Care Of Mother, Child & Adolescent-Well Clients (NSG 107) PDF

CARE OF MOTHER, CHILD & ADOLESCENT-WELL CLIENTS (NSG 107)  REPRODUCTIVE DEVELOPMENT Intrauterine Development -A gonad is a body organ that produces the cells necessary for reproduction (ovary in females, testis in males). -At about week 12, the external genitals develop. In ma...

CARE OF MOTHER, CHILD & ADOLESCENT-WELL CLIENTS (NSG 107)  REPRODUCTIVE DEVELOPMENT Intrauterine Development -A gonad is a body organ that produces the cells necessary for reproduction (ovary in females, testis in males). -At about week 12, the external genitals develop. In males, under the influence of testosterone, penile tissue elongates and the urogenital fold on the ventral surface of the penis closes to form the urethra.  REPRODUCTIVE DEVELOPMENT Intrauterine Development -In females, with no testosterone present, the urogenital fold remains open to form the labia minora; what would be formed as scrotal tissue in the male becomes the labia majora in the female.  REPRODUCTIVE DEVELOPMENT Intrauterine Development  REPRODUCTIVE DEVELOPMENT Intrauterine Development  REPRODUCTIVE DEVELOPMENT Intrauterine Development  REPRODUCTIVE DEVELOPMENT Pubertal Development -Puberty is the stage of life at which secondary sex changes begin. -Hypothalamus releases gonadotropin- releasing hormone (GnRH), triggers the anterior pituitary to begin the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).  REPRODUCTIVE DEVELOPMENT Pubertal Development -FSH and LH initiate the production of androgen and estrogen, which in turn initiate secondary sex characteristics, the visible signs of maturity. Girls are beginning dramatic development and maturation of reproductive organs at earlier ages than ever before (9 to 12 years)  REPRODUCTIVE DEVELOPMENT Role of Androgen -Androgenic hormones are responsible for muscular dev’t, physical growth, and the increase in sebaceous gland secretions (acne). -In males, AH are produced by the (adrenal cortex & testes); in females, (adrenal cortex & ovaries).  REPRODUCTIVE DEVELOPMENT Role of Androgen -At age 12-14 years, testosterone levels RISE (further development of the testes, scrotum, penis, prostate, and seminal vesicles; the appearance of male pubic, axillary, and facial hair; laryngeal enlargement and its accompanying voice change; maturation of spermatozoa.  REPRODUCTIVE DEVELOPMENT Role of Androgen -In girls, testosterone influences enlargement of the labia majora and clitoris and formation of axillary and pubic hair. This development of pubic and axillary hair because of androgen stimulation is termed adrenarche.  REPRODUCTIVE DEVELOPMENT Role of Estrogen -When triggered at puberty by FSH, ovarian follicles in females begin to excrete a high level of the hormone estrogen. -Influences the development of the uterus, fallopian tubes, and vagina; typical female fat distribution and hair patterns; breast development (thelarche)  REPRODUCTIVE DEVELOPMENT Secondary Sex Characteristics - In girls, pubertal changes typically are manifest as: 1. Growth spurt 2. ↑ in the transverse diameter of the pelvis 3. Breast development (thelarche) 4. Growth of pubic hair 5. Onset of menstruation (menarche) 6. Growth of axillary hair 7. Vaginal secretions  REPRODUCTIVE DEVELOPMENT Secondary Sex Characteristics -Secondary sex characteristics of boys usually occur in the order of: 1. Increase in weight 2. Growth of testes 3. Growth of face, axillary, and pubic hair 4. Voice changes 5. Penile growth 6. Increase in height 7. Spermatogenesis (production of sperm) ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM -Gynecology is the study of the female reproductive organs. Andrology is the study of the male reproductive organs. Female External Structures The structures that form the female external genitalia are termed the vulva (from the Latin word for “covering”) ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Mons Veneris - is a pad of adipose tissue located over the symphysis pubis, the pubic bone joint. It is covered by a triangle of coarse, curly hairs. The purpose of the mons veneris is to protect the junction of the pubic bone from trauma. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Labia Majora -Longitudinal folds of pigmented skin extending from the mons pubis to the perineum with two folds of skin with fat underneath. It serves as protection for the external genitalia and the distal urethra and vagina. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Labia Minora -Soft two thin delicate tissue folds of longitudinal skin between the labia majora but no hair follicles very rich with sebaceous gland. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs. The vestibule is the flattened, smooth surface inside the labia. The openings to the bladder (the urethra) and the uterus (the vagina) both arise from the vestibule. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs. The clitoris is a small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of the labia minora. It is covered by a fold of skin, the prepuce. The clitoris is sensitive to touch and temperature and is the center of sexual arousal and orgasm in a woman. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs. -Skene’s glands (paraurethral glands) are located just lateral to the urinary meatus, one on each side. Their ducts open into the urethra. -Bartholin’s glands (vulvovaginal glands) are located just lateral to the vaginal opening on both sides. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs. -Secretions from both of these glands help to lubricate the external genitalia during coitus. The alkaline pH of their secretions helps to improve sperm survival in the vagina. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs. -The fourchette is the ridge of tissue formed by the posterior joining of the two labia minora and the labia majora. -This is the structure that is sometimes cut (episiotomy) during childbirth to enlarge the vaginal opening. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs. -Posterior to the fourchette is the perineal muscle or the perineal body. Because this is a muscular area, it is easily stretched during childbirth to allow for enlargement of the vagina and passage of the fetal head. -Perineum is a muscular tissue between the anus and vagina. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female External Structures Other External Organs -The hymen is a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood. It is often torn during the time of first sexual intercourse. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Ovaries -Two almond-shaped glandular structures -grayish-white in color; an unruptured, glistening, clear, fluid-filled graafian follicle (an ovum about to be discharged); yellow corpus luteum (the structure left behind after the ovum has been discharged). ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Ovaries -functions: produce, mature, & discharge ova -ova produce estrogen & progesterone & initiate and regulate the menstrual cycles. -estrogen prevents osteoporosis & reduces cholesterol levels. -oocytes (immature ova) ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Ovaries -reproductive cells (gametes) (both ova and spermatozoa) have only half the usual number of chromosomes. -22 autosomes & X sex chromosome (female); 22 autosomes & X or Y sex chromosome (male)= fertilization =new individual will form (boy/girl) ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Ovaries Ovulation is necessary for maturation of ova -5-7 million ova form in the utero -2 million ova are present after birth -500,000 ova are present by age 7 -300, 000 ova are present by age 22 -NONE if woman is already menopause ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Fallopian Tubes -located at each upper corner of the uterine body and extend outward and backward until each opens at its distal end, next to an ovary. -functions: transport the ovum from the ovary to the uterus & serve as the site of fertilization. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Fallopian Tubes Parts of Fallopian Tube 1. Interstitial- most proximal division, lies within the uterine wall. 2. Isthmus- next distal portion (extremely narrow). Site for tubal ligation/sterilization. 3. Ampulla-longest portion(5cm),fertilization occurs. 4. Infundibular- most distal segment *Fimbria- small hairs; helps to guide the ovum into the fallopian tube ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus -a hollow, pear-shaped muscular organ (6 g) -located in the lower pelvis posterior to the bladder & anterior to the rectum. -during childhood (cervix is the largest while uterine body is the smallest) -after pregnancy, uterus never return to its prepregnancy size ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus Functions: receive the ovum from the fallopian tube provide a place for the ovum to implant provide nourishment & protection for the growing fetus expel the fetus from the mother’s body when mature ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus Divisions of the Uterus: 1.Body or Corpus -the uppermost part and forms the bulk of the organ; expands during pregnancy Fundus- the portion of the uterus between the points of attachment of the fallopian tubes, can be palpated abdominally. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus Divisions of the Uterus: 2. Isthmus -is a short segment between the body and the cervix. -most commonly cut during CS ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus Divisions of the Uterus: 3. Cervix -lowest portion of the uterus; half of it lies above the vagina and half extends into the vagina. -junction of the cervix and isthmus is the internal cervical os; the distal opening into the vagina is the external cervical os (level of the ischial spine). ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus 3 Layers of the Uterus: 1. Endometrium –inner mucous membrane layer of the uterus that is shed during menstruation. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus 3 Layers of the Uterus: 2. Myometrium –three interwoven layers of smooth muscle that give the uterus its strength -holds the internal cervical os closed during pregnancy & contracts at the end of pregnancy. -contracts after delivery to prevent hemorrhage. -myoma arises in this layer ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Female Internal Structures Uterus 3 Layers of the Uterus: 3. Perimetrium –is the outermost layer of the uterus, serves the purpose of adding strength and support to the structure. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male Reproductive System ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male External Structures -External genital organs of the male include the testes (which are encased in the scrotal sac) and the penis. -Scrotum is a rugated, skin-covered, muscular pouch suspended from the perineum. Its functions are to support the testes and to help regulate the temperature of sperm. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male External Structures -Testes are two ovoid glands, 2 to 3 cm wide, that lie in the scrotum. Seminiferous tubules produce spermatozoa. Leydig’s cells are responsible for the production of testosterone. -Testes in a fetus first form in the pelvic cavity. They descend, late in intrauterine life (34th-38th week), into the scrotal sac. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male External Structures -Penis is composed of three cylindrical masses of erectile tissue in the penis shaft: two termed the corpus cavernosa, and a third termed the corpus spongiosum. -it serves as the outlet for both the urinary and the reproductive tracts in men. -Glans is the distal end of the penis (bulge/sensitive). Prepuce is a retractable casing of skin that protects the glans. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male External Structures - With sexual excitement, nitric oxide is released from the endothelium of blood vessels. This results in dilation of blood vessels and an increase in blood flow to the arteries of the penis (engorgement). ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male External Structures -The ischiocavernosus muscle at the base of the penis then contracts, trapping both venous and arterial blood in the three sections of erectile tissue and leading to distention and erection of the penis. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male Internal Structures -Epididymis: coiled tube acts as a maturation and storage for sperm before they pass into the vas deferens -Vas Deferens (spermatic cord): a thin tube that carries mature sperm -Accessory gland: provide fluids for lubrication to nourish the sperm cells (bulbourethral/cowper’s gland) ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male Internal Structures -Bulbourethral gland: produces fluid serves to lubricate the urethra and neutralize the acidity -Seminal vesicle: are sac like structure attached to vas deferens produces a yellowish fluid that provides energy to the sperm cells and aids in motility. -Prostate gland: responsible for the proof semen, liquid mixture of sperm cells, prostate fluid and seminal fluid. ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM ANATOMY & PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM Male Internal Structures -Semen, is derived from prostate gland (60%), the seminal vesicles (30%), the epididymis (5%), and the bulbourethral glands (5%). -Urethra is a hollow tube leading from the base of the bladder to the outside through the shaft and glans of the penis.  FEMALE PELVIS It supports and protects the reproductive organs. bony ring formed by 4 united bones. -2 innominate (flaring hip) bones form the anterior & lateral aspect, each divided into 3 parts – ILIUM, ISCHIUM, & PUBIS *Ilium – forms the upper & lateral portion; the flaring superior border forms the prominence of the hip.  FEMALE PELVIS *Ischium – forms the inferior portion. -the ischial tuberosities are 2 projections at the lowest portion -the ischial spines are the small projections that mark the midpoint of the pelvis. *Pubis – forms the anterior portion of the innominate bone, the SP being the junction of the innominate bones at the front of the pelvis.  FEMALE PELVIS *Ischium – forms the inferior portion. -the ischial tuberosities are 2 projections at the lowest portion …point of fusion bet. the ischium & SP …markers when det. lower pelvic width -the ischial spines are the small projections that mark the midpoint of the pelvis. *Pubis – forms the anterior portion of the innominate bone, the SP being the junction of the innominate bones at the front of the pelvis.  FEMALE PELVIS -The sacrum & the coccyx form the posterior aspect. *The sacrum forms the upper posterior portion of the pelvic ring. -sacral prominence is a marked anterior projection *The coccyx is below the sacrum -made up of very fine small bones fused together  FEMALE PELVIS The pelvis is divided into false pelvis & the true pelvis. -this determination is used only for obstetric purposes -the pelvis are separated by an imaginary line – the linea terminalis – that’s drawn from sacral prominence at the back to the superior aspect of the symphysis pubis at the front.  FEMALE PELVIS *Ischium – forms the inferior portion. -the ischial tuberosities are 2 projections at the lowest portion …point of fusion bet. the ischium & SP …markers when det. lower pelvic width -the ischial spines are the small projections that mark the midpoint of the pelvis. *Pubis – forms the anterior portion of the innominate bone, the SP being the junction of the innominate bones at the front of the pelvis.  FEMALE PELVIS -The false pelvis lies ABOVE the line *supports the uterus during the late months of pregnancy *directs the fetus into the true pelvis for birth -The true pelvis lies BELOW the line =most significant part of the pelvis  FEMALE PELVIS The INLET, the PELVIC CAVITY, & the OUTLET INLET- entrance to the true pelvis. Its transverse diameter is wider than its antero-posterior diameter. *Transverse diameter – 13cm *Anteroposterior – 11cm *Right and left oblique diameter – 12cm  FEMALE PELVIS PELVIC CAVITY–space between the inlet & outlet (from the pelvic brim to pelvic outlet) -curved so that the passage of the fetus through the cavity is slowed & controlled. -snugness of the cavity compresses the fetal chest. OUTLET –inferior portion of the pelvis -for a fetus to be delivered vaginally, it must be able to pass through the ring of the pelvic bone & the opening must be sufficient.  FEMALE PELVIS Classification of Pelvis 1. Gynecoid (normal female pelvis) -Inlet is well rounded forward and back. -Most ideal for child birth. 2. Anthropoid -is long, narrow, & oval shaped pelvis  FEMALE PELVIS Classification of Pelvis 3. Platypelloid -Inlet is oval, diameter is shallow. 4. Android (Male pelvis) -Inlet has a narrow, shallow posterior portion and pointed anterior portion.  FEMALE PELVIS Classification of Pelvis 3. Platypelloid -Inlet is oval, diameter is shallow. 4. Android (Male pelvis) -Inlet has a narrow, shallow posterior portion and pointed anterior portion.  STATISTICS ON MATERNAL & CHILD HEALTH Statistics is the science of collecting and interpreting numerical data. -nurses may use statistical data in:  reproductive trends  at risk population  prenatal care evaluation  comparison of relevant information from other regions  Definitions Recommended by the National Center for Health Statistics & CDC Perinatal Period -all births weighing 500g or more & ends @ 28 completed days after birth. Birth -the complete expulsion or extraction from the mother of a fetus, irrespective of whether the umbilical cord has been cut or placenta is attached.  Definitions Recommended by the National Center for Health Statistics & CDC Birthweight -the weight of a neonate determined immediately after delivery, expressed to the nearest gram.  Definitions Recommended by the National Center for Health Statistics & CDC Fertility Rate -number of pregnancies per 1000 women of childbearing age. Live Birth -whenever the infant at or sometime after birth breathes spontaneously, or shows any other sign of life such as heartbeat or definite spontaneous movement of voluntary muscle.  Definitions Recommended by the National Center for Health Statistics & CDC Stillbirth (fetal death) -no signs of life are present at or after birth. Neonatal Death -early ND refers to death of a live- born infants during the first 7days after birth. Late ND refers to death after 7days, but before 29 days.