maternal_ Care of the Mother and the Fetus during the Perinatal Period

Pre-embryonic

Three time periods of fetal growth and development: FIRST 2 WEEKS STARTING FERTILIZATION

Embryonic

Three time periods of fetal growth and development: WEEK 3 TO 8

Fetal

Three time periods of fetal growth and development: WEEK 8 TO BIRTH

Ovum

From OVULATION to FERTILIZATION

Zygote

From FERTILIZATION to IMPLANTATION

Embryo

From IMPLANTATION to 5-8 WEEKS

Fetus

From 5-8 WEEKS until term

Conceptus

Developing embryo and placental structures throughout pregnancy

Age of Viability

The earliest age at which fetuses survive if they are born is generally accepted as 24 weeks or at the point a fetus weighs more than 500-600 g

Decidua

The corpus luteum in the ovary continues to function rather than atrophying under the influence of hCG secreted by the trophoblast cells.

hCG

This hormone causes the uterine endometrium to continue to grow in thickness and vascularity instead of sloughing off

Latin word for " falling off"

decidua

Part the endometrium that lies directly under the embryo (or the portion where the trophoblast cells establish communication with maternal blood vessels)

DECIDUA BASALIS

Portion of the endometrium that stretches or encapsulates the surface of the trophoblast

DESIDUA CAPSULARIS

Remaining portion of the uterine lining

DESIDUA PARIETALIS/ VERA

Projection of the trophoblast that produce hCG and begin osmosis of nutrients to the embryo

Chorionic Villi

chorionic villi

As early as the 11th or 12th day after fertilization, miniature villi, resembling probing fingers reach out from the trophoblast cells into the uterine endometrium to begin formation of the placenta

CHORIONIC VILLI

CENTRAL CORE consisting of connective tissue and fetal capillaries surrounded by a double layers of cells produce various PLACENTAL HORMONES , such as hCG, SOMATOMAMMOTROPIN, ESTROGEN AND PROGESTERONE

Cytotrophoblast

Also called as Langhans' layer, it protects the growing embryo and fetus from certain infectious organisms such as spirochetes of syphilis early in pregnancy

Latin for "pancake" descriptive of its size and appearance at term

placenta

Placenta

Grows from a few identifiable trophoblastic cells at the beginning of pregnancy to an organ 15 to 20 cm in diameter and 2 to 3 cm in depth

Provides OXYGEN and NUTRIENTS to the growing fetus and REMOVE WASTE PRODUCTS from the baby's blood

PLACENTA

Cotyledons

30 or more partitions or septa. This transmit fetal blood and allow exchange of oxygen and nutrients with maternal blood.

No nonessential drugs during pregnancy, including alcohol and nicotine (fetal alcohol spectrum disorder)

True statement about placental circulation

Uteroplacental blood flow increases from about __________________.

50 ml/min at 10 weeks to 500 or 600 ml/min at term

Braxton Hicks contractions

starts at 12th week, aid in maintaining pressure in the intervillous spaces by closing off the uterine veins momentarily with each contraction

lying on the left side

it promotes uterine perfusion and placental circulation

Vena cava syndrome

placental circulation is reduced that supine hypotension can occur

Placenta weighs

400 to 600 g (1lb)

Human Chorionic Gonadotropin (hCG)

Maternal and blood urine as early as the first missed menstrual period
Completely negative after 1-2 weeks after birth
The production of hCG begins to decrease at about 8th week of pregnancy

Progesterone

Hormone that maintains pregnancy
Present in the maternal serum as early as the fourth week of pregnancy as a result of the corpus luteum Level rises progressively during the remainder of the pregnancy.
Reduce contractility of the uterus, thus preventing premature labor

Estrogen (Estriol)

Produced as a second product of the syncytial cells of the placenta.
Contributes to the mammary gland development and uterine growth

Human Placental Lactogen (Human Somatomammotropin)

Promotes mammary gland growth, regulation of maternal glucose, and fat levels for fetal consumption

Placental Proteins

May contribute to decreasing immunologic impact of the growing placenta and help prevent hypertension in pregnancy

Amniotic Membranes

Produces and protects the amniotic fluid. Produces a phospholipid that initiates the formation of prostaglandin which may trigger the labor.

Chorionic membrane

Forms from the chorionic villi on the medial surface of the trophoblast (do not touch the endometrium) gradually thins until it becomes the outermost fetal membrane.

Amniotic membrane or amnion

Forms beneath the chorion; a dual-walled sac with the chorion as the outermost part and the amnion as the innermost.

Amniotic Fluid

Constantly formed and absorbed even if the amniotic membranes rupture before birth and the bulk is lost

Fetus continually swallows, absorbed from the fetal intestine into the fetal bloodstream. It is 800 to 1,200 ml

Amniotic Fluid

Hydramnios

More than 2,000 ml in total or pockets of fluid larger than 8 cm on UTZ; cases of esophageal atresia, anencephaly, GDM

Oligohydramnios

reduction in the amount of amniotic fluid

Amniotic fluid index

It must be at least 5 cm, vertical pocket should be greater than 2 cm.

