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APGAR SCORE
APGAR
• Apgar score is a test given
to newborns soon after birth. This test
checks a baby's heart rate, muscle tone,
and other signs to see if extra medical
care or emergency care is needed.
• The test is usually given twice: once at
1 minute after birth, and again at 5
minutes after birth. Sometimes, if there are
concerns about the baby's condition, the
test may be given again.
What does “Apgar” Mean?
• Apgar stands for
"Appearance, Pulse, Grimace, Activity,
and Respiration."
• In the test, five things are used to check
a baby's health. Each is scored on a scale
of 0 to 2, with 2 being the best score:
• Appearance (skin color)
• Pulse (heart rate)
• Grimace response (reflexes)
• Activity (muscle tone)
• Respiration (breathing rate and effort)
• Doctors, midwives, or nurses add up
these five factors for the Apgar score.
Scores are between 10 and 0. Ten is the
highest score possible, but few babies get
it. That's because most babies' hands and
feet remain blue until they have warmed
up.
APGAR SCORING
What does the baby’s score mean?
• A baby who scores a 7 or above on the
test is considered in good health. A
lower score does not mean that your baby
is unhealthy. It means that your baby may
need some immediate medical care, such
as suctioning of the airways or oxygen to
help him or her breathe better. Perfectly
healthy babies sometimes have a lower-
than-usual score, especially in the first few
minutes after birth.
• A slightly low score (especially at 1
minute) is common, especially in babies
born:
• after a high-risk pregnancy
• through a C-section
• after a complicated labor and delivery
• prematurely
• At 5 minutes after birth, the test is given
again. If a baby's score was low at first
and hasn't improved, or there are other
concerns, the doctors and nurses will
continue any necessary medical care. The
baby will be monitored closely.
What if the baby has a Low Score?
• Many babies with low scores are
perfectly healthy and do just fine after
adjusting to life outside the womb.
• If your doctor or midwife is concerned
about your baby's score, he or she will let
you know and will explain how your baby
is doing, what might be causing problems
(if any), and what care is being given.
 What Else Do I Need to Know?
• This test was not designed to predict a
baby's long-term health, behavior,
intelligence, personality, or outcome. It
was designed to help health care
providers tell a newborn's overall physical
condition so that they could quickly decide
whether the baby needed immediate
medical care.
•With time to adjust to the new
environment and with any necessary
medical care, most babies do very well.
So rather than focusing on a number, just
enjoy your new baby!
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VITAL SIGNS
• Vital signs are used to measure the
body's basic functions. These
measurements are taken to help assess
the general physical health of a person,
give clues to possible diseases and show
progress toward recovery. The normal
ranges for a person's vital signs vary with
age, weight, gender and overall health.
• There are four main vital signs: body
temperature, blood pressure, pulse (heart
rate), and breathing rate.
BODY TEMPERATURE
• The normal body temperature of a
person varies depending on gender,
recent activity, food and fluid consumption,
time of day, and, in women, the stage of
the menstrual cycle. Normal body
temperature can range from 97.8° F
(36.5°C) to 99°F (37.2°C) for a healthy
adult. A person's body temperature can be
taken in any of the following ways:
ORALLY
• Temperature can be taken by mouth
using a digital thermometer that uses an
electronic probe to measure body
temperature. Normal range is 98.6° F
(37°C).
RECTALLY
• Temperatures taken rectally (using
a glass or digital thermometer) tend to be
0.5 to 0.7 degrees F higher than when
taken by mouth. Patient’s position should
be in lateral or sim’s position.
AXILLARY
• Temperatures can be taken under the
arm using a glass or digital thermometer.
Temperatures taken by this route tend to
be 0.3 to 0.4 degrees F lower than those
temperatures taken by mouth.
BY EAR
• A special thermometer can quickly
measure the temperature of the ear drum,
which reflects the body's core temperature
(the temperature of the internal organs).
BY SKIN
• A special thermometer can quickly
measure the temperature of the skin on
the forehead.
 - Body temperature may be
abnormal due to fever (high
temperature)or hypothermia (low
temperature). A fever is indicated
when body temperature rises
about one degree or more over the
normal temperature of 98.6
degrees Fahrenheit, according to
the American Academy of Family
Physicians. Hypothermia is defined
as a drop in body temperature
below 95 degrees Fahrenheit.
