The Reproductive System PDF

The Reproductive System The Reproductive System Gonads---primary sex organs Testes in males Ovaries in females Gonads produce gametes (sex cells) and secrete hormones Sperm---male gametes Ova (eggs)---female gametes Male Reproductive System Overview Testes Duct system Epididymis Ductus (...

The Reproductive System The Reproductive System Gonads---primary sex organs Testes in males Ovaries in females Gonads produce gametes (sex cells) and secrete hormones Sperm---male gametes Ova (eggs)---female gametes Male Reproductive System Overview Testes Duct system Epididymis Ductus (vas) deferens Urethra Male Reproductive System Overview Accessory organs Seminal vesicles Prostate Bulbourethral glands External genitalia Penis Scrotum Male Reproductive System Figure 16.2a Male Reproductive System Figure 16.2b Testes Coverings of the testes Tunica albuginea---capsule that surrounds each testis Septa---extensions of the capsule that extend into the testis and divide it into lobules Testes Figure 16.1 Testes Each lobule contains one to four seminiferous tubules Tightly coiled structures Function as sperm-forming factories Empty sperm into the rete testis (first part of the duct system) Sperm travels through the rete testis to the epididymis Interstitial cells in the seminiferous tubules produce androgens such as testosterone Testes Figure 16.1 Duct System Epididymis Ductus (vas) deferens Urethra Epididymis Comma-shaped, tightly coiled tube Found on the superior part of the testis and along the posterior lateral side Functions to mature and store sperm cells (at least 20 days) Expels sperm with the contraction of muscles in the epididymis walls to the vas deferens Epididymis Figure 16.1 Ductus Deferens (Vas Deferens) Carries sperm from the epididymis to the ejaculatory duct Passes through the inguinal canal and over the bladder Moves sperm by peristalsis Spermatic cord---ductus deferens, blood vessels, and nerves in a connective tissue sheath Ductus Deferens (Vas Deferens) Figure 16.1 Ductus Deferens (Vas Deferens) Ends in the ejaculatory duct which unites with the urethra Expanded end is called the ampulla Ejaculation---smooth muscle in the walls of the ductus deferens create peristaltic waves to squeeze sperm forward Vasectomy---cutting of the ductus deferens at the level of the testes to prevent transportation of sperm Urethra Extends from the base of the urinary bladder to the tip of the penis Carries both urine and sperm Sperm enters from the ejaculatory duct Urethra Regions of the urethra Prostatic urethra---surrounded by prostate Membranous urethra---from prostatic urethra to penis Spongy (penile) urethra---runs the length of the penis Urethra Figure 16.2b Accessory Organs Seminal vesicles Prostate Bulbourethral glands Accessory Organs Figure 16.2b Seminal Vesicles Located at the base of the bladder Produces a thick, yellowish secretion (60% of semen) Fructose (sugar) Vitamin C Prostaglandins Other substances that nourish and activate sperm Accessory Organs Figure 16.2b Prostate Encircles the upper part of the urethra Secretes a milky fluid Helps to activate sperm Enters the urethra through several small ducts Prostate Figure 16.2a Bulbourethral Glands Pea-sized gland inferior to the prostate Produces a thick, clear mucus Cleanses the urethra of acidic urine Serves as a lubricant during sexual intercourse Secreted into the penile urethra Bulbourethral Glands Figure 16.2a Semen Mixture of sperm and accessory gland secretions Advantages of accessory gland secretions Fructose provides energy for sperm cells Alkalinity of semen helps neutralize the acidic environment of vagina Semen inhibits bacterial multiplication Elements of semen enhance sperm motility External Genitalia Scrotum Penis External Genitalia Figure 16.2a External Genitalia Scrotum Divided sac of skin outside the abdomen Maintains testes at 3°C lower than normal body temperature to protect sperm viability External Genitalia Penis Delivers sperm into the female reproductive tract Regions of the penis Shaft Glans penis (enlarged tip) Prepuce (foreskin) Folded cuff of skin around proximal end Often removed by circumcision External Genitalia Figure 16.2a External Genitalia Internally there are three areas of spongy erectile tissue around the urethra Erections occur when this erectile tissue fills with blood during sexual excitement External Genitalia Figure 16.1 Male Reproductive System Overview PLAY Spermatogenesis Production of sperm cells Begins at puberty and continues throughout life Occurs in the seminiferous tubules Spermatogenesis Figure 16.3 Spermatogenesis Figure 16.3 (1 of 2) Spermatogenesis Figure 16.3 (2 of 2) Spermatogenesis Spermatogonia (stem cells) undergo rapid mitosis to produce more stem cells before puberty Follicle-stimulating hormone (FSH) modifies spermatogonia division One cell produced is a stem cell, called a type A daughter cell The other cell produced becomes a primary spermatocyte, called a type B daughter cell Spermatogenesis Primary spermatocytes undergo meiosis One primary spermatocyte produces four haploid spermatids Spermatids---23 chromosomes (half as much material as other body cells) Human Life Cycle Union of a sperm (23 chromosomes) with an egg (23 chromosomes) creates a zygote (2n or 46 chromosomes) Human Life Cycle Figure 16.4 Spermiogenesis Late spermatids are produced with distinct regions Head Midpiece Tail Sperm cells result after maturing of spermatids Spermatogenesis (entire process, including spermiogenesis) takes 64 to 72 days Structure of a Sperm Figure 16.5b Structure of a Sperm Figure 16.5a Anatomy of a Mature Sperm Cell The only human flagellated cell Head Contains DNA Acrosome---"helmet" on the nucleus, similar to a large lysosome Breaks down and releases enzymes to help the sperm penetrate an egg Midpiece Wrapped by mitochondria for ATP generation Testosterone Production The most important hormone of the testes Produced in interstitial cells During puberty, luteinizing hormone (LH) activate the interstitial cells In turn, testosterone is produced Testosterone Production Functions of testosterone Stimulates reproductive organ development Underlies sex drive Causes secondary sex characteristics Deepening of voice Increased hair growth Enlargement of skeletal muscles Thickening of bones Hormonal Control of the Testis Figure 16.6 The Reproductive System Female Reproductive System Ovaries Duct System Uterine tubes (fallopian tubes) Uterus Vagina External genitalia Female Reproductive System Figure 16.8a Ovaries Composed of ovarian follicles (sac-like structures) Each follicle consists of Oocyte (immature egg) Follicular cells---surround the oocyte Ovaries Figure 16.7 Ovarian Follicle Stages Primary follicle---contains an immature oocyte Graafian (vesicular) follicle---growing follicle with a maturing oocyte Ovulation---when the egg is mature, the follicle ruptures; occurs about every 28 days The ruptured follicle is transformed into a corpus luteum Support for Ovaries Suspensory ligaments---secure ovary to lateral walls of the pelvis Ovarian ligaments---attach to uterus Broad ligament---a fold of the peritoneum, encloses suspensory ligament Female Reproductive System Figure 16.8b Duct System Uterine tubes (fallopian tubes) Uterus Vagina Uterine (Fallopian) Tubes Receive the ovulated oocyte Provide a site for fertilization Attach to the uterus Little or no contact between ovaries and uterine tubes Supported and enclosed by the broad ligament Uterine Tube Anatomy and Physiology Fimbriae Finger-like projections at the distal end of the uterine tube Receive the oocyte from the ovary Cilia Located inside the uterine tube Slowly move the oocyte towards the uterus (takes 3--4 days) Fertilization occurs inside the uterine tube since oocyte lives about 24 hours Female Reproductive System Figure 16.8b Uterus Located between the urinary bladder and rectum Hollow organ Functions of the uterus Receives a fertilized egg Retains the fertilized egg Nourishes the fertilized egg Support for the Uterus Broad ligament---attached to the pelvis Round ligament---anchored anteriorly Uterosacral ligaments---anchored posteriorly Female Reproductive System Figure 16.8b Regions of the Uterus Body---main portion Fundus---superior rounded region above where uterine tube enters Cervix---narrow outlet that protrudes into the vagina Walls of the Uterus Endometrium Inner layer Allows for implantation of a fertilized egg Sloughs off if no pregnancy occurs (menses) Myometrium---middle layer of smooth muscle Perimetrium (visceral peritoneum)---outermost serous layer of the uterus Female Reproductive System Figure 16.8b Vagina Extends from cervix to exterior of body Located between bladder and rectum Serves as the birth canal Receives the penis during sexual intercourse Hymen---partially closes the vagina until it is ruptured Female Reproductive System Figure 16.8b External Genitalia (Vulva) Mons pubis Labia Clitoris Urethral orifice Vaginal orifice Greater vestibular glands