NCM107j - MATERNAL
type of oestrogen.
October 6, 2022- 10:30 am to 12 nn
NCM107j Maternal (Coverage)
Menstrual Cycle
Embryonic, Fetal Development
Human Sexuality
Physiologic Changes of Pregnancy
Psychologic Changes of Pregnancy
Promoting Fetal and Maternal Wellbeing
MENSTRUAL CYCLE
4 MAIN HORMONES
● Follicle Stimulating Hormone (FSH)
● Luteinising Hormone (LH)
● Oestrogen
● Progesterone
FOLLICLE STIMULATING HORMONE
- Stimulates egg development and the
release of oestrogen.
- Follicle-stimulating hormone is
produced by the pituitary gland. It
regulates the functions of both the
ovaries and the testes.
- Lack or insufficiency of it can cause
infertility in both men and women.
- Follicle-stimulating hormone is one of
the gonadotropic hormones, the other
being the luteinising hormone, and both
are released by the pituitary gland into
the bloodstream.
- Follicle-stimulating hormone is essential
to pubertal development. In women, this
hormone stimulates the growth of
ovarian follicles in the ovary before the
release of an egg and it also increases a
LUTEINISING HORMONE (LH)
- Stimulates the release of the egg (called
ovulation). Stimulates oestrogen and
progesterone production
- Luteinising hormone, like a
follicle-stimulating hormone, is a
gonadotrophic hormone produced and
released by cells in the anterior pituitary
gland.
- It is crucial in regulating the function of
the testes in men and ovaries in women.
- In women, the luteinizing hormone
carries out different roles in the two
halves of the menstrual cycle. In weeks
one to two of the cycle, luteinizing
hormone is required to stimulate the
ovarian follicles in the ovary to produce
the female sex hormone, oestradiol.
- Around day 14 of the cycle, a surge in
luteinizing hormone levels causes the
ovarian follicle to tear and release a
mature oocyte (egg) from the ovary, a
process called ovulation.
- For the remainder of the cycle (weeks
three to four), the remnants of the
ovarian follicle form a corpus luteum.
- The luteinizing hormone stimulates the
corpus luteum to produce progesterone,
which is required to support the early
stages of pregnancy if fertilization
occurs.
OESTROGEN
- causes growth of the uterine lining.
Inhibits FSH. Stimulates the release of
LH and hence release of the egg.
Inhibits LH after ovulation.
- Oestrogen is one of the main female sex
hormones. While both women and men
 produce oestrogen, it plays a bigger role
in women’s bodies.
- It has many roles in the body, from
controlling puberty to strengthening
bones. Having too much or too little
oestrogen can cause a range of different
medical conditions.
TYPES OF OESTROGEN
1. Oestradiol - is produced in women of
childbearing age, mostly by the ovaries.
2. Oestriol - is the main oestrogen
produced during pregnancy, mostly in
the placenta.
3. Oestrone - produced by the adrenal
glands and fatty tissue, is the only type
of oestrogen produced after menopause.
PROGESTERONE
- maintains the uterine lining. Inhibits LH
after ovulation.
- Progesterone belongs to a group of
steroid hormones called progestogens. It
is mainly secreted by the corpus luteum
in the ovary during the second half of
the menstrual cycle.
- It plays important role in the
menstrual cycle and in maintaining
the early stages of pregnancy.
