BULLETS

Bullets

Here are the pediatric nursing bullets:

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1. A child with HIV-positive blood should receive inactivated poliovirus vaccine (IPV)
rather than oral poliovirus vaccine (OPV) immunization.

2. To achieve postural drainage in an infant, place a pillow on the nurse’s lap and lay
the infant across it.

3. A child with cystic fibrosis should eat more calories, protein, vitamins, and minerals
than a child without the disease.

4. Infants subsisting on cow’s milk only don’t receive a sufficient amount of iron (ferrous
sulfate), which will eventually result in iron deficiency anemia.

5. A child with an undiagnosed infection should be placed in isolation.

6. An infant usually triples his birth weight by the end of his first year.

7. Clinical signs of a dehydrated infant include: lethargy, irritability, dry skin decreased
tearing, decreased urinary output, and increased pulse.

8. Appropriate care of a child with meningitis includes frequent assessment of

neurologic status (i.e., decreasing levels of consciousness, difficulty to arouse) and
measuring the circumference of the head because subdural effusions and obstructive
hydrocephalus can develop.

9. Expected clinical findings in a newborn with cerebral palsy include reflexive

hypertonicity and crisscrossing or scissoring leg movements.
10. Papules, vesicles, and crust are all present at the same time in the early phase of
chickenpox.

Chicken Pox. Image via. kidshealth.org

11. Topical corticosteroids shouldn’t be used on chickenpox lesions.

12. A serving size of a food is usually one (1) tablespoon for each year of age.

13. The characteristic of Fifth disease (erythema infectiosum) is erythema on the face,
primarily the cheeks, giving a “slapped face” appearance.

Fifth disease rash.

14. Adolescents may brave pain, especially in front of peers. Therefore, offer analgesics
if pain is suspected or administer the medication if the client asks for it.

15. Signs that a child with cystic fibrosis is responding to pancreatic enzymes are the
absence of steatorrhea, improved appetite, and absence of abdominal pain.

16. Roseola appears as discrete rose-pink macules that first appear on the trunk and that
fade when pressure is applied.
17. A ninety-ninety traction (90 degree–90 degree skeletal traction) is used for fracture
of a child’s femur or tibia.

Ninety-ninety traction
18. One sign of developmental dysplasia is limping during ambulation.

19. A small-for-gestational age (SGA) infant is one whose length, weight, and head
circumference are below the 10th percentile of the normal variation for gestation age as
determined by neonatal examination.

20. Neonatal abstinence syndrome is manifested in central nervous system

hyperirritability (e.g., hyperactive Moro reflex) and gastrointestinal symptoms (watery
stools).

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21. Classic signs of shaken baby syndrome are seizures, slow apical pulse difficulty
breathing, and retinal hemorrhage.

22. An infant born to an HIV-positive mother will usually receive AZT (zidovudine) for
the first 6 weeks of life.

23. Infants born to an HIV-positive mother should receive all immunizations of

schedule.

24. Blood pressure in the arms and legs is essentially the same in infants.
25. When bottle-feeding a newborn with a cleft palate, hold the infant’s head in an
upright position.

26. Because of circulating maternal antibodies that will decrease the immune response,
the measles, mumps, and rubella (MMR) vaccine shouldn’t be given until the infant has
reached one (1) year of age.

27. Before feeding an infant any fluid that has been warmed, test a drop of the liquid on
your own skin to prevent scalding the infant.

28. A newborn typically wets 6 to 10 diapers per day.

29. Although microwaving food and fluids isn’t recommended for infants, it’s common in
the United States. Therefore the family should be taught to test the temperature of the
food or fluid against their own skin before allowing it to be consumed by the infant.

30. The most adequate diet for an infant in the first 6 months of life is breast milk.

31. An infant can usually chew food by 7 months, hold spoon by 9 months, and drink
fluid from a cup by one year of age.

32. Choking from mechanical obstruction is the leading cause of death (by suffocation)
for infants younger than 1 year of age.

33. Failure to thrive is a term used to describe an infant who falls below the fifth
percentile for weight and height on a standard measurement chart.

34. Developmental theories include Havighurst’s age periods and developmental tasks;
Freud’s five stages of development;

35. Kohlberg’s stages of moral development; Erikson’s eight stages of development; and
Piaget’s stages of cognitive development.
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36. The primary concern with infusing large volumes of fluid is circulatory overload.
This is especially true in children and infants, and in clients with renal disease (or any
person with renal disease, for that matter).

