Maternal and Child Health Nursing MIDTERM PDF

# Anatomy of the Male Reproductive System ## External Genital Organs * **Penis** * **Glans penis** * **Shaft** * **Prepuce (foreskin)** covers the glans * **Urethra** transports urine and semen out of the body. * Three cylindrical bodies of erectile tissue, a spongy network...

# Anatomy of the Male Reproductive System ## External Genital Organs * **Penis** * **Glans penis** * **Shaft** * **Prepuce (foreskin)** covers the glans * **Urethra** transports urine and semen out of the body. * Three cylindrical bodies of erectile tissue, a spongy network of vascular spaces which fill with blood during sexual excitement. * **Corpora cavernosa** - paired erectile bodies dorsal to the urethra which are responsible for erection. * **Corpus spongiosum** - surrounds the urethra and prevents the collapse of the urethra during erection.. ## Internal Genital Organs * **Scrotum** * A pouch of skin formed from the lower abdominal wall. * The scrotum keeps the testes at a temperature slightly cooler than body temperature. * **Testes** * Organs responsible for the production of: * **Male sex steroid hormone testosterone** * **Sperm**** * **Seminiferous tubules** * Are made of a simple columnar epithelium of Sertoli (Nurse) cells. * The sperm development (spermatogenesis) occurs between sertoli cells from the basal surface (inside the body)of the seminiferous tubule to the lumen (outside the body). * **Interstitial (Leydig) cells** found between again tubules synthesize testosterone. * Fluid within the seminiferous tubules flows toward the epididymis carrying the sperm. * **Epididymis** * A mass of coiled tubes on the superficial surface of each testes that the sperm must pass through prior to ejaculation * Sperm become mature (capable of fertilizing an ovum) as pass through its tubes toward the vas deferens. * During ejaculation, a layer of smooth muscle that surrounds the distal epididymis contracts, expelling sperm into the vas deferens. * **Vas Deferens (Ductus Deferens)** * A thin tube that starts from the epididymis to the urethra in the penis. * Convey sperm during sexual arousal through peristaltic contractions * Can also store sperm several months * **Accessory Glands** * These glands produce nourishing fluids for the sperms that enter the urethra. * **Seminal Vesicle** * Are sac-like structures attached to the vas deferens at one side of the bladder. * They produce a sticky yellowish fluid that contains fructose. * **Prostate Gland** * Surrounds the ejaculatory ducts at the base of the urethra, just below bladder. * Responsible for making the production of semen, a liquid mixture of sperm cells, prostate fluid and seminal fluid. * **Bulbourethral Glands (Cowper's Glands)** * Are two small glands located on the sides of the urethra just below prostate gland. * These glands produce a clear, slippery fluid that empties directly into the urethra. * 2 pea-sized glands inferior to the prostate. * Produce thick, clear mucus during erection which: * Neutralizes traces of acidic urine in the urethra * Lubricate the urethra to facilitate the ejaculation of semen # The Female Reproductive System ## Ovary * The female reproductive system has two ovaries. * They contain undeveloped eggs (ova) which are present from birth. * They also make hormones which regulate the menstrual cycle. * One of the ovaries releases a mature egg as part of the menstrual cycle. ## Oviduct * The oviducts are two tubes which connect the ovaries to the uterus. * Oviducts are also known as fallopian tubes. * They are lined with hair like cells called cilia to help move the egg from the ovary to the uterus. ## Uterus * The uterus is muscular with a soft lining. * A fertilized egg can implant in the uterus wall and develop from an embryo to a baby over the course of a pregnancy. * The lining of the uterus wall comes away as a period if an egg is not fertilized by a sperm. ## Cervix * The cervix is a ring of muscle which keeps the baby in the uterus during pregnancy. * The cervix dilates to open during labor ## Vagina * The vagina is a muscular tube which connects the cervix to outside the body. * It is where the penis enters during sexual intercourse and where the baby exits the body during child birth. * The vagina is also where the menstrual blood (period) leaves the body. # The Menstrual Cycle and Hormones ## Day 1-5 * Menstruation occurs if the egg is not fertilized by a