Download - STAGES OF FETAL DEVELOPMENT.pptx
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By: Melissa D. Sarmiento, RN, RM, MSN
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THREE PERIODS OF FETAL GROWTH &
DEVT.
1. Pre- embryonic
2. Embryonic
3. Fetal
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I. FERTILIZATION
Ampulla portion of the fallopian tube where
fertilization takes place
72 hours total critical time span during
which sexual relations must occur for
fertilization to be successful
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1. ZONA PELLUCIDA
2. CORONA RADIATA
FIMBRIAEfine hairlike structures that lines theopenings of the fallopian tubes
FLAGELLAtail of the spermatozoa
HYALURONIDASEprotective enzyme releasedby
the spermatozoa and acts to dissolve the
layers of cell protecting the ovum
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HYDATIDIFORM MOLE (H-MOLE) multiple
sperm enter the ovum that leads to
abnormal growth
FERTILIZATION IS NEVER CERTAIN, ITDEPENDS ON THREE SEPARATE FACTORS
1. Equal maturation of both sperm and ovum
2. Ability of the sperm to reach the ovum3. Ability of the sperm to penetrate the zona
pellucida and cell membrane
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II. IMPLANTATION contact between thegrowing structure and the endometrium
- occurs approximately 8-10 days afterfertilization
3-4 days zygote migrates towards the body ofthe uterus
MORULA the zygote that reaches the body of
the uterusBLASTOCYSTstructure that attaches to the
uterine endometrium leaving a fluid spacesurrounding an inner cell mass
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TROPHOBLASTcells in the outer ring
PARTS THAT WILL FORM THE PLACENTA
AND MEMBRANE1. Blastocyst
2. Trophoblast
EMBRYOBLAST CELL portion of the structurethat
will form the embryo
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APPOSITION process whereby the blastocyst
brushes against the rich uterine
endometrium in the secretory phase
ADHESION blastocyst attaches to the surface
of endometrium
INVASIONblastocyst settles down into its soft
folds
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EMBRYOthe implanted zygote
III. EMBRYONIC
DECIDUAendometrium growing in thickness
and vascularity
3 SEPARATE AREAS OF THE DECIDUA
1. Decidua Basalis
2. Decidua Capsularis
3. Decidua Vera
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About the 10thto 14thday of conception, theblastocyst cells differentiate into the primarygerm layers
1. Ectoderm2. Mesoderm
3. Endoderm
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CHORIONfirst and outermost membrane toform
CHORIONIC VILLI miniature villi or probing
fingers on the surface of the chorion- at term almost 200 villi will have formed
LAYER OF TROPHOBLAST CELL IN THE
CHORIONIC VILLI DIFFERENTIATION1. Syncytiotrophoblast (Syncytial layer)
2. Cytotrophoblast (Langhanslayer)
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Begins to form at the time of implantation
A. THE PLACENTA
- arises out of trophoblast tissue
- 15-20 cm in diameter and 2-3 cm in
depth at term
- serves as the fetal lungs, kidneys, GI tract
and as a separate endocrine organ
throughout pregnancy
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2 PARTS OF THE PLACENTA
1. maternal portion
2. fetal portion
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CIRCULATION
As early as the 12thday of pregnancy, maternalblood begins to collect in the intervillous spaces
of the uterine endometrium surroundingchorionic villi
By the 3rdweek, oxygen and other nutrientsand water diffuse from the maternal bloodthrough the cell layers of the chorionic villi tothe villi capillaries; nutrients are thentransported back to the developing embryo
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COTYLEDONS 30 separate segments in a
mature placenta; makes the maternal side
of the placenta at term look rough and
uneven
100 MATERNAL UTERINE ARTERIES supply
the mature placenta
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1. hCG
2. Estrogen
3. Progesterone
4. Human Placental Lactogen
B. UMBILICAL CORD formed from the fetal
membranes and provides a circulatorypathway that connects the embryo to the
chorionic villi of the placenta
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Transport oxygen and nutrients to the fetusfrom placenta and to return waste productsfrom the fetus to the placenta
