NCMA217 PRELIMS (1).pdf

equipment for routine maternal and newborn care and management of complications. WEEK 1: FRAMEWORK FOR MATERNAL AND CHILD A...

equipment for routine maternal and newborn care and management of complications. WEEK 1: FRAMEWORK FOR MATERNAL AND CHILD ADVANCED-PRACTICE ROLES FOR NURSES IN HEALTH NURSING MATERNAL AND CHILD HEALTH STANDARDS OF MATERNAL AND CHILD HEALTH Clinical nurse specialists - master’s or doctorate NURSING PRACTICE degree level who are capable of acting as consultants 1. Health promotion - Educating clients to be in their area of expertise, as well as serving as role aware of good health through teaching and models, researchers, and teachers of quality nursing role modeling care. 2. Health maintenance - Intervening to Neonatal nurse specialists - manage the maintain health when risk of illness is care of infants at birth and in intensive care present settings. 3. Health restoration - Promptly diagnosing Childbirth educators - teach families about and treating illness using interventions that normal birth and how to prepare for labor will return clients to wellness most rapidly. and birth 4. Health rehabilitation - Preventing further Lactation consultants - educate women complications from an illness; bringing an ill about breastfeeding and support them while client back to an optimal state of wellness or they learn how to do this. helping a client to accept inevitable death Genetic nurse counselors - consult with families about patterns of inheritance and STANDARDS OF CARE AND MEASURES OF offer support to families with a child who has QUALITY (WHO) inherited a genetic disorder. Standard 1: Every woman and newborn receives Case Manager - graduate-level nurse who routine, evidence-based care and management of supervises a group of patients from the time they complications during labor, childbirth and the early enter a health care setting until they are discharged postnatal period, according to WHO guidelines. from the setting. - Case management can be a vastly satisfying Standard 2: The health information system enables nursing role, because if the healthcare use of data to ensure early, appropriate action setting is “seamless,” or one that follows people both during an illness and on their Standard 3: Every woman and newborn with return to the community, condition(s) that cannot be dealt with effectively with the available resources is appropriately referred. Nurse practitioners - educated at the master’s or doctoral level. Recent advances in technology, Standard 4: Communication with women and their research, and knowledge have amplified the need for families is effective and responds to their needs and longer and more in-depth education for nurse preferences. practitioners as they play pivotal roles in today’s health care system Standard 5: Women and newborns receive care with respect and preservation of their dignity. Women’s Health Nurse Practitioner - advanced study in the promotion of health and prevention of Standard 6: Every woman and her family are illness in women. They care for women with illnesses provided with emotional support that is sensitive to such as sexually transmitted infections, and offer their needs and strengthens the woman’s capability. information and counsel them about reproductive life planning. Standard 7: For every woman and newborn, competent, motivated staff are consistently available Pediatric Nurse Practitioner (PNP) - prepared with to provide routine care and manage complications. extensive skills in physical assessment, interviewing and well-child counseling and care. In this role, a Standard 8: The health facility has an appropriate nurse interviews parents as part of an extensive physical environment, with adequate water, sanitation health history and performs a physical assessment of and energy supplies, medicines, supplies and the child.  - If PNP determines that a child has a Nurses need to be conscientious about common illness (such as iron deficiency obtaining informed consent for invasive anemia), he or she orders the necessary procedures and determining that pregnant laboratory tests and prescribes appropriate women are aware of any risk to the fetus drugs for therapy. associated with a procedure or test. - If the PNP determines that the child has a Adolescents who support themselves or who major illness (such as congenital subluxated are pregnant are termed “emancipated hip, kidney disease, heart disease), he or minors” or “mature minors” and have the she consults with an associated pediatrician; right to sign for their own health care. together. ETHICAL CONSIDERATIONS OF PRACTICE Neonatal Nurse Practitioner - skilled in the care of newborns, both well and ill. NNPs may work in level 1, Some of the most difficult ethical quandaries level 2, or level 3 newborn nurseries, neonatal in healthcare today are those that involve follow-up clinics, or physician groups. children and their families. Examples are: Family Nurse Practitioner (FNP) - provides health Conception issues, especially those related care not only to women and children but also to the to in vitro fertilization, embryo transfer, family as a whole. In conjunction with a physician, an ownership of frozen oocytes or sperm, FNP can provide prenatal care for a woman with an cloning, stem cell research, and surrogate uncomplicated pregnancy. mothers Abortion, particularly partial-birth abortions Certified Nurse-Midwife (CNM) - individual educated Fetal rights versus rights of the motherUse of in the two disciplines of nursing and midwifery and fetal tissue for research licensed. Plays an important role in assisting women Resuscitation (for how long should it be with pregnancy and childbearing. Either continued?) independently or in association with a physician, Number of procedures or degree of pain assumes full responsibility for the care and that a child should be asked to endure to management of women with uncomplicated achieve a degree of better health pregnancies. Balance between modern technology and quality of life LEGAL CONSIDERATIONS OF MATERNAL-CHILD PRACTICE Philosophy of Maternal and Child Health Nursing Maternal and child health nursing is family Maternal and child health nursing carries centered; assessment must include both some legal concerns that extend above and family and individual assessment data. beyond other areas of nursing, because care Maternal and child health nursing is is often given to an “unseen client”—the community centered; the health of families fetus—or to clients who are not of legal age depends on and influences the health of for giving consent for medical procedures. In communities. addition, labor and birth of a neonate are Maternal and child health nursing is considered “normal” events, so the risks for evidence based, because this is the means a lawsuit are greater when problems arise whereby critical knowledge increases. (O’Grady et al.,2007) A maternal and child health nurse serves as Nurses are legally responsible for protecting an advocate to protect the rights of all family the rights of their clients, including members, including the fetus. confidentiality, and are accountable for the Maternal and child health nursing includes a quality of their individual nursing care and high degree of independent nursing that of other health care team members functions, because teaching and counseling Understanding the scope of practice and are major interventions. standards of care can help nurses practice within appropriate legal parameters. Promoting health and disease prevention are Documentation is essential for protecting a important nursing roles because these nurse and justifying his or her actions. protect the health of the next generation.  Maternal and child health nurses serve as live births previous year, this is a change of important resources for families during 2.42% childbearing and childrearing as these can Sustainable Development Goals be extremely stressful times in a life cycle. 1. No poverty Personal, cultural, and religious attitudes and 2. Zero hunger beliefs influence the meaning and impact of 3. Good health and well-being childbearing and childrearing on families. 4. Quality education Circumstances such as illness or pregnancy 5. Gender equality are meaningful only in the context of a total 6. Clean water and sanitation life. 7. Affordable and clean energy Maternal and child health nursing is a 8. Decent work and economic growth challenging role for nurses and a major 9. Industry, innovation and infrastructure factor in keeping families well and optimally 10. Reduced Inequalities functioning. 