Antepartum Normal Flashcards
Name the stages from sex to implantation?
Sex–>Fertilization–>zygote–>blastomeres–>morula–>blastocyst–>implantation
What period is the first 7 days after conception
Zygotic period (1-2 weeks)
What and when is the embryonic period?
week 3-7 after conception. 3 layers of cells (ectoderm, endoderm, and mesoderm) makes up all tissues and organogenesis at this time.
How does Teratogens affect this time period
May be lethal (cause SAB) or cause major congenital malformations.
Fetal development week 2 (after conception)
endo and ectoderm development
Fetal development week 3 (ac)
mesoderm development and notochord
Fetal development week 4 (ac)
heart beat begins, neural tube closes, beginning organ system, CRL 4-6mm
FD week 5 (ac)
rapid brain development, head enlarges, eyes, CRL 7-9mm
FD week 6 (ac)
nose, mouth, limb differentiation, ears, CRL 11-14
FD week 7 (ac)
Neck established, intestines herniated in umbilical cord, distinct human characteristics, CRL 16-18mm
FD week 8 (ac)
All structured present, eyelids closed, genitalia evident CRL 27-31mm
When does the fetal period begin
Week 9 (after conception) 11 weeks from LMP
FD week 9-12 (ac)
Body/limb growth accelerate, ears lowset, intestines back in abdomen, erythropoiesis shifts to spleen, swallows, breathe, urinates moves limbs (11-14 wks GA)
FD week 13-16 (ac)
Rapid growth, ossification of skeleton, ovaries differentiated, genitals recognizable, eyes/ears move to normal position, wt 3.5-4oz (15-18 wks GA)
FD week 17-20 (AC)
Movements stronger (mother feels now) Brown fat deposited, by 20wks body is covered in vernix; wt 1 lb (19-22 wks GA)
FD week 21-26 (ac)
Fetus gains wt, surfactant production, skin w/o SQ fat, lanugo present, crying and sucking, can make fist or grip, wt 1.25lbs (23-28 wks GA)
FD week 26 - 29 (ac)
Lungs capable of breathing air, CNS controls breathing, some fat storage begins, eyes open/shut, fingernails, wt 2.25 lbs (28 - 31 wks GA)
FD week 30-32 (ac)
Lanugo on face disappear, rhythmic breathing, can control body temp, wt 3.75 lbs (32-34 wks GA)
FD week 33-36 (ac)
Testes descended, more fat, less wrinkles, rounder body, wt 5.5 lbs (35-37 wks GA)
FD week 37 - 40 (ac)
Protuberant mammary glands, testes in scrotum, no lanugo, nails beyond fingers/toes, pulmonary, GI and renal permit extrauterine survival 7.5 lbs (39-42 wks GA)
Teratogens effect on weeks 1-4 after fertilization
either SAB or no reaction (all or nothing principle)
Teratogens effect of week 3-8 after fertilization
most critical for structural defects (during organogenesis)
Heart, arms/legs susceptible and neural tube defects w/o enough folic acid.
Teratogen effects what after 1st trimester
eyes, ears teeth CNS and genitalia
Which system has the longest sensitivity to teratogens? and how long
CNS and for a 16week window can be effected.
Increased teratogens (amount) has…
1) Decreased in effect
2) no change in the effect
3) increase in effect
Increase in effect. The more teratogen, the more likely more severe the defect.
Teratogen effect from week 8 - Term
functional defects and/or minor abnormalities
Placental development of the primary structure begins…
8 to 10 wks after conception
When does the placenta achieve full thickness
4 months
Function of placenta
Protection of fetus from pathogens
Allows passage of nutrients, waste and drugs and IgG antibodies, late in pregnancy
When does formation of the placenta begin
At invasion of trophoblast into endometrium 6-7 days after conception
Decidua
Name of endometrium during pregnancy
Decidua basalis
beneath implantation site (maternal contribution)
Decidua capsularis
covering the embryo
Decidua parietales
lines the rest of the uterus
Placental development day 14
chorionic villi begin to form, placental septa, and cotyledons
Role of placental septa and cotyledons
Septa- restrict exchange of blood between cotyledons (keeping problems localized)
Cotyledons- main stem of chorionic villi and its branches
Describe placental circulation
Mothers’ blood enter from spiral arteries and bath chorionic villi, so no mixing of maternal and fetal blood.