PULSE RATE
• The pulse rate is a measurement of the
heart rate, or the number of times the
heart beats per minute. As the heart
pushes blood through the arteries, the
arteries expand and contract with the flow
of the blood. Taking a pulse not only
measures the heart rate, but also can
indicate the following:
- Heart rhythm
- Strength of the pulse
• The normal pulse for healthy adults’
ranges from 60 to 100 beats per minute.
The pulse rate may fluctuate and increase
with exercise, illness, injury, and emotions.
Females ages 12 and older, in general,
tend to have faster heart rates than do
males. Athletes, such as runners, who do
a lot of cardiovascular conditioning, may
have heart rates near 40 beats per minute
and experience no problems.
How to check your pulse
• As the heart forces blood through the
arteries, you feel the beats by firmly
pressing on the arteries, which are located
close to the surface of the skin at certain
points of the body. The pulse can be found
on the side of the neck, on the inside of
the elbow, or at the wrist. For most people,
it is easiest to take the pulse at the wrist. If
you use the lower neck, be sure not to
press too hard, and never press on the
pulses on both sides of the lower neck at
the same time to prevent blocking blood
flow to the brain.
RESPIRATION RATE
• The respiration rate is the number of
breaths a person takes per minute. The
rate is usually measured when a person is
at rest and simply involves counting the
number of breaths for one minute by
counting how many times the chest rises.
Respiration rates may increase with fever,
illness, and other medical conditions.
When checking respiration, it is important
to also note whether a person has any
difficulty breathing.
• Normal respiration rates for an adult
person at rest range from 12 to 16
breaths per minute.
 BLOOD PRESSURE • These numbers should be used as a
• Blood pressure is the force of the blood guide only. A single blood pressure
pushing against the artery walls during measurement that is higher than normal is
contraction and relaxation of the heart. not necessarily an indication of a problem.
Each time the heart beats, it pumps blood Your doctor will want to see multiple blood
into the arteries, resulting in the highest pressure measurements over several days
blood pressure as the heart contracts. or weeks before making a diagnosis of
When the heart relaxes, the blood high blood pressure and starting
pressure falls. treatment. Ask your provider when to
• Two numbers are recorded when contact him or her if your blood pressure
measuring blood pressure. The higher readings are not within the normal range.
number, or systolic pressure
(numerator), refers to the pressure inside
the artery when the heart contracts and
pumps blood through the body. The lower
number, or diastolic pressure
(denominator), refers to the pressure
inside the artery when the heart is at rest
and is filling with blood. Both the systolic
and diastolic pressures are recorded as
"mm Hg" (millimeters of mercury). This
recording represents how high the
mercury column in an old-fashioned
manual blood pressure device (called a
mercury manometer or
sphygmomanometer) is raised by the OXYGEN SATURATION
pressure of the blood. Today, your • Oxygen saturation is a measure of how
doctor's office is more likely to use a much hemoglobin is currently bound to
simple dial for this measurement. oxygen compared to how much
• High blood pressure, or hypertension, hemoglobin remains unbound. At the
directly increases the risk of heart attack, molecular level, hemoglobin consists of
heart failure, and stroke. With high blood four globular protein subunits. Each
pressure, the arteries may have an subunit is associated with a heme group.
increased resistance against the flow of
• Normal: 95% or higher.
blood, causing the heart to pump harder to
circulate the blood.

• Blood pressure is categorized as normal,

elevated, or stage 1 or stage 2 high blood
pressure:
- Normal blood pressure is systolic
of less than 120 and diastolic of
less than 80 (120/80)
- Elevated blood pressure is systolic
of 120 to 129 and diastolic less
than 80
- Stage 1 high blood pressure is
systolic is 130 to 139 or diastolic
between 80 to 89
- Stage 2 high blood pressure is
when systolic is 140 or
higher or the diastolic is 90 or
higher
Care of Mother, Child & Adolescent
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ANAPHY OF THE HEART
• Your heart is the main organ of your
cardiovascular system, a network of blood
vessels that pumps blood throughout your
body. It also works with other body
systems to control your heart rate and
blood pressure. Your family history,
personal health history and lifestyle all
affect how well your heart works.

What is the Heart?

• The heart is a fist-sized organ that
pumps blood throughout your body. It's
the primary organ of your circulatory
system.
• Your heart contains four main sections
(chambers) made of muscle and powered
by electrical impulses. Your brain
FUNCTION
and nervous system direct your heart’s
function.
