Care Of Mother And Fetus During Perinatal Period - 1 PDF

○ FHB - Audible at 10th to 12th week by doppler, 18th to 24th week by stet at 120-160 beats/ min. Module 3 - NCM 107 CARE OF M...

○ FHB - Audible at 10th to 12th week by doppler, 18th to 24th week by stet at 120-160 beats/ min. Module 3 - NCM 107 CARE OF MOTHER, CHILD & ADOLESCENT PERINATAL PERIOD Fetal movements felt by an examiner ○ Fetal Outline and Movement: UTZ and X-ray shows fetal skeleton 14th Care of the Mother and the Fetus During the Perinatal Period - 1 to 20th week of pregnancy. Visualization of the fetus by ultrasound Other sounds: Funic Souffle and uterine Souffle Pregnancy isn’t always easy. The extra emotions, fatigue, morning sickness, and difficulty to find a comfortable position to sleep. But, just knowing your Psychological Changes of Pregnancy baby is growing inside of you is one of the most rewarding experience a First Trimester woman can enjoy. Ambivalence - changing emotions Fear Definition of Terms Fantasies about motherhood & about having a “dream child” PARA Possible decrease in sex drive The number of pregnancies that have reached viability, The Psychological Task of Pregnancy regardless of if the infants were born alive ○ Accept the Pregnancy ○ “I am pregnant” GRAVIDA A woman who is or has been pregnant Second Trimester alternate feelings of emotional well being and lability PRIMIGRAVIDA acceptance of pregnancy A woman who is pregnant for the first time possible increase in sex drive adjustment to change in body image PRIMIPARA The Psychological Task of Pregnancy A woman who has given birth to one child past age of viability ○ Accept the Fetus ○ “A baby is growing inside me” MULTIGRAVIDA A woman who has been pregnant previously Third Trimester feelings of awkwardness & clumsiness GRAND MULTIPARA Fears & tension about labor A woman who has carried five or more pregnancies Spurt of energy during the last month The Psychological Task of Pregnancy MULTIPARA ○ Preparing for parenthood Woman who has carried two or more pregnancies to viability ○ preparing the baby and end of pregnancy ○ arranging for infants care NULLIGRAVIDA ○ developing economic patterns A woman who has never been and is not currently pregnant ○ reevaluation of household assignments ○ acquisition of knowledge about pregnancy childbirth and Maternal Adaptation During Pregnancy parenthood Diagnosis of Pregnancy (Affirmation & Confirmation of Pregnancy ○ expectant father Presumptive Signs: (need further confirmation) Amenorrhea Physiologic Changes Fatigue 1. Breasts Uterine Enlargement Increase in size Nausea and vomiting enlarged Montgomery’s tubercles Breast changes veins become prominent Urinary Frequency precolostrums can be expressed from nipples as early as Darkening of face, breast and abdomen 12th-14th weeks Quickening 2. Uterus Increase in Vascularity Probable Signs: (observable) presence Hegar’s sign Uterine Changes enlarged (50 - 1000 grams) Chadwick’s - violet colored vagina amenorrhea Goodell’s - softening of cervix Hegar’s - softening of lower uterine segment 3. Cervix Enlargement of Uterus formation of mucus plug or operculum Ballottement - use 2 hands to palpate baby from inside & outside presence of Goodell’s sign Pregnancy Test - effectiveness is only 95-96% there are cases of positive pregnancy but ultrasound shows no baby inside 4. Vagina Braxton Hicks - contractions Chadwick’s sign Leukorrhea - whitish, viscous vaginal discharge, an increase in Positive Signs: (signs that conclude pregnancy) the amount of normal vaginal secretions Demonstration of a fetal heart separate from mother’s (use back of stethoscope bell to hear, normal fetal heartbeat: 120-160 bpm) ○ Heart -Starts to beat as early as 24th day 5. Cardiovascular System Process of Conception Increase in blood volume Increase in cardiac output STAGES OF FETAL DEVELOPMENT varicosities supine hypotension Typically Divided into Three Periods: edema of lower extremities 1. Preembryonic - First 2 weeks, beginning with fertilization palpitations 2. Embryonic - Weeks 3 through 8 physiologic anemia 3. Fetal - From week 8 through birth increase in WBC, fibrinogen (clotting factor important for delivery) heart rate increases 10- 15 beats / min Common Terms Used to Describe Fetal Growth: 1. Ovum - from ovulation to fertilization 6. Respiratory System 