37. Certain hazards present increased risk of harm to children and occur more often at
different ages. For infants, more falls, burns, and suffocation occur; for toddlers, there are
more burns, poisoning, and drowning for preschoolers, more playground equipment
accidents, choking, poisoning, and drowning; and for adolescents, more automobile
accidents, drowning, fires, and firearm accidents.

38. A child in Bryant’s traction who’s younger than age 3 or weighs less than 30 lb
(13.6 kg) should have the buttocks slightly elevated and clear or the bed. The knees
should be slightly flexed, and the legs should be extended at a right angle to the body.

Bryant’s Traction
39. The body provides the traction mechanism.

40. In an infant, a bulging fontanel is the most significant sign of increasing intracranial
pressure.

THE NEWBORN
Profile of the Newborn

Newborns may look alike, but each has their own physical attributes and personalities.
Some newborns are fat and short while some are long and thin. There are newborns who
never give a fuss whenever they are changed or cuddled, but some can cry in high
decibels whenever you lift them from their cradles.

 The weight of newborns varies according to their race, genetics, and nutritional
factors.
 To determine if the newborn’s weight is appropriate for its gestational age, a
neonatal graph should be used in plotting the newborn’s weight.
 Plotting the height and head circumference of the newborn also helps determine
any disproportions.
 The average birth weight for a mature female newborn in the United States is
3.4kg or 7.5 lbs, and for the mature male newborn is 3.5 kg or 7.7 lbs.
 For all races, the normal weight is 2.5 kg or 5.5 lbs.
 The newborn loses 5% to 10% of its birth weight during the first few days of
life, then has 1 day of stable weight, and gains weight rapidly afterward.
 The newborn must gain 2 lbs per month for the first six months of life.
 The average birth length of mature female newborns is 53 cm or 20.9 inches.
The mature male newborn has an average birth length of 54 cm or 21.3 inches.
 A mature newborn has a head circumference of 34 to 35 cm.
 Head circumference is measured with a tape measure drawn across the center
of the forehead and around the most prominent part of the posterior head.
 The chest circumference in a mature newborn is 2 cm less than the head
circumference.
 Chest circumference is measured at the level of the nipple using a tape
measure.
Vital Statistics

Parameter Average

Weight 6.5 to 7.5 lbs (2.9 kg to 3.4 kg)

Length 50 cm (20 in)

Head circumference 33 to 35 cm (13 to 13.7 in)

31 to 33 cm or
Chest circumference
2cm less than head circumference

Abdominal circumference 31 to 33 cm

Vital signs
Vital Sign Immediately At Birth After Birth

Temperature 36.5 to 37.2 Celsius

120-140 beats/minute
Pulse 180 beats/minute
ave.

Respiration 80 breaths/minute 30-50 breaths/minute

100/50 mmHg (by 10th

Blood Pressure 80/46 mmHg
day)

Adjustment to Extrauterine Life

  The newborn’s color on the first 15 to 30 minutes of life is still acrocyanotic,
and after 2 to 6 hours, there are quick color changes that may occur with
movement or crying.
 The temperature within the first 15 to 30 minutes after birth falls from the
intrauterine temperature of 100.6⁰F or 38.1⁰C then stabilizes at 37.6⁰C after 2 to
6 hours.
 The rapid heart rate of as much as 180 BPM on the first 15 to 30 minutes of life
will have wide swings in rate with activity as it slows to 120-140 BPM.
 The newborn’s respirations are irregular in the first few minutes of life, then
slows to 30-60 breaths per minute after 30 minutes and will become irregular
again only during activity.
 The newborn would be alert in the first 15 to 30 minutes of life, and later on,
will alternate between the sleeping and awakening phases.
 Just a few minutes after birth, the newborn would respond to stimulation
vigorously but would be difficult to arouse while it is still on a resting period
until it becomes responsive again 2 to 6 hours after birth.
 The bowel sounds can be heard after the first 15 minutes of life and becomes
present afterward.

