Reproductive Concepts

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NurseFaith
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282232
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Reproductive Concepts
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2014-09-06 12:38:13
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Reproductive Concepts
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  1. Sperm can live up to _____ with adequate cervical secretions
    5 days
  2. Ovum live _____
    24 hours
  3. When is the fertile window?
    • 3-5 days prior to ovulation
    • 24 hours after ovulation
    • (total of 6 days)
  4. Ovulation occurs:
    mid-cycle (+/- 3 days)

    Day 14 of a 28 day cycle
  5. What happens during ovulation?
    • When a woman ovulates the egg will burst from the follicle. Then what is left of the
    • follicle will become the corpus luteum.
    • The corpus luteum produces progesterone. Progesterone makes the lining of the uterus thick for implantation and is necessary to
    • sustain a healthy pregnancy. The corpus luteum produces progesterone until the placenta begins to take over progesterone production around ten weeks gestation.

    • After a woman ovulates, the corpus luteum only lasts for about 12-14 days unless it begins receiving HCG (human chorionic
    • gonadotropin) from a developing embryo. If the egg is not fertilized, the corpus luteum dies and progesterone production stops. When progesterone levels drop, the uterus lining stops thickening and is consequently shed during menstruation.

    • If the egg is fertilized, the corpus luteum
    • will begin receiving HCG from the embryo. HCG tells the corpus luteum to keep producing progesterone. The corpus luteum lasts for about ten weeks after ovulation. After ten weeks the placenta takes over progesterone production through the end of pregnancy.
  6. Process of Conception:
    the nucleus of a single sperm enters the nucleus of the oocyte (egg)

    (sperm passes through the Corona Radiata and Zona Pellucida to reach the nucleus)

    50-150 out of 35-200 million sperm reach the ovum

    Fertilization is complete when the ovum and spermatozoon's nuclei merge...a zygote is formed and contains the diploid number of chromosomes (46)...Cell Division Begins
  7. Stages of Growth:
    • Pre-embryonic:  0-2 weeks (most women don't know they are pregnant)
    • Embryonic:  3-8 weeks, all internal organs formed
    • Fetal:  9+ weeks, Details!!!
  8. What happens during the Pre-Embryonic Stage:
    • Single cell zygote --> cleavage
    • 3 days after fertilization, the zygote forms into a 16 cell solid sphere called a morula.

    Mitosis continues and around day 5 it is known as a blastocyst and enters the uterus.

    Implantation takes from day 6-10  Normally in UPPER uterus

    • Surge of HCG – protein that shows up on pregnancy test
    • Progesterone– supports endometrium

    • 2 weeks from Conception: implantaion is complete...
    • The blastocyst is composed of an inner cell mass called the embryoblast, which will develop into the embryo and an outer cell mass called the trophoblast  which will assist in implantation and will become the
    • placenta
  9. Two important hormones during pre-embryonic stage:
    • Progesterone
    • hCG
  10. What happens during the Embryonic Stage?
    lasts from weeks 3-8

    Basic structures of all major body organs are completed!
  11. What happens in fetal growth 3 weeks from conception
    Beginning of Embryonic Stage

    • Heart begins beating at 22-23 days
    • 3 germ layers form: ectoderm (external), mesoderm (muscle/blood cells), endoderm (lung, thyroid, pancreatic cells)
    • CNS begins to develop
  12. What happens in fetal growth at 4 weeks from conception:
    • C-shaped cylinder
    •    -head/tail
    •    -4-6mm in length

    • Heart beat visible on ultrasound
    • Neural Tube Closesfailure to close causes neural tube defects...suggest women to take folic acid!
    • Eyes/Ears begin to develop

    Limb Buds present
  13. What happens in fetal development at 5 weeks from conception:
    7-9 mm in length

    Heart develops 4 chambers

    Nasal pits and hand plates develop
  14. What happens in fetal development at 6 weeks from conception:
    11-14mm in length

