Unit 1 Maternal Newborn

Uterus

Hollow, thick-walled organ; Centered in pelvic Cavity

Uterine Corpus/body

Upper layer of uterus

Uterine Corpus layers

1. Serosal Layer (perimetrium)

2. Muscular Layer (myometrium)

3. Mucosal Layer (endometrium)

Fundus

Rounded uppermost portion of uterus

Endometrium

Monthly renewal from menarche to menopause with absence of pregnancy

Cervix

Lower portion of uterus

Internal os

Opens to uterus

External os

Opens to vagina

Cervix Functions

• Lubricate vagina

• Act as passage from vagina to uterus

• Acts as bacteriostatic agent

• Provides alkaline environment to protect sperm

Uterine ligaments that support uterus

-Broad

-Round

-Ovarian

-Cardinal

-Infundibulopelvic

-Uterosacral

Isthmus

Part of fallopian tube next to uterus, site of tubal ligation.

Ampulla

Fertilization occurs here, next to isthmus

Fimbria

Funnel like enlargement with many moving fingerlike projections (frimbriae) reaching out to the ovary which helps to intercepting the ovum when released.

Fallopian tube functions

1. Transport ovum to uterus

2. Site for fertilization

3. Nourishing environment for ovum/zygote

Ovaries

-obtains three layers

-Store and develop follicles and secrete hormones: Estrogen and Progesterone

Female reproductive cycle (FRC)

1. Ovarian cycle (2 phases)

2. Menstrual (3 phases)

   • Take place simultaneously

Estrogen

-Secreted by ovary

-Controls women’s secondary sex characteristics (femaleness)

-Maturation of ovarian follicles

-Amount greatest during proliferative phase of menstrual cycle

Progesterone

-Hormone of pregnancy**

-Secreted by corpus luteum (inside ovary, little space that is created once follicle ovulates out of ovary)

-Helps thicken uterine lining to help embryo attach

-Greatest amount during secretory phase of menstrual cycle

Prostaglandins (PGs)

-Play a significant role in ovulation; helps release mature egg

–PGF vasocontricts (increases contractility)

–PGE vasodiolator (relax muscles)

Hypothalamus secretes:

gonadotropin-releasing hormone (GnRH) which causes anterior pituitary to release FSH and LH

FSH

Responsible for maturation of follicle (follicle will secrete estrogen as it matures)

LH

-Increases production of progesterone, release of mature follicle

-Surge 10-12 hrs before women ovulates

-Estrogen drops and progesterone rises when ovulation occurs

Ovarian cycle

• 2 phases

  1. Follicular phase (days 1-14)

     • Graffian follicle (fluid filled sac with ovum in it) appears by day 14)

       • Under dual control of FSH and LH

       • Body temp increases after ovulation due to increased progesterone (24-48hrs after)

  2. Luteal phase (15-28, fixed)

     • Begins when ovum leaves follice

     • If ovum fertilized and implants in endometrium, egg secretes hCG which trigger pregnancy test (best to take in morning with dilute urine).

     • Corpus luteum degenerates when fertilization does not occur

Menstrual Cycle (28 days, three phases)

-Menstrual phase (bleeding signifies start of cycle)

• Some endometrial areas shed-bleeding

• Estrogen levels low

• Corpus luteum begins to degenerate

• Small blood vessels rupture, and cells escape into stromal cells

• Menstrual flow begins

-Proliferative phase

• Increasing amounts of estrogen enlarge endometrial glands with peak before ovulation and Cervical Mucous thins

-Secretory phase—follows ovulation

• Increased vascularity of uterus in preparation for fertilized ovum

Somatic cell

-any cell other than reproductive cells

-23 pairs, 46 chromosomes (diploid)

-22 autosomes (similar cells in males and females)

1 sex chromosome

Each human begins life as a:

single cell; fertilized ovum or zygote

Cells reproduce in a continuing process:

–Mitosis (growth and development)

–Meiosis (human production)

Mitosis

-Exact copies of original cell (somatic cells)

-Essential for growth, development, and tissue repair

-One-stage cell division

-Two daughter cells

-Makes growth and development possible

Gametogenesis- Meiosis

-Process by which germ cells (ovum and sperm) are produced

-Only half the genetic material of typical body cell

-Haploid number of cells to form full zygote (23)

