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188 Cards in this Set
- Front
- Back
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sexually undifferentiates
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first 6 weeks
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external genitalia look similar until///
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ninth week
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differentiation of external genitaloa complete by
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12th week
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primary hormones of testes and ovaries
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testosterone
estrogen |
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Sexual Maturity
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hypothalamus stimulates anterior pituitary to produce hormones
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Primary Sex characteristics
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maturation of ova in ovaries
production of sperm in testes |
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Secondary sex CHaracteristics
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changes in other systems that differentiate males from females not directly related to reproduction
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Females Puberty HOrmones
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FSH/ LH in response to hypothalamus secretion og GnRH---> estrogen and progesterone
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first noticeable change in girls
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breast development
8-13 |
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Menarche
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2-2.5 years after breast development
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Climactic
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transitional phase starting as female fertility declines and extends through menopause and post-menopause
40-50 |
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Vulva
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external female reproductive organs
mons pubis, labia majora/minora, clitoris, vestibule, perineum |
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reproductive organs contained within the bony pelvis
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vagina, uterus, fallopian tubes ovaries
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Vagina Functions (3)
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1. allows discharge of menstrual flow
2. female organ of coitus 3. passage of fetus |
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Corpus Cervix
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upper division
--> upper of this is the fundus |
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Isthsmus
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"transition zone"
--> lower uterine segment during late pregnancy |
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Cervix
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"neck" of the uterus
effaces ( thins) and dilates ( opens) to allow passage of fetus |
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External Os of childless woman/ after pregnancy
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round and smooth
irregular, slitlike and tags of scar tissue |
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Layers of the Uterus
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Perimetrium
Myometrium Endometrium |
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Perimetrium
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outer peritoneal layer that covers uterus
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Myometrium
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middle layer of thick muscle
-most muscle in upper layer |
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Endometrium
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responds to cyclic variations in estrogen and prgesterone during cycle
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Fallopian tubes
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forms a pathway from ovary to uterus for the ovum
fertilization occurs here |
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Ovary functions
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sex hormone production
maturation of an ovum during cycle |
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MOst important part of pelvis for childbirth
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TRUE pelvis
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important nerves enter spinal cord @
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t12- l2
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Ligament functions
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maintain the internal reproductive organs and their nerve and blood supply in their proper positions within the pelvis
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Paired Muscle function
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enclose the lower pelvis and provide support for internal reproductive, urinary and bowel structures
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Pelvic Fascia
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provides support for pelvic organs
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Reproductive cycle driven by
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feednack loop between anterior pituitary and ovaries
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Fertilization
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when one spermatozoon enter the ovum and two nuclei containng the parents chromosomes merge
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Zygote
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fertilized ovum
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Morula
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12-16 cells
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blastocyst enters uterus when
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100 cells
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implntation
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6-10 days after conception
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HCG
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zygote produces to signal that a pregnancy has begun
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Advantages of Upper Uterus Implantation
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rich supply of blood
lining is thicker--prevents from attaching too deeply limits blood loss after birth- muscles compress vessels |
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Nourishment during implantation
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nutritive fluid passes to embryo by diffusion
circulatory system not yet established |
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Embryonic Period
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beginning of third week through 8th after conception
basic structures of body organs are completed in this period |
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Teratogens affect during embryonic stage
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because they are developing very rapidly
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development occurs
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cephalocauda (head to toe)
central to peripheral |
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FEtal period
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LONGEST
9 weeks after conception--> birth all major systems present |
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gestational age
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2 weeks longer than fertilization age
first day of women's period |
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FEtus assumes head down position because...
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uterus is shaped like an inverted egg
head is heavier and gravity causes head to drift downward |
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Surfactant
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lung explansion and makes it easier for baby to breath after birth
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Vernix Caseosa
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protects fetus from exposure to amniotic fluid
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Lanugo
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helps vernix adhere to the skin
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Brown Fat
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maintain temp stability after birth
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Auxiliary Structures
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placenta
umbilical cord fetal membranes |
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PLacenta functions
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metabolic functions
transfer functions endocrine functions |
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Decidua
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changed endometrium
protects mother from uncontrolled invasion of fetal placental intrusion of placental tissue into uterine wall |
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exchange of substances happens in the...
