reproductive health I

maternity nursing

• focuses on well-being of mother and fetus/infant

• support emotional, physical, spiritual well-being of both clients

• provides advice & personalized health care

• provides support to family

mons pubis

fatty area overlying pubic symphysis that protects pelvic bone

labia majora

the two outer folds of the vulva that protect underlying tissues

what does the labia minora do?

lubricates the skin and provides bactericidal secretions

clitoris

female erectile tissue between the labia

urethral meatus

the opening through which urine leaves the body

skene's glands

surrounding the paraurethral glands, secretions lubricate vaginal opening

hymen

mucous membrane partially or completely covering the opening to the vagina

fundus of uterus

rounded region superior to the entrance of the uterine tubes

cervix

The opening to the uterus

anterior/posterior fornix

space around cervix that allows pooling of semen

where is the egg implanted?

endometrium

perimetrium

outer layer of uterus

myometrium

muscular middle layer of the uterus

endometrium

inner lining of the uterus where fertilized egg should implant

internal os

opening between uterus and cervix

external os

the opening of the cervical canal of the uterus into the vagina

uterine ligaments

broad, round, and cardinal

broad ligament

• sheath that covers pelvic cavity

• helps provide stability for uterus in pelvis & keeps it centrally placed

round ligament

• on each side of uterus, helps keep it in place

• pulls uterus down & forward to help fetal presenting part get into cervix

cardinal ligament

• helps suspend uterus in the pelvis

• helps prevent uterus from prolapsing into vagina

isthmus

connects fallopian tube with uterus

where does tubal ligation occur?

isthmus

ampulla

usual site of fertilization

fimbriae

fingerlike projections that help to reach out and grab egg to bring into into the fallopian tube

ovaries

• stores eggs & releases during ovulation

• primary source for estrogen & progesterone before pregnancy

bony pelvis

• supports & protects pelvic contents

• forms fixed axis for birth passage

false pelvis

• above linea terminalis

• role is to support weight of an enlarged pregnant uterus & helps direct fetus into true pelvis

true pelvis

• below linea terminalis

• determines if pt. is able to deliver vaginally

ischial spines

lies above the ischial tuberosity, inward projections, situation of fetal head is estimated in terms of centimeters above or below

pelvic inlet

in between true and false pelvis

pelvic cavity

Contains urinary bladder, reproductive organs, and rectum

cephalic pelvic disproportion

baby can't pass through true pelvis

pelvic outlet

inferior margin of true pelvis

breasts

specialized sebaceous gland that produces milk and protected maternal antibodies

female hormones

• estrogen

• progesterone

• prostaglandins

• FSH

• LH

estrogen

gives female-like characteristics

• breasts develop & get larger

• widening of hips

• uterus increases in size

• increases body hair

• increases sexual desires

progesterone

• helps stabilize uterus for implantation after fertilization: cervix secretes thick protective mucus

• involved with lactation & increasing breast glandular tissue

prostaglandins

fatty acids that work together to both relax and constrict smooth muscle in arteries

FSH

• follicle-stimulating hormone

• helps egg follicle to mature

LH

• luteinizing hormone

• causes decrease in estrogen production while allowing progesterone secretions to continue

two phases of ovarian cycle

1. follicular phase

2. luteal phase

follicular phase

• day 1-14

• immature follicle matures as a result of FSH

• oocyte grows in follicle

• ovum discharged into fimbria of fallopian tube

when does ovulation usually occur?

day 13-15

luteal phase

• day 15-28

• ovum leaves follicle

• ovum remains in ampulla if fertilized (fertile 12-24 hours)

• reaches uterus in 72-96 hours after release then implants into endometrium & secretes hCG if fertilized

• in no fertilization, corpus luteum degnerates

human chorionic gonadotropin (hCG)

stimulates the secretion of the hormones required to maintain pregnancy

four phases of menstrual cycle

• menstrual

• proliferative

• secretory

• ischemic

menstrual phase

shedding of some endometrial cells

proliferative phase

endometrial cells enlarge & thicken due to increased estrogen, peaking just before ovulation; cervical mucus more elastic, thin, clear (better for sperm)

secretory phase

progesterone causes marked swelling of epithelium, vascularity of uterus increases to provide nourishing bed for implantation

ischemic phase

begins if implantation doesn't occur, estrogen and progesterone levels decrease, corpus luteum degenerates (bleeding occurs- menstrual phase begins)

penis

male external organ of reproduction that has a shaft gland that contains urethra

scrotum

sac that contains testes to protect sperm by keeping temp. lower than body temp.

