Maternal and Child Health PRELIMS PDF

| LESSON #1 | Promotes health and disease prevention Introduction because these protect the health of the next Maternal and Child Health refer to generation....

| LESSON #1 | Promotes health and disease prevention Introduction because these protect the health of the next Maternal and Child Health refer to generation. philo-mother and child relationship to one Serves as an important resource for families another and consideration of the entire family during childbearing and childrearing as these as well as the culture and socio-economic can be extremely stressful times in a life cycle. environment as framework of the patient. Respects personal, cultural, and spiritual It involves the care of the woman and family attitudes and impact of childbearing and throughout pregnancy and childbirth and the childrearing. health promotion and illness care for the children and families. B. Maternal and Child Health Goals and Standards Goals of MCH To ensure that every expectant and nursing 1. Global Health Goals (MDGs) mother maintains good health, learns the art of Eradicate extreme poverty and hunger child care, has normal delivery and bears Achieve universal primary education healthy child. Promote gender equality and empower women That every child, whenever possible lives and Reduce child mortality grows up in a family unit with love and security Improve maternal health in health surroundings, receive adequate Combat HIV/Aids, malaria, and other diseases nourishment, health supervision, and efficient Ensure environmental sustainability medical attention, and is taught the elements of Develop a global partnership and development healthy living. 2. Sustainable Development Goals (SDGs) A. Goals and Philosophies of MCH Nursing No poverty Zero hunger Primary Goal Good health and well-being Promotion and maintenance of optimal family Quality education health of the women and newborn Gender equality To ensure that every expectant and nursing Clean water and sanitation mother maintains good health, learns the art of Affordable and clean energy child care, has normal delivery, and bears Decent work and economic growth healthy child. Industry, innovation, and infrastructure Reduced inequalities Philosophies: Sustainable cities and communities Family-centered Responsible consumption and production Community-centered Climate action Evidence-based Life below water Challenging role for nurses and a major factor Life on land in keeping families well and optimally Peace, justice, and strong institutions functioning. Partnerships for the goals A Maternal and Child Health Nurse: Maternal Satisfaction Considers a family as a whole and as a partner → Outcome, Delivery outcome in care when planning or implementing or → Structure (physical environment, cleanliness, human evaluating the effectiveness of care. resources, medicine, and supplies) Serves as an advocate to protect the rights of all → Access, Cost family members including the fetus. → Process (promptness, interpersonal behavior, Demonstrates a high degree of independent privacy/confidentiality, perceived good care, cognitive nursing functions because teaching and support, emotional support, female providers) counseling are major interventions. _____________________________________________  Thecal cells: Cells in the ovarian stroma | LESSON #2: REPRODUCTIVE ○ Thecal & granulosa cells work together SYSTEM | to produce estrogen ○ A protective layer of glycoprotein Female Reproduction forms around the egg called the zona Unlike males, who are able to produce sperm pellucida cells throughout their reproductive lives, females produce a finite number of egg cells. Follicle Development During early fetal development, germ cells 1. Primordial follicle: one layer of squamous-like migrate into the ovaries and differentiate into follicle cells surrounds the oocyte oogonia (?) 2. Primary follicle: two or more layers of Note: Earlier menarche, earlier menopause cuboidal granulosa cells enclose the oocyte Note: 40 years of menstruation (40 X 12) = 3. Secondary follicle: has a fluid filled space almost 500 pregnancies since every year between granulosa cells that coalesces to form pwedeng manganak a central antrum 4. Graafian follicle: secondary follicle at its most The Ovaries mature stage that bulges from the surface of the The ovaries are solid, ovoid structures, about 2 ovary cm in length and 1 cm in width. 