Narm Exam: Anatomy, Fetal Development, Nutrition

Front 1

Pelvic bones and landmarks

Back 1

-Innominate bones: ileum (2), ischium (2). aka: pelvic girdle, coxal bones, pelvic bones
-Pubis, sacrum, coccyx
-Iliac crest: top of hip bones
-Pelvic brim: true pelvis, inlet
-Pubic arch: space between pubic bones should be ~90°
-Ischial spines: midpelvis, used to measure station
-Ischial tuberosities: outlet, "sits bones"
- Joints: named by which bones they connect. ex: sacroiliac connects ilium to sacrum.

Front 2

Four joints in pelvis

Back 2

Pubis symphysis
sacroiliac (2)
sacrococcygeal

Front 3

Relaxin

Back 3

Produced by ovaries
Relaxes ligaments/ connective tissue

Front 4

hCG

Back 4

Human chorionic gonadotropin
Produced by trophoblast
Maintains corpus luteum (produces progesterone until placenta takes over)
Max 8-12 weeks
Levels: increases after fertilization, increases at implantation.
Day 28: ~100 mIU/mL
Peak 8-12 weeks: 60,000 mIU/mL
10-20 weeks: decreases to 1/5 peak level (20,000 mIU/mL
Plateaus until term

Front 5

Oxytocin

Back 5

Produced by hypothalamus
Released by pituitary
Stimulates uterine ctx
Stimulates milk ejection
More receptors present in labor
Dilation and vaginal stimulation encourage release

Front 6

Estrogen

Back 6

Produced in ovaries, adrenal cortex
Increases:
-growth and function of uterus/ breasts
-pliability of connective tissue
-skin pigmentation
-sodium & water retention

Front 7

hPL

Back 7

Human placental lactogen
Produced by syncytiotrophoblast, then placenta
-Regulates glucose availability to fetus
-Stimulates growth of fetus and maternal tissues

Front 8

Prolactin

Back 8

Produced by fetal and maternal pituitary/ uterus/ breast
-sustain and regulate milk production
-encourage emotional bonding
-breast development

Front 9

Progesterone

Back 9

Produced by ovaries, then placenta
-Relaxes smooth muscle of uterus, blood vessels, intestines
-increases basal body temp
-Inhibits prolactin
-Required for syntheses of fetal hormones
-increases decidua of uterus
Levels: < 5ng/mL = nonviable pregnancy
5-10ng/mL = pathologic pregnancy (ectopic)
> 25 ng/mL = adequate for pregnancy

Front 10

Prostaglandins

Back 10

Produced locally
-Decrease acid secretion in stomach
-Regulate blood pressure
-Ripen cervix
-Stimulate strong ctx

Front 11

Teratogens

Back 11

Substances that may cause fetal malformations/ death if exposed during pregnancy.
Most susceptible 2-12 weeks gestation

Front 12

Stages of embryonic development

Back 12

(ZiMBabwE)
-Zygote
-Morula
-Blastocyst
-Embryo

Front 13

Pre-embryonic stage
Weeks 1-3

Back 13

Week 1: Fertilization to zygote
-Blastocyst to trophoblast (features inner cell mass)
-Implantation
Week 2: Inner cell mass to Bilaminar disc (epiblast and hypoblast)
-Trophoblast differentiates
-Yolk sac
-Prochordal plate
Week 3: Gastrulation
-Trilaminar disc (ectoderm, mesoderm, endoderm)
-Neural plate

Front 14

Embryonic stage
Weeks 4-8

Back 14

Week 4: Open neural tube, C-shaped curve, Optic pits, Limb buds, Beating heart, Forebrain, 4 to 6 mm in length
Week 5: Brain/head increases in size, facial features begin, limbs longer, interim kidneys, 7-9 mm
Week 6: Upper limbs increase in size, external ears forming, eyes forming, responds to touch, 11-14 mm
Week 7: Finger notches, liver begins, intestines begin, 16-18 mm
Week 8: Toe notches, tail disappears, limb movements, ossification begins, eye lids begin, genitalia evident but not distinct, 27-31 cm

Front 15

Fetal Period
9-12 Weeks

Back 15

Increases in length, limbs more developed.
Ossification continues
Intestines begin to work
RBCs produced by liver, then spleen
Urine is produced
Swallowing fluid

Front 16

Fetal Period
13-16 Weeks

Back 16

Rapid growth
Coordinated movement
Ossification
Eye movements
Ovaries
External genitalia recognizable