Figure 16.9 External Genitalia (Vulva) Mons Pubis Fatty area overlying the pubic symphysis Covered with pubic hair after puberty Mons Pubis Figure 16.9 Labia Labia---skin folds Labia majora---hair-covered skin folds Labia minora---delicate, hair-free folds of skin Labia Figure 16.9 Vestibule and Greater Vestibular Glands Vestibule Enclosed by labia majora Contains external openings of the urethra, vagina Greater vestibular glands One is found on each side of the vagina Secretes lubricant during intercourse Vestibule and Orifice of Vestibular Gland Figure 16.9 Clitoris Contains erectile tissue Corresponds to the male penis The clitoris is similar to the penis in that it is Hooded by a prepuce Composed of sensitive erectile tissue Becomes swollen with blood during sexual excitement Clitoris Figure 16.9 Perineum Diamond-shaped region between the anterior ends of the labial folds, anus posteriorly, and ischial tuberosities laterally Perineum Figure 16.9 Oogenesis and the Ovarian Cycle The total supply of eggs are present at birth Ability to release eggs begins at puberty Reproductive ability ends at menopause Oocytes are matured in developing ovarian follicles Oogenesis and the Ovarian Cycle Oogonia---female stem cells found in a developing fetus Oogonia undergo mitosis to produce primary oocytes Primary oocytes are surrounded by cells that form primary follicles in the ovary Oogonia no longer exist by the time of birth Oogenesis and the Ovarian Cycle Primary oocytes are inactive until puberty Follicle stimulating hormone (FSH) causes some primary follicles to mature each month Cyclic monthly changes constitute the ovarian cycle Oogenesis and the Ovarian Cycle Meiosis starts inside maturing follicle Produces a secondary oocyte and the first polar body Follicle development to the stage of a vesicular follicle takes about 14 days Ovulation of a secondary oocyte occurs with the release of luteinizing hormone (LH) Secondary oocyte is released and surrounded by a corona radiata Ovulation Figure 16.11 Oogenesis and the Ovarian Cycle Meiosis is completed after ovulation only if sperm penetrates Ovum is produced Two additional polar bodies are produced Once ovum is formed, the 23 chromosomes can be combined with those of the sperm to form the fertilized egg (zygote) If the secondary oocyte is not penetrated by a sperm, it dies and does not complete meiosis to form an ovum Male and Female Differences Meiosis Males---produces four functional sperm Females---produces one functional ovum and three polar bodies Sex cell size and structure Sperm are tiny, motile, and equipped with nutrients in seminal fluid Egg is large, non-motile, and has nutrient reserves to nourish the embryo until implantation Oogenesis Figure 16.10 Meiotic Events Follicle Development in Ovary Before birth Childhood Primary oocyte Primary oocyte (still arrested in prophase I) Mature vesicular (Graafian) follicle Primary follicle Primary follicle Primary follicle Oocyte Ovulated secondary oocyte Growing follicle Primary oocyte (arrested in prophase I; present at birth) Oogonium (stem cell) Each month from puberty to menopause Meiosis I (completed by one primary oocyte each month) First polar body Mitosis Growth Meiosis II of polar body (may or may not occur) Polar bodies (all polar bodies degenerate) Ovum Second polar body Meiosis II completed (only if sperm penetration occurs) Sperm Ovulation Secondary oocyte (arrested in metaphase II) Follicle cells (ovary inactive) 2n 2n 2n 2n n n n n n Oogenesis Figure 16.10, step 1 Meiotic Events Follicle Development in Ovary Before birth Primary oocyte Primary follicle Oocyte Oogonium (stem cell) Mitosis Follicle cells 2n 2n Oogenesis Figure 16.10, step 2 Meiotic Events Follicle Development in Ovary Before birth Primary oocyte Primary follicle Primary follicle Oocyte Primary oocyte (arrested in prophase I; present at birth) Oogonium (stem cell) Mitosis Growth Follicle cells 2n 2n 2n Oogenesis Figure 16.10, step 3 Meiotic Events Follicle Development in Ovary Before birth Childhood Primary oocyte Primary follicle Primary follicle Oocyte Primary oocyte (arrested in prophase I; present at birth) Oogonium (stem cell) Mitosis Growth Follicle cells (ovary inactive) 2n 2n 2n Oogenesis Figure 16.10, step 4 Meiotic Events Follicle Development in Ovary Before birth Childhood Primary oocyte Primary oocyte (still arrested in prophase I) Primary follicle Primary follicle Primary follicle Oocyte Growing follicle Primary oocyte (arrested in prophase I; present at birth) Oogonium (stem cell) Each month from puberty to menopause Mitosis Growth Follicle cells (ovary inactive) 2n 2n 2n 2n Oogenesis Figure 16.10, step 5 Primary oocyte (still arrested in prophase I) Mature vesicular (Graafian) follicle Primary follicle Growing follicle Each month from puberty to menopause 2n Oogenesis Figure 16.10, step 6 Primary oocyte (still arrested in prophase I) Mature vesicular (Graafian) follicle Primary follicle Ovulated secondary oocyte Growing follicle Each month from puberty to menopause Meiosis I (completed by one primary oocyte each month) First polar body Ovulation Secondary oocyte (arrested in metaphase II) 2n n Oogenesis Figure 16.10, step 7 Primary oocyte (still arrested in prophase I) Mature vesicular (Graafian) follicle Primary follicle Ovulated secondary oocyte Growing follicle Each month from puberty to menopause Meiosis I (completed by one primary oocyte each month) First polar body Sperm Ovulation Secondary oocyte (arrested in metaphase II) 2n n Oogenesis Figure 16.10, step 8 Primary oocyte (still arrested in prophase I) Mature vesicular (Graafian) follicle Primary follicle Ovulated secondary oocyte Growing follicle Each month from puberty to menopause Meiosis I (completed by one primary oocyte each month) First polar body Meiosis II of polar body (may or may not occur) Polar bodies (all polar bodies degenerate) Ovum Second polar body Meiosis II completed (only if sperm penetration occurs) Sperm Ovulation Secondary oocyte (arrested in metaphase II) 2n n n n n n Oogenesis Figure 16.10, step 9 Meiotic Events Follicle Development in Ovary Before birth Childhood Primary oocyte Primary oocyte (still arrested in prophase I) Mature vesicular (Graafian) follicle Primary follicle Primary follicle Primary follicle Oocyte Ovulated secondary oocyte Growing follicle Primary oocyte (arrested in prophase I; present at birth) Oogonium (stem cell) Each month from puberty to menopause Meiosis I (completed by one primary oocyte each month) First polar body Mitosis Growth Meiosis II of polar body (may or may not occur) Polar bodies (all polar bodies degenerate) Ovum Second polar body Meiosis II completed (only if sperm penetration occurs) Sperm Ovulation Secondary oocyte (arrested in metaphase II) Follicle cells (ovary inactive) 2n 2n 2n 2n n n n n n The Reproductive System Uterine (Menstrual) Cycle Cyclic changes of the endometrium Regulated by cyclic production of estrogens and progesterone FSH and LH regulate the production of estrogens and progesterone Both female cycles are about 28 days in length Ovulation typically occurs about midway through cycle on day 14 Uterine (Menstrual) Cycle Stages of the menstrual cycle Menstrual phase Proliferative stage Secretory stage Uterine (Menstrual) Cycle Menstrual phase Days 1--5 Functional layer of the endometrium is sloughed Bleeding occurs for 3--5 days By day 5, growing ovarian follicles are producing more estrogen Uterine (Menstrual) Cycle Proliferative stage Days 6--14 Regeneration of functional layer of the endometrium Estrogen levels rise Ovulation occurs in the ovary at the end of this stage Uterine (Menstrual) Cycle Secretory stage Days 15--28 Levels of progesterone rise and increase the blood supply to the endometrium Endometrium increases in size and readies for implantation Uterine (Menstrual) Cycle Secretory stage (continued) If fertilization does occur Embryo produces a hormone that causes the corpus luteum to continue producing its hormones If fertilization does NOT occur Corpus luteum degenerates as LH blood levels decline Fluctuation of Gonadotropin Levels Figure 16.12a Fluctuation of Ovarian Hormone Levels Figure 16.12b Ovarian Cycle Figure 16.12c Uterine (Menstrual) Cycle Figure 16.12d Hormone Production by the Ovaries Estrogens Produced by follicle cells Cause secondary sex characteristics Enlargement of accessory organs Development of breasts Appearance of axillary and pubic hair Increase in fat beneath the skin, particularly in hips and breasts Widening and lightening of the pelvis Onset of menses (menstrual cycle) Hormone Production by the Ovaries Progesterone Produced by the corpus luteum Production continues until LH diminishes in the blood Does not contribute to the appearance of secondary sex characteristics Other major effects Helps maintain pregnancy Prepare the breasts for milk production Female Reproductive System Overview Postovulation PLAY Ovulation PLAY Female Reproductive System Overview PLAY Developmental Stages of Ovarian