5. Corpus luteum: ruptured follicle after Like the testes, they develop from embryonic ovulation tissue along the posterior abdominal wall, near the kidneys. Corpus Luteum Accessory organs include the uterine tubes, After ovulation, the remains of the follicle are uterus, and vagina. transformed into a structure called the corpus Functions: Ovary functions result in ovulation, luteum. refers of ovum… If a pregnancy occurs, it produces progesterone to maintain the wall of the uterus during the Oogonia early period of development. They divide by mitosis for the next few months and some differentiate into primary oocytes. Corpus Albicans By fifth month, there are about 7 million If fertilization does not occur, the corpus primary oocytes, but most will degenerate luteum will begin to break down about 2 weeks (atresia) during the next 2 months. after ovulation. Those that remain will be surrounded by a Degeneration occurs when fibroblasts enter the single layer of squamous epithelial cells corpus luteum and a clump of scar tissue forms (follicle cells) called a primordial follicle. called the corpus albicans. Degeneration of primary oocytes continues. At birth = 1 million primordial follicles Ovarian Cycle At puberty = 400,000 remain Monthly challenges that occur in the ovary Only 400-500 will reach maturity during a woman’s reproductive life. Ovaries: Each month, FSH stimulates primordial ○ Each follicle consists of an immature follicles to grow and mature (follicular phase). egg called an oocyte Ovulation: Release of the egg (LH) ○ Cells around the oocyte are called: Luteal Phase: The corpus luteum produces Follicle cells (one cell layer progesterone that maintains uterine walls. thick) If fertilization does not occur, the corpus Stimulated to mature luteum degenerates within 2 weeks into a mass by FSH from the of scar tissue called the corpus albicans pituitary gland Granulosa cells (when more Fallopian Tube (Uterine Tube) than one layer is present) Receive the ovulated oocyte and provide a site for fertilization.  Empty into the superolateral region of the Secretory phase: glands are enlarged and have uterus via the isthmus. branches. Preparing the endometrium for Expand distally around the ovary forming the implantation ampulla. If no implantation, then endometrium breaks The ampulla ends in the funnel shaped, ciliated down and menstruation begins. infundibulum containing fingerlike projections called fimbriae. Cervix Fimbriae sweep oocyte into tube, cilia and Opening of the uterus peristalsis move it along, sperm reaches oocyte Opens widely during delivery of the fetus. in ampulla, fertilization occurs within 24 hours Mucus becomes thinner when in ovulation and after ovulation and zygote reaches uterus about thickens to block sperm 7 days after ovulation. Narrow lower neck of the uterus which projects into the vagina inferiorly. Uterus Cervical Canal: Cavity of the cervix that Hollow, thick-walled organ located in the pelvis communicates with: anterior to the rectum and posterosuperior to 1. The vagina via the external os the bladder. 2. The uterine body via the internal os. Nurtures the fertilized ovum that develops into The cervical glands secrete mucus that covers the fetus and holding it ‘till the baby is mature the external os and blocks sperm entry except enough for birth. during midcycle. The fertilized ovum gets implanted into the endometrium and derives nourishment from Vagina blood vessels which develop exclusively for Thin walled tube lying between the bladder and this purpose. the rectum, extending from the cervix to the The uterus provides structural integrity and exterior of the body support to the bladder, bowel, pelvic bones, and Wall consists of three coats: fibroelastic organs as well. It separates the bladder and the adventitia, smooth muscle muscularis, and a bowels. stratified squamous mucosa Body: Major portion of the uterus Mucosa near the vaginal orifice forms an Fundus: Rounded region superior to the incomplete partition called the hymen entrance of the uterine tubes Vaginal fornix: upper end of the vagina Isthmus: Narrowed region between the body surrounding the cervix. and cervix. Endometrium: FEMALE EXTERNAL GENITALIA: ○ Simple columnar epithelium Mons pubis: fatty pad over the pubic symphysis ○ Stroma