Maternal And Child Health Nursing (ncm 101 Lect) Part 1

NCM 101 LECTURE (Maternal and Child Health Nursing) Fallopian Tube -2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the amplla to the uterus -4 significant segments * infundibulum – most distal, part trumpet shape, has fimbrae * ampulla – outer 3rd or 2nd half, site of fertilization, common site for ectopic pregnancy * isthmus – site for sterilization, site for BTL * interstitial – most dangerous site for ectopic pregnancy Fertilization: 1.Union of the ovum and spermatozoon 2.Other terms: conception, impregnation or fecundation 3.Normal amount of semen/ejaculation= 3-5 cc = 1 tsp. 4.Number of sperms: 120-150 million/cc/ejaculation 5.Mature ovum may be fertilized for 12 –24 hrs after ovulation 6.Sperms are capable of fertilizing even for 3 – 4 days after ejaculation (life span of sperms 72 hrs) 7. Normal life span of sperm is 7 days Implantation- nidation- takes 1 week after fertilization General Considerations: o Once implantation has taken place, the uterine endometrium is now termed decidua o Occasionally, a small amount of vaginal bleeding occurs with implantation due to breakage of capillaries o Immediately after fertilization, the fertilized ovum or zygote stays in the fallopian tube for 3 days, during which time rapid cell division (mitosis) is taking place. The developing cells now called blastomere and when about to have 16 blastomere called morula. o Morula travels to uterus for another 3 – 4 days o When there is already a cavity in the morula called blastocyt o finger like projections called trophoblast form around the blastocyst, which implant on the uterus o Implantation is also called nidation, takes place about a week after fertlization -morula- 16 blastomere -morula- cavity in the morula -trophoblast- fingerlike projections Age of reproductivity- 15-44y/o Childbearing- 20-35 y/o Average menstrual cycle- 28 days Average menstrual period- 5 days Normal blood loss- 50cc/1/4 cup accompanied by FIBRINOLYSIS – prevents clot formation Fetal Growth and Development First Lunar Month – first four weeks -germ layers differentiate by the 2nd week

1. endoderm – gives rise to lining of GIT, Respiratory Tract, tonsils, thyroid (for basal metabolism), parathyroid (for calcium metabolism), thymus gland (for development of immunity), bladder and urethra 2. Mesoderm – forms into the supporting structures of the body (connective tissues, cartilage, muscles and tendons); heart, circulatory system, blood cells, reproductive system, kidneys and ureters. 3. Ectoderm – responsible for the formation of the nervous system, skin, hair and nails and the mucous membrane of the anus and mouth 1 month: 2nd week – fetal membranes 16th day – heart forms ; 4th week – heart beats 2nd month: All vital organs and sex organs formed; placental fully developed; meconium formed (5th –8th wk) 3rd month: Kidneys function - 12th wk- urine formed ; Buds of milk teeth form ; begin bone ossification ; allows amniotic fluid ; establishment of feto-placental exchange 4th month: Lanugo appears; buds of permanent teeth form; heart beat heard by fetoscope 5th month: Vernix appears; lanugo over entire body; quickening; FHR audible with stethoscope 6th month: Attains proportions of full term but has wrinkled skin 7th month: 28 weeks – lower limit of prematurity; alveoli begins to form 8th month: 32 weeks – fetus viable; lanugo disappears, subcutaneous fat deposition begins 9th month: Lanugo continue to disappear; vernix complete; amniotic volume decrease Focus of Fetal Development First Trimester – period of organogenesis Second Trimester – period of continued fetal growth and development; rapid increase in length Third Trimester – period of most rapid growth and development because of the deposition of subcutaneous fat Fetal Membranes 1.Amnion – gives rise to umbilical cord/funis – with 2 arteries and 1 vein supported by 2.Wharton’s jelly- protects the umbilical cord 3.Amniotic fluid: clear albuminous fluid, begins to form at 11 – 15th week of gestation, chiefly derived from maternal serum and fetal urine, urine is added by the 4th lunar month, near term is clear, colorless, containing little white specks of vernix caseosa, produced at rate of 500 ml/day. Known as BOW or Bag of Water Umbilical Cord/Funis -whitish gray -connects the fetus to the placenta -carry oxygen and nutrients from the placenta to the fetus and return unoxygenated blood and fetal waste product to the placenta -liver functions for the detoxification -A,V, A (2 arteries, 1 Vein) Cord Abnormalities: BASA PRAVIA- the umbilical cord loses the protection of the wharton’s jelly Signs and Symptoms: 1. Sudden gosh bright red blood at the tip of the rapture of membrane 2. Sudden fetal bradycardia 3. Sinusoidal fetal heart rate pattern- long term variability consist of 5-15 bpm every 35mins 4. Short Cord results to: 1. Intrapartum hemorrhage (during delivery)

2. 3. Long 1.

Delayed descend of the fetus during labor Inversion of the uterus Cord results to: True Knots Cord a. Central insertion- cord inserted at the center of the placenta b. Lateral insertion- cord inserted away from the center of the placenta 2. Villatentous insertion – membranes of cord is inserted to the membrane to the placenta 3. Battledoor Insertion – at the edge

Diagnosis of Basa Pravia 1. Transvaginal sonography at 16 weeks of gestation 2. Caesarean Section is the best remedy

Knots of the cord- fetal movement may cause knots in the cord *true knots- fetus passes through a loop of cord * false knots- Wharton’s jelly containing a loop of umbilical vessels Loops of the cord- cord coil around the fetal body and neck, when the cord coil is the neck it is called nuccal cord. Torsion of the cord- deficiency of Wharton’s jelly number Hematoma of the cord- results from the rapture of the vessels with a fusion of blood into the cord Cord Cyst- vesicular formation on the cord *true cord cyst- derived from remnants of the umbilical vesicles *false cord cyst- large and derived from Wharton’s jelly. Edema of the cord- commonly seen in the dead fetus Single Umbilical Artery- renal associated with other renal anomalies 2 sides of placenta 1. Maternal (rami- collection of villi)- each cotyledon is a collection of villi which terminate in one main stem, the lobes are separated by grooves called septic. Amniotic Fluid Purposes of Amniotic Fluid Protection – shield against pressure and temperature changes Can be used to diagnose congenital abnormalities intrauterine– amniocentesis Aid in the descent of fetus during active labor Implication: Polyhydramios = more than >1500 ml due to inability of the fetus to swallow the fluid as in trachoesophageal fistula. Oligohydramnios = less than <500 ml due to the inability of the kidneys to add urine as in congenital renal anomaly Fetal Membranes •Chorion - together with the deciduas basalis gives rise to the placenta, start to form at 8th week of gestation; develops 15 – 20 cotyledons

•Purpose of Placenta: respiratory; exchange of nutrients and oxygen •Renal system •Gastrointestinal system •Circulatory system •Endocrine system: produces hormones (before 8th week-corpus luteum produces these hormones) hCG keeps corpus luteum to continue producing estrogen and progesterone •HPL or human chorionic somatomammotropin which promotes growth of mammary glands for lactation •Protective barrier: inhibits passage of some bacteria and large molecules