MCN REVIEWER
Increase in weight
PUBERTY
- Stage of life at which secondary sex changes
begin
- The HYPOTHALAMUS serve as a gonadostat
regulation mechanism set to “turn on” gonad
functioning
 Females: 9-12 yrs or we. Of 95lbs (43kg)
 Males: 12-14yrs
ROLE OF ANDROGEN
- Hormones responsible for muscular
development, physical growth and the increase
in sebaceous gland secretions that causes acne
in boys and girls
- In males, androgenic hormones are produced by
the adrenal cortex and testis
- In females, by adrenal cortex and ovaries
- In girls, testosterone influences enlargement of
labia majora and clitoris and formation of
axillary and pubic hair
- In boys, testosterone influence further
development of testes, scrotum, penis,
prostate, and seminal vesicles: the appearance
of male pubic, axillary and facial hair; laryngeal
enlargement and its accompanying voice
change; maturation of spermatozoa; and
closure of growth in long bones
- in girls, testosterone influences the growth of
labia majora and clitoris and formation of
pubic and axillary hair
 Adrenarche- development of pubic and axillary
hair due to androgen stimulation
ROLE OF ESTROGEN
- Increase in estrogen levels in female at puberty
influences the development of uterus, fallopian
tubes, and vagina, typical female fat
distribution, hair patterns, breast development,
an end to growth because it closes the
epiphyses of long bones
 Thelarche- beginning of breast development
EFFECTS OF ESTROGEN
- Inhibits production of FSH
- Causes endometrial hypertrophy
- Stimulates growth of ductile structures in the
breast
- Increases quantity and pH of cervical mucus
causing it to be thin and watery and can be
stretched to a distance of 10-13cm
SECONDARY SEX CHARACTERISTICS
Girls
1. Growth spurt
2. Increase in transverse diameter of the pelvis
3. Breast development
4. Growth of pubic hair
5. Onset of menstruation
6. Growth of axillary hair
7. Vaginal secretion
Boys
1.
2. Growth of testis
3. Growth of face, axillary and pubic hair
4. Voice change
5. Penile growth
6. Increase in height
7. Spermatogenesis
DEFINITION OF TERMS
 Menarche- first menstruation
 Menopause- cessation of menstruation
 Amenorrhea- absence of menstruation
 Menorrhagia- excessive bleeding during regular
menstrual flow
 Metrorrhagia- bleeding at completely irregular
intervals
4 BODY STRUCTURES INVOLVED
1. Hypothalamus- GnRH
2. Pituitary gland (anterior pituitary of
adenohypophysis) – FSH and LH
3. Ovary- estrogen and progesterone
4. Uterus
FOUR PHASES OF MENSTRUAL CYCLE
1. First phase of menstrual cycle (Proliferative)
- it is also known as proliferative, estrogenic,
follicular, post- menstrual phase
- Immediately after menstrual flow (occurs during
first 4-5 days of cycle)
- The endometrium or lining of the uterus is very
thin. As the ovary begins to produce estrogen
the endometrium begins to proliferate so
rapidly the thickness of the endometrium
increases as much as eightfold from day 5-14.
2. Second phase of menstrual cycle (Secretory)
- Termed the pregestational, luteal, premenstrual
or secretory phase
- After ovulation the formation of progesterone in
the corpus luteum (under the direction of LH)
causes the glands of the uterine endometrium
to become corkscrew or twisted in appearance
and dilated with quantities of glycogen
(elementary sugar) and mucin (protein). It takes
the appearance of rich, spongy velvet.
3. Third phase of menstrual cycle (Ischemic)
- If fertilization does not occur, the corpus luteum
in the ovary begins to regress after 8-10 days
and therefore, the production of progesterone
decreases. With the withdrawal of
progesterone, the endometrium of the uterus
begins to degenerate (at about day 24 or 25 of
the cycle). The capillaries rupture with minute
hemorrhages and endometrium sloughs off
4. Fourth phase of menstrual cycle (Menses)
- Composed of mixture of blood from the ruptured
capillaries; mucin; fragments of endometrial
 tissue; and the microscopic; atrophied; and
unfertilized ovum
- Menses, is the end of arbitrarily defined menstrual
cycle. Because it is the only external marker of the
cycle, however, the first day of menstrual flow is
used to mark the beginning day of a new
menstrual cycle
- Menstrual flow only contains 30-80 ml of blood. It
it seems to be more, it is because the
accompanying mucus and endometrial shreds.
- The iron loss is typically 11mg. this is enough loss
that women could benefit from a daily iron
supplement to prevent iron depletion during their
menstruating years
SIGNS OF OVULATION
1. Thin, abundant, and stretchy cervical mucus
(spinnbarkeit)- midpoint of mens cycle, way to
demonstrate high levels of estrogen are being
produced and by implication, ovulation is about to
occur.
2. Ferning
3. Mittelschmerz
4. Breast tenderness
HUMAN SEXUALITY
- Encompasses complex emotions, attitudes,
preferences, and behaviors related to expression
of the sexual self and eroticism
 Sex- denote biological male or female status, also
used to describe specific sexual behavior
 Sexuality- crucial part of peoples identity. It
reflects our human character, not solely our
genital nature
3 ASPECTS OF SEXUALITY
 Biologic sex/ biologic gender- used to denote
chromosomal sexual development
 Gender/ sexual identity- inner sense a person has
of being male or a female, or the sense of
masculinity or femininity
 Gender role behavior- the way a person acts as
male or female including the expression of what is
perceived as gender appropriate behavior
SEXUAL HEALTH ACCORDING TO WHO
 Sexual health- is the integration of
somatic/physical, emotional, intellectual and
social aspects of sexual well-being in ways that are