    Heart chambers completed

    Upper/Lower extremities more defined

    Intestines contained in umbilical cord
  15. What happens in fetal development at 7 weeks from conception:
    2 cm in length

    Eyelids present

    Ears distinguishable
  16. What happens in fetal development at 8 weeks from conception?
    End of embryonic stage

    3 cm in length

    Eyelids/lips fuse

    External Genitalia well developed

    Fingers/Toes distinct

    Heart rate audible by doppler! (some people wait until they hear heartbeat to tell people about pregnancy!)
  17. Chemical or infectious agent that causes birth defects
    • Teratogen
    • IE: medication for epilepsy

    (1st 8 weeks of pregnancy are most dangerous/vulnerable bc many women don't know they are pregnant yet)
  18. The effect on the fetus from a teratogen is highly dependent on:
    • Gestational age at time of exposure
    • (0-2 weeks not risk, but 3-8 are highest risk!)
  19. Types of Teratogens
    • Infectious:
    •    -Rubella, Syphilis, Cytomegalovirus
    • Medications:
    •    -Accutane, Tetracycline (baby's teeth), Warfarin, Valproic Acid (depakote)
    • External Agents:
    •    -Radiation, Hyperthermia, ETOH, Tobacco
    • Maternal disorders (suggest counseling)
    •    -Diabetes
    •    -PKU
    •    -Hypo/hyperthyroidism
  20. Medication Pregnancy Categories:
    • A- no human risk 
    •    Folic Acid, very few other drugs
    • B- animals show no risk, but not many human studies done
    •    Penicillin, Zyrtec
    • C- no good studies
    •    Macrobid (UTI med)
    • D- fetal risk clear cut, but benefits outweigh risks
    •    Tetracylcine, Paxil, Dilantin
    • X- Fetal Risks outweigh benefits
    •    ETOH, Warfarin, DES, Valproic Acid, Accutane
  21. What happens in fetal development at 9-12 weeks from conception:
    Beginning of Fetal Stage

    Fetal Head is 1/2 body

    Urine starts to form

    Fingers/Toes defined

    Nasal Septum and palate

    Sucking reflex

    Digestive tract patent
  22. What happens during fetal development at 13-16 weeks from conception:
    • Rapid growth, fetus doubles in size
    • Lanugo present
    • Fingernails
    • Eyes face anteriorly
    • Fully formed placenta
  23. What happens during fetal development at 17-23 weeks from conception:
    • Growth slows down
    • Lower limbs fully formed
    • Lanugo over entire body
    • Vernix caseosa by 20 weeks (waxy covering)
    • Eyebrows and head hair
    • Brown Fat forms
  24. What happens in fetal growth at 24-27 weeks from conception
    Red, wrinkled skin

    Eyes re-open, eyelashes form

    Lungs begin to make surfactant

    Alveoli develop (increased chance of survival outside of womb)
  25. What happens in fetal growth at 28-31 weeks from conception:
    Capable of breathin air

    If born, may have RDS (because not enough surfactant)

    SQ white fat

    Bone marrow makes RBC

    Vertex position
  26. What happens in fetal development at 33-38 weeks from conception
    Pulmonary system maturation (deliver after 38 weeks to avoid lung problems)

    Growth of all body systems

    Weight Gain

    NS mature

    Skin becomes smoother
  27. Disk shaped organ that has critical functions to pregnancy (metabolic functions, transfer functions and endocrine functions)
    Placenta
  28. Maternal side of the placenta:
    Rough, attaches to uterus

    Maternal blood flows through the placenta's intervillous space

    Exchange occurs in the intervillous spaces

    Maternal and fetal blood do not mix
  29. Fetal side of Placenta
    Smooth, covered with membranes

