Conception and Pregnancy

1. Conception and Pregnancy

2. http://www.youtube.com/watch?v=Cr45f2OjC5U&list=PL676C9F52251404E4http://www.youtube.com/watch?v=Cr45f2OjC5U&list=PL676C9F52251404E4

3. Fertilization • Sperm + ova = zygote • Ovum can be fertilized over a maximum range of 72 hours each menstrual cycle. • Estimated that 30% of all fertilized oval naturally do not survive.

4. Fertilization begins when: • The head of one sperm enters ovum. • Occurs in outer 1/3 of fall. Tube. • Fertilized ovum is called a zygote. One cell, one nucleus, all the necessary ingredients for its development.

5. In Vitro Fertilization • 1st attempted in 1978 • Ovum retrieved by laparoscope, mixed with semen in a test tube. • Returned to uterus after 2 ½ days • 50% success rate of fertilization • 20-30% implant rate of those fertilized.

6. http://www.youtube.com/watch?v=7FHLPi5YCz0

7. Cell Division • It is called cleavage. • Bulk of cell does not change. • Rapidly dividing cell ball develops: blastocyst • Passage to uterus takes 7-9 days.

8. Embryo Stage: • Begins the 2nd week and extends through the 8th week. • Fetal Stage: • After the 8th week, until birth.

9. Blastocyst • Fluid filled hollow ball of cells • Burrows little finger-like projections called villi into the blood supply of the endometrium. • Outer rim becomes the chorion (fetal membrane). • Cells near the outer rim become the embryo.

10. Placenta • Develops by 3 months • Takes over job of providing nourishment for the fetus and carrying fetal waste to the maternal blood. • Joined to fetus by umbilical cord • Begins to secrete estrogen and progesterone.

11. Approximately 8 in. in diameter, 1 in. thick, and about 1/6 of fetal wt. • Transfer of nourishment and waste occurs by osmosis • Calcium, phosphorous, amino acids, glucose, fats, bacteria, viruses, antibodies pass from maternal side to fetal side.

12. NO intermixing of maternal blood and fetal blood. • O2 and CO2 pass through by diffusion • Prevents passage of some but not all harmful substances into fetus.

13. Nicotine, alcohol, most drugs pass through placental barrier and harm the fetus. • Umbilical cord: 1 umbilical vein, 2 umbilical arteries, Wharton’s jelly enclosed in a membrane. • Cords are examined at birth for completeness.

14. Birth • At birth, lung function is established. • Umbilical vein and arteries become fibrous cords. • Once cord is cut, large amount of blood returns to the heart from the lungs.

15. Also at birth, the foramen ovale closes due to equalization of pressure in the atria, and normal circulation begins.

16. Gestation is the period of development of the child in the mother’s uterus. Lasts approximately 280 days. • Pregnancy is described in terms of the number of weeks of gestation (40 total), or it may be divided into three trimesters of 3 months each.

17. The due date, or estimated date of confinement (EDC), is calculated from the first day of the last menstrual period (LMP). • A fetus is viable when it is capable of living outside of the mother. It depends on the developmental age, birth wt, and developmental stage of the lungs.

18. The amnion, also known as the amniotic sac, is the innermost of the membranes that surround the embryo in the uterus and form the amniotic cavity. • Amniotic fluid is the liquid in which the fetus floats and is protected.

19. Amniocentesis is a surgical procedure in which a needle is inserted through the abdominal and uterine walls to obtain a specimen of amniotic fluid. • Done after 16th week of pregnancy, is used to evaluate fetal health and diagnose certain congenital disorders.

20. Abruptio Placentae: • An abnormal condition in which the placenta separates from the uterine wall prematurely before the birth of the infant.

21. Placenta previa: • The abnormal implantation of the placenta in the lower portion of the uterus. Symptoms include painless sudden-onset bleeding during the third trimester. Treatment ranges from bed rest to immediate delivery by C-section.

22. Pregnancy:Physiological Changes • Hegar’s sign: softening of the lower part of the uterus; about the 6th week. • Goodell’s sign: cervix softening

23. Chadwick’s sign: tissue around the vagina becomes thicker, softer, and takes on a bluish, purple color. • Braxton-Hicks contractions: painless, intermittent contractions of the uterus, caused by enlargement.

24. Ballottement: rebounding of the floating fetus in the uterus when the fetus is lightly tapped during a vaginal exam; after the 4th month.

