Week 1 Chapters 3 and 10 Flashcards
Antepartum Nursing includes
Presentation 1
A and P of the Reproductive System
Menstrual Cycle
Genetics
Fetal Development
Pelvis includes
Bones :
- Inominate Bones: ilium, ischium, pubic bone
- Sacrum
- Coccyx
Bony Structures of the Female Reproductive System includes
Sacral Promontory
Ischial Spines
Symphasis Pubis
Linea Terminalis
Ischial Tuberosities
Pubic Arch
Pelvic Divisions Include
Inlet
Mid Pelvis
Outlet
Bordered by linea terminalis and upper third of sacrum
Inlet
Bordered by upper third of sacrum and ischial spines
Mid Pelvis
Bordered by ischial spine, coccyx and ischial tuberosities
Outlet
True Pelvis includes
Midplane and Outlet
False Pelvis Includes
Inlet
Female Pelvic Type
Gynecoid
Male Pelvic type
Android
Widest in posterior aspect of pelvic types
Anthropoid
Flat and shallow pelvic type
Platypelloid
External Female Genetalia Includes
Differences related to age, number of pregnancies, race and heredity
Mons Pubis
Labia Majora and Minora
Clitoris
Vaginal Vestibule
Perineum
External genetalia expands how far to get the baby out?
13.5 inches
Muscular area between fourchette and anus
Perineum
Composed of glandular tissue, fatty and connective
Increases with size with puberty, pregnancy, and lactation
Breast
Supported by suspensory Coopers Ligament
Contains Nipple and Areola
Breast
Nipple is erectile tissue with numerous openings
Very sensitive
Areola contains smooth muscle fibers and sebaceous glands to lubricate the nipple
Abundant Vascular Supply
Structures
Organs for sexual arousal
Lactation
Breast
Muscular organ that is thick walled and hollow in non pregnant state
Uterus
Becomes thin walled sac late in pregnancy
Components of Uterus includes
Fundus
Corpus
Cervix
Outer layer of the Uterus
Serosal layer outer layer: Peritoneum
Muscle layer is myometrium - composed of smooth muscle fibers
Muscle fibers of Uterus include
Longitudinal
Interlacing Figure Eight
Circular Fibers
Outer Muscle layer
thick fibers located in the fundus
Function is that of expulsion
Longitudinal
Middle muscle layer
Located around capillaries and arterioles, function is that of hemostasis
Figure Eight
Interlacing
Located near the cervix
Inner layer of fibers
Weak fibers
Function close to cervical anal
Circular Fibers
Involuntary muscle that can even function with spinal damage
Uterus
Triple Gradient Theory
How the uterine functions
Contractions are stronger in the upper parts of the uterus than lower parts
When upper portion of uterus becomes thicker and shorter what does it promote?
Promotes the descent of the fetus toward lower uterine segment
Mucosal layer of uterus in non pregnant women
Endometrium
Pregnant called Decidua
Has the ability to proliferate and slough in response to hormone levels
The uterus is suspended in the pelvis by
10 ligaments
Types include broad, round, ovarian, and uterosacral
Located at the terminal end of the uterus
Elastic characteristic which allows effacement and dilation during labor
Cervix
Secretes fluid - Bacteriostatic quality and enhances spermatozoa motility and survival
Musculo-membranous tube
Female organ copulation
Birth Canal
Vagina
Capable of great distention from rugae (foldings)
Few Nerve Endings
Vagina
Formed from sloughed epithelial cells containing glycogen which interact with bacteria in the vagina
Vaginal Discharge
Doderiens Bacilli- Produces lactic acid
This contributes to self cleaning abilities of the vagina
Lactic Acid
Acidic pH which protects the vagina from infection
Uterus is an essential organ
FALSE
Mom goes top physiological crisis, blood and oxygen will be shunted away from the uterus and the fetus
Tubular structures located either side of the uterus; arising from the fundal portion of the uterus
Fallopian Tubes
Propel fertilized ovum to the uterus
Nourish the fertilized ovum during transport
Functions of the Fallopian Tubes
Composed of smooth muscle
Has peristaltic motion
Three components
- Isthmus
- Ampulla- Site of fertilization
- infundibulum
Characteristics of Fallopian Tubes
Ovoid organs adjacent to fallopian tubes and uterus
Ovaries
Characteristics of Ovaries
Ova are formed in the fetal state
Mature and release an ovum for fertilization each menstrual cycle
Ovaries Functions
Female infant is born with all the ova she will ever produce
False
Current info contradicts this theory
Expulsion of inner uterine occurring monthly
Marks the beginning and end of each menstrual cycle
Menstruation
Establishment of menstruation in females
Menarche
Frequency variable of menstrual cycles
21to36 days
average of 28 days
GnRH
FSH and LH
Estrogen
Progesterone
Hormone
Hormone Sequence
Hypothalamus
GnRH