sperm. * Blood is lost. ## Day 5-14 * FSH causes the egg to mature in the ovary. ## Day 14 * LH stimulates the release of an egg. ## Day 14-28 * Progesterone maintains the lining of the uterus, ready for a fertilized egg. # Fertilization * Is the process where a sperm cell unites with an egg cell to form a fertilized egg, known as zygote. # Menstrual Cycle * The menstrual cycle involves changes in the uterus as it grooms the uterus for a possible implantation and later on pregnancy * The menstrual cycle is regulated by a complex interplay of hormones. ## Hormonal Regulation * **Hypothalamus** * **Pituitary gland** * **Ovaries** * **Uterus** ## Phases of the Menstrual Cycle * **Menstrual Phase (Day 1-4)** * Shedding of the uterine lining * **Follicular phase (Days 6-14)** * Follicle development and estrogen production * **Ovulatory phase (Day 14)** * Release of immature egg from the ovary * **Luteal Phase (Days 15-28)** * Formation of the corpus luteum and progesterone production ## Normal Variations. In The Menstrual Cycle * The menstrual cycle lasts an average of 28 days. * **Cycle Length** * **Flow** * **Pain** * **Other Variations** * *Irregular Cycles* * *Spotting* * *Premenstrual Symptoms* ## Factors Influencing Cycle Length * Includes: * **Age** * **Stress** * **Weight** * **Medications** ## Common Menstrual Cycle-related Issues * **Premenstrual syndrome (PMS)** * **Premenstrual dysphoric disorder (PMDD)** * **Amenorrhea** * **Oligomenorrhea** * **Menorrhagia** ## Premenstrual Syndrome (PMS) * A cluster of physical and emotional symptoms that occur in the days leading up to menstruation. * Symptoms can include mood swings, irritability, bloating, breast tenderness, and fatigue ## Premenstrual Dysphoric Disorder (PMDD) * A more severe form of PMS characterized by significant emotional distress and impairment in daily functioning ## Amenorrhea * Absence of menstruation. * Can be caused by various factors including hormonal imbalances, stress and underlying medical conditions. ## Oligomenorrhea * Infrequent menstruation, with cycles longer than 35 days ## Menorrhagia * Heavy menstrual bleeding, lasting longer than 7 days or involving the passage of large blood clots. # Hormones Involved Sexual Development, Reproduction, and Sexual Function ## What Is Hormones? * Hormones act as the body's chemical messengers, assisting organs and tissues in performing their functions by traveling through the bloodstream. ## Estrogen * Primary sex hormones that plays a crucial role in the development and regulation of the female reproductive system and secondary characteristics * Three Major Forms Of Estrogen: * **Estrone (€1)** * **Estradiol (E2)** * **Estriol (€3)** ## Progesterone * A type of hormones made by the body that plays a role in the menstrual cycle and pregnancy ## Prolactin. * The pituitary gland releases this hormone after childbirth to support lactation, allowing females to breastfeed. ## Testosterone * A hormone responsible for their role in male secondary characteristics. ## Oxytocin * Is a hormone produced in the hypothalamus and released by the pituitary gland, known for its roles in childbirth, lactation, and social bonding. # Fertilization, Implantation and Conception ## Fertilization * The process of fusion of male gamete which is called a spermcell and female gamete which is called an ova or egg cells to form the zygote. * This process typically happens in the fallopian tube after ovulation. * The site of fertilization is the ampulla of the uterine tube. ## Process of Fertilization * **Approach of sperm to ova** * Chemotaxis is the ovum releases chemical signals, guiding sperm towards the egg. * Hyperactivation increases sperm motility, allowing them to penetrate the fallopian tubes. * **Capacitation and contact** * Capacitation is the maturation process that sperm undergo to gain the ability to fertilize an egg which happens in the uterus and oviducts, while contact involves the initial interaction between the sperm and egg, leading to fertilization. * **Acrosomal reaction and penetration** * The acrisomal reaction is triggered when the sperm meets the egg the acrosome at the tip of the sperm releases hydrolytic enzymes that digest material surrounding the egg ## Activation of ovum * The process that occurs immediately after a sperm successfully penetrates the egg which make the sperm nucleus merge withe egg nucleus and the cell division begins.. ## Amphimixis * Is the fusion of female and male pronuclei creating a zygote which completes the fertilization process ## Implantation * Follows fertilization. * After the zygote undergoes several cell divisions, it becomes a blastocyst and travels down to the uterus. * Penetration of the blastocyst into the superficial layer of the endometrium. * The endometrium after implantation is called decidua ## Site of implantation * Posterior wall of the uterine body in the functional layer of the endometrium ## Stages of Implantation * **Hatching** * Blastocyst gets released from zonal pellucida. * **Adplantation** * Blastocyst slowly rolls on the surface, aligns with the ICM close to the epithelium. * **Apposition** * The very first loose connection between the blastocyst and the endometrium. * **Adhesion** * The trophoblast adhere by penetrating the endometrium with protrusions of trophoblast cells. * **Invasion** * Invading into the uterine strom ## Conception * Natural conception is the interaction of many factors include correct timing between release of mature ovum at ovulation and ejaculation of enough healthy, mature, motile sperm into the vagina. * Conception refers to the beginning of pregnancy, which can be seen as the point when the zygote starts developing into an embryo. # Embryonic and Fetal Structures: Decidua, Chorionic Villi and Placenta ## What Is Decidua? * The decidua is the specialized endometrial lining of the uterus that undergoes significant transformation during pregnancy. * Upon implantation of the blastocyst, the endometrium undergoes a process called decidualization, which involves extensive cellular and molecular changes. ## The Decidua Can Be Categorized into Three Regions: * **Decidua Basalis:** This is the part of the decidua that interacts directly with the chorion and forms the maternal portion of the placenta. * **Decidua Capsularis:** This encases the developing embryo and surrounds the chorionic sac. * **Decidua Parietalis:** This lines the remainder of the uterus not directly in contact with the chorion ## Roles of Decidua During Pregnancy * **Nutrient Supply:** The decidua provides nutrients to the early embryo before the placenta is fully developed. * **Immune Protection:** It acts as a barrier to help protect the embryo from the mother's immune system, which might otherwise recognize it as foreign and try to reject it. * **Support for Placenta:** The decidua helps anchor the placenta to the uterine wall and supports its growth. ## What Is Chorionic Villi? * Chorionic villi are small, finger-like structures that come from the chorion, which is the outermost layer surrounding the fetus. * These villi start to form around the second week of pregnancy and are important for creating the placenta. * They grow into the mother's uterine lining (endometrium) and help connect the fetus to the mother for nutrient and waste exchange. ## Roles of Chorionic Villi During Pregnancy * **Nutrient and Gas Exchange:** They facilitate the transfer of oxygen, carbon dioxide, nutrients, and waste products between the mother and the fetus. * **Hormone Production:** Chorionic villi produce hormones such as human chorionic gonadotropin (hCG), which supports pregnancy by maintaining the corpus luteum. * **Immune Protection:** The villi create a semi-permeable barrier that limits maternal immune cell infiltration, protecting the fetus. ## What Is Placenta? * The placenta is a complex organ made from both maternal tissue (the decidua basalis) and fetal tissue (the chorion frondosum). * It is a temporary organ that lasts for the duration of the pregnancy and is essential for the health and development of the fetus ## How Does The Placenta Develops? * **Implantation:** The process starts when the blastocyst (a tiny, early embryo) attaches to the uterine lining (the decidua). This is when the first structures of the placenta, called chorionic villi, begin to form. * **Placental Maturation:** As the pregnancy progresses, the chorionic villi grow and develop a network of blood vessels. This helps the placenta become more efficient at transferring nutrients and oxygen to the growing fetus and removing waste products.. * **Full-Term Placenta:** By the end of the pregnancy, the placenta has developed into a disk-shaped organ that is about 20-25 centimeters wide and weighs around 500-600 grams. It's fully formed and ready to support the baby's needs. ## Roles of Placenta During Pregnancy * **Nutrient and Gas Exchange:** The placenta helps move nutrients (like glucose and oxygen) from the mother to the baby, and waste (like carbon dioxide) from the baby to the mother, using processes like diffusion and transport. * **Hormone Production:** The placenta makes important hormones, like progesterone and hCG, that support the pregnancy by regulating the mother's body and helping the baby develop. * **Waste Removal:** The placenta removes waste products from the baby (like urea and carbon dioxide) by passing them into the mother's blood, where they are excreted. * **Immune Protection:** The placenta protects the baby from being attacked by the mother's immune system and helps shield the baby from certain infections. ## Conclusion * The decidua, chorionic villi, and placenta are fundamental components in embryonic and fetal development, each contributing distinct yet interrelated functions to ensure the successful continuation of pregnancy. Understanding these structures and their roles not only illuminates the intricacies of human development but also highlights the remarkable adaptations that have evolved to support and protect the unborn child. # Embryonic and Fetal Structures: (Amniotic Membranes, Amniotic Fluid, Umbilical Cord) ## What Is Amniotic Membrane? * Amniotic membrane (AM) or amnion is a thin membrane on the inner side of the fetal placenta; it completely surrounds the embryo and delimits the amniotic cavity, which is filled by amniotic liquid. * The chorionic villi on the medial surface of the trophoblast gradually thin until they become the chorionic membrane, the outermost fetal membrane. * (Trophoblast - those that are not involved in implantation because they do not touch the endometrium) * The amniotic membrane, or amnion, forms beneath the chorion. The amniotic membrane is a dual-walled sac with the chorion as the outmost part and the amnion as the innermost part. * The amniotic membrane not only offers support to amniotic fluid but also actually produces the fluid. * In addition, it produces a phospholipid that initiates the formation of prostaglandins, which may be the trigger that initiates labor.. ## What Is Amniotic Fluid? * Amniotic fluid is a clear, slightly yellowish liquid that surrounds the unborn baby (fetus) during pregnancy, contained in the amniotic sac. * Polyhydramnios may occur when a fetus cannot swallow a normal amount of amniotic fluid due to a gastrointestinal, neurological, or other problem. * At term, the amount of amniotic fluid has grown so much it ranges from 800 to 1,200 ml.. * If for any reason the fetus is unable to swallow (esophageal atresia or anencephaly are the two most common reasons), excessive amniotic fluid or hydramnios (more than 2,000 ml in total or pockets of fluid larger than 8 cm on ultrasound) will result ## what Is The Umbilical Cord? * About 53 cm (21 in.) in length at term and about 2 cm (0.75 in.) thick. * The bulk of the cord is a gelatinous mucopolysaccharide called Wharton jelly * An umbilical cord contains: * Only one vein (carrying blood from the placental villi to the fetus) and * Two arteries (carrying blood from the fetus back to the placental villi). * 1% to 5% of infants are born with a cord that contains only a single vein and artery ## The rate of blood flow through an umbilical cord is rapid (350 ml/min at term). * The adequacy of blood flow (blood velocity) through the cord, can be determined by ultrasound examination * The walls of the umbilical cord arteries are lined with smooth muscle. * When these muscles contract after birth, the cord arteries and vein are compressed to prevent hemorrhage of the newborn through the cord. # Pregnancy Trimesters: A Guide ## Fetal Development (Every Semester) * By the end of the first 12 weeks: * All the body's major organs and structures have begun to develop. * The heart is beating regularly. * Fingers and toes have formed. * The fetus is around 3 inches (in) long and weighs nearly 1 ounce. * The nerves and muscles work together, and the fetus can make a fist. * The eyelids have formed and will remain closed until around week 28, to protect the eyes ## The First Trimester: * The first trimester is the first 12 weeks of the pregnancy, and it is a crucial time for fetal development. * The first trimester spans from conception to 12 weeks. The baby develops from a group of cells into a fetus that is starting to have a baby's features. **The