NCM 101 LECTURE (Maternal and Child Health Nursing) Fallopian Tube -2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the amplla to the uterus -4 significant segments * infundibulum – most distal, part trumpet shape, has fimbrae * ampulla – outer 3 rd or 2nd half, site of fertilization, common site for ectopic pregnancy * isthmus – site for sterilization, site for BTL * interstitial – most dangerous dangerous site for ectopic pregnancy
Fertilization: 1.Union
of the ovum and spermatozoon 2.Other terms: conception, impregnation or fecundation 3.Normal amount of semen/ejaculation= semen/ejaculation= 3-5 cc = 1 tsp. 4.Number of sperms: 120-150 million/cc/ejaculation 5.Mature ovum may be fertilized for 12 –24 hrs after ovulation 6.Sperms are are capable of fertilizing even for 3 – 4 days after ejaculation (life span of sperms 72 hrs) 7. Normal life span of sperm is 7 days
Implantation- nidation- takes 1 week after fertilization General Considerations: Considerations: o Once implan implantatio tation n has taken taken place, place, the uterine uterine endometr endometrium ium is now now termed termed decidua decidua o Occasiona Occasionally, lly, a small small amount amount of of vaginal vaginal bleeding bleeding occurs occurs with with implan implantati tation on due to breakage of capillaries o Immediat Immediately ely after after fertiliz fertilizatio ation, n, the fertilize fertilized d ovum or zygote zygote stays in in the fallopian fallopian tube for 3 days, during which time rapid cell division (mitosis) is taking place. The developing cells now called blastomere and when about to have 16 blastomere blastomere called morula. o Morul Morula a travel travels s to uter uterus us for for anoth another er 3 – 4 days days o When there there is alrea already dy a cavity cavity in the the morula morula calle called d blastocy blastocytt o finger finger like project projections ions called called tropho trophoblas blastt form around around the the blastocyst, blastocyst, which which implant implant on the uterus o Implantat Implantation ion is also also called called nidati nidation, on, takes takes place place about a week week after after fertliz fertlizatio ation n -morula- 16 blastomere -morula- cavity in the morula -trophoblast- fingerlike projections Age of reproductivity- 15-44y/o ChildbearingChildbearing- 20-35 y/o y/ o Average menstrual cycle- 28 days Average menstrual period- 5 days Normal blood loss- 50cc/1/4 cup accompanied by FIBRINOLYSIS – prevents clot formation Fetal Growth and Development
First Lunar Month – first four weeks -germ layers differentiate by the 2 nd week
1. end endoder oderm m – gives ves ris rise to lini linin ng of GIT, GIT, Respi espirrator atory y Tract, ct, tons tonsiils, thyr thyroi oid d (for (for basal asal metabolism), parathyroid (for calcium metabolism), thymus gland (for development of immunity), bladder and urethra 2. Mes Mesoder derm – for forms into the the suppo upporrtin ting struc tructu turres of the the body ody (conn connec ecti tive ve tis tissues ues, cartilag cartilage, e, muscles muscles and tendons) tendons);; heart, heart, circula circulatory tory system, system, blood blood cells, cells, reprod reproducti uctive ve system, system, kidneys and ureters. 3. Ectoderm – responsible for the formation of the nervous system, skin, hair and nails and the mucous membrane of the anus and mouth
1 month: 2nd week – fetal fetal membran membranes es 16th day – heart heart forms forms ; 4th week – heart heart beats 2nd month: All vital organs and sex organs formed; placental fully developed; meconium formed (5th –8th wk) 3rd month: Kidneys Kidneys function function - 12th 12th wk- urine urine formed formed ; Buds of milk teeth form ; begin bone bone ossification ; allows amniotic fluid fluid ; establishment establishment of feto-placental exchange exchange 4th month: Lanugo Lanugo appears; appears; buds of permanent permanent teeth form; form; heart beat heard heard by fetoscope 5th month: Vernix appears; lanugo over entire body; quickening; FHR audible with stethoscope 6th month: Attains proportions of full term but has wrinkled skin 7th month: 28 weeks – lower lower limit of prematurity; prematurity; alveoli begins to form 8th month: 32 weeks – fetus viable; lanugo disappears, subcutaneous fat deposition begins 9th month: Lanugo continue to disappear; vernix complete; amniotic volume decrease