positively enriching and that enhance personality,
communication and love.
3 BASIC ELEMENTS OF SEXUAL HEALTH
1. Capacity to enjoy and control sexual and
reproductive behavior in accordance with social
and personal ethics
2. Freedom from fear, shame, guilt, false beliefs, and
other psychological factors inhibiting sexual
response and impairing sexual relationship
3. Freedom from organic disorders, diseases and
deficiencies that may interfere sexual and
reproductive function
 Sexual normalcy- state whereon a person is within
the average of sexual capacity and expression
within a framework of sexual meaning and or
direction when he has a sense of well being within
that context
FACTORS INFLUENCING SEXUALITY
 Developmental level- the development od
sexuality begins with conception and changes
throughout the life span
 Culture- all cultural groups have their own
practices and values relating to sexuality
 Religious values- it provides guidelines for sexual
behavior and acceptable circumstances for the
behavior, prohibited sexual behavior and the
consequences of breaking the sexual rules
 Personal ethics/ beliefs- many individuals and
groups have developed written or unwritten codes
of conduct based on ethical principles
 Health status- some conditions or illnesses may
interfere person’s expression of sexuality.
CONCEPTS OF SEXUALITY IN THE PHILIPPINES
- Regarding the sexual relation of filipino husbands
and wives, the following have been observed
1. Objections to foreplay before coitus. Reasons
vary as some women feel that prolonged
foreplay they are not treated like women
anymore, not respected as wives
2. Sexual relations generally take place at night
3. Filipinos during the act as being naked makes
them feel “embarrassed” before their
husbands
4. Arousal of body sensations is done through
embracing, caressing and sometimes biting
5. Females are expected to repress or restrict
their interest in heterosexual relations. A wife
is not supposed to ask for sexual intercourse
from her husband. Thus non verbal behavior
is resorted to imply their needs
HUMAN SEXUAL RESPONSES (Masters & Johnson, 1998)
1. Excitement phase
- Begins with onset of erotic feeling and sensation
which occurs with physical and psychological
stimulation (sight, sound, emotion or thought)
that causes parasympathetic nerve stimulation
2 PRIMARY PHYSIOLOGIC CHANGES
a. Vasocongestion- congestion of the blood
vessels in the genital area and in a number of
different body parts
b. Myotonia- an increased muscle tension
CHARACTERIZED BY THE FOLLOWING BODY REACTIONS
Men:
- Erection of the penis and nipples
- Scrotal thickening and elevation of testes
- Presence of clear lubricating droplets at the urethral
meatus
- Increased in temperature, perspiration, RR, HR and
BP
- Increased muscle tension in both smooth and
skeletal muscle
Women:
- Erection of the clitoris and nipples of breats
 - Presence of mucoid fluid or lubrication of the vaginal
walls
- Vagina widens in diameter and increases in length
- Increase in size and change in color of the labia,
uterus and breast
- Flushing of the skin
- Increased temperature, perspiration, RR, HR, BP
- Increased muscle tension in both smooth and
skeletal muscle
2. Orgasmic phase/ orgasm
- Is the involuntary climax of sexual tension,
accompanied by physiologic and psychologic release
- This phase last for 3-10 seconds
Men:
- Muscle contractions surrounding the seminal vessels
and prostate project semen into the proximal urethra
- These contractions are followed immediately by 3-7
propulsive “ejaculatory contractions” occurring at
the same time interval as women, which force semen
from the penis
Women:
- A vigorous contraction of muscles in the pelvic area
- An average of 8-15 contractions at intervals of 1
every 0.8 seconds
3. Resolution phase
- The period during which the external and internal
genital organs return to unaroused state of pre-
coital stage
Men:
- Refractory period- occurs during which further
orgasm is impossible, from a few hours or days,
depending on age and other factors
Women:
in the wrong body; sex change surgery may be
desired and undertaken)
TYPES OF SEXUAL EXPRESSION
1. Celibacy- abstinence from sexual activity. It is the
avowed state of certain religious orders
2. Masturbation- self stimulation for erotic pleasure; it
can also be a mutually enjoyable activity for sexual
partners
3. Erotic stimulation- the use of visual materials such as
magazines or photographs for sexual arousal
4. Fetishism- sexual arousal by the use of certain
objects or situations
5. Transvestism- an individual who dresses to take on
the role of opposite sex
6. Voyeurism- sexual arousal by looking at another’s
body
7. Sadomasochism- involves in inflicting pain (sadism)
or receiving pain (masochism) to achieve sexual
satisfaction
OTHER TYPES OF SEXUAL EXPRESSION
1. Exhibitionism- revealing one’s genital in public
2. Pedophiles- individual who are interested in sexual
encounters with children (sex offenders)
3. Bestiality- sexual relation between a human being
and lower animal
4. Obscene phone calling- unsolicited phone call where
a person uses profane or sexual language to interact
with someone who may be known to them or may
be a complete stranger
Sexual harassment- unwanted, repeated sexual advances,
remarks or behavior that is offensive and interferes with job
performance of the recipient
1. Quid pro quo (equal exchange)- employer ask for
something in return for sexual favor such as hiring or
promotion preference
2. Hostile work environment- employer creates an
environment in which an employee feels
uncomfortable and exploited.