Appearance of the Newborn

Newborn Appearance
 Increased concentration of red blood cells in newborns, and decreased amount
of subcutaneous fat gives them a ruddy complexion.
 In the first month, this ruddy complexion slightly fades.
 A pale and cyanotic newborn signifies that she may have poor central nervous
system control.
 A gray color in newborns may indicate infection.
 Acrocyanosis is normal in a newborn, wherein the hands, feet, and lips are
bluish in color.
 Central cyanosis, however, is a cause for concern as this may indicate a
decrease in oxygenation.
 Jaundice appears on the second or third day of life as a result of the breakdown
of fetal red blood cells.
 Early feeding to speed the passage of feces through the intestine and prevent
reabsorption of bilirubin from the bowel may diminish physiologic jaundice.
 Pallor in newborns is a sign of anemia, and the newborn must be watched
closely for signs of blood in the stool or vomitus.
 Harlequin sign or when a newborn who is lying on his or her side appears red
on the dependent side and pale on the upper side does not have a clinical
significance.
 Vernix caseosa or the white cream cheese-like substance is washed away in the
first bath, but never rub harshly as it will only come off gradually.
 Lanugo or the fine, downy hair that covers the shoulders, arms and back of the
newborn would be rubbed away by the friction of the bedding and clothes of
the newborn.
 A white, pinpoint papule called milia can be found in some newborns, mainly
on the cheek or the bridge of the nose, and they disappear by 2 to 4 weeks of
age.
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 The fontanelles or the spaces or openings where the skull bones join are soft
spots on the newborn’s head.
o The anterior fontanelle is located between the two parietal bones and
the two frontal bones which gives it a diamond shape, and normally
closes at 12 to 18 months of age.
o The posterior fontanelle is located at the junction of the parietal bones
and the occipital bone and is triangular in shape, and closes at the end
of the second month.
 Newborns cry tearlessly until three months of age when the lacrimal ducts
mature.
 Birthmarks
o Hemangiomas are vascular tumors of the skin.
o Nevus flammeus are muscular purple or dark red lesion. Generally
appear on the face and thighs.
o Strawberry hemangiomas—elevated areas formed by immature
capillaries and endothelial cells.
o Cavernous hemangiomas—these are dilated vascular spaces.
o Mongolian spots—slate gray patches across the sacrum or buttocks
and consist of a collection of pigment cells.
o Forceps marks—these are circular or linear contusion matching the
rim of the blade forceps on the infant’s cheeks.
  Permanent eye color appears on the 3rd to 12th month of age.
 The newborn’s external ear is not yet fully formed, and the top part of the
external ear should be on a line drawn from the inner canthus to the outer
canthus of the eye and back across the side of the head.
 The newborn’s nose tends to look large for the face but the rest of the face will
grow more than the nose does.
 The newborn’s mouth must open evenly when he or she cries.

PRENATAL VISIT

Initial Interview

 The first prenatal interview could take a long time, so the person who is
scheduling appointments for the visits should make the woman aware to avoid
cancelling of appointments or rushing of the interview because the woman has
an errand to attend to.
 It is important that the healthcare provider should establish rapport even on the
first visit because information such as what the woman feels about her
pregnancy and if she has any fears can only be taken once the woman trusts her
healthcare provider.
 Personal interviews can also make the woman feel important and that she is not
just one of the patients that would immediately be forgotten after the visit.
 The interview must take place in a private, quiet environment because it would
be difficult for the woman to answer all the questions when you are in a sitting
room full of waiting patients or on the hallway.
 The woman must also understand your role in the assessment, because if she
views you only as the interviewer you would only get superficial information
from her.
Health History

 One of the purposes of the initial interview is to assess the health history of the
pregnant woman.
 Establishing a baseline health data is crucial especially when there is a new
symptom that arises from the woman and it could only be identified as new
based on the data gathered from her health history.

Demographic Data

 The demographic data are the superficial data that can be obtained from the
woman.
 These include the name, age, address, telephone number, and health insurances.

Chief Concern

 The chief concern of the woman when she visits the clinic is she thinks she
might be pregnant.
 Assess the first day of the last menstrual period of the woman.
 Assess any early signs of pregnancy such as nausea and vomiting, fatigue, and
breast tenderness.
 Inquire if she has tried any home pregnancy test kit or had a pregnancy test
from a clinic to establish her pregnancy.

History of Past Illnesses

 It is important to assess any past illness because it might become active during
or after the pregnancy.
 Assess if there are any infections from the past, especially sexually transmitted
diseases so you could educate the woman and suggest any vaccines available.
 There are vaccines that are not friendly for a pregnant woman; however,
vaccines such as influenza and poliomyelitis can be administered.
  Assess any allergies present even before pregnancy to avoid triggers that could
also affect the fetus.

