Maternal and Child Health Nursing

 

Maternal and Child Health Nursing Notes FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING  Nursing

Process  Nursing Theory  QSEN: Quality and Safe Education for Nurses A.  Goals and Philosophies of Maternal and Child Nursing

Maternal and child health nurse:   Considers the family as a whole and as a partner in care when planning or implementing or evaluating the effectiveness of care.   Serves as an advocate to protect the rights of all family members, including the fetus.   Demonstrates a high degree of independent nursing functions because teaching and counseling are major interventions.   Promotes health and disease prevention because these protect the health of the next generation.   Serves as an important resource  for families during childbearing and childrearing as these can be extremely stressful times in a life cycle.   Respects personal, cultural, and spiritual attitudes and beliefs as these so strongly influence the 

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The primary goal of both maternal and child health nursing is the promotion and maintenance of optimal family health. Maternal and child health nursing extends  from preconception to menopause with an extensive array of health issues and healthcare providers. Examples of the scope practice include:

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  Preconception health care   Care of women during

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three trimesters of pregnancy and the puerperium (the 6 weeks after childbirth, sometimes termed the  fourth trimester of pregnancy)   Care of infants during the perinatal period (the time span beginning at 20 weeks of pregnancy to 4 weeks (28 days) after birth).   Care of children from birth through late adolescent   Care in a variety of hospital and home care settings.

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discharge options to reunite  families as soon as possible in order to create a seamless, helpful transition process.   Encourages families to reach out to their community so the family can develop a wealth of support people they can call on in a time of  family crisis.

Philosophy of Maternal and Child Health Nursing Maternal and Child Health Nursing is:   Family centered; assessment should always include the family as well as an individual.   Community centered; the health of  families is both affected by and influences the health of communities.   Evidence based; this is the means whereby critical knowledge increases.   A challenging role for nurses and a major factor in keeping families well and optimally functioning.

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meaning impact of childbearing and and childrearing. Encourages developmental stimulation during both health and illness so children can reach their ultimate capacity in adult life. Assesses families for strength as well as specific needs or challenges. Encourages family bonding through rooming-in and family visiting in maternal and child health settings. Encourages early hospital

B. Maternal and Child Health Goals and Standards in the Philippines American Nurses Association/Society of Pediatric Nurses Standards of Care and Professional Performance

  Standards of Care

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Comprehensive pediatric nursing care focuses on helping children and their families and communities achieve they optimum health potentials. This is the best achieved within the framework of family-centered care and the nursing process, including primary, secondary, and tertiary care coordinated across health care and community settings.

C. Theories Related to Maternal and Child Nursing Theorist and the Major Concepts of Theory Patricia Benner Nursing is a caring relationship. Nurses grow from novice to expert as they practice in clinical settings.

STANDARD I: Assessment

Dorothy Johnson

STANDARD II: Diagnosis STANDARD III: Outcome Identification STANDARD IV: Planning STANDARD V: Implementation STANDARD VI: Evaluation

A person comprises subsystems that must remain in balance for optimal  functioning. Any actual or potential threat to this system balance is a nursing concern.

  Standards of Professional

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Performance STANDARD I: Quality of Care STANDARD II: Performance Appraisal STANDARD III: Education STANDARD IV: Collegiality STANDARD V: Ethics The pediatric nurse’s assessment, actions, and recommendations on behalf of children and their families are determined in an ethical manner. STANDARD VI: Collaboration The nurse collaborates with the patient, significant others, and health care providers in providing patient care. STANDARD VII: Research The nurse uses research findings in practice. STANDARD VIII: Resource Utilization The nurse considers factors related to safety, effectiveness, and cost in planning and delivering patient care. STANDARD IX: Practice Environment The nurse contributes to the environment of care delivery within the practice settings. STANDARD X: Accountability The nurse is professionally and legally accountable for his/her practice. The professional may delegate to andregistered supervisenurse qualified personnel who provide patient care.

