Contraindicated vaccinations during pregnancy
- Flu with nasal spray
Allowed vaccinations during pregnancy
- Hep B (only if they’ve been exposed)
- Health Promotion
What is a teratogen?
Any substance or agent that can cause abnormalities in fetal development
____ ____ cross the placental barrier and can cause harm to fetus
Smoking can cause _____
Low birth weight and prematurity
Alcohol can cause ____
Growth retardation and FAS
Normal process of cell division- body cells
Cell division that only occurs in reproductive cells.
Cellular division of the sperm is called
Cellular division of the ovum (egg) is
Each sperm has ____ chromosomes
Sperm can have _______ sex chromosomes
X or Y
Ova have _____ chromosomes
Ova only have _____ sex chromosomes
____ sperm develop from one sperm cell
____ ova develop from 1 egg cell
Fertilization occurs when
Sorry successfully penetrates an ovum
Fertilization occurs in the ______ of the Fallopian tube, the area ______ to the ovary.
- 1) outer third
- 2) closest
The egg can survive ____ after OVULATION
Sperm can survive _____ after ejaculation
Sex determination occurs _____
A fertilized cell is called (Sperm and Ova join)
The size of the zygote_____
After three days the fertilized cells go through a cleavage and are known as
The inner layer of the morula that will form the embryo is called
The outer layer of the morula that develops into the chorion is called
Zygotes implant into the ____
After implantation, the endometrium is called
The deidua basalis is
The area immediately under the blastocyst. Forms the maternal side of the placenta
The chorion is the ___ of the fetal membrane
The amnion is the ____ of the fetal membrane
The chorion envelopes the
Amnion, embryo, and yolk sac
Surrounds and protects the embryo and grows until it sticks to the chorion.
The amnion contains ____ ml of fluid at 10 weeks.
The amnion contains ____ ml of fluid at term
Functions of the amniotic fluid
- Equalizes pressure
- Protects and cushions
- Maintains even temp and fluid for the fetus to swallow
- Allows movement and normal growth
- Lubricates and prevents sac from sticking to fetus.
Yolk sac functions
- Functions only during embryonic development
- Initiates production of RBC until 6 weeks when the liver takes over.
What is the placenta
Organ that provides nutrients, oxygenation, and waste removal for the fetus
The placenta has
1 umbilical vein and 2 umbilical arteries.
The umbilical vein
Carries oxygenated blood to fetus
The umbilical arteries
Carry deoxygenated blood and waste from fetus.
The placenta produced 4 hormones:
Stimulates uterine growth, helps with lactation, causes some physical changes during pregnancy
Maintains uterine lining, reduced contraction, and hell’s prepare for lactation.
Causes continued production of estrogen and progesterone to sustain pregnancy
Helps to make more glucose available to fetus to accommodate growth
Softens connective tissue in pelvis
What does Wharton’s jelly do
Protects the umbilical cord vessels ( arteries and veins)
How long is the umbilical cord
Zygote is what stage
Embryo is what stage
Fetal is what stage
Week 9- delivery.
Fetal development occurs
What are the three shunts needed in fetal circulation.
- Ductus arteriosus
- Ductus venosus
- Foraminifera ovale.
Describe ductus arteriosus
- Diverts blood from pulmonary artery to aorta
- (Lungs -body)
Describe ductus venosus
- Diverts blood from the liver to the inferior vena cava
- (Body- heart)
Describe foremen ovale
Connects right atria to left atria
Describe monozygotic twins.
- Come from one egg (mono)
- Same sex
- Share placenta and chorion but have separate amnions
Describe dizygotic twins
- Two eggs fertilized by two sperm
- May not be the same sex
- 2 separate placentas, chorions and amnions
What is fundal height
When uterus is just below xiphoid process
Progesterone continues to be produced for up to _____ weeks to maintain pregnancy
A mucus plug is formed in the ___
During dilation, ____ be expelled from the cervix
During pregnancy the _____ of the vagina may change to protect from infections.