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Infant Death -includes all deaths of live-born infants from birth through 12 months of age.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Fetal Death Rate: Number of fetal deaths (fetuses weighing more than 500 g) per 1000 live births.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Fetal Death Rate -it reflects the overall quality of maternal health and prenatal care. -maternal factors such as maternal disease, premature cervical dilation, or maternal malnutrition or fetal factors such as fetal disease, chromosome abnormality, or poor placental attachment.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Neonatal Death Rate -Number of deaths per 1000 live births occurring at birth or in the first 28 days of life. -the first 28 days of life are known as the neonatal period, and an infant during this time is known as a neonate.  Definitions Recommended by the National Center for Health Statistics & CDC Neonatal Death Rate Majority of newborns die due to stressful events or conditions during labor, delivery, and the immediate postpartum period. Out of 4 newborn deaths 3 occur in the first week of life  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Neonatal Death Rate Causes of Deaths ,2010 Prematurity (27%) Asphyxia (26%) Infection (sepsis + pneumonia) (10%) Neonatal tetanus (2%) Diarrhea (2%)  Definitions Recommended by the National Center for Health Statistics & CDC What Can We Do To Save Newborns Lives? Preventive Interventions Breastfeeding (13%) Insecticide-treated materials (7%) Complementary feeding (6%) Clean delivery (4%) Hib vaccine (4%) Water sanitation, hygiene (3%)  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Perinatal Death Rate -Number of deaths of fetuses weighing more than 500 g and within the first 28 days of life per 1000 live births. -perinatal period is the time period beginning when a fetus reaches 500 g (about week 20 of pregnancy) and ending about 4 to 6 weeks after birth. -the perinatal death rate is the sum of the fetal and neonatal rates.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Infant Mortality Rate -Number of deaths per 1000 live births occurring at birth or in the first 12 months of life. -IMR measures the quality of pregnancy care, nutrition, and sanitation as well as infant health. -major causes of infant death: prematurity, low birth weight, congenital malformations, and SIDS.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Low Birthweight -the first newborn weight obtained after birth is less than 2,500 g. Very Low Birthweight -the first newborn weight obtained after birth is less than 1,500 g. Extremely Low Birthweight - the first newborn weight obtained after birth is less than 1,000 g.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Term Infant -an infant born anytime after 37 completed weeks of gestation & up to 42 competed weeks of gestation (260-294 days). Preterm Infant -an infant born before 37 completed weeks (259th day) Postterm Infant -an infant born anytime after completion of the 42nd week (295↑)  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Abortus -a fetus or embryo removed or expelled from the uterus during the first half of gestation (less 24 weeks), weighing less than 500 g. Induced Termination of Pregnancy -purposeful interruption of an intrauterine pregnancy, which does not result in a live birth.  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Direct Maternal Death -this includes death of the mother resulting from obstetrical complication of pregnancy, labor, or puerperium, & from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors. -ex. Maternal death due to hemorrhage during delivery  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Indirect Maternal Death -this includes a maternal death not directly due to an obstetrical cause. -ex. Maternal death from complication of heart failure  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Nonmaternal Death -death of a mother resulting from accidental or incidental causes not related to pregnancy. -ex. Death from vehicular accident  Definitions Recommended by the National Center for Health Statistics & CDC Statistical Terms Used to Report Maternal and Child Health Maternal Mortality Rate -Number of maternal deaths per 100,000 live births that occur as a direct result of the reproductive process.  Definitions Recommended by the National Center for Health Statistics & CDC Maternal Mortality Rate Causes of Maternal Deaths, 2006 1 Hypertensive disorders in pregnancy, childbirth and puerperium.P 2 Complications of labor and delivery 3 Pregnancy of abortive outcome  Definitions Recommended by the National Center for Health Statistics & CDC Maternal Mortality Rate “Big 5” of Direct Maternal Deaths (HOUSE) Hemorrhage Obstructed labor Unsafe abortion Sepsis Eclampsia WHO  Statistical Terms Used to Report Maternal and Child Health Childhood Mortality Rate -Number of deaths per 1000 population in children, 1 to 14 years of age. -motor vehicle crashes remain the leading cause of death in children.  STATISTICS ON MATERNAL & CHILD HEALTH Statistical Terms Used to Report Maternal and Child Health Childhood Mortality Rate -high incidence of homicide and suicide in the 10 to 19 year-old age group.  FEMALE REPRODUCTIVE CYCLE -A menstrual cycle is episodic uterine bleeding in response to cyclic hormonal changes. -its purpose is to bring an ovum to maturity (fertilization) and renew a uterine tissue bed (implantation/nidation). -menarche is termed as the 1st menstruation.  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle -average length (cycle) is 28 days, from the beginning of one flow to the beg. of the next. -average length of the menses is 4-6 days. -initiated by the release of Gonadotrophin- releasing hormone (GnRH) from the hypothalamus. *stimulates anterior pituitary to produce 2 hormones (FSH & LH) that acts on the ovaries to influence the menstrual cycle.  