• The heart beats around 100,000 times a What is the heart’s function?
day, pumping approximately 8 pints of Your heart’s main function is to move
blood throughout the body 24/7. This blood throughout your body. Your heart
delivers oxygen- and nutrient-rich blood to also:
tissues and organs and carries away • Controls the rhythm and speed of
waste. your heart rate.
Inside of the Heart • Maintains your blood pressure.

How does your heart work with other

organs?
Your heart works with other body systems
to control your heart rate and other body
functions. The primary systems are:
• Nervous system: Your nervous
system helps control your heart rate. It
sends signals that tell your heart to beat
slower during rest and faster during stress.
• Endocrine system: Your endocrine
system sends out hormones. These
hormones tell your blood vessels to
constrict or relax, which affects your blood
pressure. Hormones from your thyroid
gland can also tell your heart to beat faster
or slower.

ANATOMY

Where is your heart located?

• Your heart is located in the front of your
chest. It sits slightly behind and to the left
of your sternum (breastbone). Your
ribcage protects your heart.
What side is your heart on?
• Your heart is slightly on the left side of
your body. It sits between your right and
left lungs. The left lung is slightly smaller
to make room for the heart in your left
chest.
How big is your heart?
• Everyone’s heart is a slightly different
size. Generally, adult hearts are about the
same size as two clenched fists, and
children’s hearts are about the same size
as one clenched fist.
How much does your heart weight?
• On average, an adult’s heart weighs
about 10 ounces. Your heart may weigh a
little more or a little less, depending on
your body size and sex.
What are the parts of the heart’s
anatomy?
• The parts of your heart are like the parts
of a house. Your heart has:
- Walls.
- Chambers (rooms).
- Valves (doors).
- Blood vessels (plumbing).
- Electrical conduction system
(electricity).
HEART WALLS
• Your heart walls are the muscles that
contract (squeeze) and relax to send
blood throughout your body. A layer of
muscular tissue called the septum divides
your heart walls into the left and right
sides.
• Your heart walls have three layers:
Endocardium: Inner layer.
Myocardium: Muscular middle layer.
Epicardium: Protective outer layer.
• The epicardium is one layer of your
pericardium. The pericardium is a
protective sac that covers your entire
heart. It produces fluid to lubricate your
heart and keep it from rubbing against
other organs.
HEART CHAMBERS
• Your heart is divided into four chambers.
You have two chambers on the top
(atrium, plural atria) and two on the
bottom (ventricles), one on each side of
the heart.
- Right atrium: Two large veins
deliver oxygen-poor blood to your
right atrium. The superior vena
cava carries blood from your upper
body. The inferior vena cava brings
blood from the lower body. Then
the right atrium pumps the blood to
your right ventricle.
- Right ventricle: The lower right
chamber pumps the oxygen-poor
blood to your lungs through the
pulmonary artery. The lungs reload
blood with oxygen.
- Left atrium: After the lungs fill
blood with oxygen, the pulmonary
veins carry the blood to the left
atrium. This upper chamber pumps
the blood to your left ventricle.
- Left ventricle: The left ventricle is
slightly larger than the right. It
pumps oxygen-rich blood to the
rest of your body.
HEART VALVES
• Your heart valves are like doors between
your heart chambers. They open and
close to allow blood to flow through.
• The atrioventricular (AV) valves open
between your upper and lower heart
chambers. They include:
Tricuspid valve: Door between your right
atrium and right ventricle.
Mitral valve: Door between your left
atrium and left ventricle.
Semilunar (SL) valves open when blood
flows out of your ventricles. They include:
Aortic valve: Opens when blood flows out
of your left ventricle to your aorta (artery
that carries oxygen-rich blood to your
body).
Pulmonary valve: Opens when blood
flows from your right ventricle to
your pulmonary arteries (the only arteries
that carry oxygen-poor blood to your
lungs).
BLOOD VESSELS
• Your heart pumps blood through three
types of blood vessels:
Arteries carry oxygen-rich blood from
your heart to your body’s tissues. The
exception is your pulmonary arteries,
which go to your lungs.
Veins carry oxygen-poor blood back to
your heart.
Capillaries are small blood vessels where
your body exchanges oxygen-rich and
oxygen-poor blood.
• Your heart receives nutrients through a
network of coronary arteries. These
arteries run along your heart’s surface.
