NCMA217 LEC PRELIM.pdf

Bachelor of Science in Nursing 2YA NCMA217 LEC: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - How? – If between 7th or 8th of pregnancy if the level of Coverage for Prelim...

Bachelor of Science in Nursing 2YA NCMA217 LEC: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - How? – If between 7th or 8th of pregnancy if the level of Coverage for Prelim testosterone being produce by primitive testes will became Reproductive Development high the mesonephric duct will turn into the male Pelvis and Fetal Skull reproductive organs, whereas paramesonephric duct will Menstruation and Menopause regress. (kase ang paramesonephric duct will be the one to Conception, Fertilization, & Implantation turn into the female reproductive system) Fetal Development & Milestones High testosterone level Family Planning and Contraception - Mesonephric duct – male reproductive organs Human Genetics - Paramesonephric duct – regression Perinatal Care If testosterone level is not present by 10th week - Gonadal tissues will become – ovaries – therefore, Basahin nyo rin daw yung Week1-5 sa canvas paramesonephric duct will turn to – female reproductive organs. REPRODUCTIVE DEVELOPMENT - So it is all about the testosterone but we can say that Discussed by Prof. Francis A. Vasquez this is already pre-determined. Obstetric Nursing – came from the word “obstetric” means “midwife”. Midwife – took care of the client during the under prandial period, inter prandial period, post-prandial period. Reproductive development Gonads – the male and female reproductive organ (para sa lalaki – testes; sa babae – ovary, which means sex glands) a) Sperm – produce by the testes carry the x and y chromosomes b) Ovaries – egg coming from the ovary they carry xx chromosomes (That determine of the gender/sex of the individual) REMEMBER: - OVARIES – produce egg cells, Ovum produced by the ovaries are carrying XX chromosomes. How does gender of individual develop? When the woman gets - TESTES – produce sperm cells. Carry X or Y pregnant of the 5th week of intrauterine life, there is a presence of chromosome. primitive Gonadal Tissue that has two ducts: Therefore, if the xx chromosomes of the sperm fertilize or if Two Ducts – Mesonephric Duct & Paramesonephric Duct the sperm that is carrying an xx chromosome fertilize the egg - (These two ducts will be the one that will change so that always carrying the xx chromosomes (pre-determined), so that the baby will become male or female the paring and the combination will be xx, therefore the What happened to the developing baby? gender of the baby will be female - Bet. The 7th and 8th week of pregnancy the baby/fetus will But the sperm cell carrying a y chromosome and it fertilized producing or developing a primitive testis. the egg cell that always carrying xx chromosomes the - Primitive Testes – capable of producing a small amount of combination will be xy, therefore the gender baby will become testosterone. boy. - The level of testosterone will be the one to determine if Therefore, if the combination of the chromosomes will be x mesonephric duct and paramesonephric duct will turn to and y the primitive testes is expected to increase in production male or female reproductive organ. testosterone. So, the mesonephric duct will turn into male J.A.K.E 1 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 reproductive organ whereas, the paramesonephric duct Male secondary sex characteristics (In order) progresses. 1. Increase in weight. RECAP: 2. Broadening of shoulders - If the sperm that is carrying an xx chromosome fertilize 3. Growth of testes. the egg that always carrying the xx chromosomes (pre- 4. Growth of face, axillary and pubic hair. determined). What will happen? The level of the 5. Voice changes- because of androgens testosterone by the 10th week of intrauterine life will not 6. Penile growth increase so therefore the mesonephric duct will be the one 7. Increase in height (second to the last) that will regress, and the paramesonephric duct will 8. Spermatogenesis develop into the female reproductive organs. NOTE: Pubertal development - If a 10-year-old masturbate there is no sperm cell, seminal - Puberty will start at the age of 9 and end the age of 17, called fluid pa lang kase ang production ng sperm sa male last pa pubertal period. nangyayari 12–14-year-old. - Secondary sex changes begin: Range: 9-17 years old Male Reproductive system Average: 9-12 (girls); 12-14 (boys) - The male and female reproductive anatomy are composed of Growth spurt – is earlier in girl and later in boys. A external and internal parts. sudden increase External structures Role of androgen hormone Penis – covered by glands skin known as prepuce. - Female: adrenal cortex and Ovaries Scrotum –a sac of skin that hangs from the body at the front Master clock is the hypothalamus of the pelvis bet. Legs o Hypothalamus – will trigger the adrenal cortex to Scrotal Sac – testicles are inside of this start producing the hormones Why is it the testes are found inside the scrotal sac? And scrotal o Ovaries – will produce estrogen and progesterone sac is found outside the body? - Male: Adrenal Cortex and Testis Because there are sperms inside the testes Adrenal cortex – will start producing androgen and will Sperm cells are heat sensitive (pag masyadong mainit stimulate the testes to produce testosterone (that’s why namamatay sila) there will be an appearance of characteristics of male and What’s temperature diff. bet. the body temp. and scrotal temp? female secondary characteristics 1 degree Fahrenheit Tanner’s sexual development The body temp is 1 degree Fahrenheit higher than the Female secondary sex characteristics (In order) scrotal temperature. (vice versa) 1. Acceleration in linear growth (growth spurt) How long is the average length of the penis fully erect? (Could have Broadening of the hips) Around 4 to 5 inches 2. Increase transverse diameter of the pelvis There is lesser than 4 in. or longer than 5 in. 3. Breast development (thelarche) Urethra – tip portion of the penis 4. Growth of pubic hair (adrenarche) Function: dual, passageway of urine and semen 5. Onset of menstruation (menarche) Therefore, reproduction and elimination 6. Growth of axillary hair (adrenarche) not frequently asked so How long is the male urethra? our code will be ABTAMOI 5 to 9 in an average of 7 dual function 7. Ovulation Socratal sac – does not equally level. (isa mababa, left 8. Increase in vaginal secretions side) CBQ: Internal structures Thelarche Adrenarche Menarche Ovulation What is the earliest sign of female secondary sex characteristics? Increase in height or Breast development? - Increase in height (accelerated in linear growth) Among the following which is the female secondary sign of sex characteristics? Adrenarche, Thelarche, Menarche, Ovulation. - Thelarche (breast development) Ano ang unang lumalabas pubic hair or axillary hair? - Pubic hair. Pubic hair before axillary hair. 1. Testes J.A.K.E 2 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 2. Epididymis – on top of testes Sperm route: Testes (produce) → epididymis (mature/storage, 3. Vas difference 5% fluid) → vas deferens (connecting struct.) → ampulla (dito 4. Ampulla naka pila mga sperm) → seminal vesicle (already prod. 30% 5. Seminal vesicle seminal fluid kaya super lubricated na ung ejac. duct) → 6. Ejaculatory duct – where the ampulla and seminal vesicle meet prostate 60% and cowpers 5% at the same time produce total connected to the urethra of 65% seminal fluid 7. Urethra – structure connected to this is ejaculatory duct, Sperm Cells are alkaline in nature because of the fluids (able prostate gland, & bulbourethral gland (cowper’s gland) to survive the acidity of vaginal canal bec. of alkaline) 8. Corpora spongiosum – came from the word sponge Vaginal canal is acidic Penis – not highly mascular 2 structures produced alkaline: How will the penis erect? 