Maternal NB 2

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Maternal NB 2
2012-01-29 20:58:40
Maternal Newborn chapters 11 13

Conception, Fetal Development, Preparation for Parenthood
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  1. Acrosomal reaction
    Follows capacitation. Enzymes released hat breakdown hyaluronic acid that holds the corona radiata together. This is necessary for one sperm to penetrate the ovum.
  2. Amnion
    Thin inner protective membrane that contains amnionic fluid. Originates from the ectoderm.
  3. Capacitation
    Removal of the plasma membrane and glycoprotein coat overlying the spermatozoa. If glycoprotein coat not removed, sperm can't fertilizze ovum.
  4. Chorion
    Outermost embryonic membrane - thick, forms from the trophoblast layer. Forms chorionic villi. protects and supports embryo as it gorws and develops.
  5. Cleavage
    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.
  6. Cotyledon
    Beefy red functional units of the placenta
  7. Decidua basalis
    • Under blastocyst
    • Site of implantation
    • "Base" of conceptus
  8. Decidua capsularis
    • Capsule/blister around the blast
    • Bubble-like structure that covers the blastocyst
  9. Decidua vera (parietalis)
    Remaining lining (endometrium) - not the basalis, not capsularis
  10. Ductus arteriosus
    Pumped from the lft ventrical to the pulminary artery through the ductus arteriousus into the descending aorta, bypassing the lungs.
  11. Ductus venosus
    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.
  12. Ectoderm
  13. Endoderm
  14. Foramen ovale
    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.
  15. Gametogenesis
  16. 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.
  17. Haploid number of chromosomes
    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).
  18. Lanugo
  19. Meiosis
    Produces reproductive cells (gametes) with haploid number (23) of chromosomes. Allows random assortment of maternal and paternal chromosomes between the gametes.
  20. Mesoderm
  21. Mitosis
    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
  22. Morula
    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
  23. 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: Embryonic
    • 9+ wks: Fetal (Fetal heart tones @ 8-12wks)
  24. Teratogen
  25. Trophoblast
  26. Wharton's jelly
    Specialized connective tissue that surrounds blood vessels in the umbilical cord. Prevents compression of umbilical cord in utero.
  27. Fertilized ovum
  28. Homozygous
    Individual has inherited similar genes for a particular trait from each parent.
  29. Heterozygous
    Dissimilar genes
  30. Oogenesis
    Process that produces the female gamete (ovum/egg). Meiosis.
  31. 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.
  32. Zona Pelucida
    Layer around the ovum closest to the ovum's cell membrane. Sperm binds here.
  33. Malel/Female chromosome pairs
    • Female: XX
    • Mal: XY
  34. EPF
    Early Pregnancy Factor
    Immunosuppressant secreted by the trophoblastic cells. In maternal serum w/in 24-48 hrs after fertilization
  35. Nidation
    Implantation into the endometrium
  36. Amnionic fluid
    • Cushions embryo
    • Controls temperature
    • Permits growth
    • Prevents adherance
    • Protects cord from compression
    • Acts as a wedge during labor
    • Fluid can be used for analysis
  37. Amnionic fluid contains:
    • albumin
    • urea
    • uric acid
    • creatinine
    • lecithin
    • sphingomyelin
    • bilirubin
    • fat
    • fructose
    • leukocytes
    • proteins
    • epithelial cells
    • enzymes
    • fine hair (LANUGO)
  38. Placenta
    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))
  39. Coronary circulation
    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.
  40. 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.
  41. Goodell's sign
    Softening of the cervix
  42. Chadwick's sign
    Blue-purple discoloration of the cervix
  43. Uterine Corpus
    • Perimetrium (peritoneum): Outer
    • Myometrium (muscle layer): Work of labor
    • Endometrium (mucosal layer): Soughed @ Menses
  44. First menses
  45. Which uterine ligaments enlarge during PG, cause 'round ligament "pain"' during PG?
    Round ligaments
  46. Chief uterine supports (ligaments)
    Cardinal ligaments
  47. pH of cervix
    • Acidic when NOT fertile (controls flora!)
    • Alkaline when fertile

    Semen pH is 8.4. Sperm like alkaline environment!
  48. Which part of the falopian tube does fertilization normally take place in?
    The ampula - the distal 1/3
  49. Functions of the ovaries
    • Store and develop follicles
    • Secrete Estrogen
    • Secrete Progesterone
  50. Ovarian Cycle - 3 phases
    • 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)
  51. Menstrual Cycle - 4 phases
    • 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
  52. Basal body temp
    Drop followed by rise = ovulation


    • Estrogen DROPS body temp (proliferative phase)
    • Progesterone RAISES body temp
  53. Characteristics of Proliferative phase (days 7 - 14)
    • Fertile!
    • Estrogen peaks
    • Endometrium / myometrium thickens
    • Cervical mucus at ovulation: clear, thin, watery, alkaline, ferning pattern, skinnbarkheit (stretchy)
    • Favorable to sperm
  54. Ferning indicitive of:
    • Fertile mucus
    • Ruptured membranes
  55. 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
  56. Amenorrhea
    • Primary: 16yr and has never started
    • Secondary: established >3mo, then stops

    • Primary cause is PG
    • Other: lactation, hormonal, nutrition bad, stress, disease, ovarian lesions
  57. Dysmenorrhea
    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)
  58. Metabolic Syndrome
    Major predisposing factor to CHD
  59. Antibody Transport from Mother to Fetus
    • Via Placenta
    • Last 4 wks gestation
    • Passive immunity as IgE from mom / fetus
  60. Fundal Ht @ >20 Wks?
    Roughly = # wks gestation

    20wks = 20cm
  61. Amnionic Fluid Irregularities
    • 38 - 40 wks = 1L
    • Decreases thereafter

    • Polyhydramnios: Excessive. Not swallowing, DM, multiples
    • Oligohydramnios: Decreased.
  62. AFI - Amnionic Fluid Index
    Measures approximate amount of amn fluid around fetus

    Measure pockets, add them up.

    Normal AFI = 5-18
  63. Amnionic Fluid pH
    • Normal amnionic pH >7.0 (Alkaline)
    • Normal cervical secr = acidic

    pH test (Dk Blue) if membranes have ruptures
  64. Fetal Development
    • 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
  65. 1st system to function in embryo
    • 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
  66. Vital structures in fetal circulation
    • 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
  67. Pulmonary Circulation
    • 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
  68. TTN: Transient tachypnea of NB
    Fluid goes away w/draining, suction, absorption

    >60resp, flaring, retractions, poor color, low O2 sat
  69. Hepatic fcn
    • 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
  70. Endocrine system
    • Screen neonates for thyroid fcn
    • Pancreas: produces insulin 20wks gest
    • Glucose: crosses placenta/insulin doesn't. Monitor maternal hyperglycemia
  71. Immunity
    • Passive immunoglobins via placenta
    • IgG crosses placenta "GIFT" of IgG
    • IgM NOT cross placenta. If present=neonate infection.