Imogene King Nursing is a process of action, reaction, interaction, and transaction, needs are identified based on client’s client’s social system, perceptions, and health; the role of the nurse is to help the client achieve goal attainment. Madeleine Leininger The essence of nursing is care. To provide transcultural care, the nurse  focuses on the study and analysis of different cultures with respect to caring behavior. Florence Nightingale The role of the nurse is viewed as changing or structuring elements of the environment, such as ventilation, temperature, odors, noise, and light to put the client into the best opportunity for recovery. Betty Neuman A person is an open system that interacts with the environment, nursing is aimed at reducing stressors through primary, secondary, and tertiary prevention. Rosemarie Rizzo Parse Nursing is a human science. Health lived is a lived experience. Man-living health as a single unit guides practice.

 

Hildegard Peplau The promotion of health is viewed as the forward movement of the personality; this is accomplished through and interpersonal process that includes orientation, identification, exploitation, and resolution. Martha Rogers The purpose of nursing is to move the client toward optimal health; the nurse

E. WHO’s 17 Sustainable Development Goals   A set of 17 goals for the world’s  future, through 2030   Backed up by set of 169 detailed targets.   Negotiated over a 2-year period at the United Nations   Agreed to by nearly all the world’s nations 

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should view the client as whole and constantly changing and help people to interact in the best way possible with the environment.

These goals apply to every nation, and every sector. Cities, businesses, schools, organizations, all are challenged to act. This is called UNIVERSALITY.

Sister Callista Roy The role of the nurse is to aid clients to adapt to the change caused by illness; levels of adaptation depend on the degree of environmental change and state of coping ability; full adaptation includes physiologic interdependence.

It is recognized that the goals are all interconnected, in a system. We cannot aim to achieve just one goal. We must achieve them all. This is called INTEGRATION.

D. Roles and Responsibilities of Maternal Child Nurse

  Maternal and child health nursing

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carries some legal concerns above and beyond other areas of nursing because care is often given to patients who are not of legal age for giving consent.

  New

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technologies can lead to potential legal action, especially if patients are uninformed about the reason or medical necessity for these procedures.

  Nurses are legally responsible for

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protecting the rights of their patients, including confidentiality, and are accountable for the quality of their individual nursing care and that of other healthcare team members.

  Understanding the scope of practice

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and standards of care can help nurses’ practice within appropriate legal parameters. Documentation is    justifying actions.

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It is widely recognized that achieving these goals involves making very big,  fundamental changes in how we live on earth. This is called TRANSFORMATION. 1.  2.  3.  4.  5.  6.  7.  8. 

NO POVERTY ZERO HUNGER GOOD HEALTH AND WELL-BEING QUALITY EDUCATION GENDER EQUALITY CLEAN WATER AND SANITATION AFFORDABLE AND CLEAN ENERGY DECENT WORK AND ECONOMIC GROWTH 9.  INDUSTRY, INNOVATION & INFRASTRUCTURE 10.  REDUCED INEQUALITIES

 

11.COMMUNITIES SUSTAINABLE CITIES AND 12.  RESPONSIBLE CONSUMPTION AND PRODUCTION 13.  CLIMATE ACTION 14.  LIFE BELOW WATER 15.  LIFE ON LAND 16.  PEACE, JUSTICE AND STRONG INSTITUTIONS 17. PARTNERSHIPS FOR THE GOALS

 

REPRODUCTIVE AND SEXUAL HEALTH A.  Concepts of Unitive and Procreative Health Procreation is the creation of a new human person, by the act of sexual intercourse, by a man and a woman. Unitive meaning is found only in natural intercourse between a man and a woman, in the type of act that is inherently ordered toward procreation.

The Prostate Gland is a gland that secretes a thin, alkaline fluid, which then added to the secretion from the seminal vesicles, further protects sperm by increasing the naturally low pH level of the urethra. The Bulbourethral Gland or Cowper’s glands lie beside the prostate gland and empty by short ducts into the urethra. It supplies one more source of alkaline fluid to help ensure spermatozoa.

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B.  Female/Male Reproductive System Male Reproductive System Andrology is the study of the male reproductive organs. The male reproductive system consists of both external and internal divisions. Male External Structures The Scrotum is a rugated, skin covered, muscular pouch suspended from the perineum. Its functions are to support the testes and help regulate the temperature of sperm. The Testes are two ovoid glands that rest in the scrotum. The Penis is composed of three cylindrical masses of erectile tissue in the penis shaft. The penis is serving as both the outlet for the urinary and reproductive tracts in men. Male Internal Structures The Epididymis it is responsible for conducting sperm from the tubule to the vas deferens, the next step in the passage to the outside. The Vas Deferens (Ductus Deferens) is an additional hollow tube which carries sperm from the epididymis. The Seminal Vesicles are two convoluted pouches that secretes a viscous alkaline liquid with a high sugar, protein, and prostaglandin content.