Front 17

Fetal Period
17-20 Weeks

Back 17

Growth slows slightly
Limbs proportionate
Quickening
Vernix produced
Brown fat produced

Front 18

Fetal period
21-25 Weeks

Back 18

Weight increases
Translucent skin
Rapid eye movements
Blink-startle reflex
Surfactant begins
Fingernails
Viability- 24 weeks

Front 19

Fetal Period
26-29 Weeks

Back 19

Lungs capable
CNS can control breathing movements
Eyes open
Toenails
Fat increases
RBCs production moves from spleen to marrow

Front 20

Fetal Period
30-34 Weeks

Back 20

Pupil reflex
white fat increases
survival more likely

Front 21

Fetal Period
35-38 Weeks

Back 21

Firm grasp
orientates toward light
head circumference = abdomen circumference
white fat increases

Front 22

Protein

Back 22

Need: 80-100g
Function:
-cell production
-growth
-fluid balance
Sources:
-Animal products
-legumes
-seeds
-nuts
-minimally in vegetables/fruit

Front 23

Calcium

Back 23

Need: 1000mg
Function:
-Bone formation
Sources:
-Dairy
-Supplements
-Fortified foods

Front 24

Vitamin D

Back 24

Function:
-Calcium absorption
-Prevents IUGR, preeclampsia
-bone defects
Sources:
-sunlight
-PN vitamins
-fortified foods
Toxicity with overdose: developmental disability
Dark-skinned or women who do not get exposure to sunlight should supplement

Front 25

Vitamin A

Back 25

Need: 770 mcg
Function:
-Prevents low birth weight, IUGR, other complications
Sources:
-Well-balanced diet
-Supplementation not recommended
1st trimester over-consumption can cause deformities of the face, CNS

Front 26

Vitamin C

Back 26

Need: 75mg or more
Function:
-Immune function
-Prevents premature birth, PROM
Sources:
-Citrus fruits/ juices
-peppers
-many fruits/ veggies

Front 27

B-12
(cobalamin)

Back 27

Need: 2.6 mcg
Function:
-Regenerates folic acid
-Prevents macrocytic anemia
Sources:
-animal products
-fortified foods
-supplements

Front 28

Folate (Folic acid)

Back 28

Need: 600 mcg
Function:
-cell division
-prevents neural-tube defects
-prevents microcytic anemia
Sources:
-Most processed foods are enriched
-green leafy vegetables
-orange juice
-lentils

Front 29

Iron

Back 29

Need: 27 mg
Function:
-Formation of RBCs
-Prevention of anemia, IUGR, Preterm labor, stillbirth
Sources:
-Animal products
-fortified foods
-legumes
Enhanced by: vitamin C
Inhibited by: coffee, tea, milk (oxalates)

Front 30

Iodine

Back 30

Need: 220mg
Function:
-Synthesis of thyroid hormones
-prevents hypothyroidism
-prevents cretinism
Sources:
-Iodized salt
-Saltwater seafood

Front 31

Sodium

Back 31

Need: 1500mg
Function:
-Maintain fluid balance
Sources:
-Plentiful with balanced diet

Front 32

Zinc

Back 32

Need: 11 mg
Function:
-DNA, RNA synthesis
-Prevents malformation, preterm labor, IUGR
Sources:
-Shellfish
-Red meat
-Fortified foods
-Supplements
Supplemental zinc is inhibited by supplemental iron. OK if consumed nutritionally together.

Front 33

Goodell's Sign

Back 33

-Significant softening of the cervix

Front 34

Chadwick's Sign

Back 34

-Bluish coloration of cervix and vaginal tissue

Front 35

Hegar's sign

Back 35

-Softening and compressibility of the uterine isthmus

Front 36

Piskacek's Sign

Back 36

Palpable asymmetry of the uterus. Uterus is larger on the side of implantation.

Front 37

Presumptive signs of pregnancy

Back 37

-Signs reported by woman
Amenorrhea
Breast Changes
Nausea/ Vomiting
Quickening
Increased Urination
Fatigue
Abdominal enlargement
Braxton Hicks

Front 38

Probable signs of pregnancy

Back 38

-Signs midwife can detect
Positive beta pregnancy test
Chadwick's sign
Hegar's sign
Hegar's sign
Piskacek's sign
Palpable Braxton-Hicks
Ballotment of fetus

Front 39

Positive signs of pregnancy

Back 39

-Signs attributed directly to the fetus, detected by midwife
FHT visualized on ultrasound
FHT auscultated with Doppler or fetoscope
Palpation of fetal movement