They serve the heart itself.
Electrical Condition System
• Your heart’s conduction system is like
the electrical wiring of a house. It controls
the rhythm and pace of your heartbeat. It
includes:
Sinoatrial (SA) node: Sends the signals
that make your heart beat.
Atrioventricular (AV) node: Carries
electrical signals from your heart’s upper
chambers to its lower ones.
Your heart also has a network of electrical
bundles and fibers. This network includes:
Left bundle branch: Sends electric
impulses to your left ventricle.
Right bundle branch: Sends electric
impulses to your right ventricle.
Bundle of His: Sends impulses from your
AV node to the Purkinje fibers.
Purkinje fibers: Make your heart
ventricles contract and pump out blood.
CONDITIONS & DISORDERS
What conditions & disorders affect
the human heart?
• Heart conditions are among the most
common types of disorders affecting
people. In the United States, heart disease
is the leading cause of death for people of
all genders and most ethnic and racial
groups.
• Common conditions that affect your
heart include:
Atrial fibrillation (Afib): Irregular
electrical impulses in your atrium.
Arrhythmia: A heartbeat that is too fast,
too slow or beats with an irregular rhythm.
Cardiomyopathy: Unusual thickening,
enlargement or stiffening of your heart
muscle.
Congestive heart failure: When your
heart is too stiff or too weak to properly
pump blood throughout your body.
Coronary artery disease: Plaque buildup
that leads to narrow coronary arteries.
Heart attack (myocardial infarction): A
sudden coronary artery blockage that cuts
off oxygen to part of your heart muscle.
Pericarditis: Inflammation in your heart’s
lining (pericardium).

Dual System of the Human Blood

Circulation
• Blood flows from the right atrium to the
right ventricle, where it is pumped into the
pulmonary circuit. The blood in the
pulmonary artery branches is low in
oxygen but relatively high in carbon
dioxide. Gas exchange occurs in the
pulmonary capillaries (oxygen into the
blood, carbon dioxide out), and blood high
in oxygen and low in carbon dioxide is
returned to the left atrium. From here,
blood enters the left ventricle, which
pumps it into the systemic circuit.
Following exchange in the systemic
capillaries (oxygen and nutrients out of the
capillaries and carbon dioxide and wastes
in), blood returns to the right atrium and
the cycle is repeated.
Care of Mother, Child & Adolescent
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STAGES OF LABOR
Labor
• the body’s natural process of childbirth. It
lasts on average 12 to 24 hours for a first
birth. Usually, labor is shorter for births
after that.
• It happens in three stages.
The First Stage of Labor
• The first stage is the longest part of labor
and can last up to 20 hours. It begins
when your cervix starts to open (dilate)
and ends when it is completely open (fully
dilated) at 10 centimeters.
EARLY OR LATENT LABOR
• The early or latent phase is when labor
begins. You’ll have mild contractions that
are 15 to 20 minutes apart and last 60 to
90 seconds. Your contractions will
become more regular until they are less
than 5 minutes apart. The contractions
cause your cervix to dilate and efface,
which means it gets shorter and thinner,
and more ready for delivery. During the
early phase, your cervix dilates from 0 to 6
centimeters, and contractions get stronger
as time goes on. During this phase, you
may have discharge from your vagina
that’s clear to slightly bloody.
• This part of labor could take hours or
even days. It’s best to spend it in the
comfort of your home. Here are some
things you can do to help the process
along:
- Take a walk.
- Change positions often.
- Continue practicing breathing and
relaxation techniques.
- Soak in a warm tub or take a warm
shower. If your water has broken,
talk to your doctor before soaking
in a tub.
- Rest if you can.
- Drink plenty of liquids and have
something light to eat.
- Get yourself packed and ready for
the hospital if you aren’t already.
ACTIVE PHASE
• While the cervix dilates from 6 to 8
centimeters (called the Active Phase),
contractions get stronger and are about 3
minutes apart, lasting about 45 seconds.
You may have a backache and increased
bleeding from your vagina (called the
"bloody show"). If your amniotic
membrane ruptures -- or your "water
breaks" at this point -- the contractions
may get much stronger.
• This part usually lasts about 4 to 8 hours.
Your mood may become more serious as
you focus on managing the contractions.
You’ll depend more on your support
person.