The Urethra is a hollow tube leading  from the base of the bladder. Like other urinary tract, it is lined with mucous membrane. Female Reproductive System Gynecology is the study of the female reproductive organs. Like the male, it has both external and internal components. Female External Structures  The Mons Veneris (Mons Pubis) A pad of adipose tissue located over the symphysis pubis, the pubic bone joint.  The Labia Minora Posterior to the mons veneris spread two hairless folds of connective, the folds of the labia minora are pink in color; the internal surface is covered with mucous membrane, and the external surface covered with skin.  The Labia Majora Two folds of tissue fused anteriorly but separated posteriorly, it serves as protection for the external genitalia.  Vestibule Flattened, smooth surface inside the labia. The openings to the bladder (the urethra) and the uterus (the vagina) both arise from this space.  Clitoris A small, rounded organ of erectile tissue at the forward junction of the labia minora.  Fourchette The ridge of tissue formed by the posterior joining of the labia minora and the labia majora. This is the structure that sometimes or is cut (episiotomy) tears during (laceration) childbirth to enlarge the vaginal opening.

 

 Hymen

A tough but elastic semicircle of tissue that cover opening to the vagina during childhood.

Gender Identity Describes the gender with which a person identifies (whether the person perceives to be a man or woman; describes d escribes oneself in some less conventional way).

Female Internal Structures  The

Ovaries The function of the two ovaries is to produce, mature, discharge ova (the egg cells).  The

Fallopian Tubes Convey the ovum from the ovaries to the uterus and to provide a place for  fertilization of the ovum by sperm.  The

Uterus A hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum. Function:   Receive the ovum from the fallopian tube   Provide a place for implantation and nourishment.   Furnish protection to a growing fetus   At maturity of the fetus, expel it from a woman’s body.  body. 

Sexual Identity Describes how a person identifies related to their sexual orientation. Hence a man who exclusively prefers women will usually have a straight or heterosexual sexual identity, and a woman who exclusively prefers women usually a lesbian or homosexual sexual identity. C. Human Sexuality Comprises a broad range of behavior and processes: physiological, psychological, social, cultural, political, philosophical, ethical, moral, theological, legal and spiritual or religious aspects of sex and human sexual behavior.

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C.1 Human Sexual Response Cycle The human sexual response cycle has four discrete stages:   excitement   plateau   orgasm   resolution Whether stages are felt as separate steps this way or blended into one smooth process of desire, arousal, and orgasm is individualized. 

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Vagina A hollow, musculomembranous canal, located posterior to the bladder and anterior to the rectum. Its function is to act as the organ of intercourse and to convey sperm to the cervix. The

Breast

The mammarylife. glands, breast, form early in intrauterine Theyor then remain in a halted stage of development until a rise in estrogen at puberty causes them to increase in size. Boys, especially those who are obese, may notice a temporary increase in breast size at puberty, name gynecomastia. B.1 Gender Gender Role A set of perceived behavioral norms associated particularly with males or  females, in a given social group or system.

1. Excitement Occurs with physical and psychological stimulation (sight, sound, emotion, or thought) that causes parasympathetic nerve stimulation. This leads to dilation and venous constriction in the genital area. 2. Plateau This stage is reached before orgasm. In the woman, the clitoris is drawn forward and retracts under the clitoral prepuce, the lower part of the vagina becomes extremely congested, and there is increased breast nipple elevation. In men, vasoconstriction leads to distention of the penis.

 

3. Orgasm This stage occurs when stimulation proceeds through the plateau stage to a point at which a vigorous contraction of muscles in the pelvic area expels or dissipates blood and fluid from the area of congestion. Orgasm is usually experienced as intense pleasure affecting the whole body. It is also a highly personal experience. 4. Resolution The resolution is a 30-minute period during which the external and internal genital organs return to an unaroused state. THE INFLUENCE OF THE MENSTRUAL CYCLE ON SEXUAL RESPONSE During the second half of the menstrual cycle –  cycle –  the  the luteal phase –  phase –  there  there is

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fluid retention and vasocongestion in the woman’s lower pelvis.