What happens to blood transfer when placenta matures
It degenerates somewhat allowing passage of more nutrients and IgG from mom. However more passage of fetal blood cells enter into maternal circulation (hence the importance of RhoGAM)
Amnion
The inner fetal portion of fetal membranes
End of 3rd month its in contact with chorion
together with chorion, forms the amniotic sac
What hormones are produced by placenta
HCG - maintains corpus luteum and endometrium
HPL - produced early for lactogenic and metabolic processes
Estrogen and Progesterone
Production and function of estrogen in pregnancy
Produced in ovaries and placenta.
Function promotes breast tissue growth,
-increased myometrial activity and vasodilation,
-softens cervical collegen,
-increases secretion of prolactin, but decreases sensitivity to receptors
-ductal system development (glandular tissue mammary growth)
-decrease plasma proteins,
-increase fibrinogen and clotting factors
Production and function of progesterone in pregnancy
Produced- corpus luteum til 5 wks after fertilization and the placenta thereafter (drops in late pregnancy)
Function - fetal synthesis of cortiocosteroids
- decreases myometiral activity (quiets uterus) and constricts myometiral blood vessels,
-inhibits prolactin
-aveolar system development contributin to mammary growth
-suppresses mom’s immune response to fetal antigens,
-relaxees smooth muscle in GI and Urinary tracts
Production and Function of HCG
Produced- placenta (detected 7 days after fertilization)
concentration rises by 66% q 48 hrs during first 2-3 months after feritlization
Function Maintains Corpus lutuem for progesterone
stimulates fetal testes and adrenals for testosterone and corticosteroid secretion
suppress lymphocyte responses to prevent fetal rejection
HCG levels in molar pregnancy
increased > 100K
when is HCG decreased
ectopic preg,
abnormal preg, or impending SAB
production and function of HPL
Produced - placenta begins 5-10 days after fertilization, increases and levels off 34-36 weeks GA
concentration proportional to placenta
Function- promotes fetal growth by diverting mom’s metabolism
-regulated by glucose for lipolysis and anti insulin for constant nutrients to fetus.
-Stimulates mammary growth
Prolactin
Produced, by the pituitary
Function- increased secretion in the presence of estrogen, but not responsive until progesterone decreases by end of pregnancy
causes milk production.
Changes in breast (3)
2 fold increase in blood flow,
Wt increased to 12 oz (hyperplasia)
Increase size and pigmentation of areola
Respiratory changes
Diaphragm increases 4 cm and widening of ribcage leads to diaphramatic breathing
- Hgb and CO increase
- decrease in PCO2
- incrase awareness of a desire to breathe
What happens to blood volume during pregnancy
increases 30-50%, starting 1st trimester, expands rapidly during 2nd and slows during 3rd, plateaus last few weeks during pregnancy
Physiologic anemia
plasma volume increase more rapidly than erythrocyte production
What happens to erythrocyte production during pregnancy
increases by 33%, but not as much as plasma volume, thus a slight decrease in Hgb and Hct
CDC definition of anemia in pregnancy
< 11g/dL in 1st and 3rd trimesters and <10.5g/dL in the 2nd trimester
What happens to blood coagulation during pregnancy
increase in fibrinogen by 50% (and other clotting factors) and increase in PT and PTT
Cardio changes during pregnancy
Pulse rate increases 10-15 bpm
systolic murmor heard in 90% of pregnancies
Exaggerated S1 splitting.
CO increases by as much as 22%
BP changes during pregnancy
BP in brachial... higher while sitting lower in the lateral recumbant intermittent while supine decreases during 2nd and early 3rd trimesters and returns to baseline by end of term.
Circulatory changes during pregnancy
blood flow to legs impeded (more venous return when lying on side,
more dependent edema closer to term
more varicosities in legs, vulva, and rectum
GI changes during pregnancy
stomach and intestines displaced,
GI motility decreased (thx to progesterone)
Prolonged gastric emptying time
Pyrosis (heartburn) caused by acid reflux in lower esophagus