Maternal NB 2

Follows capacitation. Enzymes released hat breakdown hyaluronic acid that holds the corona radiata together. This is necessary for one sperm to penetrate the ovum.

Thin inner protective membrane that contains amnionic fluid. Originates from the ectoderm.

Removal of the plasma membrane and glycoprotein coat overlying the spermatozoa. If glycoprotein coat not removed, sperm can't fertilizze ovum.

Outermost embryonic membrane - thick, forms from the trophoblast layer. Forms chorionic villi. protects and supports embryo as it gorws and develops.

Period of rapid mitotic cellular divisions of the zygote. New cells are called BLASTOMERE. Blastomere eventually forms ball of 12-16 cells that is the MORULA.

Beefy red functional units of the placenta

• Under blastocyst
• Site of implantation
• "Base" of conceptus

• Capsule/blister around the blast
• Bubble-like structure that covers the blastocyst

Remaining lining (endometrium) - not the basalis, not capsularis

Pumped from the lft ventrical to the pulminary artery through the ductus arteriousus into the descending aorta, bypassing the lungs.

Umbilical blood flows through ductus venosus directly into the inferior vena cava, bypassing the liver (most). A small amount of blood circulates through the hepatic system to the inf vena cava.

After fetus blood enters the right atrium from the vena cava, it flows through the foramen ovale into the left atrium and into the left ventrical, which pumps it into the aorta.

23 prs (46) of chromosomes in every cell in the human body. Daughter cells from MITOSIS contain the same number of chromosomes as the parent cell.

Contain half the genetic material of the parent cell - only 23 chromosomes. Occurs in Meiosis - special type of cell division that results in gametes (sperm and ova).

Produces reproductive cells (gametes) with haploid number (23) of chromosomes. Allows random assortment of maternal and paternal chromosomes between the gametes.

process of cellular division that results in daughter cells that are exact replicas of the original cell. A continual process - 5 stages:

• Interphase: before division - replication of DNA
• Prophase: spindle/centrosome, nucleus gone
• Metaphase: chomosomes line up betw spindles
• Anaphase: chromosomes separate, polarize
• Telophase: Opposite prophase, furrow, division

Solid ball of 12 - 16 cells from the Blastomere. When Morula moves to uterus, BLASTOCYST (inner solid mass), TROPHOBLAST (outer layer that replaces the zona pellucida

Fertilization to the end of embryonic period (8 wks), age expressed in days/wks. Fetal period (9th wk) till birth, age is given in weeks.

• 3 - 8 wks: Embryonic
• 9+ wks: Fetal (Fetal heart tones @ 8-12wks)

Specialized connective tissue that surrounds blood vessels in the umbilical cord. Prevents compression of umbilical cord in utero.

Zygote

Individual has inherited similar genes for a particular trait from each parent.

Dissimilar genes

Process that produces the female gamete (ovum/egg). Meiosis.

• Ova are fertile 12 - 24 hrs after ovulation.
• Sperm can survive in the female reproductive tract 48 - 72 hrs; are healthy and highly fertile for 1st 24 hrs.

Layer around the ovum closest to the ovum's cell membrane. Sperm binds here.

• Female: XX
• Mal: XY

Immunosuppressant secreted by the trophoblastic cells. In maternal serum w/in 24-48 hrs after fertilization

Implantation into the endometrium

• Cushions embryo
• Controls temperature
• Permits growth
• Prevents adherance
• Protects cord from compression
• Acts as a wedge during labor
• Fluid can be used for analysis

• albumin
• urea
• uric acid
• creatinine
• lecithin
• sphingomyelin
• bilirubin
• fat
• fructose
• leukocytes
• proteins
• epithelial cells
• enzymes
• fine hair (LANUGO)

The means of metabolic and nutrient exchange between the embryonic and maternal circulations. Produces glycogen, cholesterol, fatty acids for the fetus, plus hormones hCG, estrogen, progesterone

• Dirty Duncan - maternal side.
• Shiny Schultz - fetal side.

• Umb. Cord:
• ONE Vein: O2 TO baby
• TWO Arteries: Mixed blood FROM the baby

• Uterine souffle = maternal pulse
• Fetal souffle - FHR (over cord (blowy))

Fetal circulation delivers the highest available oxygen concentration to the head, neck, brain and heart of the fetus. Leads to cephalocaudal (head-to-tail) development of the fetus.

Average of 10 lunar months - 40 wks, 280 days. Calculated from the beginning of the last normal menstrual period to the time of birth.

Full term @ 38wks.