- Do not go through this period so it is possible for

women to have additional orgasm if properly
stimulated

ORGASM DISORDER

1. Erectile dysfunction (impotence)- inability of man to

produce or maintain erection long enough for vaginal
penetration or partner satisfaction
2. Premature ejaculation- ejaculation before penile-
vaginal contact. Ejaculation before partner’s
satisfaction has been achieved

PAIN DISORDERS

1. Vaginismus- involuntary contraction of the muscles

at outlet of the vagina when coitus is attempted
2. Dyspareunia/ vestibulitis- pain during coitus

TYPES OF SEXUAL IDENTITY

1. Heterosexual- one who is sexually attracted to

persons of opposite sex (straight)
2. Homosexual- one who is sexually attracted to
persons of same sex (gay, lesbian)
3. Bisexual- one who is sexually attracted to persons of
both sexes
4. Transsexual- one’s belief that one is not the sex of
one’s physical body but of the opposite sex. (trapped
REPRODUCTIVE LIFE PLANNING - Woman takes her temp every morning before she
rises up to bed
- Includes all the decisions an individual or couple
 IFR- 3%
make about whether and when to have children,
 FR- 25%
how many, and how they are spaced
CERVICAL MUCUS METHOD (BILLING’S METHOD)
IDEAL CONTRACEPTIVE
 Before ovulation- cervical mucus is thick and odes
- Safe
not stretch
- Effective
 Spinnbarkeit- during ovulation cervical mucus is
- Compatible with spiritual and cultural beliefs and
copious, thin, watery and transparent
personal preferences of both user and sexual partner
- Convenient to use and easy obtainable TWO DAY METHOD
- Affordable
- Free of effects after discontinuation - Woman assess for vaginal secretion daily. If she feels
 Ideal failure rate- the number of unintended secretions are 2days in a row, she avoid coitus that
pregnancies that will occur in 1 yr for couple who day and following day as the presence of secretions
uses method consistently and correctly suggest fertility
 IFR- 3-4%
NATURAL FAMILY PLANNING METHOD  FR- 13-14%
ABSTINENCE- refraining from sexual relation SYMPTOTHERMAL METHOD
 Failure rate- 0% (theoretically), 85% - Woman checks her temp and cervical mucus and
 Ideal failure rate- 100% observe mittelschmerz (abdominal pain) andif her
- Most effective way to prevent STI cervix is soft
- Acceptable to all religious group - Couple abstain for 3days from the rise of temp or 4th
 Periodic abstinence- method to avoid pregnancy by day after the peak of cervical mucus change
avoiding sex on the days a woman may conceive  IFR- 0.4%
 FR- 25%
LACTATION AMENORRHEA METHOD (LAM)
STANDARD DAYS METHOD
- Considered natural suppression of ovulation
 Ideal failure rate- 1-5% under six months - For woman who has 26-32 menstrual cycle days
 Failure rate- 95% after 6 months  Red bead- 1st day menstruation
- Continuous breastfeeding of the infant at least every  6 brown beads- safe days
4hrs during the day and every 6hrs at night  12 glow in the dark beads- unsafe days
 Followed by 13 brown beads- safe days
COITUS INTERRUPTUS
 IFR- 5%
- Oldest known method of conception  FR- 12-13%
- Couple proceeds with coitus until the moment of
OVULATION DETECTION
ejaculation and spermatozoa are emitted outside the
vagina - Detects midcycle surge of LH in the urine by 12-24hrs
 82% effective before ovulation
 IFL- 4% - 98-100% accuracy
 FR- 22%
MARQUETTE MODEL
DOUCHING
- Combines the use of ovulation detection with other
- Ineffective as contraceptive measure signs of ovulation
- Developed late 1990 in Marquette university,
FERTILITY AWARENESS METHOD
Wisconsin
- Rely on detecting when a woman will be capable of
BARRIER METHOD OF CONTRACEPTION
impregnation so she can use periods of abstinence
during that time - Forms of birth control that place a chemical or latex
barrier bet. Cervix and advancing sperm so sperm
cannot reach ovum
CALENDAR METHOD
SPERMICIDE
- Requires couple to abstain from coitus on the day of
- Agent that causes death of sperm before it enters
menstrual cycle when the woman is most likely to
cervix
conceive
- Change vaginal pH to strong acid level not conductive
- Day of ovulation: 14th day (applies to the women
to sperm survival
with 28 day menstrual cycle)
- Insert 1hr before coitus
 IFL- 1-9%
 Suppositories- 15mins before coitus
 FR- 25%
MALE CONDOM
BASAL BODY TEMP (BBT)
