EXAM 1 Flashcards
28 weeks
Glucose Tolerance Test Blood Draw CBC and STI Rhogan Shot if RH- Fetal Heart Tones Counseling and Education
Mental Health Questionaire
First Visit and 28 weeks
First Visit: 8-12 weeks
-NOT doppler/ trans-vaginal dating ultrasound instead
offer cervical exam, pap smear if needed
-Mental Health Questionnaire
-Labs
Common Signs/Symptoms of 3rd trimester: Prep for labor
- Lightening (drop of fetal head into pelvis)
- Loss of mucus plug (not concerned unless before 37 weeks)
- More Braxton-Hicks contractions
- Nesting
True Labor
- Contractions that may radiate BEYOND abdomen
- No intervention will change intensity
- Longer, Closer, Stronger together
- Cause Cervical Change
False Labor
- Braxton-Hicks Contractions or abdominal tightening
- Improve with a change in position, rest, or intervention
- Irregular, random, temporary
- DOES NOT cause cervical change
1st stage of Labor
0-10 cm
- Latent phase 0-6 (takes longest)
- Active phase 6-10
2nd stage of Labor
10 cm until delivery of baby
3rd Stage of labor:
Delivery of baby until delivery of placenta
Naegele’s Rule
Assume 28 day cycle: LMP+7 days - 3 months + 1 year
First Trimester (Weeks)
0-13 Weeks
Second Trimester (Weeks)
14-26 Weeks
Third Trimester (Weeks)
27 weeks-Birth
What is the most deciding factor if patient is in labor?
Cervical Change
Leopold’s Maneuver
Way to externally palpate fetal position:
- Palpate fundus (top) (tells you is this baby breech or head down)
- Palpate side of of fetus for the spine vs fetal small parts
3rd: Palpate the bottom of uterus (tells you if cephalic)
4th: Palpate the fetal head (tells you altitude)
Cervical Exam
Dilation: opening of cervix
Effacement: Thinning of Cervix in %
Station: when widest part of the newborns head is at the level of the ischial spine of the pelvis (0 station is level of ischial ) in cm + below…- above spine
1st Trimester Milestones
4 weeks- pregnant
8-12 weeks: first prenatal appointment
What is anterior lip
9.5-10 cm
SROM = Spontaneous Rupture of Membranes Tests
Water broke on it’s own: Exam by 3 tests
- pooling (presence of fluid in vagina)
- Nitrazine (ph test)
- Ferning:n (microscopic analysis of amniotic fluid)
2nd Trimester Milestones
14-18 weeks: quickening
20 weeks: anatomy ultrasound
22-24 weeks: (viability: when baby can survive out of womb)
Third Trimester Milestones
40 weeks = Estimated date of birth/due date/confinement (EDB/EDD/EDC)
SROM- Spontaneous Rupture of Membrane Questions
Time?-prolonged is beyond 18 hours which means at risk of infection
Amount?- was it a leak
Color?- meconium could be in amniotic fluid
Odor?- infection
Gravid
of TOTAL pregnancies
Para
pregnancies past 20 weeks gestation regardless of outcome
Preterm Weeks
20-36.6 weeks
20-33.6 (early preterm)
34-36.6 (late term)
Abortion or Miscarriage Weeks
0 to <20 weeks
Full Term Weeks
37+ weeks Early Term:37-38.6 Full Term:39-40.6 Late Term:41-41.6 Post Term: 42+
2 Digit System
Gravity and Parity
Differs before and after birth
*Example: G1P0 upon admission
for labor and G1P1 upon
discharge
5 Digit System
Gravida Term Preterm (<37 weeks) Abortions Living
Pregnancy Hormones
HCG, Progesterone, Estrogen, HCS
Beta-human chorionic gonadoptropin (hCG)
What pregnancy tests measure;
-necessary to ensure the corpus luteum is maintained to secrete estrogen and
progesterone until the placenta is mature enough to take over
Progesterone
Maintains endometrial lining, decreases tone and motility of smooth
muscle (including uterus), increases fat stores; suppresses LH/FSH
Estrogen
Maintains endometrial lining, decreases tone and motility of smooth
muscle (including uterus), increases fat stores; suppresses LH/FSH
Human Chorionic Somatomammotropin (hCS)
Acts almost as a growth hormone, establishes insulin resistance, and works
with prolactin to prepare breasts for lactation
Professor says what’s most important in this class?