About 53 cm in length at term and about 2 cmthick
WHARTONS JELLY a gelatinous
mucopolysaccharide which gives the cord body
and prevents pressure on the veins and arteries
that pass through it
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C. AMNIOTIC MEMBRANES (AMNION)
- second membrane lining the chorionic
membrane and forms beneath the chorion
Chorionic membranes outermost fetalmembranes; arises from the smooth chorion leftby the chorionic villi not involved in
implantation
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D. AMNIOTIC FLUID
- constantly being newly formed by the
amniotic membrane
- 800 to 1,200 ml at term
HYDRAMNIOS excessive amniotic fluid
OLIGOHYDRAMNIOSreduction in the
amountof amniotic fluid
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Important protective mechanism for the fetus
Protects fetus from changes in temperature
Aids in muscular development
Protects umbilical cord from pressure
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PREGNANCY IS CALCULATED TO LASTAN AVERAGE OF 10 LUNAR MONTHS, 40
WEEKS OR 280 DAYS
Embryonic stage starts on day 15 andcontinues approximately the 8thweek or untilthe embryo reaches a crown-to-rump (C-R)length of 3cm (1.2in)
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Embryonic disc becomes elongated and pearshape with a broad cephalic end and a narrowcaudal end
Ectoderm has formed a long cylindric tube forbrain and spinal cord development
GIT created from the endoderm
Most advanced organ is the heart, a singletubular heart forms just outside the body cavityof the embryo
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Days 21-32, somites form an either side of the embryosmidline, it is where the vertebrae of the spinal columnwill develop
Prior to 28 days, arms and leg buds are not visible, butthe tail bud is present
Pharyngeal arches which will form the lower jaw,hyoid bone and larynx develop
Pharyngeal pouches appears, form the eustachian tubeand cavity of the middle ear, the tonsils and theparathyroid and thymus glands
Primordia of the ear and eye are present End of 28 days, tubular heart is beating at a regular
rhythm
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Head structure are more highly developed and the trunk isstraighter than in earlier stages
Recognizable upper and lower jaws External nares are well formed Trachea has developed and its caudal end is divided for beginning
lung formation Upper lip has formed, palate is developing Ears are developing rapidly Arms extend ventrally across the chest and both arms and legs
have digits (still webbed) Slight elbow bend in the arms Prominent tail will recede Heart has more of its definitive characteristics Fetal circulation begins to be established Liver starts to produce blood cells
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Embryo is rounded and nearly erect
Eyes have shifted and are closer together,eyelids beginning to form
Beginning of all essential external and internalstructures are present
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Clearly resembles a human being Facial features continue to develop Eyelids begin to fuse Auricles of external ears begin to assume their final
shape, but still set low External genital appear, but sex is not clearly
discernable Rectal passage opens with the perforation of the anal
membrane
Circulatory system is well established through theumbilical cord Long bones beginning to form and the large muscles
are capable of contracting
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Every organ system and external structuresthat will be found in the full-term newborn ispresent
Remainder of gestation is devoted to refiningstructures and perfecting functions
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End of 9thweek, fetus reaches a C-R length of 5cm (2in) and weighs about14g (0.5oz)
Head is large and comprises almost half of the fetus entire size At 12 weeks, face is well formed with nose protruding, chin is small and
the ear acquiring a more adult shape Sucking reflex has been observed
Tooth buds appear for all 20 childs baby teeth Limbs are long and slender with well formed digits Fetus begin to make tiny fist Legs are still shorter and less developed than the arms Urogenital tract complete Well-differentiated genitals appear Kidneys begin to produce urine Red blood cells produced primarily by the liver Spontaneous movements of the fetus occur Fetal heart rates can be ascertained by electronic devices