- Latex rubber or synthetic sheath that is placed over
- Just before ovulation the bodys temp at rest falls
the erect penis before coitus trap sperm
about 0.5F
 IFR- 2%
- Ovulation temp rises 0.2C
 FR- 18%
FEMALE CONDOM
- Sheaths made of latex or polyurethane, pre-
lubricated with spermicide so, similarly to male
condoms
 IFR- 5%
 FR- 21%
DIAPHRAGM
- Circular rubber disk that is placed over the cervix
before intercourse to mechanically halt the passage
of sperm
- Used of spermicidal gel
 IFR- 6%
 FR- 12%
 Prescription is needed- must be fitted initially by
health care provider to ensure correct fit
 Should remain in place 6hrs after coitus
CERVICAL CAPS
- Made of soft rubber, shaped like a thimble, which fits
snugly over the uterine cervix
- Can be placed longer for 48hrs
 IFR- 23% parous women, 9% nulliparous
 FR- 35% parous, 9% nulliparous
HORMONAL CONTRACEPTION
- Hormones when taken orally, transdermally,
intravaginally or intramuscularly causes such
fluctuation in normal menstrual cycle that ovulation
or sperm transport does not occur
ORAL CONTRACEPTIVE
- Commonly known as the pill or COC’s are composed
of varying amounts of natural estrogen or synthetic
combined with small amounts of synthetic
progesterone
COMBINED ORAL CONTRACEPTIVE
 Monophasic- with certain fixed doses of both
estrogen and progestin throughout a 21 days cycle
 Biphasic- preparation that delivers constant amount
of estrogen throughout the cycle but varying
amounts of progestin
 Triphasic and tetraphasic- preparation which vary in
both estrogen and progestin content throughout the
cycle
 28 pills dispenser
 Pelvic exam, PAP smear
 IFR- 3%
 FR- 9%
 Effectiveness- 99.7%
HOW TO TAKE YOUR PILLS
 Sunday start- take the pill on the first Sunday after
the beginning of mens flow
 Quick start- take it as soon as it is prescribed by
healthcare provider
 First day start- begin the pills on the first day of
menses
 Post partum- 2 weeks after delivery
 D&C- begin on the first Sunday after the procedure
PROGESTIN ONLY PILLS (MINI-PILLS)
- Progesterone only pill
- Ovulation may occur
- Endometrium does not develop fully hence
implantation cannot occur
- Taken everyday
Side effects: nausea, weight gain, headache, breast
tenderness, mild hypertension, depression, breakthrough
bleeding, monilial vaginal infections
Contraindication:
1. Thromboembolic diseases
2. Cardiovascular/ cerebrovascular accidents (CVA)
3. Liver cirrhosis
 Diabetes, smokers, breastfeeding, age 35
 Certain medication like corticosteroid,
acetaminophen, anti-coagulants
 Several drugs such as barbiturates, griseofulvin,
isoniazid, penicillin, tetracycline decreases the
effectiveness of COC
DANGEROUS SIGNS- ACHED
1. Abdominal pain
2. Chest pain
3. Headache
4. Eye problems
5. Severe leg pain
6. Shortness of breath
- Loss of interest in coitus for the first 18 months
- Discontinue pill if (+) pregnancy
- Discontinuity of pills- no pregnancy (1-2/6/8 moths)
ESTROGEN/ PROGESTERONE TRANSDERMAL PATCH
- Refers to patches that slowly but continuously
release a combination of estrogen and progesterone
- Patches applied each week for 3weeks
- Less effective with obese patient
- Applied in upper torso, abdomen, buttocks
- Can remove patch, but must be replaced
immediately
VAGINA ESTROGEN/ PROGESTIN RINGS (NuvaRing)
- Flexible silicone vaginal ring that when placed in the
vagina continually releases a combination of
estrogen and progesterone
- Place it for 3weeks and then removed it for 1 week
when menses occur
SUBDERMAL HORMONE IMPLANTS
 Etonogestrel implant (Nexplanon)-can be embedded
just under the skin on the inside of the upper arm
where it will slowly release progestin for over a
period of 3 years
 It suppress ovulation, thicken the mucus, and change
the endometrium lining
- Can be place within 7days of menstrual period,
immediately after termination of pregnancy of
6weeks after birth
 FR- 1%
 Side effects: weight gain, irreg mens, depression,
scarring at insertion site, need for removal
 Contraindication- pregnancy desire to be pregnant
within 1yr and undiagnosed uterine bleeding
INTRAMUSCULAR INJECTION (DMPA)
- Depot medroxyprogesterone acetate is a
progesterone given every 12 weeks
- Inhibits ovulation, alters endometrium and thicken
cervical mucus
 Effectiveness- 100%
 Side effects: weigh gain, depression, irregular