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intervillous spaces of the placenta
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Umbilical cord
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transfers blood between fetus and placenta
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Vein of the chorionic villus
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returns oxygenated blood and nutrients to the embryo and fetus
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Fetus can thrive in low oxygen environment because (3)
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Hg carries more o2
higher o2 carrying capacity ( higher Hg and hct) Bohr Effect* |
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IgG
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passed from mother to fetus through placenta
*passive immunity |
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Rh neg mom with rh pos fetus
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BAD--- death and fetal anemia
kills fetal erythrocytes |
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Human Chorionic SOmmatotropin
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glucose available to the fetus
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Functions of Estrogen during pregnancy
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uterus enlargement
breast enlargement growth of ductal system in breasts enlarge external genitalia |
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FUnctions of Progesterone
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provides nourishment as conceptus enters uterus
convert cells to decidua which characterize pregnancy reduce muscle contraction immune tolerance in mothers body for coneptus breast development for nursing |
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amnion
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inner membrane- continuous with surface of umbilical cord
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chorion
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outer membrane
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Amniotic fluid protection
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cushioning
stable temperature |
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Amniotic promotes development by...
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allowing symmetric development
preventing membranes from adhereing to developing fetal parts allow room and buoyancy |
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Amniotic fluid derived from
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fetal urine
fluid transported from maternal blood |
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Amniotic Volume
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700-800 mL @ 40 weeks
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Oligohydraminos
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under 400 ml
-poor placental blood flow -preterm rupture -fetal kidney failure developmen - blocked urinary excretion |
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Polyhydraminos ( Hydraminos)
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>2000ml
imbalance water exchange poorly controlled maternal diabetes mellitus--> large quanitites of fetal urine excretion having an elevted glucose level |
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Monozygotic Twins
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union of a single ovum and spermatozoon with later division of the conceptus into two
- when a single conceptus divides early in gestation |
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Dizygotic Twins
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arise from two separate zygotes, membranes and placentas are separate
- arise from two separate conceptions |
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most obvious changes are in the _____system
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reproductive
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Uterus changes
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weighs 800 -1200 g
capacity of 5000 mL |
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Uterine growth
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Hyperplasia- first trimester
hyerplasia and hypertrophy- 2,3,trimester = greatly increases strenth of muscle wall |
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Uterine Palapable above the symphysis pubis by ____ weeks
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12
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By____ weeks, the fundus reaches its highest level at the ______. It pushes against the _______ and the mom may experience______,
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36
Xphoid process diaphragm SOB |
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By ____ weeks the fetal head descends into the ____ and the uterus _____.
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40
pelvic cavity sinks to a lower level = LIGHTENING |
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Braxton Hicks COntractions
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irregular contractions
uterus tightens and becomes firm |
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Uterine SOuffle
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sound of blood circulation through the placenta and it corresponds to the maternal pulse
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Chadwick's Sign
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bluish purple color that xtends to include vagina and labia
earliest signs of pregnancy |
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Goodell's Sign
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cervix feels more like the lobe of the ear rather than tip of the nose
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Mucous plug
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in cervical canal , blocks ascent of bacteria from the vagina into the uterus
- prostects fetus from infection |
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Bloody Show
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mucous plug and small amout of blood rpoduced by disruption of the cervical capillaries as the muscous plug is dislodged
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Vagina changes
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mucosa thickens and rugae become prominent
- increased white, discharge - pH is acididc |
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Secretion of Progesterone
(early to late) |
Ovaries
Corpus luteum placenta |
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EStrogen stimulates
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growth of mammary ductal tissue
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Progesterone stimulates
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growth of lobes, loules and alveoli
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Striations may occur in breast
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Stretch marks
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Nipple changes
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increase in size and become more erect
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Areolae
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larger and more pigmented
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Tubercles of MOntgomery
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sebaceous glands
become more prominent secretions lube the nipple |
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Colostrum
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thick yellow breat fluid is present at the second trimester and readily expressed by the third
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Cardio changes
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minor heart enlargement
*auscultations shifted up and lateral |
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total blood volume
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increases 40%-50%
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increased plsma needed:
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1. transport nutrients and oxygen to the placenta
2. meet demansd of the explanded maternal tissue in uterine and breasts |
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physiologic anemia or pseudoanemia of pregnancy
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dilution of rbc due to increased plasma
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Cardiac output
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30-50 % by third trimester
highest lying on her side lowest sitting standing or supine |
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BP
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remains stable despite the increace in blood volume
- affected by position |
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above 140/90
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preclamspia
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Varicose veins, vuvlva or hemorrhoids
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weight of explanding uterus on the infereior vena cava and iliac veins partially obstructs blood return from veins in the legs, blood pools in the deep and superficial veins of the legs
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Erythrocyte production increases
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increases maternal need for iron
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Increase in clotting factors
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prtotect from hemorrhage
increase risk for thrombus formation |
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O2 consumption
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increases
hyperventilation by breathing deeply rr remains unchanged |
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heightened awareness for need to breath
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progesterone:
sensitivity increased to CO2 decreases airway resistance |
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Estrogen in respiratory system
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increased vascularity--nasal and sinus stuffiness, epistaxis and changes in voice
sense of fullness in ear earaches |
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breathing becomes thoracic rather than abdominal
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Relaxin
relaxation around ligaments of ribs |
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appetite
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unless nauseaou increases, increased
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mouth
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hyperemia-- gingivitis bleeding gums
excessive salivation ( ptyalism) |
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esophagus
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pyrosis
lower esophageal sphincter relaxes ( relaxation effecs of progesterone) |
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stomach
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progesterone relaxes smooth muscle and stomach empyting time might be changed
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small intestine
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takes longer to empty( allow addl time for nutrient absorption)
bloating, abdominal distention |
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large intestine
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more water absorption-- stool hard---constipation--hemorrhois exacerbation--strain for bowel movement
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gallbladder
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bile is thicker--gallstone and retain bile salts---itching ( pruritius)
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Bladder ( which trimester?)