Amniotic fluid Purposes

Protection against pressure or a blow to the mother's abdomen
Protection from temperature changes
Aids in fetal muscular development
Protects the umbilical cord from pressure

Amniotic fluid alkalinity

Slightly alkaline, ph of 7.2. Differentiate from urine (pH of 5.0 to 5.5)

Umbilical Cord

Formed from the fetal membranes, chorion and amnion. Connects the embryo to the chorionic villi of the placenta. Transports oxygen and nutrients to the fetus and returns waste products from the fetus to the placenta. It is 53 cm long and about 2 cm thick at term

Wharton jelly

The gelatinous mucopolysaccharide which gives the cord its body and prevents pressure on the vein and arteries

2:1 or AVA

Vein carries the oxygenated blood from the placenta to the fetus. Arteries carry the unoxygenated blood from the fetus to the placenta. What is the RATIO of artery : vein?

Nuchal cord during delivery

remove coil before the shoulders are delivered to avoid disruption of oxygen supply to the fetus

Cord clamping

Umbilical cord has no nerve supply, it can be cut at birth without discomfort to either mother or child

Unang Yakap

Delayed cord clamping

Zygote: Totipotent stem cells

undifferentiated they have the potential to grow into any cell in the human body

Embryo: Pluripotent stem cells

lose their ability to become any body cell and become specific

Multipotent stem cells

so specific that they cannot be deterred to become a particular body organ

Circulation after birth: Deoxygenated RBC from various parts of the body enter ________________.

Inferior Vena Cava

Circulation after birth: Blood cells flow in to the right atrium and continue to the _______________.

Right Ventricle

Circulation after birth: Exit to the lungs via the ____________________ where blood cells are then oxygenated

Pulmonary Artery

Circulation after birth: Blood cells get oxygenated in the __________ found in the capillaries of the lungs

Alveoli

Circulation after birth: Oxygenated blood then enters the heart via _____________________.

Pulmonary Vein

Circulation after birth: Oxygenated blood cells move in to the __________________ and in to the left ventricle.

Left Atrium

Circulation after birth: Red blood cells move in to _________ from which they are pumped to the rest of the body

Aorta

Fetal Circulation

The mother (placenta) is doing the work that the baby's lungs will do after birth.

3 shunts in fetal circulation

ductus venosus, foramen ovale, ductus arteriosus

Foramen ovale

Bypasses the lungs. This shunt moves blood from the right atrium of the heart to the left atrium.

Ductus arteriosus

Moves blood from the pulmonary artery to the aorta.

Ductus venosus

Carries freshly oxygenated blood to the fetal heart.

Oxygen and nutrients from the mother's blood are sent across the __________ to the fetus. The enriched blood flows through the ______________ to the liver.

placenta; umbilical vein

The blood then reaches the __________________. This is a major vein connected to the heart. Most of this blood is sent through the ______________________. This is also a shunt that lets highly oxygenated blood bypass the liver to the inferior vena cava and then to the right atrium of the heart.

inferior vena cava; ductus venosus

INSIDE THE FETAL HEART: Blood enters the _______________. This is the chamber on the upper right side of the heart. When the blood enters the right atrium, most of it flows through the _______________ into the left atrium.

right atrium; foramen ovale

INSIDE THE FETAL HEART: After the blood enters. Blood then passes into the ________________. This is the lower chamber of the heart. Blood then passes to the _________. This is the large artery coming from the heart.

left ventricle; aorta

INSIDE THE FETAL HEART: From the __________, blood is sent to the heart muscle itself and to the brain and arms. After circulating there, the blood returns to the right atrium of the heart through the ____________________. Very little of this less oxygenated blood mixes with the oxygenated blood. Instead of going back through the foramen ovale, it goes into the right ventricle.

aorta; superior vena cava

Diaphragmatic hernia

diaphragm fails to close completely

Surfactant

Formed and excreted by the alveolar cells of the lungs beginning at approx. 24th week of pregnancy; decreases alveolar surface tension on expiration, preventing alveolar collapse and improving the infant's ability to maintain respirations in the outside environment at birth.

At 35 weeks, lecithin becomes the chief component by a ratio of _______. L/S ratio analysis via amniocentesis technique is a primary test of fetal maturity

2:1

Respiratory distress syndrome

Severe breathing disorder because of lack or immature form of surfactant

Betamethasone

Administered to women in preterm labor to facilitate fetal lung maturity

Meconium

Early stool passed by a newborn soon after birth; collection of wastes, biles, fats, mucoproteins accumulated in the intestines as early as the 16th week; sticky in consistency appears lack or dark green

Vit K thru IM

Given to NB to helps the blood to clot and prevent serious bleeding

Hypoglycemia and hyperbilirubinemia

Two serious problems that can occur in the fetus 24 hours after birth

Undescended testes in preterm males (cryptorchidism)

Poor sperm production and testicular cancer later in life

Lanugo

Soft downy hairs that serve as insulation to preserve warmth in utero

Vernix caseosa

Cream cheese-like substance important for lubrication and for keeping the skin for macerating in utero.