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NURSING CARE DURING ANTEPARTUM. Maternal Nursing – care given by the nurse to the expectant family before, during, & following birth Obstetrics – branch of medicine that pertains to the care of women during pregnancy, childbirth, & the postpartum period Obstetrician = physician.
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Maternal Nursing – care given by the nurse to the expectant family before, during, & following birth • Obstetrics – branch of medicine that pertains to the care of women during pregnancy, childbirth, & the postpartum period • Obstetrician = physician
Family-Centered Care • Recognizes the strength & integrity of the family as the core of planning & implementing health care • Nurse & family members need to be partners
History: • Before the 1900’s – most babies born @ home • By 1960 – more than 90% of births occurred in hospitals • And Now???
Merging of the Maternity Unit • Used to be separate labor room, delivery room, postpartum room, & newborn nursery • Now combining labor, delivery, & recovery (LDR) – may still be transferred to a postpartum unit, but baby usually rooms-in • Some facilities combine keep woman in same area throughout her entire experience (LDRP)
Lengths of Stay • Mandated by legislation • Vaginal delivery = 24-48 hrs. • Cesarean delivery = 72 hrs.
Statistics r/t Maternal Nursing: • Birthrate • Fertility rate • Fetal Mortality rate • Infant Mortality rate • Maternal Mortality rate • Neonatal Mortality rate • Perinatal Mortality rate
How are these statistics used? • To become aware of reproductive trends • To determine populations at risk • To evaluate the quality of prenatal care • To compare relevant information from state to state & country to country
Male Reproductive System: • Penis – deposits sperm into female’s vagina to fertilize an ovum • Testes – Manufacture sperm & secrete male sex hormones • Semen – seminal plasma & sperm together; excreted during sexual intercourse • Testosterone – most abundant male sex hormone • ↑ muscle mass & strength • Promotes growth of long bones • ↑ basal metabolic rate • Enhanced production of RBC’s • Produces enlargement of vocal cords • Affects distribution of body hair
Female Reproductive System: • Vagina – tubular structure made of muscle & membranous tissue • provides passageway for sperm to enter uterus • allows for drainage of menstrual fluids & other secretions • provides passageway for infant’s birth • Cervix – lower part of uterus • Lubricates vagina • Acts as a bacteriostatic agent • Provides alkaline environment for sperm • Produces mucus plug during pregnancy • Thins and dilates during labor
Female Reproductive System: • Uterus – hollow muscular organ; site of implantation of fertilized ovum & houses developing fetus • Consists of 3 parts: cervix, corpus, & fundus • Begins a pelvic organ, becomes temporary abdominal organ • Layers: • Perimetrium – outermost • Myometrium – middle • Endometrium - innermost
Female Reproductive System: • Fallopian Tubes – from uterus to ovary on each side • Provide passageway in which sperm meet ovum • Site of fertilization • Safe nourishing environment for ovum • Means of transporting ovum to uterus • Ovaries – almond-shaped glands • Produce estrogen & progesterone • Maturation of ovum during each reproductive cycle
Female Reproductive System Breasts = accessory organs of reproduction; produce milk after birth to provide nourishment & maternal antibodies to infant
Hormones • Follicle Stimulating Hormone (FSH): • Stimulates maturation of the follicle in the ovary that contains a single ovum • Luteinizing Hormone (LH): • Stimulates final maturation & release of the ovum • Corpus Luteum – empty follicle after ovum is released • Produces increasing amounts of estrogen & progesterone which lead to a build-up of the endometrium
Anterior pituitary secretes FSH & LH – maturation of ovum Ovulation – occurs when mature ovum is released from follicle ~ 14 days before onset of next menstrual cycle Corpus luteum turns yellow & secretes ↑ amounts progesterone If no fertilization – corpus luteum degenerates - ↓ amts. estrogen & progesterone (after 12 days) Endometrium breaks down – menstruation occurs Anterior pituitary secretes more FSH & LH – beginning a new cycle (refer to picture in book-pg 27)
Menarche – beginning of menstruation • Climacteric – period of years during which woman’s ability to reproduce gradually declines • Menopause – end of menstruation ___________________________________ • Conception (Fertilization) – sperm joins with ovum
Physiology of Pregnancy • Fertilization • During sexual intercourse, the sperm carried in the ejaculatory semen of the male enters the vagina of the female. • Through flagellation, the sperm travel through the mucus of the cervical canal, enter the uterine chamber, and move into the ampulla, the outer third of the fallopian tube. • If the timing is such that an ovum has been produced and is also within the ampulla of the tube, fertilization may occur.
Physiology of Pregnancy • Fertilization (continued) • Fertilization takes place when the sperm joins or fuses with the ovum; this is called conception. • Once fertilization has occurred, the new cell is referred to as a zygote or fertilized ovum. • At the moment of fertilization, the sex of the zygote and all other genetic characteristics are determined and they do not change. • 46 chromosomes- xx-girl xy-boy
Physiology of Pregnancy • Implantation • The zygote moves through the uterine tube through ciliary action and some irregular peristaltic activity. • It requires about 3 or 4 days to enter the uterine cavity. • During this time, the zygote is in a phase of rapid cell division called mitosis; further changes result in formation of a structure called the morula. • The morula develops into a blastocyst.
Implantation (continued) • The condition of the uterine lining is critical if implantation of the zygote is to occur. • Implantation usually occurs in the fundus of the uterus on either the anterior or posterior surface. • If uterine conditions are not suitable, it is unlikely that implantation will occur. • If the intrauterine vascular or hormonal conditions cannot sustain the implanted embryo, a spontaneous abortion will occur; usually during the first 8 weeks of pregnancy.