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first and third= fregquency of urination
bladder capacity doubles nocturia lightening causes fetus to press against the bladder UTI |
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Kidneys and ureters
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bacteriauria---UTI and pyelonephritis
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Increases in renal plasma flow
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excretion of additional metabolic waste from mom and fetus
excretion of glucose--uti |
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Skin
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warmer and sweat more ( last trimester)
blemishes hyperpigmentation |
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hyperpigmentation
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woemn with darker hair or skin are affected more
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Melasma, Chloasma
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brownish patches
"mask of pregnancy" forehead, cheeks and brim of nose |
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Linea Alba
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line that marks longitudinal division of abdomen- darkens
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Skin chages due to increased blood vessels size
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angiomas ( spider veins)
redness of palms, soles of feet= palmar erythema |
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Striae Gravidarum
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stretch marks
linear tears in connective tissue ab, breast, buttokcs |
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Hair and Nails
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hair grows more rapidly and less falls out
hair loss after pregnancy nail growth increases - thinning and softenin may ocur |
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Calcium storage
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increased at first for mother ad stored for later use by fetus
- does not deplete mother's bones |
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postural changes
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pain at pymphysis and inner thighs ( relaxation of pelvis)
"waddling gait" leans back during third trimester backaches |
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abdominal wall
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stretches beyond capacity
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pitutitary gland changes
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FSH and LH are supressed ( which stimulate ovulation)
GH decreases prolactin increases ( breast milk) |
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posterior pituitary
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Oxytocin--- stimulates milk ejection after birth
inhibited during preg by progesterone |
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Thyroid gland
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basal metabolic rate increases due to metabolic activity of fetus
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Parathyroid gland
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calcium homestasis
slightly decreased... Ca remains stable |
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Pancreas changes
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blood glucose is lower---fluctuations in insulin production
---hypoglycemia may occur 2nd trimester- rise in glucose--add'l insulin produced ( more than doubles during meals) inadequate---gestational diabetes |
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Adrenal glands
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cortisol and aldosterone
cortisol regulates carb and protein metabolism--glucogenolyss aldosterone- Na absorption increases |
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hCG
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produced by trophoblastic cells surrounding the embryo
early- prevent deterioration of corpus luteum = positive pregnancy test |
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estrogen
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produced by corpus luteum--then by placenta
- stimulate uterine growth increase blood to uterine vessels - increasing uterine contraction near term - glands and ductal system in breasts - hyperpigmentation, vascular changes, salivary gland activity, hyperemia of gum and nasal mucous membrane |
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progesterone
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corpus luteum----placenta
- maintain endometrial layer for implantation - relax smooth mucles of uterus ( no abortion) - prevent tissue rejection of fetus - dev. of lobes and lobules in breast - deposit of maternal fat stores - relaxes smooth muscle |
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hPL
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increase availability of glucose to the fetus
potent insulin antagonist |
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relaxin
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corpus luteum and placenta
inhibit uterine activity softens connective tissue in the cervix relaxes cartilage and connective tissue of pelvic joints |
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Weight gain
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25-35 pounds
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water metabolism
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water needed increases
- maintennace of Na balance |
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dependent edema
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fluid shifts from vascular departments to interstitial
- to allow for fluid needs of fetus and mom - 1.5-9 L of water retained feet and ankles at end of day |
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carpal tunnel syndrome
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fluid retention
edema compresses the median nerve |
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carb metabolism
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more insulin required...glucose increased---hyperglycemia
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Eye changes
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thickening of the cornea in third trimester due to edema
-contacts discomfort |
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ear changes
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block ears due to estrogen changes affecting the eustachian tube, mild hearing loss
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Immune system changes
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changes to allow foreing tissue ( fetus) to grow
resistance to infection is decreased |
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Confirmation of pregnancy
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ultrasonography
presumptive probable postitve indication |
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Presumptive
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subjective-least reliable
- amenorrhea - NV - fatigue -urinary frequency - breast and skin changes - vagina and cervical changes -fetal movement |
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probable indications of pregnancy
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objective findings documented by examiner
- abdominal enlargement - cervical softening -changes in urinary consistency -ballottment -braxton hicks contractions - pregnancy tests |
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Positive indications of pregnancy
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- auscultation of fetal heart sounds
-fetal movement by examiner - visualization of the fetus |
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Preconception Visit
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before conception
first few weeks vital organs are forming complete history and physical |
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Initial Prenatal Visit
