infertility, conception through pregnancy Flashcards
FSH: follicle stimulating hormone
Stimulates the follicle (which houses the eggs) to grow and mature
LH-luteinizing hormone
After ovulation, converts the empty follicle into the corpus luteum and supports this structure(which in turn supports an early pregnancy until the placenta forms)
estrogen
stimulates uterine growth and uteroplacental blood flow, cases a proliferation of the breast glandular tissue and stimulates myometrial contractility (at term)
progesterone
The hormone of pregnancy-
- maintains the endometrium
- decreases the contractility of the uterus
- stimulates maternal metabolism and development of breast alveoli
relaxin
relaxes the ligaments in the pelvis and softens and widens the cervix.
prostaglandins
PGE: vasodilatory; smooth muscle relaxant (for uterine growth)
PGF: vasoconstrictive; smooth muscle contractor (for labor)
GnRH
- what shows up on pregnancy test
- once egg is fertilized in uterine linning
human chorionic gonadotropin
- high levels at beg of preg
- lower at end
- HCG starts being produced after implantation
- Remains low for duration of pregnancy
- Levels can be checked to evaluate state of pregnancy
- This is the hormone pregnancy tests test for
- HCG can also be tested by blood test, certain levels (amounts) correspond to weeks of gestation.
- If someone is miscarrying or having a pregnancy abnormality (ectopic preg, hydatidiform mole, genetic abnormality) then levels would be off what they should be at that gestation. - Multifetal pregnancies may cause increased levels of HCG
HCG peaks at
60-70 days of gestation (weeks 8-10)
hcg declines at
100-130 days of pregnancy (14- 19 weeks)
infertility
inability to get preg for <12m
reasons for infertility
- decrease sperm
- endometriosis
- ovulation disorders
- tubal occlusion
intrauterine insemination
procedure use to place prepared sperm in the uterus at the time of ovulation
in vitro fertiliation- embryo transfer
procedure of collecting clients eggs from the ovaries, fertiliizing the eggs in the labatory with sperm, and transfering the embryo to the uterus
gamete intrafallopian transfer
- oocytes are retrieved and immediately placed with prepared motile sperm. both are placed together into a thin flexible tube. gametes are than injected into the fallopian tubes using surgical labroscopy
donor oocyte
donated eggs are collected from a donor by IVF. eggs are inseminated. embroyos are placed in a recipents uterus. prior to implantation, the recipient undergoes hormonal therapy to prepare the uterus
donor embryo
donated embryo is placed in the recipients uterus, which is hormonally prepared
gestational carrier
couple completes the process fo IVF with the embryo placed in aother person, who will carry the preg. this is a contract agreement with the carrier having no genetic investment with the embryo
surrogate mother
person is inseminated with semen and carries the fetus untill birth
therapeutic donor insemination
donor sperm is used to inseminate a person
embryonic development
The embryonic stage lasts from day 15 after fertilization until 8 weeks. All organ systems and external features are developing during this time. This is the most critical time, where the embryo is most vulnerable to malformations caused by environmental teratogens.