Implantation (continued) • After the blastocyst is free in the uterine cavity for 1 or 2 days, the exposed cell walls of the blastocyst (called the trophoblast) secrete enzymes that are able to break down protein and penetrate cell membranes. • These enzymes allow the blastocyst to enter the endometrium and implant. • The action of the enzymes normally stops short of the myometrium but may cause slight bleeding; this is called implantation bleeding. • The bleeding may confuse some women who think they had a very light and short menstrual cycle.
Physiology of Pregnancy • Implantation (continued) • Ectopic pregnancy, in which implantation occurs outside of the uterine cavity, also poses serious problems. • During the first few weeks after implantation, primary villi appear; these villi are able to use maternal blood vessels as a source of nourishment and oxygen for the developing embryo.
Physiology of Pregnancy • Implantation (continued) • It is also during these first few weeks that the first stages of the chorionic villi occur. • Chorionic villi secrete human chorionic gonadotropin (hCG), a hormone that stimulates the continued production of progesterone and estrogen by the corpus luteum; this is the reason that ovulation and menstruation cease during pregnancy. • The chorionic villi become the fetal portion of the placenta.
PLACENTA • Is a disc-like endocrine organ that secretes HCG, estrogen, & progesterone. Only present during preg. • Site of nutrient & waste exchange • Circulation thru to fetus is well established after 4th week gest. • Able to block transfer of certain substances: placental barrier • Meds such as Insulin & Ephedrine do not cross • Most bacteria do not cross (too large), some viruses able to cross • Shiny Schultz –fetal side, Dirty Duncan- maternal side
Amniotic Sac – 2 layers: amnion (fetal side) & chorion (outer layer); appears fragile but strong enough to hold fetus & amniotic fluid @ full term • Amniotic Fluid – acts as cushion against mechanical injury; helps regulate fetal body temp., allows room for growth, indicator of fetal well being & renal perfusion
Umbilical Cord – joins embryo to placenta • 20-22” long, <1” diameter • Wharton’s jelly – major part of the cord • Vessels: (remember AVA) • 1 vein – carries oxygenated blood to fetus • 2 arteries – carries deoxygenated blood back to placenta • No pain receptors • Can have knots, wrapped around fetus
Placental Hormones • Progesterone • Maintains uterine lining • ↓ uterine contractions • Prepares glands of breasts for lactation • Stimulates testosterone production in male fetus • Estrogen • Stimulates uterine growth • ↑ blood flow to uterine vessels • Stimulates development of breast ducts to prepare for lactation
Placental Hormones • Human Chorionic Gonadotropin (HCG) • Causes corpus luteum to persist & continue production of estrogen & progesterone to sustain pregnancy • Basis of most pregnancy tests • Human Placental Lactogen (HPL) • ↓’s insulin sensitivity & utilization of glucose by mother making more glucose available to fetus. Is Insulin Antagonist. • Relaxin: • Increases. Helps decrease contractions and remodel collagen in cervix
Stages of Prenatal Development • Germinal – fertilization to implantation • Called Zygote, up to 2 weeks • Embryonic – implantation (2nd wk) thru 8 weeks, basic form of all major organs & systems develop, simple heart beat, human appearance • Called Embryo • Fetal – 9 weeks to birth (38-40 wks. considered full term) • Called Fetus
Stages of Pregnancy • Trimesters: • First: conception-12 weeks • Second: 13-27 weeks • Third: 28- delivery
4 weeks 8 weeks 3 weeks
16 weeks 12 weeks
Fetal Circulatory Shunts: • Ductus Venosus – diverts some blood away from the liver as it returns from the placenta and goes to Rt atrium • Foramen Ovale – diverts most of the blood from the Rt. Atrium directly to Lt. Atrium, rather than circulating to the lungs • Ductus Arteriosus – diverts most of the blood from the pulmonary artery into the aorta
Fetal Circulation Rest of blood from Rt. Ventricle Blood from Left Ventricle Join thru Ductus Arteriosus Circulates thru fetal body Returns to placenta thru Umbilical Arteries
Closure of Fetal Shunts: • Foramen Ovale – pressure in Rt. side of heart ↓’s as lungs become fully inflated & now is little resistance to blood flow • Functional – 2 hrs. post birth • Permanent – by 3 months • Ductus Arteriosus – blood O2 level ↑’s • Functional – 15 hrs. post birth • Permanent – 3 weeks • Ductus Venosus – flow from umbilical cord stops • Functional – when umbilical cord is cut • Permanent – 1 week
Conditions that impede full lung expansion & decrease blood O2 levels may cause the Foramen Ovale &/or Ductus Arteriosus to reopen • Example: Respiratory Distress Syndrome • Can give Prostaglandins to keep open • Can give Indomethacin to help close
Determination of Pregnancy • Presumptive Signs • Amenorrhea • Nausea and vomiting • Frequent urination • Breast changes • Changes in shape of the abdomen • Quickening • Skin changes • Chadwick’s sign: discoloration of cervix • Fatigue
Determination of Pregnancy • Probable Signs • Changes in the Reproductive Organs • Hegar’s sign: softening of uterus • Goodell’s sign: softening of cervix • Chadwick’s sign: discoloration of cervix • Ballottement: • Enlargement of uterus • Positive Pregnancy Test