- During the menstrual cycle, when an
egg is released from the ovary at
ovulation (approximately day 14), the
remnants of the ovarian follicle that
enclosed the developing egg form a
structure called the corpus luteum. This
releases progesterone and, to a lesser
extent, oestradiol.
- Progesterone prepares the body for
pregnancy in the event that the
released egg is fertilized.
- If the egg is not fertilized, the corpus
luteum breaks down, the production of
progesterone falls and a new menstrual
cycle begins.
- If the egg is fertilized, progesterone
stimulates the growth of blood vessels
that supply the lining of the womb
(endometrium) and stimulates glands in
the endometrium to secrete nutrients that
nourish the early embryo.
PHASES OF MENSTRUAL CYCLE
● MENSTRUATION
● FOLLICULAR PHASE
● OVULATION
● LUTHEAL PHASE
MENSTRUATION
- first stage of the menstrual cycle
- This phase starts when an egg from the
previous cycle isn’t fertilized. Because
pregnancy hasn’t taken place, levels of
the hormones estrogen and progesterone
drop.
- The thickened lining of your uterus,
which would support a pregnancy, is no
longer needed, so it sheds through your
vagina. During your period, you release
 a combination of blood, mucus, and
tissue from your uterus.
- On average, women are in the menstrual
phase of their cycle for 3 to 7 days.
Some women have longer periods than
others.
FOLLICULAR PHASE
● The follicular phase starts on the first
day of your period (so there is some
overlap with the menstrual phase) and
ends when you ovulate.
● It starts when the hypothalamus sends a
signal to your pituitary gland to release
follicle-stimulating hormone (FSH).
This hormone stimulates your ovaries to
produce around 5 to 20 small sacs called
follicles. Each follicle contains an
immature egg.
● Only the healthiest egg will eventually
mature. (On rare occasions, a woman
may have two eggs mature.) The rest of
the follicles will be reabsorbed into your
body.
● The maturing follicle sets off a surge in
estrogen that thickens the lining of your
uterus. This creates a nutrient-rich
environment for an embryo to grow.
● The average follicular phase lasts for
about 16 days. It can range from 11 to
27 days
OVULATION
● Rising estrogen levels during the
follicular phase trigger your pituitary
gland to release luteinizing hormone
(LH). This is what starts the process of
ovulation.
● Ovulation is when your ovary releases a
mature egg. The egg travels down the
fallopian tube toward the uterus to be
fertilized by sperm.
● The ovulation phase is the only time
during your menstrual cycle when you
can get pregnant. You can tell that
you’re ovulating by symptoms like
these:
○ a slight rise in basal body
temperature
○ thicker discharge that has the
texture of egg whites
● Ovulation happens at around day 14 if
you have a 28-day cycle — right in the
middle of your menstrual cycle. It lasts
about 24 hours. After a day, the egg will
die or dissolve if it isn’t fertilized.
LUTEAL PHASE
● After the follicle releases its egg, it
changes into the corpus luteum. This
structure releases hormones, mainly
progesterone and some estrogen. The
rise in hormones keeps your uterine
lining thick and ready for a fertilized
egg to implant.
● If you do get pregnant, your body will