- happens after fertilization
embryoblast
becomes baby
blastocyst
embrotic cavity
trophoblast
membrane and placenta
Fetal heart beat should be SEEN on US
after 6 weeks
fetal heart beat should be heard
via doppler after 10 weeks
Assessed at each prenatal visit
fetal movement should be felt
around 16-20 weeks
Maternal education and “fetal kick counts” in 3rd trimester
what week does fetal stage start
9 weeks
what day does fetal heart start beating
17 days
embryo weeks
0-9w
first 8 weeks
most major organ develop
- most dangerous time, at risk for chemicals, diseases, toxins
20 w skin
downy hair (lenuva), vernex white waxy lotion, protect skin
full term
40 w
10m
presumptive
fatigue breast tenderness neausea and vomiting amenorrhea urinary freqeuncy hyperpigmentation fetal movements uterine enlargement breast enlargement
probable
braxton hicks contractions postive pregnancy test abdominal enlargement ballottement goodell's sign chadwicks sign hegars sign
positive
- ultrasound verification
embryo or fetus - fetal movement felt by experienced clinician
- auscultation of fetal heart tones via doppler
calculating due date
1 year - 3 months + 7 days
uterus changes
- increase size
- increase weight
- increase fibrous connective tissue
- braxton hicks
- cervical softening
- mucus plug
endocrine
placenta
thyroid
pituitary
placenta
- produces HCB, HPL
- nutrients to fetus
- waste away from fetus
thryoid
- increase size and activity
- increase basal metabolic rate
- increase parathyroid activity
pituitary
- enlarges 9th month
- produces fsh, lh, thyrodtropin, andrenotropin and prolactin
cardio vascular changes
- increase blood volume (30-40%)
- increase hr
- increase cardiac palpitations
- heart enlargement
- murmurs
- pseudoanemia: more plasma volume less rbc
musculoskeletal changes
- increase lumbosacral curve
- altered center of gravity
- duck waddling gait- gooy ligaments
gastrointestimal
N/V normal with hormonal changes, constipation is very common due to intestines being displaced by enlarged uterus, GI motility is decreased for increased absorption
skin changes
Chloasma- increased in pigmentation on the face (‘the mask of pregnancy’), linea nigra- dark line of pigmentation from the umbilicus to pubic area, striae gravidarum- stretch marks on abd and thighs, Spider nevi (spider veins) and palmar erythema due to progesterone
fundus hight
12 20 after 20 36 40
12 weeks: fundus just above pubic bone
20w: at belly botton hole
after 20w: 1cm per week above umbillical cord
36w: at level of ziphoid process
40 w: uterus comes down
vena cava syndrome
- enlarged uterus compress the inferior vena cava and the lower aorta when pt. is supine
- reduced venois return to heart
- symtoms include decreased BP, light headedness, syncope, racing hert, sweating, fetal heart rate changes
** turn on left side laterally- blood flow back
healthy weight to gain
25-35lbs
nutritional needs
- Increase in protein (basic growth),
- iron (increase maternal RBCs, 2x pre-preg recommendation),
- folate 600mcg/day (prevent neural tube defects),
- calcium 1000 mg/day
- Increase of 340- 452 calories / day
Fluid- 8-10 glasses (2.3 L)/ day (water, fruit juice, milk)
iron
- Double amt recommended pre-pregnancy-(anemia is very common in pregnancy)
- best absorbed between meals and when given with Vit C.
- Milk and caffeine interfere with absorption.
- Food sources- beef liver, read meats, fish, poultry, dried peas, beans, fortified cereals and breads. Iron supplements can cause constipation- stool softener may be needed
nutrition avoid
- Limit caffeine (no more than 200mg/day)
- No alcohol
- Pica- craving to eat nonfood substances, like chalk, dirt, red clay. CALL DOC
TORCH
“TORCH”- acronym for the following infections:
- Toxoplasmosis
- Other: Varicella, Parvovirus,
- Syphilis, Listeria, & Coxsackie Virus, Zika
- Rubella
- Cytomegalovirus (CMV)
- Herpes Simplex Virus (HSV)
- All are associated with potential for significant negative fetal outcomes including fetal death if infection occurs during pregnancy
- Often mild or even NO symptoms in mother
- Often limited or no treatment available
- *PREVENTION, PREVENTION, PREVENTION!!!!!!!
Toxoplasmosis
- Avoid eating raw or undercooked meat, avoid contact with feces of infected cats
Parvovirus (Fifth’s disease),
- Coxsackie (Hand, Foot & Mouth), CMV
Check status of those with high exposure risks-day care workers, etc. Precautions if non-immune.
Listeria
- Avoid eating unpasteurized cheeses (cantaloupe outbreak in 2011)
Rubella, Varicella
- Immunization available but not given during pregnancy – check status, precautions if non-immune, immunize postpartum.
Syphilis, Herpes
- Safe sex practices (condoms), suppressive therapy for HSV in the weeks before labor to prevent an active outbreak and transmission to baby.
