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Fertilization To Conception: Maternal and Child Health Nursing Pregnancy
Fertilization To Conception: Maternal and Child Health Nursing Pregnancy
Pregnancy
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Fertilization to Conception
Fertilization: the union of the ovum & sperm. The start of Mitotic cell division &fetal sex determination.
> Primary oocyte (immature ovum) contains Diploid number of chromosomes (46).
> One oocyte contains a haploid (23) number of chromosomes after division.
> Gamete (mature ovum): is a cell or ovum that has undergone Maturation & will be ready for
fertilization.
> One gamete carries 23 chromosomes.
> A sperm carries 2 types of sex chromosomes. X & Y.
> 400 million sperm cells in one ejaculation.
> Functional Life of spermatozoa is 48 hours
> XX= female, XY= male.
Morula
Process of Fertilization:
After ovulation
ovum will be expelled from the Graafian follicles
ovum will be surrounded byZona
Pellucida(mucopolysaccharide fluid) & a circle of cells (Corona Radiata) which increases the bulk of the Ovum
expelled from the Fallopian Tube by the Fimbriae (infundibulum). Sperms move by flagella & Penetrate the &
dissolve the cell wall of the ovum by releasing a proteolytic enzyme
(Hyaluronidase)
After
penetration Fusion will result to Zygote.
Zygote migrate for 4 days in the body of the uterus (Mitosis will
take place-Cleavage formation will begin)
After 16-50 cell formation from mitosis, a mulberry & Bumpy
appearance will follow morula after 3-4 days, the structure will be ball like in appearance which will be called
Blastocyst. Cells in the outer ring are called Trophoblast (later it forms the placenta, responsible for the devt of
placenta & fetal membrane; Cells in the inner ring are called Erythroblast cells (which will be the embryo).
Terms to remember:
Ovum: From ovulation to fertilization
Zygote: From fertilization to implantation
Embryo: From implantation to 5-8 weeks.
Fetus:From 5-8 weeks until term
The ovum is said to be viable for 24-36 hours.
Sodium Bicarbonate- the frequent medication to alter the vaginal ph, decrease the acidity of the vagina
so as to INCREASE THE MOTILITY OF THE SPERM.
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Fetal Membranes
Fetal Membranes: membranes that surround the fetus, & give the placenta the shiny appearance.
2 Layers:
1. Amnion: shiny membrane on the 2nd week of Embryonic Development & encloses the Amniotic Cavity
2. Chorion: Outer membrane that supports the sac of the amniotic fluid.
Chorionic Villi: finger like projections from the chorion. This is the place where gases, nutrients and
waste products between the maternal & fetal blood takes place.
Amniotic Fluid: surrounds the embryo, contains fetal urine, lanugo from fetal skin & epithelial cells.
Ph is 7. 2. Specific Gravity: 1.005 1.025
Normal Amount:
500 1000 ml.
Oligohydramniosless than 300 ml.
Polyhydramniosmore than 2000 ml. observe for Down syndrome & congenital defects
Functions of Amniotic Fluid:
a. Protects the fetus from changes in the temperature & cushion against injury.
b. Protects the umbilical cord from pressure, the fetus drinks & breaths the fluid into the lungs.
Amniotic Fluid Colors: Normal color: transparent, clear, with white tiny specks
Dark amber or yellow: Ominous sign of presence of Bilirubin, hemolytic disease
Port Wine Colored: Abruptio Placenta
Greenish: Meconium Stained / FETAL DISTRESS: always go for Cesarian Section! Also if ph is less
than 7.2
If with odor: deliver within 24 hours, may indicate infection.
Umbilical Cord: 21 inches in length & 2 cm in thickness, circulatory communication of the fetus to the
mother. CONTAINS 2 ARTERIES & 1 VEIN. Covered by a gelatinous mucopolysaccharide called
Whartons jelly.
Implantation occurs at the end of the 1st week after fertilization, when the blastocyst attaches to the endometrium.
During the 2nd week (14 days after implantation), implantation progresses and two germ layers, cavities, and cell
layers develop. During the 3rd week of development (21 days after implantation), the embryonic disk evolves into
three layers, and three new structures the primitive streak, notochord, and allantois form. Early during the
4th week (28 days after implantation), cellular differentiation and organization occur.
Fertilization Cycle
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CONCEPTION
PRE-FERTILIZATION
ACTIVITIES
Capacitation
Acrosome reaction
IMPLANTATION
Zona reaction
PROBABLE
POSITIVE
Auscultation of fetal
heart by week 8
Ultrasound imaging
of fetal heart motion
Braxton-Hicks contractions
by week 7
Ballotment: bouncing of the fetus in the amniotic fluid againstUltrasound
the
examiners hand. During the 16th-20th week.
confirmation of
gestational sac by
Braxton Hicks Contractions: painless
week 6
contractions felt for 20-30 minutes occurs on
the 16th week.
Ultrasound: 6 weeks can
auscultate the fetal heart.
Chadwicks sign is a bluish coloring of the vaginal
mucosal that occurs as early as 6 weeks gestation.
Fetal movements palpated
Rationale: due to increase vascularity & blood
by the provider by week
vessel engorgement.
20.
Increase size of the uterus
The most objective sign of
+ Pregnancy Test
pregnancy is fetal
> Secretion of HCG in the urine (Frog Test).
movement felt by the
Detectable 10 days after the missed period
examiner.
. The fetal heartbeat typically can be heard and fetal
rebound is possible between 18 and 22 weeks. The
fetal outline becomes palpable and the fetus is highly
mobile between 28 and 31 weeks. Braxton Hicks
contractions increase in frequency and intensity
between 32 and 35 weeks.
