Pre-preg and prenatal lab (updated)


Anatomy and Physiology of Reproductive Systems

Female Reproductive Tract

External Structures:

  • Mons pubis: Rounded mass of fatty tissue located over the pubic bone, contributing to external protection and aesthetic form.

  • Labia majora and labia minora: External lips of the vulva that protect internal structures and provide sexual stimulation.

  • Clitoris: Highly sensitive organ that plays a significant role in female pleasure, consisting of erectile tissue similar to the male penis.

  • Vaginal orifice: The entrance to the vagina; it is flexible and varies in size.

  • Urethral opening: The external opening of the urethra, separate from the vaginal orifice, facilitating urination.

Internal Structures:

  • Vagina: Elastic muscular tube connecting the external genitals to the uterus, serving as the birth canal and the site for sexual intercourse.

  • Uterus: Hollow organ where fetal development occurs; consists of three layers: endometrium, myometrium, and perimetrium.

  • Cervix: Narrow passage forming the lower end of the uterus, regulating the entry of semen and the exit of menstrual fluid.

  • Fallopian tubes: Tubes through which eggs travel from the ovaries to the uterus; site of fertilization if sperm is present.

  • Ovaries: Paired organs that produce ova (eggs) and hormones such as estrogen and progesterone, crucial for regulating the menstrual cycle and maintaining pregnancy.

Female Anatomy

  • Mons Pubis: Rounded mass of fatty tissue resting over the pubic bone, providing cushioning and protection to underlying structures.

  • Labia: External lips of the vulva that create a protective barrier for internal reproductive organs, with the labia majora being more prominent.

  • Clitoris: A complex structure with numerous nerve endings, playing an essential role in sexual arousal and pleasure.

  • Cervix: This cylindrical structure measures about 2.5 inches long, serving as the gateway to the uterus and has vital functions during menstruation and childbirth.

  • Ovaries: Each ovary contains thousands of immature ova; the hormonal functions regulate the menstrual cycle and fertility.

Pelvic Anatomy

Bony Pelvis

Functions:

  1. Protects pelvic structures: encases reproductive and urinary organs, safeguarding them from trauma.

  2. Accommodates the growing fetus during pregnancy: The shape and size of the pelvis are crucial for childbirth.

  3. Anchors pelvic support structures: muscles and ligaments attached to the pelvic bones provide structural support.

True vs. False Pelvis

  • False Pelvis: upper portion of the pelvis that supports the weight of the growing fetus.

  • True Pelvis: The lower part involved in childbirth includes the inlet, the cavity, and the outlet through which the fetus passes during vaginal birth.


Female Reproductive System (Continued)

Breasts

  • Structure:

    • mammary gland composed of numbers of lobes, divided into lobules.

    • lobules are clusters of acini

      • acinus is a saclike terminal part of a compound gland emptying through a narrow lumen or duct

      • acini are lined with epithelial cells that secrete colostrum and milk.

        • colostrum as immunitys that the mother passes on to the baby

Hormonal Cycle Overview

Hypothalamic-Pituitary Cycle

  • GnRH (gonadotropin-releasing hormone) is released from the hypothalamus, stimulating the pituitary gland to secrete:

    • FSH (Follicle-stimulating Hormone): Stimulates the growth of ovarian follicles in the ovaries.

    • LH (Luteinizing Hormone): Triggers ovulation and stimulates the corpus luteum to produce progesterone.

  • Ovarian Cycle Phases: Three phases including the follicular phase, ovulation, and luteal phase, each regulated by feedback mechanisms.

Menstrual Cycle Phases

  • Proliferative Phase: The endometrium thickens due to rising estrogen levels preparing for potential implantation.

  • Secretory Phase: After ovulation, progesterone predominates, further preparing the endometrium for implantation.

  • Ischemic Phase: If implantation does not occur, levels of estrogen and progesterone drop, shedding the uterine lining, leading to menstruation.

Reproductive Health Issues

Amenorrhea

  • Primary: Anatomic or endocrine issues affecting menstruation onset, associated with conditions like Turner syndrome.

  • Secondary: Often results from pregnancy, hormonal imbalances, extreme weight loss, or stress, necessitating comprehensive evaluation.

Dysmenorrhea

  • Pain occurring before or during menstruation, categorized as:

    • Primary Dysmenorrhea: Linked to elevated levels of prostaglandins, causing heightened uterine contractions and discomfort.

  • Treatment Options: Include NSAIDs, hormonal contraceptives, heat therapy, and alternative remedies to alleviate pain.

Premenstrual Syndrome (PMS)

  • Symptoms: Emotional and physical symptoms occur cyclically in the luteal phase, affecting daily life.

  • Management Strategies: Address lifestyle factors through diet, exercise, and herbal therapies based on symptom severity.

Endometriosis

  • Condition: The growth of endometrial tissue outside the uterus leads to significant pain and infertility.

  • Management: Involves ongoing drug therapy, hormonal interventions, and surgical options when necessary.

  • major symptoms

    • dysmenorrhea: pain during or shortly before menstruation, often described as severe cramping in the lower abdomen.

    • deep pelvic dyspareunia (painful intercourse)

Sexually Transmitted Infections (STIs)

  • Definition: Encompasses over 30 infectious organisms that can be transmitted sexually, necessitating education and preventative measures.

  • Prevention:

    • Stresses safer sex practices,

    • knowledge of partners' sexual health

    • proper condom use

    • available vaccinations against preventable STIs.

Infertility

Common Factors

  • Affects approximately 12% of reproductive-age women; requires understanding of female (hormonal imbalance, tubal issues) and male (hormonal, testicular/transport issues) factors.