Softening of the cervix

Blue-purple discoloration of the cervix

• Perimetrium (peritoneum): Outer
• Myometrium (muscle layer): Work of labor
• Endometrium (mucosal layer): Soughed @ Menses

Menarche

Round ligaments

Cardinal ligaments

• Acidic when NOT fertile (controls flora!)
• Alkaline when fertile

Semen pH is 8.4. Sperm like alkaline environment!

The ampula - the distal 1/3

• Store and develop follicles
• Secrete Estrogen
• Secrete Progesterone

• Follicular (days 1 - 14) (pre-ovulation)
• Graafian follicle (ovulation) by day 14
• Luteal phase (days 14 - 28) (Corpus Luteum - hollow space left in ovary after ovulation)

• Menstrual phase: day 1 of flow=day 1 of cycle
• Proliferative phase: Prep for implantation
• Secretory phase:
• Ischemic phase: necrose & slough

• Estrogen = proliferation
• Progesterone = sedating hormone, slows body, quieting, calms everything, calms uterus to prevent miscarriage

Drop followed by rise = ovulation

Why?

• Estrogen DROPS body temp (proliferative phase)
• Progesterone RAISES body temp

• Fertile!
• Estrogen peaks
• Endometrium / myometrium thickens
• Cervical mucus at ovulation: clear, thin, watery, alkaline, ferning pattern, skinnbarkheit (stretchy)
• Favorable to sperm

• Fertile mucus
• Ruptured membranes

• Cervical mucus changes: watery, thin, clear, spinnbarkheit, FERNING
• Basal body temp INCR 0.6deg 24-48 hr after ovulation
• Middelschmerz (pain) may be present (mid-cycle)
• Midcycle spotting may occur

• Primary: 16yr and has never started
• Secondary: established >3mo, then stops

• Primary cause is PG
• Other: lactation, hormonal, nutrition bad, stress, disease, ovarian lesions

Painful menses (onset)

• Primary: cramps w/o disease
• Secondary: pathology - endometriosis, PID, cysts, tumors, IUD, fibroids

TX: OCP (no ovulate =no pain), NSAIDS, rest, nutrition, exercise, Vit B&E (prostaglandin inhibitors)

Major predisposing factor to CHD

• Via Placenta
• Last 4 wks gestation
• Passive immunity as IgE from mom / fetus

Roughly = # wks gestation

20wks = 20cm

• 38 - 40 wks = 1L
• Decreases thereafter

• Polyhydramnios: Excessive. Not swallowing, DM, multiples
• Oligohydramnios: Decreased.

Measures approximate amount of amn fluid around fetus

Measure pockets, add them up.

Normal AFI = 5-18

• Normal amnionic pH >7.0 (Alkaline)
• Normal cervical secr = acidic

pH test (Dk Blue) if membranes have ruptures

• 12wks Heartbeat w/Doppler
• 16wks Lanugo/Gender/quickening
• 20wks Quickening, heartbeat w/fetoscope
• 24wks Alveoli beginning to form in lungs
• 28wks Lungs mature, eyes open
• 36wks Subq fat, skin pink, Lanugo/vernix shed
• 38wks Smooth pink skin, lanugo gone, fetus flexed

• Circulatory system
• H&H >mom
• fHgb>moms r/t carries more O2
• FHR 120-160
• fsyst BP low: allows blood flow back to placenta
• fpulm BP high: r/t constriction pulm vess

• Umbilical vein: O2 blood to fetus
• Umbilical arteries: returns blood to placenta
• Ductus venosus; shunt bypasses liver
• Ductus arterious: shunt bypasses lungs
• Foramen Ovale: shunts blood from Rt atrium to left atrium

ASD: Foramen Ovale doesn't close

• 24wks: suff alveoli for lung fcn
• 32wks: suff surfactant for alveolar fcn

Born 24-32 wks: give surfactant intrabronchial

• Lecithin (incr p 24wks) (most import)
• Spingomyelin (constant level)
• **L/S ratio >2:1 = mature lungs >35wks

Test amnio fluid for L/S ratio

Fluid goes away w/draining, suction, absorption

>60resp, flaring, retractions, poor color, low O2 sat

• Stores glycogen
• Stores iron
• Unable to synth clotting factors in sterile gut, so give Vit K IM w/in 2hrs post delivery to prevent coag defic

• Screen neonates for thyroid fcn
• Pancreas: produces insulin 20wks gest
• Glucose: crosses placenta/insulin doesn't. Monitor maternal hyperglycemia

• Passive immunoglobins via placenta
• IgG crosses placenta "GIFT" of IgG
• IgM NOT cross placenta. If present=neonate infection.