Istanbul Gelisim University 6th Week of Pregnancy PDF

gelisimedu igugelisim Department of Nursing (ENG) Name of Course: WOMEN’S HEALTH AND DISEASES NURSING Name of Lecturer: N. Alper Sahbaz, MD Course Information Course credit 8 Credit / 9 ECTS GBS Linki https://gbs.gelisim.edu.tr/en/lesson-details-17-319-12715-2 Week...

gelisimedu igugelisim Department of Nursing (ENG) Name of Course: WOMEN’S HEALTH AND DISEASES NURSING Name of Lecturer: N. Alper Sahbaz, MD Course Information Course credit 8 Credit / 9 ECTS GBS Linki https://gbs.gelisim.edu.tr/en/lesson-details-17-319-12715-2 Week Week 17 What we are going to learn in this week? Prenatal period and care, monitoring and examining the pregnant women, training and consultancy for the pregnant women and their families igugelisim gelisimedu Commencing of pregnancy All the time an egg has been ripening and preparing for ovulation, the endometrium of the uterus has been forming a nutrient-rich lining. It is preparing to receive a fertilized egg. (If no egg is fertilized, this lining will leave the body during a process called menstruation.) igugelisim gelisimedu Stages of early embryo development Around the seventh or ninth day after conception, the blastocyst burrows into the uterine lining in a process called implantation. The protective covering quickly develops into the amnion, surrounding the organism in amniotic fluid. A yolk sac also develops, producing blood cells until the liver, spleen, and bone marrow is mature. The woman’s ovaries produce massive doses of the hormone progesterone, signaling the body that a pregnancy is in progress. igugelisim gelisimedu Stages of early embryo development 1. Germinal period: happens within 2 weeks after conception 2. Embryonic period: between 2 and 8 weeks 3. Fetal period: 8th week and onwards igugelisim gelisimedu Twins Multiple births can occur two different ways. Sometimes two (or more) different eggs are released, and both are fertilized by two different sperm. The result is fraternal twins. They may be both boys or both girls or one of each; they may or may not look similar. In other cases, a single egg fertilized by a single sperm will split completely in half during that very first cell division. This results in identical twins. They will both be of the same sex and will look very similar if not the same. igugelisim gelisimedu igugelisim gelisimedu Layers of embryonic development igugelisim gelisimedu Week 4 Nerve growth begins when a sheet of cells on the back of the embryo folds in the middle to form a tube, which will become the future spinal cord. At one end tube enlarges to form the brain's major sections. The amniotic fluid that cushions the fetus begins to form. igugelisim gelisimedu Week 5 and 6 5 weeks - At this time the embryo is still the size of a raisin. Low on the sides of the head are two folds of tissue that will become the ears. Although not completely developed, all the major body organs and systems are formed. The neural tube enlarges into three parts, that will soon to develop to become a very complex brain. Also the placenta begins functioning, including the chorionic villi and the umbilical cord, through which the baby will receive nourishment and oxygen. The spine and spinal cord grows faster than the rest of the body at this stage and will give the appearance of a tail. This disappears as the baby grows. 6weeks - The embryo's tiny heart begins to beat. Other major organs, including the kidneys and liver, have begun to develop, and the neural tube, which connects the brain and spinal cord, closes. The physical sensations of pregnancy start--nausea, fatigue, sore breasts and frequent urination. igugelisim gelisimedu Week 7 The embryo's hands and feet are shaped like paddles, but the fingers are beginning to take shape. The embryonic tail has almost disappeared. The pituitary gland is also forming and the fetus is beginning to grow muscle fibers. The heart has divided into the right and left chambers and is beating about 150 beats a minute which is about twice the rate of an adult. The baby's facial features are visible, including a mouth and tongue. The eyes have a retina and lens. The major muscle system is developed, and the baby starts to practice moving. The baby has its own blood type and the blood cells are produced by the liver now instead of the yolk sac. igugelisim gelisimedu Week 8 The unborn baby is now called a fetus. The fetus is protected by the amniotic sac and filled with fluid. Inside the child swims and moves gracefully. The fetus is now about 2cm long. The arms and legs have lengthened. During this time of development, the baby's head appears much larger than the body because the brain is growing very rapidly. Brain waves can now be measured. The teeth and the palate are beginning to form and the larynx is developing. Through its parchment-thin skin, the baby's veins are clearly visible. By the eighth week the ears begin to take shape. igugelisim gelisimedu Week 9 Though the fetus is constantly moving, you won't be able to actually feel fetal movement for several more weeks. All of the organs, muscles, and nerves are in place and beginning to function. As the hands and feet develop fingers and toes, they lose their paddle-like look, and the touch pads on the fingers form. igugelisim gelisimedu Week 10 The fetus weighs about 7 to 8 gr. The heart is almost completely developed and very much resembles that of a newborn baby. The eyelids have fused shut. The wrists and ankles have formed and the fingers and toes are clearly visible. Genitals have begun to form, but it is a bit early