Fertilization, Implantation and early
Development of the embryo
Lecture 3
3/10/2006
1
Placenta
Remarkable organ originating from trophoblast layer
of fertilized ovum.
Placental functions
Transport
Respiratory
Nutrient function
Hormone production
Storage
Barrier function (molecular as heparin, syphilis,
2 toxoplasma
Abnormalities In Placenta
– Placenta Marginata: disorder of placental
attachment, mild type of abruption in which
slight separation occurs at the edge of
placenta in region of marginal sinus of
mother.
– Placenta circumvallata: opaque ring seen on
fetal surface, its formed by doubling edge.
– Placenta membranacea: covered all of the
fetus.
– Placenta Accretta, increta, percreta
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Fetus
Rate of growth development under control of
genetic control and nutrient in body
Size
--5th wk- sac
--12th wk-30gm
--28th wk-1100gm
--Full term-50cm (2700-3600 gm)
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Fetal Circulation
During intra uterine life of fetal, respiratory system is
not functioning because oxygenation of blood is
occurring in placenta, therefore 4-temporary structures
in fetal circulation, these are
Ductus Venous: runs from umbilical vein to the vena
cava, it carries oxygenated blood to the heart
Foramen Ovale: allows blood to flow from Rt atrium
directly to Lf atrium (bypass Rt ventricle and fetal
lungs).
Ductus Arterioses: communicating duct from
pulmonary artery to descending arch of aorta, it carries
deoxygenated blood.
Hypo gastric arteries: branching from internal iliac
5 arteries to enter the umbilical cord as umbilical arteries
6
Summary of fetal circulation
– O2 blood enters fetus via umbilical vein
– Umbilical vein goes straight to liver ,however most of blood go to Ductus
venous to inferior vena cava
– Inferior vena cava carrying co2 blood from lower parts of fetus
– Inferior vena cava empties its blood into Rt atrium
– Main volume of blood passes straight to Lt atrium via foramen Ovale.
– From Lf atrium blood passes to Lt ventricle and out into aorta to supply
brain and upper limbs
– Co2 blood returned from upper part of body via superior vena cava
– From superior vena cava blood travels through Rt atrium and ventricle
to enter pulmonary artery
– Most of the blood bypasses through Ductus Arterioses straight to
descending arch of aorta
– Main volume of blood diverted through hypo gastric arteries to cord and
7 then to placenta as umbilical arteries for replenishment.
Changes after birth
After clamping umbilical cord and take first
deep breath as a result of stimuli like
-Infant’s thorax first compressed and rapidly re
expands during delivery
-Cold of external environment
-Bright lights
-Noises
-Pressure on infant’s body and sensation of
8 weight
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Amniotic Fluid (liquor)
Allows growth and free movement of fetus
Equalizes pressure and protect fetus from injury
Maintains temperature and provides small
amounts of nutrients
In labour protects placenta and umbilical cord
from pressure of uterine contractions
Aids effacement of cervix and dilatation of
uterine os.
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Abnormalities
Polyhydraminus: exceeds 1500 ml (e.g.
encephalopathy)
Oligohydraminus: less than 300 ml (e.g. fetus
unable to pass urine)
Meconium: in case of fetal distress
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Umbilical Cord
Length 15-120 cm (average 50cm) sufficient
to allow delivery of baby without traction to
placenta occur.
-Transmits umbilical blood vessels
-Two arteries from internal iliac artery, un
oxygenated blood and one vein from Ductus
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venosus having oxygenated blood.
Abnormalities
Less than 40 cm short cord
Very long cord may wrapped around neck or
body of fetus or become knotted
True knots result occlusion of blood vessels
False knots
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Fetal Membranes (amniotic Sac)
Function
keep amniotic fluid
Asses in formation of fluid
Protection
Asses material exchange.
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Terminology
Para- number of births after 20 weeks
gestation regardless of whether the infants
were born alive or dead,twins are
considered a single para
Primagravida- woman pregnant for the first
time
Mulrigravida- woman who is in her second or
more pregnancy
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Terminology
Gravida-any pregnancy, regardless of
duration
Nulligravida- a woman who has never
been pregnant
Primapara-woman who has not given birth
at more than 20weeks gestation
Multipara-woman who has given birth two
or more times at more than 20 weeks
gestation
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Trimesters & length of
pregnancy
Average Pregnancy lasts
280 days-40 weeks and
is divided into trimesters
– 1st trimester 0-
3months(13WK)
– 2ndTrimester 3-6
months(26WK)
– 3rdTrimester-6-9
months(39WK)
– 10 lunar months
– 9 calendar months
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Profile of previous obstetric
history
GTPALM
G=gravida
T=term
P=premature births
A=abortions
L= number of living
children
M= multiple births
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GTPALM
A lady who is pregnant has 3 children
and a history of 1 miscarriage (abortion).
