107-M2.pdf

NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 Care of the Mother and Fetus during the Perinatal Relaxes smooth muscles, including Period the myometrial muscle of the A. Prenatal Care...

NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 Care of the Mother and Fetus during the Perinatal Relaxes smooth muscles, including Period the myometrial muscle of the A. Prenatal Care uterus. Progesterone maintains i. Care of the Mother pregnancy ii. Care of the Fetus A drop in progesterone in early pregnancy may lead to abortion; in MENSTRUAL CYCLE HORMONAL CONTROL late pregnancy before term may lead A. Hypothalamic hormones to premature labor. Hypothalamus secretes gonadotropin releasing Drop in progesterone at term is one hormone(GnRF) → stimulate pituitary gland to of the theories of labor onset, so secrete or inhibit secretions of gonadotropins (Gn) when smooth muscle relaxant progesterone drops at term, uterine B. Anterior Pituitary Gland (APG) Hormones muscle are easily stimulated to 1. Gonadotropins (Gn) contract due to rising stimulants late 2. Follicle-stimulating hormone (FSH) in pregnancy particularly oxytocin 3. Luteinizing hormone (LH) and prostaglandin by maintaining the decidua 1. Gonadotropins: Estrogen and Progesterone Thermogenic - increases BBT o Estrogen Has antidiuretic action Secreted by the ovaries and adrenal Increase fibrinogen levels, thus cortex; secreted by the placenta in increasing blood coagulability pregnancy. Decreases hemoglobin and Responsible for the development of hematocrit levels secondary sex characteristics, assists in maturation of ovarian 2. Follicle-stimulating hormone (FSH) follicles o Secreted by APG in response to the Inhibits secretion of FSH and stimulation of the hypothalamic follicle- stimulates secretion of LH stimulating hormone - releasing factor Responsible for the proliferative (FSHRF) triggered by low blood levels of phase of the menstrual cycle. estrogen during the half of the menstrual Responsible of fertile of cervical cycle. mucus Oestrogen: lowest on the 4th to 5th day of the ▪ Thin, clear, colorless menstrual cycle ▪ Stringy, stretchable (positive o Stimulates the development of primordial for spinnbarkeit test) follicles (immature follicles) into Graafian ▪ Slippery, lubricative follicles (mature follicles); FSH stimulates ▪ Produces fern pattern when follicle cells to secret estrogen dry (ferning test) In pregnancy, it increases 3. Luteinizing Hormone (LH) vascularity, maintains the highly o Also called interstitial cell-stimulating specialized endometrium called hormone. decidua, stimulates uterine muscle o Secreted by APG in response to the contraction, causes fatigue, and stimulation of hypothalamic luteinizing antagonizes insulin. hormone releasing factor (LHRF) triggered o Progesterone by low blood levels of progesterone. Secreted by the corpus luteum in a nonpregnant state and early part of THE UTERINE (MENSTRUAL) CYCLE pregnancy, secreted by the placenta o Cyclic changes in endometrium in response as early as 6 week of pregnancy until to fluctuating ovarian hormone levels parturition. Inhibits secretion of LH Three phases Helps maintain the endometrium by ▪ Days 1-4 - menstrual phase, menstruation/ facilitating the secretory phase of bleeding phase the menstrual cycle; also called ▪ Days 5-14 - follicular proliferative phase nidation ▪ Days 15-28 - luteal or secretory phase DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 TERMS o Duration of menstruation: variable, with a Menarche - first menstruation usual duration of 3-5 days or up to 4-6 days. Dysmenorrhea - painful menstruation o Amount: 25 to 60 mL, equivalent to about Amenorrhea - absence of menses for 3 months 0.4-1.0 mg of iron loss every day of the cycle. Menorrhagia - prolonged menses at regular intervals o Menstrual blood is incoagulable because Metrorrhagia - irregular but frequent menses the blood, coagulated as it is shed, and is Menopause - cessation of menstruation within 12 promptly liquefied by fibrinolytic activity. months (mean age 45-55 y.o.) ; premature menopause may occur before 45 years old B. FOLLICULAR OR PROLIFERATIVE PHASE o The follicular phase of the female menstrual PREOVULATORY PERIOD cycle includes the maturation of ovarian Negative Feedback on the Pituitary follicles to prepare one of them for release o The increased amount of thyroid hormones during ovulation. in the circulation causes