- Treat every patient as if they have had a traumatic experience
- Anticipatory guidance
- Informed consent
- Advocate for patient
1st Trimester: Common Discomforts
● “Morning” sickness (N/V) ● Fatigue ● Constipation ● Sore/tingling breasts ● Headaches ● Ptyalism (increased salivation)
2nd & Third Trimester: Common Discomforts of Pregnancy
● Melasma (“mask of pregnancy”) ● Linea nigre (dark line down abdomen) ● Striae gravidarum (stretch marks) ● Libido changes (often increases) ● Palmar erythema (palms of hands turn red) ● PEP (formerly known as PUPPPS) - rash on stomach ● Carpal tunnel syndrome ● Maternal pyrosis (GERD) ● Leg cramps ● Varicose veins/hemorrhoids ● Braxton-Hicks (“warm up”) contractions
5 P’s
- Power: contractions
- primary: involuntary- secondary: voluntary
- Passenger: size/presentation/lie/attitude/position
- Passageway:pelvis and surrounding soft tissues influence labor course
- Position: more specific to relation 4 quadrants of pelvis
- described using 3 letters
- Psyche: psychological aspect, obstacles such as stress or exhaustion is going to effect labor
OA vs OP
Occipital Anterior (OA): smaller diameter -will fit easier thru pelvis
Occipital Posterior (OP): sunny side up (baby is looking up) can take longer to push out baby. Labor person tends to have more back pain
-Peanut Ball or hands and Knees can help
Physiologic Changes: Reproductive
- ligaments and joints relax
- Uterus: drastic increase in blood and in size (hegars)
- Cervix: changes color (chadwicks) and softens (goodells)
- Vagina: elongates and changes in structure
- Breasts: darker and larger- colostrum produced as early as 16 weeks
Goodell’s Sign:
Softening of Cervix
Chadwick’s Sign
Tissue’s are purplish and red
Physiologic Changes: Cardiac
- Increase Coagulability (more likely for DVT)
- Heart shifts up and to left
- Heart Rate increases
- Diastolic decreases during mid pregnancy
- Blood Volume increases 1200-1500 ml
- cardiac output is 30-50%
- Transient adventitious heart sounds are normal
Physiologic Changes: Respiratory
-Chronic hyperventilation
-Slight alkalosis
-rise in diaphragm
-
Physiologic Changes: Renal
-Kidneys and ureters dilate → urinary stasis → increased UTI and
pyelonephritis risk
-GFR) increases by 50% in first trimester and remains elevated
-Tubular reabsorption is increased to prevent excessive sodium depletion
○ NO DIURETICS!
Signs of Pregnancy: The 3 P’s
● Presumptive: subjective and are not exclusive to pregnancy
○ Amenorrhea, nausea, fatigue, sore breasts, quickening
● Probable: objective signs of likely pregnancy
○ Pregnancy test, Goodell, Chadwick & Hegar’s signs, Braxton-Hicks
contractions, ballottement
● Positive: objective signs associated with a fetus
○ Seeing/feeling fetal movements, visualizing on ultrasound, hearing fetal
heart tones
Of 3 P’s (signs of pregnancy, which is diagnostic?)
POSITIVE:
○ Seeing/feeling fetal movements, visualizing on ultrasound, hearing fetal heart tones
Lithotomy
Position traditionally on their back for pushing or delivery
Body Fluids
Emesis - nausea/vomiting during labor
Urination- catheterization used
Bowel Movements- baby pushing against rectal nerves
Bloody Show- normal bleeding as cervix changes
Amniotic Fluid- continuously thruout labor
When you should start pushing as soon as the birthing person is 10 cm?
If unmedicated: let birthing person tell you
If patient has an epidural, wait 1 hour for fetal to descend
Frequency of Prenatal Visits
Once a month until 28 weeks; then q2 weeks until 36 weeks then weekly until birth
Nursing Role in education during Prenatal Visits
○ Educate; build rapport and trust at a vulnerable time; identify and assess risk factors (AMA (advanced maternal age), obesity, teen, little support, complex social history)
Types of Pushing
- Instinctual, open glottis
- Directed, closed glottis
* push for 10 sec ,breath, then repeat twice more per contraction
Should nurse’s expect they may deliver?