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Period of rapid growth
LANUGO or fine downy hair begins to developespecially on the head
Blood vessels clearly visible
More muscle tissue and body skeleton developed
Active movement are present
Fetus stretches and exercises its arms and legs
Makes sucking motions, swallows amniotic fluidand produces MECONIUM in the intestinal tract
Skeletal ossification is clearly identifiable by thebeginning of 16thweek
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Lanugo covers the entire body, prominent onthe shoulder
Nipples appear over the mammary gland
Head is covered with fine, wooly hair Eyebrows and eyelashes beginning to form
Muscles are well-developed, fetus is active
Mother feels fetal movement (QUICKENING) Fetal heartbeat audible through stethoscope
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Hair is growing long
Eyebrows and eyelashes have formed
Eyes structurally complete and will soon open
Has a reflex hand grip (GRASP REFLEX)
End of 6 months, (STARTLE REFLEX)
Skin covering the body is reddish and wrinkled withlittle subcutaneous fat
Thickened skin on the hands and feet with skin ridges
on palms and soles forming distinct foot andfingerprints
Skin of entire body is covered with VERNIX CASEOSA
Alveoli in the lungs just beginning to form
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At 6 months, fetal skin is still red, wrinkled andcovered with vernix caseosa
Brain is developing rapidly and nervous system is
complete enough to provide degree of regulationof body functions
Eyelids can open and close under neural control
Nails are present on fingers and toes
In male, testes begin to descend into the scrotal sac Respiratory and circulatory systems have
developed
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At 30 weeks, pupillary light reflex is present
Fetus is gaining weight from an increase in bodymuscle and fat
CNS has matured enough to direct rhythmicbreathing movements and partially controlledbody temperature, lungs are not yet fully mature
Bones fully developed but soft and flexible
Fetus begins to store iron, calcium and phosphorus Active MORO REFLEX
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Fetus begins to get plump
Less wrinkled skin covers the deposits ofsubcutaneous fats
Lanugo begins to disappear and nails reach theedge of the fingertips
By 35 weeks fetus has a firm grasp and exhibitsspontaneous orientation to light
Infant born at this time has a good chance ofsurvival but require some special care
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considered full term Skin has a smooth polished look Only lanugo left is on the upper arms and shoulders Hair on head is coarse about 1 inch long Vernix caseosa with heavier deposit in the creases and folds
of the skin Body and extremities are plump with good skin turgor Chest is prominent but still a little smaller than the head Mammary glands protrude in both sexes Fingernails extend beyond fingertips Testes are in the scrotum Fetal assumes position of comfort (LIE) Extremities and head are well-flexed
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Postterm labor labor that occurs after 42 weeks gestation
Gravida any pregnancy, regardless of duration, including presentpregnancy
Nulligravida a woman who has never been pregnant
Primigravida a woman who is pregnant for the first time
Multigravida a woman who is in her second or any subsequent
pregnancy
Para birth after 20 weeks gestation regardless of whether the infant isborn alive or dead
Nullipara a woman who has had no births at more than 20 weeks
gestation Primipara a woman who has one birth at more than 20
weeks gestation regardless of whether the infant was born alive ordead
Multipara a woman who has had two or more births at more than 20
weeks gestation
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LMP last menstrual period
EDC expected date of confinement
EDB estimated date of birth
EDD expected date of delivery
AOG age of gestation
NAGELES RULE standard method used to
predict the length of pregnancy Mc Donalds Rule a symphysis-fundal height
measurement
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NAGELES RULE
FOR LMP JAN. TO APRIL
-3MONTHS +7 DAYS
FOR LMP MAY TO DEC.