Follicle Figure 16.7 Mammary Glands Present in both sexes, but only function in females Modified sweat glands Function is to produce milk Stimulated by sex hormones (mostly estrogens) to increase in size Anatomy of Mammary Glands Areola---central pigmented area Nipple---protruding central area of areola Lobes---internal structures that radiate around nipple Lobules---located within each lobe and contain clusters of alveolar glands Alveolar glands---produce milk when a woman is lactating (producing milk) Lactiferous ducts---connect alveolar glands to nipple Female Mammary Glands Figure 16.13a Female Mammary Glands Figure 16.13b Mammography X-ray examination that detects breast cancers too small to feel Recommended every 2 years for women between 40 and 49 years old and yearly thereafter Mammograms Figure 16.14 Stages of Pregnancy and Development Fertilization Embryonic development Fetal development Childbirth Fertilization The oocyte is viable for 12 to 24 hours after ovulation Sperm are viable for 24 to 48 hours after ejaculation For fertilization to occur, sexual intercourse must occur no more than 2 days before ovulation and no later than 24 hours after Sperm cells must make their way to the uterine tube for fertilization to be possible Mechanisms of Fertilization When sperm reach the oocyte, enzymes break down the follicle cells of the corona radiata around the oocyte Once a path is cleared, sperm undergo an acrosomal reaction (acrosomal membranes break down and enzymes digest holes in the oocyte membrane) Membrane receptors on an oocyte pull in the head of the first sperm cell to make contact Mechanisms of Fertilization The membrane of the oocyte does not permit a second sperm head to enter The oocyte then undergoes its second meiotic division to form the ovum and a polar body Fertilization occurs when the genetic material of a sperm combines with that of an oocyte to form a zygote The Zygote First cell of a new individual The result of the fusion of DNA from sperm and egg The zygote begins rapid mitotic cell divisions The zygote stage is in the uterine tube, moving toward the uterus Cleavage Rapid series of mitotic divisions that begins with the zygote and ends with the blastocyst Zygote begins to divide 24 hours after fertilization Three to 4 days after ovulation, the preembryo reaches the uterus and floats freely for 2--3 days Late blastocyst stage---embryo implants in endometrium (day 7 after ovulation) Figure 16.15 Cleavage Fertilization Secondary oocyte Ovulation Uterus Endometrium Uterine tube Blastocyst cavity Inner cell mass Trophoblast Zygote (fertilized egg) Early cleavage 4-cell stage Early blastocyst Late blastocyst (implanting) Morula Ovary (a) (b) (d) (e) (c) (a) (b) (c) (d) (e) Figure 16.15, step 1 Cleavage Secondary oocyte Ovulation Uterus Endometrium Uterine tube Ovary Figure 16.15, step 2 Cleavage Fertilization Secondary oocyte Ovulation Uterus Endometrium Uterine tube Zygote (fertilized egg) Ovary (a) (a) Figure 16.15, step 3 Cleavage Fertilization Secondary oocyte Ovulation Uterus Endometrium Uterine tube Zygote (fertilized egg) Early cleavage 4-cell stage Ovary (a) (b) (a) (b) Figure 16.15, step 4 Cleavage Fertilization Secondary oocyte Ovulation Uterus Endometrium Uterine tube Zygote (fertilized egg) Early cleavage 4-cell stage Morula Ovary (a) (b) (c) (a) (b) (c) Figure 16.15, step 5 Cleavage Fertilization Secondary oocyte Ovulation Uterus Endometrium Uterine tube Blastocyst cavity Zygote (fertilized egg) Early cleavage 4-cell stage Early blastocyst Morula Ovary (a) (b) (d) (c) (a) (b) (c) (d) Figure 16.15, step 6 Cleavage Fertilization Secondary oocyte Ovulation Uterus Endometrium Uterine tube Blastocyst cavity Inner cell mass Trophoblast Zygote (fertilized egg) Early cleavage 4-cell stage Early blastocyst Late blastocyst (implanting) Morula Ovary (a) (b) (d) (e) (c) (a) (b) (c) (d) (e) Developmental Stages Embryo---developmental stage until ninth week Morula---16-cell stage Blastocyst---about 100 cells Fetus---beginning in ninth week of development The Embryo The embryo first undergoes division without growth The embryo enters the uterus at the 16-cell state (called a morula) about 3 days after ovulation The embryo floats free in the uterus temporarily Uterine secretions are used for nourishment The Blastocyst (Chorionic Vesicle) Ball-like circle of cells Begins at about the 100-cell stage Secretes human chorionic gonadotropin (hCG) to induce the corpus luteum to continue producing hormones Functional areas of the blastocyst Trophoblast---large fluid-filled sphere Inner cell mass---cluster of cells to one side The Blastocyst (Chorionic Vesicle) Primary germ layers are eventually formed Ectoderm---outside layer Mesoderm---middle layer Endoderm---inside layer The late blastocyst implants in the wall of the uterus (by day 14) Derivatives of Germ Layers Ectoderm Nervous system Epidermis of the skin Endoderm Mucosae Glands Mesoderm Everything else Embryo of Approximately 18 Days Figure 16.16 Development After Implantation Chorionic villi (projections of the blastocyst) develop Cooperate with cells of the uterus to form the placenta Amnion---fluid-filled sac that surrounds the embryo Umbilical cord Blood-vessel containing stalk of tissue Attaches the embryo to the placenta Embryo of Approximately 18 Days Figure 16.16 The 7-week Embryo Figure 16.17 Functions of the Placenta Forms a barrier between mother and embryo (blood is not exchanged) Delivers nutrients and oxygen Removes waste from embryonic blood Becomes an endocrine organ (produces hormones) and takes over for the corpus luteum (by end of second month) by producing Estrogen Progesterone Other hormones that maintain pregnancy The Fetus (Beginning of the Ninth Week) All organ systems are formed by the end of the eighth week Activities of the fetus are growth and organ specialization This is a stage of tremendous growth and change in appearance Photographs of a Developing Fetus Figure 16.18a Figure 16.18b Photographs of a Developing Fetus Table 16.1 (1 of 2) Development of the Human Fetus Development of the Human Fetus Table 16.1 (2 of 2) Effects of Pregnancy on the Mother Pregnancy---period from conception until birth Anatomical changes Enlargement of the uterus Accentuated lumbar curvature (lordosis) Relaxation of the pelvic ligaments and pubic symphysis due to production of relaxin Effects of Pregnancy on the Mother Physiological changes Gastrointestinal system Morning sickness is common due to elevated progesterone and estrogens Heartburn is common because of organ crowding by the fetus Constipation is caused by declining motility of the digestive tract Effects of Pregnancy on the Mother Physiological changes (continued) Urinary system Kidneys have additional burden and produce more urine The uterus compresses the bladder, causing stress incontinence Effects of Pregnancy on the Mother Physiological changes (continued) Respiratory system Nasal mucosa becomes congested and swollen Vital capacity and respiratory rate increase Dyspnea (difficult breathing) occurs during later stages of pregnancy Effects of Pregnancy on the Mother Physiological changes (continued) Cardiovascular system Blood volume increases by 25--40% Blood pressure and pulse increase Varicose veins are common Childbirth (Parturition) Labor---the series of events that expel the infant from the uterus Rhythmic, expulsive contractions Operates by the positive feedback mechanism False labor---Braxton Hicks contractions are weak, irregular uterine contractions Childbirth (Parturition) Initiation of labor Estrogen levels rise Uterine contractions begin The placenta releases prostaglandins Oxytocin is released by the pituitary Combination of these hormones oxytocin and prostaglandins produces contractions Figure 16.19 Initiation of Labor Hypothalamus sends efferent impulses to posterior pituitary, where oxytocin is stored Posterior pituitary releases oxytocin to blood; oxytocin targets mother's uterine muscle Uterus responds by contracting more vigorously Afferent impulses to hypothalamus Pressoreceptors in cervix of uterus excited Baby moves deeper into mother's birth canal Positive feedback mechanism continues to cycle until interrupted by birth of baby Figure 16.19, step 1 Initiation of Labor Baby moves deeper into mother's birth canal Figure 16.19, step 2 Initiation of Labor Pressoreceptors in cervix of uterus excited Baby moves deeper into mother's birth canal Figure 16.19, step 3 Initiation of Labor Afferent impulses to hypothalamus Pressoreceptors in cervix of uterus excited Baby moves deeper into mother's birth canal Figure 16.19, step 4 Initiation of Labor Hypothalamus sends efferent impulses to posterior pituitary, where oxytocin is stored Afferent impulses to hypothalamus Pressoreceptors in cervix of uterus excited Baby moves deeper into mother's birth canal Figure 16.19, step 5 Initiation of Labor Hypothalamus sends efferent impulses to posterior pituitary, where oxytocin is stored Posterior pituitary releases