1) Cowper’s gland Sexual stimulation – have blood rush, when the male person 2) Prostate gland sexually stimulated the penile arteries dilate more blood rush During contraction of ejaculatory duct there is forceful towards the penis and penile veins will constrict, the blood ejaculation so that the sperm will not stay in the acidic vaginal inside corpora spongiosum will trapped and it will absorb by it canal. that’s why the penis will erect. (pinkish color) Sperm cells will reach the cervix in 90 seconds and fallopian If sexual stimulation subside the penile vein will dilate and tube in 5 minutes blood goes out of corpus spongiosum so mawawala ang Testes- male sex gland erection. Testosterone- male sex hormones Parasympathetic stimulation Vas Deferens Testes – male sex gland - the site of the male surgical sterilization (vasectomy- ligate - They produce testosterone ligate then cut) - Responsible of spermatogenesis (production of sperm in the sperm cells after maturation will die seminiferous tubule) they provide nurishment - Where is the specific site of the spermatogenesis? made up of protein - In the seminiferous tubules Vasectomy is permanent contraception - Epididymis – serving as storage room for growth and After vasectomy still possible to make the wife pregnant maturation for the sperms. because may natira sa vas deferens - Vas Deferens/Ductus Deferens – is the conduit bet. the Nursing Teaching Plan (After vasectomize) seminal vesicle and epididymis or the connecting structure. - Do not forget that after vasectomy that you need to wear Site for male surgical sterility (vasectomy) condom if you are going to engage sexual intercourse for - Zation (vasectomy) at least 2 months - (during intercourse kapag umabot ang sperm sa ampulla - Sperm cells that located on your vas deferens are capable sperms go out of the ampulla and the seminal vesicle will of 64 days maturing causing pregnancy produce seminal fluid to lubricate sperms sa ejaculatory - To quickly emptying the part needed to ejaculate (35 to 45 duct) ejaculation, there is no guarantee) 4 Structures Producing Seminal Fluid - Surest method is you need to test your sperm count 1. Epididymis - 1st result – not sure even the sperm count is zero 2. Seminal vesicle - 2nd result – still zero 3. Prostate gland - 2 consecutive zero sperm count results 4. Cowper’s gland - Vasectomy cannot stop the erection and not preventing How many percent of the seminal fluid will epedidymis produce? spermatogenesis and can still ejaculate (but seminal fluid 5% of the seminal fluid comes from epididymis only no sperm) 30% from seminal vesicle - Vasectomy cannot protect the husband from STD 60% from prostate gland – main producer of seminal fluid Sperm Analysis Result the male reproductive anatomy 3-5 mL - average amount of semen/ejaculation 5% from cowper’s gland Per mL how many sperms are there? 20M (minimum sperm During anal intercourse why is it some males ejaculate even count/mL) – 150M sperm/mL without masturbating? - Oligospermia – the condition that the amount of sperm is - Because of the vibration of the prostate gland during anal less than 20M per mL sex - Aspermia – zero sperm cell Maturation of cells in epididymis – 64 to 70 days (common - Clomid – is the drug to help increase the sperm answer 64 days more than 2 months) production also helping for fertility Sperm Cells travels from vas deferens to ampulla – because of 400M sperms/ejaculation- average sperm per ejaculation the 5% of the seminal fluid produce by the epididymis Lifespan 3-5 days or 72 hours pH 7-8 alkaline J.A.K.E 3 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 pH 4-5 acidity level of vaginal canal Morphology – 30% are in normal shape and size (400M ave. sperm/ejac. And 50% viability so every ejaculation 200M are alive) Motility – 50% (are activley moving) Viability – 50% (30% are in normal shapes, normal size) Female Reproductive System External structures Mons pubis/ Mon veneris- protects the symphysis pubis Labia Majora and labia minora Clitoris- sit of sexual excitement for female. Homologous part of glans penis of the male. Vestibule – pear-shaped space. 2 obvious opening found in here: urethral meatus and vaginal orifice (for vaginal opening) Female urethra – 2-3 inches; Male- 5-9 average of 7. That is why female is prone to UTI. Have single function for elimination only passage of urine D- vaginal canal For correct catheterization we can see the clitoris C- uterus Fourchette – where labia minora and majora meet A- ovary Perineum- fourchette to anus B- fallopian tubes Paraurethral gland (skene’s) – lubricates the urethra Uterus Bartholin’s gland – lubricates the vagina - Size 3”x2”x1”- 3 in long 2 in wide and 1 in thick. Down the fourchette and perineum this is the site of - Weight: 50-60 grams, but in pregnancy it can weight episiotomy. minimum of 500 gram Episiotomy – the cutting of the perineum of the woman to - Shape: pear shaped hollow organ, during non-pregnant state it provide wider space to delivery and prevent laceration. Has 2 is empty so if the woman is not pregnant and something is types: midline and mediolateral episiotomy. inside the uterus then it is no longer hollow it becomes Mediolateral episiotomy- is better than midline. abnormal like myoma or endometriosis. - Location: suspended between the urinary bladder anteriorly If you have laceration and there is total communication bet. and the rectum posteriorly. Located at the back of the bladder The vaginal canal and the rectum that can lead to infection and in front of the rectum. because of fecal contamination - Position: When will the doctor perform the cut? During contraction or Anteflexion- fundus of between contraction? Is there an anesthesia? No, because it uterus is leaning sharply has a natural anesthesia, the doctor will cut during the peak of forward and it is abnormal the uterine contraction, because when there is strong uterine contraction during the acme, because one contraction is because it can compress to much of urinary bladder and composed of three parts: relaxation, contraction, relaxation other organs in front of it. A Anteverted/ anteversion (non-pregnant)- normal position, fundus of uterus is I D I- ncrement (start), A- cme (peak), D- ecrement (end) leaning forward The doctor will not do the cut during the increment and Retroverted/ retroversion decrement. The doctor will do the cut during acme because (pregnant) during this time the peak of the uterine contraction, the head Retroflexion of the baby is already pressuring the perineum of the woman. Flexion- means abnormal If the head of the baby is pressuring the perinium of the When will the uterus assume the retroverted position? woman the nerve ending will not be able to transmit pain J.A.K.E 4 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 The uterus assumes the retroverted position during the 2nd - NOTE: site of implantation? Uterus, what specific part? trimester/ 4-6 months. Endometrium. Note: 1st tri. 1-3 mos, 2nd tri. 4-6 mos, 3rd tri. 7-9 mos o The ideal site of implantation is Upper uterine segment – The woman is 2 ½ mos pregnant is the uterus already enlarging? posterior. Yes, and its position is anteverted and can compress the - Not in the lower because the site of implantation is the bladder so discomfort of pregnancy experienced by site of placental development. Ibigsabihin kung saan nag pregnant woman is urinary frequency and this will plant dun din mag grow ang placenta. disappear in 2nd trimester beginning 4th month because the - If the implantation happened in lower, called placenta uterus assume the retroverted position previa. The placenta obstructs the birth canal and lead to In the 3rd mos. of trimester, she experiences urinary frequency bleeding. why? - Posterior because uterine arteries are located at the Because the baby is so big posterior. Rich in nourishment, nutrient supply and - Functions of the uterus: oxygen supply. 