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NARRATIVE PATHOPHYSIOLOGY OF PREGNANCY Fertilization.

The sperm and egg unite in one of your fallopian tubes to form a one-celled entity called a zygote. If more than one egg is released and fertilized, you may have multiple zygotes. The zygote has 46 chromosomes 23 from you and 23 from your partner. These chromosomes will help determine your baby's sex, traits such as eye and hair color, and, to some extent, personality and intelligence. Soon after fertilization, the zygote travels down the fallopian tube toward the uterus. At the same time, it will begin dividing rapidly to form a cluster of cells resembling a tiny raspberry. The inner group of cells will become the embryo. The outer group of cells will become the membranes that nourish and protect it. ImplantationBy the time it reaches the uterus, the rapidly dividing ball of cells now known as a blastocyst has separated into two sections. The inner group of cells will become the embryo. The outer group of cells will become the membranes that nourish and protect it. On contact, it will burrow into the uterine wall for nourishment. This process is called implantation. The placenta, which will nourish your baby throughout the pregnancy, also begins to form. The embryonic period begins.The fifth week of pregnancy, or the third week after conception, marks the beginning of the embryonic period. This is when the baby's brain, spinal cord, heart and other organs begin to form. The embryo is now made of three layers. The top layer the ectoderm will give rise to your baby's outermost layer of skin, central and peripheral nervous systems, eyes, inner ear, and many connective tissues. The cells of the embryo now multiply and begin to take on specific functions. This process is called differentiation. It leads to the various cell types that make up a human being (such as blood cells, kidney cells, and nerve cells). There is rapid growth, and the baby's main external features begin to take form. It is during this critical period (most of the first trimester) that the growing baby is most susceptible to damage. The following can interfere with the baby's development:

Alcohol, certain prescription and recreational drugs, and other substances that cause birth defects Infection (such as rubella or cytomegalovirus) Nutritional deficiencies X-rays or radiation therapy

Week by week changes.The period of time between conception and birth during which the fetus grows and develops inside the mother's womb is called gestation. In humans, the length of pregnancy, or gestational age, is the time measured from the first day of the woman's last menstrual cycle to the current date. It is measured in weeks. Gestational age may also be called menstrual age. Fetal development is from ninth week to birth. Pain during labor is caused by contractions of the muscles of the uterus and by pressure on the cervix. This pain may be felt as strong cramping in the abdomen, groin, and back, as well as an achy feeling. Some women experience pain in their sides or thighs as well.Other causes of pain during labor include pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina.

Pain during labor is different for every woman. Although labor is often thought of as one of the more painful events in human experience, it ranges widely from woman to woman and even from pregnancy to pregnancy. Women experience labor pain differently for some, it resembles menstrual cramps; for others, severe pressure; and for others, extremely strong waves that feel like diarrheal cramps. It's often not the pain of each contraction on its own that women find the hardest, but the fact that the contractions keep coming and that as labor progresses, there is less and less time between contractions to relax. Labor is sometimes accompanied by intense and prolonged pain. Pain levels reported by laboring women vary widely. Pain levels appear to be influenced by fear and anxiety levels. Vaginal delivery with RMLE. An incision is made in the midline but directed to the right or left. The advantages of a mediolateral episiotomy are that there is less tearing beyond the incision and the incision can be directed away from the rectum. The disadvantages are that there is greater blood loss, faulty healing is more common, there is more perineal discomfort, and they are more difficult to repair. An episiotomy results in a clean surgical cut instead of a ragged tear, it minimizes pressure on the fetal head, and shortens the second stage of labor. The risks now for RMLE are risk for Fluid volume deficit, acute pain ,Risk for infection , and activity intolerance.

Reference:
http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/lesson_5_Section_1.htm http://www.nlm.nih.gov/medlineplus/childbirth.html http://www.mayoclinic.com/health/prenatal-care/PR00112 http://www.nlm.nih.gov/medlineplus/ency/article/002398.htm http://kidshealth.org/parent/pregnancy_center/childbirth/childbirth_pain.html