Training Communication materials Course at Duly Designated Training d. Advocacy and social mobilization for Centers FP 3. Administrative Order 2011-0011: Establishment of Basic Emergency 2. Network of Training Providers Obstetric and Newborn Care a. 31 Training Centers that provide Training Centers in Regional BEmONC Skills Training Hospitals and Medical Centers 4. Administrative Order 2015-0020: 3. Monitoring, Evaluation, Research, Guidelines in the Administration of and Dissemination with support from Life Saving Drugs During Maternal the Epidemiology Bureau and Health Care Emergencies by Nurses and Policy Development and Planning Midwives in Birthing Centers Bureau 5. Administrative Order 2016-0035: a. Monitoring and Supervision of Guidelines on the Provision of Private Midwife Clinics in Quality Antenatal Care in All Birthing cooperation with PRC Board of Centers and Health Facilities Midwifery and Professional Providing Maternity Care Services Midwifery Organizations 6. Administrative Order 2018-0003: b. Maternal Death Reporting and National Policy on the Prevention of Review System in collaboration with Illegal and Unsafe Abortion and Provincial and City Review Teams Management of Post-Abortion Complications CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 Republic Act No. 10354: replacement rate, in line with the Responsible Parenthood and State’s duty to promote the right to Reproductive Health Law (RPRH health, responsible parenthood, Act of 2012) social justice and full human - Section 2. Declaration of Policy. development; The State recognizes and d. The provision of ethical and guarantees the human rights of all medically safe, legal, accessible, persons including their right to affordable, non-abortifacient, equality and nondiscrimination of effective and quality reproductive these rights, the right to sustainable health care services and supplies human development, the right to is essential in the promotion of health which includes reproductive people’s right to health, especially health, the right to education and those of women, the poor, and the information, and the right to choose marginalized, and shall be and make decisions for themselves incorporated as a component of in accordance with their religious basic health care; convictions, ethics, cultural beliefs, e. The State shall promote and and the demands of responsible provide information and access, parenthood. without bias, to all methods of - Section 3. Guiding Principles for family planning, including Implementation. – This Act effective natural and modern declares the following as guiding methods which have been proven principles: medically safe, legal, a. The right to make free and informed non-abortifacient, and effective in decisions, which is central to the accordance with scientific and exercise of any right, shall not be evidence-based medical research subjected to any form of coercion standards and must be fully guaranteed by the f. The State shall promote programs State, like the right itself; that: (1) enable individuals and b. Respect for protection and fulfillment couples to have the number of of reproductive health and rights children they desire with due which seek to promote the rights and consideration to the health, welfare of every person particularly particularly of women, and the couples, adult individuals, women resources available and affordable and adolescents to them and in accordance with c. Since human resource is among the existing laws, public morals and their principal assets of the country, religious convictions: Provided, That effective and quality reproductive no one shall be deprived, for health care services must be given economic reasons, of the rights to primacy to ensure maternal and have children; child health, the health of the g. The provision of reproductive health unborn, safe delivery and birth of care, information and supplies giving healthy children, and sound CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 priority to poor beneficiaries as elements of reproductive health and identified population and development; h. The State shall respect individuals’ n. The resources of the country must preferences and choice of family be made to serve the entire planning methods that are in population, especially the poor, and accordance with their religious allocations thereof must be convictions and cultural beliefs, adequate and effective: Provided, i. Active participation by non That the life of the unborn is government organizations (NGOs), protected women’s and people’s organizations, o. Development is a multi-faceted civil society, faith-based process that calls for the organizations, the religious sector harmonization and integration of and communities is crucial policies, plans, programs and j. While this Act recognizes that projects that seek to uplift the quality abortion is illegal and punishable by of life of the people, more law, the government shall ensure particularly the poor, the needy and that all women needing care for the marginalized; and post-abortive complications and all p. That a comprehensive reproductive other complications arising from health program addresses the needs pregnancy, labor and delivery and of people throughout their life cycle. related issues shall be treated and counseled in a humane, Administrative Order 2008-0029: nonjudgmental and Implementing Health Reforms to compassionate manner in Rapidly Reduce Maternal and accordance with law and medical Neonatal Mortality ethics; - This policy issuance provides the k. Each family shall have the right to strategy for rapidly reducing determine its ideal family size: maternal and neonatal deaths Provided, however, That the State through the provision of a package shall equip each parent with the of maternal, newborn, child health necessary information on all aspects and nutrition (MNCHN) services. of family life, including reproductive The goal of rapidly reducing health and responsible parenthood, maternal and neonatal mortality shall in order to make that determination; be achieved through effective l. There shall be no demographic or population-wide