• It’s usually during the active phase of
labor that you’ll go to the hospital or
birthing center. Upon arrival, you will be
asked to wear a hospital gown. Your
pulse, blood pressure, and
temperature will be checked. A monitor
will be placed on your abdomen for a
short time, or continuously, to check for
uterine contractions and assess the baby's
heart rate. Your health care provider will
also examine your cervix during a pelvic
exam to determine how far labor has
progressed.
• An intravenous (IV) line may be placed
into a vein in your arm to deliver fluids
and medications if necessary. Your
doctor may have you limit what you eat
and drink at this time if they think it’s
possible you’ll need a C-section
with general anesthesia.
• Some tips to help you through the active
phase of labor:
- Try changing your position. You
may want to try getting on your
hands and knees to ease the
discomfort of back labor.
- Keep walking between
contractions.
- Empty your bladder often to make
more room for the baby’s head in
your pelvis.
- Continue practicing breathing and
relaxation techniques.
- Ask your birth partner for a gentle
massage.
- Listening to soothing music.
- Focus on taking one contraction at
a time. Remember that each one
 brings you closer to holding your
baby.
TRANSITION PHASE
• The transition phase is short, but also
intense and painful. It usually takes from
15 minutes to an hour for the cervix to
dilate from 8 to 10 centimeters.
Contractions are 2 to 3 minutes apart and
last about 1 minute. You may feel
pressure on your rectum and your
backache may feel worse. Bleeding from
your vagina will be heavier.
• You may feel the urge to push, but don’t
until your doctor tells you to. Pushing
before your cervix is fully dilated may
cause it to swell and slow down the
process.
is reported in a number called a station. If
the baby's head hasn’t started its descent,
the station is described at minus 3 (-3).
When your baby's head is at the zero
station, it is at the middle of the birth canal
and is engaged in the pelvis. The station
of your baby helps indicate the progress of
the second stage of labor.
• When your baby is born, your health
care provider will hold the baby with their
head lowered to prevent amniotic
fluid, mucus, and blood from getting into
the baby's lungs. The baby's mouth and
nose will be suctioned with a small bulb
syringe to remove any additional fluid.
Your health care provider will place the
baby on your stomach and shortly after,
the umbilical cord will be cut.

The Second Stage of Labor (Delivery) The Third Stage of Labor (Delivery of
• The second stage of labor begins when the Placenta)
your cervix is fully dilated at 10 • The third stage of labor begins after the
centimeters. This stage continues until baby is born and ends when the placenta
your baby passes through the birth separates from the wall of the uterus and
canal, vagina, and is born. This stage may is passed through the vagina. This stage
last 2 hours or longer. is often called delivery of the "afterbirth"
• Contractions may feel different from the and is the shortest stage of labor. It may
first stage of labor -- they will slow to 2 to 5 last from a few minutes to 20 minutes. You
minutes apart and last from about 60 to 90 will feel contractions but they will be less
seconds. You’ll feel a strong urge to push painful. If you had an episiotomy or small
with your contractions. Try to rest as much tear, it will be stitched during this stage of
as possible between intervals of pushing, labor.
and only push when the health
care provider tells you.
• Some tips can help you push:
- Try several positions -- squatting,
lying on your side with your leg up,
or resting on your hands and
knees.
- Take deep breaths in and out
before and after each contraction.
- Curl into the push as much as
possible; this allows all of your
muscles to work.
• You may get pain-relieving medications
or have an episiotomy if necessary while
pushing. An episiotomy is a procedure in
which a small cut is made between
the anus and vagina to enlarge the
vaginal opening. An episiotomy may be
necessary to get your baby out quicker or
to prevent large, irregular tears of your
vaginal wall.
• The location of your baby's head as it
moves through the pelvis (called descent)
Care of Mother, Child & Adolescent
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FALSE LABOR & ACTIVE LABOR
False Labor
• Also known as Braxton Hicks, the
symptoms of this “false labor” can feel a
lot like the real thing and send you
hurrying to the hospital. By knowing the
difference, you can determine when it’s
time to grab your labor bag for real and
when to wait until your symptoms resolve.
And if you’re unsure, it’s always a good
idea to call your doctor or midwife.
What do Braxton Hicks Contractions
feel like?
• Some women describe Braxton Hicks
contractions as tightening in their belly that
comes and goes. Many say they feel like
mild menstrual cramps. Braxton Hicks
contractions may be uncomfortable, but
they don’t cause labor or open
your cervix.