MENSTRUATION A menstrual cycle is episodic uterine bleeding in response to cyclic hormonal changes. The purpose of a menstrual cycle is to:   bring an ovum to maturity and renew a uterine tissue bed that will be necessary for the ova’s growth should it be fertilized. 

The length of menstrual cycles differs  from woman to woman, but the average length is 28 days. It is not unusual for cycles to be as short as 23 days or as long as 35 days. The length of the average menstrual flow (termed menses) is 4 to 6 days, although women may have flows as short as 2 days d ays or as long as 9 days. THE PHYSIOLOGY OF MENSTRUATION Four body structures are involved in the physiology of the menstrual cycle:   The hypothalamus   The pituitary gland   The ovaries   The uterus 

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THE INFLUENCE OF PREGNANCY ON SEXUAL RESPONSE Pregnancy is another time in life when there is vasocongestion of the lower pelvis because of the blood supply needed by a rapidly growing fetus. Following a pregnancy, many women continues to experience:   Increased sexual interest because the new growth of blood vessels 

during pregnancytolasts for some time and continues facilitate pelvic vasocongestion.   Increased breast engorgement that accompanies pregnancy results in extreme breast sensitivity during coitus.

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Hypothalamus The release of GnRH (also called luteinizing hormone-releasing hormone [LHRH]) from the hypothalamus initiates the menstrual cycle. GnRH then stimulates the pituitary gland to send the gonadotropic hormone to the ovaries to produce estrogen. When the level of estrogen rises,

release of GnRH is repressed, and no  further menstrual cycles will occur. The

Pituitary Gland Under the influence of GnRH, the anterior lobe o the pituitary gland (the adenohypohysis) produces two hormones:   FSH (Follicle Stimulating Hormone), a hormone active early in the cycle that is responsible for maturation of the ovum.   LH (Luteinizing Hormone), a hormone that becomes most active at the midpoint of the cycle and is 

MASTURBATION A self-stimulation for erotic pleasures; it can also be a mutually enjoyable activity for sexual partners. It offers sexual release, which may be interpreted by the person as overall tension or anxiety relief.

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responsible for ovulation, or release of the mature egg cell from the ovary. It also stimulates growth of the uterine lining during the second half of the menstrual cycle.

 

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Ovaries FSH and LH are called gonadotropic hormones   because they cause growth hormones (trophy) in the gonads (ovaries). Every month during the fertile period of a woman’s life,  life,    one of the ovary’s oocyte is activated by FSH to begin to grow and mature.   Its cells produce a clear fluid (follicular fluid) that contains a high degree of estrogen and some progesterone.   At full maturity, the follicle is visible on the surface of the ovary as a clear water blister.   At this stage of maturation, the small ovum with its surrounding follicular membrane and fluid is termed as graafian follicle .  

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By day 14 or the midpoint of a typical 28day cycle, the ovum has divided by mitotic division into two separate bodies: 1.  A primary oocyte, which contains the bulk of the cytoplasm 2.  A secondary oocyte, which contains so little cytoplasm that is not functional. After an upsurge of LH from the pituitary at about day 14, prostaglandins are released and the graafian follicle ruptures. The ovum is set free from the surface of ovary, a process termed ovulation .   LH, continues to rise in amount and directs the follicle cells left behind in 

the ovary to produce lutein (a bright yellow fluid high in progesterone). progesterone) .   With lutein production, the follicle is renamed a corpus luteum . 

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If conception (fertilization by a spermatozoon) occurs as the ovum proceeds down a fallopian tube and the  fertilized ovum implants on the endometrium of the uterus   For about 16 to 20 weeks, the corpus luteum remain throughout the major portion of the pregnancy.

If conception does not occur, the unfertilized ovum atrophies after 4 to 5 days and the corpus luteum (now called a “false” corpus luteum) remains for only 8 to 10 days.  The

Uterus Uterine changes also occur due to the stimulation of the estrogen and progesterone produced by the ovaries. PHASES OF MENSTRUAL CYCLE  THE

FIRST PHASE OF THE MENSTRUAAL CYCLE (PROLIFERATIVE) Immediately after a menstrual flow (which occurs during the first 4 or 5 days of a cycle), the endometrium, or lining of the uterus, is very thin, approximately one cell layer in depth.   From day 5 to day 14, the endometrium begins to proliferate so rapidly the thickness of the endometrium increases as much as eightfold, as the ovary begins to produce estrogen.   This first half of menstrual cycle is interchangeably termed the proliferative, estrogenic,  follicular, or postmenstrual phase. 

