Professional Documents
Culture Documents
Antepartum
Objectives
Understand embryonic development
Stages of
Development
Pre-embryonic:
1st 14 days after ovum fertilized
Embryonic:
Day 15 end of 8th week
Fetal stage:
End of 8th week until birth
Pre-embryonic Development
Fertilization takes place in fallopian tube
Union of sperm and ovum forms a zygote
Cleavage cell division continues to form a morula (mass of 16
cells)
Inner cell mass are blastocysts, which form amnion and chorion
Outer cell mass are trophoblasts, which form placenta and
chorion
Implantation occurs 7-10 days post-conception into endometrium
Embryonic Stage
Starts day 15 (3rd week after conception)
Tissues differentiate into essential organs
Main external embryonic features develop
Embryo most vulnerable to teratogens during this
period
Teratogen: substance that adversely affects fetus
Ends at completion of week 8
At this point embryo clearly resembles a human
being
Key points of
development
4 weeks: fetal heart activity noted
8 weeks: all organs formed
16 weeks: can see gender
20 weeks: mother feels fetal movement
24 weeks: fetus weighs 500 grams
Fetal respiratory movement noted
Embryonic development
Signs of Pregnancy
Subjective signs (aka Presumptive signs)
Signs a woman experiences but can be due
to other causes
Subjective Signs of
Pregnancy
Amenorrhea
Nausea and vomiting
Excessive fatigue
Urinary frequency
Breast changes (tender, pigment changes)
Quickening
Objective Signs of
Pregnancy
Softening of cervix- Goodells sign
Bluish color of cervix- Chadwicks sign
Softening of uterine isthmus- Hegars sign
Ease of flexing body of uterus against cervixMcDonalds sign
General uterine enlargement and softening:
10-12 wks fundus palpable above symphasiS
20-22 weeks at umbilicus
Hegars Sign
Positive Signs of
Pregnancy
Fetal heartbeat audible: 10 wks with a
doppler
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Nongenetic Factors
Influencing Development
Teratogens
Drugs
Chemicals
Infection
Exposure to radiation
Maternal conditions
Maternal nutrition
Malnutrition
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Genetics
Provides the tools to determine the hereditary
component of many diseases
Improves our ability to predict susceptibility, onset,
progression, and response to treatment
A gradual shift from genetics to genomics
19
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Genetic Counseling
Standard practice in obstetrics
Goal is to identify risk
Genetic history should be obtained using a
questionnaire or checklist
Genetic counseling
Information
Education
Support
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Fundal Height
Indicates uterine size by measuring from top
of symphysis pubis to top of fundus
Breast Changes in
Pregnancy
Respiratory System
Changes
Progesterone decreases airway resistance which
results in greater oxygen consumption
Volume of air breathed each minute increases
(tidal volume)
these changes occur to meet the increased
oxygen demands of the pregnant woman/fetus
Enlarging uterus pushes diaphragm up
Respiratory system
changes, cont.
Breathing changes from abdominal to thoracic as
enlarging uterus pushes diaphragm up and changes
shape of thoracic cavity (chest circ increases)
Hyperventilation and dyspnea commom
Nasal stuffiness and epistaxis (nose bleed) occur due to
estrogen induced edema and increased vascularity
Cardiovascular System
Changes
Blood Volume
Blood volume increases 50% (1500 ml)
Mostly plasma (1000ml)
Begins 10-12 weeks, peaks at 32 weeks
Needed to provide nutrition and hydration to
fetus; perfuse uterus and other organs, esp
kidneys (due to increased waste excretion)
Provides reserve for birth and postpartum
Cardiovascular System
Changes
Cardiac Output and Heart Rate
Increases from 30-50% over non pregnant by
32 weeks
Heart rate increases 10-15 bpm in 2nd
trimester and remains until delivery
Slight hypertrophy to accommodate increase
in blood volume and cardiac output
This is to meet increased oxygen demands of
mother and fetus
Cardiovascular system
Changes
Blood Pressure
Decreases due to progesterone induced
vasodilation
Decreases in 2nd trimester and returns to near
normal by 3rd trimester
Supine hypotension syndrome (aka vena caval
syndrome)
In supine position, large uterus puts pressure on
vena cava, decreasing blood flow to heart
Woman becomes dizzy, diaphoretic
Cardiovascular system
Changes
Blood Components
Number of RBCs increase, to deliver more
oxygen
But there is a larger increase in plasma
volume (due to sodium and water retention)
This hemodilution causes physiologic
anemia of pregnancy
Cardiovascular system
changes
Iron (Fe) requirements increase due to fetal
demand and increase in maternal blood vol
Fe necessary for hemoglobin formation
Fibrin and fibrinogen increase (as well as other
clotting factors)
This makes pregnancy a hypercoaguable state
This factor and others increase risk of
thromboembolic events
Cardiovascular
system (cont)
Leukocyte production increases slightl
Clotting factors increase (VII, VIII, IX & X); pregnancy
is a hypercoagulable state
Physical Changes of GI
Tract
Reflux of gastric contents common due to relaxation of
smooth muscles by progesterone
Ptyalism (excess salivation) is a common condition of
pregnant women
Decrease in intestinal motility due to progesterone
causes constipation
Nausea and vomiting due to high hCG levels from weeks
6-12
Gastrointestinal System
Changes
Gums become hyperemic, swollen, friable
Hygiene impt; dental referral
GI System, cont
Smooth muscle relaxation and decreased
peristalsis due to progesterone
This causes delay in gastric emptying (heartburn)
due to relaxation of cardiac sphincter, and
constipation
Emptying time of gallbladder prolonged (due to
progesterone) which increases risk of gallstone
formation
Renal/Urinary System
Changes
Changes in renal function to accommodate
larger workload
More blood flows to kidneys, increases
glomerular filtration rate (GFR)
Causing increase in urine flow and volume
Increases substances delivered to kidneys
Increases filtration of water and solutes
Renal/Urinary, cont
Kidneys enlarge during pregnancy
Ureters elongate and dilate (progesterone)
Kidney activity increased with supine
position (even nonpregnant) but this is
increased in pregnancy
Increase in nighttime urination
Even more increase with left lateral position
Due to increase in venous return to heart
Spider veins
Above waist (arms, face, thorax), disappear
Striae gravidarum (stretch marks)
Musculoskeletal System
Changes
Joints of pelvis relaxresults in waddling gait
typical of pregnancy, due to progesterone and
relaxin
Center of gravity shifts due to increased
curvature of spinelow backache
Diastasis recti caused by pressure of enlarging
uterus on abdominal muscles
Psychosocial Response to
Pregnancy
Ambivalence: initial response; no visible body changes
yet
Acceptance: triggered by quickening in 2nd trimester
Introversion: turning in on oneself
Mood swings: from joy to despair
Body image changes