Pregnancy
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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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Development of the embryo
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


Nidation implantation
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


Nidation implantation1
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


  • 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



Placenta
Placenta

  • A round disc-shaped tissue

  • 2 to 3 cm in thickness at the umbilical cord attachment


Placenta1
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.


Side note
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


Spontaneous abortion
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


Umbilical cord baby s lifeline
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


The amniotic fluid
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


The amniotic fluid1
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


Terms of pregnancy
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


Terms of pregnancy1
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


Examples

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…



Diagnosis of pregnancy1
Diagnosis of Pregnancy

  • Pregnancy Tests

    • primarily work on detecting the levels of HCG in the blood or urine


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


Diagnosis of pregnancy2
Diagnosis of Pregnancy

  • Presumptive signs

    • noticed by the woman

  • Probable signs

    • seen on examination

  • Positive signs

    • have to do with the baby


Presumptive signs
Presumptive Signs

  • Amenorrhea

  • Morning sickness

  • Breast enlargement

    • TTT-tight, tender and tingling

  • Abdominal enlargement

  • Bladder symptoms (TWB)


Presumptive signs1
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 


Probable sign
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…


Positive signs
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


Positive signs1
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






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