menstruation for 1 yr, bone loss
- Given on the 5th day of mens cycle
INTRAUTERINE DEVICE- IUD
- Small plastic device inserted into the uterus through
the vagina and can be either hormonal or non
hormonal
1. Copper t380- t- shaped plastic device wound with
copper (10yrs)
2. Levonorgestrel-releasing intrauterine device system
52mg (mirena or liletra)- IUD which features a drug
reservoir of progesterone in the stem
3. Levonorgestrel- releasing intrauterine system
13.5mg (Skyla)- has a lower dose of progesterone
(3yrs)
4. Levonorgestrel- releasing intrauterine system 19.5
(Kyleena)-mhas a lower form of progesterone than
mirena but higher than Skyla (5yrs)
Side effects: abdominal cramps, higher risk for PID,
contraindicated for woman with distorted uterus, anemia,
Copper T is contraindicated for woman with menorrhagia and
dysmenorrhea
SURGICAL METHODS OF REPRODUCTIVE LIFE PLANNING
VASECTOMY
- Small puncture wound made in the scrotum to pull,
cut, tie , cauterize or plugged the vas deferens to
block the passage of sperm
- Needs 2 neg sperm report at 6weeks and 10weeks
(10-20 ejaculations)
 Complication- hematoma at the surgical site,
development of urolithiasis, or may develop chronic
pain after vasectomy
TUBAL LIGATION
- Fallopian tubes are occluded by cautery, rushed,
claped or blocked thereby preventing passage of
both sperm and ova
- Woman may resume coitus after 2-3days
- 99.5% effective
 Side effects: bowel/ ureter perforation, umbilical
hernia, light to severe abdominal cramping post
procedure
FETAL GROWTH AND DEVELOPMENT
STAGES OF FETAL GROWTH AND DEVELOPMENT
 Pre- embryonic- first 2 weeks beginning with
fertilization
 Embryonic- 3-8 weeks
 Fetal- 8 weeks to birth
 Ovum- from ovulation to fertilization
 Zygote- from fertilization to implantation
 Embryo- from implantation to 5-8 weeks
 Fetus- 5-8 weeks to term
 Conceptus- developing embryo and placental
structures throughout pregnancy
 Age of viability- the earliest age at which fetus
survive if they are born is generally accepted as 24
weeks or at point a fetus is 500-600gm
FERTILIZATION: THE BEGINNING OF PREGNANCY
- Also known as conception and impregnation, is the
union of an ovum and spermatozoon
- Occurs in the outer third of a fallopian tube ampullar
potion
- Critical time for fertilization to be successful is about
72hrs (48hrs before ovulation and 24hrs after)
3 factors:
- Equal maturation of both sperm and ovum
- Ability of the sperm to reach the ovum
- Ability of the sperm to penetrate the zona pellucida
and membrane and achieve fertilization
IMPLANTATION
 Zygote migrates over the next 3-4 days towards the
body of the uterus
 Implantation or opposition or contact between the
growing structure and the uterine endometrium,
occurs approx. 8-10 days after fertilization
 Mitotic cell division or cleavage begins (1st within
24hrs at a rate of every 22hrs so by the time it
reaches the uterus it is consist of 15-50 cells
 Over the next 3-4days, large cells tend to collect at
the periphery of the ball, leaving a fluid space
surrounding an inner cell mass called blastocyst
 Trophoblast- outer ring, that will later form the
placenta and membranes
 Embryoblast- inner cell mass, will later form the
embryo
 the blastocyst sheds the last residue of the zona and
corona radiata brushes against the rich endometrium
and settles down into its oft folds
 implantation occurs high in the uterus posterior
surface
 implantation bleeding- occurs when capillaries are
rupture by implanting trophoblast cell
THE DECIDUA OR UTERINE LINING
- under the influence of hCG (secreted by the
trophoblast) the corpus luteum in the ovary
continues to function
- causes uterine endometrium to continue to grow in
thickness and vascularity
 decidua basalis- lies directly under embryo
 decidua capsularis- portion that stretches and
encapsulate the surface of trophoblast
 decidua vera- remaining portion of uterine lining
CHRONIC VILLI
- as early day of 11th-12th day of fertilization, miniature
villi resembling probing fingers and termed chorionic
villi reach out from the trophoblast cell into the
uterine endometrium to begin formation of the
placenta
- it produces placental hormones Hcg,
somatomammotropin (Hpl), estrogen and
progesterone
- some protection from certain infection
(cytotrophoblast)
PLACENTA