+9 MONTHS + 7 DAYS + 1 YEAR
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Mc Donalds Rule distance from the uterine
fundus to the symphysis pubis is equal to
AOG between the 20thand 31stweek of
pregnancy
APPROXIMATE HEIGHT OF FUNDUS AT
VARIOUS WEEK OF PREGNANCY:
Over the symphysis pubis 12 weeks Level of umbilicus 20 weeks
At the xiphoid process 36 weeks
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Multiple pregnancy
A miscalculated due date
A large for gestational age infant
Hydramnios
H-mole
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Intrauterine growth restriction
Miscalculated length of pregnancy
Anomaly (anencephaly)
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FETAL MOVEMENT
QUICKENINGfetal movement felt by the
mother
METHOD OF ASSESSING FETAL MOVEMENT
1. Sandovsky Method
2. Cardiff Method
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FETAL HEART RATE Counted and heard as early as 10thto 11th
weeks of pregnancy by using UltrasonicDoppler techn ique
Audible through stethoscope at 18-20 weeks
120-160 beats/min
FETAL TACHYCARDIA sustained rate of 161bpm or above
MARKED TACHYCARDIA 180bpm or above
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Early fetal hypoxia
Maternal fever
Maternal dehydration
Beta-symphatomimetic drugs Amnionitis
Maternal hyperthyroidism
Fetal anemia
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FETAL BRADYCARDIA is a rate less than120bpm
CAUSES:
Late fetal hypoxia
Maternal hypotension
Prolonged umbilical cord compression
Fetal arrhyhtmia
Uterine hyperstimulation
Abruptio placenta
Uterine rupture
Vagal stimulation in the second stage
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Any agent that can cause development ofabnormal structures in an embryo
Substances that affect the normal growth anddevelopment of the fetus
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TOBACCO specific mechanism of smokingseffect on the fetus is not known
Effects:Low birth weight
Risk of spontaneous abortion
Preterm birth
PROM
Placenta previa
Abruptio placentaHigher morbidity
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Greatest Risks: Intrauterine growth restriction or prematurity Intrauterine distress Neonatal neurobehavioral abnormalities
ALCOHOLEffects:
a. heavy drinkers FASb. moderate drinkers lowered birth weight,
neurologic effectsc. occasional drinkers does not carry any
known risk
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CAFFEINEEffects:
- increased risk of decreased birth weight has been
found in infants of mothers who consume at least
600mg of caffeine daily
DRUGS
Vit. A derivatives craniofacial, cardiac, CNS
anomalies Analgesics (ASA, NSAIDs) prolonged pregnancy,
maternal bleeding, patent ductus arteriosus
Antineoplastics multiple anomalies
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Anticonvulsants Phenytoin (Dilantin) neural tubedefects, fetal anomalies
Anticoagulants (Warfarin) fetal bleeding or anomalies
Antidepressants cardiovascular anomalies
Antischizophrenic (Lithium) hydramnios Antithyroid (Methimazole) hypothyroidism in fetus
Antibiotics (sulfonamides) hyperbilirubinemia innewborn
Antibiotics (Tetracycline) teeth and bone deformities
Antihelmintics (Lindane) limit exposure to 2 doses ACE inhibitors oligohydramnios
Softdrinks, chocolates low birthweight
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1. Toxoplasmosis CNS damage,hydrocephalus, microcephaly, intracerebralcalcification and retinal deformities
2. Rubella deafness, mental and motor challenges,
cataracts, cardiac defects, IUGR, dental andfacial clefts, cytopenic purpura3. Herpes Simplex (Genital Herpes) severe
congenital anomalies, spontaneous miscarriage,premature birth, IUGR, continuing infection atbirth
4. Syphillis congenital anomalies, congenitalsyphillis
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1. Metal and chemical hazards (pesticides, carbonmonoxide, formaldehyde, lead)cognitive orneurological abnormalities
2. Radiation
- exposure before implantation, the zygote iskilled
- causes nervous system, brain and retinal
damages
3. Hyperthermia abnormal fetal brain development,
seizure disorders, hypotonia, skeletal
deformities
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PRESUMPTIVE (SUBJECTIVE) CHANGESA. AmenorrheaB. Nausea & vomitingC. Urinary frequency
D. Changes in the breastE. QuickeningF. FatigueG. Uterine enlargement
H. Linea nigraI. Melasma
J. Striae gravidarum
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PROBABLE (OBJECTIVE) CHANGESA. Changes in pelvic organs
1. GoodellsSign2. Chadwicks Sign3. HegarsSign
4. Mc Donalds SignB. Enlargement of the abdomenC. Braxton Hicks ContractionsD. Uterine SouffleE. Palpation of fetal outlineF. BallotementG. Presence of hCG in serum laboratory testH. Sonographic evidence of gestational sac
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POSITIVE (DIAGNOSTIC CHANGES)
A. Fetal heartbeat audible
B. Fetal movement felt by examiner
C. Visualization of fetus by ultrasoundexamination (evidence of fetal outline)
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Vaginal bleeding
Persistent vomiting
Chills and fever
Sudden gush of clear fluid from the vagina Abdominal or chest pain
PIH
Increase or decrease in fetal movement
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A major strategy for helping to reduce the numberof low-birthweight babies born yearly.
