CMCA-Midterm-Lesson-1-and-2 PDF

Care of Mother, Child, & Adolescent (Well Clients) Main Reference: Silbert-Flagg, J. (2022). Maternal & Child Health Nursing. LWW. SVCN, RN, LPT, MD Professor...

Care of Mother, Child, & Adolescent (Well Clients) Main Reference: Silbert-Flagg, J. (2022). Maternal & Child Health Nursing. LWW. SVCN, RN, LPT, MD Professor Faculty Member, School of Nursing SVCN, RN, LPT, MD  Responsible Parenthood Care of Mother, Child, & Adolescent Main References: Co, E. (2022). Anatomy and Physiology (1st Edition). Cengage Learning, Inc. Silbert-Flagg, J. (2022). Maternal & Child Health Nursing. LWW. World Health Organization Department of Sexual and Reproductive Health and Research (WHO/SRH) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge SUCCESS. Family Planning: A Global Handbook for Providers (2022 update). Baltimore and Geneva: CCP and WHO; 2022. Shayne Verli O. Cadavedo-Novicio, RN, LPT, MD Professor Faculty Member, School of Nursing SVCN, RN, LPT, MD Hormonal Contraceptives Responsible Parenthood SVCN, RN, LPT, MD  Hormonal Contraception hormones that when taken: orally transdermally intravaginally intramuscularly SVCN, RN, LPT, MD  Oral Contraceptives Combination Oral Contraceptives 28-pill dispensers (21 active pills and 7 placebo pills Progestin-only Pills (Mini-Pills) SVCN, RN, LPT, MD  Combined Oral Contraceptives Pills that contain low doses of 2 hormones—a progestin and an estrogen—like the natural hormones progesterone and estrogen in a woman’s body. “the Pill,” low-dose combined pills, OCPs, and OCs Work primarily by preventing the release of eggs from the ovaries (ovulation). SVCN, RN, LPT, MD  Combined Oral Contraceptives COCs must be prescribed by a healthcare provider after screening for eligibility. If the woman is over the age of 21 years and due for a routine exam, a pelvic exam and Pap smear are usually completed at this visit as well. 99.9% effective typical failure rate is closer to 5% SVCN, RN, LPT, MD  Combined Oral Contraceptives estrogen acts to suppress FSH and LH to suppress ovulation progesterone action causes a decrease in the permeability of cervical mucus and so limits sperm motility and access to ova interferes with tubal transport and endometrial proliferation to such an extent the possibility of implantation is significantly decreased SVCN, RN, LPT, MD  Combined Oral Contraceptives Monophasic pills which contain fixed doses of both estrogen and progestin throughout a 21-day cycle Biphasic preparations that deliver a constant amount of estrogen throughout the cycle but varying amounts of progestin SVCN, RN, LPT, MD  Combined Oral Contraceptives Triphasic and tetraphasic preparations which vary in both estrogen and progestin content throughout the cycle SVCN, RN, LPT, MD  Combined Oral Contraceptives Effectiveness depends on the user: Risk of pregnancy is greatest when a woman starts a new pill pack 3 or more days late, or misses 3 or more pills near the beginning or end of a pill pack. SVCN, RN, LPT, MD  Combined Oral Contraceptives Effectiveness depends on the user: When no pill-taking mistakes are made, less than 1 pregnancy per 100 women using COCs over the first year (3 per 1,000 women). As commonly used, about 7 pregnancies per 100 women using COCs over the first year. 93 of every 100 women using COCs will not become pregnant. SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Combined Oral Contraceptives Known Health Benefits Help protect against: Risks of pregnancy Cancer of the lining of the uterus (endometrial cancer) Cancer of the ovary Symptomatic pelvic inflammatory disease SVCN, RN, LPT, MD  Combined Oral Contraceptives Known Health Benefits May help protect against: Ovarian cysts IDA SVCN, RN, LPT, MD  Combined Oral Contraceptives Known Health Benefits Reduce: Menstrual cramps Menstrual bleeding problems Ovulation pain Excess hair on face or body Symptoms of polycystic ovarian syndrome Symptoms of endometriosis (pelvic pain, irregular bleeding) SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Combined Oral Contraceptives COCs are not routinely prescribed for women with a history of thromboembolic disease or a family history of cerebral or cardiovascular accident, who have migraine with aura, or who smoke because of the increased tendency toward clotting as an effect of the increased estrogen. SVCN, RN, LPT, MD  Combined Oral Contraceptives Advise all women taking COCs to notify their healthcare provider if symptoms of