2. Zygote - from fertilization to implantation increase O2 demand 3. Embryo - from implantation to 5- 8 weeks dyspnea 4. Fetus - from 5-8 weeks until term displacement of the diaphragm 5. Conceptus - developing embryo & placental structures throughout nasal stuffiness & or congestion pregnancy 6. Age of Viability - Earliest age at which fetuses survive if born is 7. Gastrointestinal System generally accepted as 24 weeks or at the point a fetus weighs more Morning sickness and Pyrosis than 500-600 g Ptyalism Softening of gums Stages of Fetal Development Pica - excessive eating 1. Prefertilization Constipation ovum moves to the ampulla by means of peristaltic movement sperms move into the ampulla by means of their tail 8. Urinary System before sperm can penetrate ovum, cap must be removed urinary stasis capacitation urinary frequency ○ physiologic removal of acrosome asymptomatic bacteriuria ○ final process that sperm must undergo to be ready for reduced bladder tone fertilization Acrosome Reaction 9. Musculoskeletal System ○ reaction that occurs in the acrosome of the sperm as it lordosis (pride of pregnancy) approaches the egg characteristics waddle Hyaluronidase diastasis recti - overstretching & separation of the abdominal ○ proteolytic enzyme released by the spermatozoa vasculature ○ acts to dissolve layers of cells protecting the ovum ○ corona radiata - cells that encircle the zona pellucida 10. Integumentary System ○ zona pellicuda - protective covering of the ovum chloasma / melasma linea nigra 2. Fertilization / Conception / Impregnation striae gravidarum (stretchmarks) beginning of pregnancy erythematous changes on palms and face the union of ovum and sperm diaphoresis (excessive sweating) zona reaction - ovum becomes impenetrable to other sperm fertilization is never a certain occurrence because it depends on 11. Endocrine System at least three separate factors secretion of estrogen and progesterone by the corpus luteum ○ Equal maturation of both sperm and ovum during the first 3 months ○ Ability of the sperm to reach the ovum slight hyperthyroidism and hyperplasia of the thyroid gland ○ Ability of the sperm to penetrate the zona pellucida and cell increased size of parathyroid membrane and achieve fertilization increased melanocyte stimulating hormone life span of ovum – 24-48 hours addition of the placenta as an endocrine gland life span of sperm – 48-72 hours gradual increase of insulin increase BMR suppression of FSH / LH increase production of growth hormone production of Oxytocin late in pregnancy production of Prolactin QUESTION: Pregnant women state that she waddles when she walks. The nurse’s explanation is based on which of the following as the cause? A. relaxation of pelvic joints COUVADE SYNDROME - group of physiological & behavioral manifestation experienced by the husband - often the result of stress anxiety & empathy for the pregnant women Sex Determination Embryonic and Fetal Structure ovum – 23 chromosomes: THE DECIDUA ○ 22 autosomes because of influence of human chorionic gonadotropin (HCG), a ○ 1 x sex chromosome hormone secreted by the trophoblast cells, the Corpus Luteum sperm – 23 chromosome: continues to function after fertilization ○ 22 autosomes endometrium, instead of sloughing off, continues to grow in thickness ○ 1 x or y sex chromosome and vascularity - now called Decidua (Latin word meaning “falling off”) Zygote - fertilized ovum to implantation - single cell, the product of fertilization 3. Implantation Takes 8-10 days after fertilization CHORIONIC VILLI Zygote migrates at 3-4 days toward the body of the uterus fingerlike projections that reach out from the trophoblast cells into the (+) mitotic cell division = Cleavage [24h] uterine endometrium to begin formation of the placenta. a. Blastomere – 2nd day this is about the 11th or 12th day after fertilization b. Morula – 3rd day (16-50 cells); Mulberry at term nearly 200 are formed c. Blastocyst ○ 4th day ○ signals differentiation of embryo ○ mass of cells form to a periphery with fluid space Trophoblast – outer portion Embryoblast – inner portion By the 3% or 4% day of free floating (7-10 days) blastocyst brushes against uterine endometrium: “Apposition” then attaches to endometnum: "Adhesion” finally settles down into soft folds of endometrum: Invasion (only 50% can successfully