April 16, 2012 NURS 330 Human Reproductive Health
Announcements • Office Hours • Mondays, 5:30pm – 6pm • SH C240 • Class e-mail list • Send your e-mail address by Mon, 4/23/12
Fertilization • Also referred to as conception • Occurs in the Fallopian tube • Oocyte = mature ovum is viable for 12-24 hours • Sperm are viable 3 to 5 days in woman’s body
The zygote • Once fertilized, the egg is called a zygote. • Zygote travels four days to the uterus • Divides rapidly • Identical (Monozygotic) Twins • One egg fertilized by one sperm but divides into two separate masses • Fraternal (Dizygotic) Twins • Two separate eggs fertilized by two separate sperm
Implantation • The zygote continues to develop and becomes a blastocyst • The blastocyst floats around in the uterus for about 3 days before implanting itself in the uterine wall • Implantation, occurs 7 days after fertilization
Length of Pregnancy • 266 days (280 days after last normal menstrual period) • 40 weeks
Embyronic Period • From implantation until the 8th week of pregnancy (gestation), the blastocyst is now known as an Embryo • Embryo • Prenatal organism from implantation on uterine wall to 8th week of pregnancy • During this period, internal and external structures begin to form
The Embyronic Period (cont) • Yolk sac • first element seen in the gestational sac during pregnancy, usually at 5 weeks gestation • Placenta • Develops at the site of implantation • Secretes human chorionic gonadotropin (hCG) • Effect on ovaries • Effect on corpus luteum • Nourishment, oxygen, elimination of waste products • Umbilical cord • Connects the developing embryo of fetus to the placenta • Waste products are removed from the fetus and nutrients are transported from the mother through the placenta
The Embyronic Period (cont) • Amniotic sac • Protective membrane around the fetus • Amniotic fluid • watery liquid surrounding and cushioning a growing fetus within the amnion. • allows the fetus to move freely without the walls of the uterus being too tight against its body.
Fetal Period • From the 8th week of gestation to delivery, at about 40 weeks. • The embryo is now known as a fetus • When internal and external structures (organs that developed during the embryo period) grow and mature
Prenatal Sex Differentiation (cont) • Nature is predisposed toward female development. Female development requires no added hormones. • For a male to develop, the testes must produce large amounts of testosterone between the 6th and the 12th week of the prenatal period. • For the vast majority, sex differentiation occurs flawlessly and normal genitalia develop. However, in rare instances, problems may occur.
Prenatal Care • Health care during pregnancy before the baby is born • Good prenatal care • Protects the mother’s health • Nutrition, diet, exercise • Enhance probability of having a healthy baby
Pregnancy Tests • All pregnancy tests look for a special hormone in the urine or blood that is only present when a woman is pregnant. • This hormone, human chorionic gonadotropin (hCG), is also called the pregnancy hormone. • Blood test detects HCG sooner than Urine tests • 7 days vs. 2 weeks
Trimesters • First: 0 – 13 Weeks • Second: 14 – 26 Weeks • Third: 27 – 40 Weeks
Early Pregnancy Signs and Symptoms • Symptoms: missed period, breast tenderness, etc • Hegar’s Sign: • softening of the uterus just above the cervix, purplish hue of labia minora, vagina and cervix
Pregnancy Symptoms • First trimester • 2/3rds of pregnant women experience nausea, vomiting, fatigue and painful swelling of the breasts • Second trimester • Most nausea and vomiting subside, fetal movements = quickening • Braxton Hicks - False Labor
Pregnancy Symptoms • During the third trimester • pressure on the internal organs causes heartburn, acid reflux and frequent urination. • Edema causes swelling of ankles, face, hands and feet.