Focus of Fetal Development First Trimester – period of organogenesis Second Trimester – period of continued fetal growth and development; rapid increase in length Third Trimester – period of most rapid growth and development because of the deposition of subcutaneous fat Fetal Membranes 1.Amnion – gives rise to umbilical cord/funis – with 2 arteries and 1 vein supported by 2.Wharton’s jelly- protects the umbilical cord 3.Amniotic fluid: clear albuminous fluid, begins to form at 11 – 15th week of gestation, chiefly derived from maternal serum and fetal urine, urine is added by the 4th lunar month, near term is clear, colorless, containing little white specks of vernix caseosa, produced at rate of 500 ml/day. ml/day. Known as BOW or Bag of Water Water Umbilical Cord/Funis -whitish gray -connects the fetus to the placenta -carry oxygen and nutrients from the placenta to the fetus and return unoxygenated unoxygenated blood and fetal waste product to the placenta -liver functions functions for the detoxification detoxification -A,V, A (2 arteries, 1 Vein) Cord Abnormalities: BASA PRAVIA- the umbilical cord loses the protection of the wharton’s jelly Signs and Symptoms: 1. Sudden gosh gosh bright red red blood at the tip of the rapture rapture of membrane membrane 2. Sudden Sudden fetal fetal brad bradyca ycard rdia ia 3. Sinusoidal fetal heart rate rate pattern- long term term variability variability consist of 5-15 bpm bpm every 35mins 4. Short Cord results to: 1. Intrapart Intrapartum um hemorr hemorrhage hage (durin (during g delivery) delivery)
2. 3. Long 1.
Delayed Delayed descen descend d of the the fetus fetus during during labor labor Invers Inversion ion of the the uterus uterus Cord results to: True rue Knot Knots s Cord Cord a. Central Central insertio insertionn- cord insert inserted ed at the center center of the placenta placenta b. Lateral insertioninsertion- cord inserted inserted away away from the center center of the placenta 2. Villatentous Villatentous insertion insertion – membranes membranes of cord is inserted to the membrane membrane to the placenta 3. Battledoor Battledoor Insertion Insertion – at the edge
Diagnosis of Basa Pravia 1. Transvaginal sonography at 16 weeks of gestation 2. Caesarean Section is the best remedy
Knots of the cord- fetal movement may cause knots in the cord *true knots- fetus passes through a loop of cord * false knots- Wharton’s jelly containing a loop of umbilical vessels Loops of the cord- cord coil around the fetal body and neck, when the cord coil is the neck it is called nuccal cord. Torsion of the cord- deficiency of Wharton’s jelly number Hematoma of the cord- results from the rapture of the vessels with a fusion of blood into the cord Cord Cyst- vesicular formation on the cord *true cord cyst - derived from remnants of the umbilical vesicles *false cord cyst - large and derived from Wharton’s jelly. Edema of the cord- commonly seen in the dead fetus Single Umbilical Artery- renal associated with other renal anomalies 2 sides of placenta 1. Maternal (rami(rami- collection collection of villi)villi)- each cotyledon cotyledon is a collection of villi which which terminate terminate in one main stem, the lobes are separated by grooves called septic.
Amniotic Fluid Purposes of Amniotic Fluid Protection – shield against pressure and temperature changes Can be used to diagnose congenital abnormalities intrauterine– intrauterine– amniocentesis Aid in the descent of fetus during active labor Implication: Polyhydramios = more than >1500 ml ml due to inability of the fetus to swallow swallow the fluid as in trachoesophageal fistula. Oligohydramnios = less than <500 <500 ml due to the inability of the kidneys to add urine urine as in congenital renal anomaly
Fetal Membranes Chorion - together with the deciduas basalis basalis gives rise rise to the placenta, start to form at 8th week of gestation; develops 15 – 20 cotyledons •
Purpose of Placenta: respiratory; exchange of nutrients and oxygen Renal system Gastrointestinal system Circulatory Circulatory system Endocrine system: produces hormones (before 8th week-corpus luteum produces these hormones) hCG keeps corpus luteum to continue producing estrogen and progesterone HPL or human chorionic somatomammotropin somatomammotropin which promotes growth of mammary glands for
• • • • •
•
lactation Protective barrier: inhibits passage of some bacteria and large molecules
•