myocardial or thromboembolic complications occur, such as: Chest pain (pulmonary embolus or myocardial infarction) Shortness of breath (pulmonary embolus) Severe headache (cerebrovascular accident) Severe leg pain (thrombophlebitis) Eye problems, such as blurred vision (hypertension, cerebrovascular accident SVCN, RN, LPT, MD  Estrogen-Based Oral Contraceptive Use Contraindications Breastfeeding and less than 6 weeks postpartum Aged 35 years or older and smoking 15 or more cigarettes per day Multiple risk factors for arterial cardiovascular disease, such as older age, smoking, diabetes, moderate or severe hypertension Current or history of deep vein thrombosis or pulmonary embolism SVCN, RN, LPT, MD  Estrogen-Based Oral Contraceptive Use Contraindications Major surgery that requires prolonged immobilization Current or history of ischemic heart disease or cerebrovascular accident Complicated valvular heart disease Migraine with focal neurologic symptoms (migraine with aura) SVCN, RN, LPT, MD  Estrogen-Based Oral Contraceptive Use Contraindications Current breast cancer or diabetes with nephropathy, retinopathy, neuropathy, vascular disease, or diabetes of more than 20 years’ duration Severe cirrhosis or liver tumors Women taking certain seizure drugs such as phenobarbital or phenytoin (Dilantin) and women taking rifabutin for tuberculosis treatment Women prescribed certain broad-spectrum antibiotics such as tetracycline SVCN, RN, LPT, MD  Progestin-Only Pills (Mini Pills) Without estrogen content, ovulation may occur, but because the progestins have not allowed the endometrium to develop fully or sperm to freely access the cervix, fertilization and implantation will not take place. SVCN, RN, LPT, MD  Progestin-Only Pills (Mini Pills) Do not contain estrogen, and so can be used throughout breastfeeding and by women who cannot use methods with estrogen. SVCN, RN, LPT, MD  Progestin-Only Pills (Mini Pills) Do not contain estrogen, and so can be used throughout breastfeeding and by women who cannot use methods with estrogen. SVCN, RN, LPT, MD  Oral Contraceptives Side Effects Changes in bleeding patterns, including: Lighter bleeding and fewer days of bleeding Irregular bleeding Infrequent bleeding No monthly bleeding SVCN, RN, LPT, MD  Oral Contraceptives Side Effects Headaches Dizziness Nausea Breast tenderness Weight change SVCN, RN, LPT, MD  Oral Contraceptives Side Effects Mood changes Acne Other possible physical changes: Blood pressure increases a few points (mmHg). When increase is due to COCs, blood pressure declines quickly after use of COCs stops. SVCN, RN, LPT, MD  Oral Contraceptives Nursing Care Planning Based on Family Teaching Q: Dana, 17 years old, asks you, “What do I do if I forget to take an oral contraceptive pill?” A: The answer differs, depending on your situation. SVCN, RN, LPT, MD  Oral Contraceptives Nursing Care Planning Based on Family Teaching If the pill omitted was one of the placebo ones, ignore it and just take the next pill on time the next day. SVCN, RN, LPT, MD  Oral Contraceptives Nursing Care Planning Based on Family Teaching If you forgot to take one of the active pills, take it as soon as you remember. Continue the following day with your usual pill schedule. Doing so might mean taking two pills on one day if you don’t remember until the second day, but that’s all right. Missing one pill this way should not initiate ovulation. SVCN, RN, LPT, MD  Oral Contraceptives Nursing Care Planning Based on Family Teaching If you miss two consecutive active pills, take two pills as soon as you remember. Then, continue the following day with your usual schedule. You may experience some breakthrough bleeding (vaginal spotting) with two forgotten pills. Missing two pills may allow ovulation to occur, so an added contraceptive such as a spermicide should be used for the remainder of the month. SVCN, RN, LPT, MD  Oral Contraceptives Nursing Care Planning Based on Family Teaching If you miss three or more pills in a row, throw out the rest of the pack and start a new pack of pills. You might not have a period because of this routine and should use extra protection until 7 days after starting a new pack of pills. SVCN, RN, LPT, MD  Combined Oral Contraceptives Nursing Care Planning Based on Family Teaching If you think you might be pregnant, stop taking pills and notify your healthcare provider. SVCN, RN, LPT, MD Progestin Only Pills SVCN, RN, LPT, MD Combined Oral Contraceptives SVCN, RN, LPT, MD  