Zika
- Avoid travel to high risk countries, use bug sprays/clothes to prevent mosquito bites, avoid contact with infected individuals
health promotion (X)
- No over the counter meds unless OBGYN/CNM ok’d
- No Alcohol (birth defects) or Tobacco (low birth weight)
- No Substance use
- No undercooked meat/poultry/eggs, sushi, soft cheeses(unpasteurized), seafood high in mercury, unwashed fruits/veggies, wet paint, kitty litter
- No hot tubs/saunas
health promotion (y)
Exercise good- ~ 30min moderate daily if not contraindicated Avoid TORCH infections Hair dye, massages, mani/pedi Sexual intercourse Travel
common discomforts of preg
Nursing Implications:
- N/V- 1st trimester dry crackers/toast before rising in the morning, small meals, avoid spicy, greasy, or gas-forming foods, encourage fluids in-between meals
- Constipation- 2nd/3rd trimesters, encourage plenty of fluids, high fiber diet, exercise regularly
- Breast tenderness- 1st trimester most freq, supportive bra needed
- Urinary freq- 1st/3rd trimesters, empty bladder freq, decrease fluid before bed, Kegels
- UTIs- common during preg, proper wiping, no bubble baths, use cotton underwear, looser pants, increase water intake, urinate before/after intercourse, don’t hold it, notify provider if urine is foul-smelling, bloody, or cloudy
- Fatigue- normal, freq rest
- Headaches- only normal in 1st trimester, hormonal/stress/lack of sleep, balanced diet, plenty of water, rest freq
- Heartburn- small freq meals, check with provider about over the counter antacids
- Hemorrhoids- 2nd/3rd trimesters, warm sitz bath, witch hazel pads (TUCKS), topical ointments
- Backaches- 2nd/3rd trimesters, exercise regularly, pelvic tilt exercises, proper body mechanics, side lying position
- SOB- mild common during 3rd trimester, maintain good posture, sleep with extra pillows, notify provider if worsening
- Leg cramps- 3rd trimester, extend affending leg, dorsiflex, heat over muscle or foot massage (not the calf!)
- Varicose veins/ edema- 2nd/3rd trimesters, rest with legs elevated, avoid constricting clothing, support hose, avoid sitting/standing in one position for too long, freq walking
- Gingivitis, nasal, epistaxis- due to estrogen levels, brush teeth gently, use humidifier, saline nose drops/spray
- Braxton Hicks- practice contraction, common during 3rd trimester, if it goes away with walking or change in position, not true labor. Your uterus is just practicing for the real thing
- Supine hypotension- lie on your side or semi-sitting with keens slightly flexed
initial labs
CBC (hgb/hct/plt) Blood Type, Rh, ABS Syphilis (RPR/VDRL Rubella status Hepatitis HIV Urinalysis/Urine culture Gonorrhea & Chlamydia Pap smear *cystic fibrosis carrier screen *TB testing *varicella
28 week labs
- CBC
- Glucose tolerance test: greater than 140 FAIL
- ABS (if Rh negative)
35-37 week
GBS testing
retest sugar
1 Hr Glucose Tolerance Test- >140 mg/dL fail= needs further follow-up with 3 hr test
3Hr Glucose Tolerance Test- fasting, 1 hr, 2hr, and 3rd later (95, 180, 155, 140~ respectively. If 2 or more values are off= diagnosed with Gestational Diabetes
other optional test
Antenatal screening (Maternal alpha-fetoprotein or QUAD screening testing for genetic abnormalities) Hep C (waterbirth) TORCH
recommended immunizations
Tdap
Influenza
not during preg immunizations
No Live vaccines!
*Rubella (MMR)- wait until postpartum!!! HPV Varicella TB Zoster
RH-
receive rogam
first semester danger signs
- Burning on urination (infection)
- Severe vomiting (Hyperemesis gravidarum)
- Diarrhea (infection)
- Fever/Chills (infection)
- Abd cramping/ vaginal bleeding (miscarriage, ectopic pregnancy)
2nd and 3rd
- Gush of vaginal fluid (not urine, rupture of membranes)
- Vag bleeding (placenta problems)
- Abd pain ( preterm labor, placental issue, ectopic preg)
- Change in fetal movements (may be fetal distress)
Persistent vomiting (hyperemesis) - Severe headaches/blurred vision/edema of face or hands/ epigastric pain (pre eclampsia)
- Fever (infection)
- Dysuria (UTI)
- Flushed, dry skin, fruity breath, rapid breathing, increased thirst/urination, headache (hyperglycemia)
- Clammy pale skin, weakness, tremors, irritability, lightheadedness (hypoglycemia)