negative feedback o During the same period, there are by inhibiting the anterior pituitary to secrete concurrent changes in the endometrium, TSH as well as inhibiting the hypothalamic which is why the follicular phase is also production of TRH which in turn causes the known as the proliferative phase reduction of TSH and thyroid hormones. o Endometrial cells proliferate and the lining o Negative feedback stops and inhibits the thickens. hormone from being produced o At the completion of the proliferative phase, ▪ Examples negative feedback include the endometrium consists of 3 layers: the regulation of blood glucose a. Basal layer: 1 mm thick, lowermost levels and osmoregulation. layer lying immediately above the Positive Feedback on the Pituitary myometrium: contains all the o Positive feedback is the amplification of a necessary rudimentary structures body's response to a stimulus. For example, for building up new endometrium. in childbirth, when the head of the fetus b. Functional layer: 2-5 mm thick; pushes up against the cervix, it stimulates a middle layer, which contains tubular nerve impulse from the cervix to the brain. glands; constantly changes o Positive feedback stimulates and increases according to the hormonal hormone secretion. influences of the ovary. ▪ Examples of positive feedback are c. Cuboidal ciliated epithelium layer: contractions in child birth and the uppermost layer; covers the ripening of fruit functional layer, dips down to line the tub glands. MENSTRUAL CYCLE STAGES/PHASES o Ovulation A. MENSTRUAL PHASE OR MENSTRUATION the process of release of ovum from /BLEEDING PHASE a mature graafian follicle, non- o may last 3-5 days; terminal phase of the fertilized ovum from the ovary menstrual cycle. It usually happens in the middle of o Vaginal bleeding occurs as uterine the menstrual cycle,13 to 15 days, or endometrium is shed down to the basal an average of 14 days prior to the layer along with blood from the capillaries next menstruation in regular cycle and the unfertilized ovum. Estrogen is high while progesterone o Menstruation: periodic discharge of blood, is low mucus, and cellular debris from the uterine Signs of Ovulation: mucosa and occurs at regular, cyclic, a Breast tenderness predictable intervals from menarche to Slight rise in BBT (0.3 to 0.5 menopause. degrees Centigrade or 0.4 to o The menstrual period is a woman's period of 0.8 degrees Farhenheit) absolute infertility. during ovulation and a slight o Menarche is the first menstruation; it drop (0.2 degrees occurs between 12 and 13 years of age and Fahrenheit) to 36 hours is usually anovulatory, infertile, and before. irregular. DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 Fertile time: 3 to 4 days 2. Selection and maturation of before ovulation and 1 to 2 dominant follicle days after. 3. Ovulation Positive spinnbarkeit test 4. Corpus luteum formation and (with stretchable mucus). degeneration Mittelscherz (left of right lower quadrant pain MENSTRUAL PHASE corresponding to the rupture Degeneration and casting off endometrium of Graafian follicle). due to regression of corpus luteum with fall Positive ferning test in level of O+P. Degeneration is due to stasis of blood and How To Estimate Ovulation Time spasm of vessels leading to damage of o Subtract 14 days from the menstrual cycle vessels with escape of blood. length. Proteolytic enzymes from. lysosomes o 28-day cycle, ovulation occurs on the 14th causes local damage. [Enzymatic day, counting from the first day of bleeding. autodigestion] o 30-day cycle, ovulation occurs on the 16th day, counting from the first day of bleeding. HOW DOES MENSTRUATION STOP? o Most fertile period during ovulation time, Prolonged vasoconstriction known as the period of absolute fertility. Myometrial contraction Local aggregation of platelets C. LUTEAL OR SECRETORY PHASE (15 to 28 days; Endothelin and platelet activating factor are lasts about 12 days) potent vasoconstrictors. o Initiated by the ovulation in response to a surge in LH that promotes the development CONCEPTION of the corpus luteum from the ruptured o means to become pregnant. follicle, the yellow body that secretes high o Conception or pregnancy occurs when levels of progesterone and estrogen. fertilized ovum embeds in the uterus. o Progesterone stimulates the already o Process of Conception: proliferated endometrium, causing the Gametosis functional layer to become