invade) Implantation THE PLACENTA ○ the process wherein the zygote burrows into the endometrium. arises out of the trophoblast tissue (fusion of chorionic villi and decidua basalis endocrine organ throughout pregnancy functions of the Placenta: ○ source of oxygen and nutrients for the fetus ○ important hormone-producing system Endocrine Function of the Placenta: 1. Human Chorionic Gonadotropin first hormone to be produced by placenta present in maternal blood & urine as early as before first missed menstrual period (6th or 7th day after implantation) & its peak level @ about 16th day then diminished its level by 20th week Functions: ○ hCG’s purpose is to act as a fail-safe measure to ensure the corpus luteum of the ovary continues to produce progesterone and estrogen so the endometrium of the uterus is maintained. ○ hCG also may play a role in suppressing the maternal immunologic response so placental tissue is not detected and rejected as a foreign substance 2. Estrogen (estriol) THE AMNIOTIC FLUID Functions: dual-walled sac with the chorion as the outmost part and the amnion ○ contributes to the development of mammary gland in as the innermost part preparation for lactation after birth the two fuse together as the pregnancy progresses, and by term, they ○ stimulates the uterus to grow to accommodate the appear to be a single sac. developing fetus The most important purpose of amniotic fluid is: 3. Progesterone to shield the fetus against pressure or a blow to the mother’s Functions: abdomen. ○ maintains the endometrial lining for its growth because liquid changes temperature more slowly than air, it also ○ reduce the contractility of the uterus during pregnancy, thus protects the fetus from changes in temperature. preventing premature labor. it aids in muscular development, as amniotic fluid 4. Human Placental Lactogen allows the fetus freedom to move. Functions: it protects the umbilical cord from pressure, thus protecting the fetal ○ both growth-promoting & w/ lactogenic properties (milk oxygen supply. producing) ○ regulates maternal glucose, protein and fat levels to ensure THE UMBILICAL CORD adequate amount of these are always available to the fetus. formed from the fetal membranes, the amnion and chorion Functions: Origin and Development of Organ Systems ○ provides a circulatory pathway that connects the embryo to the THE MEMBRANE chorionic villi of the placenta. the chorionic villi on the medial surface of the trophoblast gradually ○ to transport oxygen and nutrients to the fetus from the placenta thin and leave the medial surface of the smooth structure which and to return waste products from the fetus to the placenta. eventually becomes the chorionic membrane Length: 53 cm ○ Support the sac that contains amniotic fluid Contains: ○ Arteries and Veins Amniotic Membrane/ Amnion ○ Wharton’s Jelly Functions: Function: to insulate & protect umbilical cord in the womb ○ offer support to the amniotic fluid. ○ Amniotic Membrane ○ produces the amniotic fluid. ○ Rate of blood flow ○ produces a phospholipids that initiates formation of ○ Nerve supply prostaglandins blood flow in chord. - 140 ml per Amniotic Fluid/Liquor Amnii Functions: ○ protective mechanism for the fetus THE AMNIOTIC MEMBRANES ○ it shields against pressure or blow to the mother’s abdomen dual-walled sac with the chorion as the outmost part and the amnion ○ it protects the fetus from changes in temperature as the innermost part ○ it aids muscular development because it allows the fetus to move the two fuse together as the pregnancy progresses, and by term, they ○ protects umbilical cord from pressure, protecting fetal appear to be a single sac. oxygenation ○ Average amount - 800 ml ○ Polyhydramnios - more than 800 ml ○ Oligohydramnios - less than 800 ○ Measured through ultrasound (Amniotic Fluid Index or AMI) ○ AMI - 5-25 cm in average ○ Ph - Alkaline from the beginning of fetal growth, development proceeds in a CEPHALOCAUDAL (head to tail) direction which continues after birth at the time of implantation, the blastocyst already has differentiated to a point at which three separate layers of these cells are present: the ectoderm, the endoderm, and the mesoderm first feces passed out from baby: Meconium Amniotic fluid is clear to white - color. PRIMARY GERM LAYERS Digestive System at the time of implantation, the