1. Site of implantation. (endometrium) o The implantation should only happen in endometrium. 2. Houses and nourishes the products of conception. - It should not reach in myometrium. 3. Aids in labor and delivery (by promoting uterine - If the implantation invaded the myometrium, in the future contraction) the placenta is attach up to myometrium. - After the baby goes out, the placenta goes out next. The placenta separate itself from endometrium. Meaning, the placenta is superficially implanted on the endometrium. - If implantation goes deeper/ invasive, the placenta is attached permanently on the myometrium (because during delivery the baby goes out and after that the placenta goes out next and it separates itself from endometrium meaning placenta is superficially implanted in the endometrium but if the implantation goes deeper invasive implantation the placenta is attached permanently and it is called placenta accrete - Aids in delivery because it is composed of three layers: - If there’s placenta accrete, the placenta will not go out, Perimetrium- outermost layer, Myometrium- middle and because the placenta becomes part of the uterus. When the Endometrium- inner most layer and the site of implantation. baby went out, but the placenta cannot detach itself from o Myometrium - Highly muscular layer and considered as the uterus, the women bleed to death. (Management: thickest layer. Source origin of uterine contraction. removal of uterus called hysterectomy) o The uterus composed of 4 parts: Cervix 1. Fundus – upper most triangular portion Internal OS – during 2. Corpus – the working you find the uterine cavity. Body of pregnancy it effaces uterus (thinning) 3. Isthmus – lower segment/part Cervical canal – 4. Cervix (collar) – mouth/opening of uterus. during pregnancy turns Upper uterine segment into operculum F (thickened) External OS – during C pregnancy it dilates (widening/opening) Location: above vaginal canal I - During delivery we measure internal os by percentage. What C is the full cervical effacement? 100%, how about dilatation? Lower uterine segment Centimeters, what is the full dilatation? 10 cm. o The thickest layer of the myometrium located in the fundus. - During pregnancy, the level of estrogen is high. - Because that is the site of uterine contraction. - When the level of estrogen is high, it makes the cervix soft. - The strongest uterine contraction. And softening of cervix is known as Goodell’s sign. - When the fundus contracts it gives the baby a downward - Three probable signs of pregnancy can be found in the push. vagina, cervix and isthmus: o The uterine contraction here are not that strong. 1. Chadwick sign – purplish or blueish discoloration of - If the uterine contraction here is strong, the baby cannot vaginal mucosa go out the baby will have a hard time going out. 2. Goodell’s sign – softening of cervix J.A.K.E 5 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 3. Hegar’s sign – softening of cervix Hegar’s sign Goodell’s sign Chadwick sign - GS and HS are the same thanks to estrogen because during pregnancy the level of estrogen increases causes to increase vascularity (means temporary capillaries are building up that Uterine Blood Supply increases fluid supply that’s why it becomes soft) on the DECENDING AORTA isthmus and cervix. ↓ How soft is non pregnant cervix? 2 ILIAC ARTERIES - as soft as tip of the noses ↓ How soft is Early pregnancy cervix? HYPOGASTRIC ARTERIES - Earlobe ↓ How soft is late pregnancy cervix? UTERINE ARTERIES - lips Why is there a need to cervix soften? - To be able to allow the cervix to efface and dilates. Uterine Nerve Supply Kailangan lumambot para numipis ang internal os at mag open ang external os. Operculum - Thickened cervical mucus - When the cervical mucus thickened it acts as a seal that protects the mother and the baby against the ascending - Uterus nerves infection. a) Afferent sensory – from thoracic #11 to #12 - Protection against m.o are acidity of vaginal canal and b) Efferent motor – from t5 to t10 operculum CBQ: - Dislodge during through labor (bloody show) - Epidural Anesthesia – stops pain of uterine contraction at t11 - Supporting Ligament Structures of Uterus and t12 without stopping uterine contraction. For painless Broad Ligament – it keeps the fallopian tube and uterus in delivery. place. Because the motor nerves that will allow the motor nerves Round ligament – upper support, pair of ligament to contract is t5 to t10, sensory from t11 to t12. attached to the fundus. Kaya if woman receives epidural anesthesia the woman Cardinal ligament – middle support (important, it is vital) will continue uterine contraction because epidural Uterosacral ligament/pelvic floor ligament – lower anesthesia affects at t11 and t12 but not affecting the support nerves t5- t10 so she will contiue uterine contraction but What ligament allows the uterus to assume the retroverted position not feeling the pain. during pregnancy? Vagina Round ligament. During 2nd trimester the round ligament - Length – 3 to 4 inc is contracting so fundus is going up retroverted position. - Rogaeted – skin folds, stretching - Function – organ of intercourse; passageway of menstrual discharge; birth canal - Environment; Acidic – douderline bacillus this produces lactic Cardinal ligament. It will not be called cardinal if it is not acid important. Fundus and isthmus is not stable. Middle part - pH – 4 to 5 is usually stable and not becoming soft so what is the - During IE the fingers are inserted to vaginal canal ligament attached? Cardinal. - Vagina can accommodate a bigger and longer size of penis, because it has rogae - During sexual intercourse the cervix moves little upward and the rogae is stretched J.A.K.E 6 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 Fallopian Tubes - When level of estrogen is increasing it encourages contraction - Pair of tubular organs in the fallopian tube nag kakaroon ng wave like motion. Inner - Also called oviduct, because it is the passage way of ovum portion of the fallopian tube is ciliated so as the fallopian tube once it is fertilized is contracting the cilia are moving so the fertilized egg is also - Length 3-4 inc moving inward for another 3-4 days if it moves outward it will - Ciliated (may cilia) cause high risk of ectopic pregnancy. Parts - After fertilization the implantation will happen 6 to 8 days or 1. Interstitial – dangerous of ectopic preganancy bec. it is average of 7 days (1 week) and maximum of 10 days narrowest