- latin for “pancake” which is descriptive of its size and
appearance at term, growns from a few trophoblast
cells at the beginning od pregnancy
 15-20cm in diameter, 2-3cm in depth
 400-600g at term ( 1/6 of weight of the NB)
 16-30 Cotyledons
 Uteroplacental blood flow is 50ml/min at 10th weeks,
500-600 ml/min at term
 Braxton hicks contraction- noticeable at 12 weeks to
aid in maintaining pressure In the intervillous spaces
by closing off the uterine vein momentarily with each
contraction
 Endocrine functions- produces Hcg, PROGESTERONE,
estrogen and Hpl
 Produces plasma protein
AMNIOTIC MEMBRANES
- Medial surface of the trophoblast (those not involve
in the implantation) gradually thin becomes
chorionic villi, the outermost fetal membrane
 Amniotic membrane- dual walled sac with the
chorion as the outmost part and amnion as the
innermost part.
AMNIOTIC FLUID
 Slightly alkaline, ph 7.2
 Constantly being newly formed and absorbed by the
direct contact with fetal surface of the placenta
 800-12—ml at term
 Color: colorless or yellow tinged
 Hydramnios- (>2000 ml, >8cm by ultrasound) the
fetus is unable to swallow the fluid
- Esophageal atresia or anencephaly are common
 Oligohydramnios- (>300ml) reduction in the amount
of amniotic fluid
- Disturbance in the fetal kidney function
UMBILICAL CORD
- Formed from the fetal membranes, the amnion and
chorion and provides a circulatory pathway that
connects the embryo to the chorionic villi of the
placenta
- 53cm in length (21in), 2cm (0.75in) thick
- 2 arteries, 1 vein (AVA)
 Wharton’s jelly- gelatinous mucopolysaccharide,
which gives the cord body and prevents pressure on
the vein and arteries that pass through it
 Rate of blood flow- 350 ml/min at term
Functions:
1. Transport oxygen and nutrients to the fetus
2. Return waste product from the fetus to the placenta
 Has no nerve supply
 Hypocoiling- maternal hypertension
 Hypercoiling- respiratory distress
ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS
 Stem cells- totipotent- undifferentiated cells that
have the potential to grow into any cell in the human
body (during the first 4 days of life)
 Zygote growth- cephalocaudal
 Organogenesis- completed at 8 weeks of life
 ECTODERM
- CNS
- Peripheral nervous system
- Skin, hair, nails, tooth enamel
- Sense organs
- Mucous membranes of the anus , mouth and nose
- Mammary gland
 ENDODERM
- Lining of the pericardial, pleura and peritoneal
cavities
- Lining of the GI tract, respiratory tract, tonsils,
parathyroid, thyroid and thymus gland
- Lower urinary system (bladder and urethra)
CARDIOVASCULAR SYSTEM
- One of the first system to become functional in
intrauterine life
- Simple blood cells joined to the walls of the yolk sac
to become a network of blood vessls and single heart
tube (16th week) and beats as early as 24th day
- The septum that divides the heart into the chambers
develops in the 6th-7th week
- Heart valves develop at 7th week
- Heart sound may be heard at 10th-12th week
- ECG at 11th week
- 28th week sympathetic nervous system matures and
heart rate is 110-160bpm
FETAL CIRCULATION
1. Highly oxygenated blood passes thru umbilical vein
(carries oxygenated blood because the direction is
towards the heart)
2. Flows to first supply the liver, kidneys and brain
3. Blood flows from the umbilical vein to the ductus
venosus, an accessory vessel that discharge
oxygenated blood is directed to the right side of the
heart
4. The bulk of blood is shunted and as it enters the right
atrium to the left atrium through an opening in the
atrial septum called foramen ovale
5. From left atrium it follows the course of adult
circulation, into the left ventricle
6. Then into the aorta via ductus arteriosus to the
descending aorta through the umbilical arteries
END OF 4 GESTATION WEEKS
 Length- 0.7cm to 1 cm
 Weight- 400mg
 The spinal cord is formed and fused at midpoint
 Trophoblast embed in decidua
 Chorionic villi form
 Foundation for nervous system, gut, skin, bones and
lungs are formed
 The rudimentary heart appears as a prominent bulge
on the anterior surface
 Back is bent so the head almost touches the tip of
the tail
 Back is bent so the head almost touches the tip of
the tail
 Arms and legs are budlike structures
 Rudimentary eyes, ears nose appear
END OF 8 GESTATION WEEKS END OF GESTATION WEEKS