blastocyst forms 2 separate cavities by the 4th week - digestive tract separates from the respiratory tract appear in the inner structure: and after that, begins to grow extremely rapidly. a large one, the AMNIOTIC CAVITY by 16th week- meconium starts to form. a smaller cavity, the Yolk Sac ○ Components: collection of cellular wastes, bile, fats, between the amniotic cavity and the yolk sac forms a third layer mucoproteins, of primary cells the mesoderm. mucopolysaccharides, and portions of the vernix caseosa surfactant - substance used for lung function GIT is sterile before birth brain already formed in womb but not fully develop until 5-6 years old the liver is active but still immature at birth sucking and swallowing reflex are not mature until about 32 weeks or Origin of Body Tissue weighs 1500 g. each germ tissue develops into distinctive body systems 1. Ectoderm Musculoskeletal System the nervous system (CNS – Brain & Spinal Cord, PNS) by 11th week - seen to move by utz skin, hair, nails, and tooth enamel quickening by 20th week. sense organs mucous membranes of the anus, mouth and nose mammary glands Reproductive System 2. Mesoderm by 6th week - the gonads are formed supporting structures of the body (connective tissue, bones, Testosterone is produced from wollfian duct or mesonephric duct cartilage, muscle, ligaments, and tendons) male genitalia is developed upper portion of the urinary system (kidneys & ureters) on the 8th week female hormones is produced from mullerian duct or reproductive system paranephric duct – female genitalia is formed. heart, lymph and circulatory system and blood cells 3. Endoderm Urinary System lining of the pericardial, pleura, and peritoneal cavities end of 4th week - rudimentary kidney is present lining of the gastrointestinal tract, respiratory tract, tonsils, by 12th week - urine is formed parathyroid, thyroid, and thymus glands by 16th week - urine is excreted in the amniotic fluid lower urinary system (bladder & urethra) at term - urine is being excreted at the rate of 500ml/day Cardiovascular System Integumentary System one if the first systems to become functional in intrauterine life 36th weeks - skin appears thin & translucent & fat begins to be its development is a progression from simple blood cells deposited lanugo - soft, downy hairs Respiratory System vernix caseosa - a white-cream cheese like substance 3rd week of life - respiratory & digestive tracts exist as a single tube end of 4th week - septum begins to divide esophagus & trachea Immune System 7th week of life - the diaphragm is starting to divide the thoracic by 3rd trimester - maternal antibodies cross the placenta cavity from the abdomen the level of passive immunity is peak at birth 24th to 28th week - alveoli and capillaries begin to form surfactant - a lipoprotein produce by alveolar cells Two components: Fetal Circulation ○ Lecithin contains mixed blood with less than maximal O2 concentration; only ○ Sphingomyelin exception is umbilical vein upon its immediate entrance into the liver fetus receives O2 thru placenta since lungs do not function as organs Nervous System of respiration; to meet situation, fetal circulation contains special by the 3rd week of gestation - a neural plate is apparent in the vessels developing embryo (forming the CNS & PNS) all parts of brain form in uteru brain waves can be detected on an electroencephalogram (EEG) by Special Vessels of a Fetal Circulation the 8th week 1. DUCTUS VENOSUS - is a connection between the umbilical vein & ascending vena cava, bypassing the fetal liver. 2. DUCTUS ARTERIOSUS - a connection between the pulmonary trunk Endocrine System & aorta, bypassing the fetal lungs. as soon as endocrine organs mature in intrauterine life, function 3. FORAMEN OVALE - is an opening between the right & left atria begins during fetal life, also bypassing the fetal lungs. function of endocrine organs begins along with neurosystem development. ○ fetal pancreas ○ thyroid / parathyroid glands ○ fetal adrenal glands  Arms and legs are bud-like structures. Rudimentary eyes, ears, and nose are discernible. Length is 0.75 cm to 1 cm. Weight is 400 mg. End of 8th Gestational Week Length is 2.5 cm (1 in.) Weight is 20 grams Organogenesis is complete. Heart has a septum & valves & is beating rhythmically Facial features are