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THE SECOND PHASE OF MENSTRUAL CYCLE (SECRETORY)

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After the ovulation, the formation of progesterone in the corpus luteum (under the direction of LH) causes the glands of the t he uterine endometrium to become corkscrew or twisted in appearance.

  This second phase of the menstrual

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cycle is termed the progestational, luteal, premenstrual, or secretory phase.  THE

THIRD PHASE OF THE MENSTRUAL CYCLE (ISCHEMIC)

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If fertilization does not occur, the corpus luteum in the ovary begins to regress 8 to 10 days, and therefore, the production of progesterone decreases. The capillaries rupture, with minutes hemorrhages, and the endometrium sloughs off.

 

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THE FOURTH PHASE OF MENSTRUAL CYCLE (MENSES)

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Menses, or a menstrual flow, is composed of a mixture of blood from the ruptured capillaries; mucin; fragments of endometrial tissue; and the microscopic, atrophied, and the unfertilized ovum. Menses is the end of an arbitrarily defined menstrual cycle, however the first day of menstrual flow is used to mark the beginning day of a new menstrual cycle. FERTILIZATION   FERTILIZATION Also referred to as conception and impregnation, it is the union of an ovum and a spermatozoon. This usually occurs in the outer third of the fallopian tube, termed the ampullar portion. Once the mature ovum is released,  fertilization must occur quickly because an ovum is capable of fertilization for only about 24 hours (48 hours at most) and the  functional life of a spermatozoon is also about 48 hours, possibly as long as 72 hours As the ovum is extruded from the graafian follicle of an ovary with ovulation, it is surrounded by a ring of mucopolysaccharide fluid (the zona pellucida) and a circle of cells (the corona radiata). At the time of ovulation, there is a reduction in the viscosity (thickness) of the woman’s cervical mucus, which makes easy it for spermatozoa to penetrate it. All the spermatozoa that reach the ovum cluster around its protective layer of corona cells. Hyaluronidase (a proteolytic enzyme) is release by the spermatozoa and dissolves the layer of cells protecting the ovum.

IMPLANTATION Once fertilization is complete, a zygote migrates over the next 3 to 4 days toward the body of the uterus, aided by the currents initiated by the muscular contractions of the fallopian tubes. During this time, mitotic cell division, or cleavage begins. The first cleavage occurs at about 24 hours. Over the next 3 to 4 days, large cells tend to collect at the periphery of the ball, leaving a fluid space surrounding an inner cell mass, at this stage the structure is termed as blastocyst. The cells in the outer ring are trophoblast cells, they are part of the structure that will later form the placenta and membranes (ectoderm, mesoderm, endoderm). Implantation or contact between the growing structure and the uterine endometrium, occurs approximately 8 to 10 days after fertilization. Implantation usually occurs at the upper third portion of the uterus. Once implanted, the zygote is now called embryo. STAGES OF FETAL DEVELOPMENT In just 38 weeks, a fertilized egg (ovum) matures from a single cell to a fully developed fetus ready to be born. Fetal growth and development can be divided into three time periods:   Pre-embryonic (first 2 weeks, beginning with fertilization)   Embryonic (weeks 3 through 8)   Fetal (from week 8 through birth) 

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TERMS USED TO DESCRIBE FETAL GROWTH Ovum –   –  From  From ovulation to fertilization   Ovum   Zygote  –   From fertilization to implantation   Embryo  –   From implantation to 5-8 weeks. Conceptus –   –  Developing   Developing embryo and   Conceptus placental structures throughout

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Immediately after penetration of the ovum, the chromosomal material of the ovum and spermatozoon fuse to form a zygote. Because the spermatozoon and ovum each carried 23 chromosomes, the  fertilized ovum has 46 chromosomes.

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pregnancy.

 

  AGE OF VIABILITY  –   THE EARLIEST

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AGE AT WHICH FETUSES SURVIVE IF THEY ARE BORN IS GENERALLY ACCEPTED AS 24 WEEKS OR AT THE POINT A FETUS WEIGHS MORE THAN 500-600g.  500-600g. 