fetus** * At conception, the egg and sperm combine to form a zygote, which implants in the wall of the uterus. * The zygote becomes an embryo as its cells divide and grow. ## The Second Trimester: * Weeks 14-27 are the second trimester. * The fetus goes through many changes during this time, growing to be around 1 foot long and weighing 1.5 pounds. * The second trimester is often seen as the best part of the pregnancy. * By this time, any morning sickness is probably gone, and the discomfort of early pregnancy fades. ## The Third Trimester: * The third trimester lasts from week 29 until delivery, which is usually around week 40. * Throughout the third trimester, the baby gains weight quickly, adding body fat that will help after birth. The baby's brain is developing rapidly at this time, and it can see and hear. * The baby's reflexes coordinate so he or she can blink, close the eyes, turn the head, grasp firmly, and respond to sounds, light, and touch. * The baby moves less due to tight space. Near the due date, the baby's position may have changed to prepare for birth. Ideally, the baby is head down in the uterus. * The typical full-term pregnancy is 40 weeks, which can come to ten months. ## The Fetus: * Most organs and body systems have formed by now, and they will continue to grow and mature. ## During this trimester: * Bones are hardening. Movements become more noticeable. * The eyes are open and can sense light. Lung formation becomes complete. * Lanugo falls away, and a waxy coating, called vernix, develops. * Toward delivery, the fetus drops lower in the person's abdomen and usually turns head-down # Signs and Symptoms of Pregnancy ## Sign vs. Symptom ### Signs * Is something a doctor, or other person, notices. * For example: If the doctor, nurse, or anyone other than the patient notices the rash, it is a sign. ### Symptoms * Is something an individual experiences. * For Example: If the patient notices the rash, it is a symptom. ## 3 Categories * **Presumptive** * **Probable** * **Positive** ## Presumptive (Subjective Signs) * Are the first indicators that you might be pregnant / unconfirm. * Include pigmentation and discoloration of skin and mucous membranes. # Presumptive (Presume) ## P- Period Absent (Amenorrhea) ## R - Really Tired (fatigue) ## € - Enlarged breast ## S- Sore breast ## U - Urination (frequency increased) ## M - Movement Perceived (Quickening) ## € - Emesis (Nausea, Vomiting) ## P- Period Absent ## R - Really Tired ## E - Enlarged breast ## S - Sore Breast ## U - Urination * Frequent Urination- is a common early sign of pregnancy, occurs due to increased levels of the hormones progesterone and human chorionic gonadotropin (hCG) ## M- Movement. Perceived. * Quickening it is the first fetal movement felt by mother. Maternal feeling of the fetus move, the earliest usually around 16 weeks. ## E - Emesis * Nausea and vomiting It is often called "morning sickness," but it can occur any time of day or night. may signal the rise in hormones within the body that's needed for a healthy pregnancy. ## Probable (Objective Signs) * Are related to detectable physical changes in the size, shape, and consistency of the uterus. # Probable (PROBABLE) ## P - Positive Pregnancy Test ## R - Returning of fetus when uterus pushed with fingers (Doctor, Nurses ), ( Ballottement) ## 0 - Outline of fetus palpated ## B - Braxten Hick's Contraction ## A- A softening of cervix (Goodell's Sign) ## B - Bluish color vulva, vagina, cervix (Chadwick's Sign) ## L - Lower uterine segment soft ( Hegar's Lower Sign) ## € - Enlarged Uterus ## P- Positive Pregnancy Test * Means that hCG was found in your sample. Meaning that you're pregnant. ## R - Returning of fetus when uterus pushed with fingers * Ballottement: examiner inserts finger into the vagina, pushes on uterus and feels the return of the fetus to the finger ## 0 - Outline of fetus palpated * When palpated the examiner spilling the abdomen there feeling if there's something there it could be a baby or it could be something else. ## B - Braxton Hick's Contraction * Are sporadic contractions and relaxation of the uterine muscle. Referred to as prodromal or "false labor" pains. It is believed they start around 6 weeks gestation but usually are not felt until the second or third trimester of the pregnancy. # Positive (Confirmative Sign) * Conclusive, absolute, definite. -include detection of physical heartbeat and recognition of fetal