History of Family Illnesses

 Assess the presence of family illnesses such as hypertension, diabetes, or

asthma on both the father and mother.
 There are illnesses that could become a potential problem during pregnancy or
one that could be transferred to the fetus.

Social Profile

 Assess the woman’s current nutrition profile, or ask her to have a 24-hour recall
to obtain nutrition information.
 Assess the frequency, type, and amount of exercise she does to determine if her
pattern of activities is still recommended during pregnancy.
 Assess if the woman smokes or drinks, its frequency, and amount because these
vices could cause fetal alcohol syndrome or preterm birth.
 Assess history of medication intake and what medication the woman is taking
during pregnancy to determine its possible effects on the fetus.

Gynecologic History

 Obtain the age of the woman’s menarche, her usual cycle, the duration, and the
amount of menstrual flow.
 Assess any past reproductive tract surgery as it can affect the present
pregnancy, such as tubal surgery from ectopic pregnancy.
 Assess the reproductive planning method that the woman used or will be using
after pregnancy, and also her sexual history to educate her about safe sex
practices.

Obstetric History
  Assess the woman’s pregnancy history using GTPALM.
 G is the gravid classification or the number of times the woman became
pregnant.
 T is the number of full term infants born.
 P is the number of preterm infants born.
 A is the number of miscarriages or therapeutic abortions.
 L is the number of living children.
 M refers to multiple pregnancies.

Systemic Assessment

 Assess the woman’s respiratory system, if she is currently experiencing cough,

asthma, pain upon breathing, or any serious respiratory illnesses such as
tuberculosis.
 Assess the cardiovascular system and any history of heart murmurs, heart
diseases, hypertension, and if she knows her blood pressure level and any
experience of blood transfusion.
 Assess her gastrointestinal system; ask about her pre-pregnancy weight, any
discomforts such as vomiting, diarrhea or constipation, hemorrhoids, and
changes in bowel habits.
 Assess her genitourinary system and ask about any urinary tract infections,
STIs, PIDs, any difficulties in conceiving, and hematuria.
 Assess any breast lumps, secretions, pain upon palpation of the breast, or
tenderness.
 Assess the woman’s last dental exam, the use of any dentures, the condition of
the teeth, and if she is experiencing any difficulty in swallowing.

Laboratory Assessment
Papanicolaou Smear (Pap smear)

 Pap smear is performed to detect and diagnose the presence of precancerous

and cancerous conditions of the cervix, vulva, or vagina.
 The test also reveals infectious diseases and inflammation.
 The classification of Pap smear can be seen in the Bethesda classification of
Pap smears.
 Women who have multiple sexual partners, smoke cigarettes, have a history of
HPV, and sexually active before 21 years old should have Pap smear done
more frequently.

Blood Studies

 Complete blood count should be taken to assess the hemoglobin, hematocrit,

and red cell index and determine the presence of anemia.
 White blood cell count and platelet count must also be obtained to assess for
infection clotting ability.
 Blood typing with Rh factor is also important because blood needs to be
available if ever the woman experiences bleeding during pregnancy.
 Maternal serum alpha fetoprotein detects birth defects such as neural tube
defects if elevated and chromosomal anomalies if decreased.
 Antibody titers for rubella and hepatitis B or HBsAG determine whether the
woman is protected against rubella and if the newborn would have a chance of
developing hepatitis B.

Glucose Tolerance Test

 A woman with a history of diabetes, large for gestational age babies, obese, or
has glycosuria should undergo glucose tolerance test.
 A 50-g oral toward the end of the first trimester should be performed to rule out
gestational diabetes.
 The plasma glucose level should not exceed 140mg/dl at 1 hour.
Urinalysis

 Urinalysis is performed to assess proteinuria, glycosuria, and pyuria.

 These can be done through test strips or microscopic examination of the urine.

Ultrasonography

 To confirm pregnancy, an ultrasound must be scheduled especially if the

woman is unsure of the date of her last menstrual period.
 Ultrasonography would also determine the growth of the fetus, but only the
gestational sac would be seen at this stage.

Many couples are excited for their first prenatal visit, especially those who are having
their first baby. Compliance of all the instructions of the healthcare provider is essential
so the woman could achieve a smooth and healthy pregnancy and delivery. A mother
would only want the best for her child, starting from her womb until she is already
cuddling her little angel in her arms.