ENDOCRINE FUNCTION  Human

Chorionic Gonadotropin The first placental hormone produced, hCG, can be found in maternal blood and urine as early as the first missed menstrual period.

EMBRYONIC AND FETAL STRUCTURES  The

Decidua or Uterine Lining After fertilization, the corpus luteum in the ovary continues to function rather than atrophying under the influence of human chorionic gonadotropin (hCG) secreted by the trophoblast cells. This hormone also causes the uterine endometrium to continue to grow in thickness and vascularity instead of sloughing off as in a usual menstrual cycle. The endometrium is now typically termed the decidua because it will be discarded after birth of the child.  Chorionic

Villi

As early as 11 or 12th day after  fertilization, miniature villi, resembling probing fingers and termed chorionic villi, reach out from the trophoblast cells into the uterine endometrium to begin formation of the placenta. Chorionic villi have a central core consisting of connective tissue and fetal capillaries surrounded by a double layer of cells, which produce various placental hormones such as:   Human Gonadotropin Hormones (hCG) (Human   Somatomamotropin Placental Lactogen [hPL])   Estrogen   Progesterone 

hCG’s purpose is to act as a fail-safe fail-safe measure to ensure the corpus luteum of the ovary continues to produce progesterone and estrogen so the endometrium of the uterus is maintained.  Progesterone

Progesterone is referred as “hormone that maintains pregnancy”. pregnancy”.

the

Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy.  Estrogen

Estrogen (primarily estriol) often referred as the “hormone of women” which women”  which influences a female appearance and is produced as a second product of the syncytial cells of the placenta. Estrogen contributes to the woman’s mammary gland development in preparation for lactation and stimulates uterine growth to accommodate developing  fetus.  Human

Placental Lactogen (hPL) hPL is a hormone with both growthpromoting and lactogenic (milk producing) properties. It promotes mammary gland (breast) growth in preparation for lactation in the mother.

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Placenta The placenta grows from a few identifiable trophoblastic cells at the beginning of pregnancy to an organ.  Placental

Circulation

As early as the 12th day of pregnancy, maternal blood begins to collect in the intervillous spaces of the uterine endometrium surrounding the chorionic villi.

It also serves as the important tole of regulation maternal glucose, protein, and  fat levels so adequate amounts of these nutrients are always available to the fetus.  Placental

Proteins This hormone may contribute to decreasing the immunologic impact of the growing placenta and help prevent hypertension of pregnancy.

 

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Amniotic Membranes

An umbilical cord contains only:   1 vein (Umbilical vein)  –   carrying blood from the placental villi to the  fetus)   2 arteries (Umbilical arteries)  –   carrying blood from the fetus back to the placental villi) 

The chorionic villi on the medial surface of the trophoblast gradually thin until they become the chorionic membrane, the outermost fetal membrane. The amniotic membrane, or amnion  forms beneath the chorion. The amniotic membrane is a dual-walled sac with the chorion as the outermost part and the amnion as the innermost part. The amniotic membrane not only offers support to amniotic fluid but also actually produces the fluid.  The

Amniotic Fluid

The most important purpose of amniotic fluid is to shield the fetus against pressure or a blow to the mother’s abdomen. Because liquid changes temperature more slowly than air, it also protects the fetus from changes in temperature. Another function is that it aids in muscular development, as amniotic fluid allows the fetus freedom to move. Finally, it protects the umbilical cord from pressure, thus protecting the fetal oxygen supply. The fetus continually swallows the  fluid, it is absorbed from the fetal intestine into the fetal bloodstream. If for any reason the fetus is unable to swallow, excessive amniotic fluid hydramnios (polyhydramnios) more than 2,000 mL in total of fluids will result. A disturbance of kidney function therefore, may cause oligohydramnios or a reduction in the amount of amniotic fluid.

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Umbilical Cord The umbilical cord is formed from the  fetal membranes, the amnion and chorion and provides a circulatory pathway that connects the embryo to the chorionic villi of the placenta.

