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Pregnancy

Pregnancy. Development of the Embryo. Differentiation of the embryo occurs soon after fertilization Tissues placenta fetus Cells multiply (morula) as they travel through the fallopian tube Soon, implantation is required for the zygote to obtain sufficient O 2 and nutrients.

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Pregnancy

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  1. Pregnancy

  2. Development of the Embryo • Differentiation of the embryo occurs soon after fertilization • Tissues placenta fetus • Cells multiply (morula) as they travel through the fallopian tube • Soon, implantation is required for the zygote to obtain sufficient O2 and nutrients

  3. Nidation/Implantation • Chorionic villi -finger-like extensions surrounding the trophoblast • erode through the endometrium (now called the decidua) • destroy the glands and stroma leaving only the arteries and veins

  4. Nidation/Implantation • Anchoring villi • attach themselves to the decidua • form a sealed sinusoid which is filled with endometrial blood • Terminal (or true) villi • float freely to absorb nutrients in the blood for the growing cellular mass

  5. Decidua Capsularis • covers the embryo and becomes a layer of the amniotic sac • Decidua Basalis • is where the attachment started and it will become the placenta attachment area • The rest of the intrauterine lining that is left is the Decidua Vera

  6. The area of the sinusoid becomes the Chorion Frondosum, which is just another name for placenta

  7. Placenta • A round disc-shaped tissue • 2 to 3 cm in thickness at the umbilical cord attachment

  8. Placenta Four major pacental functions: • Respiratory – transport of O2 and CO2 (diffusion) • Excretory – transfer of waste molecules (urea, etc.) • Nutritional – transport of glucose • Endocrine – production of hormones • replaces the production from ovaries, corpus luteum of pregnancy & pituitary • Estrogen • Progesterone • HCG • HCS • Etc.

  9. Side Note • The change over to placental hormone production occurs between the 8th and 12th week of pregnancy • This is a serious period of concern for the growing fetus… “testing period” for fetal viability

  10. Spontaneous Abortion Multiple testing periods • abnormal development of the fetus • inability to produce proper hormones • lack of proper nutrients to support life may cause the fetal tissue to die and be expelled

  11. Umbilical Cord – baby’s lifeline • Tough tortuous shaped tube • two (2) smaller arteries • one (1) larger vein surrounded by Wharton’s Jelly • attenuates pressure on the vessels • prevents kinking of the cord www.inksplat.net/umbilical_cord.jpg http://medicine.ucsd.edu/cpa/talasm/Talapoin07.jpg

  12. The Amniotic Fluid • Surrounds the embryo/fetus • Increases from 250 mL at 16 weeks to 800 mL around 38 weeks • volume begins to decrease after 38 weeks • Composed of the fluid output of the fetal kidneys (fetal urine) and lung secretions www.udel.edu/Biology/Wags/histopage/colorpage/cfr/cfras.GIF

  13. The Amniotic Fluid • Very dynamic fluid • Cleansed about every three (3) hours • absorption through fetal swallowing • removal at the amnio-chorionic interface and by intervillous space capillary action

  14. Terms of Pregnancy Gravidity • the state of a woman being pregnant • refers to the number of times she has been pregnant (any duration) Gravida pregnant Primigravida pregnant for the first time Multigravida pregnant again (2nd, 3rd, etc.) or has had 2 or more pregnancies

  15. Terms of Pregnancy Parity • the state of a woman having given birth to a viable fetus • capable of survival (even if they did not survive) • does not reflect the number of babies delivered Primipara delivered one viable pregnancy Multipara has delivered 2 or more viable pregnancies

  16. Gravida 1, Para 0 currently pregnant for the first time was pregnant once and lost the pregnancy Gravida 1, Para 1 delivered a viable fetus from her first pregnancy delivered viable twins (or more) from her first pregnancy Gravida 2, Para 0 currently pregnant for the second time, lost the first pregnancy pregnant twice and lost both Gravida 2, Para 1 pregnant for the second time, first pregnancy was a viable delivery ? Gravida 2, Para 2 pregnant twice and both were viable deliveries Examples…

  17. Diagnosis of Pregnancy

  18. Diagnosis of Pregnancy • Pregnancy Tests • primarily work on detecting the levels of HCG in the blood or urine

  19. Urine hCG Test Can do at home commonly used inexpensive, private, and easy to use Able to tell if you're pregnant about 2 weeks after ovulation some more sensitive urine tests claim that they can tell if you are pregnant as early as one day after a missed period (25 mIU) *NOTE: Implantation needs to occur before hCG is produced (generally happens 6-12 days post ovulation). Therefore, the earliest you can get a positive result on the most sensitive pregnancy tests is seven days after ovulation. Blood hCG Test Must see a doctor Can pick up hCG earlier than urine tests can can tell if you are pregnant about 6 to 8 days after ovulation* Quantitative blood test (beta hCG test) measures the exact amount of hCG in the blood can find even tiny amounts of hCG very accurate Qualitative hCG blood test checks to see if the pregnancy hormone is present or not about as accurate as a urine test

  20. Diagnosis of Pregnancy • Presumptive signs • noticed by the woman • Probable signs • seen on examination • Positive signs • have to do with the baby

  21. Presumptive Signs • Amenorrhea • Morning sickness • Breast enlargement • TTT-tight, tender and tingling • Abdominal enlargement • Bladder symptoms (TWB)

  22. Presumptive Signs • Skin changes later signs, noticed while pregnant • Cholasma • mask of pregnancy; face color • Linea nigra • dark line down center of abdomen • Areola of breast darkens • Birthmarks and scars darken 

  23. Probable Sign • Braxton Hicks sign • intermittent contractions of the uterus after the third month of pregnancy • Operculum • mucus plug in the cervical os • Palpable uterus above the pubis • Ladin’s Hegar’s, McDonald’s signs…

  24. Positive Signs • Fetal parts • felt by external palpation using Leopold’s maneuver • Movement • felt by the examiner, not the patient, during palpation of the abdomen • A heartbeat • that is 2:1 of that of the woman’s • usually done by examination with a stethoscope

  25. Positive Signs • Funic Soufflé • murmur of umbilical blood • heard on examination with a stethoscope • same as the heart rate of the fetus • Visualizing the fetal skeleton • on x-ray or ultrasound

  26. Order of Events

  27. Order of Events

  28. Order of Events

  29. Order of Events

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