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Luteinizing Hormone
- -Stimulates the follicle to produce estrogen
- -LH surge results in the establishment of the corpus luteum, which produces estrogen and progesterone.
- -Menstrual cycle hormone
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Preembryonic Stage (time frame)
fertilization through 2 weeks
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Embryonic Stage (time frame)
end of 2nd week through 8th week
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Fetal Stage (time frame)
end of 8th week through birth
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Preembyronic Development
- -Fertilization in ampulla of fallopian tube
- -union of sperm & ovum forms a zygote (46 chromosomes)
- -cleavage cell division continues to form a morula (mass of 16 cells)
- -Inner cell mass is called blastocyst, which forms embryo & amnion
- -Outer cell mass is called trophoblast, which forms placenta & chorion
- -Implantation occurs 7-10 days post conception into endometrium
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Blastocysts
Form embryo and amnion
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Trophoblasts
Form placenta and chorion
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Ectoderm
Forms the central nervous system, special senses, skin & glands
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Mesoderm
Forms skeletal, urinary, circulatory & reproductive organs
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Endoderm
Forms respiratory system, liver, pancreas & digestive system
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Functions of Placenta and Umbilical Vessels
- -Hormone production to maintain pregnancy
- -Vehicle for fetal gas exchange
- -Source of fetal nutrition
- -Essential to a healthy pregnancy
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Placenta
- -Means of metabolic and nutrient exchange b/w embryonic/fetal circulation & maternal circulation
- -Begins to function around 3rd week, fully functional at about 11-14 weeks
- -Suppresses maternal immunologic response so antibodies don't attack fetus as foreign body
- -Maternal portion: decidua basalis
- -Fetal portion: chorionic villi
- -Functions: fetal respiration, nutrition and excretion - produces glycogen, cholesterol & fatty acids - hormone production
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Placental Hormones
- -hCG (human chorionic gonadotropin)
- -hPL (human placental lactogen)
- -2 steroid hormones (estrogen and progesterone)
- -Progesterone is main hormone of pregnancy
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Umbilical vessels
- -Umbilical vein (1) carries O2 from mother to fetus
- -Umbilical arteries (2) carry depxygenated blood from the fetus to the mother
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Amniotic Fluid
- -Embryonic membranes from amniotic sac - amniotic membrane = amnion & chorion
- -Production of amniotic fluid - fetus develops & urinary system activates - amniotic fluid from mom is swallowed and excreted as urine = amniotic fluid
- - Functions: protection & cushion for fetus & umbilical cord - temp control - allows fro development of musculoskeletal system - allows for fetal movement - contains fetal cells (useful in testing) - can tell about the fetus' lungs
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Nageles' Rule for EDD/EDB/EDC
- -1st day of LMP 11/21/07
- -Subtract 3 months 8/21/07
- -Add 7 days 8/28/07
- -Adjust the year 8/28/08
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Gravida
Gravida I (primagravida)
Gravida II (secundgravida)
Nulligravida
Multigravida
Grandmultigravida
- pregnant woman
- 1st pregnancy
- 2nd pregnancy
- Has never been pregnant
- 3+ pregnancies
- 5+ pregnancies
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Parity
Primapara
Multipara
- a woman who has produced one or more offspring carrying a pregnancy 20 weeks or more
- one birth after a pregnancy of at least 20 weeks
- 2+ pregnancies resulting in viable offspring
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G
T
P
A
L
- Gravida: all pregnancies including the present one
- Term births: # of pregnancies ending @ 38-42 weeks gestation
- Preterm births: # of preterm pregnancies ending > 20 weeks but < 38 weeks
- Abortions: # of pregnancies ending before 20 weeks
- Living children: # of children currently living
- *multiple births (twins, etc.) = 1 pregnancy
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1st trimester (timing)
- conception - end of 13 weeks
- **All organs developed
- **Placenta developed
- **Baby developed
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2nd trimester (timing)
week 14 - end of 26th week
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3rd trimester
- week 27 - birth
- **transfer of maternal antibodies to baby (34-36 weeks)
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Presumptive Signs of Pregnancy
- -Fatigue (12 weeks)
- -Brest Tenderness (3-4 weeks)
- -N & V (4-14 weeks)
- -Amenorrhea (4 weeks) - major signs
- -Urinary frequency (6-12 weeks)
- -Fetal Movements/Quickening (16-20 weeks)
- -Hyperpigmentation of skin (16 weeks)
- -Uterine Enlargement (7-12 weeks)
- -Breast Engorgement (6 weeks)
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Probable Signs of Pregnancy
- -Braxton-Hicks contractions (16-28 weeks)
- -Positive pregnancy test (4-12 weeks)
- -Abdominal Enlagement (14 weeks)
- -Ballottement (16-28 weeks) - uterus pushes back
- -Goodell's Sign (5 weeks) - softening of cervix
- -Chadwick's Sign (6-8 weeks) - cervix becomes blue
- -Hegar's Sign (6-12 weeks) - softness in the middle of the uterus
- -Uterine Souffle - sound of blood going through the uterus
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Positive Signs of Pregnancy
- -Ultrasound verification of embryo or fetus (4-6 weeks)
- -Fetal movement felt by experienced clinician (20 weeks)
- -Auscultation of fetal heart tones via doppler (10-12 weeks)
- -Fetal heart beat - 2-3 weeks; can auscultate at 10-12 weeks; can ultrasound at 5-6 weeks
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1st Prenatal Visit
- -Comprehensive Health Hx
- -Physical Exam - head to toe assessment
- -Psychosocial Hx - alcohol, smoking
- -Pelvic Exam
- -Labs - CBC, hormones, blood type & Rh, HIV, rubella, group B strept (GBS), STDs, TORCH
- -Doppler HR
- -Baseline VS
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T
O
R
C
H
- Toxoplasmosis
- Other (HIV)
- Rubella
- Cytomegalovirus
- Herpes
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Prenatal Visit Schedule
- -Every 4 weeks up to 28 weeks
- -Every 2 weeks from 28-36 weeks
- -Every week from 36 weeks to birth
- -Pt. will be seen with greater frequency to monitor & manage high risk conditions
- -Poor compliance with visit schedule has been associated with poor outcomes
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Assessments at subsequent prenatal visits
- -weight and BP
- -UA for protein, glucose, ketones & nitrates - gestational diabetes
- -fundal height - assesses fetal growth
- -Assess for quickening
- -Assess FHR (120-160 bpm = normal)
- -Preeclampsia: toxemia of pregnancy, characterized by HTN, albuminuria & edema
- -Give rogam if mom is Rh - : just in case she's carrying an Rh + baby to stop her from creating antibodies against the body
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Pregnancy & Nutrition
- -Caloric intake increased 300 kcal/day
- -"eating for 2" leads to excessive weight gain
- -RDA for most nutrients increase
- -Folic Acid & Iron supplements usually the only recommended - possibly calcium also
- -Limit fish intake
- -Avoid weight loss diets
- -Limit Soda, Caffeine
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Weight Gain During Pregnancy
- -Recommended total wt. gain for women beginning singleton pregnancy at normal wt. = 25-30 lbs
- -1st trimester = 3-5 lb wt. gain
- -2nd & 3rd trimesters = 1 lb/week
- -Pattern of wt. gain is as significant as total wt. gain!
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Weight Gain Distribution:
-Breasts
-Blood
-Extra H2O
-Uterus
-Placenta, Fetus, Amniotic Fluid
-Maternal Stores
-Total
- Weight Gain Distribution:
- -Breasts = 3 lbs
- -Blood = 4 lbs
- -Extra H2O = 2-3 lbs
- -Uterus = 2 lbs
- -Placenta, Fetus, Amniotic Fluid = 11 lbs
- -Maternal Stores = 5-10 lbs
- -Total = 25-35 lbs
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Danger Signs of Pregnancy
- -Bleeding or spotting
- -Persistent vomiting
- -Dysuria
- -Fever > 100.0 F
- -Sudden gush or leakage of fluid from vagina
- -Severe upper abdominal/epigastric pain
- -Severe HA
- -Visual disturbances
- -Pain in calf
- -Decreased fetal movement
- -Preterm Labor
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Progesterone
Greatest role is maintaining pregnancy. Relaxes smooth muscle and inhibits uterine contractions
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Human Chorionic Gonadotropin (hCG)
Secreted by fertilized egg to stimulate corpus luteum to secrete setrogen and progesterone
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Human Plactenal Lactogen
Decreases insulin sinsitiviey, insulin antagonist, increases insulin resistance so glucose can go to the fetus
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Estrogen
Uterine & breast development. Produced in corpus luteus then placenta
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Prostaglandins
Decreased placental vascular resistance
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