FETAL GROWTH ASSESSMENT

Estimating Fetal Growth

McDonald’s Rule

 McDonald’s rule is the measurement of the fundal height from the symphysis
pubis.
 To measure, instruct the woman to lie supine and start measuring from the
symphysis pubis to the uterine fundus.
 The distance between in centimeters depicts the week of gestation between the
20th to the 31st weeks of pregnancy.
 At 12 weeks, the uterine fundus should be at the level of the symphysis pubis.
 At 20 weeks, the uterine fundus should be at the level of the umbilicus.
 At 36 weeks, the uterine fundus should be at the level of the xiphoid process.
Fetal Movement

 Quickening or the first fetal movement that is felt by the mother usually starts
at 18 to 20 weeks of pregnancy.
 A healthy fetus moves at an average of at least 10 times a day.
 In the Sandovsky method, to assess the fetal movement, ask the woman to lie
in a recumbent position after a meal and record the number of fetal movements
within an hour.
 In every 10 minutes, the fetus normally moves at least twice or 10 to 12 times
in an hour.
 If there is less than 10 movements in an hour, the woman should repeat the
procedure for the next hour.
 The Cardiff method or the “Count-to-Ten” method, the woman records the
time interval between every 10 fetal movements she feels within 60 minutes.

Fetal Heart Rate

Rhythm Strip Testing

 The normal fetal heart rate is 120 to 160 beats per minute.
 In rhythm strip testing, the fetal heart rate is assessed if a good baseline heart
rate or a degree of variability is present.
 The results are categorized as absent (none apparent), minimal (extremely small
fluctuations), moderate (a range of 6-25 beats per minute), and marked (range
over 25 beats per minute).
 The rhythm strip testing is done as the woman is asked to remain in a fixed
position for 20 minutes.

Nonstress Test

 In a nonstress testing, the response of the fetal heart rate is measured in

response to the fetal movement.
  The woman is attached to a fetal heart rate and uterine contraction monitor.
 The woman should push the button of the monitor whenever she feels the fetus
move.
 Normally, when the fetus moves, the fetal heart should increase for about 15
beats per minute and remain elevated for 15 seconds.
 The nonstress test is done for 10 to 20 minutes.
 The result is reactive if there are two accelerations of fetal heart rate lasting for
15 seconds that occurs after movement.
 The result is non reactive if there are no fetal accelerations after a fetal
movement, or there is no fetal movement.
 If the nonstress test is nonreactive, a contraction stress test or biophysical
profile will be scheduled.

Contraction Stress Testing

 In contraction stress testing, the fetal heart rate is assessed in conjunction with
uterine contractions.
 The woman is attached to an external uterine contraction and fetal heart rate
monitor.
 The woman is instructed to roll a nipple between her fingers and thumb to
produce uterine contractions.
 Within a 10-minute window, three contractions with a duration of 40 seconds
or longer must be present.
 The test is negative or normal if there are no decelerations in the fetal heart rate
during contractions.
 It is positive or abnormal if there is a late deceleration at the end of a
contraction and even after the contraction.

Ultrasonography

 Ultrasonography measures the response of sound waves against solid objects.

  It can diagnose a pregnancy of 6 weeks’ gestation, confirm the presence, size,
and location of the placenta, establish that the fetus is growing, detect any gross
anomalies, establish the fetal sex, and determine the presentation and position
of the fetus.
 The woman has to have a full bladder at the time of the procedure.
 Have the woman drink a full glass of water every 15 minutes 90 minutes before
the procedure until the start of the procedure.
 Ultrasonography is also used to predict fetal maturity by the measurement of
the biparietal diameter of the fetal head.
 Placental grading can also be done through ultrasound as 0 (12 to 24 weeks), 1
(30 to 32 weeks), 2 (36 weeks), and 3 (38 weeks).
 The amount of amniotic fluid present can also be detected through
ultrasonography and is also a way to estimate fetal health.

Electrocardiography

 As early as the 11th week of pregnancy, fetal ECG can be recorded.

 However, fetal ECG is inaccurate before the 20th week as the fetal electrical
conduction is still weak.

Magnetic Resonance Imaging

 MRI does not have any harmful effects to both the mother and the fetus, and is
now largely considered as one of the preferred fetal assessment techniques.
 MRI can diagnose complications like ectopic pregnancy and trophoblastic
disease or H-mole because fetal movements could hide the findings later in
pregnancy.