11. Sustainable cities and communities 12. Responsible consumption and production Statistical Terms Used to Report Maternal and 13. Climate action Child Health 14. Life below water Birth rate: Number of births per 1000 15. Life on land population. 16. Peace, justice and strong institutions Fertility rate: Number of pregnancies per 17. Partnerships for the goals 1000 women of childbearing age. Fetal death rate: Number of fetal deaths Envision2030 (weighing more 500 g) per 1000 live births. The year 2016 marks the first year of the Neonatal death rate: Number of deaths per implementation of the SDGs. At this critical 1000 live births occurring at birth or in the point, #Envision2030 will work to promote first 28 days of life. the mainstreaming of disability and the Perinatal death rate: Number of deaths of implementation of the SDGs throughout its fetuses weighing more than 500g and within 15-year lifespan with objectives to: the first 28 days of life per 1000 live births. Raise awareness of the 2030 Agenda and Maternal mortality rate: Number of the achievement of the SDGs for persons maternal deaths per 100,000 live births that with disabilities; occur as a direct result of the reproductive Promote an active dialogue among process. stakeholders on the SDGs with a view to Infant mortality rate: Number of deaths per create a better world for persons with 1000 live births occurring at birth or in the disabilities; and first 12 months of life. Establish an ongoing live web resource on Childhood mortality rate: Number of each SDG and disability. deaths per 1000 population in children, 1 to The campaign invites all interested parties in 14 years of age sharing their vision of the world in 2030 to be inclusive of persons with disabilities. Infant mortality rate For the Philippines in 2019 was WEEK 2: HUMAN SEXUALITY 19.239deaths per 1000 live births, a2.16% decline from 2018. The top three leading causes of infant - a multidimensional concept. mortality were Pneumonia (3,146; 14.3%); - stating that sexuality integrates the somatic Bacterial sepsis of newborn (2,731; 12.4%); (bodily), emotional, intellectual, & social and Respiratory distress of newborn (2,347; aspects of being a human sexual being. 10.7%). - It involves the anatomy & physiology of the human body, as well as one’s attitudes & Maternal Mortality Rate feelings about oneself Philippines maternal mortality ratio was at Biologic gender – is the term used to denote level of 121 deaths per 100,000 live births in chromosomal sexual development: male (XY) or 2017, down from 124 deaths per 100,000 female (XX) Gender / sexual identity – is the inner sense a DISORDER OF SEXUAL FUNCTIONING person has of being male or female Erectile Dysfunction – formerly referred to as Gender role – is the behavior a person conveys impotence about being a male or female. - inability to produce or maintain an erection long enough for vaginal penetration or COMPONENTS OF SEXUALITY partner satisfaction. 1. Reproductive Sexuality - involves the Premature Ejaculation – ejaculation before penile biological aspects of conception & contact. procreation. It also includes the sexual - can be unsatisfactory and frustrating to both response partners 2. Gender Sexuality - deals w/ the social & - can be psychological emotional aspects of being a man or a Failure to achieve orgasm - can be due to poor woman. sexual technique or possible negative attitudes 3. Erotic Sexuality - refers to sexual love and toward sexual relationships arousing sexual desires Vaginismus – involuntary contraction of the muscles at the outlet of the vagina when coitus is attempted. TYPES OF SEXUAL ORIENTATION - This muscle contraction prohibits penile Heterosexuality – one who finds sexual penetration. fulfillment with a member of opposite gender Dyspareunia – pain during coitus, can be due to Homosexuality – a person who finds sexual endometriosis fulfillment with a member of his or her own Inhibited Sexual Desire – lack of desire for sexual sex. relations may be a concern of young or middleaged - usually they prefer to be called as adults. Support or a caring sexual partner or relief of “gay” for men & “lesbian” for women the tension causing the stress allows a return to Bisexuality – people are bisexual if they sexual interest. achieve sexual satisfaction from both homosexual and heterosexual relationship HUMAN SEXUAL RESPONSE Transexuality – is an individual who, - The sexual experience is unique to each although one biologic gender, feels as is he individual, but sexual physiology (i.e., how or she should be of the opposite gender the body responds to sexual arousal) has - sex change operations (synthetic common features. vagina/penis) Excitement physical and psychological stimulation (i.e., SEXUAL EXPRESSION sight, sound, emotion, or thought) that Celibacy – abstinence from sexual activity. causes parasympathetic nerve stimulation. - the ability to concentrate on the means of This leads to arterial dilation and venous giving and receiving love other than through constriction in the genital area. The resulting sexual expressions. increased blood supply leads to Transvestism – individual who dresses to take on the vasocongestion and increasing muscular role of the opposite sex tension. Voyeurism – sexual arousal by looking at another’s In women, this vasocongestion causes the body. Almost all children and adolescents pass clitoris to increase in size and mucoid fluid to through a stage when voyeurism is appealing appear on vaginal walls as lubrication. The Sadomasochism – involves inflicting pain (sadism) vagina widens in diameter and increases in or receiving pain (masochism) to achieve sexual length. The nipples become erect. satisfaction In men, penile erection occurs, as well as Masturbation – self-stimulation for erotic pleasure. scrotal thickening and elevation of the testes. - Children between ages 2 to 6 years discover In both sexes, there is an increase in heart masturbation as an enjoyable activity as they and respiratory rates and blood pressure. explore their bodies. Plateau Exhibitionism – revealing one’s genitals in public. The plateau stage is reached just before Pedophiles – interested in sexual encounters with orgasm. In the woman, the clitoris is drawn children. forward and retracts under the clitoral prepuce; the lower part of the vagina  becomes extremely congested (formation of Mesonephric ducts develops in males the orgasmic platform), and there is Paramesonephric ducts develops in increased nipple elevation. females In men, the vasocongestion leads to Physiology of Onset distention of the penis. Heart rate increases Puberty is initiated by hypothalamic pituitary to 100 to 175 beats per minute and – gonad complex. respiratory rate to approximately 40 Puberty usually starts in Girls at 10-13 years respirations per minute. old and Boys starts at 12-14 years old Orgasm Puberty - stage of life at which secondary sex occurs when stimulation proceeds through changes begin. the plateau stage to a point at which the Girls (estrogen) body suddenly discharges accumulated Growth Spurt sexual tension. Increase in the A vigorous contraction of muscles in the transverse diameter pelvic area expels or dissipates blood and of the pelvis fluid from the area of congestion. The Breast development average number of contractions for a woman Growth of pubic hair is 8 to 15 contractions at intervals of 1 Onset of every 0.8 seconds. menstruation In men, muscle contractions surrounding the Growth of axillary seminal vessels and prostate project semen hair into the proximal urethra. These contractions Vaginal secretions are followed immediately by three to seven Boys (testosterone) propulsive ejaculatory contractions, Increase in weight occurring at the same time interval as in the Growth of testes woman, which force semen from the penis. Growth of face, Resolution axillary & pubic hair Is a 30-minute period during which the Voice changes external and internal genital organs return to Penile growth an unaroused state. Increase in height For the male, a refractory period occurs spermatogenesis during which further orgasm is impossible. Women do not go through this refractory Female and Male Reproductive System period, so it is possible for women who are Homologues interested and properly stimulated to have Female additional orgasms immediately after the Clitoral glans first. Clitoral shaft Labia majora Ovaries Skene’s glands THE REPRODUCTIVE SYSTEM Bartholin’s glands To ensure survival of the species Male has four functions: Penile glans ○ To produce egg and sperm cells Penile shaft ○ To transport and sustain these cells Scrotum ○ To nurture the developing offspring Testes ○ To produce hormones Prostate Cowper’s REPRODUCTIVE DEVELOPMENT glands Gonad is a body organ that produces sex cells (the ovary in females and the testis