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ASSESSING OF FETAL GROWTH AND DEVELOPMENT Test for fetal growth and development are commonly done for a variety of reasons, including to:   Predicting the outcome of the pregnancy   Manage the remaining weeks of the pregnancy   Plan for possible complications at birth   Plan for problems that may occur in the newborn infant   Decide whether to continue the pregnancy   Find conditions that may affect future 

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pregnancies  Health

History Like all assessments, a fetal assessment begins with a health history. Physical

Examination A second step in evaluating fetal health. Assess maternal weight and general g eneral appearance because both obesity and underweight are clues that the mother’s nutrition may not be adequate for sound  fetal growth. Estimating

Fetal Health

Fetal Growth  Growth  As a fetus grows, the uterus expands to accommodate its size. Typical fundal measurements are:   Over the symphysis pubis at 12 weeks.   At the umbilicus at 20 weeks   At the xiphoid process at 36 weeks. 

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 McDonald’s Donald’s  Mc

Rule   Rule Another symphysis-fundal height measurement is an easy method of determining mid-pregnancy growth.

 

ASSESSING FETAL WELL BEING  Fetal Heart Rate Fetal heart sounds can be heard and counted as early as the 10th to 11 weeks of pregnancy by the use of an ultrasound Doppler technique.

As soon as conception has taken place, development proceeds in a cephalocaudal (head to tail) direction.

 Daily

 Primary

 Ultrasonography

All organ systems are complete, at least in a rudimentary form, at 8 weeks gestation (the end of the embryonic period).

Fetal Movement Count Fetal movement that can be felt by the mother (quickening) occurs at approximately 18 to 20 weeks of pregnancy and peaks in intensity at 28 to 38 weeks.

Measures the response of sound waves against solid objects, is a much-used tool for fetal health assessments. It can be used to: complications of   Discover pregnancy, such as the presence of intrauterine device, hydramnios, or oligohydramnios, multiple pregnancy. Genetic disorders such as Down syndrome and fetal anomalies. 

ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS

Germ Layers As a fetus grows, body organs systems develop from specific tissue layers called germ layers.

During this early time of organogenesis (organ formation) the growing structure is most vulnerable to invasion by teratogens.

 Biophysical

Profile Combines five parameters: fetal reactivity, fetal breathing movements, fetal body movement, fetal tone, and amniotic  fluid volume. A biophysical profile is more accurate in predicting fetal well-being than any single assessments.  Magnetic

Resonance Imaging

 fetus. Another way to assess a growing  Maternal

Serum Can reveal information about the pregnant woman as well as the fetus.  Invasive

Fetal Testing If a genetic or growth concern is identified by noninvasive measures, a number of invasive measures allow for more refined investigations.

  Amniocentesis

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  Chorionic villi sampling

 Cardiovascular

System The cardiovascular system is one of the first systems to become functional in the t he intrauterine life. Forms as early as the 16th  day of life and beats as early as the 24th day. The septum divides the heart into chambers develop during the 6th or 7th week.

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The heartbeat may be heard with a Doppler instrument as early as the 10th to 12th week of pregnancy.

 

 Fetal

Circulation Blood flows from the umbilical vein to the ductus venosus, an accessory vessel that discharges oxygenated blood into the  fetal liver, vessel that discharges oxygenated blood into the fetal liver, and then connects to the fetal inferior vena cava so oxygenated blood is directed to the right side of the hear. Bulk of blood is shunted as it enters the right atrium into left atrium through an opening in the atrial septum called foramen called foramen ovale.. ovale However, the larger portion of even this blood is shunted away from the lungs through an additional structure, the ductus arteriosus, directly into the descending aorta.  Respiratory

System At the 3rd week of intrauterine life, the respiratory and digestive tracts exist as a single tube. Until the 7th week of life, the diaphragm does not completely divide the thoracic cavity from the abdomen. If the diaphragm fails to close completely, the stomach, spleen, liver, or intestines may be pulled up into the thoracic cavity (diaphragmatic hernia). Surfactant, a phospholipid substance is formed and excreted by the alveolar cells of the lungs beginning at approximately the 24th week of pregnancy.

