Pregnancy & Fetal Development PDF

The Miracle of Life Pregnancy & Fetal Development © 2002 Delmar, a Thomson Learning company 1 Class Objectives 1. To define and consider the concepts of “family” and “family-centred care,” including current trends 2. To discuss to biology of conception, and pregnanc...

The Miracle of Life Pregnancy & Fetal Development © 2002 Delmar, a Thomson Learning company 1 Class Objectives 1. To define and consider the concepts of “family” and “family-centred care,” including current trends 2. To discuss to biology of conception, and pregnancy 3. Describe the growth & development of the fetus and pregnant person, including accessory organs/structures of pregnancy 4. Identify the role of the nurse in teaching, and health promotion (including © 2002 Delmar, a Thomson Learning company 2 What is a family The family is defined biologically, legally, or as a social network with personally constructed ties and ideologies. A set of relationships that the client identifies as family or as a network of individuals who influence each other’s lives, whether or not there are actual biological or legal ties The family is each person’s definition of who or what constitutes Current Trends and New Family Forms Families are smaller. People are delaying childbirth. Some people are not having children. Blended families. Single parent families Canada’s population is aging. LGBTQ2S+ families  Fertilization or Conception Begins when a sperm and ovum unite, fertilize and becomes a zygote; occurs in the outer 1/3 of the fallopian tube Sex of zygote is determined at time of fertilization Fraternal twins are two ova fertilized by two sperm Identical twins are one ovum fertilized by one sperm that splits into form two embryos © 2002 Delmar, a Thomson Learning company 5 Conception Video Watch this brief video, which provides a detailed audio & video of conception http://www.youtube.com/watch?v=_5OvgQW6FG4 © 2002 Delmar, a Thomson Learning company 6 Fetal Development Three basic stages – zygote, embryo and fetus 1. Zygote 2. Embryonic stage (Week 2 to 8) 3. Fetal stage (Week 9 until birth) © 2002 Delmar, a Thomson Learning company 7 ZYGOTE 1st week of development Implantation By 5 days after fertilization blastocyst is buried in uterine lining Begins to produce human chorionic gonadotropin (hCG) Endometrium is called the decidua from implantation through end of pregnancy Cell division occurs as the zygote travels the fallopian tube to the uterus © 2002 Delmar, a Thomson Learning company 8 EMBRYO Embryonic stage Lasts from the 2nd week after fertilization until the end of the 8th week Developing conceptus becomes the embryo Differentiation begins Three germ layers develop Ectoderm Mesoderm Endoderm © 2002 Delmar, a Thomson Learning company 9 EMBRYO Ectoderm: outer layer of cells Forms skin, hair, nails, external nervous system Mesoderm: middle layer Forms the skeletal, muscular, and circulatory systems Endoderm: inner layer Forms the linings: lungs, and urinary and digestive tracts © 2002 Delmar, a Thomson Learning company 10 FETAL From 9 weeks after fertilization until delivery © 2002 Delmar, a Thomson Learning company 11 Teaching opportunities Implantation bleeding Trying for pregnancy Sexual Counselling © 2002 Delmar, a Thomson Learning company 12 Amniotic fluid Fills the amniotic cavity Serves four main functions Physical protection Prevents sac from adhering to the skin Acts as a barrier to infection Acts as a cushion to provide protection Temperature regulation Provision of unrestricted movement Fluid source Polyhydramnios/Oligohydramnios © 2002 Delmar, a Thomson Learning company 13 Amniotic Fluid & Placenta © 2002 Delmar, a Thomson Learning company 14 Placenta Connects the fetus to the pregnant person, it produces hormones to sustain a pregnancy, supplies the fetus with oxygen and food, and transports waste products out of the fetal system Three main functions Provide for the transfer and exchange of substances To act as a barrier to certain substances To function as an endocrine gland by producing hormones © 2002 Delmar, a Thomson Learning company 15 Umbilical cord Extends from the umbilicus of the fetus to the fetal surface of the placenta Two arteries that bring deoxygenated blood from the fetus to the placenta and one vein that carries oxygenated and nourished blood from the placenta to the fetus Wharton’s jelly surrounds these three vessels © 2002 Delmar, a Thomson Learning company 16 © 2002 Delmar, a Thomson Learning company 17 Physiologic changes of Pregnancy MATERNAL CHANGES IN PREGNANCY Physiologic Changes to Pregnancy Reproductive changes: Uterus Change in weight and capacity Change from almost solid structure to thin, muscular sac Change in location from pelvis to abdominal cavity Term has the capacity for 5000 ml, enough to house the term fetus, placenta and amniotic fluid. 