in Role of Androgens males) Androgenic hormones - responsible for muscular Scrotum - loose pouch-like sac of skin that hangs development, physical growth, and an increase in behind the penis sebaceous gland secretions causing typical acne in - rugated, skin covered muscular pouch both boys & girls suspended from the perineum - Produced by adrenal cortex & testes(males) - contains testes, epididymis, and the lower Functions of the Male Reproductive System portion of the spermatic cord Production of gametes Contains male gonads (testes) ○ Male sex cells, i.e., sperm - help regulate the temperature of sperm Synthesis of androgens through contraction and relaxation and ○ Male sex hormones, e.g. moving closer to and further away from the testosterone perineum Delivery of sperm into the female - the looseness of the scrotum is intentional reproductive tract. to provide expansion and contraction - lowers T° by 3°C * Main reproductive organs of the male are the testes Cool temperature - Scrotum contracts and draws the - produce sperm and male hormones, in the form of testes closer to the body for warmth testosterone. Warm Temperature - Scrotum becomes very loose and allows the testes to hand further away from the Penis - Tubular structure located above the scrotum, near of the body. High temperature can cause delicate composed of shaft and glans. sperm cell to die - Half is an internal root and half is the external visible shaft. Testes - Two ovoid glands, 2 to 3 cm wide that lie in - Soft and flaccid (2.5 to 4 in) the scrotum (walnut size) - Erection - blood vessels in the shaft become Surrounded by 2 tunics: congested, penis become hard and erect Tunica vaginalis (5.5 to 7in) ○ Derived from the parietal peritoneum. Glans - distal end of the organ is bulging sensitive Tunica albuginea ridge of tissue which has the external urinary meatus at its tip - Smooth and freely movable Corona - proximal margin of the glans. - one testis is slightly larger than the other and Prepuce (foreskin) - Loose skin attached to the is suspended slightly lower in the scrotum shaft, allowing for expansion during erection than the other (usually the left one) for less - Retractable casing of skin that protects the possibility of trauma to them nerve sensitive glans at birth. - Spermatozoa do not survive at the body Frenulum - Ventral fold of tissue attaches the skin to temperature the glans - It is suspended outside the body where the Contains the urethra as well as 3 erectile bodies: temperature is approximately 1 F lower than 2 dorsal erectile tissues known as the body temperature and sperm survival is corpora cavernosa ensured 1 midventral tissue known as the corpus - Each testis is encased by a protective white spongiosum fibrous capsule and is composed of a ○ Surrounds penile urethra number of lobules, each lobule containing ○ Expands distally to form the glans interstitial cells (Leydig’sCell) and penis seminiferous tubules. Sexual excitement - Nitric acid is released from the Seminiferous Tubules - produce spermatozoa endothelium of blood vessels → Result in Leydigs’s Cell - produce male hormone testosterone engorgement or an increase in the blood flow to the arteries of the penis →The Ischiocavernosus muscle Epididymis - tightly coiled tube at the penis base then contracts → Trapping both - 20ft long venous and arterial blood in the 3 sections of erectile - Site of sperm maturation and storage tissue →Leading to distention and erection of the - Conducting sperm from the testis to the vas penis deferens  - Contains smooth muscle to propel sperm male urethra and aid in the transport of during ejaculation. sperm - Sperm ar immobile and incapable of - 5% semen fertilization as they passed or are stored at the epididymis level Urethra - hollow tube leading from the base of the - Takes 12-20 days to travel the length of bladder epididymis 3 sections - Total of 64 days to reach maturity Prostatic - within the prostate Aspermia - absence of sperm Membranous - within the urogenital diaphragm Oligospermia - less than 20 million per mL Penile (spongy) - within the penis *do not appear to respond immediately to therapy but *The seminal vesicles, prostate gland and Cowper’s rather only after 2 months* gland produce a liquid called a seminal plasma Seminal plasma - aids in transport of sperm Vas Deferens (Ductus Venosus) - carries sperm - Provides energizing nutrients for the sperm from epididymis through the inguinal canal into the - Contains form of sugar – fructose, mucous, abdominal cavity where it ends at the seminal salts, water, base buffers and coagulators to vesicles and ejaculatory ducts. aid the sperm in their journey - 40cm long Semen / seminal fluid - Transport function and area of the ampulla - Thick, creamy white fluid with the serves as a storage reservoir of sperm for consistency of mucus or egg whites release at ejaculation. - Normal amount is 2 mL – 6 mL per - Sperm mature as they passed through the ejaculation vas deferens - Fertile man will dispel 20-160 million sperm per ejaculate. Seminal vesicle - 2 convoluted pouches that lie Spermatozoon – is made up of a head and a tail along the lower portion of posterior surface of the - Head -carries the males’s haploid number of bladder chromosomes (23) - Secrete seminal fluid - The part that enters the ovum at fertilization - Sperm become increasingly motile - Tail - specialize in motility - Sperm may be stored in the male genital Ejaculatory ducts - formed by the fusion of the vas system for 42 days deferens and the seminal vesicles. - Sperm can live only 2-3 days in the female - The ejaculatory ducts empty into the urethra. genital tract once ejaculated. The ejaculatory ducts are part of the human male anatomy, which cause the reflex action of ejaculation. Each male has two of FEMALE REPRODUCTIVE SYSTEM them. They begin at the vas deferens, pass through the prostate, and empty into the urethra at the Colliculus seminalis. During HUMAN GENETICS ejaculation, semen passes through the ducts and exits the body via the penis. Genetics - study of the ways such disorders occur. Prostate gland - chest-nut sized gland that lies just Genetic Disorders - resulting from a defect in the below the bladder structure or number of genes or chromosomes. - alkaline fluid further protects sperm from being immobilized by the naturally low pH Nature of Inheritance level of the urethra Genes are the basic units of heredity that - Bulbourethral Glands - 2 bulbourethral or determine both the physical and cognitive Cowper’s gland lie beside the prostate gland characteristics of people. Composed of and by short ducts empty into the urethra segments of DNA, they are woven into - Produce small droplets of fluid during sexual strands in the nucleus of all body cells to activity that neutralizes the acidity of the form chromosomes.  A person’s phenotype refers to his or her 3. The family history for the disorder is negative outward appearance or the expression of the – that is no one can identify anyone else who genes. had it (a horizontal transmission pattern) A person’s genotype refers to his or her 4. A known common ancestor between the actual gene composition. parents sometimes exists. This explains how A person’s genome is the complete set of both male and female came to possess a genes present which is about like gene for the disorder 50,000-100,000. INHERITANCE OF THE DISEASE X. Linked Dominant Inheritance There are about 300 known X-linked Autosomal Dominant Inheritance disorders. If the gene is dominant, only one With an autosomal dominant condition, X chromosome with the trait needs to be either a person has two unhealthy genes or present for symptoms of the disorder to be is heterozygous, with the gene causing the manifested. disease stronger than the corresponding Family characteristics seen with this type of healthy recessive gene for the same trait. inheritance include the following: Examples of autosomal dominant disorders 1. All individuals with the gene are affected are Huntington’s disease, 2. All female children of affected men are Facioscapulohumeral muscular dystrophy, a affected; all male children of affected men form of Osteogenesis imperfecta and Marfan are unaffected syndrome 3. It appears in every generation In assessing family genograms for the 4. All children of homozygous affected women incidence of inherited disorders, a number of are affected. 