Maternal Serum Alpha Fetoprotein

AFP is found in the amniotic fluid and the maternal serum and is produced by the fetal
liver.
  MSAFP levels start to increase at 11 weeks’ gestation and increases steadily
until term.
 The MSAFP level is abnormally high if there is a spina bifida defect or
abdominal defect.
 The MSAFP level is low if the fetus has a chromosomal defect such as Down
syndrome.
 The MSAFP is assessed at the 15th week of pregnancy and can detect 85% to
90% of neural tube defects and 80% of Down syndrome.

Amniocentesis

Amniocentesis is the aspiration of amniotic fluid from the pregnant uterus for
examination.

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 The test is typically done between the 14th and 16th weeks of pregnancy so that
there is a generous amount of amniotic fluid present.
 Before the procedure, instruct the woman to void, and then place her on a
supine position.
 Fetal heart rate and uterine contraction monitors are attached to the woman, and
blood pressure and fetal heart rate are taken.
 An ultrasound is performed first to determine the position of the fetus and the
location of a pocket of amniotic fluid and the placenta.
 Antiseptic solution is applied to the abdomen and local anesthetic is injected.
 Inform the woman that she might feel pressure as the needle is introduced, but
do not advise her to take a deep breath and hold it in.
 About 15 mL of amniotic fluid is aspirated.
 Amniotic fluid is analyzed for AFP, bilirubin determination, chromosome
analysis, color, fetal fibronectin, inborn errors of metabolism, lecithin-
sphingomyelin ratio, and phosphatidylglycerol and desaturated
phosphatidylcholine.
Biophysical Profile

 The biophysical profile combines five parameters into one assessment.

 Fetal heart rate and breathing measure short-term central nervous system
function.
 The amniotic fluid volume measures long-term adequacy of placental function.
 The biophysical profile is more accurate than any other single assessment
method.
 The score ranges from 2-10, with 10 as the highest.
 If the fetus has a score of 8 to 10, it is doing well.
 If the score is 6, this is considered suspicious.
 A score of 4 denotes that fetus might be in jeopardy.
 The assessment is similar to that of an Apgar scoring, and it is commonly
called as fetal Apgar.

Fetal assessment is just one of the many assessments that a pregnant woman must
undergo to ensure the health of the fetus and even her own health. Undergoing these tests
can give comfort to the mother regarding the status of her baby’s health, and compliance
of her health care provider’s orders is the key to a healthy and safe pregnancy.

FETAL DEVELOPMENT

Fertilization

Fertilization is the process wherein the ovum and the spermatozoa unite at the ampullary
portion of the fallopian tube, the usual site of fertilization.

 A mature ovum can only be fertilized within 24 to 48 hours after being released.
 The functional life of the spermatozoa is only 48 to 72 hours.
 The best time that fertilization would occur is 72 hours after sexual intercourse.
 The fertilized ovum is propelled along the tube through the help of the peristaltic
movements of the fallopian tube and the tube’s cilia.
  The average time that the sperm can reach the cervix is within 90 seconds, and it
can reach the outer fallopian tube within 5 minutes.
 If the ovum has already been penetrated by a spermatozoon, it changes its
composition so that it becomes impermeable to other spermatozoa.
 After penetration, the chromosomal materials of both the ovum and the
spermatozoon combine to form a zygote.
 Three factors determine the certainty of fertilization:
o the maturation of both the sperm and the ovum;
o the ability of the sperm to reach the ovum; and
o the ability of the sperm to penetrate the cell membrane and achieve
fertilization.

Implantation

 The migration of the zygote towards the uterus reaches 3 to 4 days, and it is
propelled by the muscular contractions in the fallopian tube.
 Mitotic cell division or cleaving starts after 24 hours. The rate of cleaving is an
average of one every 22 hours.
 As the zygote reaches the uterus, it already has 16 to 50 cell divisions, and it is
now called a morula because of its bumpy appearance.
 The morula floats freely along the body of the uterus within 3 to 4 days, and it
becomes a blastocyst.
 The blastocyst attaches into the endometrium, and this process is called
implantation, which occurs 8 to 10 days after fertilization.
 Apposition, or the brushing of the blastocyst against the endometrium, is the first
part of implantation.
 Adhesion occurs afterwards as the blastocyst attaches to the surface of the
endometrium, then invasion, as it settles into the folds of the endometrium.
 On the day of implantation, the woman may experience a small amount of vaginal
spotting as the capillaries by the implanting blastocyst.
 As implantation occurs, the zygote now becomes an embryo.