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases D. Menstrual Phase/Bleeding Phase -characterized by vaginal bleeding as the uterine endometrium shed down (blood from the capillaries & unfertilized ovum) -menstrual period is the period of absolute infertility. -amount (25-60 mL/day of the cycle); equivalent to 0.4-1mg of iron loss video  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases A. Menstrual Phase/Bleeding Phase -characterized by vaginal bleeding as the uterine endometrium shed down (blood from the capillaries & unfertilized ovum) -menstrual period is the period of absolute infertility. -amount (25-60 mL/day of the cycle); equivalent to 0.4-1mg of iron loss  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases B. Proliferative (follicular) Phase -estrogen production increases, leading to regrowth & thickening/proliferation of the endometrium -Ovulation: present in the middle of the cycle (14th day); monthly release of a mature, unfertilized ovum from the ovary  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases B. Proliferative (follicular) Phase -Ovulation signs: *breast tenderness *slight rise in BBT during ovulation (progest.) *Positive Spinnbarkeit test (with stretchable mucus) *Mittelschmerz (left or right LQP due to rupture of the graafian follicle) *Positive Ferning test  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases D. Menstrual Phase/Bleeding Phase -characterized by vaginal bleeding as the uterine endometrium shed down (blood from the capillaries & unfertilized ovum) -menstrual period is the period of absolute infertility. -amount (25-60 mL/day of the cycle); equivalent to 0.4-1mg of iron loss video  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases C. Secretory (luteal) Phase *the corpus luteum forms under the influence of LH. *estrogen and progesterone production increase *progesterone stimulates the functional layer of the endometrium *the endometrium is prepared for implantation of fertilized ovum  FEMALE REPRODUCTIVE CYCLE Menstrual Cycle Stages/Phases C. Secretory (luteal) Phase *If fertilization occurs, implantation follows (average of 7 days) after fertilization. *corpus luteum lives longer & secretes P & E in early pregnancy, then later replaced by placenta. D. Ischemic phase (days 25-28) *corpus luteum will become degenerates & P&E levels drops if fertilization does not occur  Human Development of Normal Pregnancy Fertilization -occurs with the fusion of a spermatozoon and an ovum (oocyte) in the ampulla of the fallopian tube. -the fertilized egg is called a zygote. -the diploid number of chromosomes (44 autosomes & 2 sex chromosomes (46)) *male zygote is formed (sperm has Y C.) *female zygote is formed (sperm has X C.)  Human Development of Normal Pregnancy Implantation -if fertilization is complete, a zygote migrates (3-4 days) towards the uterus. -during this time, mitotic cell division, or cleavage begins (24hours); blastomeres are divided cells -if the zygote reaches the body of the uterus (morula) -cells tend to collect at the periphery of the ball leaving a fluid space @ the inner cell mass (blastocyst) -blastocyst attaches the endometrium & cells in the outer ring (trophopblast) -trophoblast will later form the placenta & membranes -inner cell mass (embryoblast) will form an embryo  Human Development of Normal Pregnancy How Fertilization Occurs? *the acrosome releases enzymes that help to penetrate the protective layers (corona radiata) of the ovum before fertilization. *the sperm penetrates the zona pellucida. *the sperm releases its nucleus into the ovum, its tail (flagella) degenerates, its head fuses w/ the nucleus of the ovum & zygote (46 chromosomes) is formed.  Human Development of Normal Pregnancy Implantation (Nidation) -occurs when the cellular wall of the blastocyst (trophoblast) implants itself in the endometrium of the anterior or posterior fundal region (8-10 days after fertilization) -abnormal implantation (ectopic pregnancy); lower uterine segment implantation (placenta previa) -after implantation, the endometrium is called the decidua -primary villi appear w/in weeks after implant. Human Development of Normal Pregnancy  Human Development of Normal Pregnancy Implantation -if fertilization is complete, a zygote migrates (3-4 days) towards the uterus. -during this time, mitotic cell division, or cleavage begins (24hours); blastomeres are divided cells -if the zygote reaches the body of the uterus (morula) -cells tend to collect at the periphery of the ball leaving a fluid space @ the inner cell mass (blastocyst) -blastocyst attaches the endometrium & cells in the outer ring (trophopblast) -trophoblast will later form the placenta & membranes -inner cell mass (embryoblast) will form an embryo  Human Development of Normal Pregnancy Implantation -if fertilization is complete, a zygote migrates (3-4 days) towards the uterus. -during this time, mitotic cell division, or cleavage begins (24hours); blastomeres are divided cells -if the zygote reaches the body of the uterus (morula) -cells tend to collect at the periphery of the ball leaving a fluid space @ the inner cell mass (blastocyst) -blastocyst attaches the endometrium & cells in the outer ring (trophopblast) -trophoblast will later form the placenta & membranes -inner cell mass (embryoblast) will form an embryo  Human Development of Normal Pregnancy Stages Of Fetal Development Preembryonic Period (zygote) -begins w/ fertilization & lasts about 4 weeks -from zygote to mitotic division to morula to blastocyst w/c attaches to the endometrium Embryonic Period (embryo) (5th to 8th week) -human shape, germ layers develop -highly vulnerable to injury (drugs, infections) Fetal Period (fetus) (8th week until birth) -matures, enlarges, & grows heavier -head is larger than the body, lacks subq fats  Human Development of Normal Pregnancy Chorionic Villi -vascular projections (200 for TERM), reach out into the uterine endometrium to begin formation of the PLACENTA. -have a central core of connective tissue and fetal capillaries. -covered by a double layer of trophoblast cells (syncytiotrophoblast or syncytial layer) & (cytotrophoblast or Langhans’ layer) -fetal membranes (chorion & amnion)  Human Development of Normal Pregnancy Fetal Membranes (chorion & amnion) Health History Ask specifically about: Nutritional intake Personal habits Experienced accidents/intimate partner abuse Obstetrical History 5-Point System (GTPAL) Gravida, Para, (GTPAL) G-total of pregnancies (gravida) T- number of full term births P- number of premature births A- number of abortions L- number of currently living children  Developmental Tasks Of Pregnancy Depending on the woman’s age, tasks may include acceptance & comfort w/ body image, development of a personal value system, adjustment to an adult identity, and internalization of sexual role & identity. Other tasks: acceptance of pregnancy’s termination at the TOD & resolution of fears about childbirth 1st Trimester (Acceptance of the pregnancy) 2nd Trimester (Acceptance of the baby) 3rd Trimester (Preparation for parenthood)  Emotional/Psychosocial Adaptations in Pregnancy A. 1st Trimester 1. Normal denial to confirmation of pregnancy 2. Ambivalence about pregnancy, child, & parenting 3. Mood swings & emotional lability 4. Focusing on the self B. 2nd Trimester 1. Acceptance of the baby as distinct from self, enhanced by quickening “my baby is kicking” as stated 2. With fantasy & daydreaming 3. Introspective; evaluates marriage, career, in-laws 4. Most comfortable stage  Emotional/Psychosocial Adaptations in Pregnancy C. 3rd Trimester 1.Fear/anxiety/dreams about labor, pain, mutilation, & death 2. Anxiety related to responsibilities 3. Preparation for birth: nesting behavior; role- playing Psychological Tasks of Pregnancy 1. Acceptance of pregnancy as a reality & incorporation of the fetus into the body image 2. Preparation for physical separation from fetus 3. Attainment of maternal role  Emotional/Psychosocial Adaptations in Pregnancy Implementations 1. The pregnant woman should be encouraged to verbalize & express feelings, concerns & discomforts. 2. The nurse should validate normalcy of the pregnant woman’s feelings & reactions to provide psychological support. 3. Provide health teachings related to prevention & management of common discomfort of pregnancy 4. Encourage prenatal check-up/classes  Emotional/Psychosocial Adaptations in Pregnancy Paternal Reactions Sibling Reactions Generally same w/ the Normal rivalry mother dependent on Thinks about role change developmental stage Identifies w/ mother’s 1st Regression in behavior trimester discomfort (bedwetting, thumb (Couvade) sucking) May need more love & attention Physiologic Changes During Pregnancy  Physiologic Changes During Pregnancy A. Reproductive System 1. Uterus - The most obvious alteration in a woman’s body during pregnancy is the increase in the size of the uterus. Length increases from 6.5 to 32 cm. Depth increases from 2.5 to 22 cm. Width expands from 4 to 24 cm. Weight increases from 50 to 1000 g.  Physiologic Changes During Pregnancy A. Reproductive System 1. Uterus Early in pregnancy, the uterine wall thickens from about 1 cm to about 2 cm. The volume of the uterus increases from about 2 mL to more than 1000 mL. The uterus can hold a 7-lb (3175-g) fetus plus 1000 mL of amniotic fluid for a total of about 4000 g at term.  Physiologic Changes During Pregnancy A. Reproductive System 1. Uterus Fundic Height Changes 12th week: level of the symphysis pubis 13th week: rising from pelvic cavity (may be palpable just above the symphysis pubis) 14th week: an abdominal content 20th to 22nd week: at umbilical level 36th week: at xiphoid process level  Physiologic Changes During Pregnancy Fundic Height Changes  Physiologic Changes During Pregnancy A. Reproductive System 1. Uterus Increased vascularity to the pelvic region (estrogen effect) results: Chadwick’s sign: bluish or purplish discoloration of the vaginal mucosa Goodell’s sign: softening of the cervix Hegar’s sign: softening of lower uterus (isthmus)  Physiologic Changes During Pregnancy A. Reproductive System 1. Uterus Braxton-Hicks contractions: an intermittent irregular, painless, abdominal, and false labor contractions felt as abdominal muscle tightening (4 months); more pronounced (8 mons.) Ballottement: rebounding of the fetal head against examining fingers by 4-5 months. Secondary amenorrhea: due to the persistence of the corpus luteum  Physiologic Changes During Pregnancy A. Reproductive System 2. Cervix Shorter, thicker, more elastic With edema and hyperplasia of mucus lining, increased mucus production (mucus plug). It seals the cervix and prevents bacterial contamination of the uterine cavity. 3. Vagina Hypertrophy and hyperplasia thickened vaginal mucosa Leukorrhea: whitish, mucoid, non-foul, non-pruritic vaginal secretions (↑ estrogen level)  Physiologic Changes During Pregnancy A. Reproductive System 4. Perineum Hypertrophy, edema, ↑ in size, ↑ vascularization (deeper color) 5. Ovaries Ovum production stops Corpus luteum persists & takes over hormonal production task in early pregnancy Placenta: major endocrine organ in pregnancy  Physiologic Changes During Pregnancy A. Reproductive System 6. Breast Increased in size & firmness Tingling sensation of the nipples in 4 weeks & presence of breast tenderness. Enlargement of the areola Darkening of the areola and skin around it Enlargement of the superficial veins & Montgomery’s gland Colostrum (4-5 months): thin, watery, light yellow, high protein secretion Physiologic Changes During Pregnancy  Physiologic Changes During Pregnancy B. Endocrine System 1. Placenta a. Chorion of the placenta secretes HCG w/c functions to: -maintain the corpus luteum (most important function) -aid in diagnosing pregnancy (serum/blood: as early as 8-10 days or at the time of implantation; urine: as early as 10-14 days after the missed menstruation) b. Mature placenta at 10-12 weeks; ↑ placental hormones estrogen, progesterone, HCG, HPL Human placental lactogen is the major insulin antagonist in pregnancy  gestational DM  Physiologic Changes During Pregnancy B. Endocrine System 2. Anterior Pituitary Gland a. No ovulation from ↑ FSH b. Breast is prepared for lactation with ↑ prolactin 3. Posterior Pituitary Gland a. Oxytocin is regulated by the hypothalamus stored and secreted by the PPG b. Fetal head pressure on the cervix stimulates PPG to secrete oxytocin  stimulates uterine myometrium  uterine contraction  labor onset  Physiologic Changes During Pregnancy B. Endocrine System 4. Thyroid Gland a. Elevated serum estrogen and placental effects  ↑ thyroid activity elevates BMR 5. Parathyroid Gland a. Enhanced calcium & phosphorus metabolism to meet fetal needs for increased calcium b. Leg cramps during pregnancy results from calcium & phosphorus imbalance.  