50% of the children of common findings are usually discovered heterozygous affected women are affected. when a dominantly inherited pattern is present in the family: X-Linked Recessive Inheritance 1. One of the parents of a child with the The majority of X-linked inherited disorders disorder also will have the disorder (a are recessive, and inheritance of the gene vertical transmission picture) from both parents is incompatible with life. 2. The sex of the affected individual is Examples are Hemophilia A, color blindness, unimportant in terms of inheritance Duchenne muscular dystrophy and fragile X 3. There is usually a history of the disorder in syndrome other family members When family genograms are assessed for inherited disorders, the following findings Autosomal Recessive Inheritance usually are apparent if an X-linked recessive More than 1,500 autosomal recessive inheritance disorder is present in the family: disorders have been identified. In contrast, to 1. Only males in the family will have the structural disorders, these tend to be disorder biochemical or enzymatic. 2. A history of girls dying at birth for unknown Examples include cystic fibrosis, reasons often exists (females who had the adrenogenital syndrome, albinism, affected gene on both X chromosomes Tay-Sachs disease, galactosemia, 3. Sons of an affected man are unaffected phenylketonuria, limb-girdle muscular 4. The parents of affected children do not have dystrophy and Rh-factor incompatibility the disorder When family genograms are assessed for the incidence of inherited disease, situations Y-Linked Inheritance commonly discovered when a recessively Although genes responsible for features inherited disease is present in the family such as height and tooth size are found on include the following: the Y chromosome, no known disease genes 1. Both parents of a child with the disorder are are inherited by Y-chromosome clinically free of the disorder transmission. 2. The sex of the affected individual is unimportant in terms of inheritance COMMON CHROMOSOMAL DISORDERS  Trisomy 13 Syndrome - also called Patau - The normal color of the menses is dark red syndrome, a chromosomal condition that contains mucus and endometrial cells. associated with severe intellectual disability and physical abnormalities in many parts of Organs Involved in Menstruation the body. Hypothalamus - stimulates anterior pituitary gland to Trisomy 18 Syndrome - also called begin production of gonadotropic hormones. Edwards syndrome, a chromosomal Pituitary gland - under the influence of LHRH, the condition associated with abnormalities in anterior pituitary gland produces 2 hormones that act many parts of the body. They often have on the ovaries to further influence menstruation. slow growth before birth (intrauterine growth - FSH : a hormone that is active early in a retardation) and a low birth weight. cycle & is responsible for maturation of the Cri-du-Chat Syndrome - also known as 5p- ovum syndrome and cat cry syndrome - is a rare - LH : a hormone that becomes most active at genetic condition that is caused by the the midpoint of the cycle & is responsible for deletion (a missing piece) of genetic material ovulation or release of the mature egg cell on the small arm (the p arm) of chromosome from the ovary, and growth of uterine lining. 5 Ovaries – one ovum matures in one or the other Turner Syndrome - a chromosomal ovary & is discharged from it each month. condition related to the X chromosome that Uterus – stimulation from the hormones produced by alters development in females, though it is the ovaries causes specific month effects on the not usually inherited in families. uterus Klinefelter Syndrome - also known as the XXY condition, males who have an extra X Estrogens ( Hormone for Women) chromosome in most of their cells. 1. Stimulate the growth, development, and Fragile X Syndrome (FXS) - a genetic maintenance of female reproductive disorder characterized by mild-to moderate structures, secondary sex characteristics intellectual disability. and the breast. Down Syndrome- (sometimes referred to as 2. They help regulate fluid and electrolyte "Down's syndrome") or trisomy 21 - balance. common genetic disorder that occurs when a 3. The stimulate protein synthesis person has three copies of chromosome 21. 4. They lower blood cholesterol levels 5. Spinnbarkeit and ferning 6. Thickening of the endometrium Progesterone MENSTRUATION - Is secreted mainly by the corpus luteum and works with estrogen to prepare the - Monthly menstrual bleeding (menstruation endometrium for implantation and mammary or menstrual period) that you have from your glands for lactation. early teen years until your menstrual periods - Decrease GI motility ends around 50 (menopause) - Increase permeability of kidney to lactose & - Once a month the uterus grows a new, dextrose thickened lining (endometrium) that can hold - Responsible for the mood swings of the a fertilized egg. mother - When there is no fertilized egg to start a - Mammary gland development pregnancy, the uterus then sheds its lining. - Measured from the first day of menstrual OVARIAN CYCLE bleeding, Day 1, up to Day 1 of your next The Follicular Phase: Days 1 through 13 menstrual bleeding. In response to follicle stimulating hormone - A teen's cycles tend to be long (up to 42 (FSH) released from the pituitary gland in the days), growing shorter over several years. brain, ultimately one egg matures. - Average menstrual period 5 days. Ovulation: Day 14 - The amount of blood loss every menstrual At about day 14, in response to a surge of period is 30 to 80 ml. luteinizing hormone, the egg is released from the ovary.  The egg travels through the fallopian tube As the ovum is extruded from the graafian toward the uterus. follicle of an ovary with ovulation, it is The Luteal Phase: Days 14 through 28 surrounded by a ring of mucopolysaccharide The remains of the follicle become the fluid (the zona pellucida) and a circle of cells corpus luteum which releases progesterone (the corona radiata). The ovum and these surrounding cells UTERINE CYCLE (which increase the bulk of the ovum and Proliferative Phase: Days 5 -14 serve as protective buffers against injury) are The uterine lining increases rapidly in propelled into a nearby fallopian tube by thickness, and the uterine glands proliferate currents initiated by the fimbriae—the fine, and grow. hairlike structures that line the openings of Secretory Phase: Days 14 through 28 the fallopian tubes. A combination of When an egg is not fertilized, the corpus peristaltic action of the tube and movements luteum gradually disappears,estrogen and of the tube cilia help propel the ovum along progesterone levels drop, and the thickened the length of the tube. uterine lining is shed. This is menses (your At the time of ovulation, there is a reduction period). in the viscosity (thickness) of the cervical mucus, which makes it easy for spermatozoa Time of ovulation to penetrate it. Sperm transport is so efficient - An easy way to approximate the time of close to ovulation that spermatozoa ovulation for women with regular cycles is to deposited in the vagina generally reachthe subtract 16 from the number of days into the cervix within 90 seconds and the outer end cycle and then add 4. This will calculate the of a fallopian tube within 5 minutes after span of days in which ovulation is most likely deposition. to occur. Spermatozoa move through the cervix and the body of the uterus and into the fallopian Signs & Symptoms of Ovulation tubes, toward the waiting ovum by the Mittelschmerz – abdominal tenderness on combination of movement by their flagella left/right iliac regions,brought about by (tails) and uterine contractions. peritoneal irritation due to blood coming out Capacitation - a final process that sperm from the graafian follicle. must undergo to be ready for fertilization. Spinnbarkeit – vaginal secretion is clear & This process, which happens as the sperm transparent moves toward the ovum, consists of changes Change in vaginalmucus in the plasma membrane of the sperm head, Goodel’s sign which reveal the sperm-binding receptor Mood changes sites. Breast tenderness Hyaluronidase (a proteolytic enzyme) - Increased levels of Progesterone released by the spermatozoa and dissolves Change in basal body temperature the layer of cells protecting the ovum. Under ordinary circumstances, only one ANTEPARTAL PERIOD spermatozoon is able to penetrate the cell Ovum – from ovulation to fertilization membrane of the ovum. Once it penetrates Zygote – from fertilization to implantation the cell, the cell membrane changes Embryo – from implantation to 5-8 weeks composition to become impervious to other Fetus – from 5-8 weeks until term spermatozoa. Conceptus – Developing embryo or fetus And placental structure throughout pregnancy Implantation Once fertilization is complete, a zygote Process of Fertilization migrates over the next 3 to 4 days toward Fertilization ( Conception, Fecundation) - is the union the body of the uterus, aided by