and connected to the uterus so bleeding is - 7 to 10 days implantation will occur in upper segment in profuse posterior uterus in the endometrium 2. Isthmus – site of tubal ligation. The doc. Will fold - Pro (for) gesterone (gestation)- hormone of preganancy, fallopian tube. provides nourishment for the baby and hormone that prevents 3. Ampulla – fertilization happens and common site of contraction. ectopic pregnancy (pregnanacy outside the uterus) and - Estrogen- hormone that encourages contraction and hormone meeting place/mating place, widest part. that enlarges the uterus. Ovaries - Female gonad that produce estrogen and progesterone - 3 Division 1) Surface epithelium 2) Cortex – maturation of oocytes 3) Medulla - During the pregnancy ovaries are not active because placenta will be the one will provide the estrogen and progesterone. Breast: Mammary Glands - If fallopian tubes is divided into 3 equal parts it is called: - The breast lies in the pectoralis muscle ampulla- outer most third, isthmus- middle third and interstisial- inner most third (narrowest and goes to 3 layers of uterus) - Fimbrae- farthest part of the infundibullum, to cath the egg cell. When the follicle of the ovary releases an egg cell the fimbrae catch the egg cell. The egg cell will then go to ampulla to wait for the arrival of the sperm. QUESTIONS: - Site of fertilization? Fallopian tube, specific part? Ampulla - Functions: site of sterilization and transports ovum to the uterus. - Pomeruy Procedure – cutting of fallopian tube - Modified Pomeruy – no cutting the fallopian tube - The doctor will do the tubal lateral ligation during menstruation because it is a sign that the woman is not pregnant. - When is the best time will the woman undergo tubal ligation? – 1st day after the last menstrual period or during mens. Choose the day closest to the day that the woman is menstruating. - For example the woman had sex the sperms enter vaginal canal → uterine cavity → 2 fallopian tubes → tapos wala pa ung egg cell dahil hindi pa siya nag ovulate, eh ung life span Lobes of the breast- are connected to the lactiferous ducts ng sperm ay 72 hrs/3 days maximum of 5 days so tatambay Lactiferous sinuses/Ampulla of the breast- dulo ng lactiferous duct, muna siya sa ampulla → nag ovulate na ung egg cell → storage room for the milk mature egg cell ika-catch sya ng fimbrae → it will enter From: Lobes → lactiferous ducts → Lactiferous sinuses/Ampulla ampulla → there will be fertilization. → opening of lactiferous - Once its fertilize the egg it stays on the fallopian tube for 3-4 What hormone stimulates the breast to produce milk? days, during w/c the level of estrogen is increasing and - Prolactin – it produces by the pituitary gland. (Anterior progesterone is increasing more because the woman is already and posterior) pregnant. J.A.K.E 7 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - Prolactin – from anterior pituitary gland; Oxytocin – from 2) True pelvis – simula sa symphysis pubis pababa (serves as Posterior pituitary gland. the birth canal) - Oxytocin causes uterine contraction. - Prolactin stimulates acinar cells (found inside lobes that can produce milk) How will the mother breast feed the baby after delivery? - Because of the action of the prolactin and oxytocin. - Prolactin stimulates the production of milk by acini cells inside the lobes - Milk ejection reflex or let down reflex of the milk we need oxytocin, coming from the posterior pituitary gland. Mammary glands and milk ejection reflex 4 types of pelvis - Cells responsible for producing the milk is the acini cells that is found in the lobe that contains 15-20 each breast. - How milk ejection happens? When the newborn baby sucks the nipple of mother, it sends signal to the posterior pituitary 1. Gynecoid gland to release oxytocin. - True female pelvis because this is the most rounded type - Once oxytocin release, it will cause the contraction of milk of pelvis. gland cells and acini cells will release milk. - It can easily support pregnancy and delivery. - Then, the milk flows into lactiferous ducts, it will be stored in 2. Anthropoid the lactiferous sinus. - Can also support pregnancy and delivery. - Because sucking action of the baby, the milk is expressed in 3. Android the nipple. - Male pelvis – heart or triangular shape - Is there any advantage when posterior pituitary gland during 4. Platypelloid breast feeding releases oxytocin – the advantage will be - The anterior and posterior diameter is short. contraction of the uterus during the post-partum period. Then, - Flat pelvis the uterus remains firm and contracted, it stops or prevents - Cannot support pregnancy and delivery post-partum bleeding. - The normal consistency of the uterus after delivery must be True pelvis firm and contracted. Because if the uterus is relaxing, the woman bleeds. PELVIS Discussed by Prof. Francis A. Vasquez - Supports and protects the reproductive and other pelvic organs. - Bony ring structure - Inside the pelvic cavity there is female internal reproductive system including the part of the renal system the bladder and the digestive system, the rectum and the anus. 1. Inlet - 2 divisions: 2. Cavity 1) False pelvis – simula sa symphysis pubis pataas (support 3. Outlet growing uterus) J.A.K.E 8 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - All oblique and cavity are 12 - Inlet- transverse is bigger and AP dia. is smaller - Outlet- transverse is smaller and AP dia. is bigger The baby needs to rotate while passing the birth canal. – 6 mechanism labor. D-FIRE-ER-E 1) Decent 2) Flexion 3) Internal rotation 4) Extension 5) External rotation 6) Expulsion Ischial spines – landmark for the station zero. (Station zero is landmark of engagement – means the head is already between Ischial tuberosity- called sitting bones, the ones carrying our body the ischial spines naka sipit ang head kaya tinawag na sipit- weight when we are sitting sipitan) Ischial spine/ sipit-sipitan- katapat ng coccyx If the fetus still inside of the uterus of mother, there is Anterior Posterior Lateral amniotic fluid. The fetus bouncing in the amniotic fluid. Sacral Ballottement – the bouncing of the baby in the amniotic fluid. Inlet Superior pubis Ileum prominence Cavity - - - Ischial Station zero Outlet Inferior pubis Coccyx (-) Not Engaged spines - If u get the distance from superior pubis to sacral prominence it is anterior-posterior diameter of the inlet - If u get the distance from inferior pubis to coccyx it is (+) Engaged anterior-posterior diameter of the outlet - If u get the distance between the 2 ileums, then transverse diameter - If u get the measurement between the 2 ischial spines then, Engagement is when the head of the baby reaches at least minimum of station zero or if the head of the baby is already transverse diameter of outlet and inlet kase may diameters ang reaching the two ischial spine pelvis If the head of the baby is already engaged Diameter of the pelvis Station zero- is the level of the ischial spine Anterior- Above station zero is negative 1, negative 2 etc. Transverse Oblique Below station zero is positive 1, positive 2 etc. Posterior 1 station = 1 cm. Inlet 11 cm 13 cm 12 cm EXAMPLE: Cavity 12 cm 12 cm 12 cm 1. The head is located at the negative 2 station, so the baby is Outlet 13 cm 11 cm 12 cm located 2 cm above ischial spine. 2. If the head is located at the positive 3 station the baby is located 3 cm below ischial spine. 