Essential for ensuring the overall health ofnewborns and their mothers.
1. Health history Demographic data
Chief concern
- LMP, result of pregnancy test
- use of pregnancy test
- signs of early pregnancy
- discomforts of pregnancy
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- danger signs of pregnancy- ask if pregnancy was planned
2. History of Past Illnesses/Past Medical History- history of kidney disease, HPN, STI, diabetes,
thyroid disease , recurrent seizures, gallbladderdisease, UTI, varicosities, phenylketonuria, TBand asthma
- childhood diseases like chickenpox, mumps,measles, German measles, or poliomyelitis
- ask about allergies and any past surgeries- surgical procedures and presence of bleeding
disorders or tendencies
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3. History of Family Illnesses/Family MedicalHistory
- cardiovascular and renal diseases, cognitiveimpairment, blood disorders, or any known
genetically inherited diseases or congenitalanomalies
- occurrence of multiple births- occurrence of caesarian births and causes
4. Social Profile- current nutrition, elimination, sleep, exercise,recreation, and interpersonal interactions
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5. Gynecologic History Age of menarche Usual cycle (interval, duration, amount of
menstrual flow)
Presence of discomforts Monthly perineum self-examination Past surgery on reproductive tract Family planning methods used
Sexual history Assess possibility of stress incontinence Pap Smear Previous infections
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6. Obstetric History Review pregnancy briefly Previous miscarriage or abortions GTPAL or GTPALM, TPAL/FPAL Score
G number of times she has been pregnantT number of full-term infants bornP number of preterm infantsA number of spontaneous or induced
abortionL number of living childrenM multiple pregnancies
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7. Current Medical History Weight Blood type and Rh factor Any medications presently taken
Previous or present use of alcohol Drug use or abuse Drug allergies and other allergies Potential teratogenic insults
Presence of diabetes, HPN, cardiovascular disease,renal problems, thyroid disease Record of immunization
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8. Review of systems
9. Physical Examination
Baseline data
System assessment Pelvic examination
- pregnant women should remain in a lithotomy
position for a short time to prevent
thromboembolism and supine hypotensionsyndrome
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10. Laboratory Assessment Blood assessment Urinalysis TB
Ultrasound11. Nutritional status
- woman must eat adequately to supplyenough nutrients to the fetus
- woman will not have to increase thequantity of food but they will have toincrease the quality of food they eat
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Systematic way to evaluate thematernal abdomen
Preparation:
Empty the bladder
Lie on her back with her feet on thebed and her knees bent
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1. First maneuver
Facing the woman, palpate the upper abdomenwith both hands.
Note the shape, consistency, and mobility ofthe palpated part.
Fetal head is firm and round and movesindependently of the trunk. The buttocks feelssofter, and it moves with the trunk.
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4. Fourth Maneuver.