the currents of an ovum and a spermatozoon. This usually occurs initiated by the muscular contractions of the in the outer third of the fallopian tube. fallopian tubes. During this time, mitotic cell division, or cleavage, begins. Fertilization  The first cleavage occurs at about 24 hours; cleavage divisions continue to occur at a rate Function of the Health Professional in Family of about one every22 hours. By the time the Planning zygote reaches the body of the uterus, it - To counsel, reassure, give information and consists of 16 to 50 cells. At this stage, allow an individual/couple to decide because of its bumpy outward appearance, it his/her/their course of action according to is termed a morula(from the Latin word what he/she think is appropriate for them morus, meaning “mulberry”). and in accordance to their own personal, Large cells tend to collect at the periphery of societal, religious beliefs & values the ball, leaving a fluid space surrounding an inner cell mass. At this stage, the structure FAMILY PLANNING SERVICES becomes a blastocyst. It is this structure that Temporary Conception Control - methods used to attaches to the uterine endometrium. The prevent conception, ovulation and implantation. Cells in the outer ring are trophoblast cells. Sterilization/Permanent Conception Control - Implantation, or contact between the Tubal Occlusion/Bilateral Tubal Ligation(BTL), growing structure and the uterine Vasectomy or Vas ligation endometrium, occurs approximately 8 to10 days after fertilization. Methods used to prevent conception The structure brushes against the rich Natural Methods uterine endometrium (in the second Coitus Interruptus - oldest [secretory] phase of the menstrual cycle), a - Premature withdrawal of the penis before process termed apposition. It Attaches to the ejaculation surface of the endometrium (adhesion)and - Psychological disadvantage settles down into its soft folds (invasion). - Not accepted by the Catholic Church The blastocyst is able to invade the Withdrawal - removal of the penis from the vagina endometrium because, as the trophoblast before ejaculation cells on the outside of the structure touch the - Effectiveness rate 80% endometrium, they produce proteolytic Coitus reservatus - male does not reach orgasm and enzymes that dissolve any tissue they touch. therefore no ejaculation occurs This action allows the blastocyst to burrow - Requires considerable control over the deeply into the endometrium and receive sexual urge some basic nourishment of glycogen and Rhythmic abstinence - Identification of the periods mucoprotein from the endometrial glands. As of fertility and the periods of sterility in the menstrual invasion continues, the structure establishes cycle of a woman and the restriction of sexual an effective communication network with the intercourse to the sterile periods or the time when the blood system of the endometrium. pregnancy is unlikely because the woman is Apposition – the blastocyst brushes against biologically unprepared to conceive. the rich uterine endometrium - “safe or infertile period” technique and Adhesion – it attaches to the surface of the “natural birth control” or NFP because there endometrium is nothing artificial used to prevent Invasion – the blastocyst settles down into conception its soft folds. - a human ovum is susceptible to fertilization ***Once the zygote is implanted it is an for 18-24 hrs after ovulation. EMBRYO. - The sperms deposited in the vagina are ordinarily capable of fertilizing the ovum for no more than 72 hours FAMILY PLANNING - Present methods of determining ovulation The concept of enhancing the quality of families w/c time are inexact and seldom sufficiently includes: predictive (by at least 48 hours) so that in Regulating & spacing childbirth practice, it is necessary to avoidintercourse Helping subfertile couples beget children for a far longer period of time than 72 hours Counseling parents and would-be parents before ovulation and 24 hours after ovulation The motive is justified and the means are Calendar method - mathematical calculations to moral. predict time of ovulation. “Ovulation most often takes place 14 days before the onset of the next - duration is invariable, could be menstruation.” days, weeks,months or zero (if Ogino-knaus formula cycle is short) 1. Shortest cycle = 28 days - Infertile days Longest cycle = 36 days - day 4 after the peak till the end of 2. Cycle is irregular, subtract 18 from the the cycle shortest and 11 from the longest - ends about 2 weeks after the 3. The difference between the shortest cycle peak and 18 determines the earliest time when Lactational Amenorrhea Method - woman is not ovulation occurs. fertile and unlikely to become pregnant during full 4. The difference between the longest cycleand lactation or exclusive breastfeeding. 11 determines the last day when ovulation - Full lactation describes breastfeeding when can occur no regular supplemental feeding of any type 5. OVULATION CAN OCCUR ANYTIME IN is given (not even water) and the infant is BETWEEN feeding both day and night with little 6. In a regular 28 day cycle, abstinence should separation from the mother. be observed from day 9 to day 17. (count 5 - LAM provides maximum protection as days before the earliest ovulation and 3 days - long as: after the last day) Menstruation has not resumed and Basal Body Temperature - slight changes in basal Bottle feeds or regular food supplements are body temp. May occur just before ovulation not introduced and - Preovulatory temp - low because of high Baby is less than 6 months of age. estrogen levels - Post-ovulatory temp. rise - due to high Ovulation Detection Test Kits - measures the level progesterone of LH and predict ovulation - Temp taken every morning at the same time - detect the level of LH in the urine w/c surges with the same thermometer just before 12-24 hours before ovulation arising and after at least 4-6 hours of - 98 to 100% effective continuous sleep - LH level is high, she should avoid coitus. - 3 days of elevation indicate temperature Emergency Contraception - can reduce change of change is due to ovulation pregnancy to 75% if taken within 72 hrs of - Abstinence should be observed 5 days unprotected sex before and 3 days after temp rise. - Floods the ovaries with high amount of Billings or CERVICAL MUCUS METHOD - cervical hormone and prevents ovulation mucus felt by the woman at the vaginal opening is a - Alters the environment of the uterus, making signal of ovulation it disruptive to the egg and sperm - Clear and translucent and about the - Two sets of pills taken exactly 12 hours apart consistency of raw egg white Phases of Wetness/Dryness Local barrier methods 1. Wet - mens Condom - thin stretchable rubber - Possible fertility - Pregnancy rate 7–28% - changing mucus; non-slippery at - Potential of preventing STDs first later becoming slippery - Perfect effectiveness rate = 97% - peak: last day of slippery mucus - Typical effectiveness rate = 88% - days 1-3 after the peak are part of - Combining condoms with spermicides raises fertile period effectiveness levels to 99% Female condom - inserted to the vagina. The closed 2. Dry - basic infertile pattern ends cover the cervix. - sequence of dry days (or days of Vaginal Diaphragm - shallow,dome-shaped rubber unchanging mucus) indicating low device with a flexible wire rim that covers the cervix; level of estrogen and present inserted several hours before intercourse and left in infertility place for at least 6 hours after the last intercourse - Initially fitted by a health professional  - Weight loss/gain of 15 lbs may require All-progestin (minipill) – taken everyday re-fitting Does not necessarily inhibit ovulation; - May cause cervicitis if left in place for too prevents implantation of the zygote long - Washed with mild soap & water, lasts for 2-3 Client Instructions on taking CPs years Before starting CP, the woman must undergo - 97% efficiency physical examination, pelvic exam and Pap Cervical cap - 2 types: presized and custom fitted (a Smear to rule out contraindications. plastic cap fitted to conform to the individual woman’s CPshould be prescribed by a physician. cervix) Must be taken on a Sunday following menses and abortion or the first Sunday 2 Intravaginal contraceptives (spermicides) weeks after delivery,she is to use condom on Side-Effects of Spermicides the first 7 days of pill taking. They should be - may be allergic to materials in spermicide. taken at the same time everyday Advantages If she is taking 28 day pills, there is no rest - Available w/o prescription day or interval. If she is taking a 21 day pill, - Lubrication increase pleasure she ends on a Saturday and begins a new - Can