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Conception
| Question | Answer |
|---|---|
| Cultural competence in care | Recognizing, respecting, and integrating, aspects of a patient's culture into their care. Key to competence is good communication and an open mind. |
| Cultural Encompasses | Religion, Language, Profession, age, Gender Identity, Disability, Sexual Orientation, Beliefs & Traditions |
| Nursing implication | you will never know everything about every culture, focus on cultural sensitivity, open communication, and avoiding assumptions for all patients |
| Health disparities | differences in health provision and/or healthcare outcomes that are not driven by patient choice |
| Family structures | Family structures is not indicative of available support. |
| US maternity care funding and health outcomes | US spends more on health care than any other country, yet outcomes are not always better 2023 US maternal mortality rate: 18.6 maternal deaths per 100,000 live births |
| Preconception care | 1 in 5 pregnancies report receiving preconception care First weeks of a pregnancy most critical Average maternal age at time of the first birth 27.5 years. Pregnancies age between 20-34 are not considered high risk due to age |
| Preconception care | Important time to discuss optimal nutrition, fertility, management of concurrent health conditions |
| Preconception Age | Pregnancies age between 20 and 34 are not considered high risk due to age |
| Preconception Age | Pregnancies after 35 after considered high risk due to: potential for diminished egg equality increased risk of pregnancy-related complications increased risk of preexisiting health conditions |
| Preconception Age | Adolescent pregnancies under the age of 20 are considered high risk large due to socioeconomic conditions |
| health history general history | sexual history & gender identity self care & health promotion review of systems allergies & medications diet, sleep, & exercise patterns immunization status workplace & environmental exposures family medical history |
| health history gynecological history | age of menarche last menstrual cycle (LMP) cycle length & regularity STI history gynecological surgeries gynecological conditions number of sexual partners |
| health history obstetric history | prior pregnancies live births & losses gestational age at each. birth mode off birth & anesthesia location of birth pregnancy complications birth weight & percentile length of labor |
| health history gynecological history | obstetric history includes: dates of prior pregnancies live and losses/terminations |
| health history | GTPAL is an acronym used to describe a person's pregnancy history in a short-hand form and to determine obstetric care for patients |
| GTPAL | Gravida: total number of pregnancies (including current) Term: pregnancies delivered at 37+ weeks gestation Preterm: pregnancies delivered between 20-36 6/7 weeks Abortion/Loss: Pregnancy losses before 20 weeks (spontaneous or elective) |
| GTPAL | Living: number of children currently living |
| Female Reproductive Hormones | Hypothalamus low E2/P4 > releases GnRH Anterior Pituitary GnRH releases LH & FSH Ovary FSH > follicle masturation LH peak > ovulation (~12-24hrs) |
| After Ovulation: Corpus Luteum Phase | Corpus Luteum forms- the ruptured follicle becomes the corpus luteum after ovulation Progesterone & Estrogen released- maintains uterine lining for potential implantation |
| After Ovulation: Corpus Luteum Phase | If no implantation- corpus luteum degrades after ~1 week > hormone levels drop > GnRH released > cycle restarts |
| Female Reproductive Hormones | Interactions between the ovaries, anterior pituitary, and the hypothalamus regulate the female reproductive cycle when estrogen and progesterone levels are low, the hypothalamus is stimulated to produce gonadotropin-releasing hormone (GnRH) |
| Female Reproductive Hormones | In response to GnRH, the anterior pituitary releases luteinizing hormone (LH) and follice-stimulated hormone (FSH). FSH is responsible for maturation of oovarian follicles that will release eggs for fertilization. |
| Female Reproductive Hormones | LH levels peak approximately 12 to 24 prior to ovulation. |
| Female Reproductive Hormones | After ovulation (follicle rupture), the ovarian follicle is called a corpus luteum. The corpus luteum produces large amounts of progesterone and a smaller amount of estrogen, which maintain the uterine lining for implantation |
| Female Reproductive Hormones | If implantation does not occur, the corpus luteum begins to lose its secretory function after about a week. Progesterone and estrogen levels are decreased causing hypothalamus to produce GnRH. |