definitely discernible. Legs, arms, fingers, toes, elbows, & knees have developed. External genitalia are present but male & female are not distinguishable by simple observation. Primitive tail is undergoing retrogression. Abdomen appears large as fetal intestine is growing rapidly. A sonogram done at this time demonstrates a gestational sac & is diagnostic of pregnancy. End of 12th Gestational Week (First Trimester) Length is 7 to 8 cm. Weight is 45 grams. Nail beds are forming on fingers & toes. Capable of spontaneous movements although too faint to be felt by the mother. Some reflexes, such as Babinski reflex are present Bone ossification centers begin to form Tooth buds are present. Sex is distinguishable on outward appearance. Urine secretion begins but may not yet be evident in amniotic fluid. Heartbeat is audible through Doppler Technology End of 16th Gestational Week Length is 10 to 17 cm. Weight is 55 to 120 g. Fetal heart sounds are audible by an ordinary stethoscope. Lanugo is well formed Liver & pancreas are functioning. Fetus actively swallows amniotic fluid; urine is present in amniotic fluid Sex can be determined by ultrasonography. End of 20th Gestational Week Length is 25 cm. Weight is 223 g. Spontaneous fetal movements sensed by the mother. Antibody production is possible Hair, including eyebrows, forms on the head; vernix caseosa begins to cover the skin. Meconium is present in the upper intestine. MILESTONES OF FETAL GROWTH AND DEVELOPMENT Brown fat begins to form behind the kidneys, sternum, & posterior neck. CONCEPTION Passive antibody transfer from mother to fetus begins. Sperm fertilizes ovum, which then divides and burrows into the uterus Definite sleeping & activity patterns are distinguishable. End of 4th Gestational Week End of 24th Gestational Week (Second Trimester) Human embryo is a rapidly growing formation cells but does not Length is 28 to 36 cm. resemble a human being yet. Weight is 550 g. Spinal cord formed & fused at midpoint. Passive antibody transfer from mother to fetus (if born before will have Head will shortly fold forward & become prominent, comprising about no natural immunity). 1/3 of the entire structure. Vernix Caseosa begins to form. Back is bent so the head touches the tip of the tail. Meconium present as far as the rectum. Heart appears as a prominent bulge on the anterior surface. Active production of lung surfactant begins.  Eyelids, previously fused since the 12th week, now open; pupils react to light. Membrane that had fused the eyelids dissolves so eyes can now open & pupils are capable of reacting to light. Low-end age of viability. (or 601g.) End of 28th Gestational Week Length is 35 to 38 cm. Weight is 1200 g. Lung alveoli are almost mature, surfactant can be demonstrated in amniotic fluid. In male fetus, the testes begin to descend into the scrotal sac from the lower abdominal cavity. Blood vessels of the retina are extremely susceptible to damage from high oxygen concentrations End of 32nd Gestational Week Length is 38 to 43 cm. Weight is 1600 g. Subcutaneous fat begins to be deposited in the fetus. Fetus responds by movement to sounds outside the mother’s body Active Moro reflex is present. In some cases, has assumed delivery position. Iron stores begin to be built. Fingernails reach the end of fingertips. End of 36th Gestational Week Length – 42-48 cm Weight is 1,800-2,700g (5-6 lb). Body stores of glycogen, iron, carbohydrate, and calcium are deposited. Additional amounts of subcutaneous fat are deposited. Sole of the foot has only one or two crisscross creases compared with a full crisscross pattern evident at term. Amount of lanugo begins to diminish. Most fetuses turn into a vertex (head down) presentation during this month. End of 40th Gestational Week (Third Trimester) Length is 48 to 52 cm. Weight is 3000 g. (7- 7.5 lbs.) At this time, the sole of the foot has only one or two crisscross creases. Lanugo begins to diminish Kicks actively. Vernix Caseosa is fully formed. Fetal hemoglobin begins its conversion to adult hemoglobin. Fingernails extend over the tips of fingers. Creases on the soles of the feet cover at least 2/3 of the surface. Lightening for primiparas (experience by the women as the fetus sinks into the birth canal and giving the pregnant woman a feeling that her load is being lightened).