YES! protect perineum and slow down head from coming out
Fundal Height Measurements
Do not start measuring until 20 weeks gestation
● From the pubic bone to the fundus
● At 12 weeks, uterus rises above the pubic bone
● After 20 weeks, the # in centimeters should correlate with the # of gestational
weeks +/- 2 centimeters
HALF WAY THRU PREGNANCY SHOULD BE AT UMBILICUS
What are four questions that pregnant patients are routinely asked during prenatal
visits and/or triage visits?
● Are you experiencing any contractions?
● Are you experiencing any leaking of fluid?
● Are you experiencing any vaginal bleeding?
● Are you experiencing good fetal movement?
○ Won’t be occurring regularly until after quickening and closer to end of 2nd
trimester
Fetal Movement Tracking (concerned when)
Fewer than 3 kicks in 1 hour warrants further evaluation
Group Beta Stress Test is when?
36 weeks
RH factor is Resessive?
TRUE
When do you give RHOGAM (prevents antibodies from forming)
● If pregnant person is Rh negative: given in all pregnancies
○ Given at 28 weeks
● AND If pregnant person is Rh negative, given for ANY bleeding
● AND If pregnant person is Rh negative, given during any procedure that may cause mixing of maternal/fetal blood
● AND If pregnant person is Rh negative, given after all pregnancies, including miscarriages/abortions
○ Given within 72 hours of delivery/miscarriage/abortion
Do Clients need to sign a consent to receive Rhogam?
YES
How do you treat (GBS) Group Beta Streptococcus?
Penicillin q4 hours during labor until birth
What is best practice in regards to cord clamping?
Preterm baby : DELAY cord clamping
-recommended for term babies as well
Skin-to-Skin Benefits
NEWBORN BENEFITS: improves vita signs thermoregulate, decreases cortisol and risk for diabeties leads to epigenetic and microbiome changes
MATERNAL BENEFITS:Decreases cortisol, risk for postpartum hemorrhage, risk for postpartum mood disorders increases breastfeeding, improves bonding and attachment
Nurse’s role at delivery
- Document shoulder and head delivery
- stimulate newborn
- facilitate skin-to-skin
- Neonatal resuscitation
- Turn on postpartum Pitocin
- Apgar Score
- Alert staff
What types of vaccinations are given during pregnancy?
Flu shot and TDAP
DO NOT GIVE LIVE IMMUNIZATIONS
Placenta Delivery
Active Management: helping encouraging contractions
- breastfeeding/Pitocin can encourage
Passive Management: do nothing
Warning Signs of Placental Separation
- Lengthening of umbilical cord
- Palpation of tissue in vagina
- Sudden gush in blood
- Change in uterus shape from discoid to globular- moves down and contracts
What can happen if placenta separates?
Uterine inversion- if uterus turns inside out it can lead to immediate pain, shock, and hemorrhage; DANGEROUS
Pregnancy Diet Calories
● No longer eating for two….eat twice as healthy!
● Recommendations for additional calories:
○ First trimester: No change
○ Second trimester: + 340 calories
○ Third trimester: +450 calories
Recommended Changes in Diet
● Increase calories based on trimester ● Increase protein (at least >25g) ● Increase water intake ● Increase fruits/vegetables ● Decrease processed foods/sugar ● Quality of food is important if affordable/accessible
Folic Acid
Prevents neural tube defects (NTD)
○ At least 0.4mg (400mcg) daily important for any female of childbearing years (possibly up to 4mg if a history of a pregnancy with NTDs)
Perineal Lacerations Degree
1st degree: through perineal skin only
2nd degree: through perineal muscles
3rd degree: through the anal sphincter muscle
4th degree: through the anal sphincter and rectal mucosa
OASIS (obstetric anal sphincter Injuries)
Risk for infection: give antibiotics Pain control Decrease pressure/straining Pelvic Floor Physical Therapist Referral Sitz Bath/Stool Softner
Are prenatal vitamins recommended?