This would be written as follows
–G T P A l M
– 5-3-0-1-3-0
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Other institutions use only 2
letters
– P & G to indicate PARA and Gravida
– A woman pregnant for the first time
would be
P0, G1
A woman is pregnant has 4
children and has a history of 2
abortions
20 P4, G 7
DETERMINATION OF DATE OF
BIRTH
Nagele’s rule
1st day LMP - 3
months + seven
days
LMP Oct 10th2003
-3mts July 10th
+7 days
EDD= July 17th 2004
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Pre-natal care
Improved pre-natal care has dramatically reduced
infant and maternal mortality
Detecting potential problems early leads to prompt
assessment and treatment
Preventative measures such as adequate
nutrition, proper exercise, assessment of
pregnancy and a planned regimen of care are
essential
A pregnant woman should seek health care as
soon as she suspects she is pregnant
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The initial pre-natal visit
The initial visit will include
the following data
collection
– Health history
– Past medical history
– Genetic disorders
– Obstetric history
– Personal & social
history
23 – Physical assessment
Take health history
last period started on
menstrual cycles are regular and how long they
usually last;
details about any gynecological problems
details about any previous pregnancies.
medical history, including chronic conditions and
medications used to treat them, drug allergies,
psychiatric problems, and any past surgeries or
hospitalizations
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ask about activities such as smoking, drinking,
and drug use that could affect pregnancy.
Take family health history
askif any of relatives or
baby's father or his relatives
have had any chronic or
serious diseases
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Do a genetic and birth defect
history
ask if you, the baby's father, or anyone else
in the family has a chromosomal or genetic
disorder or was born with a structural birth
defect.
know about all the medications and
nutritional supplements you've taken since
your last period
any exposures to potential toxins
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Pre-natal visits
At each pre-natal visit the nurse
collects the following data
– Weight
– Urine for glucose & protein
– Vital signs
– Doppler of the fetal heart beat
– Leopold’s maneuvers to
determine presentation of the
fetus
27 – Assessment of fundal height
Signs of pregnancy
(table9.2),P.223
– Presumptive signs-these signs
suggest pregnancy
– Probable signs-indicate that the woman
is most likely pregnant
– Positive signs- definite evidence that a
28 woman is pregnant
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30
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Signs of pregnancy
Presumptive Probable Positive
Amenorrhea Goodell’s Fetal heart
Nausea & Hegar’s sounds,
vomiting
Chadwick's sign, Outline &
Urinary
ballottement move on
frequency
braxton hicks ultrasound
Quickening
Uterine contractions
enlargement +preg test
Pigmentation
32 changes
How do pregnancy tests work?
All pregnancy tests look for a special
hormone in the urine or blood that is only
present when a woman is pregnant. This
hormone, human chorionic gonadotropin
(hCG), is also called the pregnancy
hormone.
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What's the difference between a urine
and a blood pregnancy test?
Blood tests can pick up hCG earlier in a
pregnancy than urine tests can.
-Blood tests can tell if you are pregnant about 6 to
8 days after you ovulate (or release an egg from
an ovary).
-Urine tests can determine pregnancy about 2
weeks after ovulation. Some more sensitive urine
tests can tell if you are pregnant as one day after
you miss a menstrual period.
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Counsel and let woman know
what's coming
eat well
weight gain
Discomfort of early pregnancy
symptoms that require immediate
attention
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Nursing Diagnosis
Health-seeking behaviors related to
interest in maintaining optimal health during
pregnancy
Anxiety related to minor symptoms of
pregnancy
Risk for fluid volume deficient related to
nausea and vomiting
Constipation related to reduced peristalsis
36 during pregnancy
Nursing Diagnosis-Cont.
Disturbed body image R/T change of
appearance with pregnancy
Risk for ineffective sexuality patterns
R/t fear of harming fetus during pregnancy.
Disturbed sleep pattern R/t frequent
need to empty bladder during night
Fatigue R/t metabolic changes of
pregnancy.
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Danger signs during pregnancy
Headache –visual disturbances, or dizziness
Increase in systolic BP 30mmHg or more
Increase in diastolic blood pressure 15mmHg
Epigastric pain
Burning on urination or backache
Abnormal fatigue and nervousness
Anginal pain, shortness of breath
Muscular irritability, confusion, seizures
Vaginal bleeding or fluid leaking from the vagina
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