of connective tissue and Labia majora & minora: folds of skin encircling endometrial glands vestibule where find urethral and vaginal Stratum functionalis: Shed openings during menstruation Clitoris: small mass of erectile tissue Stratum basalis: Replaces Bulb of vestibule: masses of erectile tissue just stratum functionalis each deep to the labia on either side of the vaginal month orifice Myometrium: 3 layers of smooth muscle Perineum: Area between the vagina and anus Perimetrium: Visceral peritoneum Urethral Orifice: Where urine exits Vaginal Orifice: Where menstruation happens Endometrium Prepuce of Clitoris Proliferative phase: glands and blood vessels Anus scattered throughout the functional zone with … little or no branching. New glands form and endometrium thickens. Breasts Produces the milk. Mammary Glands:  ○ Modified sweat glands that produce milk (lactation) 1. Scrotum ○ Amount of adipose determines size of A skin-covered, highly pigmented, muscular breast sac that extends from the body behind the ○ Milk-secreting glands open by penis. lactiferous ducts at the nipple Site of sperm production. ○ Areola is pigmented area around nipple Protects the sperm by keeping the temperature ○ Suspensory ligaments suspend breast in the testes slightly below normal. from deep fascia of pectoral muscles (aging & Cooper's droop) 2. Penis ○ Mammary line is a thickened ridge of The male organ of copulation (sexual embryonic tissue that extends from the intercourse). axilla to the groin. Penetrates into the vagina and deposit semen Hormones: into the female reproductive tract. 1. Prolactin from the pituitary gland stimulates the synthesis of milk. 3. Testes 2. Oxytocin from the posterior pituitary The male gonads (the male reproductive gland stimulates milk ejection. organs). Lymphatic Drainage/Glands: Produce both sperm and androgens, such as ○ Lymph nodes draining the breast are testosterone, and are active throughout the located in the axilla. reproductive lifespan of the male. IMPORTANT TERMS: A. Seminiferous Tubules - Composed of Menarche: First menstruation developing sperm cells surrounding a Puberty: Transitional between childhood and lumen, the hollow center of the tubule, sexual maturity. At around age 13, reproductive where formed sperm are released into organs become functionally active the duct system of the testis. Menopause: The cessation of menstruation cycle B. Sertoli Cells - Elongated branching Post-menopausal Period: Time of life cells that secrete signaling molecules following menopause that promote sperm production. Perimenopausal: Period during which menopausal change are occurring between C. Germ Cells - The least mature cells, 44-50 years old (spermatogonia), line the basement membrane inside the tubule; the stem Functions of the Male Reproductive System cells of the testis, that are still able to The two main functions of the male differentiate into a variety of different reproductive system are the production and cell types throughout adulthood. storage of sperm and the transfer of sperm to the female’s body during sexual intercourse. Hormones produced in the pituitary gland Internal Structure: stimulate the production of testosterone. Testosterone initiates physical changes that 1. Epididymis signal maturity, including broadening of the A coiled tube attached to the testis where newly shoulders, development of muscles and facial formed sperm continue to mature. and other body hair, and deepening of the voice. 2. Vas Deferens A thick, muscular tube that is bundled together STRUCTURE OF THE MALE REPRODUCTIVE inside the scrotum with connective tissue, SYSTEM: blood vessels, and nerves. Site where complete maturation of sperm takes External Structure: place.  3. Seminal Vesicles Glands that contribute approximately 60 percent of the semen volume. Seminal vesicle fluid contains large amounts of fructose, which is used by the sperm mitochondria to generate ATP to allow movement. 4. Ejaculatory Duct A short structure formed from the ampulla of Spermatogenesis the ductus deferens and the duct of the seminal Spermatogenesis is the process by which male vesicle. primary sperm cells undergo meiosis and Transport the seminal fluid into the prostate produce a number of cells called gland. spermatogonia, from which the primary spermatocytes are derived. 