oxytocin to blood; oxytocin targets mother's uterine muscle Afferent impulses to hypothalamus Pressoreceptors in cervix of uterus excited Baby moves deeper into mother's birth canal Figure 16.19, step 6 Initiation of Labor Hypothalamus sends efferent impulses to posterior pituitary, where oxytocin is stored Posterior pituitary releases oxytocin to blood; oxytocin targets mother's uterine muscle Uterus responds by contracting more vigorously Afferent impulses to hypothalamus Pressoreceptors in cervix of uterus excited Baby moves deeper into mother's birth canal Positive feedback mechanism continues to cycle until interrupted by birth of baby Stages of Labor Dilation Cervix becomes dilated Full dilation is 10 cm Uterine contractions begin and increase Cervix softens and effaces (thins) The amnion ruptures ("breaking the water") Longest stage at 6--12 hours Figure 16.20 (1 of 3) Stages of Labor Stages of Labor Expulsion Infant passes through the cervix and vagina Can last as long as 2 hours, but typically is 50 minutes in the first birth and 20 minutes in subsequent births Normal delivery is head first (vertex position) Breech presentation is buttocks-first Stages of Labor Figure 16.20 (2 of 3) Stages of Labor Placental stage Delivery of the placenta Usually accomplished within 15 minutes after birth of infant Afterbirth---placenta and attached fetal membranes All placental fragments should be removed to avoid postpartum bleeding Stages of Labor Figure 16.20 (3 of 3) Developmental Aspects of the Reproductive System Gender is determined at fertilization Males have XY sex chromosomes Females have XX sex chromosomes Gonads do not begin to form until the eighth week Testosterone determines whether male or female structures will form Developmental Aspects of the Reproductive System Reproductive system organs do not function until puberty Puberty usually begins between ages 10 and 15 Developmental Aspects of the Reproductive System Males Enlargement of testes and scrotum signals onset of puberty (often around age 13) Females Budding breasts signal puberty (often around age 11) Menarche---first menstrual period Developmental Aspects of the Reproductive System Menopause---a whole year has passed without menstruation Ovaries stop functioning as endocrine organs Childbearing ability ends There is a no equivalent of menopause in males, but there is a steady decline in testosterone A Closer Look: Contraception Contraception---birth control Birth control pill---most-used contraceptive Relatively constant supply of ovarian hormones from pill is similar to pregnancy Ovarian follicles do not mature, ovulation ceases, menstrual flow is reduced A Closer Look: Contraception Morning-after pill (MAP) Taken within 3 days of unprotected intercourse Disrupts normal hormonal signals to the point that fertilization is prevented Other hormonal birth control devices cause cervical mucus to thicken Minepill (tablet) Norplant (rods placed under the skin) A Closer Look: Contraception Intrauterine device (IUD) Plastic or metal device inserted into uterus Prevents implantation of fertilized egg Sterilization Tubal ligation (females)---cut or cauterize uterine tubes Vasectomy (males)---cut or cauterize the ductus deferens A Closer Look: Contraception Coitus interruptus---withdrawal of penis prior to ejaculation Rhythm (fertility awareness)---avoid intercourse during period of ovulation or fertility Record daily basal temperature (body temperature rises after ovulation) Record changes in pattern of salivary mucus A Closer Look: Contraception Barrier methods Diaphragms Cervical caps Condoms Spermicidal foams Gels Sponges A Closer Look: Contraception Abortion---termination of pregnancy Miscarriage---spontaneous abortion is common and frequently occurs before a woman knows she is pregnant RU486 or "abortion pill"---induces miscarriage during first 7 weeks of pregnancy Flow Chart of Events that Must Occur to Produce a Baby Figure 16.21 (1 of 2) Some Contraceptive Devices Figure 16.21 (2 of 2) **Trisomy 21 (Down Syndrome)** ##### **Definition** - ##### **Clinical Manifestations** - - - - - - - - - ##### **Diagnosis** - - - - - - - - ##### **Causes** - - ##### **Who Can Be Affected** - ##### **Treatment and Management** - - #### **Trisomy 18 (Edward\'s Syndrome)** ##### **Definition** - ##### **Types of Trisomy 18** - - - ##### **Clinical Manifestations** - - - - - ##### **Diagnosis** - - - - - - ##### **Causes** - - ##### **Who is Affected** - - ##### **Treatment** - - - #### **Trisomy 13 (Patau Syndrome)** ##### **Definition** - ##### **Clinical Manifestations** - - - - - - - ##### **Diagnosis** - - - - ##### **Causes** - - ##### **Who is Affected** - ##### **Treatment** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Klinefelter Syndrome (47, XXY)** ##### **Cause** - - - - - ##### **Diagnosis** - - - ##### **Symptoms** - **In Babies**: - - - **In Boys/Teenagers**: - - - - - - - **In Men**: - - - - - - ##### **Treatment** - - - - - - ##### **Prognosis** - - - - ##### **Inheritance** - #### **Sickle Cell Anemia** ##### **Definition** - - ##### **Clinical Manifestations** - - - - - - - - - ##### **Diagnosis** - - - - - - - ##### **Inheritance** - - - - - - - ##### **Treatment** - - #### **Klinefelter Syndrome (47, XXY)** ##### **Definition** - ##### **Cause** - - - ##### **Symptoms by Age** - - - - - - - - - - - - - - - - - - - - ##### **Diagnosis** - - ##### **Treatment** - - - - - ##### **Prognosis** - - ##### **Inheritance** - #### **Hemolytic Disease of the Newborn (HDN)** ##### **Definition** - ##### **Symptoms in the Baby** - - - - - - - ##### **Rh Factor Inheritance Chart** - - - - - ##### **Pathophysiology of Rh Disease** - - - ##### **Diagnosis** - - - ##### **Treatment** - - - #### **Huntington\'s Disease (HD)** ##### **Definition** - ##### **Clinical Manifestations** - - - - - ##### **Diagnosis** - - - ##### **Cause** - ##### **Treatment** - - - - #### **Hemophilia** ##### **Definition** - ##### **Types of Hemophilia** 1. - - 2. - - 3. - - ##### **Clinical Manifestations** - - - - - - - ##### **Diagnosis** - - - - - - ##### **Genetic Cause** - - - - - ##### **Treatment/Management** - - - - - - - - - - - #### **Cri-du-chat Syndrome** ##### **Definition** - - ##### **Characteristics** - - - - - - - - ##### **Causes** - - ##### **Inheritance** - - ##### **Diagnosis** - - ##### **Treatment** - - - - - - #### **Fragile X Syndrome** ##### **Definition** - - ##### **Causes** - - - ##### **Inheritance** - - ##### **Diagnosis** - - ##### **Clinical Manifestations** - - - - - - ##### **Treatment** - - - - #### **Chromosomal Aberrations** ##### **Definition** - ##### **Types of Aberrations** 1. - - 2. - - - - - - - - - - ##### **Clinical Significance** - - #### **Chromosomal Aberrations (Continued)** ##### **Cri-du-chat Syndrome** - - - - - - - ##### **Inversion** - - - - - - ##### **Translocation** - - - - - - #### **Chromosomal Aberrations (Continued)** ##### **Aneuploidy** - - - - - - - - ##### **Polyploidy** - - - - - - ##### **Nondisjunction** - - - - #### **Chromosomal Aberrations (Continued)** ##### **Nondisjunction** - - - - ##### **Down Syndrome** - - - - - - - - **Chromosomal Aberrations Overview:** Chromosomal aberrations are significant changes to chromosomes that often lead to genetic diseases. These include: 1. 2. 3. 4. 5. **Polyploidy Overview:** - - - **Nondisjunction and Down Syndrome:** - - - - - - In modern society, many women are delaying childbirth until later in life to establish their careers. However, this increase in age correlates with a higher risk of Down syndrome. - - - - Women in these at-risk age groups are encouraged to undergo Down syndrome screening before having children. However, for women under 30, the risks associated with testing may outweigh the likelihood of having a child with Down syndrome, making screening not recommended for this age group. TRICHOMONIASIS Prepared by: Chariz Bulaybulay Shiela Lyn Tabñag BSN - II Trichomoniasis or \"trich\" is a very common sexually transmitted infection (STI) caused by a parasite. The parasite is spread most often through vaginal, oral, or anal sex. It is one of the most common STIs in the United States and affects more women than men. TRICHOMONIASIS CAUSATIVE AGENTS: It is caused by a protozoa called Trichomonas vaginalis Usually passed by direct sexual contact Can be transmitted through contact with wet objects, such as towels, wash clothes and douching equipment Incubation Period: 4 to 20 days, with average being 7 days Many women and most men have no symptoms. Females: White or greenish-yellow odorous discharge, vaginal itching, soreness, painful urination Males: Slight itching of penis, painful urination, clear discharge from penis SIGNS AND SYMPTOMS: Diagnosis: Through microscopic slide Treatment: Curable with an oral medication (Metronidazole, Secnidazole, Nifuratel, Tioconazole) Complications: Long-term effects in adults not known. There is some evidence that infected individuals are more likely to develop cervical cancer