Chadwicks sign appear because of
Increased vascular congestion
- High in protein, vitamins, and minerals
- Provides immunity to baby
- Helps baby cleanse GI tract
During pregnancy _____ increases
- Circulating blood volume
- Pulse rate
What is vena cava syndrome
Occurs due to weight of the uterus. Reduced blood return to heart and can lead to fetal hypoxia
Oxygen consumption _____ during pregnancy
Changes in the GI system
- Constipation from decreases motility and pressure from uterus
- Gas and heart burn
- Increases appetite and thirst
Pregnant women need ____ glasses of fluids a day
Brown lines on belly
Presumptive signs of pregnancy
- Changes in breast
- Urinary frequency
- Abdominal enlargement
Probably signs of pregnancy
- Goodells sign- softening of cervix
- Hegars sign- softening of lower uterus
- Chadwicks- blue discoloration due to increased BL food
- Uterine enlargement
- Braxton Hicks contractions
- Increased pigmentation
- Ballottement- rebounding of the fetus
- Positive pregnancy test
Positive signs of pregnancy
- Heart beat of fetus
- Rate goes down in latter part of pregnancy
- Fetal movements
Normal heart rate for fetus early pregnancy
Normal heart rate for fetus later pregnancy
Total number of pregnancies
Births that reach 20 weeks
Delivery after 20 weeks but before 38
Pregnancy between 38-42 weeks
Post term is
Delivery after 42 weeks
Including induced and spontaneous (miscarriage)
Gestation age is
Calculated from first day of last missed period
Glucose tolerance test at ____
Estimate date of delivery
First day of LPM - 3 months + 7 days
Pregnant women should increase daily calorie intake by
300 calories a day
Four main nutrients needed during pregnancy
- Protein- metabolic needs
- Calcium- bones and lactation
- Iron- fetal requirements and RBC
- Folic Acid- to prevent neural tube defects and RBC production
Total weight gain recommended
- Less if overweight
- More if underweight
- Severe n/v during pregnancy that goes last first trimester
- Caused by increased hCG and stress
Closed cervix. Spotting no tissue passed. Membrane intact
Bleeding/cramping. Some cervical dilation with possible rupture of membranes.
Cervix dilated. Passage of some tissue. Bleeding heavy and cramping severe
- Products of conception are expelled. Cervix closes and bleeding stops.
Fetus dies in uterine but is not expelled. Cervix closed. Not FHT.
Series of 3 or more of any kind
Observe for ____ with abortion
_____ is given time Rh negative mothers
- Painless dilation of cervix in 2nd trimester. Might cause habitual abortions
- Treated by cerclage( suturing cervix closed)
Pregnancy where implantation occurs outside of uterus
Causes of ectopic pregnancies
- Scarring from IUD
- Abnormal hormones.
S/s ectopic pregnancy
- *appear within 5 weeks of missed period *
- Lower quad pain
- Sudden severe lower pain
- Vagina bleeding
- Possible shock
- Molar pregnancy
- Malformation in development of placenta. Chorionic villa abnormally increase and develop cyst like sacs that look like grapes
*can lead to cancer.
S/s of hydatidiform mole
- No FHT
- Vaginal bleeding
- Fundal height greater that expected
- S/s of PIH
- Servers vomiting
- High hCG
- Snowstorms on US
Treatment for molar pregnancy
- Evacuate uterus
- Avoid pregnancy for 1 year
- Give rhogam
- Test hCG
Vaginal bleeding that occurs in late pregnancy. Placenta implants and develops in lower uterine segment and overlies the cervical os.
Classifications first placenta previa
- Low lying
Complete placenta previa
Placenta completely covers cervical os
Partial placenta previa
Partially covers cervical os
Low lying placenta previa
Placenta within 2-3cm of cervix.
S/s placenta previa
- Painless vaginal bleeding
- Fetal distress and hypoxia
- Abnormal baby presentation.
Treatment for placenta previa
- Avoid pelvic exams
- C section if complete
- C section if partial
- If low lying- vaginal delivery but c section is preferred.
Steroids early on.
Premature separation of placenta from uterine wall. Can be partial or compete. Causes fetal distress.
S/s of abruptio placentae
- Vaginal bleeding
- Severe pain
- Rigid board like abdomen
- FHT los or absent
- Sudden fetal inactivity
Treatment for abruptio placentae
- C section
- Bloood snd clotting factor replacement
- Aka toxemia or pregnancy induced hypertension.
- Cause unknown.
- Appears after 20 weeks
- Hypertension BP greater than 140/90
- Or bp 30/15 higher than prepreg bp
- Blurred vision
Four classifications for PIH
Eclmapsia is Diagnosed when
Convulsive stage begins
Goal bs for pregnant women
- Developes because of pregnancy in 2nd or 3rd trimesters.
- Diagnosed with GTT 24-28 weeks
- Goal BS 70-105
- Toxoplasmosis (neuro damage low weight)
- Other.. hiv, hep b, tb, and group b step. (Tested around 30 weeks )
- Rubella (microcephaly, MR)
- Cytomegalovirus (mr, Blindness, deafness)
- Herpes virus ( neuro effects- requires c section. May cause death)
- Rh factor is either present or absent in the blood
- Mother and baby blood usually doesn’t mix but if it does and Rh is there, body will produce anti bodies.
- Antibodies are permanent.
- Can cross placenta and destroy fetal RBC
Treatment for RHA INCOM.
- Rhogam at 28 weeks and within 72 hrs of delivery
- Not beneficial if sensitization has already occurred.
S/s flat nasal bridge, thin upper lip, poorly formed grove above lip, microcephaly, short eye tissue Mc jittery nature.
- Small weight
- Withdrawal symptoms
- Some defects
- Neuro defects
- Begins after 20 weeks but before 37
- Causes vary
- Contractions, PROM, cervical dilation and effacement
- Attempts to stop labor of dilated less than 4cm
- Not stopped if health is at risk.