25. Signs and Symptoms • Skin: • Linea nigra; dark line from umbilicus to mons pubis • Chloasma: a dark freckle-like pigmentation of the face • Striae gravidarum: white streaks on breasts, abdomen, thighs.

26. Cessation of menses • Urinary frequency • Morning sickness • Quickening: 1st sensation of fetal movement, around 4th month • Breasts: fuller, larger, tender. • Fetal heartbeat: heard 3rd month with fetone

27. Ultrasound: sound waves that scan the abdomen to identify outline of baby and placenta. • Souffle: soft murmur produced by blood flow in the placenta and umbilical arteries.

28. Labor and Delivery:Engagement and Lightening • Final 2 – 4 weeks of gestation • Fetal head sinks into pelvis (engagement) • Effects on mother (lightening): • Fundus lowers, upper abdomen flattens, breathing easier; walking more difficult.

29. Onset of Labor • The “Show” – mucus streaked with blood from cervix • Rupture of waters: amniotic sac tears and releases amniotic fluid • Labor pains: regular contractions of the uterus.

30. True Labor • Characterized by rhythmic, increasingly intense uterine contractions • Cervix changes shape: • Effacement: shortening • Dilation: widening

31. Crowning: fetal head presents and can be seen • Presentation: manner in which the fetus presents itself in the vagina • Cephalic presentation: head first • Breech presentation: buttocks or legs first

32. Discussion • Suctioning of infant immediately upon delivery • Cry: present or absent; weak or strong

33. Apgar Score • An evaluation of a newborn infant’s physical status by assigning numerical values (0 to 2) to each of five criteria:

34. Heart rate • Respiratory effort • Muscle tone • Response stimulation • Skin color • The newborn is evaluated at 1 and 5 minutes after birth.

35. A total Apgar score of 8 to 10 indicates the best possible condition.

36. http://www.youtube.com/watch?v=7U2z7WMthZ0

37. Diseases and Disorders • Dysmenorrhea: • Painful spasms of uterine muscles. • Amenorrhea: • Absence of normal menstruation due to hormone imbalance, pregnancy, wt. loss, menopause.

38. PMS: • Premenstrual Syndrome; irritability, fatigue, nervousness, depression, cause unknown. • PID: • Pelvic Inflammatory Disease; can cause salpingitis, oophoritis.

39. Vaginitis: • Usually yeast infections (Candida) • Causes leukorrhea (white discharge); can be viral, bacterial, fungal, protozoan; • Causes thick discharge, mild pain on urination, itching. • Treatment: metronidazole

40. Myoma: • Fibroma / fibroids; benign tumors of the smooth muscle • Ovarian cysts: • Fluid filled sac that develops from a follicle that fails to rupture completely

41. Endometriosis: • Displaced endometrial tissue, usually on the peritoneum of the abdomen • Cancer: • Ovaries, breast, uterus, cervix (Pap smear). • Testicular, prostate (PSA test)

42. Hermaphrodite: • Has both testicular and ovarian tissue; rare in humans, more common in other species. • Klinefelter’s Syndrome: • XXY (47); male with small testes, gynecomastia, subnormal intelligence; occurs in 1:700 live births.

43. Turner’s Syndrome: • XO (45); female, poorly developed gonads, short stature, impaired intelligence, ovaries fail to respond to FSH, LH stimulation.

44. STD’s  • http://www.youtube.com/watch?v=ARe5tEpb99s • Fact or Myth?

45. Gonorrhea • Bacteria spread by genital contact as well as contact with anal and pharyngeal mucosal surfaces. • Males: painful urination & discharge of pus. • Females: lower abdominal discomfort, vaginal discharge, abnormal bleeding.

46. Gonorrhea • Treated with antibiotics.

47. Syphilis • Caused by bacteria • Causes ulcers (chancres) on penis and in vagina. • Secondary signs: pink rash over body, fever, joint pain.

48. Syphilis • Tertiary signs: destructive lesions of CNS; blood vessels, bones, skin. • Treated with penicillin (PCN).

49. Chlamydia • Most common STD • Vaginal discharge or burning abdominal, rectal, or testicular pain • Painful intercourse and irregular menses.

50. Genital Herpes • May remain silent for weeks or years. • Blister-like lesions • Congenital herpes can cause severe malformation of fetus • Can lead to cervical cancer • Incurable!!!!