Physiologic Changes During Pregnancy B. Endocrine System 6. Pancreas a.↑ insulin secretion in response to increase metabolism in pregnancy. b.↑ resistance of cells to insulin due to HPL 7. Adrenal Cortex a. Increased aldosterone promotes sodium retention  water reabsorption  Physiologic Changes During Pregnancy C. Respiratory System 1. Nose: ↑ vascularity (estrogen effect)  common epistaxis, nasal stuffiness 2.Respiratory Rate a. rate ↑ can be constant at 6/min & deeper 3.Diaphragm rises resulting in dyspnea w/c is relieved by lightening. 4.Lungs: hyperventilation occurs when the mother blows off excess CO2 & direct effect of progesterone.  Physiologic Changes During Pregnancy D. Circulatory System 1.Cardiac rate ↑ by 10-15 bpm in 2nd to 3rd trimesters. 2.Blood pressure changes: supine position  inferior vena caval compression  ↓ venous return  ↓ cardiac output  hypotension Prevention & Mgt: left lateral recumbent position 4.Cardiac Output ↑ by 25%-50% (1st&2nd tri.) to meet tissue demands  Physiologic Changes During Pregnancy D. Circulatory System  Physiologic Changes During Pregnancy D. Circulatory System 5.Vascularity increases (estrogen effect): a.dilation of pelvic veins or resulting in deep pelvic vein varicosities b.leg varicosities 6. Fibrinogen level increases by 50% (progesterone effect): a. ↑ tendency of blot clot formation  high risk for thrombophlebitis + Homan’s sign -pain in the calf of the leg on dorsiflexion of the foot 7. Edema of the lower extremities is common  Physiologic Changes During Pregnancy 8. Hematologic a. Hemoglobin and hematocrit may drop by 10% in the 2nd & 3rd trimester  pseudoanemia or physiologic anemia b. WBC: 5, 500 to 11, 500/mm3 (in pregnancy)  20,000/mm (in labor),  25,000/mm3 (in post-partum). Leukocytosis is not usually a sign of infection.  Physiologic Changes During Pregnancy E. Gastrointestinal System 1. Mouth: increased estrogen level a. Ptyalism: increase saliva in women w/ nausea; appears 2-3 weeks & disappears after delivery. b. Increased vascularity  swollen gums  difficulty in chewing/gum bleeding  Physiologic Changes During Pregnancy E. Gastrointestinal System 2. Stomach a. Displaced backward, BS may not be ausculatated in 4 abdominal quadrants b. Cardiac sphincter relaxed  esophageal reflux  heartburn c. Decreased motility & digestion contribute morning sickness & heart burn (progesterone effect) 3. GI tract relaxation  morning sickness, flatulence, constipation & hemorrhoids Physiologic Changes During Pregnancy  Physiologic Changes During Pregnancy F. Urinary System 1. Glomerular filtration rate (GFR): ↑ by 50% in 2nd & 3rd trimesters  ↑ urinary output UF 2. Increased renal tubular reabsorption rate 3. Urinary Frequency: ↑ in the 1st & 3rd trimesters because of uterine pressure of the bladder 4. Glycosuria: presence of glucose in the urine due to lowered renal threshold for glucose 5. Relaxed smooth muscle of bladder, ureters: a. dilation of ureters (uterine pressure) b. decreased bladder tone c. ↑ potential for stasis & urinary infection  Physiologic Changes During Pregnancy F. Urinary System  Physiologic Changes During Pregnancy G. Integumentary System 1. Chloasma (mask of pregnancy): dark patches on the cheeks, nose and neck due to ↑ MSH 2. Linea nigra: dark line from symphysis pubis upward to xiphoid process due to ↑ estrogen 3. Striae gravidarum: stretch marks; silvery streaks on the abdomen 4. Palmar Erythema (reddened palms) & spider nevi (facial) from ↑ vascularity due to elevated estrogen 5. Diaphoresis: due to ↑ activity of the sweat & sebaceous glands due to ↑ BMR  Physiologic Changes During Pregnancy G. Integumentary System  Physiologic Changes During Pregnancy G. Integumentary System 1. Chloasma (mask of pregnancy): dark patches on the cheeks, nose and neck due to ↑ MSH 2. Linea nigra: dark line from symphysis pubis upward to xiphoid process due to ↑ estrogen 3. Striae gravidarum: stretch marks; silvery streaks on the abdomen 4. Palmar Erythema (reddened palms) & spider nevi (facial) from ↑ vascularity due to elevated estrogen 5. Diaphoresis: due to ↑ activity of the sweat & sebaceous glands due to ↑ BMR PRESUMPTIVE, PROBABLE, AND POSITIVE SIGNS OF PREGNANCY PRESUMPTIVE, PROBABLE, AND POSITIVE SIGNS OF PREGNANCY PRESUMPTIVE, PROBABLE, AND POSITIVE SIGNS OF PREGNANCY PRESUMPTIVE, PROBABLE, AND POSITIVE SIGNS OF PREGNANCY PRESUMPTIVE, PROBABLE, AND POSITIVE SIGNS OF PREGNANCY  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetal Movement  Quickening occurs (8-20weeks) of pregnancy & peaks in intensity (28-38 weeks).  Ask the woman to lie in a LLRP after a meal and record the fetal movements she feels over the next hour (Sandovsky method).  “Count-to-Ten” (Cardiff method). A woman records the time interval (10 fetal movements).  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetal Heart Rate  Rhythm Strip Testing  Assessment of the FHR for whether a good baseline rate and a degree of variability are present.  Position the woman in semi-Fowler’s w/ elevated backrest attach an external FHR monitor abdominally record FHR for 20 minutes.  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetal Heart Rate  Nonstress Testing  It measures the response of the fetal heart rate to fetal movement (10-20 mins).  Position the woman and attach both FHR & a uterine contraction monitor instruct a woman to push a button attached to the monitor when she feels the fetus moves this creates a dark mark on the paper tracing.  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetal Heart Rate  Vibroacoustic Stimulation  Acoustic stimulator is applied to the mother’s abdomen to produce a sharp sound (80 decibels at a frequency of 80 Hz), startling and waking the fetus.  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetal Heart Rate  Contraction Stress Testing  FHR is analyzed in conjunction with contractions (nipple stimulation).  External uterine contraction and FHR monitors in place, the baseline fetal heart rate is obtained nipple stimulation 3 uterine contractions w/in 10-min.  