movement.. # Positive (FETUS) ## f - fetal Movement felt by Doctor, Nurses ## € - Electronic Device Detects ## B - Blush color vulva, vagina, cervix (Chadwick's Sign) ## T - The Delivery of the baby ## U - Ultasound detects baby ## S - See Visible movement ## A - A Softening of cervix (Goodell's Sign) * Is at approximately 4 weeks gestation, the vaginal portion of the cervix gets softer due to increased vascularization ## B Bluish color vulva, Vagina, cervis (Chadwick 's Sign) * Is a purple/blue/violet discoloration of the cervix, labia and vagina due to increased vascularity and blood flow it turns to bluish color ## L - Lower Uterine segment soft (Hegar's Sign) * Is a softening at the bottom of the uterus, usually around 4-6 weeks is a sign used to confirm pregnancy. ## E - Enlarged Uterus * The uterus must expand during pregnancy to accommodate the growing baby. # Nursing Care Related to Psychological Changes in Pregnancy ## Social Influences * How well a pregnant person and their partner feel and how prepared they are to meet challenges during pregnancy is related to their cultural background, their personal beliefs, the experiences reported by friends and relatives, as well as by the current plethora of information available on the internet or through pregnancy apps for smart phones. ## Cultural Influences * A person's cultural background may strongly influence how active a role they want to take in their pregnancy because certain beliefs and taboos can place restrictions on their behavior and activities (Iradukunda, 2020). ## Family Influences * The family in which a pregnant person was raised can be influential to their beliefs about pregnancy because it is part of the cultural environment. ## Individual Influences * A person's ability to cope with or adapt to stress plays a major role in how they can resolve any conflict about becoming a parent ## Partner' S Adaptation * The more emotionally attached a partner is to a pregnant person, the closer the partner's attachment is apt to be to the child. * Whether partners are able to form a close relationship with each other, as well as accept a pregnancy and a coming child, depends on the same factors that affect the pregnant person's decision making: cultural background, past experience, and relationships with family members (Tokhi et al., 2018) ## Emotional Responses That Can Cause Concern In Pregnancy: ## Body Image and Boundary * **Body image** - the way your body appears to yourself * **Body boundary** - a zone of separation you perceive between yourself and objects or other people Both change during pregnancy as a person begins to envision themselves as a parent or becoming "bigger" in many different ways. They may perceive themselves as needing body boundaries as if their body were delicate and easily harmed. ## Depression * A feeling of sadness marked by loss of interest in usual things, feelings of guilt or low self-worth, disturbed sleep, low energy, and poor concentration. ## Couvade Syndrome * Many partners experience physical symptoms such as nausea, vomiting, and backache to the same degree or even more intensely than their partners during a pregnancy; some begin to gain weight along with their partner. ## Changes In Sexual Desire * People who formerly were worried about becoming pregnant might truly enjoy sexual relations for the first time during pregnancy. * Others might feel a loss of desire because of their increase in estrogen, or they might unconsciously view sexual relations as a threat to the fetus they must protect. * Some may worry coitus could bring on early labor. ## Grief * Before a parent can take on a parenting role, they have to give up or alter their present role as they will never be the person they have been in exactly the same way again. ## Narcissism * Self-centeredness (narcissism) may be an early reaction to pregnancy. * A person who previously perhaps was barely conscious of their body, who dressed in the morning with little thought about what to wear, suddenly begins to concentrate on these aspects of their life. # Nursing Care Related to Physiological Changes in Pregnancy * Pregnancy-related physiological alterations can be classified as either systemic or local. * Both subjective and objective results are used to track pregnancy progress. * Typically, a 40-week pregnancy is when physiological changes take place. ## Reproductive System Changes * Pregnancy causes a variety of