testes

site of sperm production & secretion of testosterone

epididymis

duct behind each testis, sperm reservoir

vas deferens

tube that carries sperm from the epididymis to the urethra

ejaculatory ducts

help connect epididymis in prostate to allow sperm passage

how do you know ejaculatory ducts are working correctly?

shouldn't be able to release urine & sperm at the same time

seminal vessels

above prostate & secrete alkaline viscous clear fluid that is with sperm during ejaculation (helps w/ sperm motility & metabolism)

prostate glands

• encircles urethra & secretes milky fluid that protects sperm from acidic vaginal environment

• also helps with hormone production & helps regulate urine flow

spermatozoon

sperm cell

head of sperm

contains all of genetic material, what enters ovum for fertilization

mitosis

• for growth & tissue repair

• process by which our body cells divide & replace themselves

• exact copies of original cell

meiosis

• process leading to development of eggs & sperms

• cells only contain half the genetic material of chromosomes so that when fertilized occurs the normal cell number is restored

gametogenesis

when meiosis occurs and gametes (sperm & ovum) are produced

oogenesis

produces female gamete (ovum) in female, all ova present at birth

spermatogenesis

produces male gamete (sperm), takes place starting at puberty

how long are ova fertile?

12-24 hours after ovulation

how long do sperm live?

about 48-72 hours

how long is sperm fertile?

24 hours

fertilization

• limited timeframe for 2 to unite

• only single sperm enters ovum

• chromosomes pair up, creating diploid zygote

where does fertilization occur?

ampulla of fallopian tube

female chromosomes

XX

male chromosomes

XY

what makes up the amniotic sac?

chorion and amnion

embryonic membranes

begin to form at the time of implantation & help to protect & support growing embryo

chorionic villus

fingerlike projections of the chorion that extend into the uterine lining

chorion

outermost layer of the fetal membrane

amnion

membrane that encloses the embryo in protective amniotic fluid

yolk sac

how fetus gets nutrition & gas exchange before placenta forms

fraternal twins

• twins who come from two different eggs fertilized by two different sperm

• two amnions, two chorions

identical twins

twins who develop from a single fertilized egg that splits in two, creating two genetically identical organisms

amniotic fluid

• cushions fetus & umbilical cord

• helps control temp.

• allows fetus to change positions & permits symmetric external growth

• analyze for fetal health & maturity

• promotes growth & development

• fetus swallows it and fluid flows out of lungs

what is amniotic fluid made of?

• albumin

• vernix

• fetal urine

• uric acid

• lecithin

• sphinogomyelin

polyhydramnios

• excessive amniotic fluid

• seen with twins, diabetes (uncontrolled BS)

oligohydramnios

• too little amniotic fluid

• seen with perfusion issue like HTN, baby has kidney problem or bladder obstruction

umbilical cord

• body stalk connecting placenta with fetus

• contains 2 arteries, 1 vein

• surrounded by special connective tissue called Wharton's jelly

• no sensory or motor innervation

• twisted, spiral shape due to fetal movement

placenta functions

• immunologic properties: protect against antibody production since homograft

• excretion

• fetal respiration

• production fetal nutrients

• production of hormones

fetal circulation

• special vessels and circulation present in fetus

• includes de-O2 blood in umbilical arteries coursing to placenta, and O2 nutrient-rich blood via umbilical veins

umbilical vein

delivers oxygenated blood from the placenta to the fetus

umbilical arteries

carry deoxygenated blood from the fetus to the placenta

fetal side of placenta

• shiny

• closest to baby

• thin membrane that looks kinda bluish

maternal side

• dirty duncan

• meaty portion that is attached to uterus

• look for blood clots, calcifications

embryonic development: week 4

• heart begins to beat

• arm & leg buds present

• somites develop — beginning vertebrae

• primary lung buds present

• eyes & ears begin to form

embryonic development: week 6

• body is straighter

• trachea developed

• nares present

• liver produces blood cells

• heart begins circulating blood

• digits develop

• tail begins to recede

fetal development: week 12

• face well developed

• eyelids are closed

• tooth buds appear

• genitals are well differentiated

• urine is produced

• spontaneous movement occurs

• fetal heart tones can be heard

fetal development: week 20

• subcutaneous brown fat appears

• vernix begins to form

• lanugo over entire body

• nipples & nails are present

• fetal movement felt by mother***

• fetal heartbeat is heard by fetoscope

fetal development: week 24

• eyes structurally complete

• vernix caseosa covers skin

• alveoli beginning to form

• both grasp and startle reflexes present

• fingerprints and footprints present

• considered viable at this stage

fetal development: week 28

• brain develops rapidly

• nervous system begins to regulate

• eyelids open

• testes begin to descend

• lungs can provide gas exchange

fetal development: week 36`

• increase in subcutaneous fat

• lanugo begins to disappear