    Develops from outer cell layer (trophoblast) of the blastocyst

    Chorionic villi with maternal blood in the intervillous spaces

    Membranes separate chorionic villi from maternal blood
  30. Transfer Placenta Functions:
    • Gas Exchange (O2 and CO2)
    • Nutrient Transfer- glucose, fatty acids, vitamins, electrolytes, amino acids
    • Waste Removal
    • Antibody Transfer- passive immunity, IgG antibodies
  31. Metabolic Placenta Functions
    Placenta produces glycogen, cholesterol, fatty acids

    Used for: placental functions and growing embryo
  32. Endocrine Placenta Function
    • Placental Hormones:
    •   hCG- maintains corpus luteum
    •      (reason for positive pregnancy tests)
    •    Estrogen- growth of uterus and breasts
    •    Progesterone- maintains endometrium, relaxes smooth muscle
    •    Human Placental Lactogen (hPL)- ensures fetal glucose supply
    •    Relaxin- inhibits uterine activity, softens connective tissue
  33. Fetal Membranes:
    • Amnion- inner membrane
    • Chorion- outer membrane

    Both make up the Bag of Waters
  34. Amniotic Fluid provides:
    • Cushioning
    • Room for fetal movement
    • Constant temp
    • Prevents membranes from adhering to fetal parts
    • Serves as a source of oral fluid for baby
  35. The Umbilical cord consists of:
    *LIFELINE from placental to fetus

    1 vein, 2 arteries, Wharton's Jelly

    • Vein-- Carries O2 and nutrients rich blood TO
    • Arteries- Carry De-O2 and waste blood AWAY
  36. Process of Fetal Circulation:
    1. Intrauterine-- O2 from mom, fetus doesn't need to breath and liver metabolic functions are minimized

    2. Fetal Circulation is altered to BYPASS the fetal lungs and liver

    • 3. 3 Shunts in the fetal circulation cause Highest O2 Blood to Brain and Heart
    •    *Ductus Venosus- bypasses liver, enters inferior vena cava
    •    *Foramen Ovale- bypass lungs
    •    *Ductus Arteriosus- blood enters aorta through pulmonary artery
  37. Infant Circulation AFTER Birth:
    • First breath= lungs expand and change
    •     *Foramen Ovale closes > Arterial O2 > Ductus Arteriosis Constricts > baby breathes in and has normal system now

    • The fetus is connected by the umbilical cord to the placenta, the organ that develops and implants in the mother's uterus during
    • pregnancy.
    • Through the blood vessels in the umbilical cord, the fetus receives all the necessary nutrition, oxygen, and life support from the
    • mother through the placenta.
    • Waste products and carbon dioxide from the fetus are sent back through the umbilical cord and placenta to the mother's circulation
    • to be eliminated.
    • Blood from the mother enters the fetus
    • through the vein in the umbilical cord. It goes to the liver and splits into three branches. The blood then reaches the inferior vena cava, a major vein connected to the heart.

    • Inside the fetal heart:
    • Blood enters the right atrium, the chamber on the upper right side of the heart. Most of the blood flows to the left side through a
    • special fetal opening between the left and right atria, called the foramen ovale.
    • Blood then passes into the left ventricle (lower chamber of the heart) and then to the aorta, (the large artery coming from the heart).
    • From the aorta, blood is sent to the head and upper extremities. After circulating there, the blood returns to the right atrium of the heart through the superior vena cava.
    • About one-third of the blood entering the right atrium does not flow through the foramen ovale, but, instead, stays in the right side of the heart, eventually flowing into the pulmonary artery.
    • Because the placenta does the work of
    • exchanging oxygen (O2) and carbon dioxide (CO2) through the mother's circulation, the fetal lungs are not used for breathing. Instead of blood flowing to the lungs to pick up oxygen and then flowing to the rest of the body, the fetal circulation shunts (bypasses) most of the blood away from the
    • lungs. In the fetus, blood is shunted from the pulmonary artery to the aorta through a connecting blood vessel called the ductus arteriosus.

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