provision and use of population targets and the integrated MNCHN services as mitigation, promotion and/or appropriate to any locality in the stabilization of the population growth country. The strategy aims to rate is incidental to the advancement achieve the following intermediate of reproductive health; results: m. Gender equality and women 1. Every pregnancy is wanted, planned empowerment are central and supported; CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 2. Every pregnancy is adequately network of facilities that can perform managed throughout its course; the six signal obstetric functions for 3. Every delivery is facility-based and BEmONC, as well as provide managed by skilled birth 1. caesarean delivery services, attendants/skilled health 2. blood banking and transfusion professionals; and services, 4. Every mother and newborn pair 3. and other highly specialized secures proper post-partum and obstetric interventions. newborn care with smooth - It is also capable of providing transitions to the women’s health neonatal emergency interventions, care package for the mother and which include at the minimum, the child survival package for the following: newborn. 1. newborn resuscitation; 2. treatment of neonatal Administrative Order 2011-0011: sepsis/infection; Establishment of Basic 3. oxygen support for neonates; Emergency Obstetric and 4. management of low birth weight or Newborn Care Training Centers in preterm newborn; and Regional Hospitals and Medical 5. other specialized newborn services. Centers - These facilities can also serve as - Basic Emergency Obstetric and high volume providers for Newborn Care (BEmONC) Intrauterine device (IUD) and - Capable network of facilities and Voluntary Surgical Contraception providers that can perform the (VSC) services, especially tubal following six signal obstetric ligations. It should also provide an functions: itinerant team that will conduct 1. parenteral administration of oxytocin out-reach services to remote in the third stage of labor; communities. The itinerant team is 2. parenteral administration of loading typically composed of 1 physician dose of anti-convulsants; (surgeon), 1 nurse and 1 midwife. 3. parenteral administration of initial dose of antibiotics; Administrative Order 2016-0035: 4. performance of assisted deliveries Guidelines on the Provision of (Imminent Breech Delivery); Quality Antenatal Care in All 5. removal of retained products of Birthing Centers and Health conception; and Facilities Providing Maternity 6. manual removal of retained Care Services placenta. - The order seeks to improve the quality of antenatal care through the - Comprehensive Emergency provision of technical guidance in Obstetric and Newborn Care the shift in ANC concept from the (CEmONC) - Capable facility or high risk approach to the four-visit CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 model of focused ANC and 4.1 Facilitate the newborn’s early consequent service delivery scheme intiation to breastfeeding and of the ANC package transfer of colostrum through - The four –visit model support and initiation of First visit : 8-12 weeks breasfeeding. Second visit : 24-26 week 4.2 To prevent opthalmia Third visit : 32 weeks neonatorum through proper eye care Fourth visit: 36-38 weeks ( administer erythromycin or tetracycline ointment or 2.5% Essential Newborn Care Protocol povidone- iodine drops) (AO 2009-0025) - The policy ensures the provision of B. Non-immediate Interventions -usually globally accepted evidence-based given within 6 hours essential newborn care focusing on After birth the first week of life. 1. Give Vitamin K Prophylaxis - Emphasis is given to care 2. Inject Hepatitis B and BCG interventions that should be provided vaccinations to the newborn from birth until the 3. Examine the newborn. Check for first 6 hours of life birth injuries, malforamations or defects A. Ensure Quality Provision of 4. Cord care Time-Bound Interventions 1. Within the first 30 seconds - The EINC practices are 1.1 Dry and provide warmth to the evidenced-based standards for safe newborn and prevent hypothermia and quality care of birthing mothers 2. After thorough drying and their newborns, within the 48 2.1 Facilitate bonding between the hours of Intrapartum period (labor mother and her newborn through and delivery) and a week of life for skin-to-skin contact to reduce the newborn. likelihood of infection and - In December 2009, the Secretary of hypoglycaemia the Department of Health Francisco 3. While on skin-to skin contact ( up to Duque signed Administrative Order 3 minutes post- delivery) 2009-0025, which mandates 3.1 Reduce the incidence of anemia implementation of the EINC Protocol in term newborns and in both public and private hospitals. intraventricular hemorrhage in Likewise, the Unang Yakap preterm newborns by delaying or campaign was launched. non-immediate cord clamping (clamp and cut the cord after cord The EINC practices during Intrapartum pulsations have stopped, typically period 1-3 minutes.) 1. Continuous maternal support, by a 4. Within 90 minutes of age companion of her choice, during labor and delivery CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 2. Mobility during labor – the mother is maternal and newborn injuries and still mobile, within reason, during this death. stage Unnecessary interventions eliminated 3. Position of choice during labor and Likewise, the unnecessary interventions in delivery newborn care which include 4. Non-drug pain relief, before offering 1. routine suctioning, labor anesthesia 2. early bathing, 5. Spontaneous pushing in a 3. routine separation from the mother, semi-upright position 4. foot printing, 6. Episiotomy will not be done, unless 5. application of various substances to necessary the cord, 7. Active management of third stage of 6. and giving pre-lacteals or artificial labor (AMTSL) infant milk formula or other 8. Monitoring the progress of labor with breast-milk substitutes the use of partograph ANNUAL REPORT 2017 Recommended EINC practices for DEPARTMENT OF HEALTH newborn care are time-bound PHILIPPINES interventions at the time of birth 1. Immediate and thorough drying of the newborn 2. Early skin-to-skin contact between mother and the newborn 3. Properly-timed cord clamping and cutting 4. Unang Yakap (First Embrace) of the mother and her newborn for early breastfeeding initiation Unnecessary interventions eliminated - The unnecessary interventions during labor and delivery, which do not improve the health of mother and child, are eliminated. These are: 1. enemas and shavings, 2. fluid and food intake restriction, and 3. routine insertion of intravenous fluids. 