• Unlike true labor, Braxton Hicks
contractions:
- Usually aren’t painful
- Don’t have a regular pattern
- Don’t get closer together
- Don’t last longer as they go on
- Don’t get stronger over time
- May stop when you change
activities or positions
- Are felt only in your belly
- Taper off and disappear
• You may have Braxton Hicks
contractions during your third trimester of
pregnancy or as early as your second
trimester. They’re normal and nothing to
worry about.
Triggers of Braxton Hicks
Contractions
• Dehydration is the most common cause
of Braxton Hicks contractions. Other
triggers include:
- Illness that causes nausea or
vomiting
- The fetus’s movement
- The mother’s activity, especially
lifting something or having sex
How do Braxton Hicks Contractions
Compare with True Labor
Contractions?
• To figure out whether your contractions
are the real thing and you're going into
labor, ask yourself these questions.
• How often do the contractions happen?
False labor: Contractions are often
irregular and don’t get closer together.
True labor: Contractions come at regular
intervals and last about 30 to 70 seconds.
As time goes on, they get stronger and
closer together.
• Do they change when you move?
False labor: Contractions may stop when
you walk or rest. They may go away if you
change positions.
True labor: Contractions continue even
after you move, change positions, or try to
rest.
• How strong are they?
False labor: Contractions are usually
weak and don't get much stronger. Or they
may be strong at first and then get
weaker.
True labor: Contractions get stronger at a
steady pace.
• Where do you feel the pain?
False labor: You usually feel it only in the
front of your belly or pelvis.
True labor: Contractions may start in your
lower back and move to the front of
your abdomen. Or they may start in your
abdomen and move to your back.
Active Labor
• During active labor, your cervix will dilate
from 6 centimeters (cm) to 10 cm. Your
contractions will become stronger, closer
together and regular. Your legs might
cramp, and you might feel nauseated. You
might feel your water break — if it hasn't
already — and experience increasing
pressure in your back. If you haven't
headed to your labor and delivery facility
yet, now's the time.
• Don't be surprised if your initial
excitement wanes as labor progresses
and your discomfort intensifies. Ask for
pain medication or anesthesia if you want
it. Your health care team will partner with
you to make the best choice for you and
your baby. Remember, you're the only one
who can judge your need for pain relief.
How long it lasts: Active labor often lasts
4 to 8 hours or more. On average, your
cervix will dilate at approximately 1 cm an
hour.
What you can do: Look to your labor
partner and health care team for
encouragement and support. Try
breathing and relaxation techniques to
relieve your discomfort. Use what you
learned in childbirth class or ask your
health care team for suggestions.
• Unless you need to be in a specific
position to allow for close monitoring of
you and your baby, consider these ways
to promote comfort during active labor:
- Change positions
- Roll on a large rubber ball (birthing
ball)
- Take a warm shower or bath
- Take a walk, stopping to breathe
through contractions
- Have a gentle massage between
contractions
• If you need to have a Cesarean delivery
(C-section), having food in your stomach
can lead to complications. If your health
care provider thinks you might need a C-
section, he or she might recommend small
amounts of clear liquids, such as water,
ice chips, popsicles and juice, instead of
solid foods.
• The last part of active labor — often
referred to as transition — can be
particularly intense and painful.
Contractions will come close together and
can last 60 to 90 seconds. You'll
experience pressure in your lower back
and rectum. Tell your health care provider
if you feel the urge to push.
• If you want to push but you're not fully
dilated, your health care provider will ask
you to hold back. Pushing too soon could
make you tired and cause your cervix to
swell, which might delay delivery. Pant or
blow your way through the contractions.
Transition typically lasts 15 to 60 minutes.
Care of Mother, Child & Adolescent
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PARTS OF PLACENTA
What is Placenta?
• The placenta is a temporary organ that
connects your baby to your uterus during
pregnancy. The placenta develops shortly
after conception and attaches to the wall
of your uterus. Your baby is connected to
the placenta by the umbilical cord.
Together, the placenta and umbilical cord
act as your baby's lifeline while in the
womb. Functions of the placenta include:
- Provides your baby with oxygen
and nutrients.
- Removes harmful waste and
carbon dioxide from your baby.
- Produces hormones that help your
baby grow.
- Passes immunity from you to your
baby.
- Helps protect your baby.