3. The head is located 2 cm above the ischial spine, is the head already engage? Not yet but there is ballottement since the J.A.K.E 9 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 head is not yet engage the baby can still bounce and the baby is floating 4. When the head is already engaged in station zero it is no longer floating w/out ballottement. 5. When the head goes down to positive 5 the head is always engaged. 6. You performed IE upon inserting your finger you are able to feel/palpate the ischial spine, but the head is not yet there the head is located at the negative station. 7. Upon inserting your finger, you feel the head w/out feeling/ palpating ischial spine the head is located at the positive station 8. Upon inserting your finger, you feel the head along the ischial Attitudes: spine then that is station zero. 1) Flexion - yuko Crowning – when the head reaches positive 4 and 5. The 2) Extension - tinggala head of the baby is being encircle already by the vaginal 4 regions of the fetal skull: opening. 1) Face - biggest 2) Brow/ sinciput - big Fetal skull – Pelvis relationship 3) Vertex - small - The fetal skull is the most important part of the fetal body 4) Occiput – smallest during the labor and delivery because: EXAMPLE: The most frequent presenting part. (Because the most - If the head is: common fetal presentation is cephalic presentation) fully flexed the presenting part is occiput Largest part of the fetal body. (Since it is the largest that’s Partially flexed the presenting part is vertex the part of the body that can have a problem of not Partially extended the presenting part is brow passing through the birth canal kase malaki) Fully extended the presenting part is face Least compressible. (When head passed birth canal the Occiput and vertex - 2 ideal presenting part, kase maliit sila head is compressed and that is called molding) Fetal skull 3 main bones: 1) Frontal bones 2) Parietal bones 3) Occipital bones Sutures: - Cranial joints, like space 1) Frontal suture - between 2 frontal bones 2) Coronal suture - between 2 parietal and 2 frontal 3) Sagittal suture - between 2 parietal bones 4) Lambdoidal suture - between 2 parietal and 1 Fetal presentation occipital Fontanels: 1) Anterior fontanel – diamond space (closes within 12-18 mos.) 2) Posterior fontanel – triangular space (closes within 2-3 mos.) 1) Cephalic – headfirst 2) Breech – buttocks first 3) Transverse- shoulder first All babies that are in cephalic presentation will be delivered normally? No, it depends. If the presenting part in the vagina is the face of the baby delikado un because as the uterus is contracting the uterus is pushing the baby down and the head further extend is face that can cause fracture of the cervical bone J.A.K.E 10 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 Fetal Lie - Relationship of the long axis of the uterus and long axis of the Main management of menopause fetus. Estrogen replacement therapy (ERT) - Eliminates hot flushes - Prevents atrophic vagina. - Prevents mood swings, osteoporosis - You delayed aging - The absolute contraindication is family history of breast cancer. a) Start with 3 years after LMP b) Calcium 1gm/day at HS + Vit. D (Vitamin D = increases absorption of calcium) Longitudinal lie - if the axis of uterus and baby is parallel to c) Increase OFI at least 3,000 to prevent renal stones. each other. Two types: Cephalic and breech Health teachings Transverse lie 1. Regular exercise, avoid too much weightlifting. (advise the In actual area presentation is the commonly used term because woman not to wear high heels) it is direct. 2. Ca + Vit D intake (Calvit) 3. KY jelly – for sexual activity MENOPAUSE 4. Avoid smoking, alcohol – that can cause vasoconstriction Discussed by Prof. Francis A. Vasquez 5. Regular physical examination - Cessation of menstruation 6. Psychological support, emotional support - No more follicles in the ovaries. - Ovaries become less sensitive to gonadotropins therefore the level of estrogen decreases, and the woman will no longer ovulate. - During the intrauterine life, the female fetus has already 300,000-400,000 immature oocytes inside their developing ovaries during the fetal life. When this fetus is born and then she reaches the age of puberty, there only 300 – 400 immature egg cells inside her ovaries. - On a monthly basis, she’s releasing 1 egg cell per month. - Example: starts menstruation at age of 12, and she reach menopause at age of 50. 50-12 = 38, she has been fertile in 38 years. 38 yrs x 12months = 456. The woman releases 456 egg cells. - Usually happens, age of 45-50 - Less than 40 – premature menopause. - Diagnosis – no menstruations for at least a duration of 1 year for women above 45 years old. - Assessment: Hot flushes – face to chest with perspiration. That is increases mood swing. Loss of breast mass and firmness Atrophy of reproductive organs Headache, palpitations Dyspareunia – painful intercourse because the amount of lubricant that will be produce Bartholin’s gland will decreased. Mood swings – low libido, anxiety depression - CBQ – high risk for osteoporosis (fracture), renal stone formation. - Estrogen keeps the calcium in the bone. Therefore, the calcium of the bone tends go out of bone it mixes with the blood, the excess calcium go to kidney, that’s why magkakaroon ng renal stone formation. J.A.K.E 11 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 MENSTRUATION Menstruation Ovulation Menstruation Discussed by Prof. Francis A. Vasquez - A periodic cyclic discharge of blood coming from the uterus. Day 1 Day 14 Day 28 - A periodic, cyclic, regular, monthly discharge of blood coming from the uterus. Day 1-5 safe & (-5) (+3) Day 18-28 safe Day 6- 8 Days 9 to 17 - Uterus - organ of menstruation - Average blood loss during menstrual period – 30 to 80 cc, an Example: 5 days of menstruation average of 60 cc. o Days 1-5 = menstrual period is safe - 60 cc = ¼ cup. o Deduct 5 days from the day of ovulation 14-5 = 9 - Iron loss (12- 29 mg) o Add 3 days from the day of ovulation 14+3 =17 - If the woman is heavily having menstrual period, pwede siya o Day 9-17 fertile window, the woman is considered fertile mamutla/ pallor. o The woman is considered safe to have sex if she doesn’t Menstrual period VS Menstrual Cycle want to get pregnant beyond the window so less than 9 - Menstrual period are the days where in the woman is and above 17 menstruating and the average length of the menstrual period is o Specifically, the woman is safe to have sex from day 1 to three to five days, maximum of seven days. day 8 but days 1 to 5 have menstrual period. Therefore, - Menstrual cycle, starts from the first day of period to the first day 6- 8 and during menstrual period is safe. day of next period (regla to regla), average of 28 days/cycle o Day 18 – 28 is also safe - Ranges from 23-35days; maximum of 40 days. o Day 9 – 17 fertile days, not safe - Occurs during puberty, 9-17 y/o average of 12 y/o. Recap: - First onset of menstrual cycle is menarche - Menstrual cycle can be regular or irregular. 