5. Prostate Gland Each primary spermatocyte divides into two Formed of both muscular and glandular tissues. secondary spermatocytes and each secondary Excretes an alkaline, milky fluid to the passing spermatocyte into two spermatids or young seminal fluid–now called semen. spermatozoa. These develop into mature spermatozoa, also 6. Bulbourethral Glands (Cowper’s Glands) known as sperm cells. Thus, the primary Release a thick, salty fluid that lubricates the spermatocyte gives rise to two cells, the end of the urethra and the vagina, and helps to secondary spermatocytes, which in turn clean urine residues from the penile urethra. produce four spermatozoa. Spermatocytogenesis Mitotic division of a diploid spermatogonium that resides in the basal compartment of the seminiferous tubules, resulting in two diploid intermediate cells called primary spermatocytes. Each primary spermatocyte then moves into the adluminal compartment of the seminiferous tubules, duplicates its DNA, and subsequently undergoes meiosis I to produce two haploid Anatomy of Sperm secondary spermatocytes. Secondary spermatocytes later divide into haploid spermatids. During this division, random inclusion of either parental chromosome and chromosomal crossover both increase the genetic variability of the gamete. Each cell division from a spermatogonium to spermatid is incomplete; the cells remain connected to one another by bridges of Spermatogenesis cytoplasm to allow synchronous development. Not all certain types of spermatogonia divide to produce copies of themselves, thereby ensuring a constant supply of gametogonia to fuel spermatogenesis. Spermatocytogenesis  One of the centrioles of the cell elongates to become the tail of the sperm. The non-motile spermatozoa are transported to the epididymis in testicular fluid secreted by the Sertoli cells with the aid of peristaltic contraction. While in the epididymis, the spermatozoa gain motility and become capable of fertilization. However, transport of the mature spermatozoa through the remainder of 1. Spermatocytogenesis the male reproductive system is achieved via Mitotic division of a diploid spermatogonium muscle contraction rather than the that resides in the basal compartment of the spermatozoon’s recently acquired motility. seminiferous tubules, resulting in two diploid intermediate cells called primary Maturation takes place under the influence of spermatocytes. testosterone, which removes the remaining unnecessary Each primary spermatocyte then moves into the cytoplasm and organelles. The excess cytoplasm, adluminal compartment of the seminiferous known as residual bodies, is phagocytosed by tubules, duplicates its DNA, and subsequently surrounding Sertoli cells in the testes. The resulting undergoes meiosis I to produce two haploid spermatozoa are now mature but lack motility, secondary spermatocytes. rendering them sterile. The mature spermatozoa are Secondary spermatocytes later divide into released from the protective Sertoli cells into the lumen haploid spermatids. During this division, of the seminiferous tubule in a process called random inclusion of either parental spermiation. chromosome and chromosomal crossover both increase the genetic variability of the gamete. Seminiferous Tubule: Micrograph showing Each cell division from a spermatogonium to a seminiferous tubule with maturing sperm spermatid is incomplete; the cells remain connected to one another by bridges of cytoplasm to allow synchronous development. Not all spermatogonia divide to produce spermatocytes; otherwise, the supply would run out instead, certain types of spermatogonia divide to produce copies of themselves, thereby ensuring a constant supply of gametogonia to fuel spermatogenesis. Diagram of parts of a spermatozoon, including the acrosome, plasma membrane, nucleus, centriole, 2. … mitochondria, terminal disc, axial filament, tail, endpiece, midpiece, and head 3. Spermiogenesis Spermatid begins to grow a tail and develop a thickened midpiece where the mitochondria gather and form an axoneme. Spermatid DNA also undergoes packaging, becoming highly condensed. The DNA is packaged with specific nuclear basic proteins, which are subsequently replaced The Menstrual Cycle with protamines during spermatid elongation. The resultant tightly packed chromatid is transcriptionally inactive. The Golgi apparatus surrounds the now condensed nucleus, becoming the acrosome.  