NURS327 >WEEK 2 OB EDAPT NOTES
NURSING CARE DURING PREGNANCY:
Presumptive signs of pregnancy: Subjective indicators that the woman may
be pregnant but may also be caused by other non-pregnancy-related
conditions. These may include:
•amenorrhea (absence of menstruation) •nausea, vomiting •breast changes (swelling, tenderness, darkening areolae)
Probable signs of pregnancy: Objective indicators confirmed upon
examination but may also be caused by other non-pregnancy-related
conditions. These may include:
•uterine enlargement •Goodell’s sign (cervical softening) •ballottement (upon abdominal palpation a rebound is felt) •positive pregnancy test (detects presence of HCG in blood or urine) •Chadwick’s sign (increased vascularity noted upon pelvic exam)
Positive signs of pregnancy: These signs only occur in pregnancy and confirm
the presence of the fetus. These include:
•palpation of the fetal outline •visualization of the pregnancy on ultrasound •presence of the fetal heartbeat A normal pregnancy lasts 40 weeks from the first day of the last menstrual period (LMP).The blastocyst stage becomes the embryonic stage when implantation occurs around 8 weeks after fertilization. The embryo further differentiates into 3
distinct layers and tissue: the placenta, the embryonic membranes, and the
embryo itself. Cell growth is very rapid, the heart begins beating, and all the major organs and systems develop simultaneously. This is a very critical stage of pregnancy, as it is when birth defects develop, and the developing embryo is vulnerable to teratogenic agents. By the end of the embryonic stage, the embryo looks human and, beginning at week 9, is a fetus.Prenatal vitamins should be taken by all women of childbearing age who may become pregnant, prior to pregnancy. 1 / 4
The Physiology of pregnancy:
It is important for the nurse to have a basic understanding of how conception occurs and how pregnancy develops in order to recognize and analyze cues that indicate a healthy or at-risk pregnancy. Many physiologic processes and factors work together to achieve conception in the human body. Click on each item below to learn more.Fertilization - For fertilization to occur, sperm ejaculated during sexual intercourse enters the female’s vagina and must travel through cervical mucous into the outer third of the fallopian tube (called the ampulla). An ovum must be produced prior to this moment and be waiting in that spot in the fallopian tube. Fertilization (conception) can now take place when the sperm fuses with the ovum. This newly fertilized ovum, called the zygote, contains 46 chromosomes (2 of which are sex chromosomes), which means that the sex and all the genetic characteristics are determined and will not change.Fertilization occurs when a sperm nucleus of the paternal origin units with an egg nucleus of the maternal origin. This results in forming a zygote. The zygote undergoes mitosis (cell division) and becomes a blastocyst.The blastocyst possesses an inner cell mass that subsequently forms the embryo.Zygote to blastocyst - Following fertilization, another process begins. For 3-4 days, the zygote travels from the fallopian tube into the uterine cavity.During this time, the zygote is rapidly undergoing mitosis (cell division) and becomes a blastocyst consisting of a circular mass of cells with a fluid-filled cavity in the middle that is surrounded by two cell layers. If the zygote is prevented from leaving the fallopian tube and cell division continues, the blastocyst/embryo may implant in the fallopian tube, resulting in an ectopic pregnancy.The first week of pregnancy
•Secondary oocyte: 10 to 19 days of your menstrual cycle
•Fertilization: 12 to 24 hours
•Zygote formation: 24 hours
•First segmentation: 24 hours
•2-cell stage: 36 hours
•4-cell stage: 48 hours
•Morula: 4 to 5 days
•Blastocyst: 6 days
Implantation - The blastocyst has been floating in the uterine cavity for 1-2 days and is now ready to implant into the uterine lining. The lining must be in the right condition for implantation to occur in the uterine fundus. If the vascular or hormonal conditions are not right to sustain an implanted 2 / 4
embryo, a spontaneous abortion (pregnancy loss prior to 20 weeks’ gestation and commonly referred to as a miscarriage) occurs. This is a common cause of spontaneous abortion prior to 8 weeks of pregnancy, often before the woman is even aware of the pregnancy. 3 / 4
Some bleeding can occur during implantation, which women sometimes mistake for their menstrual cycle.Also, during these first early weeks of pregnancy, the chorionic villi begin forming and secreting human chorionic gonadotropic (HCG) hormone which signals the body to stop ovulating and menstruating. Tests verify pregnancy by detecting the presence of HCG.
Embryonic and fetal development - Zygote: fertilized ovum (cell
mass) prior to implantation
Blastocyst: stage in which the zygote forms into an inner and outer group
(layer) of cells •inner cell mass develops into fetus •outer cell mass develops into fetal membranes and the placenta The blastocyst stage becomes the embryonic stage when implantation occurs around 8 weeks after fertilization. The embryo further differentiates
into 3 distinct layers and tissue: the placenta, the embryonic membranes,
and the embryo itself. Cell growth is very rapid, the heart begins beating, and all the major organs and systems develop simultaneously. This is a very critical time when birth defects develop, and the developing embryo is vulnerable to teratogenic agents.•When an infant is born with a birth defect or abnormality, it is often accompanied by other defects.•Teratogenic agents include any drug, virus, or substance that can result in fetal malformation and cause serious harm. However, the Centers for Disease Control and Prevention (CDC, 2016) still recommends that pregnant women receive certain vaccinations, while others are contraindicated.At the end of the embryonic stage, the embryo looks human. The fetal stage begins at week 9.Question – women have light bleeding, assuming what?If the vascular or hormonal conditions are not right to sustain an implanted embryo, a spontaneous abortion (pregnancy loss prior to 20 weeks’ gestation and commonly referred to as a miscarriage) occurs. Also, some bleeding can occur during implantation, which women sometimes mistake for their menstrual cycle.•Placenta - The placenta, an endocrine organ, is a truly amazing and unique structure that forms at the beginning of pregnancy and exists
only to support the pregnancy. Functions of the placenta include:
•secretes the hormones that maintain the pregnancy •exchange of nutrients, oxygen, and waste products occurs between the fetus and the maternal circulation •blocks the transfer of certain substances (some drugs, some viruses, most bacteria) to the fetus, called the placental barrier
- / 4