28 DAYS CYCLE 1st half of the cycle 2nd half of the cycle 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Menstruation Ovulation Menstruation 21 22 23 24 25 26 27 28 5 days explanation: Day 1 Day 14 Day 28 1 2 3 4 5 Day 1 Day 16 Day 30 9 10 11 12 13 14 Day 1 Day 11 Day 25 28 Days Cycle Legend: Red - menstruation (safe) Green – safe days Ovulation - the day that the one of the 2 ovaries of the woman Orange - fertile window (not safe) is releasing a mature egg cell. Violet- ovulation day The woman is fertile when the one of her 2 ovaries is releasing egg cell. Blue- sex days 1) If the woman is a 28-day cycle, she will ovulate on day 14, If the woman is fertile and she had sex there is a possibility granted that the menstrual period of the woman is 1-5 days. that the egg will be fertilized by the sperm and get pregnant. 2) From the day of ovulation minus 5 (14-5 =9) & from the day How are we going to compute for the day of ovulation? of ovulation plus 3 (14+3 =17) so days 9-17 she is fertile. - From the end of the cycle, minus 14. 3) Therefore days 1-8 she is safe but if she wants to engage in sex - 28 – 14 = 14 – she will be ovulating on day 14. beyond menstrual period, she is safe from days 6-8 and from - This is only done by regular day 18-28. Hormone estrogen is high on the first half of the cycle. - Q: Is she ovulating at day 9? A: No, because day 14 is the Hormone progesterone is high on the second half of the cycle. ovulation day The length of the cycle affects the day of the cycle? Yes 1) Day 9 is 5 days before ovulation, means that if you have sex The day of ovulation is based on the cycle on day 9 sperm enters the vagina → cervix (w/in 90 sec) → If the length of the cycle is changing every month, then the uterine cavity → fallopian tube (reached w/in 5 min) and; day of your ovulation every month is also changing, then you 2) Starting from day 9 the sperm is waiting in the ampulla of the are not regular. fallopian tube for the arrival of the egg for 5 days (kase diba Fertile window ang life span ng sperm is 3-5 days so 5 days siyang mag - These are the days the woman is considered fertile. hihintay sa ampulla) and the egg will arrive on the 5th day at - If you want to get pregnant have sex during the fertile window. exactly day 14 (ovulation day) in the ampulla of the fallopian - If you don’t want to get pregnant have sex outside the window. tube therefore she will get pregnant even if the sex was 5 days ago. 3) Note the sperm lives for 3-5 days that is why you have to subtract 5 and add 3 is derived from the life span of the ovum/egg cell. It is only 1-2 days or actually average of 24 hrs. J.A.K.E 12 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 or 1 day, maximum of 48 hrs. or 2 days. Plus 3 kase they - Day 5 still menstruating and day 3 ovulation day- they are added 1 day. overlapping 4) If you don’t want to get pregnant have sex more than 5 days 38 DAYS CYCLE before ovulation: day 8 paatras. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Another Example: 4 days of menstruation 21 22 23 24 25 26 27 28 29 30 o Fertile window: 19-27 31 32 33 34 35 36 37 38 o Safe days: 1-18 and 28-38 o Ovulation day: 24 38 Days Cycle for Irregular Legend: Red - menstruation (safe) 38 DAYS CYCLE Green – safe days 1 2 3 4 5 6 7 8 9 10 Orange - fertile window (not safe) 11 12 13 14 15 16 17 18 19 20 NO ovulation day 21 22 23 24 25 26 27 28 29 30 4 Important Structures 31 32 33 34 35 36 37 38 - That regulate/control the menstrual cycle 38 Days Cycle Legend: - Hypothalamus gland that starts menstrual cycle → Red - menstruation (safe) hypothalamus stimulates what gland? anterior pituitary gland Green – safe days → APG stimulates what organ? ovaries → ovaries affect what Orange - fertile window (not safe) organ? uterus. Violet- ovulation day 1. Hypothalamus For irregular there is computation but it is not highly Producing: recommended because from the very beginning the woman is - GnRH or Gonadotropic Releasing Hormone irregular. Types of GnRH: To know if you are regular or not you have to: o FSHRF or Follicle Stimulating Hormone Releasing Factor  Monitor your menstrual cycle for at least 6 mos. o LHRF or Luteinizing Hormone Releasing Factor  For regulars your menstrual cycle should be fixed to 2. Anterior pituitary gland specific no. of days. Producing: - Ex. Your cycle is 30-day cycle so dapat every following - FSH or Follicle Stimulating Hormone month 30 days pa din siya. - LH or Luteinizing Hormone - Although naiba nung April ng 28 hindi pa din siya 3. Ovaries considered as irregular, ask ur self if you are stressed that Producing: time because it can alter mens. cycle. - Estrogen- dominant on the 1st half of cycle Type Jan Feb March April May June - Progesterone- dominant on the 2nd half of cycle Regular 30 30 30 30 30 30 4. Uterus Regular 30 30 30 28 30 30 Irregular 28 25 28 30 33 26 Dominant on the Structures Dominant on the 1st half of cycle 2nd half of cycle  For irregular, you must also monitor your menstrual cycle FSHRF Hypothalamus LHRF at least 6 months. FSH APG LH - You have to identify the month that has longest cycle and Estrogen Ovaries Progesterone the shortest cycle. - You have to deduct 11 days from the longest cycle then, 4 Dates in the Menstrual Cycle - Deduct 18 days from the shortest cycle. 1. ↓ 3rd day - the level of estrogen in the blood of the woman is - We cannot identify exactly the ovulation day but we will very low. know the fertile window. o Days 1-5, she is menstruating at the beginning menstrual cycle. Example for irregular: 2. ↑ 13th day - the level of estrogen in the blood of the woman is a) (May) Longest cycle – 38 – 11 = 27 days ↑ Considered as the cycle because it is the longest very high b) (Aug.) Shortest cycle – 21 – 18 = 3 days 3. ↓ 13th day - the level of progesterone in the blood of the woman is very low. Menstruation Ovulation Menstruation 4. ↑ 14th day - the level of progesterone in the blood of the Day 1 --------- Day 38 woman is very high. 1-5 MP (1-2 safe) 3-27 FW 28-38 safe J.A.K.E 13 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 3rd day  E 13th day  P Second half of the Cycle (P) 1) That’s why on the 13th day of the menstrual cycle the level of Hypothalamus progesterone is very low stimulating the hypothalamus to FSHRF LHRF release LHRF. 2) LFRH stimulates the APG to release LH. Anterior pituitary gland 3) LH stimulates the ovary to release progesterone. Then, FSH LH 4) Progesterone will affect the uterus. Mat. oocyctes Triggers ovulation - When the level of LH is high, LH triggers ovulation. 13th ↑ Ovaries - The high level of progesterone will convert graafian Estrogen Progesterone follicle into corpus luteum. (Corpus luteum -yellowish) Graafian follicle Graafian follicle - Progesterone will stimulate uterus, there will be Uterus increased vascularity on endometrium Corpus luteum - Increase vascularity – building up of temporary capillary. Thickening of myo and endo ↑vascularity on endo - Progesterone builds up temporary capillaries on First half of the Cycle (E) endometrium. 1) Particularly days 1-5, on the 3rd day of menstrual period the - The blood supply will be high when there’s a build-up of level of estrogen in the blood of the woman is already very temporary capillary. low because she is menstruating. - If the blood supply in endometrium will become high, it 2) That low level of the estrogen of woman stimulates the increased supply of O2, H20, Glucose, Amino Acid. hypothalamus to start a new cycle. - Progesterone made the endometrium highly nourished. 