Secretory Phase: Glands are enlarged and have BASIC TERMS: branches. Preparing the endometrium for Endometrium: Lining of the uterus implantation. Oocyte: Developing reproductive cell If no implantation, then endometrium breaks Ovum: Mature egg after meiosis down and menstruation begins. Menopause: Last menstrual cycle, after which egg production stops The Menstrual Cycle Menstrual Cycle Menstrual cycle is regulated by fluctuating levels of sex hormones. These hormones produce certain changes in the ovaries and uterus. Humans are nearly unique among species in having a menstrual cycle. Mean Duration of MC: 28 days Average Duration of Menses: 3-8 days Normal Estimated Blood Loss: 30 ml Ovulation Period: Usually day 14 of menstrual cycle Phases regulated by interaction between hypothalamus, pituitary gland, and ovaries. Mean Age of Menarche: 12.7 Mean Age of Menopause: 51.4 Symptoms of Ovulation: Body temperature changes The Menstrual Cycle Senses become heightened Spotting may occur Things get wet down there Mittelschmerz Nausea and headaches Cervix positions changes Libido changes Bloating Sensitive breasts 1. Ovarian Cycle Monthly changes that occur in the ovary during Stages of Pregnancy and Development: a woman’s reproductive life. Fertilization Each month, FSH stimulates primordial Embryonic Development - Cleavage follicles to grow and mature (follicular phase). Fetal - Differentiation Ovulation: Release of the egg (LH) Growth - Development Luteal Phase: The corpus luteum produces Childbirth progesterone that maintains uterine walls. If fertilization does not occur, the corpus Fertilization and Fetal Development luteum degenerates, within 2 weeks into a mass of scar tissue called the corpus albicans. 2. Endometrium Proliferative Phase: Glands and blood vessels scattered throughout the functional zone with little or no branching. New glands form and endometrium thickens. Fertilization The union of the ovum and sperm.  The start of mitotic cell division and fetal sex Decidua Capsularis: Portion of the determination. endometrium that stretches or encapsulates the Other name: Conception, Impregnation, and surface of the trophoblast. Fecundation Decidua Vera: Remaining portion of the uterine lining. Development After Implantation Fertilization Uterine Changes Zygote The sperm and egg join to form a zygote: the The Embryo first cell of a new individual. The embryo is the developmental stage from Zygote results of the fusion of DNA from the start of cleavage until the ninth week. sperm and egg. The embryo first undergoes division without Fertilization occurs in the fallopian tubes. growth. The zygote begins rapid mitotic cell division. The embryo enters the uterus at the 16-cell Beginning of human development. state. The embryo floats free in the uterus temporarily. Uterine secretions are used for nourishment. Differentiation Gastrulation Gastrulation involves a series of cell migrations to positions where they will form the three … primary cell layers. Ectoderm forms the outer layer. Ectoderm Uterine Changes forms skin, hair, sweat glands, epithelium, Conversion of the endometrium to decidua: brain, and nervous system. Decidua Basalis: Part of the endometrium Endoderm forms the inner layer. The where the embryo lies or where the trophoblast endoderm forms digestive, respiratory systems, cells are establishing communication with the liver, pancreas, all bladder, and endocrine maternal blood vessels. glands such as thyroid and parathyroid glands.  Mesoderm forms the middle layer. The Fetal Stage mesoderm forms body muscles, cartilage, bone, Eight weeks to the time of birth. blood, reproductive system organs, and Characterized by growth and development of kidneys. organs and organ systems. 1st Lunar Month Embryo: 1 month; 0.6 cms Ears, nose, and eyes not visible. Embryo Small arm and leg buds, backbone seen. 0.5 cms Heart beats. 20 days after fertilization. By the end of the first month, the embryo is Embryo begins to form organs during the third about 1/10 of an inch long. The heart, which is week. no larger than a poppy seed, has begun beating. Cannot tell if it is human or other vertebrate. Tall visible. Differentiation 2nd Lunar Month All vital organs are formed by the end of the 8th week. Placenta develops fully. Meconium (first stools) are formed in the intestines by the 5th-8th week. Sex organs (ovaries and testes) are formed by the 8th week. Fertilization and Fetal Development The embryo is about 1 inch long and has distinct, slightly webbed fingers. Veins are clearly visible. The heart has divided into right and left chambers.  