thicker (3.5 mm Ovulation thick),more spongy, and softer glands Copulation becoming more tortuous as the endometrial Fertilization capillaries get distended with blood in Development of fertilized ovum preparation for reception/implantation, and Implantation nourishment of the fertilize ovum. o An egg is expelled from the ovary (ovulation) FORMATION OF MALE AND FEMALE GAMETES into the pelvic cavity. Premenstrual phase, Spermatogenesis - process of formation of male the endometrium continues to mature until gamete (spermatozoa) in seminiferous tubule of the a sudden drop in hormone levels triggers testis. menstruation. Oogenesis - process of formation of female gamete o If fertilization occurs, implantation follows 6 (ovum in the follicle of the ovary) to 9 days or 7 to days (an average of 7 days) after fertilization. The corpus luteum lives GONAD longer and secretes progesterone and SPERM estrogen in early pregnancy; it is later o Per ejaculation, 2.5ml semen containing 50- replaced by the placenta. Life span of 200M spermatozoa is released (ave 400M corpus luteum is two weeks, or 10 to 14 days sperm/ejaculation)Moves through the cervix, uterus, fallopian tube because of OVARIAN CYCLE their flagella and uterine contractions Development and maturation of a follicle, o Undergoes CAPACITATION (changes in the ovulation and formation of corpus luteum plasma membrane of the sperm head to and its degeneration reveal sperm binding receptor sites) before All these events occur in 4 weeks penetrating into the corona radiata 1. Recruitment of group of follicles DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 OVA o The 16 celled resembles a mulberry like ball o Released from the Graafian Follicle or clusters of cells called Morula o Will be surrounded by a ring of o Morula enters the uterine cavity on the 4th mucopolysaccharide fluid (Zona pellucida) day and a circle or cells (Corona radiata) o Fluid enters the morula and is now called as ▪ Zona pellucida and Corona Radiata Blastocyst. protects the ova by serving as a buffer against injury Sperm and ova fuse carrying 23 pairs of o Moves from the ovary to the fallopian tube chromosomes each: through the cilia and peristaltic movement o If sperm carries X sex chromosome paired of fallopian tube with the ovum X chromosome = female o Sperm clusters around coronal cells zygote o Will release HYALURONIDASE(proteolytic o If sperm carries Y sex chromosome paired enzyme) to dissolve the corona radiata with the ovum X chromosome = male zygote o Sperm penetrates the cell; cell membrane of ova changes composition to become Decidua impenetrable to other sperm o The endometrium of the pregnant uterus o Layers: Ovulation: ▪ Compact - Superficial o The process of release of ovum from a ▪ Spongy - Intermediate mature Graafian follicle of ovary is called ▪ Basal - Thin ovulation o After interstitial implantation of blastocyst o Fertilisable life span of ovum is 12-24 hours into compact layer of decidua, it is renamed a after ovulation. as: Copulation: a. Decidua basalis/Serotina o The process of sexual intercourse in which ▪ Portion of decidual in the penis of male is inserted into female contact with the base of vagina in order to release semen. blastocyst o It is essential within 24-48 hours of ovulation ▪ Lies directly under the for union of gamtes. embryo (portion where the o Fertilisable life span 48-72 hours trophoblast establish Fertilization: communication with o The process of fusion of male and female maternal blood vessel) gamete (sperm and ovum) is called b. Decidua Capsularis/Relexa fertilization ▪ portion of the decidua o Site: ampulla of fallopian tube covering the blastocyst o Process: ovum is transported to the ampulla ▪ portion that stretches or after ovulation. Millions of sperm are encapsulates the surface of deposited in the vagina during copulation. the trophoblast o Numerous sperms are destroyed in the c. Decidua vera/Parietalis acidic medium of vagina. Some sperms ▪ Rest of the decidua lining the undergo capacitation and reaches vagina. uterine cavity outside the o The acrosomal cap of the sperms release site of implantation. Hyaluronidase enzymes which dissolutes o Functions: provides good nidus for the layer of the acromal radiata. implantation, supplies nutrition to the early o Few sperms penetrate the zona pellucida stage of growing ovum and decidua basalis and only one sperm reaches the nucleous. takes