YES: vitamin D, DHA (omega 3), probiotic, choline, B12
Iron: ferrous sulfate
○ 1st trimester: Anemia if hgb < 11 or hct < 33%
○ 2nd trimester: Anemia if hgb < 10.5 or hct < 32%
○ 3rd trimester: Same as first trimester
Pregnancy Weight Gain
Based on pre-pregnancy BMI ● Recommended total weight gain: ○ Underweight (BMI < 18.5): 28-40lbs ○ Normal Weight (BMI > 18.5, <25): 25-35lbs ○ Overweight (BMI > 25, <30): 15-25lbs ○ Obese (BMI > 30): 11-20lbs ● Recommended rate of weight gain: ○ First trimester: 0-4lbs. ○ Second and third trimesters: +1lb/week if BMI <30; 0.6lb/week for overweight; 0.5lb/week for obese
Exercise
Continue what you were doing with occasional modifications based on how
your body feels
○ If need to monitor exertion: use the “talk test”
○ No need to monitor heart rate
What is: Couvade Syndrome
Its a sympathetic pregnancy symptoms in the partner
Pain Management in Pregnancy:
● Acetaminophen is the go-to pain medication in pregnancy (normal dosing)
● Ibuprofen is contraindicated
Medication Categorization in Pregnancy and Safety
● Check with provider
● Many OTC medications can be safe
● Medications are categorized based on safety in human/animal studies: A, B, C,
D, X
● A is likely safe while X is a proven teratogen
Gravitity
How many pregnancies: twins = 1
Parity
How many births Post 20 weeks
Menarche
onset of menses
Withdrawal Bleed
You do not have menstruation while on hormonal contraceptives.
Menstruation Definition
Periodic Shedding of the uterine lining due to hormones and absence of fertilization following ovulation.
*Complex communication between the brain, hypothalamus, Pituitary, Ovaries, and uterus
Menstruation as a “vital sign”
- frequency, duration, intensity of symptoms
- normal cycles should be regular 28 days + or minus 2-5 days.
- 3-6 days of bleeding
- 20-80 ml of blood loss
Irregular Menstrual Cycle (potential clause)
Polycystic Ovarian Syndrome
is a condition often characterized by irregular menses, many small cysts on the ovaries, hirsutism (increased androgens leading to symptoms such increased body hair), and insulin resistance. There are many manifestations of PCOS, ranging from asymptomatic to symptomatic
Primary Amenorrhea
Primary amenorrhea: Absence of menarche and secondary sex characteristics by age 13 OR absence of menarche by age 15 OR absence of menarche within 5 years of breast development
Secondary Amenorrhea
Secondary amenorrhea: 6 or more month cessation of menses after menarche
Lactational Amenorrhea
Suppression of menses due to hormones involved in breastfeeding
Ovulation Changes
-Positive ovulation kit (LH surge) 24-36 hours BEFORE ovulation
-Increase in basal body temperature (BBT)
0.5-1 degree AFTER ovulation
-Cervical mucus:
Leading up to ovulation (thin, milky)
to “egg-white” (spinnbarkeit)
-Location/opening of cervix
Slightly open and positioned higher
around ovulation
-Change in symptoms: varies per person
Increase in libido, headaches,
“mittelschmerz”, ovulation spotting,
improved productivity
How long can an ovum survive?
How long can Sperm Survive?
24 hours
5 days
Where does fertilization occur?
Outer third of the fallopian tube (ampulla)
Diploid Zygote
Sperm penetrates the ovum layers and prevents other sperm from penetrating it as well. Final meiotic division
Implantation
-Cleavage (cell replication) occurs during the long trip from the ampulla to the uterus
Blastomeres → morula (day 3) → blastocyst (day 4)
Implantation usually occurs at the top of uterus (fundus) 6-10 days after ovulation
-Blastocyst is composed of a trophoblast, embryoblast, and cavity
-Trophoblast → placenta (outer cell mass)
-Embryoblast → embryo (inner cell mass)
-Blastocyst burrows into endometrium at implantation site → trophoblast forms chorionic villi that invade into endometrial blood supply
Intrauterine Development Stages (3)
- Ovum (conception → day 14)
- Embryo (day 15 → 8 weeks (60 days))
- Fetus (8 weeks (60 days) → birth)
Intrauterine Development
Stage 1: Ovum Development
- Cellular replication
- -Blastocyst formation
- Formation of embryonic membrane and primary germ layer
Intrauterine Development
Stage 2: Embryonic Development
-Most critical time for organ development
Involves:
-Embryonic disk
-Trophoblast → chorionic membrane (chorion)
Surrounds fetal side of placenta
-Inner cell mass → amniotic membrane (amnion)
Surrounds fetus and holds
amniotic fluid
-Blastocyst cavity → amniotic cavity
-Other cavity → yolk sac
Temporary source of oxygen,
nutrients, and blood cells until
placental circulation forms
Also includes development of the amniotic fluid, umbilical cord, and placenta
What is TOO much or TOO little amniotic fluid?