4th Lunar Month 4 months; 18 cms Head enlarged, face has human feature. The fetus increases in size during this trimester, and bony parts of the skeleton begin to form. Fetal movements can be felt by the mother. Lanugo appears. Buds of permanent teeth form. Heartbeat audible with fetoscope. Your baby is covered with a layer of thick, 3rd Lunar Month downy hair called lanugo. His heartbeat can be Kidneys are able to function - urine formed by heard clearly. This is when you may feel your the 12th week. baby’s first kick. Buds of milk teeth form. Beginning bone ossification. Fetus swallows amniotic fluid. Feto-placenta circulation is established by selective osmosis; no direct exchange between fetal and maternal blood. By now, the fetus is 2 ½ to 3 inches long and is fully formed. He has begun swallowing and kicking. All organs and muscles have formed and are beginning to function.  Fetal growth during this time uses large parts of 5th Lunar Month its mother’s protein and calcium intake. Vernix caseosa appears. Maternal antibodies pass to the fetus during the Lanugo covers entire body. last month, conferring temporary immunity. Quickening (fetal movements) felt. By the end of the seventh month, your baby Fetal heartbeats very audible. weighs about 3 ½ pounds and is about 12 A protective coating called vernix caseosa inches long. His body is well-formed. begins to form on baby’s skin. By the end of Fingernails cover his fingertips. this month, your baby will be nearly 8 inches long and weigh almost a pound. 6th Lunar Month 8th Lunar Month Alveoli begin to form (28th weeks gestation is Fetus is viable. said to be the lower limit of prematurity; if born, cries, breathes, but usually dies). Lanugo begins to disappear. Nails extend to ends of fingers. Subcutaneous fat deposition begins. The baby is gaining about half a pound per week, and layers of fat are piling on. He has probably turned head-down in preparation for birth. He weighs between 4 and 6 pounds. 7th Lunar Month 7 months; about 40 cms Skin markedly wrinkled. 9th Lunar Month Attains proportions of full-term baby. 9 months; about 50 cms Surfactant begins to produce. Lanugo and vernix disappear. During this trimester, the fetus increases in size. Amniotic fluid volume somewhat decreases. Circulatory and respiratory systems mature in Fat under skin, smooth wrinkles. preparation for air breathing. Nails on fingers and toes completely formed. Baby at term.  Your baby is a hefty 6 to 9 pounds and measures between 19 and 22 inches. As he becomes more crowded, you may feel him move around less. Fetal Membranes Membranes that surround the fetus and give the placenta the shiny apperance. Arise from the zygote. SPECIAL STRUCTURES OF PREGNANCY: Inner (amnion) and outer (chorion) Holds the developing fetus as well as the 1. The Decidua amniotic fluid. The part of the endometrium that undergoes Inner (Amnion): Shiny membrane on the 2nd special modifications in preparation for and week of embryonic development and encloses during pregnancy and is shed off during the amniotic cavity and holds the amniotic delivery. fluid. Decidua basalis, where the implantation takes Chorion: Outer membrane that supports the sac place and the basal plate is formed. This can be of the amniotic fluid. subdivided into a zona compacta and a zona Chorionic Villi: Finger-like projections from spongiosa (where the detachment of the the chorion. This is the place where gases, placenta takes place following birth). nutrients, and waste products between the Decidua capsularis, lies like a capsule around maternal and fetal blood takes place. the chorion. Decidua parietalis, on the opposite uterus Fetal Membranes wall. Amnion Protect the embryo during the months of PARTS OF DECIDUA: pregnancy. Helps reduce the risk of injuries to the unborn 1. Decidua Basalis - It is the part of decidua embryo and its development in the womb. between blastocyst and myometrium. It forms One of the defenses against any potential fetal the fetal part of placenta. damage during the developmental stages. Has physical contact and is filled with a liquid 2. Decidua Capsularis - It covers the blastocyst known as the amniotic fluid (serves as a shock except embryonic pole and separates it from absorber for the unborn to protect it from any uterine cavity. harmful or outside factors). Provides a gateway to transferring nutrients and 3. Decidua Parietalis - It is the rest of other essential necessities for the unborn endometrium that lines the rest of uterine embryo. cavity. Found on the innermost part of the placenta.  