3) Estrogen stimulate hypothalamus to release FSHRF 4) FSHRF stimulates the APG to release FSH. 5) FSH stimulates the ovary to release estrogen. Then, 6) Estrogen will affect the uterus. - Once APG release, FSH – will develop egg cells. It will cause the maturation of oocytes (1st effect). (Oocyte – immature egg cells) - (2nd effect of FSH) FSH stimulates ovaries to release estrogen so once estrogens is release, it converts the follicle of the ovary into graafian follicle. - Follicle is the compartment in the ovary where you can find the egg cells and becomes graafian follicle. Estrogen Pathway of woman getting pregnant is the hormone that is very high in the graafian follicle. Menstruation Ovulation Menstruation - The effect of the estrogen on the uterus is thickening of myometrium and endometrium. Corpus luteum (2 weeks life span) Day 1 Day 14 - Myometrium is also thickening – the uterus will slightly enlarge during menstrual cycle because of the hormone She is fertile and she had estrogen. sexual intercourse 2 months CL is aging - If the woman gets pregnant the level of estrogen is high that is why estrogen enlarges the uterus. Positive fertilization - Hindi sabay pinoproduce ng ovary ang estrogen and (beginning of pregnancy) Placenta progesterone. Isa isa lang. - Estrogen partner niya si FSH. Progesterone is LH 9th month – aging How ovaries produce progesterone? - Estro is low on 3rd day and high on 13th day so on the 13th Increase uterine day the level of estro is high and pro is low. Since the 13th Labor Low progesterone contraction day the level of estrogen is already very high, there will be a feedback effect. - Kaya minus 14 kase 14 days ang life span ng CL - That high level of the estrogen will send signal to the - Corpus luteum came from graafian follicle, GF produce APG to temporarily stop producing FSH. estrogen. CL combines estrogen with progesterone. But - Effect: If the FSH stop producing, then ovary will no progesterone is higher during pregnancy. - 2 hormones produced by CL is estrogen and progesterone. longer produce estrogen. (may stock na sya ng estrogen sa graafian follicle) J.A.K.E 14 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - Estrogen is high (encourage contraction) but progesterone is QUESTIONS: higher (prevent contraction) and we need these 2 hormones in 1. What gland that starts menstrual cycle? Hypothalamus pregnancy. 2. Hypothalamus stimulates? APG - The reason why the woman will not menstruate when she gets 3. APG stimulates? Ovary pregnant because lifespan of CL after fertilization, extends 4. Ovary affects? Uterus from 2 weeks to 2 months. Since nag extend menstruation 5. Hormone high in the graafian follicle? Estrogen missed. 6. Hormone high in the CL? Progesterone - On the 2nd month, corpus luteum is aging/degenerating. 7. What gland stimulate ovary to produce estrogen and - On the 2nd month of pregnancy, the placenta will develop. And progesterone? APG the placenta produces estrogen and progesterone, but the 8. What hormone will stimulate the ovary to produce progesterone is higher than estrogen. estrogen? FSH - The lifespan of placenta (inunan) is 9 months. 9. What hormone will stimulate the ovary to produce - When the placenta reaches the 9th month of pregnancy, progesterone coming from what gland? APG, under the placenta is considered aging. (Progesterone – preventing regulation of hypothalamus gland contraction) then, 10. What hormone will stimulate APG to produce LH? LHRF - The ability of the placenta to produce progesterone, will begin coming from hypothalamus to decrease. Therefore, it will increase uterine contraction. 11. What day the level of estrogen is highest? 13th Then the woman enters the labor. 12. What day the level of progesterone is lowest? 13th 13. What day the level of progesterone is highest? 14th Pathway of woman menstruation 14. What day the level of estrogen is lowest in the blood of Menstruation Ovulation Menstruation the woman? 3rd day because she is menstruating Corpus luteum (2 weeks) 15. What hormones trigger ovulation? LH Day 1 Day 14 Day 28 CARE OF THE MOTHER & THE FETUS DURING THE No sexual intercourse PERINATAL PERIOD No fertilization decreased E and P Discussed by Prof. Jhal Espinosa Conception Ova/ovum/female sex cell/mature female gamete- that has increase uterine gone reduction and released by the ovaries during ovulation contraction where it is picked up by fimbriae It is important to know when we will exactly ovulate for us to temporary capillaries Menstrual discharge rupture know to time pregnancy kase 1-day lang ang life span ng ova. Four tools to know accurately when woman is ovulating: - She did not engage in sexual intercourse, or she engaged in 1) Cycle regularity – regular menstrual cycle (21-35 days) sexual intercourse but protected. That’s why there’s no Mittelschmerz fertilization. - Can feel slightest of pain - If there is no fertilization, there is no pregnancy to support. So, - Slight discomfort associated with the stretching CL will not extend life span from 2 weeks to 2mos. So, within of follicle. 2 weeks the corpus luteum is degenerating. - One-sided, kung saan nag rerelease ng ova si - If the corpus luteum is degenerating, the level of estrogen and ovary progesterone will begin to decrease. - Situated in the lower abdomen - If the estrogen and progesterone decrease, the uterine - Lower abdominal pain associated with ovulation. contraction will increase. - German for "middle pain," mittelschmerz occurs - The temporary capillaries will begin to rupture – giving you midway through a menstrual cycle about 14 days menstrual discharge. before your next menstrual period. - Doesn't require medical attention. 2) Change in cervical mucus – there is change every month. To simplify Usually start with dry wala tayong mga secretions F H L and eventually mag kakaroon ng konti-konti until the A secretions is stretchy and clear you can actually E O P compare to egg white. G U C Spinnbarkeit - Legend: green- structure, yellow- hormones - 6 cm before it breaks - FEG- HAOU- LPC - Needs to be stretchy, so that it can go farther or it - If hormones contain “RF” releasing factor it came from can transport the sperm to ova that is targeting to hypothalamus walang “RF” from APG meet. (makiki-ride sya). - If the questions are about structures look at the middle 3) Changes in Hormones – estrogen and progesterone. - If the question is about the hormones look at the outside. There is slight increase because of the presence of corpus luteum. J.A.K.E 15 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 4) Change in body temperature – prior to ovulation there will - We also need to consider the viability, maturity and be a temp. drop to a low normal and then the following motility of this sperm cells. day it shoots up to a very high normal and this will tell us - If the male is producing 1.5ml or 1/3 of teaspoon, he may that the woman is actually ovulating. need to be further evaluated. We have to use basal body thermometer when we use - Types: this technique. The woman should check her temperature daily upon b) Androsperm – small head; y chromosomes; ph- arising (kapag bagong gising sya) alkaline Ovulating - 14 days before the next cycle. Every good fertilization, start from a good ovulation. And every good conception, starts from the good fertilization. The ovum released by the ovary is then transported through the tube by the muscular movement. Cilia- used to move the ova. Fallopian tube - Infundibulum - Ampulla – outer; meeting place; common site of ectopic pregnancy - Isthmus – inner - Interstitial – pinaka delikado na site for ectopic pregnancy Reproduction This gamete once released is ready for fertilization already and normally occur in the ampulla of the fallopian tube, whether the ova is fertilized or not tuloy pa din ang journey niya. The ovum proceeds to the uterus in approximately 4 days after it is released by the ovary. Ovum - Female sex cell - Life span – 24 hours Two important layers of ova: corona radiata and zona pellucida Parts 1. Corona Radiata – outer layer, granulosa or follicular cells that formed around developing oocyte in the ovary and remain until ovulation. 