Sperm and ovum unite to form:

Zygote

Ova are fertile for:

12 to 24 hrs after ovulation

Sperm are fertile for

72 hrs

Fertilization takes place in:

Ampulla; widest part just before it opens and connects to uterus

Sex of the zygote is determined at:

Fertilization

Implantation occurs:

7-10 days after fertilization

Blastocyst (ball of cells) burrows into:

Endometrium and endometrium in now called decidua

Body structures from primary cell layers (3 germ layers form 2 weeks after conception)

Embryonic Membranes (chorion and Amnion) Provide:

• Protection

• Nutrition

• Waste removal

• Gas exchange

Chorion:

-surrounds amnion, forms the fetal portion of placenta, site for early genetic testing

Amnion

Helps to form amniotic sac

Amniotic Fluid

Act as cushion

Temp regulation

permit symmetrical growth

Prevent embryo from attaching to amnion

Extension of fetal extracellular space

Yolk Sac

functions only in early embryonic life

Early nutrients

Forms primitive RBCs until embryo’s liver takes over (6 weeks)

Amniotic fluid contains

water, electrolytes, fats, carbs, fetal waste

Amniotic fluid Characteristics

▪Ph is slightly alkaline

▪Lanugo: fine baby hairs

▪Clear/faint yellow

▪Increases until 28 weeks to 700-1000ml

Oligohydramnios

amniotic fluid less than 400ml

Hydramnios

▪fluid greater than 2000mls

Umbilical Cord

• Lifeline placenta to baby

  –Body stalk fuses with embryonic portion of placenta

  –Provides circulatory pathway from chorionic villi to embryo

  ▪One vein-delivers O2 to the fetus, two arteries delivers deoxygenated blood back to placenta (gas and nutrient exchange)

• Wharton’s jelly

  • Connective tissue that attaches to blood vessels in umbilical cord that prevent it from collapsing in conjunction with high pressure blood.

Functions of fecal circulatory system

–Maintains blood flow to placenta

–Provides fetus with oxygen and nutrients

–Removes carbon dioxide and waste products

Fraternal twins

–Two ova and two sperm

–Dizygotic: two placenta and two amniotic sac

–Much more frequent than mono

–Just like two normal siblings, not the same

Identical Twins

–Single fertilized ovum

–Monozygotic: two babies, once placenta

–Considered a random event

–Congenital problems can occur (high risk, high rate of miscarriage)

•Originate at different stages

Placental development and functions

•After implantation cells differentiate, differentiation of fetal, trophoblast cells

•Forms week 3 and attaches to uterine wall

•Metabolic and nutrient exchange

Placenta Metabolic and transport activities

–Produces glycogen, cholesterol, fatty acids

Placenta endocrine functions

–Production of hormones

▪hCG

▪Progesterone

▪Estrogens

▪Relaxin

Placental immunologic properties

▪Exempt from immunologic reaction by the host

▪Hormones progesterone and hCG suppress cellular immunity during pregnancy

▪Prevent body from rejecting fetus

Development of FCS

-O2 blood flows through umbilical vein into abdominal wall of fetus

-Ductus venous: bypasses liver

-Foramen Ovale: passage from right to left atrium

-Ductus arteriosus: bypasses lungs; placenta assumes function

Fetal circulation delivers the highest available o2 concentration to:

the head, neck, brain, and heart and lesser to abdominal organs and lower body; hence, cephalocaudal development

Pregnancy duration

10 lunar months or 280 days

starts from beginning of last normal menstrual period and ends at birth

Most born within 10-14 days of calculated birth date.