Emergency Contraceptive Pills “morning after” pills or postcoital contraceptives. Work by preventing or delaying the release of eggs from the ovaries (ovulation). They do not work if a woman is already pregnant. SVCN, RN, LPT, MD  Emergency Contraceptive Pills A special ECP product with levonorgestrel only, or ulipristal acetate (UPA) Progestin-only pills with levonorgestrel or norgestrel Combined oral contraceptives with estrogen and a progestin— levonorgestrel, norgestrel, or norethindrone (norethisterone) SVCN, RN, LPT, MD  Emergency Contraceptive Pills When to take ECPs: As soon as possible after unprotected sex. The sooner ECPs are taken after unprotected sex, the better they prevent pregnancy. Can help to prevent pregnancy when taken any time up to 5 days after unprotected sex. SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Emergency Contraceptive Pills Side Effects: Changes in bleeding patterns, including: – Slight irregular bleeding for 1–2 days after taking ECPs – Monthly bleeding that starts earlier or later than expected SVCN, RN, LPT, MD  Emergency Contraceptive Pills Side Effects: In the first several days after taking ECPs: Nausea Abdominal pain Fatigue Headaches Breast tenderness Dizziness Vomiting SVCN, RN, LPT, MD  Emergency Contraceptive Pills All women can use ECPs safely and effectively, including women who cannot use ongoing hormonal contraceptive methods. Because of the short-term nature of their use, there are no medical conditions that make ECPs unsafe for any woman. SVCN, RN, LPT, MD Emergency Contraceptive Pills SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch patches that slowly but continuously release a combination of estrogen and progesterone SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch Patches are applied each week for 3 weeks. No patch is applied the fourth week. SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch During the week on which the woman is patch free, a menstrual flow will occur. After the patch-free week, a new cycle of 3 weeks on, 1 week off begins again. The efficiency of transdermal patches is equal to COCs, although they may be less effective in women who are obese. Because they contain estrogen, they have the same risk for thromboembolic symptoms as COCs. SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch Patches may be applied to one of four areas: ○ upper outer arm ○ upper torso (front or back, excluding the breasts) ○ abdomen ○ gluteal They should not be placed on any area where makeup, lotions, or creams will be applied; at the waist where bending might loosen the patch; or anywhere the skin is red, irritated, or has an open lesion. SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch If a patch does come loose, the woman should remove it and immediately replace it with a new patch. If the woman is not sure how long the patch has been loose, she should remove it and apply a new patch to start a new 4-week cycle, with a new day 1 and a new week to change the patch ○ use a backup contraception method (condom or spermicide) for the first week of this new cycle. SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch Mild breast discomfort and irritation at the application site Woman does not need to remember to take a daily pill SVCN, RN, LPT, MD Estrogen/Progesterone Transdermal Patch SVCN, RN, LPT, MD  Vaginal Estrogen/Progestin Rings (Nuvaring) etonogestrel/ethinyl estradiol vaginal ring flexible silicone vaginal ring when placed in the vagina, continually releases a combination of estrogen and progesterone SVCN, RN, LPT, MD  Vaginal Estrogen/Progestin Rings (Nuvaring) Continuously releases 2 hormones—a progestin and an estrogen, like the natural hormones progesterone and estrogen in a woman’s body—from inside the ring. Hormones are absorbed through the wall of the vagina directly into the bloodstream. SVCN, RN, LPT, MD Vaginal Estrogen/Progestin Rings (Nuvaring) SVCN, RN, LPT, MD  Vaginal Estrogen/Progestin Rings (Nuvaring) The ring is inserted vaginally by the woman and left in place for 3 weeks and then removed for 1 week with menstrual bleeding occurring during the ring-free week. SVCN, RN, LPT, MD  Vaginal Estrogen/Progestin Rings (Nuvaring) hormones released are absorbed directly by the mucous membrane of the vagina, thereby avoiding a “first pass” through the liver ○ beneficial in patients w/ liver disease SVCN, RN, LPT, MD  Vaginal Estrogen/Progestin Rings (Nuvaring) vaginal discomfort Women