2. Zona Pellucida – transparent but thick, composed of glycoprotein that surround the cell plasma membrane. 3. Plasma membrane 4. Cytoplasm 5. Nucleus Kapag nag karoon ng conception in a natural interaction of many factors including the correct timing in between the release of the mature ovum during ovulation and ejaculation of enough healthy motile sperm in woman vagina. Sperm Cells - Like tadpole: head, neck, tail - Life span: 48-72 hours - Male is the one who determine the sex of the baby. - Ave. male produce: 525B sperm cells over a lifetime. - Healthy adult men: 20M-150M with the max of 1.2B in a single ejaculation. - Typically, volume of climax: 3-5ml ejaculate. (3 quarters of the teaspoon) J.A.K.E 16 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 o Fertilization is a number game we started millions up to 1 sperm will survive. Usually, it takes 30 minutes to 2 hours and if the sperm did not encounter an oocyte immediately, they can survive in the uterine tubes for 3-5 days. o Thus, fertilization can still occur if intercourse takes place a few days before ovulation. o Intercourse more than a day after ovulation will therefore not usually result in fertilization. o After fertilization occurs the 23 chromosomes of sperm and 23 chromosomes of ova together restoring the diploid 46. o Fertilization is complete when cell division starts from the entry of the sperm to the ova, we call it fertilization then; o Cell will split to have – zygote; which happens from day 0 to 14. Then, the cell continues to divide, 2 cells, 4 cells, 6 cells, this is what we called cleavage. o By the time they reach the endometrium they become morula or mulberry → hallow spear of cell blastocyst. This is the preliminary stages in the embryo beginning form. o Trophoblast – cells that formed the outer layer of blastocyst. They are present 4 days post fertilization. They provide nutrients to the embryo and develop into large part of placenta. Located next to the maternal endometrium and must exhibit invasive properties that forms an effective maternal fetal vascular relationship. Nag kakaroon ng vascular relationship yung mother and fetus and this is what we call chorionic villi. o Chorionic villi – tiny projections of placenta, kumakapit sya o Sexual activity involves the insertion of erected penis into the doon sa endometrium and has same genetic material as the vagina, both for sexual pleasure and reproduction purposes. fetus. o Both of which will be culminating in an orgasm and o While in the blastocyst cavity there is a formation of the fetus ejaculation. o Early blastocyst o Irregardless of the position of the couple as long as the penis o Late blastocyst – buries itself in the endometrium and enters the vagina during sexual intercourse. eventually become fetus. o Ejaculation – ejecting semen into the body. o From the start of cell division up to the time that reaches the o When a couple executed sexual activity millions of candidates endometrium, and the fetus is formed, the process usually sit off a long peroneus journey with a single target is to reach takes 2-8 weeks. the ova. o During implantation it happens approximately around the 10th o Many sperm are loss in the vaginal introitus, because of the day after fertilization. ejaculation drips kase may nababawas ng mga sperm. o HCG – Human Chorionic Gonadotropin – available at 8-10 o Survivors continue their journey to the cervix going to the days after conception. sa pregnancy test kit natin nalalaman. uterus and the fallopian tube through the help of the whip like Primary role is to keep the corpus luteum functioning so that movement of tails to swim upward. corpus luteum continues to produce estrogen and progesterone o Only the viable sperms enter the cervix. Tapos ung seminal until placenta is fully developed tapos siya na ung mag fluid naiiwan na nag seseparate na sila. poproduce ng estrogen and progesterone. o They meet in the ampulla of the fallopian tube. o This is the stage of pregnancy where the embryo adheres to the o Remember that there is only one ova waiting to be fertilized wall of the uterus. And stages of prenatal development the for every menstrual cycle. conceptus is still called blastocyst. o The first one to reach the finish line is not guaranteed to win, o It is by adhesion of the embryo in the uterus on the upper or the sperm has to undergo capacitation – glycoprotein and lower uterine segment that embryo receives oxygen and seminal proteins that are being removed from the acrosome of nutrients from the mother in order to be able to grow. the sperm head. And after that, same pa rin ung itsura ng o Embryo receives oxygen and nutrients from the mother. sperm. Pero pag Nawala na yon, this particular sperm have a o Human Placental Lactogen/ Human Chorionic better fight or possibility of getting into or penetrating the somatomammotropin – produced by syncytiotrophoblast. corona radiata (also release hyalase) and zona pellucida From about when the production HCG begins nag covering the ovum. dediminished siya which promotes fetal growth by stimulating o Body of sperm release Acrosin – it allows the penetration of amino acid uptake and DNA synthesis. zona pellucida. o HPL – both growths promoting hormone and lactogenic o Once the sperm is able to penetrate mag kakaroon na ng hormone. Lacto – milk producing. It is produced by the fertilization placenta beginning as early as 6 weeks of pregnancy. Increases o Fertilization – this is when a sperm and egg cell combine. to a peak level by the time fetus reaches term. Promotes (nagsasama sila) and their nuclei is fused together at this time mammary gland growth in preparation for lactation of the is the beginning of pregnancy. mother. J.A.K.E 17 of 38  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 o HPL – serves important role of regulating maternal glucose, protein, and fat level. So that adequete amount of nutrients will be given to the growing fetus; diabetogenic effect or insulin antagonist. And that benefits the fetus because it increase the availability of maternal glucose for fetal consumption. It also antagonaist the cellular action of insulin decreasing the use of insulin which predisposes pregnant woman into developing glucose intolerance. That can lead to gestational diabetes. o OGTT – Oral Glucose Tolerance Test – papainumin ng liquid sobrang tamis. Ordered by the doctor between 24th- 28th weeks of pregnancy. If levels is low, it may result to abortion or intrauterine growth. o Decidua – maternal bed embracing the embryo. 1) Decidua basalis/ serotina – the area of endometrium Chorionic Villi Sampling (CVS) between the implanted chorionic vesicles and - Removal of tissue sample from the fetal portion of the myometrium. Which becomes later the maternal part of developing placenta placenta. - Used for genetic screening as it is done earlier in pregnancy 2) Decidua Capsularis – surrounds the chorionic sack. usually 9 – 12 weeks 3) Decidua Vera – makes the operculum of the mucus plug. - Prenatal test to detect birth