Ob - Intro To Maternity

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birth rate

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# of live births per 1000 people

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Perinatal morality rate

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Includes both neonatal and fetal deaths per 1000 live births

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death rate

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death in utero at 20 weeks or more gestation

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Neonatal death rate

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Number of deaths of infants less than 28 days of age

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Infant mortality rate

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# of deaths of infants less than 1 year of age per 1000 live births in a given population

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Maternal mortality rate

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# of deaths per 100,000 live births

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Preconception Care - nutrition

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Folic acid recommendations
---Pre pregnancy-400mcg
---Pregnancy 600mcg
--- h/o neural tube defects 4000 mcg

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TERATOGENS

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AN EXTERNAL EVENT THAT CAUSES ABNORMAL FETAL DEVELOPMENT

---DRUGS
--- CHEMICALS
---ENVIRONMENTAL EXPOSURES
---INFECTIONS

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FERTILIZATION FACTS

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-OVA ARE VIABLE FOR ONLY 24 HOURS AFTER OVULATION
-SPERM USUALLY SURVIVE 2-3 DAYS IN THE UTERUS BUT CAN BE VIABLE FOR
5 DAYS.
-WINDOW OF FERTILITY- 5 Days before ovulation and 1 day after ovulation.

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fertilization takes place

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in the ampulla (outer third) of the
Fallopian tube

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zygote

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when the individual nuclear membranes of the ovum and sperm disappear and the chromosomes pair up

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Blastomeres

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when the fertilized egg divides rapidly into smaller cells.

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MORULA

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16 cell “solid ball of cells”

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BLASTOCYST

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THE MORULA CHANGES INTO A HOLLOW BALL WITH AN INNER AND OUTER LAYER OF CELLS

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TROPHOBLAST

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OUTER LAYER OF CELLS OF THE BLASTOCYST WHICH BURROW INTO THE ENDOMETRIUM DURING IMPLANTATION (DAY 6-10)

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EMBRYO

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DEVELOPS FROM THE INNER CELLS OF THE BLASTOCYST. (Day 15)

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Chorionic Villi

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Fingerlike projections that extend into the blood-filled spaces of the endometrium
--Eventually forms the fetal side of the placenta

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DECIDUA

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THE NEW NAME FOR ENDOMETRIUM ONCE IMPLANTATION OCCURS

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Decidua Basalis

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portion directly under the blastocyst where the chorionic villi tap into the maternal blood vessels
… Forms the maternal side of the placenta

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Decidua Capsularis

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portion covering the blastocyst

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Decidua Vera

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portion lining the rest of the uterus

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Fetal Membranes

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--Chorion: Outer membrane which develops from the trophoblast and contains the chrorionic villi on its surface
--Amnion: Inner membrane which develops
from the interior cells of the blastocyst
Together they are called “Bag of water”

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Amniotic Fluid

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--500 to 1000 ml at term
--Helps maintain fetal body temperature
--Cushions the fetus from trauma
--Volume of amniotic fluid is important factor in assessing fetal well being

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Oligohydramnios

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--< 500 ml of fluid (< 50% of amount expected
for gestation)
-- Associated with renal dysfunction
--Poor fetal lung development
--Compressed fetal part.
--Inadequate placental blood flow
--No urine to increase the volume

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Polyhydramnios (hydramnios)

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… > 2000 ml of fluid
… Associated with a gastrointestinal or CNS defect
… Faulty swallowing mechanism in the fetus
… Increased incidence of premature rupture of membranes and preterm labor
… Overdistention of uterus can increased incidence of postpartum hemorrhage

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Umbilical Cord

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--2 arteries carry blood from embryo to the chorionic villi ; carry waste.
--1 vein which returns blood to the embryo; Carries oxygenated nutrient rich blood to the fetus.