 

 Nervous

System Begins to develop extremely early in pregnancy.   A neural plate (a thickened portion of the ectoderm)   All parts of the brain (cerebrum, cerebellum, pons, and medulla oblongata) form in utero.   Brain waves can be detected on an electroencephalogram (EEG) by the eighth week.   The eye and inner ear develop as projections of the original neural tube 

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  By 24 weeks, the ear can respond to

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sound and the eyes exhibit a pupillary reaction, indicating sigh is present.  Endocrine

System Function of endocrine organs begins along with neurosystem development.   The fetal pancreas produces insulin needed by the fetus. (Insulin is one of 

the few that does not cross the substances placenta from the mother to the fetus  Digestive

System The digestive tract separates from the respiratory tract at about the 4th week of intrauterine life and after that, begins to grow extremely rapidly. The liver is active throughout intrauterine life, functioning as a filter between the incoming blood and the fetal circulation and as a deposit site for fetal

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This decreases alveolar surface tension on expiration   Preventing alveolar collapse   Improving the infant’s ability to maintain respirations in the outside environment at birth.

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Surfactant has two components: 1.  Lecithin 2.  Sphingomyelin  –   early component of surfactant.

chief

At approximately 35 weeks, there is a surge in the production of lecithin, which then becomes the chief component by a ratio of 2:1.

stores such as iron and glycogen.  Musculoskeletal

System During the first 2 weeks of fetal life, cartilage prototypes provide position and support to the fetus. Ossification of this cartilage into bone begins at about the 12th week and continues all through fetal life and into adulthood.

 

 Reproductive

System A child’s sex is determined at the moment of conception by a spermatozoon carrying an X or a Y chromosome and can be ascertained as early as 8 weeks by chromosomal analysis. At about the 6th week after implantation, the gonads form. The testes  first form in the abdominal cavity and do not descend into the scrotal sac until the 34th to 38th week.

DETERMINATION OF ESTIMATED BIRTH DATE Gestational age wheels and birth date calculators, which can be used to predict a birth date are available, but calculation by Naegele’s rule is the standard method used to predict the length of a pregnancy. THE CONFIMATION OF PREGNANCY Pregnancy was diagnosed on symptoms reported by the woman and the signs elicited by a healthcare provider.

 Urinary

System Rudimentary kidneys are present as early as the end of the 4th week of intrauterine life. Urine, however, is formed by the 12th week and is excreted into the amniotic fluid by the 16th week of gestation. g estation. At term, fetal urine is being excreted at a rate of up to 500mg/day.  Integumentary

System The skin of a fetus appears thin and almost translucent until subcutaneous fat begins to be deposited underneath it at about 36 weeks.

Skin is covered by soft downy hairs (lanugo) that serves as insulation to preserve warmth in utero as well as a cream cheese-like substance, vernix caseosa, which as importance for lubrication and for keeping the skin from macerating in utero.  Immune

System Immunoglobulin (Ig) G maternal antibodies cross the placenta into fetus as early as the 20th week and certainly by the 24th week of intrauterine life to give a fetus temporary passive immunity against diseases for which the mother has antibodies. These often includes:   Poliomyelitis   Rubella (German measles)   Rubeola (Regular measles)   Diphtheria   Tetanus   Mumps   Hepatitis B 

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  Whooping cough (Pertussis)

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Theses signs and symptoms, still important today, are traditionally divided into three classifications:   Presumptive (subjective symptoms)   Probable (objective signs)   Positive (documented signs) 

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PHYSIOLOGIC CHANGES OF PREGNANCY

IMPORTANT TERMS: Pica –  Pica  –  Abnormal  Abnormal cravings Couvade –  infanticipation Couvade –   infanticipation experience by the husband. Ambivalence - Experiencing feelings less than pleasure. Primigravida –  woman Primigravida –   woman in her first pregnancy. Multipara –  Woman Multipara –   Woman who had one or more children. Amenorrhea –  Absence Amenorrhea –   Absence of menstrual  flow.

PSYCHOLOGIC CHANGES OF PREGNANCY

Operculum –  Mucus Operculum –   Mucus plug, seal out bacteria and help prevent infection in the fetus and membranes. Stria gravidarum  –   atrophy of small segments of the connective layer of the skin. Diastasis –  rectus Diastasis –   rectus muscle underneath the skin to actually separate. Linea nigra  –   a narrow, brown line, running from the umbilicus to symphysis pubis. Melasma –  “mask of pregnancy”, Melasma –  pregnancy”, darkened or reddened areas may appear of the face. Vascular spiders –  spiders –  “Telangiectasias”, small, fiery-red branching spots sometimes develop on the skin, particularly on the thighs.