produce human chorionic gonadotropin
(hCG). This is the hormone pregnancy
tests detect. It helps maintain the corpus
luteum and keeps the uterine lining
thick.
● If you don’t get pregnant, the corpus
luteum will shrink away and be
resorbed. This leads to decreased levels
of estrogen and progesterone, which
causes the onset of your period. The
 uterine lining will shed during your
period.
● Luteal phase last 14 days
EMBRYONIC, FETAL DEVELOPMENT
Nursing Role and Nursing care during normal
Pregnancy
- Assessment of maternal and fetal health
- Complete history
- Thorough Physical Exan
- Providing nursing care
- Health Teachings
Stages of fetal development
3 times period
➢ Pre-embryonic (1st 2 weeks, beginning
with fertilization)
➢ Embryonic (weeks 3 - 8)
➢ Fetal (from week 8 through birth)
Terms to describe fetal growth
➢ Ovum - ovulation to fertilization
➢ Zygote - from fertilization to
implantation
➢ Embryo - from implantation to 5 - 8
weeks
➢ Fetus - 5 - 8 weeks until term
➢ Conceptus - Developing embryo and
placental structures throughout
pregnancy
Age of VIABILITY
➢ earliest age @ w/c fetus survives if they
are born
➢ Generally accepted as 24 weeks or
➢ @ the point a fetus weighs more than
500 - 600g
Defining some terms
Fertilization
➢ Conception and impregnation
➢ Union of an ovum and a spermatozoon
➢ Occurs at the outer third of the fallopian
tube - ampullar region
Implantation
➢ Contact bet. the growing structure &
uterine endometrium
➢ Occurs approx. 8 - 10 days after
ovulation
➢ Occurs high in the uterus on the
posterior surface
➢ Once implanted, the zygote is called an
embryo
EMBRYONIC AND FETAL STRUCTURES
The Decidua (or uterine lining)
● After fertilization, the corpus luteum in
the ovary continues to function rather
than atrophying
○ Under the influence of human
chorionic gonadotropin (hCG) -
a hormone secreted by the
trophoblast cells
● The uterine endometrium, instead of
sloughing off as in a normal menstrual
cycle, continues to grow in thickness
and vascularity = DECIDUA
DECIDUA
- The Latin word for falling off- because
it will be discarded after birth of the
child
3 Separate Areas of Decidua
1. Decidua Basalis
- Part of the endometrium that
lies directly under the embryo
- Or the portion where the
trophoblast cells are establishing
communication w/ maternal
blood vessels
2. Decidua capsularis
- The portion of the endometrium
that stretches or encapsulates
the surface of the trophoblast
3. Decidua vera/parietalis
- The remaining portion of the
uterine lining
 - hCG (Human - Appears to
● As the embryo continues to grow, it chorionic function early
pushes the decidua capsularis before it gonadotrophi in pregnancy
like a blanket n) to protect the
● Eventually, enlargement brings the - Somatomam growing
structure into contact wl the opposite motropin embryo and
uterine wall - the decidua capsularis (human fetus from
placental certain
fuses w/ the endometrium of the lactogen infectious
opposite wall [hPLT) organisms
● This is why @ birth, the entire inner - Estrogen such as the
surface of the uterus is stripped away, - Progesteron spirochete of
leaving the organ highly susceptible too syphilis
hemorrhage and infection - Disappears
bet. 20th and
24th week =
Chorionic Villi syphilis have