Results: negative or positive  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetal Heart Rate  Comparison of Nonstress & Contractions Tests 1. What is measured? 2. Normal findings? 3. Safety considerations?  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Ultrasonography It can be used:  Diagnose pregnancy (6th week AOG)  Confirm presence of placenta & AF  Confirm anomalies if present  Establish sex if penis is revealed  Establish fetal presentation & position  Predict fetal maturity (biparietal diameter)  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Ultrasonography Before/During an UTZ:  Explain the procedure (SAFE: no x-ray)  Full bladder at the time of the procedure  Drape appropriately (expose the abdomen)  Place a towel under the right buttocks  A gel should be at room temperature  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Ultrasonography Biparietal Diameter  8.5cm or greater = 2500 g (5.5 lb) or 40weeks AOG Placental Grading  Calcium deposits in the placenta  Grade 0 (12-24 weeks), G. 1 (30-32 weeks), G. 2 (36 weeks), G. 3 (38 weeks)  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Ultrasonography Amniotic Fluid Volume Assessment  Estimate fetal health (fetal kidney output)  Amniotic volume index (AFI): -Average index: 12-15 cm (28-40 weeks) = > 20-24 cm indicates hydramnios =< 5-6 cm indicates oligohydramnios  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Chorionic Villi Sampling  Is a biopsy and chromosomal analysis of chorionic villi that is done at 10–12 weeks of pregnancy.  A thin catheter is then inserted vaginally, or a biopsy needle is inserted abdominally or intravaginally chorionic cells are removed for analysis  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Amniocentesis  Is the aspiration of amniotic fluid from the pregnant uterus for examination (14th-16th)  During the test, ask the woman to void supine position attach fetal monitor wash the abdomen aseptically anesthetic is injected the needle is inserted (AC) 15mL of AF is withdrawn30mins rest check FHT & uterine contractions  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Amniotic Fluid is analyzed for:  Alpha-Fetoprotein (AFP)– a substance produced by the fetal liver.  Bilirubin Determination- may be analyzed if a blood incompatibility is suspected.  Chromosome Analysis- fetal skin cells may be cultured & stained for karyotyping for genetic analysis.  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Amniotic Fluid is analyzed for:  Color – colorless; slightly yellow tinge (late in preg.); strong yellow (BI); green (MS)  Fetal Fibronectin- cervical mucus before 20 weeks; labor & cervical dil. damage to the fetal mem.  preterm labor may start  Lecithin/Sphingomyelin Ratio L/S Ratio- 2:1=lung maturation; shake test (+ bubbles)  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Amniotic Fluid is analyzed for:  Phosphatidyl Glycerol and Desaturated Phosphatidylcholine – found in surfactant (matured in 35-36 weeks); if present, RDS is NOT likely to occur  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Percutaneous Umbilical Blood Sampling  Also called cordocentesis or funicentesis  Is the aspiration of blood from the umbilical vein for analysis.  UC is identified by UTZ a thin needle is inserted into the uterus it pierces the umbilical vein blood sample is obtained.  RhIG is given to Rh-negative women.  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Amnioscopy  Is the visual inspection of the amniotic fluid through the cervix and membranes with an amnioscope (a small fetoscope).  Main use: to detect meconium staining  Risk: rupture of membrane  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetoscopy  The fetus is visualized by inspection through a fetoscope (an extremely narrow, hollow tube inserted by amniocentesis technique) to assess fetal well-being.  Used to: confirm intactness of the spinal column; obtain biopsy samples of fetal tissues & fetal blood; perform basic surgery  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Fetoscopy  The mother is prepared & draped as for amniocentesis local anesthetic is injected abdominally fetoscope is inserted meperidine (Demerol) may be given for active fetus  Risks: preterm labor & amnionitis  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Biophysical Profile  A biophysical profile combines five parameters: 1. Fetal reactivity 2. Fetal breathing movements 3. Fetal body movement 4. Fetal tone 5. Amniotic fluid volume  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Biophysical Profile  Assessment of Fetal Growth & Development Assessing Fetal Well-Being Biophysical Profile  Biophysical profiles may be done as often as daily during a high-risk pregnancy.  Complete fetal scoring: 8-10 (fetus is well); 6 (suspicious); 4 (in jeopardy)  Modified biophysical profile (AFI & NST)  Human Development of Normal Pregnancy Amniotic Fluid -clear, straw-colored fluid -formed & reabsorbed by the amniotic membrane -amount: 800 mL- 1200 mL -slightly alkaline (7.2) Purposes: serves as shock absorber, allows symmetrical growth & fetal movement, acts as medium of excretion, serves as fetal drink, maintains fetal temp., protects the umbilical cord from pressure. Human Development of Normal Pregnancy  Human Development of Normal Pregnancy Umbilical Cord -provides a circulatory pathway that connects the embryo to the placenta. -length: 53 cm (21 inches) at term and about 2 cm (3/4 inch) thick. -parts; (AVA) 2 arteries (carry deoxygenated blood from fetus to placenta); 1 vein (carries oxygenated blood to the fetus) -Wharton’s jelly: gelatinous substance that surrounds the UC to prevent cord compression.  Human Development of Normal Pregnancy Placenta -a flat disk-shaped structure attached in the uterus, anteriorly or posteriorly near the fundus -15 to 20 cm in diameter & 2 to 3 cm in thickness -contains 15 to 20 subdivisions (cotyledons) -weighs 400-600 g (1 lb) -appears red (maternal surface) & shiny & gray (fetal surface) -functions as a transport mechanism bet. the mother & the fetus from 3rd month until birth -beyond 42 weeks (↓functions) Human Development of Normal Pregnancy Fetal surface of Maternal surface of the Placenta the Placenta