Assessment for infertility

  • Female Assessment:

    • ovarian and hormonal factors

    • tubal and peritoneal factors

    • uterine factors

    • vaginal-cervical factors

    • other factors (obesity, nutritional deficiencies, hyper or hypothyroidism)

  • Male Assessment: check sperm count

    • hormonal factors

    • testicular factors

    • factors associated with sperm transport ( drugs, sti’s, ejaculatory dysfunction)

    • idiopathic male infertility. ( we don’t know the cause.)

Care management

  • assessment of female infertility

    • test or examination

    • evaluation of the anatomy

    • detection of ovulation

    • hormone analysis

    • ultrasonography

    • endometrial biopsy

    • hysterosalpingography

    • laparoscopy

  • assessment of male infertility

    • semen analysis assesses sperm number, morphology, and motility

    • hormone analysis

    • scrotal ultrasound

  • plan of care and implementation

    • psychosocial considerations

    • nonmedical treatment

      • lifestyle changes, diet/exercise, and well-balanced nutrition

      • stress management, relaxation, exercise

      • antioxidant vitamins E and C, zinc

    • Medical therapy

      • clomiphene citrate-ovulation induction, treatment of luteal-phase inadequacy

      • menotropins (human menopausal gonadotropins) ovarian follicular growth and maturation

      • follitropins (purified FSH) treatment of polycystic ovary syndrome; follicle stimulation for assisted reproductive techniques

      • human chorionic gonadotropin (hCG) ovulation induction

      • GnRH agonists treatment of endometriosis uterine fibroids

      • progesterone treatment of luteal-phase inadequacy

      • metformin restores cyclic ovulation and menses in many women with polycystic ovary syndrome

      • letrozole ovulation induction

    • surgical therapies

      • assisted reproductive therapies (ART)

        • IVF-ET

        • GIFT

        • IVF and GIFT with donor sperm

        • zygote intrafallopian transfer

        • donor embryo

assisted reproductive therapies

  • invitro fertilization-embryo transfer (IVF-ET) eggs are fertilized in the lab with sperm, and then transferred intothe uterus after the embryo develops

  • donor oocyte eggs are donated by IVF procedure

  • therapeutic donor insemination (TDI) donor sperm are used

  • embryo hosting another woman carries the baby

Contraceptive Methods

Importance of Contraception

  • Primary method to decrease unwanted pregnancies, allowing for informed family planning decisions.

  • Types of Contraception:

    • coitus interrupts: pull out method

    • natural family planning; no sex during fertile days

    • basal body temp; slight drop in temp during ovulation

    • cervical mucus ovulation detection changes before and during ovulation to facilitate and promote the viability and motility of sperm

    • spermicides works by attacking sperm flagella from reaching the cervical

    • condoms barrier protection (prevent STIs) careful watch for latex allergies

    • diaphragm needs fitting, is a mechanical barrier to the meeting of sperm with the ovum

    • oral contraceptives birthbcontrol

    • DepoProvera injection every 3 months

    • IUD watch for infection risk ( pelvic inflammatory infection)

  • Considerations: Safety, accessibility, cost-effectiveness, and acceptability depending on personal health and lifestyle.

Fetal Growth and Development

  • Critical Changes: Major developments occur during both the embryonic and fetal periods, with each stage requiring specific nutritional support and monitoring.

  • Nutritional Needs: Increased demand for vital nutrients essential for fetal development, particularly folic acid for neural tube formation, and iron for blood volume.

nongenetic factors influencing development

  • teratogens - environmental factors that can produce abnormalities in the embryo or fetus

    • drugs

    • chemicals

    • infection

    • exposure to radiation

    • maternal conditions

  • maternal nutrition

    • malnutrition

Maternal Nutrition Before and During Pregnancy

  • Balanced Diet: Essential for ensuring adequate nutrition supply for fetal growth and development, with particular emphasis on whole foods rich in essential vitamins and minerals.

  • Nutritional Assessments: Conducted to guide weight gain goals and address nutritional deficiencies before and during pregnancy.

  • nutrient needs before conception

    • 1st trimester crucial for embryonic and fetal organ development

    • healthful diet before conception ensures that adequate nutrients are available for developing fetus

    • folate or folic acid intake important in the periconceptual period

      • neural tube defects are more common in infants of women with poor folic acid intake, ( 600mg daily recommended)

  • nutrient needs during pregnancy

    • factors that contribute to the increase in nutrient needs

      • the uterine-placental-fetal unit

      • maternal blood vol and constituents: blood vol increase can lead to heart conditions

      • maternal mammary development

      • metabolic needs ( increase in calories about 500)

    • energy needs

      • weigh gain usually 25 lbs

      • BMI

      • pattern of weight gain

      • hazards of restricting adequate weight gain

      • excessive weight gain ( gestational diabetes)

      • protein

      • fluids

  • care management

    • collaborative care

      • N&V usually in 1st trimester

      • constipation 3rd trimester

      • pyrosis(heartburn)

      • cultural influence

      • vegetarian diets increase protein intake

Adolescent Pregnancy

  • Interventions: Aimed at improving the nutritional health of pregnant adolescents, emphasizing the importance of education and access to prenatal care services for healthy outcomes.

Lactation Nutrition

  • Nutritional Needs: Increased caloric intake and hydration during lactation similar to pregnancy to support maternal and infant health.

  • Recommendations: Emphasize wholesome foods, adequate rest, hydration, and the avoidance of harmful substances while lactating.

  • needs for energy (cal), protein, calcium, iodine, zinc, vitamin B, and vitamin C

  • energy intake increase of 300 cal

Physical Activity

  • Regular Exercise: Moderate physical activity is encouraged for enhancing overall well-being and reducing complications during pregnancy, promoting both physical and mental health.

  • Suggestions: Include recommendations for hydration and proper caloric intake when engaging in physical activity to support maternal health.