 Length- 2.5cm  Length- 38-43cm

 Weight- 20g
 Organogenesis is complete
 The heart, with a septum and vlaves is beating
 Facial features are definitely discernible
 Primitive tail is regressing
 Head is disproportionately large, owing to brain
development
 Abdomen appears large due to rapid growth of fetal
intestine
 External genitalia is present, but sex is not
distinguishable by simple observation
END OF 12 GESTATION WEEKS
 Length- 7-8cm
 Weight- 45g
 Nail beds are forming on fingers and toes
 Spontaneous movements are possible, but not felt
by the mother
 Bone ossification centers are forming
 Tooth buds are present
 Sex is distinguishable by outward appearance
 Olacenta is complete
 Heart is audible by a doppler
 Kidney secretion has begun
END OF 16 GESTATION WEEKS
 Length- 10-17cm
 Weight-55-120g
 Fetal heart sounds are audible by an ordinary steth
 Sex can be determined by ultrasound
 Lanugo is well formed
 Liver and pancreas are functioning
 Nasal septum and palate close
 Fetus actively swallows amniotic fluid
 Urine is present in amniotic fluid
END OF 24 GESTATION WEEKS
 Length- 28-36cm
 Weight- 550g
 Skin appears wrinkled
 Meconium is present as far as the rectum
 Active production of lung surfactant begins
 Eyebrow and fingernails are well defined
 Pupils are capable reacting to light
 Hearing can be demonstrated by response to sudden
sound
END OF 28 GESTATION WEEKS
 Length- 35-38cm
 Weight- 1200g
 Skin is red
 Pupillary membrane disappears from eyes and the
eyelids open
 Lung aveoli begins to mature and mature and
surfactant can be demonstrated in amniotic fluid
 Testes begins to descend into the sacrotal sac from
the lower abdominal cavity
 Eyes are open
 The fetus has an excellent chance of survival
 Weight- 1600g
 Subcutaneous fat begins to be deposited
 Fetus is viable
 Fingernails grow to reach the end of the end of the
fingertips
 Vigorous fetal movements occurs
DETERMINATION OF ESTIMATED BIRTH DATE
 EDC- estimated date of confinement
 EDB- estimated date of birth, more commonly used
 Naegele’s rule- to calculate using this rile, count
backward 3 calendar months from the first day of a
woman’s LMP and add 7 days
 Mcdonald’s rule- symphysis- fundal height
measurement, to determine mid pregnancy growth
 At the umbilicus- 20 weeks
 At xyphoid process- 36weeks
 Nonestress test- Measures the response of the fetal
heart rate to fetal movement
 Vibroacoustic stimulation- specially designed
acoustic stimulator is applied to the mothers
abdomen to produce a sharp sound of approximately
80db
 Ultrasonography- measures the sound waves against
solid objects, diagnose pregnancy as early as 6weeks
GRADING THE PLACENTA
0- Bet 12-24 weeks
1- 30-32 weeks
2- 36 weeks
3- 38 weeks
BIOPHYSICAL PROFILE
- Reactivity (2 accelerations 15bpm in 15sec) fetal
breathing movements (one episode od 30s in 30min)
body movements (at least 3limb or trunk movement
in 30min) fetal tone (fetus must extend then flex the
extremities) and amniotic volume (pocket of 2cm in
vertical diameter)
 SCORING
 8-10= fetus is doing well
 6= suspicious
 4= fetal jeopardy
MRI- Can identify fetal structure anomalies and soft tissue
disorders
PSYCHOLOGICAL AND PHYSIOLOGIC CHANGES IN
PREGNANCY
PSYCHOLOGICAL CHANGES OF PREGNANCY
 Social influences
 Cultural influences
 Family influences
 Individuals differences
 Partner’s adaptation