Most organs are formed by:

8 weeks gestation

•Two weeks pregnant at fertilization

Heartbeat at:

4 weeks

Fetal circulation at:

6 weeks

8-12 weeks (10 weeks)

Fetal heart tones can be heard by doppler

16 weeks

Baby’s sex can be seen and the fetus looks like a baby

20 weeks

Heartbeat heard with fetoscope

quickening

baby has regular schedule

hands can grasp

24 weeks

increasing activity

fetal respiratory movement begins

baby makes sucking movements

28 weeks

eyes open and close

baby can breath

baby is 2/3 final length

32 weeks

has fingernails and toenails

less red an wrinkled

subcu fat is being laid down

38+

baby fills total uterus

baby gets antibodies from mother

Factors influencing fetal development

•Quality of sperm or ovum and Genetic Code

•Adequacy of intrauterine environment

•Teratogen

—Any agent that can cause development of abnormal structures in an embryo

–Effects depend on:

▪Maternal and fetal genotype

▪Stage of development during exposure

▪Dose, duration of agent

•Organs formed primarily during embryonic development which makes them extremely vulnerable to teratogen

•Maternal nutrition/lifestyle (folic acid important to reduce neural tube defects)

Normal uterus change through pregnancy

-Enlargement

-Thickening of walls (endometrium)

-Increase in vascular and lymphatic system to support baby

-Braxton hicks contractions

Braxton hicks contractions

Irregular contractions which differs them from labor contractions. Occur early on and throughout pregnancy

Cervix changes

-Mucous plug formation; prevent microorganisms from entering cervical canal

-Increase in vascularity leading to Goodell sign and Chadwick sign

Goodell sign

Cervical softening to allow baby to pass through

Chadwick sign

Bluish-purplish discoloration

Ovary changes

-Cease ovum production during pregnancy

-HCG maintains corpus lutem

-Secrete progesterone unitl placental production is sufficient (11 weeks)

Vaginal changes

-Hypertrophy

-increased vascularization

-Hyperplasia due to estrogen

-+ secretions, loosening of connective tissue

-Increased blood flow

Breast changes; occur after first missed period

-Glandular hyperplasia and hypertrophy—> Tender breast

-Darkened areola and superficial veins prominent

-Montgomery glands form

-Striae may develop

Colostrum

Antibody rich yellow secretion

Converts to mature milk 2-3 days following childbirth

Tidal volume and o2 consumption ___

Increases and changes from abdominal to thoracic to compensate for baby’s growth

Mild dyspnea is ___ Tachypnea is ___

Normal, NOT

Lightening

Term for when baby drops at around 40 weeks

___ and ___ are common during pregnancy (Nasal)

Rhinitis and epistaxis

Blood volume increases ______ and ___ of maternal blood is contained in the uterus.

40-50% and 1/6, blood volume peaks at third trimester

There is a _____ in systemic and pulmonary vascular resistance which allows___

decrease, more blood to reach uterus and placenta.

Pulse will ___ during pregnancy, typically ___

Increase, 10bpm

Femoral venous pressure ___ causing ____

Rises, venous congestion aka edema in lower extremities

Mom needs to avoid lying on ___ to prevent _____ aka______

back, vena cava syndrome, supine hypotensive syndrome

Pt. may develop ____ as blood volume increases ____ but erythrocyte only increases ___

Anemia, 40-50%, 25%

Pt. may experience several symptoms related to uterine pressure including:

Acid reflux, heartburn, bloating, constipation, hemorrhoids

N/V during ___ caused by ___ and usually gone by ___

1st trimester, Hcg (released by fertilized egg), 2nd trimester

Gallbladder and gastric emptying may be slow leading to:

Cholelithiasis and IBS; encourage high fiber and low fat diet

Urinary changes:

GFR increased and glycosuria not uncommon

Skin and hair changes

Hyperpigmentation

Facial chloasma (subside after pregnancy) (melasma gravidarum)

Striae

Vascular spider nevi

Decreased hair growth

Hyperactive sweat and sebaceous glands

Linea Nigra-common

Pelvic joints relax leading to:

Waddling gait

Center of gravity changes leading to

Lordosis

Diastasis Recti

Separation of abdominal muscle; not painful

Eye changes

Decreased intraocular pressure

Thickening of cornea due to fluid retention; may affect contact fit; returns to normal after pregnancy

CNS Changes

Reports of decreased attention, concentration, and memory

Sleep problems common in pregnancy

Recommended to gain _______, if underweight gain ___ if overweight gain ___

25-35 lbs, more, less

Biggest weight increase occurs during ___ of pregnancy as baby is growing faster

Second Half

Insulin resistance becomes common second half of pregnancy due to increased ___ demands and ___ demands

fetal and carb.