Lines the amniotic cavity and holds the amniotic fluid and the developing embryo. Made up of tresodeum on the outside and ectoderm on the inside, which has specific cells with specific functions. Chorion The outer membrane that surrounds the amnion, the embryo, and other membranes and entities in the womb. Considered as the support platform of the fetus and the amnion. Contributes to the growth of the placenta. Two layers form the chorion (trophoblast as the outer layer and mesoderm as the inner layer). The mesoderm is the one in contact with the amnion. The trophoblast provides the nutrients for the fetus during its confinement, while the ectoderm further develops into many parts of the embryo’s body, like teeth and the nervous system. The chorion provides additional protection for Amniotic Fluid the embryo, but it also promotes the exchange Clear, yellow fluid surrounding the developing of nutrients and other necessary fluids between fetus and surrounds the embryo, contains fetal the mother and the embryo. urine, lanugo from fetal skin and epithelial cells. Chorionic Villi Functions: Finger-like projections from the chorion. * Protects/shields the fetus This is the place where gases, nutrients, and * Allows free movement waste products between the maternal and fetal * Maintains temperature blood takes place. * Provides oral fluid Villi are the essential functional elements of the pH is 7.2 (Alkaline pH): Can be tested when placenta. membrane ruptures. Small finger-like processes surrounded by Specific Gravity: 1.005-1.025 maternal blood. Normal Amount: 500-1500 mL Fetal blood circulates in their substance through Oligohydramnios: Less than 500 mL capillaries. Polyhydramnios: More than 2000 mL Called as chorionic villi as they arise as Can be aspirated and tested for various diseases offshoots from chorion. and abnormality during pregnancy (genetic). Syncytiotrophoblast or Syncytial Layer: Pale Straw Color: Normal Outer covering or layer of the chorionic villi. Yellow Stained/Dark Amber: Fetal hypoxia Secretes the following hormones: HCG, that occurred 36 hours or more before the estrogen, progesterone, and HPL rupture of membranes; fetal hemolytic disease (somatomammotropin) (Rh or ABO incompatibility, intrauterine Cytotrophoblast or Langhan’s Layer: Inner infection); ominous sign of presence of layer. Function: Protects the growing embryo Bilirubin, hemolytic disease and fetus from infectious organisms. Character: Thick secretions with unpleasant odor - Infection Greenish: Meconium stained / FETAL DISTRESS, also if pH is less than 7.2 Greenish Brown (Meconium - sustained): Fetus had a hypoxic episode; relaxation of the  anal sphincter - passage of meconium from the bowel. - Normal in breech presentation. If with odor: Deliver within 24 hours, may indicate infection. Port Wine Color: Admixture of amniotic fluid and blood - indication abruption placenta. Placenta Latin-cake Greek - A flat cake Is a union between developmental adenexa (extra-embryonic membranes and the uterine mucosa) for physiological exchange. Placenta is a feto-maternal organ which is the primary site of nutrient and gas exchange between the fetus and the mother. Transient organ allowing passage of nutrients and waste materials between mother and fetus. Contains 30 cotyledons, weighs 400-600 grams. Fully develops on the 3rd month. Form from chorionic villi and decidua basalis. Acts as an endocrine organ (hormones) and as a protective barrier against some drugs or infectious agents. Functions of Placenta: * Organ of respiration * Nutrition Umbilical Cord * Excretion 21 inches in length and 2 cm in thickness, * Immunological protection circulatory communication of the fetus to the * Protective barrier mother. * Production of hormones: There are no pain receptors in the umbilical 1. Human chorionic gonadotropin cord. 2. Estrogen, progesterone Connecting link between fetus and placenta. 