THE PSYCHOLOGICAL TASK OF PREGNANCY

FIRST TRIMESTER TASK: ACCEPTING THE PREGNANCY
- Woman and her partner both spend time in
recovering from the surprise of learning they are
pregnant and concentrate on what it feels like to be
pregnant
- Ambivalence is common
SECOND TRIMESTER TASK: ACCEPTING THE BABY
- Woman and her partner move through emotions
such as narcissism and introversion as they
concentrate on what it feel like to be a parent
 Quickening- helps woman realize that the fetus is not
just part of the body but a separate and real
individual to care for
THIRD TRIMESTER TASK: PREPARING FOR THE BABY AND
END OF PREGNANCY
- The woman and her partner prepare clothing and
sleeping arrangement for the baby but also grow
impatient as they ready themselves for birth
- Nesting activities
EMOTIONAL RESPONSES TO PREGNANCY
 Ambivalence- refers to the simultaneous negative or
positive response of the woman to pregnancy
 Grief- before a woman can take on mothering role,
she has to give uo or alter her present role
 Introversion or narcissism (self- centeredness)-
during pregnancy, the woman may become
concerned for her welfare and the effects of
pregnancy on her health and lifestyle. She may be
pre occupied with her own thought and feelings
 Extroversion- women become more active, appear
healthier than ever before, and more outgoing.
 Body image- the way your body appears to yourself
 Fear and anxiety- related to the womans concern
about her own health of the baby
 Uncertainty- some women may still in doubt that
they are pregnant despite a positive pregnancy test
 Couvade syndrome- men experience physical
symptoms such as nausea, vomiting and backache to
the same degree or even more intensely than their
partners do.
 Emotional lability- partly as manifestation of
narcissism or because of hormonal changes
 Changes in sexual desire
 1st tri- decreased libidobecause of nausea, fatigue
and breast tenderness
 2nd tri- Libido and sexual enjoyment rises markedly
because blood flow to the pelvic area increases to
supply the placenta
 3rd tri- it may remain high or decrease because of
difficulty finding a comfortable position and
increasing abdomincal size
 Changes in the expectant family- preparing the
family for the birth of a new member
PHYSIOLOGIC CHANGES IN PREGNANCY
- Occurs during pregnancy are the basis for the sign
and symptoms used to confirm a pregnancy
REPRODUCTIVE SYSTEM CHANGE
UTERUS
 Length – 6.5 cm- 32cm
 Width- 4-24cm
 Depth- 2.5cm-22cm
 Weight- 50g-1000g
 Uterine wall thicken from 1-2cm early in pregnancy
becomes thin 0.5cm
 Volume increases from abt 2ml-more than 1000ml
 Lightening- fetal head settles into the maternal pelvis
2 weeks prior to delivery
 Uterine blood flow- increases 500ml to 750ml
 Hegars sign- softening of the lower uterine segment
 Braxton hicks contraction- painless uterine
contraction
 Ballottement- French word ballotter “to quake”
bounce
 Amenorrhea- absence of menstruation occurs with
pregnancy because of the suppression of the FSH by
rising estrogen levels
 Cervical changes- due to the effect of estrogen
produced by the placenta the cervix becomes more
vascular and edematous
 Operculum- mucus plug forms to seal out bacteria
and help prevent infection
 Goodell’s sign- softening of the cervix
 Consistency- closely resembles to the earlobe,non
pregnant
VAGINAL CHANGES
 Vaginal epithelium and underlying tissues increase
ein size as they become enriched with glycogen due
to the effect of estogen
 Presence of vaginal discharge
 Chadwick’s sign- bluish discoloration of vagina
 Ph- 4-5 help resit bacterial invasion due to the action
lactobacillus acidophilus
OVARIAN CHANGES
 Ovulation stops due to the active feedback
mechanism of estrogen and progesterone
 Corpus luteum decreases at 16th weeks
BREAST CHANGES
 Feeling of fullness, tingling or tenderness by 6th
week, increases in size as pregnancy progresses
 Nipple and areola darkens and increases in size
 16th week- colostrum, thin, watery, high protein fluid
that is precursor of breast milk, can be expelled from
the nipple
 Veins may become prominent
 Montgomery tubercles- enlarges and become
protuberant
ADRENAL GLANDS
 Increased levels of corticosteroid and aldosterone
inhibit immune response, thereby preventing
rejection of fetus
PANCREAS
 Increases insulin production but insulin is less
effective due to estrogen, progesterone and other
hormones that are antagonist to insulin. This allows
for more glucose to be circulating in the maternal
blood stream to be available to the fetus
IMMUNE SYSTEM
  Decreases probably preventing the fetus to be
rejected
 igG production is decreased, which can make a
woman prone to infection during pregnancy
 increase WBC may help to counteract the decrease in
IgG
INTEGUMENTARY SYSTEM
 Striae gravidarum- stretch marks caused by the
rupture and atrophy of small segments of the
connective layer of the skin by the gravid uterus
 Diastasis- rectus muscle under the skin separates
 Linea nigra- brown line, from umbilicus to symphysis
pubis
 Vascular spiders or telangiectasis- small, fiery red
branching spots appears on thighs
 Palmar erythema- appears on hands
 Increased perspiration
 Increased hair growth
RESPIRATORY SYSTEM
 Stuffiness- congestion of nasopharynx
 RR- 18-20 bpm
 Chronic feeling of SOB
 Tidal volume- increased by 30-40%, vital capacity- no
change
 Residual volume- decreased by 20%, plasma PCO2,
decreased by 27-32 mmHg
 Plasma pH- increased to 7.40- 7.45, plasma PCO2
increased to 104-108 mmHg
 Respiratory minute volume- increased by 40%,
expiratory reserve- decreased by 20%
TEMPERATURE
 Increased due to the action of progesterone
produced by the corpus luteum
IRON
 Increased gallstone formation due to increased
plasma cholesterol level and additional cholesterol
from the bile
URINARY SYSTEM
 Renal function- changes to excrete waste from
mother and fetal blood supply
 Glomerular filtration rate- increased by 50%
 BUN- decreased by 25% a BUN of 15mg/100ml is
abnormal
 Creatinine- decreased in pregnancy 90-180 ml/min
in 24hr urine collection, serum creatinine of
1mg/100ml is abnormal
 Renal threshold for sugar- decreased
 Ureter and bladder function- increased UO but also
physiologic increase in urinary stasis
FACTORS THAT AFFECT CHANGES IN THE URINARY SYSTEM
- Effects of high estrogen and progesterone levels
- Compression of the bladder and ureters by the
growing fetus
- Increased volume that increases kidney production
of more urine
- Postural influences
THE CONFORMATION OF PREGNANCY
1. Presumptive symptoms- those which taken as single
entities, could easily indicate their conditions. These
findings discussed in connection with the body
system in which they are occur (breast changes,
nausea, vomiting)
2. Probable symptoms- objective and so can be verified
by an examiner, although they are more reliable than
presumptive (Braxton hicks, chadwicks sign, hegars
sign)

 Need 800mcg more daily for fetal growth, increased

maternal RBC

FOLIC ACID

 Need 400 mcg to prevent large non functioning RBC

and decrease risk for fetal neural tube and
abdominal wall defects

PERIPHERAL BLOOD FLOW

 Impaired blood return from lower extremities

through the pelvis, lead to edema and varicosities of
the vulva, rectum and legs
 Supine hypotension syndrome- lying supine
compresses the vena cava, blood return to the heart
decreases, can lead to faintness and palpitation and
possibly fetal hypoxia
 Blood constitution- increased clotting factors,
platelets, WBC, lipids, decreased protein level

GASTROINTESTINAL SYSTEM

 50% of women experiences nausea and vomiting

“morning sickness”
 Heartburn- reflux of the stomach contents
 Intestinal peristalsis, gastric emptying time are
decreased can lead to constipation, flatulence and
heartburn

 Subclinical jaundice- generalized itching,

reabsorption of bilirubin into the maternal blood