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Home , Amniotic sac

Dr. oday alfartosy 1 Maternity and Obstetric Nursing Lec :19 Dr. oday alfartosy ([email protected]) د.عدي الفرطوسي .Ph.D. Pediatric Nsg

جامعة املثىن College of Nursing

محاضرات النسائية والتوليد 2017-2018 الدكتور

عدي فارس الفرطوسي

Pregnancy

Lec/4

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Dr. oday alfartosy 2 Maternity and Obstetric Nursing Lec :19 Dr. oday alfartosy ([email protected]) د.عدي الفرطوسي .Ph.D. Pediatric Nsg Maternity and Obstetric Nursing Lecture (4) Dr. Oday alfartosy It is normal physiological process, its state of being with child. Normal duration of pregnancy is 280 days or 40 weeks, 10 lunars,9 calendar. Stage of Pregnancy: 1. Ovulation 2. Insemination 3. Fertilization 4. Implementation

(gravidity or gestation): The period from conception to . Term: Is the normal duration of pregnancy 40 wks. (Average), 38- 42 (range) (40 – 42wk) Preterm: (20-37wk) (28- 37 wks.) of pregnancy. Posterm: After 42 wks. gestation

Physiology of pregnancy (Stage of pregnancy) 1-Ovulation In the ovary there are many follicles at different levels of development. But only the most mature one (Graffian Follicle) will rupture at time of ovulation to produce an ovum, which will enter the Fallopian tube by the action of its fimbriae. 3- Insemination: enter of sperms to the fallopian tube to fertilized the ova 2- Fertilization Occurs at Fallopian tube, producing fertilized ovum or zygote. 3- Implantation After fertilization, the zygote divides rapidly and begins its descent to the , where it arrives on about the fifth day, and implants on the sixth. The cells then begin the process of differentiation, forming all the various types of cells that make up the human body.

Intrauterine life is including 3 periods:- 1- Ovum period: from ovulation up to 2nd weeks and include: ovum, fertilized ovum, morula, and implantation. 2- Embryonic period: begin from 3rd week of fertilization up to 8th week nearly all system are formed during this period it is critical for teratogenic effect. 3- Fetal period: from the end of the 8th week till delivery at 37-42 week of gestation.

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Dr. oday alfartosy 3 Maternity and Obstetric Nursing Lec :19 Dr. oday alfartosy ([email protected]) د.عدي الفرطوسي .Ph.D. Pediatric Nsg and Fetal Development Embryo From the time of implantation through 8 weeks of gestation. The heart forms during the 3rd gestational week and begins to beat during the 4th gestational week Stages of fetal development ❖ 4th week of gestation: fetal length about 1mm. and the fetal weight about 1mg Nervous system, genital urinary system, skin, bones, are formed. ❖ 8th week of gestation: the fetal length about 1cm. and the fetal weight about 1g. External ears, fingers and toes are formed. ❖ 12th week of gestation: the intestine completely withdrawn into the abdomen the external sexual organ begins to be differentiated. ❖ 28th week of gestation: the considers legally viable. Weight 1100gm. Length about 35cm. The skin is covered with vernix caseosa. Eyes are open. ❖ 40th week of gestation: normal weight about 2.5 -4 kg length about 50 cm.

Placenta, Membranes, , and

1- Is formed from both fetal and maternal tissue and becomes fully functional between the 8th and 10th weeks of gestation in the 9th month, the placenta is between 15 and 25 cm in diameter, 3 cm thick, and weighs approximately 600 grams and has 15-20 lobes. The maternal side of the placenta is divided into compartments or lobes known as cotyledons.

The functions of placenta: 1. Supplies the fetus by nutrient substances(nutrition) and takes away the waste products. 2. Gas exchange O2&CO2 , between the mother and fetus. 3. Placenta secrets hormones : • Progesterone and Estrogen • Human chorionic somatomammotropin (human placental lactogen (HPL). • Human chorionic gonadotrophin. 2-Embryonic Membranes 1. Two membranes ( and ) form the 2. The chorionic membrane (outer membrane). 3. The amniotic membrane (inner membrane). 4. The membranes stretch to accommodate the growth of the developing fetus and the increase of amniotic fluid.

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Dr. oday alfartosy 4 Maternity and Obstetric Nursing Lec :19 Dr. oday alfartosy ([email protected]) د.عدي الفرطوسي .Ph.D. Pediatric Nsg 3-Amniotic Fluid Is clear and is mainly composed of water. It also contains proteins, carbohydrates, lipids, electrolytes, fetal cells, lanugo, and vernix caseosa. ❖ During the 1st trimester is produced from the amniotic membrane. ❖ During the 2nd and 3rd trimesters, the fluid is produced by the fetal kidneys. ❖ Amniotic fluid increases during pregnancy and peaks around 34 weeks at 800–1,000 mL and then decreases to 500–600 mL at term. Has many functions including: 1. Protect the fetus from the external effects. 2. Easy movement of fetus. 3. Control the temperature of fetus. . 4. Prevent the attachment between the fetus and amniotic sac. 4-Umbilical Cord 1. Connects the fetus to the placenta 2. Consist of two umbilical arteries and one 3. The vessels are surrounded by Wharton’s jelly, a collagenous substance, which protects the vessels from compression. 4. Usually inserted in the center of the placenta. 5. Average length of the cord is 55 cm.

Pregnancy (antepartum (antepartal) period, prenatal period, The period from conception to birth (known as the intrapartal period).

Sign &Symptoms of Pregnancy 1-Presumptive signs: include all subjective signs of pregnancy (i.e., physiological changes perceived by the woman herself): 1. Amenorrhea 2. Nausea and vomiting 3. Breast changes: Enlargement, tenderness, and tingling of breasts 4. Fatigue 5. Urination frequency

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Dr. oday alfartosy 5 Maternity and Obstetric Nursing Lec :19 Dr. oday alfartosy ([email protected]) د.عدي الفرطوسي .Ph.D. Pediatric Nsg 6. : A woman’s first awareness of fetal movement; occurs around 18–20 weeks’ gestation in primigravida's (between 14–16 weeks in multigravidas)

3-Probable signs: Are objective signs of pregnancy and include all physiological and anatomical changes that can be perceived by the health care provider:

1. Chadwick’s sign: Bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6–8 weeks 2. Goodell’s sign: Softening of the cervix and vagina with increased leukorrheal discharge; palpated at 8 weeks 3. Hegar’s sign: Softening of the lower uterine segment; palpated at 6 weeks 4. Uterine growth and abdominal growth 5. Skin hyperpigmentation ❖ (Chloasma): Brownish pigmentation over the forehead, temples, cheek, and/or upper lip ❖ Linea Nigra: Dark line that runs from the umbilicus to the pubis ❖ Nipples and areola: Become darker; more evident in primigravida and dark-haired women ❖ stria gravidarum (stretching of the skin) 6. Ballottement: A light tap of the examining finger on the cervix causes fetus to rise in the amniotic fluid and then rebound to its original ; occurs at 16–18 weeks 7. Positive results

3- Positive signs: Are the objective signs of pregnancy (noted by the examiner) that can only be attributed to the fetus? 1. Auscultation of the fetal heart, by 10–12 weeks’ gestation with a Doppler 2. Observation and palpation of fetal movement by the examiner after about 20 weeks’ gestation Sonographic visualization of the fetus: Cardiac movement noted at 4–8 weeks

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