should be counseled that if they should take out the ring for more than 4 hours for any purpose, they should replace it with a new ring and use a form of barrier protection for the next 7 days. SVCN, RN, LPT, MD Vaginal Estrogen/Progestin Rings (Nuvaring) SVCN, RN, LPT, MD Progesterone-Releasing Vaginal Ring A smooth, soft, flexible silicone ring placed in the vagina to prolong lactational amenorrhea (postponing the return of monthly bleeding) and help breastfeeding women space pregnancies. SVCN, RN, LPT, MD Progesterone-Releasing Vaginal Ring Continuously releases natural progesterone hormone—like that in a woman’s body—from inside the ring. The hormone passes through the wall of the vagina directly into the bloodstream. SVCN, RN, LPT, MD Progesterone-Releasing Vaginal Ring Use of the ring starts 4 to 9 weeks after giving birth. Each ring is kept in place for 90 days. The woman can then replace it with a new ring immediately. Up to 4 rings can be used, one after another, with no breaks. SVCN, RN, LPT, MD Progesterone-Releasing Vaginal Ring  Subdermal Hormone Implants A progestin-filled miniature rod no bigger than a matchstick, etonogestrel implant can be embedded just under the skin on the inside of the upper arm where it will slowly release progestin over a period of 3 years. SVCN, RN, LPT, MD  Subdermal Hormone Implants effectively suppress ovulation, thicken cervical mucus, and change the endometrium lining, making implantation difficult SVCN, RN, LPT, MD  Subdermal Hormone Implants rod is inserted as an in-office procedure with the use of a local anesthetic during menses or no later than day 7 of a menstrual cycle to be certain a woman is not pregnant at the time of insertion SVCN, RN, LPT, MD  Subdermal Hormone Implants It can be placed immediately after an elective termination of pregnancy or 6 weeks after the birth of a baby. An implant is so effective, the failure rate is less than 1%, comparable to oral contraception.  Subdermal Hormone Implants Implants work primarily by: – Preventing the release of eggs from the ovaries (ovulation) – Thickening cervical mucus (this blocks sperm from reaching an egg) SVCN, RN, LPT, MD  Subdermal Hormone Implants Can be used during breastfeeding without an effect on milk production. The rapid return to fertility after removal is an advantage for women when they become ready to begin a family. SVCN, RN, LPT, MD  Subdermal Hormone Implants Side effects weight gain, irregular menstrual cycle (heavy bleeding, spotting, breakthrough bleeding, and amenorrhea), depression, scarring at the insertion site, and need for removal SVCN, RN, LPT, MD  Intramuscular Injections A single intramuscular injection of depot medroxyprogesterone acetate or DMPA (Depo-Provera), a progesterone given every 12 weeks, inhibits ovulation, alters the endometrium, and thickens the cervical mucus so sperm progress is difficult. SVCN, RN, LPT, MD  Intramuscular Injections effectiveness rate: 100% IM Do not massage the site after administration SVCN, RN, LPT, MD  Intramuscular Injections contains only progesterone, it can be used during breastfeeding - although women should wait about 6 weeks after birth for the first injection SVCN, RN, LPT, MD  Intramuscular Injections advantageous effects are reductions in ectopic pregnancy, endometrial cancer, endometriosis, and the frequency of sickle cell crises SVCN, RN, LPT, MD Intramuscular Injections “black box” warning: not to use the method long term (not over 2 years) to protect against bone loss  Intramuscular Injections Nursing Implications: Advise patient to have a routine physical examination that includes breast examination, pelvic examination, and Pap smear. Caution the patient that potential side effects such as weight gain may occur. Advise patient to maintain a high calcium intake to reduce development of osteoporosis. SVCN, RN, LPT, MD  Intramuscular Injections Nursing Implications: Advise the patient to report pain or swelling of the legs, acute chest pain, or shortness of breath; tingling or numbness in the extremities; loss of vision; sudden severe headaches; dizziness; or fainting; these could be signs of potentially serious cardiovascular complications. SVCN, RN, LPT, MD  HORMONAL CONTRACEPTION AND EFFECT ON PREGNANCY Estrogen/progestin If a woman taking an estrogen/progestin combination pills combination pill suspects she is pregnant, she (COCs) should discontinue taking any more pills if she intends to continue the pregnancy as