Pituitary
Stimulates LH and FSH
Hits Ovaries
Then OVULATION
Timing of Menstrual Cycle based on
28 day cycle
Ovarian Phase
Day 1-13
Follicular Phase
- Development of the follicle from FSH
-Developing follicle secreted increasing amounts of Estrogen
Day 14 Ovulation
- Release of mature ovum
Luteal Phase includes days
15-28
Formation of the corpus luteum
Corpus luteum secretes progesterone and some estrogen
When does corpus luteum degeneration begins
Day 22
and essentially complete by day 26-28 if no intervening factor
Uterine Phase day 1-5
Menses
Uterine Phase days 6-14
Proliferative Phase
Changes of endometrium due to Estrogen
Uterine Phase 15- 28
Secretory Phase
Changes in endometrium due to progesterone
Increased Endometrium lining
Hypertrophy of endometrial secreting gland
Vasodilation of endometrial arterioles
Proliferative Stage
Extensive increase in endometrial lining
Secretion of Endometrial glands
Continued elongation and corkscrew
development of endometrial arteriole
Secretory Stage Changes
Ovarian Cycle Includes
Follicular Phase
Ovulation
Luteal Phase
Day 1 to Ovulation approximately 10to14 days
Follicular Phase
Day 14 to 28th day cycle
Ovulation Day
Day 15 to 28th day of Menstrual Cycle
Luteal Phase
The endometrial cycle includes
Proliferative phase
Secretory phase
Ischemic phase
Menstrual phase
Produced in the gonads, pituitary gland, placenta, corpus luteum and other organs
Inhibin
FSH stimulates the secretion of ___________ from the granulosa cells of the ovarian follicles in the ovaries
Inhibin
Inhibin suppresses______.
FSH
Low levels of estrogen and progesterone acts on__________.
Menses
Then sends message to hypothalamus to produce GnRH
GnRH stimulates Anterior Pituitary to secrete FSH
Then stimulates ovary to begin follicular development
Follicles secrete levels of Estrogen
Graafian Follicle Dominant follicle produces increased levels of estrogen Estriodiol
Increased estrogen causes endometrium to change leading to what?
FSH decreases due to negative feedback caused by increased estrogen
Increases in estrogen also causes LH to increase from the Anterior Pituitary - Prostaglandins also increase)
Day 14 Ovulation leads to
Corpus Luteum develops with increase estrogen and progesterone
LH decreases
Corpus Luteum will regress if no fertilization in day21-28
Estrogen and progesterone drop
Menses Occurs
Cycle begins again
Summary of Menstrual Cycle Hormones
LH rises produces estrogen
Estrogen produced by follicle estrogen levels rise inhibiting output of LH
Ovulation occurs after LH surge, damages estrogen and declines
Establishes Corpus Luteum produces estrogen and progesterone
Estrogen and Progesterone rises and suppress LH
Lack LH degenerates corpus luteum
Cessation of the corpus luteum means decline in estrogen and progesterone
Decline of ovarian hormones ends negative effect on secretion of LH
LH secreted and menstrual begins again
Mother contributes 2
X chromosomes
Father contributes
X and Y chromosome
Father responsible for determining sex of fetus
Each sex cell contains how many chromosomes
22 and 1 sex chromosome
Total of how many chromosomes
44 plus 2 sex chromosomes = 46
either XX
or XY
Male sex cell is
SpermatozoanF
emale sex cell is
Ovum
When does ovulation take place?
day 14
Mature ovum is released by
Follicle and swept into the fallopian tube
Ovum is propelled into?
Ampullar portion
and awaits the spermatozoa
Ovum only viable for 24 hours !
What is released into the vagina during process of fertilization?
Coitus
Spermatozoa
How many sperm cells make it to fallopian tube?
50-100
Survive in female reproductive tract for 2-3 days
Capacitation
Makes the spermatozoan capable of fertilization takes place
During fertilization journey
Only one spermatozoa penetrates ovum
TRUE
After penetration a biochemical reaction occurs which make the cell membrane impervious to penetration of more spermatozoa
Where does fertilization or conception take place
The ampulla
Now fertilized ovum contains all genetic material to form fetus and now called zygote
Ovum transport slowly towards the uterus and will take
3-4 days
What aids ovum transport?`
Peristaltic activity of fallopian tubes and cilia on the inner aspect of the tubes
How is the Ovum nourished?
By the secreting glands in the fallopian tube
The fertilized ovum is protected and nourished by what two layers?
Zona Pellucida
Corona Radiata
First weeks of human development
Implantation 6 days
Blastocyte 4 days
Morula - 3days
Clevage - 1 day
(Reverse ordered)
Then Fertilization
Follicular development, ovulation, fertilization, and transport to uterus where implantation occurs
Cell division takes place when?