part in the formation of placenta. o After entry of one sperm the membrane is sealed to avoid further entry of the sperm and hence fertilization occurs and form single celled zygote o Further cell division occurs called Cleavage o After 30 hours of fertilization 2nd celled stage is reached called as Blastomeres o Blastomere continues to divide binary division through 4,8,16, 32 celled stage DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 SIGNS AND SYMPTOMS OF PREGNANCY o The number of pregnancies a woman has had regardless the outcome of the PRESUMPTIVE SIGNS – are mainly subjective pregnancy. changes experienced and reported by the woman Nulligravida PROBABLE SIGNS – are objective findings that can o A woman who has never been pregnant be documented by the examiner Primigravida POSITIVE SIGNS – indicates the confirmation of o A woman pregnant for the first time pregnancy Multigravida Presumptive signs: o A woman who Has had 2 or more 1) Amenorrhea pregnancies 2) Breast Changes Para 3) Urinary frequency o The number of pregnancies that reached 4) Quickening viability 5) Easy Fatigability Nullipara 6) Leukorrhea o A woman who has never delivered a fetus 7) Nausea and Vomiting and Morning sickness that reached the age of viability 8) Skin Changes Primipara 9) Abdominal enlargement o A woman who has Completed One Probable Signs: pregnancy to viability 1) Hegar's sign Multipara 2) Uterine growth o A woman who has completed two or more 3) Ballottement pregnancies to the Age of viability 4) Uterine suffle Term Infant 5) Goodell's sign o An infant born between 37- and 42-weeks 6) Braxton-Hick's contractions gestation 7) Fetal outline Post-term infant 8) Positive pregnancy tests o An infant born after 42 weeks gestation 9) Chadwick's sign Preterm infant Absolute or Positive Signs o An infant born Before 37 weeks gestation 1) Fetal heart tone Stillbirth 2) Funic suffle o An infant born without signs of life 3) Fetal movement felt by the examiner The terms gravida and para refer to pregnancies 4) X-ray visualization of fetal skeleton as early / birth, not the fetus. as 14 weeks 5) Ultrasonographic evidence of pregnancy THE TPAL APPROACH T DEFINITION OF TERMS number of term infants: the number of Gestation infants, born at the completion of 37 weeks' o The period during which a fertilized egg cell gestation or beyond. develops into a baby that is ready to be P delivered number of preterm infants born; number of Prenatal Care infants born before the completion of 37 o Refers to the health care given to a woman weeks' gestation. and her family during pregnancy A o Goal: Provide maximum health to expectant number of pregnancies ending in either mothers and their babies. spontaneous or therapeutic abortion. Abortion L o Pregnancy terminated before the age of number of currently living children to whom viability (24weeks AOG or weighing 400 the woman has given birth; number of live grams). births. o Before 20 weeks of gestation: abortion The TPAL approach provides more detailed o After 20 weeks of gestation: miscarriage information about the woman's pregnancy Gravida history. o Refers to the pregnant woman. DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 Pre-Natal High Risk Screening 1. Nagele's Rule (Most commonly used) o Risk factors are findings that have shown to have a negative effect on pregnancy outcome, either for the woman or her unborn child. Low income/ Educational level Poor diet Living at high altitude Multiparity >3 Weight >200 lb Weight < 100 lb Age 35 if irregular menses: Use of addicting drugs 2. Quickening Multiple gestation Smoking 1 pack/day or more Abruption Placenta and Placenta Previa Anemia Hypertension Excessive alcohol intake Cardiac Disease Diabetes Mellitus Cardiac Disease 3. Use of Fundal Height Thyroid Disorder a. Bartolomew’s Rule Sexually Transmitted Disease PIH (Pregnancy induced Hypertension) Rubella SPROM Renal Disease Pregnancy Tests o RRA (Radio-receptor assay) Identifies HCG in blood within 1 hour LH also produce a positive reaction o RIA (Radioimmunoassay) b. McDonald’s Rule Identify HCG within 1-3 hr Detects pregnancy about 6 days after conception With 100% accuracy o Enzyme - Linked Immunosorbent assay Detects HCG in urine Highly sensitive Takes 4 minutes Calculation of EDC/ EDD (Expected Date of Delivery) DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 c. Johnson’s Rule DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 