Intro and Menstrual Cycle

Biologic factors that affect maternal/newborn health

Genetics, maternal age, gestational age, birth weight, etc.

Health status and lifestyle factors that affect maternal/newborn health

Nutrition, exercise, substance use, obesity, preexisting conditions (diabetes, asthma, depression, CV disease)

Access to healthcare affecting maternal/newborn health

Early/consistent parental care, preventive care, insurance, transportation, availability

Other factors that affect maternal/newborn health

Social determinants, language barriers, stigma, discrimination

Majors risks for maternal health

High BMI, comorbidities, lack of prenatal care, social/structural inequalities

Major risks for newborn health

Lower gestational age (immature organs) and lower birth weight

Age of consent

18 years old

How is consent handled during emergency?

If pt is unconscious and consent isn’t possible, then consent would be implied

How is consent handled through the phone?

A healthcare employee as witness and documenting is required for authorized decision-maker or patient to do informed consent

Requirements for Consent

Obtained before certain procedures, truly informed, pt has capacity to make choice, must be voluntary

When is general consent required?

Routine care

When is specific informed consent required?

Surgery, invasive procedures, monitoring, high risk treatments, restraints, photos

Nurse’s Legal Responsibilities for Consent

Verify and witness signature, assess pt understanding, notify provider if pt confused, document

Legal and ethical issues in maternal/child healthcare

Abortion (may oppose), substance misuse (balance between protecting fetus)

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Mature Minor

Depending on state, minor can make independent decisions if they understand enough about their condition, know risks/benefits, complexity of treatment and if it’s necessary or elective

Emancipated Minor

Person under 18 legally recognized as independent from their guardians, being able to consent to their own treatment, refuse treatment, control over bills and their med info

How does someone become emancipated?

Varies by state: court order, marriage, military service, financially independent from guardians

Situations where minors can receive healthcare without parental consent/notificaiton

STI/STD/HIV treatment, pregnancy related care (prenatal, counseling), substance-use treatment, mental health

Consent

Legal permission given by person legally authorized to make healthcare decision

Assent

Child’s agreement/participation in the decision-making process where they should also be truly informed

Truly informed

Someone who can understand their condition/treatment, know risks and benefits, available alternatives, what may happen if they refuse treatment

Gonadotropin-Releasing Hormones (GnRH)

Secreted by the hypothalamus in pulses to stimulate pituitary gland to secrete FSH and LH to begin cycle and throughout it

Follicle-Stimulating Hormone (FSH)

Secreted by anterior pituitary gland targeting ovaries to stimulate follicle growth and maturation, XXXXXXXXXXXXmost importantly during early follicular phase

Luteinizing Hormone (LH)

Secreted by anterior pituitary gland targeting ovaries to trigger ovulation and form corpus luteum

Estrogen

Secreted by developing ovarian follicles to proliferate/thicken the endometrium, increasing blood supply and helps make cervical mucus be favorable for sperm passage

Progesterone

Secreted by corpus luteum after ovulation to maintain/prepare endometrium for implantation by making it swollen, glandular, and secretory; reduces uterine contractions and increases basal body temp (0.5-1F; 0.28-0.56C)

Prostaglandins

Secreted by endometrium to free ovum from graafian follicle to start ovulation and causes cramping and pain

Corpus Luteum

Temporary endocrine gland in ovary after ovulation that forms when follicle ruptures and closes, secreting progesterone and some estrogen

Ovarian Cycle (ovaries) Phases

Follicular → ovulation → luteal phase

Endometrial Cycle (uterine) Phases

Proliferative → secretory → ischemic → menstrual phase

Follicular Phase

Days 1—10-14: GnRH → FSH → follicles grow holding egg release estrogen → 1 mature/graafian follicle → ↑ estrogen → endometrium proliferates → LH surge →

Ovulation

Day 14: Graafian follicle ruptures from LH surge → mature oocyte released and swept into fallopian tube (24 hr lifespan) w/ cervix mucus

Luteal Phase

Days 15—28: Ruptured follicle closes → corpus luteum → ↑ progesterone and ↑ some estrogen to prepare for possible implantation → negative feedback loop on (↓) FSH and (↓) LH

What happens to luteal phase if there’s no pregnancy (ischemic phase)?

Corpus luteum breaks down → ↓ progesterone and estrogen → endometrium breaks down and menstruation begins again with follicular phase

What happens if pregnancy occurs during secretory/luteal phase?

Embryo produces hCG which keeps the corpus luteum alive → progesterone stays high → endometrium maintained

Proliferative Phase

Day 5 — ovulation (day 14): ovarian follicles produce estrogen → endometrium thickens, glands enlarge, vessels dilated, cervical mucus

What happens to cervical mucus when there’s estrogen?

Becomes thin, clear, stretchy, more alkaline to help capture, nourish, and guide the sperm through the cervix

Secretory Phase

Day 14 (ovulation) — 28: progesterone from corpus luteum thickens endometrium and makes it more vascular and secretory with more glands that produce nutrients, glycogen, and lipids

Menstrual Phase (period)

Days 1-5: Spiral arteries rupture from ↓ estrogen and progesterone → damaged endometrial tissue and blood shed and leave uterus