⬇️
● After implantation trophoblast cell a high
matures potential for

⬇️
● 11th or 12th day - miniature villi fetal damage
(probing "fingers") late in
● Chorionic villi - reach out from the pregnancy
- Offers little
⬇️
single layer of cells into the uterine
protection
endometrium viral invasion
● At term almost 200 villi have formed @ any point
Chorionic villi have a central core of loose
connective tissue surrounded by a double layer
The Placenta
of trophoblast cells
● Latin for pancake - w/c is descriptive of
● Central core of connective tissue -
its size and appearance @ term
contains fetal capillaries
● The placenta is a fetomaternal organ that
● Outer of the 2 covering layers is termed
has two components
the syncytiotrophoblast, or the syncytial
○ A fetal part that develops from
layer - instrumental in the production
the chorionic sac, the outermost
various placental hormones
fetal membrane
● Inner layer - cytotrophoblast or
○ A maternal part that is derived
Langhan's layer - present as early as 12
from the endometrium, the
days' gestation
innermost layer of the uterine
wall
Outer of the 2 Inner layer- ● Arises out of trophoblast tissue (fetal in
covering layers is cytotrophoblast or origin)
termed the langha’s layer ● Serves as fetal lungs, kidneys, and Gl
syncytiotrophoblast,
tract, and as a separate endocrine organ
or the syncytial layer-
instrumental in the throughout pregnancy
production various
placental hormones Formation of Placenta
 ● the blastocyst and uterine wall about 5
days after fertilization.
diffuse from the 3RD WEEK
● The blastocyst is a hollow fluid-filled ★ Oxygen
maternal blood thru
ball, and the inner cell mass (shown in ★ Glucose
the cell layers of the
green) is the developing baby. ★ Amino acids
chorionic villi to the
● The cells making up the wall of the ball ★ Fatty Acids
villi capillaries
are trophoblast cells that will form the
placenta. then nutrients are ★ Minerals
● At this time, trophoblast cells are transported back to ★ Vitamins
progressively fusing together to form the the developing ★ Water
syncytial trophoblast, which consists of embryo
a single giant cell with many nuclei.
● about 12 days after fertilization ● For practical purposes, there is no direct
● Maternal blood (red) is flowing into exchange of blood between the embryo
communicating spaces that develop and the mother during pregnancy
within the giant syncytial trophoblast ○ exchange is carried out by
cell that covers the surface of the selective osmosis thru the
developing placenta (blue) chorionic villi
● The baby's blood and blood vessels ● Because chorionic villi layer is only one
have not yet developed. The baby cell thick - minute breaks do allow
(embryo) has now developed into two occasional fetal cells to cross, as well as
layers. enzymes such as alpha-fetoprotein from
● a third-trimester placenta with baby the fetal liver
● The placenta (blue) consists of about 30 ● Only a few substances are able to cross
tree-like structures called cotyledons from the mother into the fetus
● The baby's blood vessels, arriving by ○ Almost all drugs are able to
way of the umbilical cord, spread out cross into fetal circulation -
within the placenta, sending a large ● All of the specific mechanisms or
branch into each cotyledon. processes that allow nutrients to cross
The Placenta the placenta are affected by:
● Its growth parallels that of the fetus ○ Maternal blood pressure and
○ from a few identifiable cells @ ○ pH of the fetal and maternal
the beginning of pregnancy to plasma
an organ 15 - 20 cm in diameter
and 2 - 3 cm in depth @ term Mechanisms by which Nutrients Cross the
● Covers about half the surface area of the Placenta (Table 8.2)
internal uterus
mechanism description
Placentral Circulation
● 12th day of pregnancy -> maternal Diffusion When there is a
blood begins to collect in the greater concentration
intervillous surfaces of the uterine of a substance on one
endometrium surrounding the chorionic side of a
semi-permeable
villi
 membrane than on molecular
the other, substances concentration to an
of correct molecular area of greater
weight cross the molecular
membrane from the concentration.
area of higher
concentration to the Amino acid
area of lower concentration in the
concentration. fetal plasma are twice
what they are in the
Oxygen, carbon mother
dioxide, sodium, and
chloride cross the Pinocytosis Absorption by the
placenta by this cellular membrane of
method microdroplets of
plasma and dissolved
Facilitated Diffusion To ensure that the substances.
fetus receives enough
concentrations of Gamma globulin,
necessary growth lipoproteins,
substances, some phospholipids, and
substances cross the other molecular
placenta more rapidly structures that are too
and more easily w/o large for diffusion
the expenditure of and that cannot
energy than would participate in active
occur if only simple transport cross in this
diffusion were manner
operating
Viruses that can
A carrier moves the infect the fetus can
substance into and also cross in this
thru the membrane manner.

Glucose is an

⬇️
example of a ● As the # of chorionic villi increases w/
substance that crosses pregnancy
by this process ● Villi form an increasingly complex

⬇️
communication network wl the maternal
Active Transport This process requires blood
energy and action of
⬇️
● Intervillous spaces grow larger and
an enzyme to
facilitate transport larger

⬇️
● Becoming separated by a series of
Essential amino acids partitions or septa

⬇️
and water-soluble ● 30 separate segments (in a matured
vitamins cross the placenta) = cotyledons
placenta against the ● These compartments make maternal side
pressure gradient or
of the placenta @ term look rough and
from an area of lower
uneven