DANGER SIGNALS OF PREGNANCY PREVENTING FETAL EXPOSURE TO TERATOGENS o Teratogens is any factor, chemical or FEVER AND CHILLS physical, that adversely affects the fertilized o Intrauterine infection ovum, embryo, or fetus. o Symptoms of benign gastroenteritis o Factors infleunce the amount of damage a VAGINAL BLEEDING teratogen can cause: o Should be reported no matter how slight 1. Strength of the teratogen o If discovered in a toilet paper, following a - Radiation in small amount bowel movement probably from may have no damage But in hemorrhoids large amounts can cause PERSISTENT VOMITING fetal death or defects o Once or twice daily vomiting is common 2. Timing of the teratogenic insult during the first trimester of pregnancy. - If the timing of insult is done o Persistent and frequent is not normal before implantation, either SUDDEN ESCAPE OF CLEAR FLUID FROM THE the zygote is destroyed or it VAGINA appears unaffected o Membranes have ruptured and mother and - If the insult occurs when the fetus are now both threatened, because the main body system is formed, cavity is no longer sealed for infection. (2nd to 8th weeks), a fetus is o If the fetus head is small and it does not fit very vulnerable to injury. snugly into the cervix - During the last trimester, the Umbilical cord prolapsed potential for harm decreases Compression of the cord because all the organs are Oxygenation is compromised formed and merely ABDOMINAL PAIN maturing. o Should be reported immediately because it 3. Teratogen's Affinity For Specific signals abnormality Tissue o Sign of some other problem (ectopic - Lead (attacks and disables pregnancy, separation of placenta, preterm nervous tissue labor - Thalidomide (causes limb o Unrelated to pregnancy (appendicitis, ulcer, defects) pancreatitis) - Tetracycline (Causes tooth CHEST PAIN enamel deficiency and long o May indicate Pulmonary embolism bone deformities) PREGNANCY - INDUCED HYPERTENSION o Fatal elevation of BP that occurs during TERATOGENIC MATERNAL INFECTIONS pregnancy. i. Toxoplasmosis o Symptoms: o Protozoan infection, from uncooked Rapid weight gain meat, handling cat stool. Over 2 lbs/week in the 2nd trimester o Can cause CNS damage, 1 lb/week in the 3rd trimester hydrocephalus, microcephaly, Swelling of the face or fingers intracerebral calcification, and Flashes of retinal deformities. Dimness of o Treated with sulfonamides (may lead Severe continuou to increase bilirubin levels in Decrease urine output newborns); INCREASE OR DECREASE IN FETAL MOVEMENT o Pyrimethamine (antiprotozoal agent, o An increase or decrease in fetal movement that can reduce Folic acid levels suggest that the fetus is responding to the that's why to be given with caution in need for oxygen. early pregnancy o Ask the woman about typical fetal ii. Rubella movement o Can cause deafness. Mental and o Instruct the woman to report any unusual motor challenges cataracts, cardiac changes defects (patent ductus arteriosus and Pulmonary stenosis), restricted intrauterine growth (SGA), DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 thrombocytopenic purpura, dental Candidiasis and facial clefts. Chlamydia o Cytomegalovirus Streptococcus B o Transmitted by droplet infection Hepatitis B o Can cause severe neurologic damage to the infant Potentially Teratogenic Vaccines (hydrocephalus, microcephaly, o Live virus of measles, mumps, rubella, and spasticity) or with eye damage (optic poliomyelitis are contraindicated during atrophy, chorioretinitis), deafness or pregnancy because they may transmit the chronic liver disease. viral infection to the fetus. iii. Herpes Simplex Virus (Genital Herpes Infection) FETAL DEVELOPMENT o 1st trimester (can cause severe I. First lunar month (End of 4th week) congenital anomalies or Heart chambers formed, heart Begin spontaneous miscarriage 2nd/3rd to beat as early as 14th day trimester (premature birth, Cartilage formation intrauterine growth restriction, Arm and leg buds present continuing infection of the newborn Primary lung buds appear at birth) Length is 4 to 5 mm; weighs.4 gm o CS is often recommended for Nervous system appears by the 3rd women with genital lesion week o DOC is acyclovir (Zovirax) Anencephaly - No head/brain is minimized Other viral diseases: II. Two Lunar Months (End of 8th weeks) i. SYPHILIS Head is large compare to trunk o Caused by Treponema pallidum External genitalia, Testes and o