be part of sex play pack on the next Sunday. Bleeding will occur - Does not affect fertility around 4 days after stopping pills. If she Disadvantages expected bleeding did not come, she should - Does not protect against HIV/AIDS consult the doctor before starting a new - Readily available and used prior penetration packet of pill. - Messy Minor side effects: nausea, weight gain, - Bad taste during oral sex headache, breast tenderness, breakthrough - Genital irritation bleeding, yeast infections, mild hypertension, - When used frequently spermicides may potential depression irritate the vagina making it easier to catch If a woman forgets one pill, take one now HIV/STI and then the next on the regular schedule of pill taking. If two pills, take two pills now and Prevention of ovulation two pills tomorrow and use a backup method Use of contraceptives: for the next 7 days. If 3 pills, discard the Pills remaining pack and start a new pack, use a Injectable back-up method for the next 7 days. Implant Contraceptive pills - if accidentally taken by child, Contraceptive pills - Estrogen & progesterone side-effect is increased blood clotting, stimulating prevent pregnancy by inhibiting the hypothalamus and vomiting by giving child syrup of ipecac. anterior pituitary so that ovulation does not occur. Danger signs: They also inhibit fertility by: A- abdominal pain 1. Altering the motility of the fallopian tubes C-chest pain and dyspnea 2. Inadequately developing the endometrium H- headache 3. Keeping cervical mucus unreceptive and E-eye problems unsupportive of sperm S- severe leg pain Types of Pills OC users should have a check-up after 4 Combination pills – contain both progesterone & months then annual check-ups to have estrogen; taken from day 5 to day 25 of the menstrual pelvic exam, breast exam and Pap Smear. cycle Another contraceptive method should be Sequential used until a woman has had 2 regular 2 types of pills are taken: menstruations or wait for three months after 1. Contains estrogen alone – taken stopping taking OC before attempting from day 5-19 pregnancy. There is usually a 1-2 month 2. Contains progestin-taken from day delay in the resumption of menstruation after 20-25 discontinuing OC.  Folic acid deficiency is common in long term Higher risk for osteoporosis so advise to increase user so that it is advisable to take folic acid calcium intake and engage in weight bearing exercise supplement Impair glucose tolerance in women at risk for DM If used by adolescents, they should have a regular menstruation for at least two years Estrogen excess before beginning OC use. Nausea & vomiting Side-effects: Dizziness 1. Thrombo-embolic disorders and other Edema vascular problems including CVA & MI Leg cramps Oral pills should be discontinued for 4-8 Increase in breast size weeks before anticipated surgery Chloasma 2. Alterations in metabolism,esp. of CHOs and Visual changes B-vitamins (pyridoxine & folic acid) Hypertension 3. Fetal effects after discontinuing the vascular headache pill evidence of increased of chromosomal changes Estrogen deficient 4. Amenorrhea after discontinuing the pill Early spotting (days 1-14) 5. Neoplastic disease (breast, liver Hypomenorrhea hepatocellular adenoma) Nervousness 6. Hypertension Atrophic vaginitis leading to painful 7. Adverse drug interactions intercourse Progesterone excess Implant (Norplant) - 6 tiny silicone rubber capsules Increased appetite or 2 rods containing progestin (levonorgestrel), Tiredness surgically implanted under the skin of the upper arm; Depression removed surgically in about 5 years or when the Breast tenderness woman wishes to discontinue the method. Vaginal yeast infection Disadvantages: Oily skin and scalp Weight gain Hirsutism Irregular menstrual cycle Post Pill amenorrhea Hair loss Progesterone deficiency Depression Late spotting and break-through Scaring at the insertion site bleeding (days 15-21) Expensive Heavy flow with clots Decreased breast size SIDE EFFECTS Extremely irregular menstrual bleeding and Safety measures in the use of pills spotting for 3-6 months! Careful screening to detect women who are NO PERIOD after 3-6 months at risk of developing problems Weight change Use of lowest possible dose for each women Breast tenderness Careful follow-up should be done every 6-12 Mood change months to detect problems — complete *NOT EVERY WOMAN HAS SIDE-EFFECTS! health assessment: should include history, PE, Pap smear & lab studies Injectable contraceptives (Depo-provera, Contraindications: Noristerat, etc.) - synthetic progestin hormones Family history injected into muscle: administered every 3 months Vascular accident (stroke) DM Depo-Provera - Birth control shot given once every Breast Ca three months to prevent pregnancy Medical history - 99.7% effective preventing pregnancy Hepatitis or hepatic insufficiency - No daily pills to remember Thrombo-embolic disease Disadvantages: Moderate/severe hypertension Fertility return is usually delayed by 6 months Smoking more than 15 cigarettes a day  Psychic depression 98% effective Sickle-cell disease T shaped plastic that releases hormones History of conditions that can be aggravated by over a one year time frame fluid retention Thickens mucus, blocking egg Migraine Check string before sex & after shedding of Convulsive d/o uterine lining Asthma Contraindications of IUD Cardiac & renal insufficiency Any inflammatory condition or infection of the PE findings Pregnancy & Lactation reproductive tract or PID 30 years old or older Abnormalities of the uterus Presence of hormone-dependent tumors Severe dysmenorrhea Breast nodules Uterine bleeding of unknown origin Fibrocystic disease Suspected pregnancy Abnormal mammogram IUD Danger Signs Varicose veins P – period late or skipped period A – abdominal pain Prevention of Implantation I – increased temperature (fever) IUD (Intrauterine Device) - made of plastic or N- noticeable vaginal discharge; foul non-reactive metal that fits inside the uterine cavity smelling - loop, coil, spiral S – spotting, heavy periods, bleeding - Causes a chronic inflammatory response in the endometrium, discouraging implantation Vaginal Ring (NuvaRing) - 95-99% Effective. A new of a fertilized ovum ring is inserted into the vagina each month - Conception may occur; if implantation takes - releases a low dose of a progestin and an place, it causes early abortion estrogen over 3 weeks. - Usually inserted during the menstrual phase - very effective at preventing pregnancy (less Sterilization/Permanent Conception Control than 2% chance per year for the Tubal Occlusion / Bilateral Tubal Ligation progesterone IUD, less than 1% chance per - Involves tying, cutting or cauterizing the year for the copper IUD) fallopian tubes Types of IUD - Usually done immediately after delivery Non-medicated (within 24-48 hours) when the incidence of 1. Lippes-Loop- available in 4 sizes (A-small morbidity & failure are lowest to D-large); has been withdrawn from the - May also be done in any phase of the market menstrual cycle methods: 2. Saf-T-coil – available in 2 sizes (small & 1. Mini-laparotomy large) 2. Laparoscopy or “band-aid surgery” Medicated 3. Vaginal tubal sterilization 1. Copper 7 (Cu 200) – copper has direct spermicidal effect; has been withdrawn from Vasectomy / Vas ligation - without entry into the the market abdominal cavity; twin incisions are made in the area 2. Copper-T (T-Cu 200, tatum copper-bearing where the scrotum joins the body, just over the vas IUD) deferens 3. Progestasert-T - The tubes are tied and separated; portions maybe excised Copper T - Follow-up sperm counts may be done after. 10 years 99.2 % effective Copper on IUD acts as spermicide, IUD WEEK 4: EMBRYONIC STRUCTURE blocks egg from implanting Must check string before sex and after shedding of uterine lining. A. The Decidua Progestasert After fertilization, the corpus luteum in the ovary 1 year continues to function rather than atrophying, because of the influence of human chorionic gonadotropin into a separate, important hormone-producing (hCG), a hormone secreted by the trophoblast cells. system. This causes the uterine endometrium to continue to grow in thickness and vascularity, instead of sloughing 1. Human Chorionic Gonadotropin. off as in a usual menstrual cycle. The endometrium is - The first placental hormone produced, hCG, now termed the decidua (the Latin word for “falling can be found in maternal blood and urine as off”), because it will be discarded after the birth of the early as the first missed menstrual period child. (shortly after implantation has occurred) The decidua has three separate areas: through about the 100th day of pregnancy 1. Decidua basalis, the part of the endometrium 2. Estrogen. that lies directly under the embryo (or the - (primarily estriol) is produced as a second portion where the trophoblast cells establish product of the syncytial cells of the placenta. communication with maternal blood vessels) Estrogen contributes to the woman’s 2. Decidua capsularis, the portion of the mammary gland development in preparation endometrium that stretches or encapsulates for lactation and stimulates uterine growth to the surface of the trophoblast accommodate the developing fetus. 