and HIV TREATMENT/MANAGEMENT: How does trichomoniasis affect a pregnant woman and her baby? Pregnant women with trichomoniasis are more likely to have their babies too early (preterm delivery). Babies born to infected mothers are more likely to have a low birth weight (less than 5.5 pounds). TRICHOMONIASIS (TRICH) Take your antibiotics as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. Do not have sex while you are being treated. If your doctor gave you a single dose of antibiotics, do not have sex for one week after being treated and until your partner also has been treated. Tell your sex partner (or partners) that he or she will also need to be tested and treated. Use a cold water compress or cool baths to relieve itching. HEALTH TEACHING: TRICHOMONIASIS (TRICH) How to prevent transmission ??? CHLAMYDIA Chlamydia infection is a common STD that occurs in pregnant and non pregnant women, and also men, particularly in adolescents and young adults. It results in urethritis in males, cervicitis in females, and lymphogranuloma venereum in both sexes. It results in urethritis in males, cervicitis in females, and lymphogranuloma venereum in both sexes. Chlamydial infections are transmitted by direct contact (such as sexual) Infection produces local inflammation. Endometritis and salpingitis occur as the organism ascends the genitourinary tract. Inflammation of the fallopian tube ENDOMETRITIS AND SALPINGITIS OCCUR AS THE ORGANISM ASCENDS THE GENITOURINARY TRACT. Chlamydia is caused by an infection with the bacterium Chlamydia trachomatis. It is spread by unprotected (unsafe) vaginal, anal,or oral sex with an infected person. Neonate infection caused by transport through the infected mother's birth canal. multiple sex partners Vaginal discharge (may be yellowish and have a strong smell) Burning or painful urination Abdominal or low back pain Nausea Fever Pain with intercourse Vaginal bleeding between periods Burning, frequent, and painful urination Penile discharge (pus or watery/milky discharge) Swollen and painful testicles If rectally: characterized by pain, discharge, and bleeding Infertility Pelvic inflammatory disease (PID) Urethral and rectal strictures Perihepatitis Cervical canver Trachoma Urethritis and epididymitis (in males) Sterility CHLAMYDIA EFFECTS TO THE MOTHER AND CHILD Premature rupture of the membranes Preterm labor Stillbirth Neonatal death. Endometritis in the postpartum period Risk for Infection related to sexual activity. Follow standard precautions. Check the neonate of an infected mother for signs of infection. Give prescribed drugs. Provide appropriate skin care. Report cases of chlamydial infection to the local board of health. Response to treatment Adverse effects of medication Complications The disorder, signs and symptoms, and treatment Proper hand-washing technique Abstinencec from intercourse or use of condoms Importance of getting tested for the human immunodeficiency virus Dealing with long-term risks and complications from infection Transmission of infection Prevention of STDs by following safer sex practices Follow-up care Complications DISCHARGE PLANNING: Refer the patient to support services. Advise rescreening at 3 to 4 months and annual screenings for sexually active teens and females ages 20 to 25. CHLAMYDIA Chlamydia infection is a common STD that occurs in pregnant and non pregnant women, and also men, particularly in adolescents and young adults. It results in urethritis in males, cervicitis in females, and lymphogranuloma venereum in both sexes. It results in urethritis in males, cervicitis in females, and lymphogranuloma venereum in both sexes. Chlamydial infections are transmitted by direct contact (such as sexual) Infection produces local inflammation. Endometritis and salpingitis occur as the organism ascends the genitourinary tract. Inflammation of the fallopian tube ENDOMETRITIS AND SALPINGITIS OCCUR AS THE ORGANISM ASCENDS THE GENITOURINARY TRACT. Chlamydia is caused by an infection with the bacterium Chlamydia trachomatis. It is spread by unprotected (unsafe) vaginal, anal,or oral sex with an infected person. Neonate infection caused by transport through the infected mother's birth canal. multiple sex partners Vaginal discharge (may be yellowish and have a strong smell) Burning or painful urination Abdominal or low back pain Nausea Fever Pain with intercourse Vaginal bleeding between periods Burning, frequent, and painful urination Penile discharge (pus or watery/milky discharge) Swollen and painful testicles If rectally: characterized by pain, discharge, and bleeding Infertility Pelvic inflammatory disease (PID) Urethral and rectal strictures Perihepatitis Cervical canver Trachoma Urethritis and epididymitis (in males) Sterility CHLAMYDIA EFFECTS TO THE MOTHER AND CHILD Premature rupture of the membranes Preterm labor Stillbirth Neonatal death. Endometritis in the postpartum period Risk for Infection related to sexual activity. Follow standard precautions. Check the neonate of an infected mother for signs of infection. Give prescribed drugs. Provide appropriate skin care. Report cases of chlamydial infection to the local board of health. Response to treatment Adverse effects of medication Complications The disorder, signs and symptoms, and treatment Proper hand-washing technique Abstinencec from intercourse or use of condoms Importance of getting tested for the human immunodeficiency virus Dealing with long-term risks and complications from infection Transmission of infection Prevention of STDs by following safer sex practices Follow-up care Complications DISCHARGE PLANNING: Refer the patient to support services. Advise rescreening at 3 to 4 months and annual screenings for sexually active teens and females ages 20 to 25. Prepared by : Chelsie Rose A. Bayawa Reyna Necesito Candidiasis and Pregnancy What Is a Yeast Infection? Occurs when the normal levels of acid and yeast in the vagina are out of balance, which allows yeast to overgrow causing an uncomfortable, but not serious, condition called a yeast infection. Causative Agent Caused by a yeast (a type of fungus) called Candida Types of Candidiasis Thrush (Oropharyngeal Candidiasis) Genital Yeast Infection (Genital Candidiasis) Diaper Rash From Yeast Infection Invasive Candidiasis What is thrush (Oropharyngeal Candidiasis) ? When the candida yeast spreads in the mouth and throat Thrush (Oropharyngeal Candidiasis) What is Genital Yeast Infection (Genital Candidiasis)? Typically happens when the balance in the vagina changes it occurs when too much yeast grows in the vagina. Genital Yeast Infection (Genital Candidiasis) What is Diaper Rash From Yeast Infection ? Though diaper rashes are usually caused by leaving a wet or soiled diaper on too long, once your baby's skin is irritated, infection is more likely. Diaper Rash From Yeast Infection What is Invasive Candidiasis? Candida yeast enters the bloodstream (usually through medical equipment or devices), it can travel to the heart, brain, blood, eyes, and bones. This can cause a serious, life-threatening infection. Invasive Candidiasis What Causes A Yeast Infection During Pregnancy? Hormonal changes that come with pregnancy or before your period Taking hormones or birth control pills Taking antibiotics or steroids High blood sugar, as in diabetes Vaginal intercourse Douching Blood or semen Why Are Yeast Infections More Common During Pregnancy? There is more sugar in vaginal secretions on which the yeast can feed, causing an imbalance which results in too much yeast. Signs and Symptoms Yeast infection symptoms can range from mild to moderate, and include: Itching and irritation in the vagina and vulva A burning sensation, especially during intercourse or while urinating Redness and swelling of the vulva Vaginal pain and soreness Vaginal rash Thick, white, odor-free vaginal discharge with a cottage cheese appearance Watery vaginal discharge Diagnosis and Tests Fungal Culture Test Yeast Infection Tests Risk factors Factors that increase the risk of developing a yeast infection include: Antibiotic use. Yeast infections are common in women who take antibiotics. Broad-spectrum antibiotics, which kill a range of bacteria, also kill healthy bacteria in your vagina, leading to overgrowth of yeast. Increased estrogen levels. Yeast infections are more common in women with higher estrogen levels --- such as pregnant women or women taking high-dose estrogen birth control pills or estrogen hormone therapy. Uncontrolled diabetes. Women with poorly controlled blood sugar are at greater risk of yeast infections than women with well-controlled blood sugar. Impaired immune system. Women with lowered immunity --- such as from corticosteroid therapy or HIV infection --- are more likely to get yeast infections. Will a yeast infection affect the baby? No, a yeast infection won\'t hurt or affect the developing baby. But if you have an infection when you go into labor, there\'s a chance that your newborn will contract it as he passes