reproductive health and the family 1

maternity nursing

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

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

• provides advice and personalized healthcare

• provides support to family

mons pubis

protects pelvis bones

labia majora

protect underlying tissues

labia minora

lubricate vulvar skin and secrete bactericidal secretions

clitoris

female erectile tissue

urethral meatus

where urine comes out

skene’s gland

lubricate vaginal opening

hymen

thin tissue surrounding vaginal opening

perineal body

skin between vagina and anus that stretches during delivery

vagina

muscular membranous tube that connects external genitalia with the uterus (birth canal)

uterus

two parts:

• fundus - upper part of uterus

• cervix - bottom/opening of uterus

fornix

space next to opening of cervix that allow for pooling of semen

• posterior fornix

• anterior fornix

layers of uterus

endometrium - inner layer that sheds during menstruation and where fertilized egg implants

myometrium - muscular middle layer

perimetrium - outside layer of uterus

os’s of cervix

internal os - part of the cervix closest to the inside

external os - part of the cervix closest to the vagina

uterine ligaments

broad ligament

round ligament

cardinal ligament

broad ligament

sheath that covers pelvic cavity and provides stability for uterus in pelvis and keeps it centrally placed

round ligament

ligaments on either side of uterus that keep it in place and pull uterus down and forward for labor

cardinal ligament

ligaments on either side of cervix that suspend the uterus in the true pelvis and prevents the uterus from prolapsing

parts of fallopian tube

isthmus

ampulla

infundibulum

fimbriae

isthmus

connects fallopian tube to uterus and is where tubal ligation occurs

ampulla

usual site for fertilization to occur

fimbriae

finger-like projections coming from fallopian tube that grab the egg produced by the ovary and bring into the fallopian tube

ovary

contains all of the eggs a woman will ever have and are responsible for releasing the eggs during ovulation; also control hormones (primary source for estrogen and progesterone)

placenta becomes primary source of progesterone during pregnancy

true

bony pelvis

supports and protects pelvic contents and forms fixed axis for birth passageway

false pelvis

support the weight of pregnant uterus and helps to direct the fetus into the true pelvis

true pelvis

size must be adequate for baby to pass through during vaginal delivery

cephalic pelvic disproportion (CPD)

when woman has inadequate true pelvis size to allow for vaginal delivery

shortest diameter of pelvis

between ischial spines in true pelvis

zero station

baby’s head is at ischial spines

pelvic inlet

transition from false pelvis to true pelvis

pelvic outlet

where baby exits bony pelvis

breasts

specialized sebaceous glands that produce milk and protected maternal antibodies

nipple

where milk comes out of

nursing considerations for breast reduction patients and lactation

stimulate the breast to encourage milk production because some glands may have been cut during reduction

female hormones

estrogen

progesterone

prostaglandins

FSH (follicle stimulating)
LH (luteinizing)

estrogen

causes breasts to enlarge/develop, widen hips, uterus increases in size, increase in body hair, increase in sexual desire

progesterone

stabilize uterus for implantation after fertilization, cervix secretes thick protective mucus, involved with lactation, increases breast glandular tissue

prostaglandins

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

follicle stimulating hormone (FSH)

helps egg follicle mature

luteinizing hormone

causes decrease in estrogen production and allows progesterone to continue being secreted

phases of ovarian cycle

follicular phase

luteal phase

follicular phase (day 1-14)

• immature follicle starts to mature as result of FSH

• oocyte grows in follicle

• ovum discharged into fimbria of fallopian tube

fertile window for 28 day cycle

day 13-15 (day 14 is most fertile day)

luteal phase (day 14-28)

• ovum leaves follicle

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

• reaches uterus in 72-96 hours after release and implants into endometrium and secrete human chorionic gonadotropin (hCG)

• if no fertilization, corpus luteum regenerates

four phases of menstrual cycle

menstrual

proliferative

secretory

ischemic

menstrual phase

shedding of some endometrial cells

proliferative phase

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

secretory phase

progesterone causes 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 and menstruation phase begins)

male external genitalia

penis and scrotum

penis

structure with a shaft and glans that contains the urethra

scrotum

sack-like pouch that contains the testes to protect the sperm by keeping the temperature lower than body temperature

male internal reproductive organs

testes

epididymis

vas deferens and ejaculatory ducts

urethra

seminal vesicle

prostate gland

testes

site of sperm production and responsible for secretion of testosterone

epididymis

duct behind each testis that is the sperm reservoir

vas deferens and ejaculatory ducts

help connect the epididymis in the prostate to allow sperm passage through the ejaculatory ducts

urethra

travels from the glans of the penis to the ejaculatory duct and bladder

seminal vesicle

above the prostate; secrete alkaline viscous clear fluid that mixes with sperm during ejaculation which helps with sperm motility and metabolism

prostate gland

encircles urethra and secretes milky fluid that protects sperm from the acidic vaginal environment and helps with hormone production and regulating urine flow

mitosis

• for growth and tissue repair

• process by which our body cells divide and replace themselves

• exact copies of original cell

meiosis

• process leading to development of eggs and sperm

• cells only contain half the genetic material of chromosomes so when fertilization happens, normal cell number is restored

gametogenesis

production of gametes (ova and sperm); meiosis occurs during this

oogenesis

production of female gamete (ovum), 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 are sperm fertile?

live 48-72 hours but are probably only fertile for 24 hours

fertilization

when single sperm enters ovum

female chromosomes

XX

male chromosomes

XY

embryonic membranes

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

outermost part of embryonic membrane

chorion; it has fingerlike projections (chorionic villi)

amnion

thin membrane that holds amniotic fluid

chorion and amnion

form amniotic sac

yolk sac

performs nutrition and gas exchange for fetus until placenta forms and takes over

fraternal twins

two separate eggs fertilized by two separate sperm that form two separate blastocysts and implant into uterus

one girl twin and one boy twin

automatically fraternal twins

two girl twins and two boy twins

could be fraternal or identical

identical twins

single egg is fertilized by a single sperm and one blastocyst is formed which then later divides into two

dichorionic diamniotic twins (di-di twins)

division occurs within about three days; two embryos, two chorions, two amnions, two placentas (sometimes fused)

monochorionic diamniotic twins

division occurs within about 5 days; two embryos, two amnions, one chorion

monochorionic monoamniotic

division occurs within 8-12 days; two embryos, one amnion, one chorion

amniotic fluid

• cushions fetus and umbilical cord

• helps control temperature

• allows fetus to change positions

• analyze for fetal health and maturity

• promotes growth and development

• made of albumin, vernix (with, cheesy substance on baby when born), fetal urine, uric acid, lecithin, sphinogomyelin

• fetus swallows it and fluid flows out of lungs

polyhydramnios

more amniotic fluid than anticipated for gestational age or greater than 2000 mL

oligohydramnios

less than 400 mL of amniotic fluid or when AFI is less than 5

amniotic fluid index (AFI)

measured between 5-25 cm

umbilical cord

body stalk connecting placenta with fetus

• contains 2 arteries and 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 (protects against antibody production since homograft)

• excretion

• fetal respiration

• production of fetal nutrients

• production of hormones

embryonic development week 4

• heart begins to beat

• arm and leg buds present

• somites develop, beginning vertebrae

• primary lung buds present

• eyes and ears begin to form

embryonic development week 6

• body is straighter

• trachea is 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 (fine soft hair) over entire body

• nipples and nails are present

• fetal movement felt by mothers

• fetal heartbeat is head 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

fetal development week 38

• full term (starts at 37 0/7 weeks gestation)

• skin smooth and polished

• vernix caseosa in creases and folds

• head bigger than chest