Define perimetrium.
Serosal outermost layer composed of the peritoneum
Define myometrium.
Muscular middle layer - includes the fallopian tubes. Present a unified reaction to various stimuli (i.e.: ovulation, orgasm, and the deposit of a sperm in the vagina)
Define endometrium.
inner mucosal layer
What does the endometrium experience from menarche to menopause?
the endometrium goes through monthly renewal and degeneration in the absence of pregnancy in response to hormone cycles.
What are the three functions of the fallopian tubes?
1. Provide transport for the ovum from the ovary to the uterus. It generally takes 3-4 days.
2. Provide a site for fertilization.
3. Serve as a warm, moist, nourishing environment for the ovum or zygote (fertilized egg).
What is the function for the longitudinal muscles?
function to expel fetus
What is the function of the middle layer?
function to constrict blood vessels to stop bleeding and prevent hemorrhage
What is the function of the inner layer?
prevent backflow of menstrual blood into fallopian tubes and dilate cervix during labor/delivery.
What is the top part of the uterus called?
fundus (used to asses contractions)
What two cycles take place simultaneously?
Ovarian Cycle and Menstrual Cycle
What does the ovarian cycle govern?
the preparation of the endocrine tissues and release of the eggs
What does the menstrual cycle govern?
the preparation and maintenance of the uterine lining
What phases make up the ovrian cycle?
follicular phase
luteal phase
When is the follicular phase?
days 1-14 (varies in women with irregular menstrual cycles)
What occurs during the follicular phase?
a. Ovarian follicles mature and get ready to release an egg. Follicle Stimulating Hormone (FSH) rises and causes one of the many follicles in the ovary (present since birth) to mature. This mature follicle now called Graafian follicle, contains the ovum (
When does the luteal phase occur?
days 15-28
What occurs during the luteal phase?
Ovulation: Mature egg or ovum is released.
What is the menstrual cycle based off of?
the rise and fall of estrogen
What is required for the production of oocytes?
the menstrual cycle
What prepares the uterus for pregnancy by thickening the lining which later provides nutrients to the implanted egg?
the menstrual cycle
What happens if there is no pregnancy?
the lining is released (menstruation)
What are the phases of the menstrual cycle?
menstrual phase, proliferative phase, secretory phase, ischemic phase
What happens during the menstrual phase?
menstruation occurs
What happens during the proliferative phase?
endometrial glands enlarge, blood vessels become prominent, endometrium thickens, cervical mucus thins and alkalines.
What happens during the secretory phase?
(fertilization) follows ovulation, estrogen causes slight cellular growth, progesterone causes swelling and growth, vascularity increase to nourish the ovum.
What happens during the ischemic phase (No fertalization)?
estrogen and progesterone levels drop, vascular changes occur, and escape of blood into stromal cells. (aka Menstrual Period)
What is the term for male and female reproductive organs being similar in function and structure?
homologous
What is estrogen responsible for in the body?
-Control development of women's secondary sex characteristics
-Maturation of ovarian follicles
-Causes enlargement of uterus, breasts, breast glandular disuse.
-Increases vascularity and vasodilation
-by 7 wls gestation, 50% of estrogen is produced by the
What are the types of estrogen in the body?
Estrone, Beta-estradiol (major), and estriol
When is estrogen most prominent in the body?
Most prominent during proliferative phase of menstrual cycle
What is secreted by the corpus luteum?
progesterone
What is the hormone of pregnancy?
progesterone. Effects on uterus allow pregnancy to be maintained.
What must be present in high levels for implantation?
progesterone
When does implantation occur?
occurs at peak Progesterone level 7-10 days after ovulation
What happens after 11 weeks gestation?
placenta takes over production of progesterone
What are prostaglandins?
Oxygenated fatty acids produced by cells of endometrium
What is the function of prostaglandins?
-Prostaglandin E (PGE) relaxes smooth muscle, vasodilator
-Prostaglandin F (PGF) increases contractility of muscles, arteries vasoconstrictor
What are the effects of estrogen?
-builds up uterine lining
-increases body fat
-depression, headache/migraine
-interferes with thyroid hormone
-increases blood clotting
-decreases libido
-impairs blood sugar control
-increases risk of endometrial cancer
-increases risk of breast cancer
What are the effects of progesterone on the body?
-maintains uterine lining
-helps use fat for energy
-anti-depressant
-facilitates thyroid hormone action
-normalizes blood clotting
-restores libido
-regulates blood sugar levels
-protects from endometrial cancer
-probable prevention of breast cancer
What is the primary function of the penis?
primary function is to deposit sperm into the female vagina so fertilization of the ovum can occur
What is the function of the scrotum?
Functions to protect the testes and the sperm by maintaining a temperature lower than body temp and harm.
