Maternal NB 2
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Maternal NB 2
Maternal Newborn chapters 11 13
Conception, Fetal Development, Preparation for Parenthood
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
Site of implantation
"Base" of conceptus
Capsule/blister around the blast
Bubble-like structure that covers the blastocyst
Decidua vera (parietalis)
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.
Diploid number of chromosomes
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.
Haploid number of chromosomes
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:
: before division - replication of DNA
: spindle/centrosome, nucleus gone
: chomosomes line up betw spindles
: chromosomes separate, polarize
: 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
Postconception age periods
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
: Fetal (Fetal heart tones @ 8-12wks)
Specialized connective tissue that surrounds blood vessels in the umbilical cord. Prevents compression of umbilical cord in utero.
Individual has inherited similar genes for a particular trait from each parent.
Process that produces the female gamete (ovum/egg). Meiosis.
Fertility of ova and sperm
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.
Malel/Female chromosome pairs
Early Pregnancy Factor
Immunosuppressant secreted by the trophoblastic cells. In maternal serum w/in 24-48 hrs after fertilization
Implantation into the endometrium
Protects cord from compression
Acts as a wedge during labor
Fluid can be used for analysis
Amnionic fluid contains:
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.
: O2 TO baby
: 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.
Length of pregnancy
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
Myometrium (muscle layer)
: Work of labor
Endometrium (mucosal layer)
: Soughed @ Menses
Which uterine ligaments enlarge during PG, cause 'round ligament "pain"' during PG?
Chief uterine supports (ligaments)
pH of cervix
Acidic when NOT fertile (controls flora!)
Alkaline when fertile
Semen pH is 8.4. Sperm like alkaline environment!
Which part of the falopian tube does fertilization normally take place in?
The ampula - the distal 1/3
Functions of the ovaries
Store and develop follicles
Ovarian Cycle - 3 phases
(days 1 - 14) (pre-ovulation)
Graafian follicle (ovulation) by day 14
phase (days 14 - 28) (Corpus Luteum - hollow space left in ovary after ovulation)
Menstrual Cycle - 4 phases
: day 1 of flow=day 1 of cycle
: Prep for implantation
: necrose & slough
Estrogen = proliferation
Progesterone = sedating hormone, slows body, quieting, calms everything, calms uterus to prevent miscarriage
Basal body temp
Drop followed by rise = ovulation
Estrogen DROPS body temp (proliferative phase)
Progesterone RAISES body temp
Characteristics of Proliferative phase (days 7 - 14)
Endometrium / myometrium thickens
Cervical mucus at ovulation
: clear, thin, watery, alkaline, ferning pattern, skinnbarkheit (stretchy)
Favorable to sperm
Ferning indicitive of:
Signs of ovulation
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
: 16yr and has never started
: established >3mo, then stops
Primary cause is PG
: lactation, hormonal, nutrition bad, stress, disease, ovarian lesions
Painful menses (onset)
: cramps w/o disease
: 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
Antibody Transport from Mother to Fetus
Last 4 wks gestation
Passive immunity as IgE from mom / fetus
Fundal Ht @ >20 Wks?
Roughly = # wks gestation
20wks = 20cm
Amnionic Fluid Irregularities
38 - 40 wks = 1L
: Excessive. Not swallowing, DM, multiples
AFI - Amnionic Fluid Index
Measures approximate amount of amn fluid around fetus
Measure pockets, add them up.
Normal AFI = 5-18
Amnionic Fluid pH
Normal amnionic pH >7.0 (Alkaline)
Normal cervical secr = acidic
pH test (Dk Blue) if membranes have ruptures
12wks Heartbeat w/Doppler
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
1st system to function in embryo
fHgb>moms r/t carries more O2
fsyst BP low
: allows blood flow back to placenta
fpulm BP high
: r/t constriction pulm vess
Vital structures in fetal circulation
: O2 blood to fetus
: returns blood to placenta
Ductus venosus; shunt bypasses liver
: shunt bypasses lungs
: shunts blood from Rt atrium to left atrium
ASD: Foramen Ovale doesn't close
: suff alveoli for lung fcn
: 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
TTN: Transient tachypnea of NB
Fluid goes away w/draining, suction, absorption
>60resp, flaring, retractions, poor color, low O2 sat
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
: produces insulin 20wks gest
: 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.