FETAL DEVELOPMENT
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1 mo/ 4 weeks
3 mos./9-12 wks
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Aware of sounds outside the body. Assumes the delivery position. Increased
chance of survival.
Length 330-360 mm. weight 2700-3400 gms.
Face and body has a loose wrinkled appearance because of subcutaneous fat
deposit.
Body is usually lump and lanugo disappears
Nails reach fingertip edge
Amniotic fluid decreases.
Increase Development. Sole of the foot have already
creases. Good chance of survival.
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Fetal Circulation
As early as 3rd week of intra-uterine life, fetal blood is already is circulating, specifically there is already exchange of
nutrients with the maternal circulation in the chorionic villi.
> Arteries carry UNOXYGENATED BLOOD. VEINS carry OXYGENATED BLOOD.
> Fetal Circulation Bypass: Why:
DUE TO NON-FUNCTIONING LUNGS:
----- Ductus arteriousus (between pulmonary artery & Aorta, OPENS AT BIRTH & CLOSES 24 48 hours after
delivery.) It CONTAINS a mixture of arterial & venous blood.
----- Foramen Ovale : between right & left atrium
DUE TO NON-FUNCTIONING LIVER:
----- Ductus Venosus (by pass the liver, closes at birth; an umbilical vein that carries High oxygen from the placenta.
ULTRASOUND
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Ultrasound:
abnormalities,
THE
BEST
PREGNANCIES
TEST
FOR
ECTOPIC
AMNIOCENTESIS
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X-RAY
ALPHA-FETOPROTEIN
SCREENING
L/S RATIO
PHOSPHATIDYL GLCEROL
CREATININE LEVEL
BILIRUBIN
PERCUTANEOUS UMBILICAL
BLOOD SAMPLING
BIOPHYSICAL PROFILE
ELECTRONIC MONITORING
A. Non-Stress Test accelerations in heart rate accompany normal fetal movement; non-invasive
Tocodynamometer records fetal movements and Doppler ultrasound measures
- Observation of fetal heart rate related to fetal movement. Fetal well-being.
Indicated for: assess placental function & oxygenation, fetal well being, evaluates fetal heart rate in response to
fetal movement especially for: Maternal Problems such as chronic hypertension, diabetes and Pre-eclampsia, given
after the 32nd week.
PREPARATION:
Patient should eat snacks.
Position: Semi-Fowlers or left lateral positions the mother may ask tom press the button every time she feels fetal
movements; the monitor records a mark at each point of fetal movement.
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RESULTS:
1. Reactive (normal): indicates a fetal fetus
Greater than 15 beats per minute- occur with fetal movement in a 10 or 20 minute period.
FAVORABLE RESULTS:
- 2 or more FHR accelerations of 15 seconds over a 20 minutes interval and return of FHR to normal baseline.
2. Non-Reactive (Abnormal): No fetal movement occurs or there is short-term fetal heart rate variability (less
than 6 beats per minute). The doctor will order an Oxytocin Test AFTER the patient has non-reactive test.
NOTE: COMMONLY PERFORMED ON DIABETIC PATIENTS BECAUSE OF THE INCREASE RISK FOR STILL
BIRTH.
B. Contraction Stress Test (CST) based on the principle that healthy fetus can withstand decreased oxygen during
contraction but compromised fetus cannot. Response of the fetus to induced uterine contractions as an INDICATOR
OF UTEROPLACENTAL & FETAL PHYSIOLOGICAL INTEGRITY.
PREPARATION:
Woman in semi-Fowlers or side-lying position.
Monitor for post-test labor onset.
TYPES:
a. Mammary stimulation Test or Breast Stimulation Exam or
Nipple Stimulated CST non-invasive
b. Oxytocin Challenge test
Indications: ALL PREGNANCIES AFTER 28 WEEKS WITH HIGH RISK CLIENTS.
Contraindicated for history of PRE-TERM LABOR.
Interpretations:
POSITIVE RESULT: Late decelerations with at least 50% of contractions. Potential risks to the fetus, which may
necessitate to C-section.
Abnormal and known as Positive window. Abnormal: Positive Window: (+) LATE DECELERATIONS OF
FHR with three contractions a 10 minute interval. Indicates Uteroplacental Insufficiency.
NEGATIVE RESULTS: No late decelerations with a minimum of 3 contractions lasting 40-60 seconds in 10 minutes
period. Normal: Negative Window: (-) LATE DECELERATIONS OF FHR with three contractions a 10m minute
interval
Normal and known as Negative window
Laboratory Studies
1. Estriol excretion: measures placental functioning through urine test.
Rh (D) & D negative who hasnt formed antibodies should receive Rhogam at 28
weeks gestation or after 72 hours after delivery.
Nitrazine Test: use of nitrazin strip to detect the presence of amniotic fluid.
Vaginal Secretions: PH: 4.5- 5.5
Amniotic fluid: PH: 7.2 7.5 (turns the yellow Nitrazine blue gray, blue green Ruptured Membranes)
Kicks count: fetal movement counting mother sits quietly on the LEFT SIDE for 1 hour after meals & count fetal kicks for
30 minutes. Notify the physician or health care provider if FEWER THAN 3 KICKS.
Biophysical Profile : surveillance of fetal well being base on 5 categories:
1. Fetal breath movt
2. Fetal tone
3. Amniotic fluid
4. Fetal heart reactivity
5. Placental Grade
Interpretation:
Fetal score of 8 10: normal fetal well-being
Fetal score of 4 6: fetal distress
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