The Placenta
● 100 maternal uterine arteries supply the
mature placenta
● Rate of uteroplacental blood flow in
pregnancy increases - from 50 mL/min
at 10 weeks to 500 - 600 mL/min @
term
● No additional maternal arteries appear
after the 1st 3 mos. of pregnancy > to
accommodate led blood flow, arteries †
in size ->
○ mother's heart rate, total cardiac
output, and blood volume † to
supply the placenta
Placental Circulation
● In the intervillous spaces - maternal
⬇️
blood jets from the coiled or spiral
arteries in streams or spurts
⬇️
● Maternal blood is then propelled from
compartment to compartment
● As blood circulates around the villi and
⬇️
nutrients osmose from maternal blood
into the villi
● Maternal blood gradually loses its
⬇️
momentum and settles to the floor of the
cotyledons
⬇️
● Blood enters the orifices of maternal
veins located in the cotyledons
● Blood is returned to maternal circulation
*SCHULTZ - Shiny area = Fetal Side
* DUNCAN - Raw beef = Maternal Side
The Placenta
● Braxton Hicks contractions
○ barely noticeable and painless
uterine contractions
○ present from about 12th weeks
of pregnancy
○ aid in maintaining pressure in
the intervillous spaces by
closing off uterine veins
momentarily w/ each
contraction
● When mother lies on her LEFT SIDE
○ most efficient uterine perfusion,
and placental circulation
○ this position lifts the uterus
away from the inferior vena
cava - preventing blood from
being trapped in her lower
extremities
● When mother lies on her BACK
○ weight of the uterus compresses
the vena cava
○ placental circulation can be
sharply reduced = SUPINE
HYPOTENSION (very low
maternal blood pressure)
● At term - placenta weighs 400 - 600 gms
(1lb.) or 1/6 the weight of the baby
○ Smaller placenta = inadequate
circulation to the fetus
○ Bigger placenta = circulation to
the fetus was threatened because
placenta was forced to spread
out in an unusual manner to
maintain sufficient blood supply
● Diabetic woman - fetus may develop a
larger than usual placenta, probably
from excess fluid collected between
cells
Endocrine Function
● Syncytial (outer) layer of chorionic villi
- serves as source of oxygen and
nutrients, and develops into a separate,
important HORMONE - PRODUCING
❗️
system
❗️
WHAT HORMONES ARE PRODUCED BY
THE SYNCYTIAL LAYER?
Hormones Produced
● Human Chorionic Gonadotrophin (hCG)
○ 1st hormone produced
○ Can be found in maternal blood
and urine as early as the 1st
 missed menstrual period
(shortly after implantation has
occurred) through about 100th
day of pregnancy
○ Negative hCG in mother's
serum - w/in 1 - 2 weeks after
birth
○ Testing for hCG can be used as
proof that all of the placental
tissue has been delivered
Purposes of hCG
● to act as a fall-safe measure to ensure
that the corpus luteum of the ovary
continues to produce progesterone and
estrogen
○ If the corpus luteum shd fail ->
progesterone level falls ->
endometrial sloughing -> loss of
pregnancy -> rise of pituitary
gonadotrophins - inducing a
new menstrual cycle
● May also play a role in suppressing the
maternal immunologic response so that
placental tissue is not rejected
● 8th week of pregnancy: outer layer of
cells of the developing placenta begins
to produce progesterone - production of
hCG begins to decrease
Estrogen
● Primarily estriol; "hormone of women"
● Produced as a 2nd product of the
syncytial cells of the placenta
● Contributes to the mother's mammary
gland development in preparation for
lactation
● Stimulates uterine growth to
accommodate the developing fetus
Progesterone
● "hormone of mothers" - progesterone is
necessary in pregnancy to maintain the
endometrial lining of the uterus
● Present in serum - as early as 4th week
of pregnancy - as a result of the
continuation of the corpus luteum
● Reduce contractility of the uterine
musculature during pregnancy =
preventing premature labor
● probably produced by a change in
electrolytes (potassium and calcium),
w/c decreases contraction potential of
the uterus
● Human Placental Lactogen (Human
Chorionic Somatomammotropin)
○ hPL is a hormone w/ both
growth-promoting and
lactogenic (milk-producing)
properties
○ produced by the placenta
beginning the 6th week of
pregnancy - increasing to a peak
level @ term
○ can be assayed/assessed in both
maternal serum and urine
○ promotes mammary gland
growth in preparation for
lactation in the mother
○ serves the important role of
regulating maternal glucose,
protein, and fat levels so that
adequate amounts of these