What is the function of the testes?
1. Serve as the site of spermatogenesis, 2. Produce testosterone.
What does semen consist of?
Seminal fluid made up of spermatozoa and the secretions of all the accessory glands
What is the function of semen?
Seminal fluid transport viable and motile sperm to the female. Effective transportation requires adequate nutrients and adequate pH of 7.5, a specific concentration of sperm to fluid, and an optimal osmolarity.
What is gametogensis?
Meiosis within the ovary and testis. Each oogonium produces a single haploid ovum. Each spermatogonium produces 4 haploid spermatozoa.
What is meiosis?
type of cell division by which sperm and ova are reproduced
"Reduction cell division" - happens only in reproductive cell and results in the formation of sperm (gametes) and oocytes (ova). Creates two cells that contain half the genetic material of the pa
What is mitosis?
cell division. Duplication of an original cell. Example. Identical twin
Occurs with somatic (tissue) cells of the body, allowing for new cells (i.e.: skin regeneration). Division of cells through Mitosis results in 2 "daughter" cells genetically identical
What is capacitation?
one of two processes a sperm must undergo before fertilization an occur. It is the removal of the plasma membrane and glycoprotein coat overlying the spermatozoa's acrosomal area and the loss of seminal plasma proteins.
What is an acrosomal reaction?
After capacitation, the acrosome caps of the sperm surrounding the ovum release their enzymes and thus break down the hyaluronic acid that holds that holds the elongated cells of the corona radiata (outer layer of the ovum).
What is a cortical reaction?
the cellular change mediated by release of materials from the cortical granules, organelles found just below the ovum's surface at the moment of penetration by a fertilizing sperm.
When is the sex of the zygote is determined?
at the moment of fertilization
What is the outer area of the egg that gets penetrated by the sperm?
zona pellucida
What happens as soon as implantation has occurred?
The fertilized egg begins to secrete hCG = Positive pregnancy test.
After fertilization, the hCG may not show up for two
What is the function of the amniotic fluid?
1. Act as a cushion to protect the fetus
2. Help control the temperature of the embryo/fetus
3. Permit symmetric external growth and development of the embryo/fetus
4. Prevent adherence of the embryo/fetus to the amnion
5. Allow the umbilical cord to be r
How does the maternal blood flow?
Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation.
How does fetal blood flow?
Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
When does the embryo become a fetus?
at 9 weeks, the embryo is called a fetus. Every organ system and external structure is present at 9 weeks.
When are the first, second, and third trimester?
1st trimester = 1-12 weeks
2nd trimester= 13 - 26 weeks
3rd trimester = 27 weeks to end of pregnancy
What are somatic cells?
are diploid: 23 pairs (46 total), (22 autosomes, 1 sex chromosome from each parent)
What are gametes?
sex cells that are haploid (23)
What are homozygous genes?
both genes are the same (i.e.: both are dominant or recessive)
What are heterozygous genes?
the two genes are different (i.e.: One dominant and One recessive)
What is a karyotype?
Pictorial analysis of an individual's chromosomes
What is Trisomy 21 (Down Syndrome)?
3 chromosomes on #21
distinct physical and mental abnormalities. Mild to moderate
What is trisomy 13 and 18?
Not compatible with life. Usually die within the first three months.
What are monosomies?
(45 chromosomes) - if not a sex chromosome, not compatible with life.
What is turner syndrome?
Monosomy X. No intellectual impairment. Facial and trunk abnormal features, underdeveloped secondary sex characteristics, amenorrhea, infertility, coarctation of the aorta, renal anomalies.
What is Klinefelter syndrome (XXY)?
ADHD, autism, gynecomastia, infertility (underdeveloped secondary sex characteristics).
What is polyploidies?
extra set of chromosomes; accounts for 5-10% of all first trimester miscarriage's
What is a simean crease?
having one crease on the hand. (a sign of down syndrome)
What is autosomal dominant inheritance?
Each offspring has a 50% probability of inheriting the mutant allele
Does not skip generations, offspring can pass on only the recessive gene
Occurs equally frequently in males and females of all ethnic groups
What disorders are associated with autosomal dominant inheritance?
a. Huntington disease
b. Myotonic dystrophy
c. Fragile X syndrome
What is autosomal recessive inheritance?
1. Both parents are carriers******
2. 25% chance of passing on abnormal gene
3. 25% chance of affected child
4. If child clinically normal, 50% chance child is carrier
5. Men and women equally affected
What is x-linked recessive inheritance?