Facing the womans feet, place both hands onthe lower abdomen and move hands gently
down the sides of the uterus toward the pubis. Note the cephalic prominence or brow.
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2. Second Maneuver
Moving the hands on the pelvis, palpate theabdomen with gentle but deep pressure.
The fetal back on one side of the abdomen feelssmooth, and the fetal extremities on the other sidefeels knobby.
3. Third Maneuver
Place one hand just above the symphysis pubis. Note whether the part palpated feels like the fetal
head or the breech and whether it is engaged.
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NURSING DIAGNOSES IN EARLY PREGNANCY Health-seeking behaviors related to interest in using
herbal medicines to relieve discomforts of pregnancy Disturbed body image related to breast and abdominal
enlargement in pregnancy Constipation related to reduced peristalsis in
pregnancy Fatigue related to increased physiologic need for sleep
and rest during pregnancy Acute pain related to frequent muscle cramps
secondary to physiologic changes of pregnancy Disturbed sleep pattern related to frequent need to
empty bladder during night
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1. Breast tenderness2. Palmar erythema3. Constipation4. Nausea, vomiting and pyrosis
5. Fatigue6. Muscle cramps7. Hypotension8. Varicosities9. Hemorrhoids10. Frequent urination11. Abdominal discomforts12. Leukorrhea
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Health seeking behaviors related todiscomforts of middle to late pregnancy
Acute pain related to sudden postural change
in pregnancy Anxiety related to shortness of breath resulting
from expanding uterine pressure ondiaphragm
Deficient knowledge related to occurrence ofBraxton Hicks contractions in late pregnancy
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1. Backache
2. Headache
3. Dyspnea4. Ankle edema
5. Braxton Hicks contractions
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LOCAL CHANGES- involves the uterus, ovaries, vagina and breasts
1. Uterine changes
a. increase in size (length,depth, width, weight, wall thickness andvolume)
length 32cm Depth 22cm
Width 24cm Weight 1,000g Thickness early pregnancy 2cm; end of pregnancy 0.5cm
thick Volume more than 1,000ml
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b. Stretching of muscle fibers of the uterus
c. HegarsSign
2. Amenorrhea
3. Cervical changes more vascular and edematous
Darken to violet
GoodellsSign
Cervical hypertrophy and hyperplasia
Mucus filled cervical canal
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4. Vaginal changes Hypertrophic vaginal epithelium Increase in vascularity Change in vaginal secretion pH5. Ovarian changes
Halt in FSH and LH production Increase in size of the corpus luteum at the surface of the ovary
until 16thweek6. Changes in the breast Feeling of fullness, tingling, or tenderness Increase breast size Darkened and increase diameter of the areola Prominent blue veins Supple nipple Breast secretes milk
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SYSTEMIC CHANGES1. Integumentary system
Striae gravidarum
Protruding umbilicus
Linea nigra
Melasma
Vascular spider
Increase perspiration Palmar erythema
Increased scalp hair growth
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2. Respiratory system Marked congestion of the nasopharynx
Shortness of breath
Total O2 consumption increase by as much as 20%
3. Cardiovascular system
Increased circulatory blood volume
Needs iron supplementation
Increase cardiac output and heart rate
Decrease BP at 2
nd
trimester and rises at third trimester Impaired blood flow at lower extremities
Supine hypotension syndrome
Increased circulating fibrinogen
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4. Gastrointestinal system Heartburn, constipation and flatulence
Hemorrhoids
Nausea and vomiting
Some women with hypertrophy of gumlines Hypertyalism
5. Urinary system
Fluid retention
Gradual increase in urinary output
Increase urinary frequency
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6. Skeletal system Increased calcium and phosphorous needs Gradual softening of the pelvic ligaments and joints pride of pregnancy
7. Endocrine system Placenta Halt in FSH and LH production Increase production of melanocyte stimulating hormone Enlarged thyroid gland
Increase production of insulin Adrenal glands activity increases
8. Immune system Decreased immunologic competency