through the birth canal. If that happens, he may develop a yeast infection in his mouth, known as thrush. Thrush is characterized by white patches on the sides and roof of the mouth and sometimes on the tongue. This condition isn\'t serious and is easily treated. (By the way, babies can get thrush even if the mother don\'t have a yeast infection.) Prevention Wear breathable cotton underwear and avoid pantyhose and tight pants, especially synthetic ones. Try sleeping without underwear at night to allow air to get to your genital area. If you prefer to wear something to bed, a nightgown without underwear allows more air circulation than pajama bottoms. Don\'t use bubble baths, perfumed soaps, scented laundry detergent, or feminine hygiene sprays. It\'s not clear whether these products contribute to yeast infections, but it\'s best to avoid them because they can cause genital irritation. Clean your genital area gently with warm water every day. (Don\'t douche -- during pregnancy or any other time.) Get out of your wet bathing suit promptly after swimming, and change your underwear after exercising if you break a sweat. Always wipe from front to back. Eat yogurt that contains a live culture of Lactobacillus acidophilus, which can help maintain the proper bacterial balance in your gut and vagina. There\'s conflicting evidence about whether yogurt helps prevent yeast infections, but many women swear by it. And in any case, it\'s a good source of protein and calcium! Management and treatment Vulvovaginal candidiasis is easy to treat with an antifungal cream or suppository. The medicine should relieve your symptoms within seven days. However, during pregnancy, you should see your doctor before starting treatment. They can confirm that you actually have a yeast infection and ensure you get a treatment that's safe to use during pregnancy. Topical antifungal drugs that are safe to use during pregnancy include: Drugs Dose Clotrimazole (gyne-lotrimin) 1% cream, 5 grams (g), once a day for 7 to 14 days Miconazole (monistat) 2% cream, 5 g, once a day for 7 days Terconazole (terazol) 0.4% cream, 5 g, once a day for 7 days Nursing responsibilities Review findings of the clinical evaluation with the client. Provide client-focused STD education, including verbal and written information concerning: Laboratory tests that she received Instructions for obtaining laboratory test results Information about the diagnosis Correct condom use, as well as client-focused counseling and literature about personal risk reduction behavior(s) B. Advise the client about: Abstaining from sexual intercourse for seven days or until completion of a 7-day medication regimen Using condoms always and using condoms correctly Identifying risk for acquiring STDs and developing a personal risk reduction plan The increased chance of acquiring HIV infection 5\. Requesting repeat HIV testing in the future if ongoing risk factors (i.e., persons with multiple partners should be tested every three (3) months, etc.) 6\. Abstaining from douching 7\. Using other disease prevention barrier methods such as dental dams, if applicable 8\. Cleaning and covering sex toys, if applicable, to decrease transmission of infections Thank you ! ☺ UNDERSTANDING HEPATITIS B DURING PREGNANCY HEPATITIS B Infection is a liver inflammation or disease that may occur from invasion of the Hepatitis B virus. It takes about 4 weeks or more from the time it is transmitted to the time the first symptoms appear. SIGNS AND SYMPTOMS When a pregnant mother is infected, warning signs are included: Fatigability Diarrhea Dark and foamy( dark yellow) urine Pale feces Right-sided abdominal pain Jaundice Joint and muscle pains Loss of appetite Nausea and vomiting CAUSES It's spread when people come in contact with the blood, open sores, or body fluids of someone who has the hep B virus. Common ways that HBV can spread are: Sexual Contact Sharing of needles Accidental needle stick Mother to child at birth Hepatitis B occurs about 1 in every 2000 pregnancies ACUTE VS. CHRONIC HEPATITIS B Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute hepatitis B from your body, and you should recover completely within a few months. Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system can\'t fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer. EFFECTS ON MOTHER AND BABY Mother can damage liver during pregnancy May slow baby's growth/preterm delivery Spontaneous miscarriage Hepatomegaly Jaundice Baby Very high level of Hep B virus may cause the virus in crossing the placenta to infect the baby If left untreated, babies could have long-term liver problems (liver cirrhosis or carcinoma) NURSING MANAGEMENT Discuss the risk for transmission and discuss the need for testing and counselling Know the HBV status of any sexual partner Do not reuse condoms Do not use illegal drugs or share needles Get vaccinated Cover all open cuts and wounds Don't share razors, toothbrushes, nail care tools To babies: All newborn with infected mothers should get Hep B immune globulin and the vaccine for hepatitis B at birth and during their first year of life -If untreated, babies could have long-term liver problems MEDICAL MANAGEMENT If being exposed to the virus, get a doctor within 2 weeks If the infection is active for longer than 6 months, the doctor may prescribe some medications: Interferon Alfa (Intron A, Roferon A, Sylatron) Take it as a shot for at least 6 months \+ boosts immune system \+ treats liver inflammation The drug makes you feel bad all over, depressed and zap your appetite Lowers white blood cell count which makes harder to fight infection Lamivudine (3tc, Epivir, Epivir A/F, Heptovir) Comes as liquid or table form, taken once a day \+ no major problem with the drug, but If taken for a long time, virus might stop responding to the drug Adefovir dipivoxil (Hepsera) comes in tablet form +works well for people who don't respond to lamivudine \- high dose can cause kidney problems Entecavir (Baraclude) -in tablet or liquid form -the newest drug for Hepatitis B virus Tenofovir (Vinead) -comes in powder or tablet -doctors will check often to make sure it doesn't hurt your kidneys Prescribed bed rest and encouraged to eat high-calorie diet Cesarean birth may be planned to reduce the possibility of blood exchange between mother and child Kathleen Pearl B. Gajelomo Shiela T. Limbaga Definition Chronic, infectious, sexually transmitted disease CAUSATIVE AGENT Spirochete Treponema pallidum Mode of transmission Primarily through sexual contact during the primary, secondary, and early latent stages of infection Transmission by way of fresh blood transfusion (rare) Complications Cardiovascular disease Irreversible neurologic disease Irreversible organ damage Membranous glomerulonephritis With fetal infection: Spontaneous abortion Stillbirth Low birth weight Deafness SIGNS AND SYMPTOMS Progresses in four stages: Primary Secondary Latent Late or Tertiary PRIMARY SYPHILIS one or more chancres on the genitalia; others on the anus, fingers, lips tongue, nipples, tonsils, or eyelids in female patient, possible chancres on cervix or vaginal wall SECONDARY SYPHILIS headache, malaise, nausea and vomiting, anorexia, weight loss sore throat, slight fever in warm, moist body areas, lesions enlarged and eroding, producing highly contagious, pink or grayish white lesions(condylomata lata) alopecia, brittle and pitted nails LATENT SYPHILIS Physical signs and symptoms absent except for possible recurrence of mucocutaneous lesions that resemble those of secondary syphilis. TERTIARY (LATE) SYPHILIS Findings that vary with the involved organ Three Subtypes Neurophilis affecting meningovascular tissues Late benign Cardiovascular RISK FOR THE CHILD AND MOTHER Miscarriage Premature birth/Low birth weight Still birth TREATMENT General Immediate examination of all sexual contacts Avoidance of pregnancy until a good response to therapy is demonstrated. Hospitalization for symptomatic late syphilis No sexual activity until cured. Medical Antibiotics (penicillin being the treatment of choice) Benzathine Penicillin Procaine Penicillin Doxycycline Azithromycin NURSING MANAGEMENT Follow standard precautions Administer prescribed drugs Promote rest and adequate nutrition In secondary syphilis, keep lesions clean and dry dispose contaminated materials properly Report all syphilis cases to the appropriate health authorities PATIENT TEACHING BE SURE TO COVER: The disorder, diagnosis and treatment The importance of completing the prescribed course of therapy even after symptoms subside The importance of informing, treating and testing sexual partners The need to refrain from sexual activity information for patient and sexual partners about HIV infection. Risk to the fetus if the patient is contemplating pregnancy following safer sex practices Reference: Kluwer, W. (2009). Nurses quick check: Diseases. (2nd ed., pp. 794-795). Philadelphia: Lippincott Williams & Wilkins THANK YOU FOR LISTENING! ☺GONORRHEA By: Chiarra Gaetana O. Binga-an Andybird A. Langam GONORRHEA Common sexually transmitted disease caused by bacteria called Neisseria gonorrhoeae or gonococcus Usually starts as infection of the genitourinary tract; can also begin in rectum, pharynx, or eyes Left untreated, spreads through the blood to the joints, tendons, mininges, and endocardium In females, can lead to chronic pelvic inflammatory disease (PID) and sterility Mode of Transmission Through sexual contact with an infected person For a child born to an infected mother, acquisition of gonococcal opthalmia neonatorum during passage through the birth canal Acquisition of gonococcal conjunctivitis by touching the eyes with a contaminated hand Signs and Symptoms GENERAL S/S: Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. For Men greater frequency or urgency of urination a pus-like discharge (or drip) from the penis (white, yellow, beige, or greenish) swelling or redness at the opening of the penis swelling or pain in the testicles a persistent sore throat For Women discharge from the vagina (watery, creamy, or slightly green) pain or burning sensation while urinating the need to urinate more frequently heavier periods or spotting pain upon engaging in sexual intercourse sharp pain in the lower abdomen RISKS To the Mother may have a greater risk of miscarriage, infection of the amniotic sac and fluid, preterm premature rupture of membranes (PPROM), and preterm birth An untreated gonorrhea infection makes the mother more susceptible to HIV and some other sexually transmitted infections (STIs), if exposed to them, and raises the risk of a uterine infection after delivery. To the Newborn Gonorrhea in newborns most commonly affects the eyes if the baby is diagnosed with a gonorrheal eye infection at birth, he\'ll be treated with systemic antibiotics as well. If left untreated, a gonorrhea infection in an infant can cause blindness or spread to other parts of a baby\'s body, causing such problems as blood or joint infections and meningitis. Prevention Abstinence Use a condom if you choose to have sex. Ask your partner to be tested for sexually transmitted infections Don\'t have sex with someone who has any unusual symptoms Consider regular gonorrhea screening To avoid reinfection with gonorrhea, abstain from unprotected sex for seven days after you and your sex partner have completed treatment and after resolution of symptoms, if present. Treatment Ceftriaxone Cefixime Spectinomycin Azithromycin Partner should also get treatment for gonorrhea, even if he/she has no signs or symptoms. Nursing Responsibilities Isolate the patient if his eyes are infected With gonococcal arthritis, apply moist heat to ease pain in affected joints Administer prescribed drugs Report all cases of gonorrhea to the local public health authorities as required Report all cases of gonorrhea in children to child abuse authorities Routinely instill prophylactic drugs, according to facility protocol, in the eyes of all neonates on admission to the nursery Check the neonate of an infected mother for signs of infection, and obtain specimens for culture from the neonate's eyes, pharynx and rectum. References Maternal an Child Human Papillomavirus the most common sexually transmitted infection group of viruses with more than 100 different strains about 30 types spread through sexual contact usually harmless and goes away by itself, but some types can lead to cancer or genital warts men and women can get cancer of mouth/ throat, and anus/rectum caused by HPV infections HPV infection occurs when the virus enters your body, usually through a cut, abrasion or small tear in your skin. The virus is transferred primarily by skin-to-skin contact. Warts are contagious. They spread by contact with a wart or with something that touched the wart. CAUSATIVE AGENT Human papillomavirus Genital HPV is spread through contact with (touching) the skin of someone who has an HPV infection. Contact includes; vaginal, anal, and oral sex. Warts are contagious. They spread by contact with a wart or with something that touched the wart. it doesn't affect the developing baby change the way a woman is cared for during pregnancy no research findings suggest that women with HPV should avoid breastfeeding passing HPV to your baby through breastfeeding is highly unlikely antibodies in your breast milk can protect your baby from many other illnesses and health complications benefits of breastfeeding with HPV likely outweigh its risks Have no effects on fetus during pregnancy. Large genital warts can block the birth canal, complicating vaginal delivery. The infection might be linked to a rare, noncancerous growth in the baby\'s voice box (larynx). Sometimes, HPV can be transmitted during birth to an infant causing genital or respiratory system infections EFFECT TO THE FETUS There is no cure for HPV but safe and effective vaccinations are recommended at the age of 11 to 12 years TREATMENT Prescription medications include: Podophyllin (chemical applied by a doctor) Imiquimod (Aldara, Zyclara) Podofilox (Condylox) Trichloroacetic acid (chemical applied by a doctor) Cryotherapy - This method uses liquid nitrogen to freeze the abnormal areas. Electrocautery - Electrical current is used to burn the abnormal areas. Laser therapy - A light beam removes unwanted tissue. Interferon injection - This is rarely used due to the high risk of side effects and cost. Surgical removal Use standard precautions when there's a risk of contact with genital secretions Administer pain medication as ordered Provide a nonthreatening, nonjudgmental atmosphere that encourages the patient to verbalize feelings about perceived changes in sexual identity and behavior NURSING MANAGEMENT Need to inform sexual partners about the risk of genital warts Need for regular Pap testing and careful medical follow-up Reasons for not using nonprescription wart removal products Use of condoms Podophyllin and Fluorouracil cream can't be used during pregnancy Availability of HPV vaccines PATIENT TEACHING PREPARED BY: ARCES, MARDIE M. ZANGGO, MUGE A WOMAN WITH BACTERIAL VAGINOSIS By: Mary Elizabeth P. Solibio Fe Marey S. Pionela WHAT IS BACTERIAL VAGINOSIS? Bacterial vaginosis --- usually called BV --- is a bacterial infection. It happens when the different kinds of healthy bacteria in your vagina get out of balance and grow too much. Causes BV is often caused by gardnerella vaginalis, the most common type of bacteria in your vagina. Any woman can get BV, but some things raise your odds, including: Smoking Sexual activity Douching Symptoms Thin white, gray, or green discharge Burning feeling when you pee Fishy smell that gets stronger after sex How can BV be treated? The treatment is oral Metronidazole (Flagyl) or Clindamycin for 7 days. How can BV affect pregnancy? If you have BV during pregnancy, your baby is at increased risk for premature birth and low birthweight. Untreated G. vaginalis infections are associated with amniotic fluid infections and premature rupture of membranes. BV also can cause pelvic inflammatory diseases (also called PID). PID is an infection in the uterus that can increase your risk for infertility (not being able to get pregnant). How can you reduce your risk for BV? Here are some things you can do to help protect yourself from BV: Don't have sex. Limit the number of sex partners you have. Use a condom every time you have sex. Don't douche. Use warm water only and no soap to clean the outside of your vagina. HERPES SIMPLEX VIRUS (Type 1 & Type 2) Prepared by: Angcon, Nizle Mae Luzano, Alleli O. DEFINITION Herpes is an infection that is caused by a herpes simplex virus (HSV). Oral herpes causes cold sores around the mouth or face. Genital herpes affects the genitals, buttocks or anal area. CAUSATIVE AGENTS It has two causative agents: Herpes Simplex Virus type 1 (HSV-1) Herpes Simplex Virus type 2 (HSV-2) 5 SIGNS AND SYMPTOMS EARLY SIGNS AND SYMPTOMS: Fever & flu-like symptoms Nausea or feeling sick Muscle aches Painful urination Tingling, burning or itching sensation in the area where blisters will appear GENITAL HERPES After the initial tingling and itching, one or more clusters of small blisters appear, filled with slightly cloudy liquid. It can be located in different areas: In men, it can appear inside or on the penis, scrotum, groin & thighs, buttocks and around the anus. In women, it can appear on the labia, inside the vagina, groin & thighs, on the buttocks and around the anus. ORAL HERPES Mild or severe itching of the mouth or lips Sores or blisters on the lips or inside the mouth Fever Headache Body aches and pains Swollen glands in the neck, armpit or groin MODE OF TRANSMISSION Herpes simplex virus type 1 (HSV-1) Transmitted by oral-to-oral contact to cause oral herpes infection. It can also be transmitted from oral or skin surfaces. This infection can be transmitted from a mother with genital HSV-1 infection to her infant during delivery. Herpes simplex virus type 2 (HSV-2) It is mainly