4. Fundal pressure to facilitate the second stage of labor is no longer practiced, because it resulted to CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 Medical Assistance Program: The tetanus less than one case auntry new Kawasaki Disease has neonatal tetanus per 1,000 live births in The Kawasaki Diseases also known as all its cities and provinces. Moreover, it now Kawasaki Syndrome is an illness with no joins 43 other countries which have definite cause that primarily affects children achieved this global public health goal. younger than 5 years of age. Through the passage of the Rare Disease Act of the Healthy Women Healthy Economies and Philippines (RA 10747), the Department of Buntis Summit 2017 Health is embarking on the provision of A regional launching of Healthy Women services to patients with rare diseases. That Healthy Economies (HWHE) was conducted is, providing patients and their families last March 8, 2017 at the conference room better access to adequeate healthcare of the Department of Health Region Ill service to treat their condition. This includes Office. This initiative seeks to enhance the Kawasaki syndrome which is supported women's economic participation by through the Medical Assistance for Indigent improving women's health. The launching Patients Program. As of December 2017, for this initiative expanded the involvement there were 59 patients served with the of other government and private workplaces Medical Assistance for Kawasaki Disease. in Central Luzon in its implementation. Nutritional Feeding Program for The Buntis Summit 2017 which was Pre-school Children attended by more than 100 pregnant Department of Health (DOH) - MIMAROPA women, aimed to reduce maternal and child under its Oplan Kain Sigla Program started mortality through increased awareness on another round of Eat to Nourish Approach the importance of the 3-Delays: 1) seeking Feeding Package targeting 420 pre-school appropriate medical care, 2) reaching an children aged 6 - 71 months in the region. appropriate medical facility, and 3) receiving The program aimed to improve the adequate care when a facility is reached. nutritional status from underweight or This year, it was held in 12 different severely underweight to normal in a span of Municipalities/Cities in the Cagayan Valley 90 days. The program provided a full meal Region from March - October 2017 with the amounting to PHP 80 per day, including theme: "Kalusugan Mo Inay, Ingatan Mo: morning snacks, to preschoolers with weight Kinabukasan Ninyo ni Baby, Nakasalalay and height that are lower for their age. Sa'yo". Maternal and Neonatal Tetanus January 9, 2017: Executive Order No. 12: Elimination (MNTE) Attaining and Sustaining Zero Unmet Need On November 29. 2017 the Philippines for Modern Family Planning through the through the Department of Health the Strict Implementation of the Responsible achievement of maternal and Of celebrated Parenthood and Reproductive Health Act, eliminating Such efforts neonatal tetanus. Providing Funds Therefor and for Other through were made possible immunization, Purposes which identifies fund sources and care and and safe enhanced delivery mechanisms to accelerate attainment of the antenatal practices, neonatal surveillance.1 targets for modern Family Planning. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 which covers the distal ends of the corpora cavernosa. Lesson 3A : Review of Anatomy: - prepuce (foreskin): hoodlike fold of Reproductive System skin that covers the glans the urethra passes through these layers MALE REPRODUCTIVE ORGANS of erectile tissue - the penis serves as the outlet for External Organs both the urinary and the reproductive Scrotum - supports the testes and tracts in men help regulate the temperature of sperm Testes - testes first form in utero in the pelvic cavity. - descend, late in intrauterine life (about the 34th to 38th week) into the scrotal sac - normal testes feel firm, smooth, and egg-shaped - Lobules consist: Leydig’s Cell – interstitial cells in each lobule - Responsible for production of Internal Organs testosterone Epididymis - Testosterone - Comma shaped organ about - The most 4 cm long that lies along the prevalent posterior border of each androgen testis - Promotes the - Consists mostly of ductus development epididymis tightly coiled of masculine approximately 20 ft long. characteristics - Responsible for conducting - Promotes a sperm from the testis to vas man’s libido deferens. Seminiferous tubule - Absorption of fluid and Produce spermatozoa addition of substances to the (Spermatogenesis) seminal fluid to nourish the maturing sperm. Penis - Organ of copulation - it takes at least 12 to 20 days - 3 cylindrical masses of erectile for them to travel the length tissue: the corpus spongiosum of the epididymis, - total of 64 expands to form the glans penis days for them to reach maturation CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 Vas Deferens - Alkaline fluid further protects - Carries sperm from the sperm from being epididymis through the immobilized by the naturally inguinal canal in the low ph level of the urethra. abdominal cavity. - Contribute to sperm motility - It ends at the seminal and viability. vesicles and ejaculatory - Hypertrophy of the prostate ducts interferes with both fertility and urination. Seminal Vesicles - Secretes viscous portion of Bulbourethral Glands the semen: High in sugar, - 2 Bulbourethral glands Protein, Prostaglandins, (Cowpers glands). Sperm becomes increasingly - Lie beside the prostate motile because of the Gland. nutrients and more favorable - Empty into the urethra