Fetal Structures
Deciduas

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sizes="(max-width: 440px) 100vw, 440px" />

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  The uterine endometrium continues to thicken because of the corpus luteum that is
influenced by hCG, and instead of sloughing off in a usual menstrual cycle, it
becomes the deciduas.
 The deciduas are divided into three parts: basalis, capsularis, and vera.
 The decidua basalis is the innermost portion of the layer which rests directly
under the embryo.
 The decidua capsularis encapsulates the trophoblast’s surface.
 The decidua vera becomes the remaining portion of the uterine lining,and sheds as
the lochias.
 Eventually, the deciduas vera and capsularis fuse because of the enlarging embryo.

Chorionic Villi

<img class="aligncenter size-

full wp-image-36746" src="https://nurseslabs.com/wp-
content/uploads/2016/05/Chorionic-Villi.jpg" alt="Chorionic Villi" width="400"
height="320" srcset="https://nurseslabs.com/wp-content/uploads/2016/05/Chorionic-
Villi.jpg 400w, https://nurseslabs.com/wp-content/uploads/2016/05/Chorionic-Villi-
300x240.jpg 300w" sizes="(max-width: 400px) 100vw, 400px" />

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  On the 11th or 12th day, the chorionic villi start to form from the miniature villi that
protrude from a single layer of cells to start the formation of placenta.
 The chorionic villi have a central core and fetal capillaries, and a double layer of
trophoblast cells.
 The syncytial layer or the outer portion of the two layers produces placental
hormones such as hPL, hCG, estrogen, and progesterone.
 The Langhans’ layer is the middle layer and it protects the embryo and fetus from
infectious diseases. This layer appears to function as early as 12 days’ gestation.
 The layer disappears on the 20th to 24th week of gestation, however, leaving the
fetus more susceptible to infections.

Placenta

The placenta, which is a Latin term for “pancake” for its appearance came from the
trophoblast tissues and has a lot of functions that benefit the fetus.

<img class="wp-image-36747 size-

large" src="https://nurseslabs.com/wp-content/uploads/2016/05/Placenta-356x330.png"
alt="Placenta" width="356" height="330" srcset="https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-356x330.png 356w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-300x278.png 300w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-768x711.png 768w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-696x644.png 696w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-1068x989.png 1068w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-454x420.png 454w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-400x370.png 400w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-640x593.png 640w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta-681x630.png 681w, https://nurseslabs.com/wp-
content/uploads/2016/05/Placenta.png 1200w" sizes="(max-width: 356px) 100vw,
356px" />It’s not just placenta it’s The Placenta.

 Nutrients such as glucose, amino acids, vitamins, minerals, fatty acids, and water
as well as oxygen are transported through the placenta from the maternal blood
supply to the fetus.
 Placental osmosis also plays an essential part in maintaining the health of the fetus.
it is impermeable to a few harmful substances, thereby it does not allow the
crossing of these substances towards the fetal blood circulation.
 The syncytial layer produces various hormones that benefit both the mother and
the fetus.
 The human chorionic gonadotropin is the first placental hormone to be produced,
and it ensures that the corpus luteum would continue to produce estrogen and
progesterone to support the pregnancy.
 Estrogen is also one of the hormones produced by the syncytial cells and it aids in
the uterine growth and the development of the mammary glands in preparation for
lactation.
 Progesterone is responsible for maintaining the lining of the uterus during
pregnancy. It also reduces the contractility of the uterus to prevent preterm labor.
 Human placental lactogen promotes lactogenic properties and mammary growth in
preparation for the lactation of the mother.

Amniotic Membranes
 <img class="aligncenter size-
large wp-image-36748" src="https://nurseslabs.com/wp-
content/uploads/2016/05/amniotic-membrane-398x330.png" alt="amniotic membrane"
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content/uploads/2016/05/amniotic-membrane-398x330.png 398w,
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membrane.png 450w" sizes="(max-width: 398px) 100vw, 398px" />

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 The smooth portion of the chorionic villi eventually becomes the chorionic
membrane which forms the sac that contains the amniotic fluid.
 The amniotic membrane forms under the chorion, giving an appearance that seem
like they are only one membrane.
 The amniotic membrane is also responsible for producing the amniotic fluid and
the phospholipids that triggers the formation of prostaglandins, the hormone that
initiates uterine contractions.