3. Somatomammotropin Contains 2 arteries and 1 vein supported by mucoid material/mucopolysaccharide called Wharton’s jelly to prevent kinking and knotting. Functions of Placenta: Enables the transport of oxygen, water, electrolytes, and nutrition (carbohydrates, Placenta lipids, polypeptides, aminoacids, and vitamins) from maternal to fetal blood.  Excretion of carbon dioxide, urea etc. by the fetus into the maternal blood. Placental Membrane/Placental Barrier Acts as a barrier (bacteria, viruses, drugs). Maternal antibodies (IgG) gives immunity to the fetus. Keeps the maternal and fetal blood streams separate, thereby preventing antigenic reactions. Expelled placenta: Flat discoidal * Volume: 500 mL (200-950 mL) * Weight: 500 gms (200-800 gms) * Diameter: 185 mm (150-200 mm) * Thickness: 23 mm (10-40 mm) * Surface Area: 30,000 cubic mm Placenta and decidua are shed off after the birth. Blood Placental Barrier The maternal and the fetal blood vessels are separated by a number of tissue layers made of fetal trophoblast basement membrane and the endothelium which together constitute the placental barrier. The flow of blood in the maternal and the fetal blood vessels is shown in the figure. PLACENTA a. Maternal Surface Fine granular, 15-30 lobes Called cotyledons separated by placental septa. b. Fetal Surface Smooth, covered by amnion, shiny, transparent, mottled appearance, vessels radiating out. Umbilical cord … Fetal Circulation: a. Placental Role in Foetal Circulation  The circulatory system of the mother is not Initially secreted by the corpus luteum and later directly connected to that of the fetus, so the by the placenta. placenta functions as the respiratory center for Produces relaxation of smooth muscle the fetus as well as a site of filtration for plasma maintains decidua. nutrients and wastes. 4. Human Chorionic b. Foetal Lungs Somatomammotropin/Human Placental Pulmonary vascular resistance is the resistance Lactogen (HCS/HPL) offered to blood through lungs. The resistance Similar to growth hormone. is very high in fetus because of the Affects maternal insulin production non-functioning of fetal lungs. Because of this (diabetogenic hormone for the mother to high pressure, the blood is diverted from diminish insulin efficiency). pulmonary artery into aorta. Prepares breast for lactation, detectable in … trophoblast as early as third week after 1. … ovulation. 2. … 5. Prolactin 3. Foramen Ovale Released from the anterior pituitary gland. It is an opening in the intra-atrial septum. Suppressed during pregnancy. It allows the blood to enter the left atrium from Milk production. the right atrium. It is also called False Septi. 6. Oxytocin Released from the PPG. Produces smooth muscle contraction. Milk ejection. PREGNANCY … HORMONES OF THE PLACENTA: 1. HCG (Human Chorionic Gonadotropin) Excreted through maternal urine. Used as a test to detect pregnancy; Indicator of pregnancy. OBSTETRICAL TERMS: Secreted by the chorionic villi and later by the Gravida: Woman who is pregnant placenta. Gravidity: Pregnancy Lengthens the lifespan of corpus luteum. Parity: Number of pregnancies whose fetus have reached the age of viability. 2. Estrogen (Mainly Estriol) Multigravida: Woman who has 2 or more Uterine growth; Development of mammary pregnancies. gland; Initially secreted by the corpus luteum. Multipara: Woman who has completed 2 or Enhances fat deposition. more pregnancies. Promotes sodium and water retention. Nulligravida: Woman who has never been Mediates vascular changes. pregnant. Produces enlargement of uterus, breast, and Nullipara: Woman who has not completed genitals. pregnancy with a fetus who have reached the stage of viability. 3. Progesterone Primigravida: Woman who is pregnant for the For maintenance of pregnancy after 4th month first time. (when the corpus luteum degenerates).  Primipara: Woman who has completed one * P: Preterm pregnancy with a fetus who have reached the * A: Abortion stage of viability. * L: Living children Viability: Capacity to live outside the uterus * M: Multiple births which about >20 weeks or >500 grams. Term: 38-42 weeks Pregnancy Post Date - Postterm: >42 weeks Gestational process, comprising the growth and Preterm: 21-37 weeks development within a woman of a new Premature: 21-27 weeks (----) individual from conception through the Abortion: