MJC - MCN (chap 6, 7, & 9)
CHAPTER 6: Nursing care for the family in need of
reproductive life planning
Reproductive Life Planning- Includes all decisions an
individual or a couple make about having children,
including
● If and when to have children
● How many children to have
● The length of time between having children
- Includes all the decisions an individual or couple
make about having children.
- An individual or couples choice of contraceptive
method should be made carefully with complete
knowledge about the advantages, disadvantages,
and side effects of the various options.
Things to consider are:
➢ Personal Values
➢ Ability to use method correctly
➢ How the method will affect sexual enjoyment
➢ Financial factors
➢ Status of couple’s relationship
➢ Prior experiences
➢ Future plans
Counseling - Counseling include:
● topics of avoiding conception
● increasing fertility
● what to do if contraception has failed.
Contraceptives - An ideal contraceptive should be
● Safe
● Effective
● Compatible with religious and cultural beliefs
and personal preferences of user and partner
● Free of bothersome side effects
● Convenient to use and easy to obtain
● Affordable and needing few instructions for use
● Free of effects on future pregnancies after
discontinuation
Categories of Commonly Used Birth Control Methods
1. Natural Methods of Reproductive Life
Planning
2. Artificial Methods of Reproductive Life
Planning
3. Surgical Methods of Reproductive Life
Planning
Natural Family Planning - Also called “periodic
abstinence methods”
- No chemical or foreign material into the body
- Failure rate ranges from 2% to 25%
- Need for a couple to be conscious of the time
period when a woman is most likely to be fertile
1. Natural Methods of Reproductive Life Planning
Abstinence
- 0% failure rate
- The most effective method to prevent sexually
transmitted infections (STIs)
- ideal failure rate (the number of unintended
pregnancies that will occur in 1 year) for couples
who use the method consistently and correctly
- the failure rate for routine use (less-than-perfect
use)
- theoretical 0% failure rate
- Periodic abstinence
- A method to avoid pregnancy by
avoiding sex on the days conception
may be possible
Lactation amenorrhea method (LAM)
- Safe method with a failure rate of 1% to 5 if an
infant is;
- under 6 months of age
- Breastfeeding with no supplements
- Menses has not returned
- Being totally breastfed at least every 4
hours during the day and every 6 hours
at night
- As long as a woman is breast-feeding an infant ,
there is some natural suppression of ovulation.
- However, the method is not dependable because
a woman may ovulate but not menstruate.
- After 6 months of breast-feeding the woman
should be advised to choose another method of
contraception.
Coitus interruptus
- Withdrawal
- One of the oldest known method of
contraception
- 82% effective; does not prevent STIs
- pre-ejaculation fluid-few spermatozoa
present=risk for pregnancy
- The couple proceeds with coitus until the
moment of ejaculation. The man withdraws and
spermatozoa are emitted outside the vagina.
- Unfortunately, ejaculation may occur before
withdrawal is complete and despite the care
used, some spermatozoa may be deposited in the
vagina.
- It offers little protection against conception.
Postcoital Douching
- Ineffective method because sperm may be
present in cervical mucus as quickly as 90
seconds after ejaculation
Fertility Awareness Methods
● Calendar (rhythm) method
● Basal body temperature (BBT) method
● Cervical mucus (Billing’s) method
● Two-day method
● Symptothermal method
● Standard days method: CycleBeads
● Ovulation detection
● Marquette mode
Calendar (Rhythm) Method
- about six (6) menstrual cycles
- subtracts 18 from the shortest cycle (first fertile
day)
- subtracts 11 from her longest cycle (last fertile
day)
- Factors for failure:
○ irregular menstrual cycles
○ a miscalculation
○ disregard for predicted fertile days.

- Requires a couple to abstain from coitus on the
days of a menstrual cycle when the woman is
most likely to conceived (3 to 4 days before and
3 to 4 days after ovulation).
- Woman should keep a diary of six menstrual
cycles.
- To calculate “safe days “ she subtracts 18 from
the shortest cycle and 11 from her longest cycle
documented.
Basal body temperature (BBT) method
- Based on Sperm’s survival rate: 3-5 days, rarely
7 day
- Time of ova ripe for maturation: 1 day
- the temperature of her body at rest
○ before the day of ovulation: 0.5°F
○ time of ovulation: 1 °F or 0.2°C
- NO SEX for the next 3 days
○ possible life of discharged ovum
- orally or with a tympanic thermometer, each
morning immediately after waking before she
rises from bed or undertakes any activity
- working nights: temperature after awakening
from her longest sleep period
- combine w/ calendar method
Factors to consider: a temperature rise caused by illness,
starting an aerobic program, or getting up earlier than
usual
- Before the day of ovulation, a woman’s BBT
falls about half a degree and at the time of
ovulation, her BBT rises a full degree because of
the influence of progesterone.
- To use the method, a woman takes her body
temp. each morning immediately after waking
before she undertakes any activity
Cervical Mucus Method (Billing’s Method)
- Just before ovulation: mucus secretion increases
- day of ovulation (the peak day): copious, thin,
watery, and transparent (like egg white)
○ Spinnbarkeit:
■ stretches at least 1 inch before
the strand breaks
- breast tenderness
- anterior tilt to the cervix
- fertile days: Copious
○ 3 to 4 days afterward done every day
- failure:difficulty in interpreting mucus status
- Uses the changes in cervical mucus that occur
naturally with ovulation. Before ovulation each
month, the cervical mucus is thick and does not
stretch when pulled between the thumb and
finger (Spinnbarkeit).
- Just before ovulation, mucus secretion increases.
- With ovulation (the peak day), cervical mucus
before copious, thin, watery and transparent. It
feels slippery and stretches at least 1 inch before
the strand breaks.
MJC - MCN (chap 6, 7, & 9)
Two-Day Method
- feels secretions for 2 days in a row
○ NO SEX for that day and the day
following
- Fertile days
○ 12 days per month
- A woman assess for vaginal secretions daily. If
she feels secretions for 2 days in a row, she
avoids coitus that day and the day following as
the presence of secretions suggests fertility.
- The method requires conscientious daily
assessment.
Symptothermal Method
- cervical mucus + BBT
- observes for other signs of ovulation:
○ mittelschmerz (midcycle abdominal
pain)
■ or if her cervix feels softer than
usual
CycleBeads
- a woman moves one bead every day to predict
her fertile days if her menstrual cycles range
from 26 to 32 days.
- Direction: to the right
- cycles between 26 and 32 days
- red:first day of her menstrual flow
- brown beads: “safe” days
- glow-in-the-dark white beads: fertile days
- brown: “safe”
- If she reaches a dark brown bead (appears on the
27th day) before she begins her next menses, her
cycle is too short for the method to be reliable.
- If she reaches the end of the string of beads (32
days) before menses, she knows her cycle is too
long for the method to be reliable
- A hands-on visual tool used by millions of
women worldwide, Cycle Beads is the original
way to identify your fertile days using the
Standard Days Method® of family planning.
- Cycle Beads is a color-coded string of beads
representing a woman's menstrual cycle. It helps
a woman track her cycle, identify when are
fertile days and non-fertile days, and monitor
that her cycles are in range for effective use of
this family planning method.
- A woman can plan or prevent pregnancy easily
and effectively with this easy to use tool.
Ovulation Detection/Awareness
- over-the-counter ovulation detection kit
- detect the midcycle surge of luteinizing hormone
(LH) that can be detected in urine 12 to 24 hours
before ovulation
- fairly expensive
- combined w/ cervical mucus assessment
- This is the use of over-the-counter ovulation
detection kit. It detect the midcycle surge of
luteinizing hormone that can be detected in urine
12 to 24 hours before ovulation.
Marquette Model
- ovulation detection + other signs of ovulation
- cervical mucus, BBT, cervix position, and
softness

A typical month showing predicted fertile days using the
calendar method as a natural family planning method.
A typical month using the cervical mucus method of
natural family planning. Unmarked days are those
predicted to be unfertile and therefore safe for sexual
relations.
Natural Family Planning
● NOT Good Candidates
○ Adolescents
■ require a great deal of thought
and persistence
■ boys may lack the control or
experience to use coitus
interruptus effectively
■ Girls tend to have occasional
anovulatory menstrual cycles
for several years after menarche
■ require adolescents to say “no”
to sexual intercourse on fertile
days, a task that may be difficult
to complete
■ because of risk to them if they
have a history of high blood
pressure, thromboembolic
disease, or cigarette smoking
● Good candidates
○ Perimenopausal women
■ may not have as much cervical
mucus as previously menstrual
cycles could become
unpredictable
● Breastfeeding Postpartum mothers
2. Artificial Methods of Reproductive Life Planning
Contraceptives: Barrier Methods
● Barrier methods are those that place a chemical
or latex barrier between the cervix and
advancing sperm.
○ Spermicides
○ Male and female condoms
○ Diaphragm
○ Cervical cap
Spemicide
- Is an agent that causes the death of spermatozoas
before they can enter the cervix
Vaginal insertion of a spermicidal agent
● contraindicated
○ in women with acute cervicitis
- Agents cause the death of spermatozoa before
they can enter the cervix.
- The agent also change the vaginal pH to a strong
acid level, a condition not conducive to sperm
survival.
Male and Female Condoms
Male condom
- is a latex rubber or synthetic sheath that is
placed over the erect penis before coitus to trap
sperm
- Ideal rate of 2% and true failure rate of about
15%
- Advantage: one of the few “male-responsibility”
birth control measures available
- A latex rubber or synthetic sheath that is placed
MJC - MCN (chap 6, 7, & 9)
over the erect penis before coitus.
- Prevents pregnancy by depositing the
spermatozoa in the tip of the condom.
Proper application of a male condom
● Certain space is left at the tip
○ helps to ensure the condom will not
break with ejaculation.
Female condom
- Sheaths made of latex or polyurethane
prelubricated with spermicide similar to male
condoms
- Offer protection against conception as well as
STIs, including HIV
- Latex sheaths made by polyurethane and
lubricated by nonoxynol-9.
- The inner ring (closed end) covers the cervix
and the outer ring (open end) rests against the
vaginal opening.
- Male and female condom should not be used
together.
●
Insertion technique
○ Male and female condoms
should not be used together
■ there is an increased
chance of tearing one
or the other.
● sensitivity or allergy to latex:
○ alternatives
■ polyurethane
■ natural membrane types can
be used
● do not offer the
same level of
protection against
STIs.
Diaphragm
- A circular rubber disc that is placed over the
cervix prior to intercourse.
- They should be left in place for 6 hours
afterwards.
- Should not be placed longer than 24 hours
Proper insertion of a diaphragm
● After spermicidal jelly or cream is applied to the
rim, the diaphragm is pinched between the
fingers and thumb.
● The folded diaphragm is then inserted into the
vagina and pushed back as far as it will go.
● To check for proper positioning, the woman→
feels the cervix to be certain it is completely
covered by the soft rubber dome of the
diaphragm.
● To remove the diaphragm, a finger is hooked
under the forward rim and the diaphragm is
pulled down and out.
● prescribed and fitted initially by a healthcare
provider to ensure a correct fit.
● REFITTING:
○ pregnancy, miscarriage, cervical surgery
(dilatation and curettage [D&C]), or
elective termination of pregnancy
○ gains or loses more than 15 lb

○ should remain in place for at least 6
hours after coitus because spermatozoa
remain viable in the vagina for that
length of time;
○ they may be left in place for as long as
24 hours.
○ more than 24 hrs: can cause cervical
inflammation (erosion) or urethral
irritation from the pressure against the
vaginal walls.
○ If coitus is repeated before 6 hours, both
a diaphragm or cap should not be
removed and replaced;
○ If more spermicidal gel should be added
to the vagina by an applicator.
○ should be washed in mild soap and
water, dried gently, and stored in its
protective case.
■ will last for 2 years,
Side Effects and Contraindications
● not effective if the uterus is prolapsed,
retroflexed, or anteflexed
● cystocele or rectocele
○ cystocele or rectocele: difficult to
insert
● a higher number of urinary tract
infections (UTIs) than nonusers
○ pressure to urethra
● Herpes virus infection, or a Papillomavirus
infection
● History of toxic shock syndrome (TSS; a
staphylococcal infection introduced through the
vagina)
● Allergy to rubber or spermicides
● History of recurrent UTIs
● herpes virus infection, or a papillomavirus
infection because the
■ close contact of the rubber
■ use of a spermicide
● can cause
additional
irritation
Cervical cap
- is placed over the cervix and used with a
spermicidal jelly the same as a diaphragm.
- tend to dislodge more readily than
diaphragms during coitus
- can be kept in place longer (up to 48 hours)
○ because they do not put
pressure on the vaginal walls
or urethra.
- If coitus is repeated before 6 hours, both a
diaphragm or cap should not be removed and
replaced
- Caps are made of soft rubber, are shaped like
a thimble and fit snugly over the uterine
cervix.
- Many women cannot use cervical cap
because their cervix is too short for the cap
to fit properly.
- It can remain longer than diaphragms
because they do not put pressure on the
vaginal walls or urethra.
- Length of time should not exceeds to 24- 48
MJC - MCN (chap 6, 7, & 9)
hours.
Hormonal Contraceptives
- Hormones that cause fluctuations in the
normal menstrual cycle to prevent
ovulation or normal transport
● Oral - Combination oral contraceptives (COCs)
● Transdermal
● Intravaginal
● Intramuscular
● Subdermal hormone implants
ORAL CONTRACEPTIVE/PILLS (combination of
hormones)
- estrogen acts to suppress follicle-stimulating
hormone (FSH) and LH→ suppress ovulation
- progesterone action→ causes a decreased
permeability of cervical mucus= limited sperm
motility and access to ova.
● Monophasic
● Biphasic
● Triphasic
● Progestin-only Pills (Mini-Pills)
- Composed of varying amount of synthetic
estrogen combined with small amount of
progesterone.
- Available in monophasic, biphasic and triphasic
preparations.
- Commonly packed in 28 pills (21 active pill and
7 placebo pills)
Monophasic pills
- contain fixed doses of both estrogen and
progestin throughout a 21-day cycle
Biphasic
- a constant amount of estrogen throughout the
cycle
- but varying amounts of progestin
Triphasic and Tetraphasic preparations
- vary in both estrogen and progestin content
throughout the cycle
- 28-pill dispensers → (21 active pills and 7
placebo pills) labeled with the day of the
cycle they should be taken.
- COCs must be prescribed by a healthcare
provider after screening for eligibility.
- If the woman is over the age of 21 years and
is due for a routine exam
● a pelvic exam and Pap smear are
usually completed at this visit as well.
Progestin-Only pills (mini-pills)
- Without estrogen content, ovulation may occur
- progestins don’t allow the endometrium to
develop fully= sperm to freely access the
cervix, fertilization and implantation will not
take place.
- Known as the progestin only pills.
- Taken by women who cannot take an
estrogen-based pill because of the dangrer of
thrombophlebitis.

Emergency Postcoital Contraceptives
- Known as the morning after pills.
- Usually taken within 72 hours of unprotected
intercourse
- For use in an emergency only (such as rape)
● High-dose progestin-based pills
● Insertion of copper IUD
● Ulipristal acetate (known as Ella)
- Postcoital methods such as Plan B One-Step
and Next Choice (the most frequently used
forms) do not cause abortion
● the pills work by inhibiting
ovulation and interfering with
fertilization by slowing the transport
of sperm.
● taken anytime within 72 hours (3
days) of unprotected coitus to
interrupt a pregnancy.
● OTC; pelvic examination→ (not
necessary)
Start Date For A Cycle Of Pills In One Of Four Ways
● Sunday start
- Take the first pill on the first Sunday
after the beginning of a menstrual flow.
● Quick start
- Begin pills as soon as they are
prescribed.
- Beginning pills immediately after a
prescription is filled may increase
compliance, reducing unintended
pregnancies.
● First-day start
- Begin pills on the first day of menses.
● After childbirth
- a woman should start the
contraceptive on a day (or Sunday)
closest to 2 weeks after birth; after
elective termination of pregnancy, she
could begin on a chosen day or the first
Sunday after the procedure.
SUGGESTIONS ON ORAL CONTRACEPTIVE
MANAGEMENT
● If the pill omitted was one of the placebo ones
- ignore it and just take the next pill on
time
the next day.
● If you forgot to take one of the active pills,
take it as soon as you remember. Continue the
following day with your usual pill schedule.
Doing so might mean taking two pills on one
day if you don’t remember until the second day,
but that’s all right. Missing one pill this way
should not initiate ovulation.
● If you miss two consecutive active pills, take
two pills as soon as you remember. Then,
continue the following day with your usual
schedule. You may experience some
breakthrough bleeding (vaginal spotting) with
MJC - MCN (chap 6, 7, & 9)
two forgotten pills.
- Do not mistake this bleeding for your
menstrual flow.
- Missing two pills may allow ovulation
to occur, so an added contraceptive
such as a spermicide should be used for
the remainder of the month.
● If you miss three or more pills in a row
- throw out the rest of the pack
- then start a new pack of pills.
➢ You might not have a period
because of this routine and
should use extra protection until
7 days after starting a new pack
of pills.
● If you think you might be pregnant,
○ stop taking pills and notify your
healthcare provider.
Side Effects and Contraindications of All Oral
Contraceptives
➢ Nausea
➢ Weight gain
➢ Headache
➢ Breast tenderness
➢ Breakthrough bleeding (spotting outside the
menstrual period)
➢ Monilial vaginal infections
➢ Mild hypertension
➢ Depression
Estrogen/progesterone-based patches
- help adherence because they need attention
only once a week.
- They may be applied on the
● upper outer arm,
● upper torso (front or back, excluding the
breasts)
● Abdomen
● buttocks
- They should not be placed in any area where
● makeup, lotions, or creams will be
applied;
● at the waist where bending might loosen
the patch
● anywhere the skin is red, irritated, or has
an open lesion.
- Refers to the patches that slowly, but
continuously release a combination of estrogen
and progesterone.
- May be applied to one of four areas: upper outer
arm, upper torso (front or back, excluding the
breast), abdomen or buttocks.
Vaginal Estrogen/Progestin Rings (Nuvaring and
Annovera)
- Progesterone is gradually released to be
absorbed by the vaginal walls.
- left in place for 3 weeks and then removed for 1
week with menstrual bleeding occurring
during the ring-free week

- avoiding a “first pass” through the liver, as
happens with COCs
● this is an advantage for women with
liver disease
- Women should be counseled that if they
should take out the ring for more than 4
hours for any purpose,
● they should replace it with a new
ring
● and use a form of barrier
protection for the next 7 days
- Commonly known as the NuvaRings
- Consist of a thin, flexible plastic ring that
contains a combination of estrogen and
progestin.
- Inserted in the vagina and left in place for 21
days then removed for 7 days.
Subcutaneous/Subdermal Hormone Implant
- will slowly release progestin over 3 years.
- inserted as an in-office procedure with the use
of a local anesthetic during menses or no later
than day 7 of a menstrual cycle
● to be certain a woman is not pregnant at
the time of insertion.
- effective and reliable alternative to
COCs’ estrogen-related side
effects.
- can be used during breastfeeding without an
effect on milk production.
- The implants slowly release the hormone,
suppressing ovulation, stimulating thick
cervical mucus, and changing the
endometrium so that implantation is difficult.
- Inserted and removed using local anethesia.
- Implanon and Norplant are the common brands
Intramuscular Injections
- Depo-Provera Contraceptive Injection
- progesterone is given every 12 weeks,
● inhibits ovulation
● alters the endometrium
● thickens the cervical mucus
➢ so sperm progress is difficult
before the fifth day after the
beginning of a menstrual flow.
- the Human Sexuality and Responsible
Parenthood the injection site after
administration= Slow absorption of the drug
from the muscle
- buttocks, deltoid, or thigh
- A single injection of medroxyprogesterone
acetate (DMPA or Depo-Provera).
- Given every 12 weeks to inhibit ovulation,
alter the endometrium and change the cervical
mucus.
Intrauterine Devices (IUDs)
- either hormonal or nonhormonal.
MJC - MCN (chap 6, 7, & 9)
- can also be used within 5 days of unprotected
sex as a form of emergency contraception.
- Properly fitted, such devices are contained
wholly within the uterus, although an attached
string protrudes through the cervix into the
vagina
- A small plastic device is inserted into the
uterus to prevent fertilization and/or decrease
sperm motility
● Copper T380
➢ 1-effective for 10 years
● Levonorgestrel-releasing intrauterine
system (Mirena or Liletta)
➢ 2-effective for 5 years (possibly
as long as 7 years).
● Levonorgestrel-releasing intrauterine
system 13.5 mg (Skyla)
➢ 3-effective for 3 years
● Levonorgestrel-releasing intrauterine
system 19.5 mg (Kyleena)
➢ 4-approved for 5 years
Intrauterine devices using copper or levonorgestrel
- first 2 or 3 weeks after IUD insertion=
● spotting or uterine cramping
theIbuprofen for pain
- Nulliparous women can be fitted
● but have a slightly higher rate of
expulsion
- infection is no longer a concern
● because the vaginal string no longer
conducts fluid
- maybe contraindicated
● for a woman whose uterus is distorted in
shape
■ the device might perforate
the uterine wall
- COPPER IUD
● not advised for
➢ a woman with severe
dysmenorrhea (painful
menstruation)
➢ menorrhagia (heavy bleeding)
➢ anemia also may not be
considered a good candidate
● usually done at a
➢ 6-week postpartum checkup
➢ immediately after childbirth
➢ after unprotected sex as
postcoital protection

3. Surgical Methods of Reproductive Life Planning
Vasectomy
- A small incision is made in each side of the
scrotum. The vas deferens is then cut and tied ,
cauterized or plugged, blocking the passage of
spermatozoa.
- Done in an ambulatory setting such as
physician’s office or reproductive life planning
clinic.
- The left vas deferens is being cut with
surgical scissors.
- The cut ends of the vas deferens are
cauterized or clamped to completely
ensure blockage o the passage of sperm.
- under local anesthesia in an ambulatory
setting
- a small amount of local pain
afterward:
● mild analgesic and applying
ice to the site.
- hematoma at the surgical site may occur
POSTVASECTOMY PAIN SYNDROME
● may DEVELOP chronic pain after vasectomy;
having the procedure reversed relieves this pain
● can RESUME SEXUAL INTERCOURSE
WITHIN 1 WEEK
● an additional birth control method should be
used UNTIL TWO NEGATIVE SPERM
reports at ABOUT 6 AND 10
● WEEKS have been obtained (proof all sperm
in the vas deferens have been eliminated,
usually
- REQUIRING 10 TO 20
EJACULATIONS.
● may also be associated with the development of
UROLITHIASIS (kidney stones)
● Some men develop AUTOIMMUNITY OR
FORM ANTIBODIES AGAINST SPERM
following a vasectomy
- even w/ successful reversal: sperm may
NOT HAVE GOOD MOBILITY OR
BE INCAPABLE OF FERTILIZATION
■ SPERM BANKED
BEFORE
VASECTOMY
Tubal Ligation
FEMALE STERILIZATION
● HYSTERECTOMY - removal of the uterus or
ovaries
● FIMBRIECTOMY - removal of the fimbria
● SALPINGECTOMY - removal of ovaries and
fallopian tubes
● OOPHORECTOMY - removal of one or both
ovaries; ovariectomy.
- The fallopian tubes are occluded by cautery,
MJC - MCN (chap 6, 7, & 9)
crushing, clamping or blocking the tubes
(Essure), thereby preventing passage of both
sperm and ova.
- Should not be undertaken unless the woman
does view it as a permanent irreversible
procedure.
CHAPTER 7: The Nursing Role in Genetic
Assessment and Counseling
Gene Replacement Therapy and Gene Editing
Gene Replacement Therapy- is an experimental
technique that uses genes to treat or prevent disease.
Gene Editing- DNA is inserted, deleted, modified or
replaced in the genome of a living organism targets the
insertions to site specific locations.
GENETIC DISORDERS
⮚ may occur at the moment an ovum and a sperm
fuse or even earlier, in the meiotic division
phase of the gametes
⮚ 50% of 1st trimester spontaneous miscarriages
⮚ Or Inherited disorders = are disorders that
can be passed from one generation to the
next because they result from some disorder
in the gene or chromosome structure.
o Genetics = is the study of the way such
disorders occur.
o Cytogenetics = is the study of
chromosomes by light microscopy and
the method by which chromosomal
aberrations are identified.
NATURE OF INHERITANCE
⮚ Genes = are the basic units of heredity that
determine both physical and cognitive characteristics of
people.
⮚ Are composed of segments of DNA, which are
woven into strands in the nucleus of all body
cells to form chromosomes.
⮚ Alleles = are the two like genes on autosomes.
⮚ Phenotype = refers to a person’s outward
appearance or the expression of genes.
⮚ Genotype = refers to a person’s actual gene
composition.
⮚ Genome = is the complete set of genes present
(about 50,000 to 100,000).
GENETIC INFORMATION
⮚ Gene – basic unit of genetic information.
Genes determine the inherited characters.
⮚ Genome – the collection of genetic
information.
⮚ Chromosomes – storage units of genes.
⮚ DNA - is a nucleic acid that contains the
genetic instructions specifying the biological
development of all cellular forms of life.

MENDELIAN INHERITANCE
Gregor Mendel- described the principle of generic
inheritance.
⮚ When dominant gene is paired with
nondominant (recessive) ones, the dominant
genes are always expressed in preference to the
recessive genes.
Ex: a gene for brown eyes is dominant over one for
blue eyes.
✔ 2 healthy genes-HOMOZYGOUS
✔ 2 unhealthy genes-HETEROZYGOUS
MEDICAL GENETICS
When studying rare disorders, general patterns of
inheritance are observed:
✔ Autosomal recessive
✔ Autosomal dominant
✔ X-linked recessive
✔ X-linked dominant
DOMINANT VS. RECESSIVE
A dominant allele is expressed even if it is paired with
a recessive allele. A recessive allele is only visible
when paired with another recessive allele.
INHERITANCE OF DISEASE
Autosomal Dominant- either a person has 2 unhealthy
genes (HOMOZYGOUS DOMINANT)
e.g. DD or is heterozygous, with the gene causing the
disease stronger than the corresponding healthy
recessive gene for the same trait e.g. Dd
AUTOSOMAL DOMINANT DISORDERS
✔ Huntington disease- progressive neuro do
✔ Marfan syndrome(CT tissue disorder)
✔ breast & ovarian CA
✔ osteogenesis imperfecta (bones are brittle)
AUTOSOMAL DOMINANT
⮚ Affected males and females appear in each
generation of the pedigree.
⮚ Affected mothers and fathers transmit the
phenotype to both sons and daughters.
▪ Huntington disease
AUTOSOMAL RECESSIVE
⮚ The disease appears in M and F children of
unaffected parents.
▪ cystic fibrosis
Autosomal Recessive cont’d
⮚ disease does not occur unless 2 genes for the
disease are present(homozygous recessive
pattern)
▪ CF, albinism, adrenogenital syndrome,
Tay-Sach’s, galactosemia, PKU, Rh-
incompatibility
X-linked Dominant Inheritance
⮚ genes are located on, and transmitted only by
MJC - MCN (chap 6, 7, & 9)
the female sex chromosome(X chromosome)
⮚ if the affected gene is dominant, only 1 X
chromosome with the trait need be present for
symptoms of the disorder to be manifested
▪ Alport’s syndrome- progressive kidney failure
disorder.
X- linked Recessive Inheritance
⮚ Usually, only males will have the disorder
⮚ history of girls dying at birth for unknown
reasons(females with affected gene on both X
chromosomes)
▪ hemophilia A, Christmas disease, color
blindness, Duchenne muscular dystrophy and
fragile X syndrome(cognitive challenge
syndrome)
Multifactorial (Polygenic) Inheritance
⮚ from multiple gene combinations +
environmental factors
▪ heart ds, DM, cleft palate, NTDs, pyloric
stenosis
CHROMOSOMAL ABNORMALITIES
(CYTOGENIC DISORDERS)
⮚ Abnormalities at fault in the number/structure
of chromosome which results in missing or
distorted genes.
⮚ When chromosomes are photographed and
displayed, the resulting arrangement is termed
a KARYOTYPE.
▪ fluorescent in situ hybridization (FISH)- the
number of chromosomes and specific parts of
chromosomes can be id by karyotyping or by
this process
Nondisjunction Abnormalities
⮚ the division is uneven(NONDISJUNCTION)
resulting to 1 sperm/ovum having 24 & the
other 22
⮚ if this fuses with a normal sperm/ovum, the
zygote will have 47 or 45 chromosomes
▪ Down’s syndrome(Trisomy 21) increases with
maternal & paternal age
▪ Turner & Klinefelter syndrome
Deletion Abnormalities
⮚ chromosome disorder in which part of the
chromosome breaks during cell division,
causing the affected person to have the
normal # of chromosomes +/- an extra
portion of a chromosome,
e.g 45.75 or 47.5
▪ Cri-Du-Chat syndrome(46XY5q-)Cat Cry
Syndrome- 1 portion of chr. 5 is missing
Translocation Abnormalities
⮚ a child gains an additional chromosome
through another route
▪ TRISOMY 21

Mosaicism
⮚ when the nondisjunction disorder occurs after
fertilization of the ovum, as the structure begins mitotic
cell division
⮚ different cells in the body will have different
chromosome counts
Isochromosomes
⮚ chr accidentally divides not by a vertical
separation but by a horizontal one, a new
chromosome with mismatched long and short
arms can result.
⮚ much the same effect as a translocation
● Turner’s syndrome
GENETIC COUNSELING
Purposes:
● Provide concrete, accurate information: process
of inheritance & inherited disorders
● Allow people to make informed choices about
future reproduction
● Offer support to people who are affected by
genetic disorders
Couples who may benefit include those:
● who have a child with congenital disorder or an
inborn error of metabolism
● whose close relatives have a child with a
genetic disorder such as translocation disorder
or inborn error of metabolism
● Who are known balanced translocation carriers
● With inborn error of metabolism or
chromosomal disorder
● Who are a consanguineous couple(closely
related)
● With the woman older than 35 and the man
older than 55
● Are of ethnic backgrounds in which specific
illnesses are known to occur; Chinese(G6PD,
Mediterranean, thalassemia)
NURSING RESPONSIBILITIES
✔ Explaining to a couple what procedures they
can expect to undergo
✔ Explaining how different genetic screening
tests are done and when they are usually
offered
✔ Supporting a couple during their wait for test
results
✔ Assisting couples in values clarification,
planning, and decision-making based on the
results
✔ do not impose your own values or opinions
ASSESSMENT FOR GENETIC DISORDERS
● HISTORY
● Document diseases in family members
● Ethnic background
● Mother’s age, spontaneous miscarriage
PHYSICAL ASSESSMENT
MJC - MCN (chap 6, 7, & 9)
⮚ PE of family member with a disorder, siblings
and the couple
Check: space between the eyes, height, contour, shape
of ears, number of fingers & toes, webbing,
dermatoglyphics(markings on skin), abnormal
fingerprints, palmar creases, abnormal hair whorls or
hair coloring.
DIAGNOSTIC TESTING
⮚ Karyotyping-sample of peripheral venous
blood or scraping of cells from buccal cavity;
cells are grown to metaphase, stained, placed
under a microscope & photographed( chr are id
according to size, shape & stain)
o Newer method of staining, FISH, can be done
immediately rather than waiting for metaphase
o FISH stands for fluorescence in situ
hybridisation.
o looks for gene changes in cells.
o FISH tests look for specific genes or parts of
genes.
Maternal Serum Screening- AFP by the fetal liver that
peaks in maternal serum between the 13th and 32nd
week;
⮚ a group of tests used in the second trimester of
pregnancy to help evaluate a woman's risk of
carrying a baby with chromosome disorders,
including Down syndrome (trisomy 21) or
Edwards syndrome (trisomy 18), or neural tube
defects such as spina bifida or a condition
called anencephaly.
o level is elevated with fetal spinal cord disease
o decreased with fetal chromosomal disorder like
Trisomy 21
Chorionic Villi Sampling(CVS)- involves retrieval &
analysis of chorionic villi from the growing placenta for
chromosome or DNA analysis
Amniocentesis- withdrawal of AF through the
abdominal wall for analysis at the 14th to 16th week
Percutaneous Umbilical Blood Sampling(PUBS)- or
cordocentesis is the removal of fetal cord blood at 17
weeks using amniocentesis methods.
COMMON CHROMOSOMAL DISORDERS
TRISOMY 13 SYNDROME (47XY13+ OR
47XX13+) OR PATAU SYNDROME
⮚ extra chr 13, severely cognitively challenged
⮚ midline body disorders like cleft
lip/palate, heart defects, abn genitalia,
microcephaly, microphthalmia, low-set
ears; most do not survive beyond early
childhood
Trisomy 18 (47XX18+ or 47XY18+)/Edward’s
Syndrome
⮚ they have 3 copies of chr 18 severely
cognitively challenged, SGA, low-set ears,

small jaw, congenital heart defects,
misshapen fingers & toes, rocker-bottom
feet
⮚ do not survive beyond early infancy
Cri-du-chat syndrome (46XX5p- or 45XY5p-)
⮚ result of missing portion of chromosome 5
⮚ abnormal cry, small head, wide-set
eyes, downward slant to the
palpebral fissure, severely
cognitively challenged
Turner Syndrome (45XO) or Gonadal dysgenesis
⮚ only 1 functional X chromosome
⮚ short in stature
⮚ streak(small non-functional) ovaries,
sterile, & secondary sex characteristics
except for pubic hair, do not develop
during puberty
⮚ hairline at the nape of the neck is low-set
⮚ neck is webbed & short,
⮚ NB may have edema of the hands & feet &
anomalies like CoA & kidney disorders
⮚ learning disabilities
⮚ human growth hormone and estrogen may
cause appearance of sex characteristics
Klinefelter Syndrome (47XXY)
⮚ males with extra X chromosome
⮚ puberty, no development of secondary sex
characteristics; small testes with
ineffective sperm, gynecomastia,
increased risk for breast CA
Fragile X Syndrome (46XY23q-)
⮚ most common cause of cognitive challenge in
males
⮚ X linked -1 long arm of X chr is defective
⮚ before puberty, boys demonstrate
maladaptive behaviours like hyperactivity
or autism, reduced intellectual functioning
with marked deficits in speech &
arithmetic
⮚ Broad forehead, long face with high
forehead, prominent lower jaw, large,
protruding ears, hyperextensive joints,
cardiac disorders
⮚ after puberty, large testicles;
⮚ fertile
Down Syndrome (Trisomy 21) (47XY21+ or
47XX21+)
⮚ most frequently occurring chromosomal
abnormality (1 in 800 pregnancies)
⮚ TRISOMY 21 SYMPTOMS
• broad & flat nose,
• eyelids have an extra fold of tissue at the
inner canthus (epicanthal fold)
• palpebral fissure tends to slant upward,
• iris may have white specks (Brushfield spots)
• tongue may protrude since the oral cavity is
MJC - MCN (chap 6, 7, & 9)
small,
• back of the head is flat
• poor muscle tone(rag-doll appearance) that
the toe can touch the nose,
• fingers are short & thick and the little finger
is curved inward,
• wide space between the 1st & 2nd toes &
between the 1st & 2nd fingers, palm of hand
has a simian line
• cognitively-challenged to some
degree(50-70%)
• neck is short, extra pad of fat at the base of
the head causes the skin to be loose it can be
lifted easily(puppy’s neck),
RETINOBLASTOMA
⮚ a rare form of cancer that rapidly develops
from the immature cells of a retina, the light-
detecting tissue of the eye. It is the most
common primary malignant intraocular cancer
in children, and it is almost exclusively found
in young children.
WILM’S TUMOR
⮚ a rare kidney cancer that primarily affects
children. Also known as
NEPHROBLASTOMA, it's the most common
cancer of the kidneys in children. Wilms' umor
most often affects children ages 3 to 4 and
becomes much less common after age 5.
NEUROBLASTOMA
⮚ a cancer that develops from immature nerve
cells found in several areas of the body.
⮚ most commonly arises in and around the
adrenal glands, which have similar origins to
nerve cells and sit atop the kidneys.
CHAPTER 9: Nursing Care During Normal
Pregnancy and Care of the Developing Fetus
A. The Nursing Role and Nursing care During
Normal Pregnancy and Birth
➢ Assures the health of the mother, and also her
baby
➢ Obtain a complete history and provide a physical
examination that influence the fetal development
➢ Ensure prenatal visit to avoid risk due to
complications.
B. Stages of Fetal Development
➢ In 38 weeks, a fertilized egg developed into
fetus
➢ Consist of three periods:
a. Pre-embryonic (1st 2 weeks, beginning
with fertilization)
b. Embryonic (weeks 3 through 8)
c. Fetal (weeks 8 through birth)

1. Fertilization: The Beginning of Pregnancy
Fertilization. Also known as conception and
impregnation. It is known as the union of an ovum and
spermatozoon.
● Occurs in the outer 1/3 of fallopian tube, also
known as ampullar portion
● Only one ovum matures each month, so
fertilization must occur quickly because it has
the capable to fertilize for only about 24 hours
and spermatozoon in about 48 hours, possibly as
long as 72 hours.
Process:
➔ Ovum exit from the Graafian follicle,
surrounded by zona pellucida (ring of
mucopolysaccharide fluid) and corona radiata
(circle of cell).
➔ Zona pellucida and corona radiata serve as
protective buffers.
➔ Ovum propelled into fallopian tube by fimbriae
through the help of peristaltic action and
movement of tube cilia.
Note: Semen ejaculation averages 2.5 ml of fluid
that contains 50 to 200 million sperm, An
average of 400 million sperm per ejaculation.
➔ Woman cervical mucus reduce, in that way
sperm can easily penetrate it.
➔ The sperm reach the cervix within 90 secs and
reach the outer end of fallopian tube within 5
minutes.
Note: Species-specific reaction is the mechanism
of spermatozoa
Note: In order for the sperm to enter the egg, it
releases hyaluronidase (proteolytic enzyme)
➔ After that, a zygote is formed.
Note: Fertilization occur in 3 factors: (a) egg and sperm
must be mature, (b) ability of sperm to reach egg, (c)
ability of sperm to penetrate.
2. Implantation
Implantation. Contact between the growing structure and
uterine endometrium, occurs approximately 8 to 10 days
after fertilization.
● Occurs high in uterus on the posterior surface
● Zygote migrate toward the body of uterus in 3 to
4 days
● Mitotic cell division occurs
Process:
➔ 24 hours- cleavage occurs
➔ Every 22 hours- cleavage division continues
➔ Next 3 to 4 days- large cells collect periphery of
the ball. Trophoblast (outer ring) forms placenta
and membranes. Embryoblast (inner ring) forms
the embryo.
➔ 8 to 10 days- implantation
Note: if the implantation is low in the uterus, the
MJC - MCN (chap 6, 7, & 9)
growing placenta may block the cervix and make birth
child difficult.
C. Embryonic and Fetal Structure
Placenta and Membranes- serve as the fetal lungs,
kidneys, and digestive tracts in utero as well as help
provide protection for the fetus.
1. Decidua or uterine Lining
- This structure continues to grow in thickness and
vascularity instead of falling off and it will be
discarded after birth of child.
2. Chorionic Villi
- It is a miniature villus, resembling probing
fingers that reach out from trophoblast cell into
uterine endometrium.
- It has:
a. Central core
- composed of connective tissue
and fetal capillaries
- surrounded by double layers
that produce placental hormones
(hCG, hPL,estrogen and
progesterone) . double layers
named syncytiotrophoblast and
cytotrophoblast.
3. Placenta
- Latin for “pancake”, 15 to 20 cm in diameter
and 2 to 3 cm in depth.
- Provides oxygen and nutrients to fetus, and
removes waste products from baby’s blood.
a. Circulation
● 12th day of pregnancy, maternal blood begins to
collect in the intervillous spaces of the uterine
endometrium surrounding chorionic villi.
● 3rd week, oxygen and other nutrients from
the maternal blood through the cell layers of
chorionic villi into villi capillaries
● 50 ml/min at 10 weeks to 500 to 600 ml/min at
term
Note: Woman should not take nonessential drugs during
pregnancy because it can cause diorders such as unusual
facial features, low-set ears and cognitive challenge.
Note: Mother should lie on her left side because it lifts
the uterus away from the inferior vena cava, prevent
blood trap in lower extremities.
b. Endocrine function
● Human Chorionic Gonadotropin
- First placental hormone produce that can
be found in maternal blood and urine.
- Levels vary throughout pregnancy
- Act as a fail-safe measure to ensure the
corpus luteum of the ovary to continues
to produce progesterone ans estrogen so

the uterine lining maintain.
- Suppress maternal immunologic
response
● Progesterone
- Hormone that maintains pregnancy
- Maintain endometrial lining and present
in maternal serum as early as the 4th
week as aresult, continuation of corpus
luteum
- Reduce contractility of uterus during
pregnancy, thus preventing premature
labor.
● Estrogen
- Hormone of women
- Second product of the syncytial cells of
placenta
- Contributes to woman’s mammary
gland development in lactation
- Stimulates uterine growth to
accommodate the developing fetus.
● Human Placental Lactogen (Human Chorionic
Somatomammotropin)
- Hormone with both growth-promoting
and lactogenic properties
- Produce by the placenta beginning as
early 6th week, increasing to a peak
level at term
- Promotes mammary gland growth in
preparation for lactation in mother.
- Serve the important role of regulating
maternal glucose, protein and fat levels
so adequate amount of these nutrients
available to the fetus.
c. Placental proteins
Note: Has not been well documented, but may contribute
decreasing immunologic impact of growing placenta and
help prevent hypertension
4. Amniotic Membranes
- Forms beneath the chorion, it is a dual-walled
sac with the chorion as the outermost part and
the amnion as the innermost part.
- Have no nerve supply, so when spontaneously
rupture at term or are artificially ruptured via a
procedure, neither the mother or fetus
experiences any pain.
- Offers support to amniotic fluid and produces
the fluid. Produces a phospholipid that initiates
the formation of prostaglandins. May triggers
that initiates labor.
5. Amniotic Fluid
- Shield the fetus against pressure or a blow to the
mother’s abdomen
- Aids muscular development and allows fetus to
MJC - MCN (chap 6, 7, & 9)
move freely
- It protects the umbilical cord from pressure, thus
protecting the fetal oxygen supply
- Slightly alkaline, with a pH of about 7.2
- Never become stagnant because it is constantly
being newly formed and absorbed by direct
contact with the fetal surface of placenta.
- Ranges from 800 to 1,200 ml
Note: Hydramnios- excessive amniotic fluid (more than
2,000 ml, larger than 8 cm on ultrasound)
Note: Oligohydramnios- a reduction in the amount of
amniotic fluid
6. 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
placenta.
- Transport oxygen and nutrients to the fetus from
the placenta and to return waste products from
the fetus to the placenta, About 53 cm (21 in) in
length and 2 cm (0.75) thick
- The bulk of chord contains Wharton jelly, gives
cord body and prevents pressure on the vein and
arteries that pass through it.
- Contains only one vein and two arteries.
- Rapid of blood flow is rapid (350 ml/min)
D. Origin and Development of Organ System
1. Stem Cells
- 4 days of life- totipotent stem cells
- Another 4 days- pluripotent stem cells
- Another few days- multipotent
2. Zygote Growth
- Cephalocaudal- a head to tail direction
3. Primary Germ Layers
- Ectoderm, Mesoderm and Endoderm
4. Cardiovascular System
- 1st system to become functional in intrauterine
life
- 16th day- network of blood and single heart
tube
- 24th day- beats
- 6th or 7th week- septum develops
- 7th week- heart valves develop
- 10th or 12th week- heartbeat heard Doppler
instrument
- 11th week- ECG may be recorded
a. Fetal Circulation
- Blood is highly oxygenated and enterd
through umbilical vein,
- Infant’s oxygen saturation level- 95% to

100% and pulse rate- 80 to 140
beats/min
b. Fetal Hemoglobin
- Different composition that differs from
adult hemoglobin) More concentrated
and has greater affinity, 2 features that
increase its efficiency
- Newborn’s hemoglobin level- 17.1
g/ml while adult’s hemoglobin- 11g/ml
- Newborn’s hematocrit- 53% while
adult’s hematocrit- 45%
5. Respiratory System
- 3rd week of intrauterine life
- Exist as a single tube with digestive tract
● End 4th week- septum divide the
esophagus from traches; lung buds
appear on trachea
● End of 7th week- diaphragm does not
completely divide the thoracic cavity
from the abdomen
● 3 months of gestation and continues-
spontaneous respiratory practice
movement
● After birth- specific lung fluid is
rapidly absorbed
● 24th week- surfactant formed and
excreted by alveolar cells.
Note: Surfactant has 2 components: lecithin and
sphingomyelin.