high levels of estrogen might be teratogenic to a growing fetus. Progestin- If a woman using a progestin ring or patch impregnated rings becomes pregnant, the progestin should have or progestin no effect on a developing fetus. After patches discontinuing both methods, women become fertile again immediately. SVCN, RN, LPT, MD  HORMONAL CONTRACEPTION AND EFFECT ON PREGNANCY Subdermal If a woman becomes pregnant while using a implants subdermal implant, the rod can be removed; although, because the implant releases only progestin, there should be no effect on the fetus. At the end of 3 years, when the implant is removed (a 5- to 10-minute procedure), the woman will be fertile again almost immediately. DMPA Should have no effect if a woman becomes pregnant. Return to fertility is often delayed by 6 to 12 months. SVCN, RN, LPT, MD  HORMONAL CONTRACEPTION AND EFFECT ON ADOLESCENT COCs Recommended that adolescent girls have well-established menstrual cycles for at least 2 years before using it. Waiting at least 2 years also helps ensure the preadolescent growth spurt will not be halted. Side benefits of improving facial acne and dysmenorrhea. SVCN, RN, LPT, MD Care of the Mother and the Fetus during the Perinatal Period Care of Mother, Child, & Adolescent Main References: Silbert-Flagg, J. (2022). Maternal & Child Health Nursing. LWW. SVCN, RN, LPT, MD Professor Faculty Member, School of Nursing SVCN, RN, LPT, MD Stages of Fetal Development Care of the Mother and the Fetus during the Perinatal Period SVCN, RN, LPT, MD  Stages of Fetal Development Pre-embryonic ○ first 2 weeks, beginning with fertilization) Embryonic ○ weeks 3 through 8 Fetal ○ from week 8 through birth SVCN, RN, LPT, MD Fetal Growth Time Period Ovum From ovulation to fertilization Zygote From fertilization to implantation Embryo From implantation to 5–8 weeks Fetus From 5–8 weeks until term Conceptus Developing embryo and placental structures throughout pregnancy Age of viability The earliest age at which fetuses survive if they are born is generally accepted as 24 weeks or at the point a fetus weighs more than 500–600 g SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Fertilization union of an ovum and a spermatozoon usually occurs in the outer third of a fallopian tube — ampullar portion also referred to as conception and impregnation SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Fertilization Immediately after penetration of the ovum, the chromosomal material of the ovum and spermatozoon fuse to form a zygote. Spermatozoon and ovum each carried 23 chromosomes (22 autosomes and 1 sex chromosome), the fertilized ovum has 46 chromosomes. SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Fertilization If an X-carrying spermatozoon entered the ovum, the resulting child will have two X chromosomes and will be assigned female at birth (XX). SVCN, RN, LPT, MD  Fertilization If a Y-carrying spermatozoon fertilized the ovum, the resulting child will have an X and a Y chromosome and will be assigned male at birth (XY). SVCN, RN, LPT, MD  Fertilization Fertilization is never a certain occurrence because it depends on at least three separate factors: Equal maturation of both sperm and ovum Ability of the sperm to reach the ovum Ability of the sperm to penetrate the zona pellucida and cell membrane and achieve fertilization SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Fertilization Blastocyst ○ As early as 4 to 5 days after fertilization, the 58-cell blastocyst differentiates into five embryo-producing cells—the inner cell mass. ○ The remaining 53 outer cells, called the trophectoderm, are destined to form trophoblasts. SVCN, RN, LPT, MD  Fertilization Blastocyst ○ The blastocyst is released from the zona pellucida secondary to secretion of specific proteases from the secretory-phase endometrial glands. SVCN, RN, LPT, MD  Fertilization Blastocyst ○ secretes interleukin-1α (IL-1α) and IL-1β, which are cytokines that likely directly influence the endometrium SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Implantation blastocyst implants into the uterine wall 6 or 7 days after fertilization occurs approximately 8 to 10 days after fertilization SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Implantation usually occurs high in the uterus on the posterior surface ○ placenta previa Once implanted, the zygote is called an embryo SVCN, RN, LPT, MD  Implantation Implantation is an important step in pregnancy because as many