ANTEPARTUM

MICHELLE D. ROSARIO RM,RN,MAN

Objectives
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Recall Human Anatomy and Physiology of the Reproductive system (Male & Female) Understand the physiology of the menstrual cycle, process of conception and milestones of fetal development Know the importance of understanding the mechanism of menstrual cycle, process of conception and fetal development in relation to dealing with maternal issues and concerns e.g contraception and pregnancy

ANATOMY AND PHYSIOLOGY

REPRODUCTIVE SYSTEM

MALE REPRODUCTIVE ORGAN

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Testicles After puberty, a mans testicles, located at the base of the penis, produce male sex cells called sperm. Also starting at puberty, testicles produce testosterone, the male sex hormone y Scrotum The testicles are covered by a pouch of skin called the scrotum. y Epididymis and vas deferens The epididymis stores the sperm after the testicles produce them, and the vas deferens transports the sperm from the epididymis to the urethra
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Urethra The urethra is a duct, or tube, that transports fluids from the inside of the body to the outside. y Penis The penis is perhaps the most visible part of the male sexual anatomy. In its reproductive capacity, the urethral opening at the tip of the penis delivers sperm into the vagina. Urine also flows out of the body through the urethral opening.
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Accessory glands
Sperm can live inside the female reproductive system for up to 48 hours, and seminal fluid helps the sperm move around and stay nourished. The seminal vesicle produces a fluid that provides energy to the sperm as they seek out the female sex cell, or the egg.

Accessory glands
The prostate gland makes a different fluid that helps the sperm move more quickly through the female reproductive system y Bulbourethral or Cowper's glands, makes a small quantity of fluid that helps protect the sperm on its way through the urethra by neutralizing any leftover traces of acidic urine.
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FEMALE REPRODUCTIVE ORGAN

TERMS AND DEFINITIONS

a. Broad Ligaments. Two wing-like structures that extend from the lateral margins of the uterus to the pelvic walls and divide the pelvic cavity into an anterior and a posterior compartment. y b. Corpus Luteum. The yellow mass found in the graafian follicle after the ovum has been expelled. y c. Estrogen. The generic term for the female sex hormones. It is a steroid hormone produced primarily by the ovaries but also by the adrenal cortex.
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d. Fimbriae. Fringes; especially the fingerlike ends of the fallopian tube. y e. Follicle. A pouch like depression or cavity. y f. Follicle Stimulating Hormone. The follicle stimulating hormone (FSH) is a hormone produced by the anterior pituitary during the first half of the menstrual cycle. It stimulates development of the graafian follicle.
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g. Graafian Follicle. A mature, fully developed ovarian cyst containing the ripe ovum. y h. Hormone. A chemical substance produced in an organ, which, being carried to an associated organ by the bloodstream excites in the latter organ, a functional activity. y i. Lactation. The production of milk by the mammary glands.
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j. Luteinizing Hormone. A hormone produced by the anterior pituitary that stimulates ovulation and the development of the corpus luteum. y k. Oocyte. A developing egg in one of two stages. y l. Ovum. The female reproductive cell.
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m. Progesterone. The pure hormone contained in the corpora lutea whose function is to prepare the endometrium for the reception and development of the fertilized ovum. y n. Reproduction. The process by which an offspring is formed.
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Fetal Circulation
Blood from the mother enters the fetus through the vein in the umbilical cord. It goes to the liver and splits into three branches. The blood then reaches the inferior vena cava, a major vein connected to the heart.

FETAL CIRCULATION

Note:
The placenta does the work of exchanging oxygen (O2) and carbon dioxide (CO2) through the mother's circulation, the fetal lungs are not used for breathing. y In the fetus, blood is shunted from the pulmonary artery to the aorta through a connecting blood vessel called the ductus arteriosus.
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COMMON TERATOGENS AND THEIR EFFECTS

HEALTH HISTORY
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Past Present Potential Biographical data Menstrual hx Current pregnancy (EDC,AOG,GRAVID) Previous pregnancies and outcome Gynecological hx Medical hx. Nutritional status

MENSTRUAL HISTORY
Menarche y Duration of menses y Interval between menses y Characteristics of menstrual flow y Presence of mittelschmerz y Date of onset of last menstrual period y Date of past/previous menstrual period y Menstrual abnormalities or problems
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Determining Gravidity and Parity

ESTIMATING THE EDC

NORMAL CHANGES DURING PREGNANCY

UTERUS CERVIX VAGINA BREASTS

Cardiovascular
1.Cardiac output 40-40% increase Pulse rate 10-15 beats 2. Pulmonary and Peripheral vascular resistance decreases 40-50% 3rd tri- prepregnant level 3.Vena cava syndrome 4. Blood Volume

RESPIRATORY

1. Volume

of air breathed 2. Intrathoracic volume

NEUROLIGIC

NO KNOWN CHANGES

MUSCULOSKELETAL

gait 2. Physiologic lordosis 3. Diastasis recti

1. Waddling

GASTROINTESTINAL
Nausea and Vomiting 2. Bloating, reflux of gastric secretions, constipation, GI problems 3. Hemorrhoids
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RENAL

Urinary frequency 2. Glomerular filtration increase

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INTEGUMENTARY

CHLOASMA LINEA NIGRA STRIAE GRAVIDARUM SWEAT AND SEBACEOUS GLAND ACTIVITY INCREASES

ENDOCRINE
METABOLISM HORMONE ( hcg,hPL, estrogen, progesterone) RELAXIN PROSTAGLANDIN

NUTRITIONAL REQUIREMENTS
Factors affecting nutritional needs 1. Pre-pregnancy nutritional status 2. Maternal Age 3. Maternal Parity Maternal Nutrition Additional 300 calories per day

Appropriate pregnancy wt gain ave. 25-35 lbs. for women with a normal prepregnant wt. a. 10-13 lbs. in the 1st 20 wks b. About 1lb per wk after 20th wk. Maternal wt. gain is distributed to a variety of structures

PSYCHOSOCIAL CHANGES
Role changes y Anxieties y Family strength in coping with the psychosocial changes of pregnancy y Priority nursing diagnosis y Planning and Implementation
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(Pls.refer to attached table)

DIAGNOSTIC AND LABORATORY

URINE TEST BLOOD TEST (cbc) ULTRASOUND