pH. - Function: Secrete an alkaline fluid that helps counteract the Ejaculatory Ducts acid secretion of the urethra. - 2 Ejaculatory ducts pass - Ensure the safe passage of through the prostate gland spermatozoa. and join the seminal vesicles to the urethra. Urethra - Terminate in the prostatic - Hollow tube leading from the urethra base of the bladder. - Function: Eject sperm and - Passes through the shaft and seminal vesicle secretions glans of the penis continues just before the release of to the outside. semen from the urethra to - 8 inches (18 to 20 cm) long. the exterior. Semen Prostate Gland - Mixture of sperm and - Chestnut sized gland. seminal fluid. - Lies below the urinary - Seminal fluid consists of the bladder. secretions: Epididymis (5%), - Urethra passes through the Seminal vesicles (30%), center of it, like the hole in a Prostate gland (60%), doughnut. Bulbourethral gland (5%) - Secretes thin, alkaline fluid. - Added to the secretion from the seminal vesicles and the accompanying sperm from the epididymis. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 FEMALE REPRODUCTIVE ORGANS childbirth to enlarge the vaginal opening. External Genitalia - Collectively known as the vulva or pudendum. Clitoris - Homologous to the penis. - Erectile organ fixed beneath the arc of the pubis - Above the urethral meatus. - Highly sensitive to temperature, touch and pressure sensation. - Serves as a landmark in locating the urethral meatus for female catheterization. Bulb of the Vestibule - Paired elongated masses of Mons veneris ( pubis) erectile tissue. - Rounded, soft, fullness over - Located at the sides of the the symphysis pubis. vaginal orifice - Covered with course dark hair during functional years Urethral meatus and thins after menopause - Pink, reddened, slit like opening. Labia Majora - Marks the terminal or distal - 2 fatty tissue containing folds urethra of skin that extend downward from the mons veneris Paraurethral Glands (Skene’s around the external vaginal Gland) opening terminating in the - 2 very short tubular perineum. structures. - Located posterolateral inside Labia Minora the urethral meatus. - Narrow folds of skin and fibro-areolar tissue extending Hymen from the clitoris to the Perineum fourchette. - Diamond shape area medial - Fourchette – line of to the thighs and buttocks of convergence of the labia both males and females. majora and minora - It contains the external - Structure that is sometimes genitalia and anus. cut (episiotomy) during - Interwoven and superimposed on each other. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - Full dilatation of the birth the vagina. After canal during delivery. childbirth it is a - Several muscles: transverse slit. At the Transverse level of the ischial Bulbocavernous spine. Ischial spine – Sphincter ani externus an important Levator ani relationship in Perineal estimating the level of the fetus in the birth Internal Genitalia canal. Vagina - Internal Os: Opening - It extends from the introitus of the canal at the to the cervix. junction of the cervix - Measures about 10cm in and isthmus. length and 14 cm width. - Cervical Canal: Space - Situated between bladder between external os and rectum. and internal os. - Acid medium (ph 4-5). Operculum – a cervical - Tends to inhibit the growth of plug or mucous the organisms produced by the - DODERLEINS BACILLI – a cervical glands normal bacterial flora of the (Naboth) that prevents vagina that maintains its ascending acidity infection. - Passageway for the sperm’s entrance to the Uterus Isthmus - For copulation - A constricted are - Passageway for menses. immediately above the cervix Uterus - It descends and - Hollow muscular organ softens during shaped like a flattened pear. pregnancy ( - Located inside the true pelvis Hegar’s Sign) and between bladder (anterior) forms the lower and the rectum (posterior). segment of the - Weight nonpregnant uterus uterine segment. 60 grams. - 1-2 mm in length - Parts of the Uterus: in non pregnant Cervix - Neck or state. mouth of the uterus. - The portion of the Parts of the cervix: uterus most - External Os : Small, commonly round distal opening to CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 cut/incised during Anteflexion – Body of the cesarean birth. uterus is bent sharply at the junction with the cervix Corpus The body of the Retroflexion – Body is bent uterus. sharply just above the cervix - Uppermost part and - Extreme abnormal flexion or forms the bulk of the version positions may organ. interfere with fertility. - It may block the deposition or Fundus Top portion of the migration of sperm. uterus. - Highly contractile portion. - Ligaments - Point of attachment of Broad Ligament - A double the fallopian tube fold peritoneum extending - Layers of the Uterus: outwards from the uterus Perimetrium: Layer of the attached to the side walls of peritoneum which covers the the pelvis uterus except at the sides. Round Ligament - It has a - Broad ligaments little support but maintains arises from the sides the normal position of the of the uterus. uterus (Anteversion). Myometrium: Middle layer Utero-Sacral Ligaments - - Made up of muscles Consist of folds of with very great peritoneum extending expansile properties. backward from the sides of Endometrium the isthmus and attached to - Inner lining of uterus the sacrum. - Rich supply of blood - Functions about 1.5 mm thick. 1. Organ of Reproduction. - Decidua – after 2. Organ of Menstruation implantation the 3. Nourishes and protects the fertilized endometrium is ovum for 40 weeks. known as decidua. 4. It expels the products of conception. - After delivery it is shed- off known as Fallopian Tubes Lochia - Approximately 10 cm in length. - Conveys the ovum from the ovaries - Position of the uterus to the uterus. Anteversion – Fundus is - Provides a place for fertilization of tipped forward the ovum by the sperm Retroversion – Fundus is - Four Parts: tipped back. Interstitial portion CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 -The most proximal - Freely movable, smooth, firm and division. slightly flattened ovoids. - Lies within the uterine - 4cm long and 1.5 cm thick. wall and opens into - Functions: the uterine cavity. 