transmitted during sex, through contact with genital surfaces, skin, sores or fluids of someone infected with the virus HSV-2 infection can be transmitted from a mother to her infant during delivery. EFFECTS ON THE MOTHER AND INFANT WITH HERPES SIMPLEX VIRUS Babies are most at risk for neonatal herpes if the mother contracts genital herpes late in pregnancy. This is because a newly infected mother does not have antibodies against the virus, so there is no natural protection for the baby during birth. Herpes simplex is most often spread to an infant during birth if the mother has HSV in the birth canal during delivery. HSV can also be spread to the baby if he or she is kissed by someone with an active cold sore. HSV may be spread by touch, if someone touches an active cold sore and then immediately touches the baby. NURSING RESPONSIBILITIES Observe standard precautions; institute contact precautions if the patient has draining lesions, and maintain contact precautions until the lesions are dry and crusted. Perform meticulous hand washing. Give prescribed drugs. Provide wound care, as appropriate. Reinforce hygiene measures with the patient. Provide comfort measures as appropriate. Offer soothing, cool liquids for a sore mouth and throat; provide soothing lozenges, as indicated. Provide frequent oral care and eye care as necessary. Encourage the patient to express concerns and feelings, and provide support. Assist with positive coping strategies. THANK YOU! ☺☺ Kathleen Pearl B. Gajelomo Shiela T. Limbaga Definition Chronic, infectious, sexually transmitted disease CAUSATIVE AGENT Spirochete Treponema pallidum Mode of transmission Primarily through sexual contact during the primary, secondary, and early latent stages of infection Transmission by way of fresh blood transfusion (rare) Complications Cardiovascular disease Irreversible neurologic disease Irreversible organ damage Membranous glomerulonephritis With fetal infection: Spontaneous abortion Stillbirth Low birth weight Deafness SIGNS AND SYMPTOMS Progresses in four stages: Primary Secondary Latent Late or Tertiary PRIMARY SYPHILIS one or more chancres on the genitalia; others on the anus, fingers, lips tongue, nipples, tonsils, or eyelids in female patient, possible chancres on cervix or vaginal wall SECONDARY SYPHILIS headache, malaise, nausea and vomiting, anorexia, weight loss sore throat, slight fever in warm, moist body areas, lesions enlarged and eroding, producing highly contagious, pink or grayish white lesions(condylomata lata) alopecia, brittle and pitted nails LATENT SYPHILIS Physical signs and symptoms absent except for possible recurrence of mucocutaneous lesions that resemble those of secondary syphilis. TERTIARY (LATE) SYPHILIS Findings that vary with the involved organ Three Subtypes Neurophilis affecting meningovascular tissues Late benign Cardiovascular RISK FOR THE CHILD AND MOTHER Miscarriage Premature birth/Low birth weight Still birth TREATMENT General Immediate examination of all sexual contacts Avoidance of pregnancy until a good response to therapy is demonstrated. Hospitalization for symptomatic late syphilis No sexual activity until cured. Medical Antibiotics (penicillin being the treatment of choice) Benzathine Penicillin Procaine Penicillin Doxycycline Azithromycin NURSING MANAGEMENT Follow standard precautions Administer prescribed drugs Promote rest and adequate nutrition In secondary syphilis, keep lesions clean and dry dispose contaminated materials properly Report all syphilis cases to the appropriate health authorities PATIENT TEACHING BE SURE TO COVER: The disorder, diagnosis and treatment The importance of completing the prescribed course of therapy even after symptoms subside The importance of informing, treating and testing sexual partners The need to refrain from sexual activity information for patient and sexual partners about HIV infection. Risk to the fetus if the patient is contemplating pregnancy following safer sex practices Reference: Kluwer, W. (2009). Nurses quick check: Diseases. (2nd ed., pp. 794-795). Philadelphia: Lippincott Williams & Wilkins THANK YOU FOR LISTENING! ☺UNDERSTANDING HEPATITIS B DURING PREGNANCY HEPATITIS B Infection is a liver inflammation or disease that may occur from invasion of the Hepatitis B virus. It takes about 4 weeks or more from the time it is transmitted to the time the first symptoms appear. SIGNS AND SYMPTOMS When a pregnant mother is infected, warning signs are included: Fatigability Diarrhea Dark and foamy( dark yellow) urine Pale feces Right-sided abdominal pain Jaundice Joint and muscle pains Loss of appetite Nausea and vomiting CAUSES It's spread when people come in contact with the blood, open sores, or body fluids of someone who has the hep B virus. Common ways that HBV can spread are: Sexual Contact Sharing of needles Accidental needle stick Mother to child at birth Hepatitis B occurs about 1 in every 2000 pregnancies ACUTE VS. CHRONIC HEPATITIS B Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute hepatitis B from your body, and you should recover completely within a few months. Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system can\'t fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer. EFFECTS ON MOTHER AND BABY Mother can damage liver during pregnancy May slow baby's growth/preterm delivery Spontaneous miscarriage Hepatomegaly Jaundice Baby Very high level of Hep B virus may cause the virus in crossing the placenta to infect the baby If left untreated, babies could have long-term liver problems (liver cirrhosis or carcinoma) NURSING MANAGEMENT Discuss the risk for transmission and discuss the need for testing and counselling Know the HBV status of any sexual partner Do not reuse condoms Do not use illegal drugs or share needles Get vaccinated Cover all open cuts and wounds Don't share razors, toothbrushes, nail care tools To babies: All newborn with infected mothers should get Hep B immune globulin and the vaccine for hepatitis B at birth and during their first year of life -If untreated, babies could have long-term liver problems MEDICAL MANAGEMENT If being exposed to the virus, get a doctor within 2 weeks If the infection is active for longer than 6 months, the doctor may prescribe some medications: Interferon Alfa (Intron A, Roferon A, Sylatron) Take it as a shot for at least 6 months \+ boosts immune system \+ treats liver inflammation The drug makes you feel bad all over, depressed and zap your appetite Lowers white blood cell count which makes harder to fight infection Lamivudine (3tc, Epivir, Epivir A/F, Heptovir) Comes as liquid or table form, taken once a day \+ no major problem with the drug, but If taken for a long time, virus might stop responding to the drug Adefovir dipivoxil (Hepsera) comes in tablet form +works well for people who don't respond to lamivudine \- high dose can cause kidney problems Entecavir (Baraclude) -in tablet or liquid form -the newest drug for Hepatitis B virus Tenofovir (Vinead) -comes in powder or tablet -doctors will check often to make sure it doesn't hurt your kidneys Prescribed bed rest and encouraged to eat high-calorie diet Cesarean birth may be planned to reduce the possibility of blood exchange between mother and child #### **Key Terms and Definitions in Genetic Counseling** 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. #### **Types of Genetic Counseling** 1. - - 2. - - 3. - - 4. - - 5. - - 6. - - #### **Steps in the Genetic Counseling Process** 1. - - - 2. - - - 3. - - - - - 4. - - 5. - - #### **Important Considerations for Nursing in Genetic Counseling** 1. - - - - 2. - - - - 3. - - - 4. - - #### **Types of Genetic Testing** 1. 2. 3. 4. 5. 6. 7. #### **Common Genetic Disorders Encountered in Nursing** 1. 2. 3. 4. 5. 6. This comprehensive overview of genetic counseling should provide a strong foundation for critical thinking in nursing, particularly when evaluating cases related to genetic disorders and testing. Understanding the process, ethical considerations, and types of genetic counseling is key to delivering appropriate care and guidance to patients. Here's a concise, bulleted summary of the transcript: - - - - - - - - - - - - - - - - - - - Here's a concise, bulleted summary of the lecture: - - - - - - - - - - - - 1. - 2. - - - - - - - - Here's a concise, bulleted summary of the lecture: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - #### **Klinefelter Syndrome** - - - - - - - - - - - - - - - - #### **Turner Syndrome** - - - - - - - - - - - - - - - - - - - #### **Summary of the Lecture: Chromosome Theory and Sex Linkage** 1. - - - 2. - - - - 3. - - - 4. - - - 5. - 6. - - 7. - - 8. - - #### **Fragile X Syndrome** **Definition\ **Fragile X Syndrome is a genetic condition that causes developmental problems, including learning disabilities and cognitive impairment. Males are typically more severely affected than females. **Causes** - - - **Inheritance** - - **Diagnosis** - - **Clinical Manifestations** - - - - - - **Treatment** - - - -