changes in a woman's reproductive system to: * Support fetal growth, * Create space for the growing fetus, and * Prepare for delivery. * Hormonal changes and the physical demands of pregnancy are the primary drivers of these changes. * Where changes take place in the reproductive system of the breast, ovaries, uterus, cervix, and vagina. ## Cervical Changes * **Increased Blood Flow And Swelling:** Higher estrogen levels cause the cervix to become more vascular and swollen, which softens it and changes its color from pink to a violet shade. * **Formation Of Mucus Plug:** Cervical glands enlarge and increase in number, producing mucus that forms a plug, known as the operculum, which protects the fetus by preventing infections. * **Goodell's Sign:** The cervix softens early in pregnancy, a change known as Goodell's sign, which is considered a probable sign of pregnancy. ## Ovarian Changes * **Corpus Luteum Maintenance:** In early pregnancy, hCG from the embryo keeps the corpus luteum active so it can produce the necessary hormones, progesterone and estrogen, to support the uterine lining. * **Placental Transition:** By around 10-12 weeks, the placenta takes over hormone production, leading the corpus luteum to shrink, and the ovaries become smaller and less active. * **Ovulation Prevention:** Elevated estrogen and progesterone levels inhibit FSH and LH, stopping ovulation during pregnancy. ## Uterine Changes * **Size And Weight Increase:** The uterus expands significantly, growing in size, weight, and volume. It starts as a small, pear-shaped organ in the pelvis and gradually stretches into the abdominal cavity. By the end of pregnancy, it can weigh over a kilogram and reach up to the lower chest. * **Wall Thickness And Stretching:** Initially thick, the uterine wall gradually thins as the uterus stretches to hold the fetus, amniotic fluid, and placenta. This allows the uterus to expand comfortably as the pregnancy progresses. * **Shape Change:** The uterus starts as a pear-shaped organ but becomes more rounded and spherical as it enlarges. * **Blood flow Increase:** Blood supply to the uterus increases dramatically to provide the necessary nutrients and oxygen to the fetus. This also helps form the placenta, which connects the fetus to the mother's blood supply. * **Position Shift:** Initially located in the pelvis, the growing uterus eventually extends into the abdomen as the fetus develops, making more room for fetal growth. ## Vaginal Changes * **Increased Blood Flow:** Enhanced blood circulation causes a bluish or purplish tint to the vaginal walls, known as Chadwick's sign, which can indicate pregnancy. * **More Vaginal Discharge:** Higher estrogen levels lead to an increase in vaginal secretions, resulting in a thin, white, and odorless discharge called leukorrhea. This discharge helps flush out bacteria, providing protection against infections, while a more acidic vaginal pH further inhibits harmful bacteria. * **Thickening And Elasticity:** The vaginal walls thicken and soften, becoming more elastic to accommodate stretching during childbirth. * **Increased Blood Vessel Activity:** Blood vessels in the vaginal and vulvar areas expand, sometimes leading to varicose veins. The balance of bacteria in the vagina also changes, with more Lactobacillus species present to help maintain acidity and protect against infections. ## Breast Changes * **Increased Size:** Breasts grow larger due to hyperplasia (an increase in cell production) in the mammary glands and the buildup of fat. * **Areola Changes:** The areola darkens and its diameter expands from about 3.5 cm (1.5 in) to between 5 and 7.5 cm (2 to 3 in). * **Montgomery Tubercles:** The sebaceous glands in the areola, known as Montgomery tubercles, enlarge. These glands produce a lubricating substance that helps keep the nipple moisturized, preventing cracking and dryness during breastfeeding. * **Increased Sensitivity:** Hormonal changes can make the breasts more sensitive and tender, especially in the first trimester. * **Visible Veins:** Increased blood flow may make veins more noticeable beneath the skin. * **Colostrum Production:** As pregnancy nears its end, the body begins to produce colostrum, a nutrient-rich fluid that provides nourishment to the newborn before breast milk fully comes in. ## Endocrine Changes: * **Hormonal Increases:** Estrogen, progesterone, and hCG levels rise to support the pregnancy and maintain