1. Release the matured ovum - About 1cm in length. monthly (ovulation) – only - 1mm lumen of the one ovum is released every tube. month. Isthmus 2. Produces estrogen and - Extremely narrow progesterone - Approximately 2cm in - Ovulation – happens length. exactly 14 days - The portion that is cut previous to the first or sealed in a tubal day of the next ligation or tubal menstrual period. sterilization - Subtracting 14 days procedure. from the usual Ampulla menstrual cycle then - Longest portion of the account one on the tube, and relatively first day of bleeding. thin walls. - Approximately 5 cm Related Structures in length. Breast - Fertilization of the - Accessory organs of reproduction. ovum occurs. - Composed of glandular, fibrous and Infundibulum adipose tissue - Most distal segment - 15 to 20 lobes on each breast. - Approximately 2 cm - Each lobe is divided into several in long. lobules. - Funnel shape with a - Contains acini – cells that produces number of irregular milk. processes – Fimbriae. Nipple - A Small cylindrical body that projects - Functions: slightly from the center of each 1. Organ of fertilization breast. 2. Transport eggs, sperm and zygote to - Composed of erectile tissue which the uterus. responds to tactile stimulation. - Lactiferous Ducts – tip of the Ovaries nipple is perforated with 15 to 20 - 2 almond shaped glands. small opening. - Located on the posterior surface of the broad ligaments. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - Colostrum – a thin yellowish fluid ischium upon which a composed of colostrum corpuscles, person sits, markers watery fluid and fat globules to determine lower pelvic width pelvis Colostrum ischial - Contains more protein but less fat spines-small - and sugar than matured milk. projections that - Continuous to be secreted until extend from the about 3rd day postpartum. lateral aspects into the pelvic cavity, Estrogen and Progesterone marks the midpoint of - Inhibits the release of prolactin from the pelvis the anterior pituitary gland, thus - Pubis: the anterior lactation is suppressed. portion symphysis Oxytocin pubis-junction of the - Hormone from the posterior pituitary innominate bones at gland that stimulate expression of the front of the pelvis milk from the lactating breast – Sacrum Letdown Reflexes. - forms the upper - Sounds of the infant crying may posterior portion of produce letdown reflexes. the pelvic ring - Fright, pain or emotional stress may - the wedge bone at inhibit the letdown reflexes. the back of the pelvis. - SACRAL Pelvis PROMINENCE: - serves to support and protect the marked anterior reproductive and other pelvic organs projection where it - a bony ring formed by four united touches the lower bones: lumbar vertebrae; Right and left innominate - serves as the bones landmark for the - Ilium: forms the pelvic measurements upper and lateral portion, the flaring Coccyx superior border forms - composed of five very the prominence of the small bones fused hip (crest of the ilium) together located - Ischium: the inferior below the sacrum portion - Sacrococcygeal joint: ischial tuberosity - the degree of two projections at the movement permits lowest portion of the the coccyx to be CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 pressed backward, - its transverse diameter is wider than allowing more room its anteroposterior diameter. for the fetal head as it - Thus-: Transverse diameter = 13.5 passes through the cm bony pelvic ring at - Anteroposterior diameter = 11 cm. birth - Right and Left oblique diameter = 13.75 cm - For obstetric purposes, the pelvis is Outlet further subdivided by an imaginary - inferior portion of the pelvis, line, the line terminalis: - Boundaries: sacral prominence coccyx superior aspect of the ischial tuberosities symphysis pubis inferior aspect of the symphysis 1. False Pelvis (superior pubis and the pubic arch. half) - its anteroposterior (AP) diameter is - shallow upper part if wider than its transverse diameter the pelvis that supports the uterus Pelvic Cavity during the late - Space between the inlet and outlet months of pregnancy - curved not a straight passage - aids in directing the - Slows and controls the speed of fetus into the true birth pelvis for birth - Reduces sudden pressure changes 2. True Pelvis (Inferior Half) in the fetal head which might rupture - lower, smaller but cerebral arteries deeper part of the - Compresses the chest of the fetus pelvis that must be - Helps to expel lung fluid and mucus adequate for the preparing the lungs for good delivery process. aeration after birth - lies below the linea terminalis. - Types/Variations of the Pelvis - is also known as the 1. Gynecoid bony birth canal. - "normal" female pelvis - Inlet is well rounded forward - Other terms: and back Inlet - most ideal for childbirth. - entrance to the true pelvis 2. Anthropoid - it is at the level of the linea terminalis - transverse diameter is - marked by the sacral prominence in narrow , AP diameter is the back larger than normal. - the ilium on the sides 3. Platypelloid - superior aspect the symphysis pubis - inlet -has a oval, AP diameter in the front is shallow. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 4. Android transverse diameter of the pelvic - "male" pelvis. outlet. - measured at the level of the - inlet has a narrow, shallow anus. Average = 11 cm posterior portion and pointed anterior portion. Lesson 3B : Menstrual Cycle - Measurements 1. External - suggestive only of pelvic size. a. Intercristal = distance between the middle points of the iliac crests. Average = 28 cm b. Interspinous = distance between the anterosuperior iliac spines. Average = 25 cm. c. intertrochanteric = distance between ft trochanters of the femur. Average = 31 cm. d. External conjugate / Bandelocque's = the distance between the anterior aspect of the symphysis pubis and depression below L5. Average =18-20 cm. 2. Internal - gives the actual diameter of the inlet and outlet Spermatogenesis a. Diagonal conjugate: distance - The process by which the between sacral promontory and seminiferous tubules of the testes inferior margin of the symphysis produce sperm. pubis. Average =12.5 cm. - Begins in males at puberty. b. True conjugate/ conjugate Vera : - 65 to 75 days. distance between the anterior - Begins with spermatogonia (stem surface of the sacral promontory and cells)with diploid (2n) number of the superior margin of the symphysis chromosomes. pubis. - Some spermatogonia lose contact - very important measurement with the basement membrane and because it is the diameter of undergo developmental changes. the pelvic inlet. Average - Differentiate into primary =10.5 -11 cm. spermatocytes (2n) 46 c. Biischial diameter/tuberischli: chromosomes. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - Each primary spermatocyte head that contains replicates its DNA and meiosis centrioles. begins. - Middle piece – - 2 Secondary spermatocytes are contains the formed by meiosis I. mitochondria which - Each secondary spermatocytes 23 provide the energy chromosomes, haploid number. (ATP) for locomotion - No further replication occurs in the of sperm. secondary spermatocytes - Principal piece – - Spermiogenesis – final stage of longest portion. spermatogenesis. - End piece – terminal, - Development of haploid spermatids taperingmportion of into sperm. the tail. - No cell division occurs in - Once ejaculated, most sperm do not spermatogenesis. survive more than 48 hours within - Spermatids transform into the female reproductive organ. elongated, slender sperm. Hormonal Control & Sexual Sperm Development - 300 million sperm complete the - Androgens – male sex hormones , process of spermatogenesis each produced in testes and adrenal day. glands - 60 um long - For devt of male sex organs and - Structures that are highly adapted secondary sex characteristics, for reaching and penetrating spermatogenesis secondary oocytes. - Testosterone is one major androgen - Parts of the sperm: - Leydig cells ( located in testes) Head – contains nucleaus secretes testosterone with 23 chromosomes Acrosome – covers the Oogenesis and Follicular Development anterior two thirds of the nucleus. - Filled with enzymes that help a sperm penetrate a secondary oocytes for fertilization. - Hyaluronidase and proteases. Tail: - Neck – constricted region just behind the - formation of gametes in the ovaries. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - Begins in females before they are - As the primary follicle grows, it forms born. a cleart glycoprotein layer called - Same manner as spermatogenesis; zona pellucida between the primary meiosis takes place. oocytes and the granulosa cells. - Fetal development - Theca folliculi – encircles the primordial(primitive) germ cells basement membrane of the migrate from the yolk sac to the granulosa cells. ovaries. Theca interna – vascularized - Germ cells differentiate within the internal layer ovary into oogonia diploid (2n). Theca externa – outermost layer. - Diploid oogonia divide mitotically to - Secondary follicle becomes larger produce millions of germ cells. turning into a mature (graafian) - Most of the germ cells degenerate , follicle. process known as atresia. - While in this follicle, the diploid - Few, develops into larger cells called primary oocytes completes meiosis primary oocytes. I, producing two haploid cells of - Primary oocytes enter prophase of unequal size – each with 23 meiosis I during fetal development chromosomes. but do not complete that phase until - First polar body Smaller cell after puberty. produced By meiosis I. - During the arrested meiosis I, each - Secondary oocytes : Begins meiosis primary oocyte is surrounded by a II Then stops in Metaphase. single layer of follicular cell. Mature (graafian) Follicle - Primordial follicle. soon ruptures And releases - Between 5-7 million ova are form in its Secondary oocytes utero Ovulation - At birth - 2M primary oocytes remain - Mature (graafian) follicle releases in each ovary. secondary oocyte during ovulation. - By age 7 – 500,000 are present in - Secondary oocyte is expelled into each ovary the pelvic cavity together with first - By 22 years – 300,000are present polar body. - By menopause – none are left - Swept into the uterine tube. - The remainder of the primary - If fertilization does not occur, it oocytes undergo atresia. degenerates. - Primordial follicle starts to grow, If sperms are present In the developing into primary follicles uterine tube and one stimulated by the gonadotropins penetrates the secondary (FSH and LH) secreted by the oocytes, meiosis II resumes. anterior pituitary. Ovum or mature egg unite - Primary follicles consists of a with sperm cell forming primary oocytes is surrounded by diploid (2n), zygote. granulosa cells. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - Corpus luteum – contains the Progesterone remnants of a mature follicle after - Secreted mainly by cells of ovulation. the corpus luteum. - Produces progesterone, estrogens, relaxin and inhibin until it Menstruation degenerates into fibrous scar tissue - Is an episodic uterine bleeding in called corpus albicans. response to cyclic hormonal changes Hypothalamic Pituitary Ovarian/ - The purpose is to bring an ovum to Testiscular Axis maturity and renew a uterine tissue Gonadotrophin Releasing bed that will be responsible for the Hormone (GnRH) ova’s growth should it be fertilized - Secreted by the hypothalamus. - That allows for conception and - Controls the ovarian and uterine implantation of a new life cycles. - Menarche – first menstrual period in - Stimulates the release, synthesis girls. and storage of follicle stimulating May occur as early as 9 hormone (FSH) and luteinizing years old or as late as 17 hormone (LH) from the anterior years old. pituitary. Average onsest at 12.4 years - Involved mainly in ovarian functions. - Normal menstrual Cycle: 23 to 35 Follicle Stimulating days, average of 28 days. Hormone (FSH) - Length/duration: 2 to 7 days, ranges - Released from the of 1-9 days - anterior pituitary gland - Average amount blood loss of 30 to - Initiates follicular growth. 