DOC: benzathine penicillin ovaries are distinct but sex not yet o If treated in the 1st trim, the fetus is distinguishable by simple unaffected, if untreated beyond 18th week, observation (8 wks) can cause deafness, cognitive challenge, Amniotic fluid surrounds embryo osteochondritis and fetal death. Assumes a human form o Screening test: Gestational sac visible at UTZ VDRL (Rapid plasma reagin test) should be done in the first prenatal Capable of some movements but visit. too faint to be felt by the mother The newborn with congenital Length:2.5 cm (1inch)/Weight : syphilis may develop congenital 2gms anomalies, extreme rhinitis Organogenesis is complete (sniffles), and a characteristic Meconeum is formed by 5th to 8th ii. LYME DISEASE week visible on UTZ (GREENISH o Caused by Borrelia burgdorferi BLACK) o Spread by bite of a deer tick. III. Three Lunar months (End of 12th weeks) o After a tick bite, a typical skin rash, Fingers and toes have nails erythema chronicum migrans (large Kidney begins to secrete urine, macular lesion with a clear center), and although may not be evident in the Joint pain Amniotic fluid o DOC (tetracycline and doxycycline, cannot Sucking reflex, Babinski reflex are be used during pregnancy because it can present cause tooth discoloration and long bone By 12 weeks fetus moves body parts, malformation in fetus.) swallows and practices inhaling and o Penicillin are given to reduce symptoms in exhaling but too faint to be felt by the pregnant women. examine FHT audible by doptone/doppler Infection that cause illness at birth: Sex is distinguishable by outward Gonorrhea appearance DIAMANTE, P.M. BSN 2-F  NCM 107 – MATERNAL AND CHILD HEALTH NURSING MODULE 2 Tooth buds are present Lung alveoli begin to mature, and Ossification in most bones surfactant can be demonstrated in IV. Four Lunar Months (End of 16th weeks) amniotic fluid. Sex can be identified at 14 weeks by Testes begin to descend into the UTZ (sex differentiation) scrotal sac from the lower Fetal heart tone heard by abdominal cavity fetoscope/Stethoscope Body less wrinkled Length: 10 to 17 cm Appearance of nails Weight: 55-120 gms VIII. Eight Lunar Months (End of 32 weeks) Lanugo (fine and downy hair on the Infants born at this time usually back and arms of the newborns, survive if given proper care which apparently serves as Length: 38-43 cm insulation of body heat) is well Weight: 1,600 gms formed Subcutaneous fats are present Amniocentesis is possible by 14-16 ("Little old man" appearance is lost) weeks (200 ml of amniotic fluid is Assumes delivery position (vertex or present) breech) Liver and pancreas are functioning Responds by movement to sounds Fetus actively swallows amniotic outside the mother's body fluid, but uncoordinated Active Moro reflex present Urine is present in the amniotic fluid Skin is pink and slightly wrinkled Meconium in bowel LS ratio in lungs now 1.2:1 Scalp hair develops IX. Nine Lunar Months (End of 36 weeks) Buds of permanent teeth form Body round, skin is pink and smooth V. Five Lunar Months (End Of 12th Week) L/S ratio is 2:1 Brown fat begins to form behind the Lanugo begins to diminish kidneys, sternum and posterior neck Length is 42-48; weight 2200- Spontaneous fetal movements 2900gms Fetal Heartbeat is more apparent Additional amounts of SQ fats are VI. Six Lunar Months End of 24th week deposited Skin is red and wrinkled with some Sole of the foot has only one or two subcutaneous fat beneath crisscross creases Surfactant production begins Most babies turn into a vertex or Start of fetal viability headdown presentation during this Length: 28 to 36 cm month Weight: 550 gms Definite wake/sleep cycle Passive transfer of antibodies from X. Ten Lunar Months End of 40 weeks mother to fetus (begins at 20th All Characteristics of a newborn week) Full term pregnancy Meconium is present as far as the Baby is active, with good muscle rectum tone, Hearing can be demonstrated by Fetus kicks actively response to sudden sound L-48-52cm SURFACTANT IS PRODUCED W-3200g or more VII. Seven Lunar Months (End of 28th weeks) Strong suck reflex An infant born at this time moves his Fetal hgb begins conversion to adult extremities quite actively and cries hgb weakly. If given an expert care, the Vernix caseosa fully formed immature infant has a high chance Little lanugo for survival If male, testes in scrotum Length: 35 to 38 cm Weight: 1, 200 gms DIAMANTE, P.M. BSN 2-F