Diagnostic Tests during Pregnancy • Amniocentesis • Genetic test - examination of chromosomes in amniotic fluid • Done during the 2nd trimester (weeks 14 and 20) • Recommended if: • woman is 35+ • previous child has a chromosomal abnormality • Chorionic Villus Sampling • Genetic test – examination of tissue from the chorion of the placenta • Done during the 1st trimester (weeks 9 and 12) • Recommended if: • Woman is 35+ • family history of an identifiable inherited genetic disorder
Diagnostic Tests during Pregnancy • Ultrasound (Sonogram) • Picture of the internal structure of the fetus, can determine fetal age and location of the placenta. • Also used as a guide during amniocentesis and CVS • Alpha-fetoprotein (AFP): • Blood test - examination of the mother’s blood can detect spinal cord defects (spina bifida; also used to screen for Down’s Syndrome) • Done during weeks 15 and 18
Postpartum Period • The period consisting of the months or weeks immediately after childbirth. • It is a time when the woman adjusts, both physically and psychologically, to the process of childbearing • Marker events • Postpartum Blues • Postpartum Depression • Postpartum Psychosis • Breastfeeding
Postpartum blues or baby blues • Common – 50 – 70% women after pregnancy • State of short-term dysphoria that my accompany the feelings of happiness and excitement that follow the baby’s birth • Only lasts a few days • Symptoms include: Bouts of crying Memory Lapses Mild Confusion Mood swings Irritability Fatigue
Postpartum Depression (PPD) • Not so common: 8% – 20% of women after pregnancy • More severe than baby blues. • Extreme sadness and feelings of worthlessness and inadequacy as a mother • May become suicidal • Most women improve on their own in 3 - 6 months • Others may require psychological intervention • Symptoms include: • Insomnia • Digestive problems • Unusual weight loss
Postpartum Psychosis • Rare • Serious disorder that probably has underlying psychological causes • Requires psychological evaluation and treatment • Marked by extreme highs and lows • Symptoms • Extremely agitated • Paranoid • Delusions & hallucinations
Breastfeeding • Facilitates uterine contractions • Colostrum • Produced in late pregnancy and for about 48 hours after birth • Contains no “milk” • Contains many nutrients and antibodies that are valuable for the newborn
Spontaneous Abortion or Miscarriage Ectopic Pregnancy Incompetent Cervix Preterm Labor Low birth weight Preeclampsia/Eclampsia Gestational Diabetes Placenta problems Abruption, previa Pregnancy Conditions/Complications
Pregnancy Conditions/Complications • High Risk Pregnancies: • Mother's health • Mother’s Age • Teenage mothers (17 and younger) • Mothers over 35 years of age • Health of the fetus (baby) • Complications unique to pregnancy
Teratogens • Substances that can be dangerous to the health of the baby • Cause defects because they cross the placenta • Greatest teratogenic effect during the first trimester
Active Teratogens • Passive Teratogens
Labor & DeliveryPreparing for Labor • Woman may experience burst of energy • Lightening and engagement of fetus • descent of fetus into pelvic region • Cessation of weight gain • Dilation and effacement (thinning) of cervix • bloody show (due to bursting capillaries) • mucus plug expelled • Rupture of amniotic sac (the water breaking)
Stage I • Early phase • mild-moderate contractions dilate cervix 0–3 cm • Active phase • moderate contractions dilate cervix 3–7 cm • Transition • intense contractions dilate cervix 7–10 cm
Stage II • Early or Rest phase • brief lull with no urge to push • Active or Decent phase • pushing during contractions • Moves baby down the birth canal • Transition or Crowning and Birth phase • head and body delivered
Stage III & Stage IV • Stage III • Placental phase • Placenta is delivered • Stage IV • Recovery phase • Mother and baby checked for complications
Episiotomy • The cutting of the perineum that allows more room for the baby to be delivered
Drugs During Labor • Analgesics • Tranquilizers or narcotics • Help a woman relax and give some pain relief • Anesthesia • Lumbar epidural • Eliminates sensation from the belly down • May sometimes prolong or even stop labor • Risks associated with drugs • Can cross the placental barrier to the baby • Temporary side effects • Irregular or slowed heart beats • Higher rates of jaundice • Breathing problems
Cesarean Section • Most common when • fetus in the breech position • labor difficult or abnormal (dystocia) • fetus is distressed • woman had a previous c-section
Breech Positions • By 36 weeks of pregnancy, most fetuses turn into a head-down, or vertex position. This is the normal and safest fetal position for birth. • A fetus with the feet, buttocks, or legs pointing down toward the cervix is said to be in breech position • Types • Complete • The buttocks are down near the birth canal • Frank • buttocks are in place to come out first during delivery • Footling • One leg (single footling) or both legs (double footling) are stretched out below the buttocks. The leg(s) are in place to come out first during delivery.
Menopause • Menopause is the medical term for the end of a woman's menstrual periods. • “Change of life.” • Average age: 51 years • As early as 40 years • As late as early 60s.
Menopause • Natural • Occurs naturally after the woman’s supply of follicles has been depleted and menstruation ends completely • Surgical • Can be induced if the ovaries are surgically removed.
Perimenopause • This period usually begins a few years before the last menstrual cycle • May last a few years
Perimenopause • Three stages of transition • Early • Middle • Late
Early Stage • Between ages 40 and 44 • Marker: • Changes in menstrual flow • Changes in length of the cycle • Sudden surges in estrogen
Middle Stage • Periods become irregular • Periods are NOT skipped
Late Stage • Women begin missing the periods until they finally stop. • Estrogen levels drop significantly • Triggers menopausal symptoms • Puts women at greater risk of certain conditions
Estrogen depletion can lead to: • Increase in heart disease • Loss of bone density • Memory loss
Hormonal Changes • Ovaries • Stop producing estrogen and progesterone • Continue to produce small amount of testosterone • Can be converted to estrogen (estradiol) in fat
Symptoms of Menopause • An array of symptoms, including: -Hot flashes -Mood Changes -Night sweats -Sexuality -Heart pounding or racing -Forgetfulness -Insomnia -Urine leakage -Vaginal Dryness -Joint stiffness • Can last from six months to more than five years after the onset of menopause
Remedies: Over-the-counter • Non Steroidal Anti-Inflammatory Drugs (NSAIDs) • Painkillers such as aspirin, ibuprofen (Advil, Motrin) • Relief of menopausal symptoms • Lubricants • Vaginal dryness • Vitamin E • Helps with hot flashes