6. Nervous System
- Begins to develop extremely early in pregnancy
● 3rd week of gestation- neural plate
● All parts of brain form in utero but none
are completely mature
● 8th week- brain waves detected on EEG
● 24 weeks- ear and eye respond
7. Endocrine System
- Fetal pancreas produce insulin
- Thyroid and parathyroid gland plays vital role
in fetal metabolic function and calcium balance
- Fetal adrenal glands supply precursor for
estrogen synthesis by placenta
8. Digestive System
- 4th week of intrauterine life- separate from
respiratory tract Rapidly grow
- 6th week- intestine become too large to be
contained in the abdomen
- 10th week- portion of intestine pushed into the
base of umbilical cord
- 16th week- meconium produce
- 36th week- secrete enzymes essential for carbs
MJC - MCN (chap 6, 7, & 9)
and protein digestion
Note: Omphalocele- intestine remains outside the
abdomen in the base of the cord
● Gastroschisis- similar defect, occurs when the
original midline fusion that occurred at the early
cell stage is incomplete.
● Gastrointestinal tract is sterile before birth
● Liver is also active and filter between incoming
blood and fetal circulation and as a deposit site
for fetal stores such as iron and glycogen
9. Musculoskeletal System
- 1st 2 weeks- cartilage prototypes provide
position and support to the fetus
- 12th week- ossification of cartilage bone begins
- 11th week- fetus can be seen move on
ultrasonography
- 16th to 20th week - movement of fetus
10. Reproductive System
- Sex can be determined at the moment of the
conception by a spermatozoon carrying an X or
Y chromosome
● 8th weeks- chromosomal analysis on
mother’s bloodstream
11. Urinary System
- Presence of kidneys does not appear because the
placenta clears the fetus’ waste products
- Fetal urine is being excreted at a rate of up to
500 ml/day
12. Integumentary System
- Skin is covered by soft downy hairs (lanugo), it
serves as insulation to preserve warmth in the
utero
● 36th weeks- skin of fetus appears thin
and translucent
13. Immune System
- Early 20th week and by 24th week-
Immunoglobin G antibodies cross the placenta
into the fetus
- Fetal has no natural immunity
- Fetus only becomes capable of active antibody
produce in late pregnancy
- IgA and IgM cannot cross the placenta
14. Milestones of Fetal Growth and Development
15. Determination of Estimated Birth Date
- Using the Naegele’s rule , a standard method
used to predict the length of pregnancy

E. Assessment of Fetal Growth and Development
➢ Predict outcome of pregnancy
➢ Manage the remaining weeks of pregnancy
➢ Plan for possible complications at birth
➢ Plan for problems that may occur in the newborn
infant
➢ Decide whether to continue the pregnancy
➢ Find the conditions that may affect future
pregnancies
➢ Nurse must:
(a) Verify a signed content,
(b)certain that woman and her support are aware
of what procedure, potential risks,
(c) prepare woman physically and
psychologically,
(d) provide support, assess both maternal and
fetal response before an dafter procedure,
(e)provide follow-up care and manage
equipment and specimen,
(f) quiet listening
1. Health History
➔ Ask mother any prepregnancy illness
➔ Ask about any drugs a woman intake
➔ Ask about personal habit
➔ Ask if woman had any exposure to teratogens
➔ Ask unintentional injuries and partner violence
2. Physical Examination
➔ Assess maternal weight and general appearance
3. Estimating Fetal Health
a. Fetal Growth
➔ 12 weeks- over symphysis pubis
➔ 20 weeks- at umbilicus
➔ 36 weeks- at xiphoid process
➔ McDonald’s Rule
- A symphysis-fundal height
measurement
- easy method of determining
midpregnancy growth
4. Assessing Fetal Well-Being
➔ Fetal Heart Rate
➔ 10th to 11th week- heard and counted by use of
an ultrasound Doppler technique
➔ Daily Fetal movement Count (Kick Counts)
➔ 18th to 20th weeks- quickening
➔ 28th to 38th weeks- peaks intensity of
quickening
➔ Rhythm Strip Testing- assessment of fetal
well-being and assess the fetal heart for a normal
baseline rate
➔ Nonstress Testing- measures the response of the
fetal heart rate to fetal movement
➔ Vibroacoustic Stimulation- applied to mother’s
MJC - MCN (chap 6, 7, & 9)
abdomen to produce a sharp sound of approx..80
dB at a frequency of 80 Hz thus startling and
waking the fetus
➔ Ultrasonography- measures the response of
sound waves solid objects, a much used tool for
fetal health assessment
➢ Biparietal Diameter (side to side
measurement) : 8.5 cm(head) and
2,500g (weigh at age of 40th weeks)
➢ Doppler Umbilical Velocimetry:
measures the velocity at which RBC in
the uterine and fetal vessels travel
➢ Placental Grading for Maturity:
placenta can be graded on particular
amount of calcium deposits presen in
base
➢ Amniotic Fluid Volume: another way
to estimate fetal health because of the
portion of fluid formed by fetal kidney
output
➢ Nuchal Translucency: pockets fats or
fluid in posterior neck
➔ Biophysical Profile- combines 5 parameters
(fetal reactivity, fetal breathing movements, fetal
body movements, fetal tone and amniotic fluid
volume)
➔ Magnetic Resonance Imaging: - fetal
assessment technique because it identifies
structural anomalies/ soft tissue disorder
➔ Maternal Serum- no, of trophoblast cell pass in
maternal bloodstream beginning at 7th week
➢ Maternal Serum α-Fetoprotein:
produced by fetal liver, found in both
amniotic fluid and maternal serum
➢ Maternal Serum for Pregnancy -
Associated Plasma Protein A: secreted
by placenta, low levels in maternal
blood are associated with fetal
chromosomal anomalies
➔ Quadruple Screening-analyzes 4 indicators
of fetal health AFP, unconjugated estriol, hCG
and inhibitin.
➔ Fetal Gender-determined by ultrasound screen
about 4th months, determined as early as 7
weeks by maternal serum
➔ Invasive fetal testing-Amniotic fluid can be
analyzed for: AFP, Acetylcholinesterase,
Bilirubin determination, Chromosome analysis,
Color, Fibronectin, Inborn errors of metabolism,
L/S ratio, and Phosphatidylyglycerol and
desaturated phosphatidylcholine
➔ Percutaneous Umbilical Blood Sampling-
aspiration of blood from the umbilical vein for
analysis
 MJC - MCN (chap 6, 7, & 9)
➔ Fetoscopy- fetus is visualized by inspection
through a fetoscope