80 ml - Receptors of FSH exist - Color of menstrual flow: Dark red; a primarily on the cell combination of blood, mucus and membrane of the granulosa endometrial cells. cells of the ovarian follicle. - Odor: Similar to marigolds. Luteinizing Hormone (LH). Main Action: - Teaching about Menstrual Health - Stimulates androgen 1. Exercise – moderate synthesis by the theca cells. exercise - Progesterone synthesis by 2. Sexual relations- not the corpus luteum. contraindicated - Stimulates prostaglandin 3. Activities of daily living- synthesis by intracellular nothing is contraindicated production of cAMP. 4. Pain relief- Prostaglandin - Triggers ovulation and inhibitors, applying local heat formation of corpus luteum. 5. Rest – more rest if Estrogen dysmenorrhea is present - Secreted by ovarian Follicles CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 6. Nutrition- iron 50-150 ml of blood, tissue supplementation fluid, mucus and epithelial cells shed from the - Four body structures involved endometrium. 1. Hypothalamus 2. Pituitary gland 3. Ovaries 4. Uterus - Phases of the female reproductive cycle 1. Menstrual phase - Episodic uterine bleeding in response to cyclic hormonal changes. - Cyclic monthly changes in ovaries and endometrium in preparations for ovulation. - Monthly shedding off uterine lining in response to drop in estrogen and progesterone 2. Preovulatory phase (proliferative) level - Time between the end of - Purpose: menstruation and ovulation. To bring an ovum to maturity - Events in the Ovaries: Renew uterine tissue bed Secondary follicles in the that will be responsible for its ovaries begin to secret growth should it be fertilized. estrogen and inhibin. - Events in the Ovaries: A single secondary follicle in Under the influence of FSH one of the two ovaries – primordial follicles develop becomes the dominant into primary follicles then into follicle. secondary follicles. Dominant follicle secretes Takes several months to estrogen and inhibins which occur. will decrease the secretion of Follicle that begins to FSH. develop at the beginning of a Decrease of FSH will cause particular menstrual cycle other less well developed may not reach maturity and follicles to stop growing and ovulate until several undergo atresia menstrual cycles later One dominant follicle - Events in the Uterus becomes the mature Menstrual flow from the (graafian follicle) and uterus CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 continues to enlarge and ovulation preceded by ready for ovulation. sudden drop. During the final maturation Cervical mucous under the process, the mature follicle influence of estrogen is continues to increase its favorable to spermatozoa. estrogen production. Fern test: Cervical mucus Follicular Phase because forms fernlike patterns when ovarian follicles are growing placed on a glass slide and and developing. allowed to dry. - Events in the Uterus: Caused by crystallization of Estrogens secreted by the sodium chloride on mucus growing ovarian follicles fibers known as arborization stimulate the repair of the or ferning. endometrium. Spinnbarkeit Test : Cervical Stratum basalis undergo mucus becomes thin and mitosis and produces a new watery and can be stretched stratum functionalis into long strands. The thickness of the Midmenstrual pain endometrium doubles to 4 to Breast tenderness 10 mm. Termed as Proliferative 4. Postovulatory phase (secretory) phase because the - Time between ovulation and onset of endometrium is proliferating. the next menses. - It is the most constant part of the 3. Ovulation female reproductive cycle. - The rupture of the mature (graafian) - Last 14 days in a day cycle, from follcile. day 15 to day 28. - Release of the secondary oocyte - Events in One Ovary: into the pelvic cavity After ovulation, the mature - Occurs on day 14 in a 28 day cycle. follicle collapses. - High levels of estrogens during the A blood clot forms from minor last part of the preovulatory phase bleeding of the ruptured exerts a positive feedback. follicle – corpus - Secrete LH and GnRH and causes hemorrhagicum. Corpus ovulation. luteum. - Mittelschmerz – the small amount Corpus luteum secretes of blood that leaks into the pelvic progesterone, estrogen, cavity from the rupture follcile can relaxinand inhibin under the cause pain. influence of LH. - Signs and symptoms of ovulation: Termed as Luteal Phase. Basal body temperature Oocyte is not fertilized – the slightly increase 0.2 to 0.5 ̊C corpus luteum has a lifespan on the day following of 2 weeks. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 Its secretory activity declines Degenerates into corpus albicans. Decrease progesterone, estrogen, and inhibin causes loss of negative feedback suppression Rise of GnRh, FSG,LH If the secondary oocyte is fertilized and begins to divide. Corpus luteum persist for 2 weeks. Lesson 4 : Human Sexuality Chorion of the embryo after 8 days of fertilization will produce human chorionic Sexuality gonadotropin (hCG). - Is a multidimensional phenomenon hCG like LH, stimulates the that includes feelings, attitudes, and secretory activity of the actions corpus luteum. - It has both biologic and cultural Progesterone and estrogens components produced by the corpus - It encompasses and gives direction luteum promote growth and to a person’s physical, emotional, coiling of the endometrial social and intellectual responses glands. throughout life VAscularization of the - BIOLOGIC GENDER endometrium. - chromosomal sexual Thickening of the development endometrium to 12 to 18 mm. - male (XY) and female (XX) Secretory Period – secretory - GENDER/SEXUAL IDENTITY activity of the endometrial - inner sense a person has of glands, being a male or a female - sex a person thinks of himself - maybe the same or different from biologic gender - develops throughout the entire lifespan Gender Role - male or female behavior a person exhibits - activities of a person undertakes CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - maybe the same or different from biologic gender or gender identity - culturally influenced - more interchangeable nowadays Prenatal Sex Determination - starts @ 12 weeks of intrauterine life. - (+) Wolffian duct - male - (+) Mullerian duct - female - concepts, questions or inquiries about - sex differs or vary with age. Development of Gender Identity 1. amount of testosterone secreted in utero 2. how appealing parents or adult role models portray their gender roles 3. culturally influenced 4. role of women and men in society 5. expectations from the child Influence of the Menstrual Cycle Human Sexual Response - during the luteal phase of menstruation there said to be an increase in since there's vasocongestion in the woman's lower pelvis which makes her more ready for plateu and orgasm. - 1st Trimester - decrease in urge for sex due to the physiologic changes to patient. - 2nd Trimester - increase in libido due to vasocongestion in the lower pelvis and breast, increase in oxytocin. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 - 3rd Trimester - increase in - union of spermatozoon and ovum libido due to preoccupation occurs 12-14 hrs after ovulation → and fear of labor and new single cell (zygote with 46 delivery. chromosomes) → will divide (mitotic divisions or cleavage and travel to Peak Sexual Response the uterine cavity → in the 30 hours - male's sexual response is at → blastomeres → morula (a solid peak during his late teen ball of cells reaches the uterus in years. three days) → blastocyst ( - female's peak sexual trophoblast into fetal membranes response is on her late 30s and the placenta and inner cell mass because male are sexually or embryoblast into embryo) oriented first than female. 2. IMPLANTATION Sexual Activity - When blastocyst implants in the Changes in sexual desire endometrium of the anterior or - 1st trimester: ↓ libido posterior fundal region, 8-10 days - 2nd trimester: ↑ sexual after fertilization after the zona enjoyment due to ↑ blood pellucida degenerates. supply to pelvic area - Primary villi appear within weeks - 3rd trimester: sexual desire after implantation may remain high or decrease - The trophoblast, proliferates the because of ↑ abdominal size underlying endometrium by separating and dissolving endometrial cells M2 : ANTEPARTAL PERIOD - The invading blastocyst sinks below the surface of the endometrium Lesson 1 : Antepartal : The 3. PLACENTATION Physiology of Conception - The chorionic villi invade the decidua (This becomes the fetal portion and 1. FERTILIZATION : The Beginning placenta portion) of Pregnancy - This is also referred to as conception, and impregnation, it is the union of an ovum and spermatozoon and this usually occurs in the ampullar portion of the fallopian tube. OVULATION is when a mature ovum is released, it would only take 24 hours to 48 hours at the most to become fertilized by a spermatozoa. CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 time for the development of the individual because all organs are being developed. - The embryo is highly vulnerable to injury from maternal drug, use of certain infections, and other factors - Any interference during this time can result in congenital defects. 3. Fetal Period - Begins with the 8th week of SUMMARY OF STAGES OF FETAL gestation and continues until DEVELOPMENT birth - During this period the 1. Pre-embryonic stage embryo, now called fetus, - Begins from matures, enlarges, and fertilization/conception to 3 grows heavier weeks of developments - The head of the fetus is - Ovum - the period of disproportionately larger than fertilization until primary villi its body appears approximately 12-14 - The fetus also lacks days gestation (0-2 weeks) subcutaneous fats - As the zygote passes through the fallopian tube, it EMBRYONIC & FETAL STRUCTURES undergoes series of mitotic division or cleavage 1. DECIDUA OR UTERINE LINING - Once formed, the zygote - endometrial lining during pregnancy, develops into the morula and provides a nesting place for the then blastocyst , eventually developing ovum becoming attached to the - divided into three separate layers endometrium - After fertilization the corpus luteum in the ovary continues to function 2. Embryonic stage ( 4th week to 7th rather than atrophies, Human week gestation) Chorionic Gonadotropin secreted by - The zygote now called an the trophoblast cell will cause the embryo, begins to take a uterine endometrium to continue to human shape grow in thickness and vascularity - Germ layers develop, giving instead of sloughing off as in a usual rise to organ systems menstrual cycle. The endometrium is - The period of rapid cell now called decidua and it will be division and the most critical CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 discarded after birth of the child. placental hormones (Canvas) present during pregnancy which are HCG (Human Chorionic Gonadotropin ), HPL (human placental lactogen), estrogen and progesterone.Later on you will learn more about these great hormones and their function. (Canvas) 2. FETAL MEMBRANES/AMNIOTIC MEMBRANES - Is a dual-walled sac with the chorion as the outermost part and the amnion as the innermost part. The two fuse together as the pregnancy progresses and by the term, they appear to be as a single sac. They have no nerve supply so when they - Proliferate and projecting into spontaneously ruptures or artificially the large blood vessels within neither the pregnant woman nor the the decidua basalis fetus experiences any pain - Through which the maternal (Coad&Dunstall.2011). blood flows 2.1. Chorion (The fetal membrane 2.2. Amnion (Is the thin , tough closest to the uterine wall) inner fetal membranes that lines the - Gives rise to the placenta amniotic sac) - Gives rise to the chorionic villi These probing fingers 3. AMNIOTIC FLUID will reach out from the - The fetus continuously swallows this trophoblast cell into fluid and it is absorbed from the fetal the uterine intestine into the fetal blood stream, endometrium to begin at term it is approximately 800-1200 formation of the ml. The most important purpose of placenta. the amniotic fluid is to shield the These villi will also fetus against pressure or blow to the produce various mother’s abdomen. It also protects CARE OF MOTHER, CHILD AND ADOLESCENTS 1st Semester | Prelims-Midterms | BSN2 the umbilical cord from pressure 6. PLAC