NUR 166 week 2

Female Reproductive System Overview

  • The female reproductive system comprises several key organs:
    • Uterus:
      • Fundus: The dome-shaped top of the uterus.
      • Body: The main part of the uterus.
    • Fallopian Tubes:
      • Located on either side of the fundus, they are delicate structures that transport the egg after it's ovulated.
    • Ovaries:
      • Positioned below the fallopian tubes, they release an egg during the menstrual cycle.

Menstrual Cycle and Ovulation

  • The cycle lasts about 28 days, divided into phases:
    • First Two Weeks (Follicular Phase):
      • The uterus's lining thickens, preparing for potential fertilization.
      • An egg is released from the ovary around day 14.
    • Post-Ovulation (Luteal Phase):
      • If fertilized, the egg moves towards the uterus; if not, it will be expelled during menstruation.
  • Fertilization Window:
    • The egg is viable for fertilization for approximately 10 days after ovulation.

Menstruation

  • If fertilization does not occur:
    • Hormone levels (progesterone and estrogen) drop.
    • The uterine lining sheds, resulting in menstruation, which is about 2 tablespoons of blood along with tissue breakdown.

Bleeding Disorders in Pregnancy

  • The disruption of pregnancy processes can lead to complications such as:
    • Spontaneous Abortion (Miscarriage): Termination of pregnancy before 20 weeks.
    • Blighted Ovum: Fertilized egg fails to develop leading to miscarriage.
    • Cervical Incompetence: A weak cervix can lead to miscarriage or preterm labor.
      • Cerclage: A stitch to hold the cervix closed can be placed in cases of incompetence.
    • Progesterone Injections: Given for women who have had frequent miscarriages to support the pregnancy.

Ectopic Pregnancy

  • Occurs when the fertilized egg implants outside the uterus, often in the fallopian tube.
  • Symptoms include:
    • Abdominal pain on one side
    • Abnormal bleeding
  • Treatment options:
    • Methotrexate injections to stop the growth of the implanted egg.
    • Surgery if it ruptures.

Gestational Trophoblastic Disease (Molar Pregnancy)

  • Caused by abnormal growth of trophoblastic tissue, leading to elevated hCG levels without a viable fetus.
  • Common sign: a higher than expected fundal height measurement.
  • Symptoms can include severe nausea and vomiting (hyperemesis gravidarum).

Late Pregnancy Bleeding

  • Placenta Previa: Placenta is positioned low in the uterus, potentially covering the cervix, causing painless bleeding. Can lead to emergency cesarean delivery if severe.
  • Placental Abruption: The placenta detaches from the uterus prematurely, causing severe pain and potential hemorrhage.

Hypertensive Disorders in Pregnancy

  • Key conditions include:
    • Gestational Hypertension: High blood pressure after 20 weeks without protein in urine.
    • Preeclampsia: Defines by hypertension and proteinuria, can lead to severe complications.
    • HELLP Syndrome: Severe form of preeclampsia with hemolysis, elevated liver enzymes, and low platelets.
  • Treatment often involves delivery and monitoring for complications.

Rh and ABO Incompatibility

  • Rh Incompatibility: If a Rh- mother has Rh+ fetus, it can lead to hemolytic disease of the newborn. RhoGAM is administered during pregnancy and after delivery to prevent this.
  • ABO Incompatibility: Occurs when a mother with type O blood has a baby with A or B blood type, leading to mild jaundice due to antibody response.

TORCH Infections in Pregnancy

  • Toxoplasmosis: Avoid cat litter and gardening without gloves.
  • Other: Includes Zika and hepatitis B.
  • Rubella: Can cause serious defects, vaccination is recommended before pregnancy.
  • Cytomegalovirus: Often asymptomatic in mothers but can cause severe issues in babies.
  • Herpes: Pregnant women with active lesions should have a cesarean to prevent transmission during delivery.