• The placenta attaches to the uterine wall
and allows metabolic exchange between
the fetus and the mother. The placenta
has both embryonic and maternal
components. The embryonic portion
comes from the outermost embryonic
membrane. The maternal portion develops
from the decidua basalis of the uterus.
The placental membrane separates the
embryonic blood from maternal blood but
is thin enough to allow diffusion and
transport of nutrients and waste. A normal
placenta is round or oval-shaped and
about 22 cm in diameter. It is 2 cm to 2.5
cm thick and weighs about a pound.
Where does the placenta form?
• The placenta can form anywhere in your
uterus. It develops wherever the fertilized
egg implants into your uterine wall. Some
of the positions of the placenta are:
Posterior placenta: The placenta grows
on the back wall of your uterus.
Anterior placenta: The placenta grows on
the front wall of your uterus closest to your
abdomen.
Fundal placenta: The placenta grows at
the top of your uterus.
Lateral placenta: The placenta grows on
the right or left wall of your uterus.
• The placenta can move up until about 32
weeks of pregnancy. It's common to have
a placenta that moves upwards and away
from your cervix as your baby gets bigger.
What is the placenta made of?
• The placenta begins to develop when the
fertilized egg implants into your uterine
wall. The placenta contains mostly blood
vessels contained within structures called
“villi.” The blood vessels connect with the
baby’s bloodstream through the umbilical
cord. The rest of the placental tissues
mainly connect the villi to the umbilical
cord and allow your blood to bathe the villi,
supplying the baby with oxygen and
nutrients.
What does placenta do?
• The placenta is an organ that develops
in the uterus during pregnancy. This
structure provides oxygen and nutrients to
a growing baby. It also removes waste
products from the baby's blood. The
placenta attaches to the wall of the uterus,
and the baby's umbilical cord arises from
it. The organ is usually attached to the top,
side, front or back of the uterus. In rare
cases, the placenta might attach in the
lower area of the uterus. When this
happens, it's called a low-lying placenta
(placenta previa).
• The placenta is a fetal organ made up of
its parenchyma, chorion, amnion, and
umbilical cord. The fetal structures form
from the zygote and therefore separate
the fetus from the endometrium. The fetal
tissues form from the chorionic sac - which
includes the amnion, chorion, yolk sac,
and allantois.
The Umbilical Cord
• connects the fetus with the fetal part of
the placenta (chorionic plate). It typically
attaches centrally to the chorionic plate of
the placenta. The development of the
umbilical cord begins at approx. the 3rd
week of embryonic development. By the
end of pregnancy, the umbilical cord is
approx. 50-70 cm long.
Amniotic Cavity
• The amniotic sac is formed very early in
pregnancy and surrounds the embryo as a
protective shell. As the fetus grows, the
amniotic cavity expands, eventually
resulting in the displacement of the
chorionic cavity and the uterine cavity.
• Development: 2nd week of development
through migration of epiblast cells
• Components
- Lined with amniotic epithelial cells
- Filled with amniotic fluid, which is
produced by amniotic epithelial
cells.
Amniotic sac
• composed of maternal (decidua) and
fetal components (chorioamniotic
membranes) that surround the fetus and
provide mechanical protection.
• Amnion
- Inner amniotic membrane
- Develops from the embryoblast
- Secretes amniotic fluid
• Chorion
- Middle amniotic membrane
- Develops from the cytotrophoblast
• Decidua
- Outermost membrane
- Develops from the decidua
capsularis, which lies above the
site of implantation.
Amniotic fluid
• protective fluid within the amniotic sac
that cushions the fetus, prevents
adherence of the fetus to the amnion, and
serves as a transport medium for nutrients
and metabolites.
➢ Composition: initially a clear liquid
• Amount: approx. 850-1500 mL by the
end of pregnancy (the amniotic fluid is
completely exchanged every 3 hours)
• pH: 7-7.5 (slightly alkaline)
• Proteins, glucose, urea
• Fetal urine, lung fluids, hair, dead skin,
sebum
• Vernix: a milky-white, lipid-rich
substance that consists of fetal dermal
cells and sebaceous gland secretions. It
covers the fetus’s skin (especially in the
third trimester)
➢ Reabsorption
• Reabsorption by the amniotic epithelium
• The fetus swallows approx. 400 mL of
amniotic fluid per day, which is excreted
through the kidneys.