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PLACENTA

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--BEGINS TO FORM AT IMPLANTATION
--CHORIONIC VILLI BECOME MORE COMPLEX
--ORGANIZE INTO INDEPENDENT, SELF- SUSTAINING UNITS CALLED COTYLEDONS

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COTYLEDONS

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ALLOW FOR PRESERVATION OF PLACENTAL FUNCTION IN CASE OF AN INFARCTION

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placenta (con't)

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--PLACENTA is fully functional at 12 weeks.
--produces four hormones that maintain pregnancy hCG, hCS, estrogen, progesterone

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Fetal Circulation Bypass

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--Present because of non -functioning lungs and immature liver
--Bypasses must close following birth to allow blood to flow through the lungs and the liver.

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FETAL ADAPTATIONS FOR MIXED BLOOD SYSTEM

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--FETAL HEMOGLOBIN CARRIES 20% MORE O2 THAN ADULT HEMOGLOBIN
--FETAL HGB LEVEL ARE 50% HIGH THAN ADULTS (HGB= 18-20 GM/DL)
--FETAL CARDIAC OUTPUT IS RELATIVELY HIGHER THAN IN ADULTS

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3 TRIMESTERS

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---1ST- ORGAN DEVELOPMENT
---2ND- ORGAN GROWTH AND MATURITY
--- 3RD- FETAL GROWTH AND MATURITY

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Stage of the embryo

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--Day 15 to 8 weeks
--Most critical time in development
--Most vulnerable to malformations caused by teratogens

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Stage of the fetus

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-- 9 weeks until end of pregnancy
-- Refinement of structure and function of organs

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Fetal development

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--Heart beats @ 4-7 weeks
-Insulin produced @ 12 weeks
-Urine formed @ 12 weeks
-Lanugo forms at 16 weeks, disappears at 36-40 weeks
-Vernix forms at 20 weeks

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Diagnosis of Pregnancy-

Presumptive Indicators

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--Amenorrhea
--Nausea and vomiting
--Breast tenderness
--Urinary frequency
--Quickening

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Diagnosis of Pregnancy-

Probable Indicators

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--HEGAR’S SIGN- SOFTENING OF THE ISTHMUS
--CHADWICK’S SIGN- BLUISH HUE TO CERVIX
--GOODELL’S SIGN- SOFTENING OF THE CERVIX
--BRAXTON-HICKS CONTRACTIONS
--UTERINE ENLARGEMENT

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Diagnosis of Pregnancy-

Positive Indicators

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--Fetal heartbeat
--Fetal movement felt by someone other than the mother
--Visualization of fetus via ultrasound

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during 2nd trimester

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the mom begins to see the baby as a separate entity

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Leukorrhea

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thick whitish or yellowish vaginal secretions

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Montgomery Tubercles

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portion of the montgomery gland on skin's surface, round bumps found in the areola, and on the nipple itself.

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changes in the CV system include

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blood volume inc. up to 50%
pulse may inc. 20%
anemia r/t hemodilution and dec. FEO2
Inc. WBC

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more CV changes

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Uterus pressure on pelvic/femoral vessels:edema, varicosities (hemorrhoids), postural hypotensions, vena cava syndrome.

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respiratory changes

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O2 req inc.
diaphragm displaced as much as 4cm
epitaxis

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GI changes

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appetite (Pica), ptyalism (drooling), bleeding gums, pruitis, rhoids, hyper cholesterolemia

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Renal changes

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urinary stagnation, glucosuria

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skin changes

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cholasma or mask
linea nigra
striae gravidarum
angiomas
oily skin and acne vulgaris

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musculoskeletal changes

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center of gravity
softening/stretching of ligaments

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metabolism changes

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diet increase of 300 kcal/day beg. in 2nd trimester.
inc. protein
Fe supplements r/t losses to the fetus

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endocrine changes

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hCS-acts as growth hormone; contributes to breast dev.
hCG-vital to maintaining pregnancy
Thyroid enlargement

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progesterone

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essential for maintaining pregnancy

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Prolactin

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initial lactation

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Oxytocin

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stimulates contractions and let-down

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assessing fetal well being

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-movement, "kick counts"; start @27 weeks
-NST external monitoring; reactive/nonreactive.
-CST response of fetal HR to controlled uterine stimulation

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assessing fetal well being con't

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-ultrasound to view fetus, placenta Umb., Amnio fluid.
-biophysical profile
-Amniocentesis
-screenings