to tell the sex of the fetus. igugelisim gelisimedu Week 11 The vital organs--the liver, kidneys, intestines, brain and lungs--are fully formed and may begin to function, while the head is almost half the length of the entire body. The fetus is only about 5cm long and weighs less than 14 gr but it is busy moving and kicking. igugelisim gelisimedu Week 12 (end of the first trimestr) Vocal chords are complete, and the baby can and does sometimes cry silently. The brain is fully formed. The fetus may even suck his thumb. The eyelids now cover the eyes, and will remain shut until the seventh month to protect the delicate optical nerve fibers. The hair is on the head and the fingers and toes have developed soft nails. The kidneys are developed. The skull is not solid bone, but has formed in sections. These sections can overlap during the birth process. There are even a couple of soft spots where bone has not formed at all called fontenals. igugelisim gelisimedu Changes in Uterus Uterine blood flow Status % of C.O. increases significantly Perfusing Uterine blood flow may Uterus approach 500 – 750 cc/ minute Non- 160 bpm for 10+ mins Bradycardia Baseline < 110 bpm for 10+ mins Values of of 90-110 can occur in a normal fetus, especially in a postdate pregnancy Intrapartum Fetal Monitoring Guideline – February 2018. Chandraharan et al Physiological CTG interpretation CTG features - Baseline variability (BLV) Normal: Reduced BLV: Increased Sinusoidal: Pseudo- BLV sinusoidal: Bandwidt < 5 for 50+ (saltatory): Regular, h mins smooth, Resembles amplitude or 25+ for 30+ undulating sinusoidal + 5-25 bpm 3+ mins mins signal at 5- more during decels 15 bpm + no ‘jagged’ accels pattern Physiological CTG interpretation CTG features – Decelerations (15+ bpm for 15+ secs) Early decelerations: Variable decelerations: Late decelerations Prolonged deceleration Gradual (ie onset to nadir V-shaped, with rapid Gradual onset + return, Decels for 3+ mins > 30 secs) + coincide with drop (< 30 secs to nadir) + increased or reduced contractions + rapid recovery variability within decel Do not indicate hypoxia Rarely indicate hypoxia, Indicative of hypoxiaemia Likely to indicate hypoxiaemia unless evolve to U-shape + (‘60’s criteria), or reduced / increased variability during decel Physiology of hypoxia in labour Acute hypoxia Prolonged decel 5+ min (or 3+ min if reduced BLV) Causes Accidents – cord prolapse, abruption, uterine rupture Iatrogenic – maternal hypotension, uterine hyperstimulation Management 3-minute rule (unless preceded by reduced BLV) 3+ min – raise emergency alarm 3-6 diagnosis 6-9 prepare for delivery 9-12 aim for delivery by 12-15 mins Physiology of hypoxia in labour Subacute hypoxia Fetus spends majority of time in decels Invariably caused by hyperstimulation Management in 1st stage Stop / reduce uterotonics Avoid supine position Start IV fluids Consider tocolytics Expedite delivery if persists Management in 2nd stage Stop pushing Intrapartum Fetal Monitoring Guideline – February 2018. Chandraharan et al Expedite delivery if no recovery in 10 mins Physiology of hypoxia in labour Gradually evolving hypoxia (stages 1-4) Most common form of hypoxia in labour Stages 1-4 - represent evidence of stress + Stage 1 Stage 2 Stage 3 Stage 4 fetal - hypoxic stress - loss of accels - exaggerated response to - redistribution to vital organs compensati - decels - lack of cycling hypoxia - facilitated by catecholamines - decels wider and deeper - rise in baseline FHR on Intrapartum Fetal Monitoring Guideline – February 2018. Chandraharan et al Physiology of hypoxia in labour Gradually evolving hypoxia – stages 5 & 6 (fetal decompensation) Stages 4 (&5) Stage 5 Stage 6 may be further redistribution terminal heart failure reversible vasoconstriction affects unstable / progressive brain decline in BLR reduced BLV ‘step ladder pattern to death’ Intrapartum Fetal Monitoring Guideline – February 2018. Chandraharan et al Management – improve fetal conditions with first signs of redistribution (stage 4) Physiology of hypoxia in labour Chronic hypoxia Antenatal type of hypoxia Presents as BLR at upper end of normal, with reduced BLV + often shallow decels Indicates a fetus with reduced reserve Low threshold for surgical intervention Intrapartum Fetal Monitoring Guideline – February 2018. Chandraharan et al What is the process called when the blastocyst burrows into the uterine lining? A) Ovulation B) Implantation C) Fertilization D) Menstruation During which period does the fetus start practicing movements? A) Week 5 B) Week 7 C) Week 9 D) Week 12 What hormone signals the body that a pregnancy is in progress? A) Estrogen B) Testosterone C) Progesterone D) Insulin Which week marks the formation of the neural tube? A) Week 2 B) Week 4 C) Week 8 D) Week 12 At what stage is the fetus first called a 'fetus' rather than an embryo? A) Week 4 B) Week 6 C) Week 8 D) Week 10 What is the primary cause of anemia in pregnancy? A) Increased iron absorption B) Enhanced coagulation C) Decreased platelet count D) Insufficient iron intake How many beats per minute is the fetal heart rate around Week 7? A) 80-100 bpm B) 120-140 bpm C) 150 bpm D) 180 bpm What is the first organ to develop in the embryo? A) Brain B) Heart C) Liver D) Lungs Which of the following is a common physiological symptom during early pregnancy? A) Increased energy B) Lowered blood pressure C) Nausea D) Increased appetite According to WHO, how many antenatal care contacts are recommended for a positive pregnancy experience? A) 4 contacts B) 6 contacts C) 8 contacts D) 12 contacts gelisimedu igugelisim