Too much: oligohydramnios
Too little: polyhydramnios
Amniotic Fluid
- Temperature Control
- Fluid/Electrolyte/waste balance
- Protective
- has 2 arteries (bring deoxygenated blood up and away from fetus back to placenta.
- has 1 vein (bring oxygenated blood to fetus)
Placenta
-Functions: metabolic, nutrition, respiratory, excretion, storage, transportation, hormone production
-Takes over the hormone production from the corpus luteum around 12 weeks
-Trophoblast cells create chorionic villi that connect endometrial spiral arteries with the maternal circulation
-An intervillous space exists at this maternal-fetal junction
*Determines what is allowed to
pass placental barrier
*Exchange of oxygen, CO2,
nutrients, wastes, teratogens, IgG
immunity
Teratogens
- Environmental/external hazard/substance that can cause functional or structural abnormalities
- Effect on fetus will depend at what point in development they are when exposed
- Types: drugs, toxins, infectious agents (like TORCH infections), chemicals, radiation
Biggest effect during:
Embryonic stage (days 15-60) when cells are rapidly dividing and differentiating
If affected ova stage, likely → miscarriage
If affected fetal stage, likely → brain development issues
Torch Infections
- Viruses, bacteria, and parasites that can cause devastating, congenital changes to a fetus
- Severity depends on infection & when exposed in pregnancy
- Fetuses that survive often have microcephaly (small head), rashes, vision or sight problems, cardiac defects
- Symptoms in pregnancy range from asymptomatic to flu-like symptoms and rashes
Toxoplasmosis:
- parasite found in contaminated soil
Often asymptomatic; educate patients to avoid changing the cat litter box and eating undercooked meat (torch infection well)
Other Torch Infections:
-
Like HIV, syphilis, chickenpox, varicella, listeria, parovirus B19 [slapped cheek rash]
-Rubella
-Routinely tested in the 1st and 3rd
trimester; [full body rash]; combat
by giving -MMR vaccine when
nonpregnant
-Cytomegalovirus (CMV)
-Very common in daycares; many
asymptomatic [petechial rash;
mimics mononucleosis
symptoms]
-Herpes (HSV)
2 types oral and genital; if active lesions near the vagina then a vaginal delivery will be contraindicated
Pregnant persons with HSV history recommended to take an antiretroviral for suppression ~36 weeks
Intrauterine Development
Stage 3: Fetal Development
Less vulnerable to teratogens (except if targets CNS development)
Ectopic Pregnancy
Implantation of a pregnancy outside the uterine cavity
95% occur in the fallopian tube
Assume all pain and bleeding may be an ectopic until proven otherwise
Treatment: Start ASAP. Methotrexate (chemotherapy drug) and close monitoring of hcg levels
If Methotrexate not effective, may need to surgically remove
If ectopic not diagnosed fast enough, can result in rupture → risk of sepsis and salpingectomy (surgical removal of fallopian tube)
- Diagnosis: no intrauterine pregnancy (IUP) despite elevated hcg levels; can sometimes visualize the pregnancy on ultrasound
- Ectopic pregnancies can also occur in old cesarean incision scars
- With a ruptured ectopic, bleeding can escape into the peritoneal cavity → distention, infection, pressure against chest wall (pain with breathing or referred shoulder pain)
Molar Pregnancies
- Abnormal growth of trophoblast tissue
- Characterized by “size > dates” (abnormal increase in uterine size), abnormally high hcg levels, hyperemesis gravidarum, no fetal heart tones, bleeding, cramping d/t uterine distention
- Treatment: Removal of tissue as soon as diagnosed (D&C)
- Risk of this tissue turning malignant
- Follow-up: Requires serial monitoring of hcg levels to ensure they drop to zero and recommendation to wait to conceive again for at least one year
Miscarriage
-Pregnancy that ends unexpectedly before 20 weeks
-Turner’s syndrome is the most common chromosomal abnormality leading to miscarriage
-No current evidence to support waiting to conceive again (personal decision)
Early 1st trimester miscarriages most common
-Risk of miscarriage exponentially decreases after cardiac activity identified and further decreases into 2nd trimester
-Majority are due to chromosomal abnormalities
Types of Miscarriages
-Threatened- vaginal bleeding, closed cervix, fetal cardiac activity
Inevitable- vaginal bleeding, dilated cervix, products of conception may be seen or felt above cervix
Incomplete- Vaginal bleeding, dilated cervix, some products of conception expelled and some remain
Complete
Infertility
- Inability to conceive after 1 year of unprotected intercourse (under age 35) and after 6 months (over age 35)
- Every cycle, a couple has a 20% chance of conceiving
- equal chance that female or male is the factor
Ovarian Hyperstimulation Syndrome (OHSS)
- Clomid and Letrozole can cause uncomfortable symptoms due fluid retention
- Fluid overload can lead to severe dehydration, blood clots, and death if untreated
Types of Fertility Treatments
-Timed intercourse
-Common medications:
Ovulation induction agents:
Clomiphene (Clomid) or Letrozole
Metformin
-Other hormonal medications
-Intrauterine insemination (IUI)
-ART = artificial reproductive technology
Infertility Work-Up: Male
- Semen analysis + lab work
- Can also do a postcoital test to assess how sperm travels in cervical mucus
Infertility Work-up: Female
-Hormone testing + lab work + ultrasound + test for fallopian tube patency (HSG) + test -uterine cavity (saline sonohysterogram, hysteroscopy)
Uterus: Endometrial Cycle: 4 Phases
- Menstrual phase-endometrial shedding of necrotic lining
- Proliferative phase-endometrial thickening
Due to increased estrogen from ovarian follicles - Secretory phase-endometrial maturation (prepares to house a baby)
Due to increased progesterone - Ischemic phase
Regression of the corpus luteum → Decreased estrogen and progesterone → Decreased blood supply to endometrium → necrosis
Precocious puberty:
Early puberty; sexual development occurring before age
Fertility Awareness Methods
-Standard days method
Should only be used if regular,
predictable cycles
Avoid or have intercourse on fertile
days depending on desire for
pregnancy
-Cervical mucus method
Observing mucus and cervical
position
-Basal body temperature (BBT) method
Checking daily temperatures upon
waking
Increase in BBT confirms ovulation
after the fact; not helpful in
predicting ovulation
Symptothermal method
Combination of methods
Hormones of Menstruation: Non Pregnant
- Gonadotropin-Releasing Hormone (GnRH): released from the hypothalamus
- Follicle-Stimulating Hormone (FSH): released from the anterior pituitary
- Luteinizing Hormone (LH): released from the anterior pituitary
- Estrogen: Primarily released from the ovary
- Progesterone: Primarily released by the corpus luteum
Menstrual Cycle Phases
-HPO cycle: hormonal positive and negative feedback loops
Involves GnRH, LH, FSH and
responds to
estrogen/progesterone
- Ovarian cycle: 2 phases
Follicular and Luteal
Endometrial cycle: 4 phases
Menstrual, proliferative, secretory,
ischemicMenstrual Cycle: Stage 1
HPO Cycle
- Characterized by hormones with positive and negative feedback loops
- At time of menstruation, low estrogen & progesterone → hypothalamus to secrete GnRH → anterior pituitary to secrete FSH → ovaries to produce several mature follicles → follicles make estrogen until mature
- Once follicles are mature right before ovulation, a decrease in estrogen → GnRH to stimulate LH → LH surge to mature dominant oocyte → ovum (egg) to be released from follicle within 24-36 hours → ovulation → decrease in estrogen and empty follicle becomes corpus luteum
- If fertilization occurs, corpus luteum is maintained → increases in progesterone and estrogen to maintain a pregnancy
- If fertilization does not occur, corpus luteum regresses → decreased estrogen and progesterone → hypothalamus to secrete GnRH
Menstrual Cycle: Stage 2
Ovarian Cycle: 2 phases
-Biological females are born with all eggs they will ever have
-Ovaries house follicles that contain oocytes (immature ova) secrete estrogen
-Ovulation and menses
*Follicular stage (pre-ovulatory):
variable in length per person and
based on stress, external factors
*Ovulation causes a drop in
estrogen
*Luteal phase (post-ovulatory):
consistent per individual; average
of 14 days
-Corpus luteum’s peak activity is about a week post-ovulation
*At this time, if implantation occurs,
corpus luteum remains and produces
estrogen and progesterone
*If no implantation, drop in hormones
and onset of menstruation