3. Decidua vera, the remaining portion of the 3. Progesterone. uterine lining. As the embryo continues to - Estrogen is often referred to as the “hormone grow, it pushes the decidua capsularis of women”; progesterone as the “hormone of before it like a blanket. mothers.” This is because, although B. Chorionic Villi estrogen influences a female appearance, Once implantation is complete, the trophoblast layer progesterone is necessary to maintain the of cells of the blastocyst begins to mature rapidly. As endometrial lining of the uterus during early as the 11th or 12th day, miniature villi that pregnancy. It is present in serum as early as resemble probing fingers, termed chorionic villi, reach the fourth week of pregnancy, as a result of out from the single layer of cells into the uterine the continuation of the corpus luteum. After endometrium to begin formation of the placenta. At placental synthesis begins (at about the 12th term, almost 200 such villi will have formed (Knuppel, week), the level of progesterone rises 2007). progressively during the remainder of the pregnancy. This hormone also appears to The Placenta - (Latin for “pancake,” which is reduce the contractility of the uterus during descriptive of its size and appearance at term) arises pregnancy, preventing premature labor. out of the continuing growth of trophoblast tissue. Its growth parallels that of the fetus, growing from a few 4. Human Placental Lactogen (Human Chorionic identifiable cells at the beginning of pregnancy to an Somatomammotropin). organ 15 to 20 cm in diameter and 2 to 3 cm in depth, - hPL is a hormone with both covering about half the surface area of the internal growth-promoting and lactogenic uterus at term. (milk-producing) properties. It is produced by the placenta beginning as early as the sixth Circulation week of pregnancy, increasing to a peak As early as the 12th day of pregnancy, maternal level at term. It can be assayed in both blood begins to collect in the intervillous spaces of the maternal serum and urine. It promotes uterine endometrium surrounding the chorionic villi. mammary gland (breast) growth in By the third week, oxygen and other nutrients, such preparation for lactation in the mother. It also as glucose, amino acids, fatty acids, minerals, serves the important role of regulating vitamins, and water, osmose from the maternal blood maternal glucose, protein, and fat levels so through the cell layers of the chorionic villi into the villi that adequate amounts of these nutrients are capillaries. From there, nutrients are transported to always available to the fetus (Taylor & the developing embryo. Lebovic, 2007). Endocrine Function - Aside from serving as the Placental Proteins - The placenta also produces conduit for oxygen and nutrients for the fetus, the several plasma proteins. The function of these has syncytial (outer) layer of the chorionic villi develops not been well documented, but it is thought that they may contribute to decreasing the immunologic impact of the growing placenta through being part of the to provide a source of red blood cells until the complement cascade (Knuppel, 2007). embryo’s hematopoietic system is mature enough to perform this function (at about the 12th week of C. The Amniotic Membranes intrauterine life). The chorionic villi on the medial surface of the trophoblast (those that are not involved in Fetal Circulation implantation, because they do not touch the As early as the third week of intrauterine life, fetal endometrium) gradually thin, leaving the medial blood begins to exchange nutrients with the maternal surface of the structure smooth (the chorion laeve, or circulation across the chorionic villi. Fetal circulation smooth chorion). The smooth chorion eventually differs from extrauterine circulation because the fetus becomes the chorionic membrane, the outermost fetal derives oxygen and excretes carbon dioxide not from membrane. Its purpose is to form the sac that gas exchange in the lung but from gas exchange in contains the amniotic fluid. A second membrane lining the placenta. the chorionic membrane, the amniotic membrane or amnion, forms beneath the chorion. MILESTONES OF FETAL GROWTH AND DEVELOPMENT D. The Amniotic Fluid I. End of 4th Gestational Week Amniotic fluid is constantly being newly formed and Length: 0.75–1 cm reabsorbed by the amniotic membrane, so it never Weight: 400 mg becomes stagnant. Some of it is absorbed by direct The spinal cord is formed and fused at the contact with the fetal surface of the placenta. The midpoint. major method of absorption, however, occurs Lateral wings that will form the body are because the fetus continually swallows the fluid. In folded forward to fuse at the midline. the fetal intestine, it is absorbed into the fetal The head folds forward and becomes bloodstream. From there, it goes to the umbilical prominent, representing about one-third of arteries and to the placenta, and it is exchanged the entire structure. across the placenta. At term, the amount of amniotic The back is bent so that the head almost fluid has increased so much it ranges from 800 to touches the tip of the tail. 1200 mL The rudimentary heart appears as a prominent bulge on the anterior surface. E. The Umbilical Cord Arms and legs are budlike structures. The umbilical cord is formed from the fetal Rudimentary eyes, ears, and nose are membranes (amnion and chorion) and provides a discernible. circulatory pathway that connects the embryo to the II. End of 8th Gestational Week chorionic villi of the placenta. Its function is to Length: 2.5 cm (1 in) transport oxygen and nutrients to the fetus from the Weight: 20 g placenta and to return waste products from the fetus Organogenesis is complete. to the placenta. It is about 53 cm (21 in) in length at The heart, with a septum and valves, is term and about 2 cm (3 ⁄4 in) thick. The bulk of the beating rhythmically. cord is a gelatinous mucopolysaccharide called Facial features are definitely discernible. Wharton’s jelly, which gives the cord body and Arms and legs have developed. prevents pressure on the vein and arteries that pass External genitalia are forming, but sex is not through it. The outer surface is covered with amniotic yet distinguishable by simple observation. membrane. The primitive tail is regressing. The abdomen bulges forward because the Primary Germ Layers fetal intestine is growing so rapidly. At the time of implantation, a blastocyst already has III. End of 12th Gestational Week (First Trimester) differentiated to a point at which two separate Length: 7–8 cm cavities appear in the inner structure: (1) a large one, Weight: 45 g the amniotic cavity, which is lined with a distinctive Nail beds are forming on fingers and toes. layer of cells, the ectoderm, and (2) a smaller cavity, Spontaneous movements are possible, the yolk sac, which is lined with entoderm cells.In although they are usually too faint to be felt humans, the yolk sac appears to supply nourishment by the mother. only until implantation. After that, its main purpose is  Some reflexes, such as the Babinski reflex, When fetuses reach 24 weeks, or 601 g, are present. they have achieved a practical low-end age Bone ossification centers begin to form. of viability (earliest age at which fetuses Tooth buds are present. could survive if born at that time), if they are Sex is distinguishable by outward cared for after birth in a modern intensive appearance. care facility. Urine secretion begins but may not yet be Hearing can be demonstrated by response evident in amniotic fluid. to sudden sound. The heartbeat is audible through Doppler VII. End of 28th Gestational Week technology. Length: 35–38 cm IV. End of 16th Gestational Week Weight: 1200 g Length: 10–17 cm Lung alveoli begin to mature, and surfactant Weight: 55–120 g can be demonstrated in amniotic fluid. Fetal heart sounds are audible by an Testes begin to descend into the scrotal sac ordinary stethoscope. from the lower abdominal cavity. Lanugo is well formed The blood vessels of the retina are formed Liver and pancreas are functioning. but thin and extremely susceptible to Fetus actively swallows amniotic fluid, damage from high oxygen concentrations demonstrating an