the uterine environment. * **Thyroid Function And Metabolic Rate Increase:** Thyroid hormones increase, boosting metabolism to meet the energy demands of mother and fetus. ## Gastrointestinal Changes: * **Slowed Motility:** Progesterone relaxes digestive muscles, slowing digestion and potentially causing constipation, acid reflux, and bloating. * **Enhanced Nutrient Absorption:** The body becomes more efficient at absorbing key nutrients to support fetal growth. ## Renal Changes: * **Increased Kidney Filtration:** Kidneys work harder, filtering more blood, which leads to increased urine production and a higher risk of UTIs.. * **Fluid Retention:** Hormonal changes cause fluid retention, often leading to swelling in the feet, legs, and hands ## Musculoskeletal Changes: * **Relaxation of Joints And Ligaments:** Relaxing hormone loosens ligaments and joints, especially around the pelvis, to prepare for delivery. * **Postural Changes:** As the abdomen grows, the body's center of gravity shifts, leading to an altered posture and additional strain on the lower back. # The Nursing Role in Promoting Nutritional Health During Pregnancy ## What is the relationship between Maternal Nutrition and Fetal Health? * During pregnancy, a mother's nutrition directly impacts the growth and development of the fetus. ## Recommended Weight Gain: * **Woman who is average** * **Woman who is underweight** * **Woman who is overweight** * **Woman who is morbidly obese** ## Components of Healthy Nutrition For The Pregnant Woman: * **Energy (Calorie) Needs** * **Protein Needs** * **fat Needs** * **Vitamin Needs** * **Mineral Needs** * **fiber Needs** * **fluid Needs** ## Energy (Calorie) Needs * Necessary to support the increased energy demands of pregnancy and fetal growth. * Increase by about 340 calories per day in the second trimester and 450 calories per day in the third trimester ## Protein Needs * Essential for the growth of fetal tissues, including the brain, and for the mother's increased blood supply. * Aim for 70-100 grams per d ## Fat Needs * Healthy fats support fetal brain and eye development. * Healthy fats should make up about 20-35% of total daily calorie. ## Vitamin Needs * **Folic Acid:** Prevents neural tube defects. Aim for 600-800 mcg per day. * **Vitamin D:** Supports bone health and immune function. Aim for 600 IU per day. * **Vitamin C:** Enhances iron absorption and promotes tissue repair. Aim for 85 mg per day. ## Minerals. * **Calcium:** Important for building the baby's bones and teeth and for the mother's bone health. Aim for 1,000-1,300 mg per day. * **Iron:** Necessary to support the increased blood volume and prevent anemia. Aim for 27 mg per day. * **Fluoride** * **Zinc** * **Iodine** ## Fiber Needs * Helps prevent constipation and supports digestive health, which can be an issue during pregnancy. * Aim for 25-30 grams per day. ## Fluid Needs * Adequate hydration is essential for maintaining the mother's increased blood volume, supporting fetal circulation, and aiding digestion. * Drink about 2.7 liters (91 ounces) of fluids per day. ## Foods To Avoid Or Limit In Pregnancy * Foods with Caffeine * Artificial Sweeteners * Weight Loss Diets # Promoting Nutritional Health During Pregnancy * **Family Considerations** * **Financial Considerations** * **Cultural Considerations** # Managing Common Problems Affecting Nutritional Health * **Nausea and Vomiting** * **Cravings** * **Diminished Gastric Mobility** * **Pyrosis (heartburn)** * **Hypercholesterolemia** # Women With Unique Needs * **The Adolescent** * **The Woman Older Than 40 Years Of Age** * **The Woman With A Stressful Lifestyle** * **The Woman With Nutritional Deficiencies** * The Woman With Decreased Nutritional Stores * The Woman Who Has Been Dieting or following a food fad * The Woman Who Eats Many fast-food Meals * The Woman Who Cannot Obtain Culturally Preferred foods * **THE WOMAN WHO HAS HAD BARIATRIC SURGERY** * **THE WOMAN WHO IS VEGETARIAN** * **THE WOMAN WITH A MULTIPLE PREGNANCУ** * **THE WOMAN WHO SMOKES OR USES DRUGS OR ALCOHOL** * **THE WOMAN WITH A CONCURRENT HEALTH PROBLEM** * **The Woman With Phenylketonuria** * **The Woman With Hyperemesis Gravidarum** * **The Woman With Lactose Intolerance** # Routine Diagnostic/Laboratory Findings and Deviations (Pregnancy Test, Urine Test) ## WhatIs Pregnancy Test? * The main use of a pregnancy test is to evaluate if you are pregnant. * Pregnancy tests look