as 50% of zygotes never achieve it (Gardosi, 2012). In these instances, the pregnancy ends as early as 8 to 10 days after conception, often before a woman is even aware she was pregnant. SVCN, RN, LPT, MD  Implantation Vaginal spotting appears on the day of implantation because capillaries are ruptured by the implantation trophoblast cells. SVCN, RN, LPT, MD  Implantation A woman who normally has a particularly scant menstrual flow could mistake implantation bleeding for her menstrual period. If this happens, the predicted date of birth of her baby (based on the time of her last menstrual period) will be calculated 4 weeks late. SVCN, RN, LPT, MD Embryonic and Fetal Structures Care of the Mother and the Fetus during the Perinatal Period SVCN, RN, LPT, MD  The Decidua or Uterine Lining human chorionic gonadotropin (hCG) secreted by the trophoblast cells ○ uterine endometrium to continue to grow in thickness and vascularity SVCN, RN, LPT, MD  The Decidua or Uterine Lining endometrium is now typically termed the decidua (Latin word for “falling off”) because it will be discarded after birth of the child SVCN, RN, LPT, MD  Chorionic Villi As early as the 11th or 12th day after fertilization, miniature villi, resembling probing fingers and termed chorionic villi, reach out from the trophoblast cells into the uterine endometrium to begin formation of the placenta. SVCN, RN, LPT, MD  Chorionic Villi produce various placental hormones, such as hCG, somatomammotropin (human placental lactogen [hPL]), estrogen, and progesterone SVCN, RN, LPT, MD  Chorionic Villi cytotrophoblast or Langhans’ layer ○ protect the growing embryo and fetus from certain infectious organisms such as the spirochete of syphilis early in pregnancy SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Placenta grows from a few identifiable trophoblastic cells at the beginning of pregnancy to an organ 15 to 20 cm in diameter and 2 to 3 cm in depth, covering about half the surface area of the internal uterus at term SVCN, RN, LPT, MD  Placental Circulation As early as the 12th day of pregnancy, maternal blood begins to collect in the intervillous spaces of the uterine endometrium surrounding the chorionic villi. SVCN, RN, LPT, MD  Placental Circulation By the third week, oxygen and other nutrients: ○ glucose, amino acids, fatty acids, minerals, vitamins, and water osmose from the maternal blood through the cell layers of the chorionic villi into the villi capillaries. SVCN, RN, LPT, MD Fetal Alcohol Syndrome SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Placental Circulation rate of uteroplacental blood flow in pregnancy increases from about 50 ml/min at 10 weeks to 500 to 600 ml/min at term SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Placental Circulation Braxton Hicks contractions ○ uterine contractions present from about the 12th week of pregnancy aid in maintaining pressure in the intervillous spaces by closing off the uterine veins momentarily with each contraction SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Placental Circulation Uterine perfusion and placental circulation are most efficient when the mother lies on her left side, as this position lifts the uterus away from the inferior vena cava, preventing blood from becoming trapped in the woman’s lower extremities SVCN, RN, LPT, MD SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Placental Circulation If the woman lies on her back and the weight of the uterus compresses on the vena cava, vena cava syndrome, placental circulation can be so sharply reduced that supine hypotension (i.e., very low maternal blood pressure and poor uterine circulation) can occur SVCN, RN, LPT, MD SVCN, RN, LPT, MD  Placental Circulation weighs 400 to 600 g (1 lb), one-sixth the weight of the newborn SVCN, RN, LPT, MD  Placenta If a placenta is smaller ○ it suggests circulation to the fetus may have been compromised and/or inadequate. SVCN, RN, LPT, MD  Placenta A placenta bigger ○ may indicate circulation to the fetus was threatened because it suggests the placenta was forced to spread out in an unusual manner to maintain a sufficient blood supply. ○ GDM SVCN, RN, LPT, MD  Endocrine Function Human Chorionic Gonadotropin Progesterone Estrogen Human Placental Lactogen (Human Chorionic Somatomammotropin) SVCN, RN, LPT, MD  Placental Proteins may contribute to decreasing the immunologic impact of the growing placenta and help prevent hypertension of pregnancy SVCN, RN, LPT, MD