nutrients are always available to
the fetus
The Umbilical Cord
● formed from the fetal membranes
(amnion and chorion)
● provides a circulatory pathway that
connects the embryo to the chorionic
villi of the placenta
● Functions:
○ to transport oxygen and
nutrients to the fetus from the
placenta and
○ to return waste products from
the fetus to the placenta
 ● 53 cm (21 inches) in length (@ term)
● 2 cm (3/4 inch) thick
● Wharton's jelly - bulk of the cord
○ gelatinous mucopolysaccharide
○ gives the cord body and
prevents pressure on thevein
and arteries that pass thru it
● outer surface - covered w/ amniotic
membrane
● the remnant of the yolk sac may be
found in the fetal end of the cord - as a
white fibrous streak @ term
Contains:
● 1 vein - carrying blood from the
placental villi to the fetus
● 2 arteries - carrying blood from the fetus
back to the placental vill
● # of veins and arteries in the cord is
always assessed and recorded @ birth:
○ 1% of all infants are born w/ a
cord that contains a single vein
and artery
○ 15% of these infants are found
to have congenital anomalies -
particularly of the kidney and
heart
Percutaneous umbilical blood sampling
(PUBS)
➔ blood is withdrawn from the umbilical
vein or transfused into the vein during
intrauterine life for fetal assessment or
treatment
● Rate of blood flow thru an umbilical
cord is rapid - 350 mL/min @ term
○ Impossible that a cord will twist
or knot enough to interfere w/
fetal oxygen supply
● Nuchal cord - loose loop of cord around
fetal neck; 20% of all births
○ oxygen supply is not impaired
● Walls of the umbilical cord arteries are
lined w/ smooth muscle
○ Constriction of these muscles
after birth contributes to
hemostasis and helps prevent
hemorrhage of the newborn thru
the cord
● Contains no nerve supply - can be cut @
birth w/o discomfort to either mother or
child
THE AMNIOTIC MEMBRANES
● The chorionic villi on the medial surface
of the trophoblast (those that are not
involved in implantation because they
do not touch the endometrium) - begins
to gradually thin, leaving the medial
surface smooth
● * chorion leave, or smooth chorion
● Eventually becomes the chorionic
⬇️
membrane - outermost fetal membrane,
or the 1st layer of fetal covering
● Once it becomes smooth, it offers
⬇️
support to the sac that contains the
amniotic fluid
● 2nd membrane lining the chorionic
membrane/ inner laver = the amniotic
⬇️
membrane/ amnion forms beneath the
chorion
● offers support to the amniotic fluid and
also produces the fluid; produces
phospholipid that initiates the formation
of prostaglandins, w/c can cause uterine
contractions and may be the trigger that
initiates labor
● The amniotic membranes, like the
umbilical cord, they have no nerve
supply
● neither mother nor child experiences
pain when these membranes
spontaneously rupture @ term or
artificially ruptured
 ● constantly being newly formed by the
amniotic membrane - never becomes
stagnant
● is reabsorbed @ the rate of 500 mL/24
hours
● some of it is probably absorbed by direct
contact w/ the fetal surface of the
placenta
● major method of absorption happens
because fetus continually swallows the
fluid
Method of absorption:
● Fetus swallows amniotic fluid
● From the fetal intestine, it will be
absorbed into the fetal bloodstream
● Goes to the umbilical arteries
● To the placenta
● And it is exchanged across the placenta
● reduction in the amount of amniotic
fluid (less than 300 mL in total, or no
pocket on ultrasound larger than
FUNCTIONS of AMNIOTIC FLUID
1. Shields fetus against pressure or a blow
to the mother's abdomen
2. Protects fetus from changes in
temperature - because liquid changes
temperature more slowly than air
3. Aids in fetal muscular development -
allows fetus the freedom to move
4. Protects umbilical cord from pressure,
protecting the fetal 02 supply
● Amniotic fluid is slightly alkaline = pH
7.2
● Urine is acidic = pH 5.0 - 5.5

● Amount of amniotic fluid @ term: 800 -

1,200 mL
○ If fetus is unable to swallow
(esophageal atresia or
anencephaly) = excessive
amniotic fluid or hydramnios
(more than 2,000 mL, or
pockets of fluid lager than 8cm
on ultrasound)
○ Hydramnios also tends to occur
in women w/ diabetes -
hyperglycemia causes excessive
fluid shift into the amniotic
space
■ Fetal urine (produced
early in fetal life, as
soon as fetal kidneys
become active) adds to
the quantity of amniotic
fluid

Oligohydramnios
● results to a disturbance of fetal kidney
function;