19 Reproductive changes (cont.) Cervix/Ovaries/Vagina Vascularity increases, and glandular tissue multiplies during pregnancy Thick mucous plug develops in the opening of the cervix Ovulation stops Corpus luteum continues to function and produces progesterone and estrogen Breasts Tenderness in the first few weeks of pregnancy Prominent areola with deepened pigmentation © 2002 Delmar, a Thomson Learning company 20 Respiratory changes RR increased slightly (2–3 breaths per minute) Nasal mucosa edematous due to vasocongestion Oxygen consumption increases © 2002 Delmar, a Thomson Learning company 21 Cardiovascular changes Blood volume increases by 45% in the 3rd trimester (Dilutional anemia) Cardiac output increases Heart rate increases by 10–15 beats per minute Supine hypotensive syndrome Increased clotting factors © 2002 Delmar, a Thomson Learning company 22 GI/GU Systems Stomach & intestines are displaced Increased appetite & thirst Decreased stomach emptying & intestinal motility Increased demands on renal function Water retention is expected Susceptible to UTI’s Increased urinary frequency (1st & 3rd trimesters) © 2002 Delmar, a Thomson Learning company 23 Integumentary changes Chloasma (mask of pregnancy) Brown blotchy areas on the forehead, cheeks, and nose Linea Gravidarum or Pregnancy Line The skin in the middle of the abdomen may develop a darkened line Striae (stretch marks) May develop on the abdomen in response to elevated glucocorticoid levels © 2002 Delmar, a Thomson Learning company 24  Linea Chloasma Gravidarum © 2002 Delmar, a Thomson Learning company 25 Watch this video, which summarizes the physiologic changes of pregnancy: https://www.khanacademy.org/science/health-and-medici ne/human-anatomy-and-physiology/reproductive-system- introduction/v/maternal-changes-in-pregnancy © 2002 Delmar, a Thomson Learning company 26  Physiological Changes First Trimester Fertilization occurs + Pregnancy Blood volume test increases Fainting is ↑Relaxin Hormone, possible HCG Nausea & vomiting Melanocyte Sensitivity to stimulating odours hormone is Chloasma released Increased © 2002 Delmar, a Thomson Learning company 27 Second Trimester Placenta takes Increases blood over fetal support volume in placental bed Broad ligament Occasional pain in stretches as groin area uterus enlarges ↑ discharge Vascularity of Orthostatic pelvis increases hypotension ↑Blood volume, Physiological Cardiac Output anemia © 2002 Delmar, a Thomson Learning company 28 Second Trimester continues Uterus rises out Centre of body of pelvis & changes, pressure sacroiliac joint on bladder & relaxes rectum Mood swings, Hormonal deeper skin fluctuations pigmentation continue Sphincter of Relaxin levels stomach relaxes increase Colostrum Pituitary gland produced, breasts secretes enlarge prolactin © 2002 Delmar, a Thomson Learning company 29 Third Trimester Weight gain 25-35 lbs TOTAL Maximum increase of Patient tires cardiac output easily Edema of Risk for carpal hands and tunnel, assess face PIH Increase level Voice changes © 2002 Delmar, a Thomson Learning company 30 of estrogen Third continues Uterine size Pressure on increases stomach, diaphragm, venous congestion lightening © 2002 Delmar, a Thomson Learning company 31 Signs of Pregnancy Presumptive (possible) signs Symptoms the pregnant person experiences and reports to the health care provider (subjective) Taken alone, each sign can have other causes besides pregnancy Probable signs Those detected by a trained examiner (objective signs) Positive signs Diagnostic © 2002 Delmar, a Thomson Learning company 32  Presumptive Signs of Pregnancy Amenorrhea Nausea Breast Changes Urinary frequency Fatigue and drowsiness Quickening Chapter 15 © 2002 Delmar, a Thomson Learning company 33  Probable Signs of Pregnancy Goodell’s sign Chadwick’s sign Uterine enlargment Braxton Hicks contractions Pregnancy tests Chapter 15 © 2002 Delmar, a Thomson Learning company 34  Positive Signs of Pregnancy Fetal heart sounds Fetal movement noted by the examiner Visualization of fetus by ultrasound Chapter 15 © 2002 Delmar, a Thomson Learning company 35  Nägele’s Rule the date of the first day of the last normal menstrual period subtract 3 months and add 7 days For example: First day of last period was 12-01 (December(12) 01, 2020) Subtract 3 months = 12- 3=09 Add 7 days = 01 + 07 = 08 EDD September 8, 2021 Chapter 15 © 2002 Delmar, a Thomson Learning company 36 Psychosocial Adaptation Identifying barriers: 1. Inadequate finances 2. Knowledge barriers re: community resources 3. Lack of transportation 4. Daycare or elder care problems 5. Domestic violence, stress, nutritional problems © 2002 Delmar, a Thomson Learning company 37 First Trimester Pregnant Person Partner Confirmation Announcement Ambivalence Phase during early weeks Focuses on self Physical changes and higher hormone levels cause emotions to increase in intensity © 2002 Delmar, a Thomson Learning company 38  Second Trimester Pregnant Person Partner Fetus becomes real, with growing size, Adjustment Phase movement, hearing heartbeat and u/s More stable time, spends ++ time on best foods and environment Tries on role of parent Changing body image either positive or negative (discomforts or sexual relationship) © 2002 Delmar, a Thomson Learning company 39 Third Trimester Pregnant Person Partner Body changes Focus Phase more dramatic Discomforts of pregnancy tiresome Prepares for labour © 2002 Delmar, a Thomson Learning company 40 Impact on adolescent Conflict and anxiety about breaking news to parents/partner and partner’s family Relationship concerns Shame, guilt, fear Age is important Pregnant adolescent must cope with two stressful transitions © 2002 Delmar, a Thomson Learning company 41 Discomforts of Pregnancy Urinary frequency Nausea and vomiting Indigestion/heartburn Constipation and hemorrhoids Edema of lower extremities Varicose veins Increased vaginal discharge Fatigue Backache Leg cramps Dyspnea Nasal stuffiness © 2002 Delmar, a Thomson Learning company 42 Activity Explain the common discomfort in your own words Tell the class what health teaching the nurse would provide to the pregnant person See Chart on page 65 of your textbook © 2002 Delmar, a Thomson Learning company 43 Danger Signs of Pregnancy to be Reported Any vaginal bleeding Swelling of the face and fingers Severe, continuous headache Vision changes Abdominal pain Chills and fever Persistent vomiting Sudden gush of fluid from the vagina © 2002 Delmar, a Thomson Learning company 44