1. No father-to-son inheritance
2. 50% chance carrier mother will pass abnormal gene to sons (affected)
3. 50% chance mother will pass abnormal gene to daughters (carrier)
4. Fathers affected cannot pass disorder to sons, but all daughters become obligate
What is x-linked dominant inheritance?
very rare
1. No Father-to-son transmission
2. Can be lethal in utero or newborn period
3. Vitamin D - resistant rickets (Most common X - linked dominant)
What is multifactorial inheritance?
congenital malformation generally caused by an interaction of many genes and environmental factors.
1. Cleft palate, heart defect, spina bifida, dislocated hips, clubfoot, pyloric stenosis
2. No clear pattern of Mendelian inheritance
3. Often sex bias
4.
When is a genetic ultrasound done?
best if done at 16-20 weeks (generally done at 18-22 weeks)
First trimester - measures fetal nuchal translucency between 11-13 weeks. (measures thickness of tissue behind neck that may indicate Down syndrome or other genetic disorder if too thick)
Increas
What is maternal serum screening?
Determines risk for Down syndrome, trisomy 18, or open spina bifida (a neural tube defect where the spinal cord and spinal column don't fuse properly. Usually fused by 28 weeks gestation)
What/When are non-invasive prenatal testing done?
through cell-free fetal DNA (Maternal blood test) for women of advanced maternal age (AMA)
What are genetic amniocentesis?
1. Maternal age 35 or older
2. Previous child born with chromosomal abnormality
3. Parent carrying chromosomal abnormality
4. Mother carrying X-linked disease
5. Both parents carrying autosomal recessive disease
6. Family history of neural tube defects
7.
What is Percutaneous Umbilical blood sampling and chorionic villus sampling?
1. Blood from umbilical cord for rapid diagnosis
2. Tissue from placenta
What are the notable changes to the uterus during pregnacy?
enlarges, increased vascularization and circulation, thicker wall that thins at about 38-41 weeks, and Braxton-Hicks contractions (False Labor).
What are notable changes to the cervix during pregnancy?
Secretes thick sticky mucous which becomes the mucous plug. Increased circulation softens the cervix (Goodell Sign) and turns it a blue-purple discoloration (Chadwick Sign).
What are the notable changes to the ovaries during pregnancy?
Cease ovum production
What are the notable changes to the vagina during pregnancy?
Estrogen causes epithelial hypertrophy, increased vascularization and hyperplasia.
What are the notable changes to the breasts during pregnancy?
change in size and develop of straie (stretch marks).
What are the notable respiratory changes during pregnancy?
1. chest circumference may increase -> elevated diaphragm - (Lung disease may be aggravated)
2. Rhinitis of pregnancy - Estrogen-induced edema and vascular congestion of the nasal mucosa
3. Epistaxis (nosebleeds)
What are notable cardiovascular changes during pregnancy?
1. The uterus puts pressure on the diaphragm which pushes the heart up, rotates left, and rotates forward.
2. Blood volume progressively increases throughout pregnancy.
3. Cardiac output increases in early pregnancy and peaks at 25-30 weeks.
4. BMR (Basal
What are the notable gland changes during pregnancy?
Parathyroid, Pituitary, and Adrenal - mild changes
What is the notable change to the pancreas during pregnancy?
increased insulin needs (Latent deficiency -> symptoms of gestational diabetes)
What are subjective/presumptive changes?
1. Amenorrhea
2. Nausea and Vomiting
3. Excessive fatigue
4. Urinary frequency
5. Change in breasts
6. Quickening (18-20 weeks after LMP)
What are objective/probable changes?
1. Changes in Pelvic Organs
2. Enlargement of abdomen and uterus*****
3. Braxton Hicks Contractions
4. Uterine souffle (blowing sound with stethoscope)
5. Changes in skin pigmentation
6. Appearance of abd. Striae
7. Fetal outline at 24 weeks
8. Pregnancy
What are diagnostic changes (positive)?
1. Fetal heartbeat (10-12 weeks via doppler)
2. Fetal movement - 20 weeks
3. Visualization of fetus by ultrasound
a. Gestational sac -> 4-5 weeks gestation
b. Fetal parts, fetal heart movement -> 8 weeks
What is vena cava syndrome?
The gravid uterus compresses the vena cava when the woman is supine. This reduces the blood flow returning to the heart and may cause maternal hypotension.
What is the linea nigra, found in pregnancy?
Black line/discoloration of the abdomen that runs from the umbilicus to the pubis
What is postural changes during pregnancy?
increasing lordosis of the lumbosacral spine and the increasing curvature of the thoracic area.
What is antepartum?
Time between conception and onset of labor
What is intrapartum?
Time from onset of labor until birth of infant and placenta
What is postpartum?
Time from birth until woman's body returns to prepregnant condition
What is gestation?
Number of weeks since first day of LMP
What is abortion?
Birth before 20 weeks gestation (spontaneous or therapeutic) termination of pregnancy
What is preterm or premature labor?
labor after 20 weeks but before completion of 37 weeks of gestation
What is postterm labor?