Amniotic Fluid
  The normal amount of amniotic fluid is 800 to 1000 mL.
 The role of the amniotic fluid in the safety of the fetus is it protects the fetus from
trauma or pressure to the mother’s abdomen. It also regulates the temperature for
the fetus and aids in muscular development allowing the fetus to move freely
 The amniotic fluid also protects the umbilical cord from trauma and pressure,
thereby protecting the fetal oxygen supply.

Umbilical Cord

<img class="size-full wp-image-36749"

src="https://nurseslabs.com/wp-content/uploads/2016/05/umbilical-cord.gif" alt="Fetal
Circulation" width="279" height="300" />Fetal Circulation

 The amnion and chorion compose the umbilical cord which connects the embryo to
the chorionic villi of the placenta.
 The main function of the umbilical cord is the transport of oxygen and nutrients
from the placenta to the fetus and the return of waste products from the fetus to the
placenta.
 The cord is made up of a gelatinous mucopolysaccharide called Wharton’s jelly
that protects the vein and arteries from trauma.
 The umbilical cord contains only one vein, which carries blood from the placenta
to the fetus, and two arteries, which carries blood from the fetus to the placenta.

Fetal Milestones
4th Week of Gestation

 Spinal cord is formed and fused at the midpoint.

 Head folds forward and is prominent.
 The back is bent, which makes the head almost touch the tail.
 A prominent bulge appears which would later form as the heart.
 Lateral wings, the body, folds forward and fuse at midline.
 Arms and legs are budlike structures.
 Eyes, ears, and nose are barely recognizable.

8th Week of Gestation

 Organogenesis is achieved and complete.

 The heart already developed a septum and valves and is beating rhythmically.
 Arms and legs have developed.
 Facial features are noticeable.
 The genital starts to form but is not yet recognizable.
 Fetal intestine is rapidly growing.
 Results of an ultrasound would show a gestational sac which confirms pregnancy.

12th Week of Gestation

 The toes and fingers already have nail beds.

 Faint fetal movements are starting.
 Early reflexes are present.
 Tooth buds are forming.
 Formation of bone ossification centers initiate.
 The genital is already recognizable through its appearance.
 Urine secretion begins but is not yet evident.
 Heartbeat could be detected by Doppler.

16th Week of Gestation

  An ordinary stethoscope could detect the fetus’ heart beat.
 Lanugo has started to form.
 The pancreas and liver are forming.
 Urine is present in the amniotic fluid.
 Fetus starts to swallow the amniotic fluid.
 Ultrasound could determine the sex of the fetus.

20th Week of Gestation

 Mother could sense spontaneous fetal movements.

 There is hair formation on the head until the eyebrows.
 The upper intestine contains meconium.
 Brown fat starts to form behind the kidneys, sternum, and posterior neck.
 Vernix caseosa also starts to form and covers the skin.
 Passive antibody transfer begins.
 The sleep and activity patterns of the fetus are evident.

24th Week of Gestation

 Lung surfactant begins to develop.

 Meconium is present at the rectum.
 Eyebrows and eyelashes are distinguishable.
 Eyelids can now open.
 Pupils react to light.
 The fetus has reached the age of viability, wherein they could survive externally if
cared for in a modern intensive facility.
 Responds to sudden sounds.

28th Week of Gestation

 Surfactant is demonstrated in the amniotic fluid.

 Alveoli are starting to mature.
 Testes descend into the scrotal sac.
 Retinal blood vessels start to form but are highly susceptible to damage.
32nd Week of Gestation

 Subcutaneous fat is deposited.

 Fetus responds to sounds outside the mother’s body through movements.
 Active Moro reflex is present.
 Iron stores are starting to develop.
 Fingernails are starting to grow.

36th Week of Gestation

 Depositions of iron, carbohydrate, calcium, and glycogen stores are in the body.
 Additional subcutaneous fats are deposited.
 One or two creases are present at the sole of the foot.
 Lanugo starts to diminish.
 Some babies turn and assume a vertex presentation.

40th Week of Gestation

 Fetus now kicks very actively and hard enough to cause discomfort.
 The fetal hemoglobin is being converted to adult hemoglobin.
 Vernix caseosa is fully formed.
 Fingernails extend to the fingertips.
 The soles of the feet have creases that cover at least two-thirds of the surface.

The slow but sure development of the fetus inside a woman’s body should be monitored
to ensure the delivery of a healthy and safe baby. Fetal development is a critical stage in a
mother’s responsibility over her children. The role of a mother starts not only during the
time that the baby is born, but most especially when she decides that she wants to
conceive an offspring.