intact but uncoordinated (an important consideration when caring for swallowing reflex; urine is present in preterm infants who need oxygen). amniotic fluid. VIII. End of 32nd Gestational Week Sex can be determined by ultrasound. Length: 38–43 cm V. End of 20th Gestational Week Weight: 1600 g Length: 25 cm Subcutaneous fat begins to be deposited Weight: 223 g (the former stringy, “little old man” Spontaneous fetal movements can be appearance is lost) sensed by the mother. Fetus responds by movement to sounds Antibody production is possible. outside the mother’s body. The hair forms on the head, extending to Active Moro reflex is present. include eyebrows. Iron stores, which provide iron for the time Meconium is present in the upper intestine. during which the neonate will ingest only milk Brown fat, a special fat that will aid in after birth, are beginning to be developed. temperature regulation at birth, begins to be Fingernails grow to reach the end of formed behind the kidneys, sternum, and fingertips. posterior neck. End of 36th Gestational Week Vernix caseosa begins to form and cover the Length: 42–48 cm skin. Weight: 1800–2700 g (5–6 lb) Passive antibody transfer from mother to Body stores of glycogen, iron, carbohydrate, fetus begins. and calcium are deposited. Definite sleeping and activity patterns are Additional amounts of subcutaneous fat are distinguishable (the fetus has developed deposited. biorhythms that will guide sleep/wake Sole of the foot has only one or two patterns throughout life). crisscross creases, compared with the full VI. End of 24th Gestational Week (Second crisscross pattern that will be evident at Trimester) term. Length: 28–36 cm Amount of lanugo begins to diminish. Weight: 550 g Most babies turn into a vertex (head down) Meconium is present as far as the rectum presentation during this month. Active production of lung surfactant begins. End of 40th Gestational Week (Third Trimester) Eyebrows and eyelashes become well Length: 48–52 cm (crown to rump, 35–37 defined. cm) Eyelids, previously fused since the 12th Weight: 3000 g (7–7.5 lb) week, now open. Fetus kicks actively, hard enough to cause Pupils are capable of reacting to light. the mother considerable discomfort.  Fetal hemoglobin begins its conversion to extensive damage to a fetus while causing few adult hemoglobin. The conversion is so rapid symptoms in a woman (Lilleri et al.,2007). that, at birth, about 20% of hemoglobin will - It is transmitted from person to person by be adult in character. droplet infection such as occurs with Vernix caseosa is fully formed. sneezing. Fingernails extend over the fingertips. - If a woman acquires a primary CMV infection Creases on the soles of the feet cover at during pregnancy and the virus crosses the least two thirds of the surface placenta, the infant may be born severely neurologically challenged (hydrocephalus, Preventing Fetal Exposure to Teratogens microcephaly, spasticity) or with eye damage A teratogen is any factor, chemical or physical, that (optic atrophy, chorioretinitis), hearing adversely affects the fertilized ovum, embryo, or fetus. impairment, or chronic liver disease. The At one time, it was assumed that a fetus in utero was child’s skin may be covered with large protected from chemical or physical injury by the petechiae (“blueberry-muffin” lesions). presence of the amniotic fluid and by the absence of 4. Herpes Simplex Virus (Genital Herpes Infection) any direct placental exchange between mother and - The first time a woman contracts a genital fetus. When infants were born with disorders, it was herpes infection, systemic involvement attributed to the influence of fate, bad luck, or, in occurs. The virus spreads into the some cultures, evil spirits. Today, it is acknowledged bloodstream (viremia) and crosses the that a fetus is extremely vulnerable to environmental placenta to a fetus posing substantial fetal injury. risk (ACOG, 2007). - If the infection takes place in the first Effects of Teratogens on a Fetus trimester, severe congenital anomalies or Several factors influence the amount of damage a spontaneous miscarriage may occur. teratogen can cause. The strength of the teratogen is 5. Other Viral Diseases one of these. For example, radiation is a known - It is difficult to demonstrate other viral teratogen. In small amounts (everyone is exposed to teratogens, but rubeola (measles), some radiation every day, such as from sun rays), it coxsackievirus, infectious parotitis (mumps), causes no damage. However, in large doses (e.g., the varicella (chickenpox), poliomyelitis, amount of radiation necessary to treat cancer of the influenza, and viral hepatitis all may be cervix), serious fetal defects or death can occur. teratogenic. Parvovirus B19, the causative agent of erythema infectiosum (also called Teratogenic Maternal Infections fifth disease), a common viral disease in 1. Toxoplasmosis - a protozoan infection, is spread school age children, if contracted during most commonly through contact with uncooked meat, pregnancy, can cross the placenta and although it may also be contracted through handling attack the red blood cells of a fetus. Infection cat stool in soil or cat litter (Friars, 2007). with the virus during early pregnancy is - As many as 1 in 900 pregnancies may be associated with fetal death. If the infection affected by toxoplasmosis. occurs late in pregnancy, the infant may be 2. Rubella - usually causes only a mild rash and mild born with severe anemia and congenital systemic illness in a woman, but the teratogenic heart disease (Barankin, 2008). effects on a fetus can be devastating (Johnson & Ross, 2007). A.Syphilis. - A sexually transmitted infection is of - Fetal damage from maternal infection with great concern for the maternal–fetal population rubella (German measles) includes hearing despite the availability of accurate screening tests and impairment, cognitive and motor challenges, proven medical treatment, as it is growing in cataracts, cardiac defects (most commonly incidence and places a fetus at risk for intrauterine or patent ductus arteriosus and pulmonary congenital syphilis (Walker, 2009). Early in pregnancy, stenosis), intrauterine growth restriction when the cytotrophoblast layer of the chorionic villi is (IUGR), thrombocytopenic purpura, and still intact, the causative spirochete of syphilis, dental and facial clefts, such as cleft lip and Treponema pallidum, cannot cross the placenta and palate. damage 3. Cytomegalovirus (CMV) - a member of the herpes virus family, is another teratogen that can cause B.Lyme Disease - a multisystem disease caused by Cigarette smoking is associated with infertility in the spirochete Borrelia burgdorferi, is spread by the women. Cigarette smoking by a pregnant woman has bite of a deer tick. The highest incidence occurs in the been shown to cause fetal growth restriction summer and early fall. The largest outbreaks of the (Lawrence & Haslam, 2007). In addition, a fetus may disease are found on the east coast of the United be at greater risk for being stillborn (Hogberg & States (Mullen, 2007). After a tick bite, a typical skin Cnattingius, 2007) and, after birth, may be at greater rash, erythema chronicum migrans (large, macular risk than others for sudden infant death syndrome. lesions with a clear center), develops. Pain in large joints such as the knee may develop. Infection in 10. Radiation pregnancy can result in spontaneous miscarriage or Rapidly growing cells are extremely vulnerable to severe congenital anomalies. destruction by radiation. That makes radiation a potent teratogen to unborn children because of their 6. Potentially Teratogenic Vaccines high proportion of rapidly growing cells. Radiation Live virus vaccines, such as measles, HPV, mumps, produces a range of malformations depending on the rubella, and poliomyelitis (Sabin type), are stage of. development of the embryo or fetus and the contraindicated during pregnancy because they may strength and length of exposure. If the exposure transmit the viral infection to a fetus (Rojas, Wood, & occurs before implantation, the growing zygote Blakemore, 2007). Care must be taken in routine apparently is killed. If the zygote is not killed, it immunization programs to make sure that survives apparently unharmed. The most damaging adolescents about to be vaccinated are not pregnant. time for exposure and subsequent damage is from Women who work in biologic laboratories where implantation to 6 weeks after conception (when many vaccines are manufactured are well advised not to women are not yet aware that they are pregnant). The work with live virus products during pregnancy. nervous system, brain, and retinal innervation are most a