24 hours after fertilization
Cells duplicated not overall size
Then continues at 22 hr intervals
By time fertilized ovum reaches uterus entrance is at
16 cell stage called morula
Zygote floats in uterus for another 3-4 days and during this time the cells have
Differentiated
Entire structure then assumes form called
Blastocyte
Outer ring of cells are called
Trophoblastic cells and will become the fetal membranes and placenta
Inner clump of cells are called
Embryoblast and will become the fetus
What do trophoblastic cells secrete
HCG
HCG will prolong the viability of the corpus luteum it will continue to secrete progesterone and estrogen for about 8-11 weeks
Rapid Cell Division that leads to multicellular embryo
Cleavage
Zygote-Eight Cell Stage-Blastula- Blastocoel- Gastrulation- Gastrula
When does implantation take place on
About day 22-23 or 7-10 days after ovulation
Zygote simply buries itself in the uterine endometrium which is now called the
Decidua
Trophoblastic cells also contain a substance that can erode some of the superficial endometrial tissue
True
Why is it important for the zygote to burrow deeply?
Tap into the maternal vascular system for a nourishment source
Trophoblastic cells will develop what?
Chorionic Villi
Project deep into the decidua and open the ends of the maternal arterioles
Implantation process allows for what?
pooling of maternal blood which facilitates oxygen and nutrient transport to the embryo and exchange of waste products
Rudimentary form of the placenta
Fertilized ovum, zygote
Conception to Implantation
Implantation to 8 weeks after fertilization
Embryo
8 weeks to birth
Fetus
Development of major organ system is essentially complete by end of embryo stage
Organogenesis
Susceptibility to teratogens is greatest at this time
Term used to describe the ability of the fetus to survive outside of the uterus
Viability
Viable will be 22-24 weeks
Maturation takes place in an orderly and predictable manner
True
Maturation is cephalocaudal
Skin, nails, nervous system, tooth enamel what germ layer?
Ectoderm
Connective Tissue, teeth, muscles and blood vessels develop from what layer?
Mesoderm
Epithelial lining of GI and respiratory tract, endocrine glands, auditory canals developed from what layer?
Entoderm
First system to develop is
Cardiovascular System
When is functional heart beating by?
3 weeks post conception
Heart developmentally complete by end of 8 weeks
Early development due to need for nourishment system and waste removal system
Fetal Circulation System
Placenta is formed by
Embryonic and uterine tissues
Factors that facilitate fetal oxygenation
FHR 110-160
Fetal hemoglobin carries more o2 per molecule and forms tighter bond than hemoglobin
Hemoglobin and HCT values are HIGHER
When does the respiratory system develop?
Week 4
Larynx, trachea, and bronchi and lung buds develop from what weeks?
4-17 weeks
Vascular structures and primitive alveoli form at what weeks?
16-24 weeks
Weeks 24-40 of the respiratory system what develops?
Maturation and increased number of alveoli; secretion of surfactant
The phospholipid is secreted by
Surfactant
Alveolar cells
Peak production at 35 weeks
Purpose is to minimize surface tension to keep alveoli partially open on exhalation
What are the components of surfactant ?
Lecithin Sphingomyelin and Phosphogycerlolipid
How can adequate amounts of surfactant be tested by?
Amniotic Fluid
These tests should be LS ratio 2:1 and PG level (positive)
Which system is very sensitive to oxygen levels?
Neurological System
Brain development during pregnancy by cellular hyperplasia and continues after birth
True
Neural Crest evolves into the
PNS develop by 4 weeks
Neural tube evolves into the
CNS
Sensory development documented response to
Painful stimuli
well developed sense of hearing
Taste buds developed; distinguish sweet vs sour
When do digestive enzymes develop?
Third Trimester
Rudimentary system by 4 weeks
GI System
Fetal stool that develops during third trimester but normally remains in gut until after birth
Meconium
Kidneys are formed by____________`
2-3 weeks
Functional by 10 weeks
Kidneys are still immature at birth unable to concentrate urine
Average is about 1 liter at term
Volume changes constantly
Electrolyte similar to blood
Also contains shed fetal cells
Sterile Fluid
Amniotic Fluid
Placenta forms from
Trophoblastic Cells
What creates a larger surface area for pooling of maternal blood, which facilitates nutrient/ waste transfer
Branching of Villi
Embryo/ Fetus is totally dependent on
Maternal Vascular system to meet nutrient and oxygen needs
Branching of villi forms what?
Cotyledons
Maternal side rough and bright red is known as
Duncan
Fetal side that is grey and shiny in appearance
Schultz
When is placenta functional by
End of third week
Continues to grow in size and function until 40 weeks
Name the Three Shunts during Fetal Life
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
Connects the umbilical vein to the inferior vena cava and bypasses the liver
Ductus Venosus
Connects the main pulmonary artery to the aorta and bypasses the lungs
Ductus Arteriosus
Anatomic opening between the right and left atrium and bypasses right ventricle
Foramen Ovale
