NCM 101 LECTURE (Maternal and Child Health Nursing)

FallopianTube- 2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or thepassageway of the mature ovum or fertilized ovum from the amplla to the uterus4 significant segments * infundibulum most distal, part trumpet shape, has fimbrae * ampulla outer 3rd or 2nd half, site of fertilization, common site for ectopic pregnancy * isthmus site for sterilization, site for BTL * interstitial most dangerous site for ectopic pregnancy Fertilization: 1.Union of the ovum and spermatozoon 2.Other terms: conception, impregnation or fecundation 3.Normal amount of semen/ejaculation= 3-5 cc = 1 tsp. 4.Number of sperms: 120-150 million/cc/ejaculation 5.Mature ovum may be fertilized for 12 24 hrs after ovulation 6.Sperms are capable of fertilizing even for 3 4 days after ejaculation (life span of sperms 72 hrs) 7. Normal life span of sperm is 7 days Implantation- nidation - takes 1 week after fertilization General Considerations: o Once implantation has taken place, the uterine endometrium is now termed deciduao Occasionally, a small amount of vaginal bleeding occurs with implantation due to breakage of capillaries. Immediately after fertilization, the fertilized ovum or zygote stays in the fallopian tube for 3 days, during which time rapid cell division (mitosis) is taking place. The developing cells now called blast omere and when about to have 16 blastomere called morula. Morula travels to uterus for another 3 4 day so When there is already a cavity in the morula called blasto cyto finger like projections called trophoblast form around the blastocyst, which implant onthe uterus Implantation is also called nidation, takes place about a week after fertilization -morula-16 blastomere -morula-cavity in the morula -trophoblast-fingerlike projections

Age of reproductivity- 15-44y/o Childbearing- 20-35 y/o Average menstrual cycle- 28 daysAverage menstrual period- 5 daysNormal blood loss50cc/1/4 cup accompanied by FIBRINOLYSIS prevents clot formation Fetal Growth and DevelopmentFirst Lunar Month first four weeks-germ layers differentiate by the 2nd week 1.endosderm gives rise to lining of GIT, Respiratory Tract, tonsils, thyroid (for basalmetabolism),parathy roid (for calcium metabolism), thymus gland (for development of immunity),bladder and urethra2.Mesoderm forms into the supporting structures of the body (connective tissues,cartilage, muscles and tendons); heart, circulatory system, blood cells, reproductive system,kidneys and ureters.3. Ectoderm responsible for the formation of the nervous system, skin, hair and nails and themucous membrane of the anus and mouth 1 month : 2nd week fetal membranes16th day heart forms ; 4th week heart beats 2nd month: All vital organs and sex organs formed; placental fully developed;meconium formed (5th 8th wk) 3rd mont h: Kidneys function - 12th wk- urine formed ; Buds of milk teeth form ; begin boneossification ; allows amniotic fluid ; establishment of feto-placental exchange 4th month : Lanugo appears; buds of permanent teeth form; heart beat heard by fetoscope 5th month : Vernix appears; lanugo over entire body; quickening; FHR audible withstethoscope 6th month : Attains proportions of full term but has wrinkled skin 7th month : 28 weeks lower limit of prematurity; alveoli begins to form 8th month

: 32 weeks fetus viable; lanugo disappears, subcutaneous fat deposition begins 9th month : Lanugo continue to disappear; vernix complete; amniotic volume decrease Focus of Fetal DevelopmentFirst Trimester period of organogenesis Second Trimester period of continued fetal growth and development; rapid increase inlength Third Trimester period of most rapid growth and development because of the depositionof subcutaneous fat Fetal Membranes 1.Amnion gives rise to umbilical cord/funis with 2 arteries and 1 vein supported by 2.Whartons jelly- protects the umbilical cord 3.Amniotic fluid: clear albuminous fluid, begins to form at 11 15th week of gestation, chiefly derived from maternal serum and fetal urine, urine is added by the 4th lunar month, near term is clear, colorless, containing little white specks of vernix caseosa, produced at rate of 500 ml/day. Known as BOW or Bag of Water U m b i l i c a l C o r d / f u n i s w h i t i s h g r a y -connects the fet us to the placenta-carry oxygen and nutrients from the placenta to the fetus and return un oxygenated blood and fetal waste product to the placentaliver functions for the detoxification-A,V, A (2 arteries, 1 Vein)Cord Abnormalities: BASA PRAVIA - the umbilical cord loses the protection of the whartons jellySigns and Symptoms:1.Sudden gosh bright red blood at the tip of the rapture of membrane2 . S u d d e n f e t a l b r a d y c a r d i a 3.Sinusoidal fetal heart rate pattern- long term variability consist of 5-15 bpm every 3-5mins4. Short Cord results to: 1.Intrapartum hemorrhage (during delivery) 2.Delayed descend of the fetus during labor 3 . I n v e r s i o n o f t h e u t e r u s Long Cord results to: 1 . T r u e K n o t s C o r d a.Central insertion- cord inserted at the center of the placentab.Lateral insertion- cord inserted away from the center of the placenta2.Villatentous insertion membranes of cord is inserted to the membrane to the placenta3.Battledoor Insertion at the edge Diagnosis of Basa Pravia

1.Transvaginal sonography at 16 weeks of gestation2. Caesarean Section is the best remedy Knots of the cordfetal movement may cause knots in the cord *true knotsfetus passes through a loop of cord * false knots - Whartons jelly containing a loop of umbilical vessels Loops of the cordcord coil around the fetal body and neck, when the cord coil is the neck it iscalled nuccal cord. Torsion of the corddeficiency of Whartons jelly number Hematoma of the cord - results from the rapture of the vessels with a fusion of blood into thecord Cord Cyst - vesicular formation on the cord *true cord cyst - derived from remnants of the umbilical vesicles *false cord cyst - large and derived from Whartons jelly. Edema of the cord - commonly seen in the dead fetus Single Umbilical Arteryrenal associated with other renal anomalies 2 sides of placenta 1.Maternal (rami- collection of villi)- each cotyledon is a collection of villi which terminatein one main stem, the lobes are separated by grooves called septic. Amniotic FluidPurposes of Amniotic FluidProtection

 shield against pressure and temperature changesCan be used to diagnose congenital abnormalities intrauterine amniocentesisAid in the descent of fetus during active labor Implication:Polyhydramios = more than >1500 ml due to inability of the fetus to swallow the fluidas intrachoesophageal fistula. Oligohydramnios = less than <500 ml due to the inability of the kidneys to add urineas incongenital renal anomaly Fetal Membranes Chorion - together with the deciduas basalis gives rise to the placenta, start to form at 8thweek of gestation; develops 15 20 cotyledons Purpose of Placenta: respiratory; exchange of nutrients and oxygen Renal system Gastrointestinal system Circulatory system Endocrine system: produces hormones (before 8th week-corpus luteum produces thesehormones) hCG keeps corpus luteum to continue producing estrogen and progesterone HPL or human chorionic somatomammotropin which promotes growth of mammary glands forlactation Protective barrier: inhibits passage of some bacteria and large molecules

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