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verify rule out pregnancy
physical health assess growth and health of fetus baseline data |
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Obstetric history
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gravida, para, abortions, living children
length of previous gestations weight of infants at birth labor experiences type of anesthesia complications method of feeding concerns |
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Gravida
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who is or has been pregnant
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para
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# of pregnancies that have ended at 20 or more weeks
* twins count as 1 *doesnt matter if alive or stillborn |
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GTPAL
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G- pregnancies
T- term births P- preterm births A- abortions L- living children |
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Mestrual history
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EDD-first day of the last menstrual cycle ( ovulation and conception occur about 2 weeks after)
40 weeks |
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Nagele's Rule
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subtracting 3 months and adding 7 daysto the first day of the LNMP, and correcting the year
inaccurate if irregular |
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Contraceptive History
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IUD masculinization of female fetuses
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Medical History/ Surgical History
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DM, hypertension, renal disease
infections, surgical procedures and trauma |
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Urinary system checks
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protein
glucose ketones bacteria |
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Scheduling visits
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Conception to 28 weeks: every 4 weeks
29-36 weeks- 2-3 weeks 37 weeks to birth- weekly |
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ultrasound
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12-20 weeks
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glucose screen
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tests for gestational diabetes
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Common Discomforts of pregnancy
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NV- increased levels of hCG and estrogen
ends by second semester B6 is safe- supplements |
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Symptoms: Heartburn
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diminished gastric motility and displacemnt of the stomach by the enlarging uterus
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Symptoms: Backache
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third trimester
proper body mechanics |
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Symptoms: Round Ligament Pain
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sharp pain in the side or inguinal area on R side
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Symptoms: Urinary Frequency
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kegels, goes away by 2nd trimester
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Symptoms: Variscosities
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weight of uterus compresses the veins returning blood from the legs and estrogen causes elsatic tissue to become more fragile
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Hemorroids
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variscosites of the rectum
external or internal |
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Symptoms: Constipation
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intestinal motility is reduced ( progesterone)
iron supplementation increases constipation |
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Leg Cramps
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imbalance of serum calcium and phosphorus, low Mg levels
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FIrst Trimester: Psychosocial
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uncertainty
ambivalence the self as primary focus |
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Second TRimester: Psychosocial
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Physical evidence of pregnancy
Fetus as primary focus Narcissism and INtroversion Body IMage Sexuality |
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Third Trimester: Psychosocial
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Vulnerability
Increasng dependence preparation for birth |
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Mimicry
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observing and copying the behavior of other women who are pregnant or are mothers in attempt to discover the characteristics of the role
- wers maternity clothes before they are needed |
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Role Play
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gives woman an opportunity to practice the expected role and receive validation from an observer that he has functioned well
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Fantasy
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consider a variety of possibilites and daydream or try on a vraiety of behaviors
- most frequent during third trimester |
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Search for a Role Fit
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she has explored the role of mother long enough to have developed a sense of herself in the role
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Grief Work
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give up certain aspects of their previous selves and can never go back
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MAternal tasks of pregnancy
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1. seeking safe passage for herself and baby
2. securing acceptance of baby and herself from partner and family 3. learning to give of herself 4. developing attachment and interconnection with the unknown child |
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Safe Passage
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priority task
seeking health care provider, following recommendations, adhereing to cultural practices |
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Securing acceptance
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reworking relationships so that the important persons in the family accept the woman in the role of mother and welcomes the baby into family
*from her own mother* |
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Learning to give of herself
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learning to "give" begins by giving her body to fetus
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Committing herself to the unknown child
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finds pleasure in the role of mother and loves contemplating the new role
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Paternal Development Processes
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-grappling with reality of pregnancy and new child
- recognition as a parent from his family and social network - making an effort to be relevant to childbearing |
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Couvade
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pregnancy related symptoms and behavior in expectant fathers
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Adaptation of Grandparents: factors
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Age
number and spacing of other grandchildren perceptions of the role of grandparents |
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Cultural negotiation
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providing info while acknowledging that the family may hold views that are different from those of the nurse
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