Labor after 42 weeks gestation
What is gravida?
any pregnancy, including present
What is multigravida?
woman in second or more pregnancy?
What is nulligravida?
a woman who has never been pregnant
What is the initial prenatal assessment?
� Focus on woman holistically
� Prepare woman for physical examination
� Cultural assessment, psychological status, educational needs, support systems, family functioning, economic status, and stability of living conditions.
What is EDB?
estimated date of birth
What is EDD?
estimated date of delivery
What is EDC?
estimated date of confinement
How do you determine the due date?
First day of the last period, add 7 days, subtract 3 months (Naegele's rule)
When is Nagele's rule not accurate?
for women with markedly irregular periods, with amenorrhea who are breastfeeding and ovulating, or conceiving before regular menstruation established following oral contraceptives or termination of pregnancy.
What is an EDB wheel?
A full gestation is considered ___ weeks.
40
What are the gestational ages of the newborn?
� Preterm - 20-37 weeks
� Late Preterm - 34 - 36 6/7 weeks******
� Early Term - 37-38 weeks
� Term - 37-42 completed weeks
� Post-term - over 42 weeks
When is it difficult to evaluate uterine size?
difficult to evaluate uterine size in obese women, multiple gestations, or in presence of uterine fibroids.
How do you measure fundal height?
-Mcdonald Method:
-top of the pubic bone to the top of the uterus (fundus)
-cm=# of wks until 36 wks
A healthcare professional holds a tape measure across a pregnant women's abdomen. One end of the tape measure is placed at the top of the symphysis pubis
What are approximate heights of the fundus at various weeks of pregnancy?
What is intrauterine growth retardation (IUGR)?
-The poor growth of a baby while in the mother's womb during pregnancy.
When does the fetal heart begin to beat?
� (begins about 10-12 weeks gestation)
What is cervical pelvimetry?
assess outlet size
What are initial assessment done for pregnancy?
Pap smear, CBC, HIV, Rubella Titer, ABO and Rh Typing, Urine Culture, Hepatitis B and Sexually transmitted infections (STI) screening.
What assessments are done throughout pregnancy?
Gestational diabetes mellitus (GDM), Hgb, Hct, Group B Strep (GBS), Hemolobin electrophoresis, Varicella immunity, PPD
What are other tests done for pregnancy?
for fetal aneuploidy (trisomy) and neural tube defects - (Down Syndrome, Trisomy 18 and 13, Turner Syndrome, Quadruple Screen, First trimester Ultrasound)
What are signs of premature labor?
� Painful menstrual-like cramps
� Dull low backache
� Suprapubic pain or pressure
� Pelvic pressure or heaviness
� Change in character or amount of vaginal discharge (bloody, thinner, thicker)
� Diarrhea
� Uterine contractions felt every 10 minutes for 1
What does parental education include for the expectant family?
� Labor and Birth
� Pain relief
� Obstetric complications and procedures
� Breastfeeding
� Normal newborn care
� Postpartum adjustment
� Content of each class directed by overall goals of the program
What is a VBAC?
Vaginal Birth After Cesarean - prepare two birthing plans.
How do you help the children/siblings feel part of the birthing process?
Sibling preparation classes: children 3-12
What are common discomforts of pregnancy during the first trimester?
� Nausea and Vomiting
� Urinary frequency
� Fatigue
� Breast tenderness
� Increased vaginal discharge
� Nasal stuffiness and epistaxis
� Ptyalism (excessive bitter saliva)
What does the presence of AFP mean?
baby spinal fluid is leaking into amniotic sack
essential fatty acids are very important
What are common discomforts of pregnancy during the second and third trimester?
� Heartburn - avoid triggers
� Ankle Edema - difficulty of venous return from lower extremities. Frequent dorsiflexion of feet. Elevate legs*****
� Varicose Veins - supportive stockings, elevate legs
� Flatulence
� Hemorrhoids - avoid constipation
� Const
When should women wanting to become pregnant get immunizations?
prior to becoming pregnant
***No Attenuated Live Viruses (i.e.: Rubella vaccine - MMR)
Only acceptable are Tdap and the flu vaccine
What are teratogenic substances?
something that will harm fetal development
When are teratogenic substances at the greatest risk?
the first trimester
What are three teratogenic substances?
1. Tobacco - modifiable, more then 10 cigs per day - consider nicotine replacement
2. Alcohol - Fetal Alcohol Syndrome (FAS)- fetal alcohol level same as mother's.
3. Caffeine - Linked to birth defects, spontaneous abortions, preterm birth.
How long does the ova survive when its not fertilized?
12-24 hrs in the fallopian tube
When is the first trimester transabdominal ultrasound?
4-5 weeks after LMP