Menstrual Cycle

Front 1

Phases of the Menstrual Cycle

A. Menstrual phase: Days 1-5 of cycle

1, Shedding of the endometrium occurs in the form of uterine bleeding.

Back 1

B. Proliferation (follicular) phase: Day 5 to ovulation

1. Endometrium is restored under primary hormone influence of estrogen.

2. In this preovulatory phase, follicle-stimulating hormone (FSH) is secreted by the anterior pituitary.

3. Preovulatory surge of luteinizing hormone (LH) converts the follicle to a corpus luteum, which produces progesterone.

Front 2

C. Secretory (luteal phase: Ovulation to approximately 3 days before menstrual cycle

1. Estrogen levels level off.

2.Progesterone levels increase.

Back 2

D. Ischemic Phase: Approximately 3 days before menstruation to

onset of menstruation.

1. If fertilization did not occur, the corpus luteum degenerates.

2. Estrogen & progesterone levels drop.

3. Endometrium becomes "blood starved", leading to onset of

menstruation.

Front 3

A. Fetal Development - 16 Weeks

1. Head still dominant, but face looks human & arm/leg ratio is

proportionate.

2. Scalp hair appears.

3. Meconium in bowel & anus open.

4. Most bones & joint cavities seen on ultrasound & muscular movements detected.

5. Heart muscle well developed & blood formation active in spleen.

Back 3

6. Elastic fibers appear in lungs & terminal;

respiratory bronchioles appear.

7. Kidneys in position.

8. Cerebral lobes delineated & cerebellum assumes some prominence

9. General sense organs differentiated

10. Testes in position for descent into scrotum or vagina open

Front 4

Fertilization

A Indications of ovulation

1. A slight drop in temperature occurs 1 day prior to ovulation; a rise of 0.5* to 1* F in temperature occurs at ovulation. Temperature remains elevated for approximately 10-12 days.

2. Cervical mucus is abundant, water, clear, & more alkaline.

Back 4

3. Cervical os dilates slightly, softens, & rises in the vagina.

4. Spinnbarkeit (egg-white stretchiness of cervical mucus) is present.

5. Ferning is seen under the microscope.

Front 5

B. Conditions for fertilization: 1.Post coital test demonstrates live,

motile, normal sperm present in cervical mucus. 2. Fallopian tubes are patent. 3. Endomentrial biopsy indicates adequate progesterone & secretory endometrium. 4. Semen is supportive to pregnancy: 2 mL semen; at least 20 million sperm per mL; >60% are normal; & > 50% are motile (moving forward).

Back 5

C. Implantation

1. Fertilization takes place in ampulla (outer third) section of the fallopian tube.

2. The zygote (fertilized ovum) takes 3-4 days to enter the uterus.

3. It takes 7-10 days to complete the process of nidation (implantation).

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D. Fetal development

1. Zygote

a. 12 - 14 days after fertilization.

b. From the time the ovum is tertilized until it is implanted in the uterus.

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2. Embryo

a. 3-8 weeks after fertilization

b. Embryo most vulnerable to teratogens (viruses, drugs, radiation, or infections), which can cause manor congenital anomalies.

3. Fetus

a. 9 weeks after fertilization to term (38+ weeks).

b. Fewer major anomalies caused by teratogens.

Front 7

Maternal Physiologic Changes during

Pregnancy

A. Pregnancy Length: counted from the 1st day of last menstrual

period (LMP).

1. 280 days

2. 40 weeks

3. 10 lunar months (perfect 28-day months)

4. 9 calendar months

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B. Pregnancy divided into (3) 13-week trimesters

1. First trimester: from the 1st day of LMP thru 13 weeks

2. 2nd trimester: 14 weeks thru 26 weeks

3. 3rd trimester: 27 weeks to 40 weeks

Front 8

Fetal & Maternal Changes - 8 Weeks

A. Fetal development

1. Development is rapid. 2. Heart begins to pump blood.

3. Limb buds are well developed. 4. Facial features are discernible

5. Major divisions of brain are discernible. 6. Ears develop from skin folds. 7. Tiny muscles are formed beneath this skin embryo

8. Weight is 2g.

Back 8

B. Maternal changes

1. Nausea persists up to 12 weeks. 2. Uterus changes from pear to globular shape. 3. Hegar sign occurs (softening of the isthmus of

cervix). 4. Goodell sign occurs (softening of cervix)

5. Cervix flexes. 6. Leukorrhea increases

7. Ambivalence about pregnancy may occur

8. There is no noticeable weight gain

9. Chadwick sign (bluing of vagina) appears as early as 4 weeks

Front 9

C. Nursing Interventions

1. Teach prevention of nausea

a. Suggest eating dry crackers b4 getting out of bed in am

b. Suggest eating small, frequent meals; avoiding fatty foods; & avoiding skipping meals

2. Teach safety: a. Avoid hot tubs, saunas, & steam rooms thru out pregnancy (increases risk for neural tube defects in 1st trimester;

hypotension may cause fainting)

Back 9

3. Prepare client for pregnancy

a. Discuss attitudes toward pregnancy

b. Discuss value of early pregnancy classes that focus on what to expect during pregnancy

c. Provide information about childbirth preparation classes.

d. Include father & family in preparation for childbirth (expectant fathers experience many of the same feelings & conflicts experienced by the expectant mother)

Front 10

A. Fetal Development - 12 Weeks

1. Embryo becomes a fetus

2. Heart is discernible by ultrasound

3. Lower body develops

4. Sex is determinable

5. Kidneys produce urine

6. Fetus weighs 19-28g

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B. Maternal Changes

1. Uterus rises above pelvic brim.

2. Braxton Hicks contractions are possible (continue thru out pregnancy)

3. Potential for urinary tract infection increases (exists thru out pregnancy)

4. Weight gain is 2-4 lb during 1st trimester.

5. Placenta is fully functioning & producing hormones.

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C. Nursing Interventions

1. Teach prevention of urinary tract infections

a. Encourage adequate fluid intake ( 3 Liters per day)

b. Instruct to void frequently (every 2 hours while awake)

c. Encourage to void b4 & after intercourse

d. Teach to wipe from front to back

Back 11

2. Discuss nutrition & exercise.

a. Increase caloric intake by 300 calories per day

b. Stress the value of regular exercise

3. Discuss possible effects of pregnancy on sexual relationship. Recognize father's role as he labors to incorporate the parental role into his self-identity.