| Phases of the Reproductive cycle | Menstrual cycle occurs when an ovum is not fertilized and typically begins 12 to 14 days after ovulation. The first half of the menstrual cycle is known as the follicular phase. |
| Phases of the Reproductive cycle | During the follicular phase, ovaries are stimulated to mature follicles and their associated oocytes. At the same time, the uterine lining begins to proliferate. |
| Phases of the Reproductive cycle | At the end of the follicular phase, one mature follicle (graafian follicle) ruptures and expels an ovum (ovulation). The second half of the menstrual cycle is called the secretory phase. |
| Phases of the Reproductive cycle | During the secretory phase, the corpus luteum secretes estrogen and progesterone to maintain the uterine lining for implantation. |
| Gametogenesis #1 | Gametogenesis is the creation of gametes (ova and sperm) through meiosis. In meiosis, the number of chromosomes is reduced from diploid (46 chromosomes; two sets) to haploid (23 chromosomes; one set). |
| Gametogenesis #1 | Females are born with 1 to 2 million oocytesin their ovaries. This is determined in utero. In males, spermatogenesis does not begin until puberty. |
| Fertilization | After ovulation, ova are viable for fertilization for 6 to 24 hours. Sperm may be capable of fertilizing an egg for as long as 5 days. Fertilization most often occurs in the fallopian tube. |
| Fertilization | When a sperm fertilizes the eggs, additional sperm are blocked from penetration through a process called cortical reaction. |
| Fertilization | After conception, the 23 chromosomes of the sperm unite with the 23 remaining chromosomes of the ovum. creating a diploid zygote with 46 chromosomes. |
| Naegele's rule | A method for calculating the estimated date of delivery (EDD). It's based on the idea that a pregnancy lasts 280 days, or 40 weeks, and adds seven days to the first day of the last menstrual period, while subtracting three months. |
| Confirming pregnancy presumptive | signs woman experiences that make her think she might be pregnant . Least reliable, can be caused by other conditions |
| Confirming pregnancy probable | changes that can be detected on physical exam by a health care provider. can still be caused by other conditions |
| Confirming pregnancy positive | Signs that are directly attributed to the fetus. Can be explained only be pregnancy. |
| Presumptive symptoms of pregnancy | amenorrhea (4 weeks) breast tenderness (3-4 weeks) nausea and vomiting (4-14 weeks) abdominal enlargement (14 weeks) |
| Probable signs of pregnancy | Braxton Hicks contractions (16-18 weeks) Positive pregnancy test (4-12 weeks) Softening of the cervix (Goodell sign) (5 weeks) Bluish discloration of the female genitalia (Chadwick sign) (6-8 weeks) Uterine enlargement (7-12 weeks) |
| Positive signs of pregnancy | Fetal heartbeat obtained via doppler (10-12 weeks) Fetus visualized on ultrasound (4-6 weeks) Fetal movement felt by HCP (20 weeks) |
| Confirming pregnancy | Human chorionic gonadotrophin (hCG) produced at implantation. hCG doubles in early pregnancy every 48 to 72 hours. Home pregnancy detects hCG in urine. |
| Confirming pregnancy | False negatives can occur. If patient thinks possibly pregnant, but urine tests negative, should repeat test 3 to 7 days. |
| Confirming pregnancy | False positive tests usually caused by user error (reading the test late) but could be caused by other issues ex. recent pregnancy loss or fertility treatment. |
| Intrauterine Development: Embryonic stage | pre embryonic: fertilized ovum, morula, blastocyst, enters uterus |
| Intrauterine Development: Embryonic stage | embryonic stage weeks 2-8 |
| Intrauterine Development: Embryonic stage week 2 | implantation complete |
| Intrauterine Development: Embryonic stage week 3 | neural tube begins to fuse, tubular heart begins to beat |
| Intrauterine Development: Embryonic stage week 4 | respiratory & digestive tracts begin forming; neural tube fusion complete |
| Intrauterine Development: Embryonic stage week 5 | limb buds appear |
| Intrauterine Development: Embryonic stage week 6 | heart reaches final form |
| Intrauterine Development: Embryonic stage week 8 | first brain waves detectable - end of the embryonic stage |
| Intrauterine Development: fetal stage | weeks 9-38+ |
| Intrauterine Development: fetal stage weeks 9-12 | fetal movement begins kidneys begin to function genitalia fully differentiated |
| Intrauterine Development: fetal stage weeks 13-16 | oogensis established in females blood vessels visible under skin fingerprints and footprints forming |
| Intrauterine Development: fetal stage week 20 | fetal swallowing present insulin production begins lanugo and vernix caseosa cover body |
| Intrauterine Development: fetal stage week 24 | lungs begin producing surfactant - key milestone for viability |
| Intrauterine Development: fetal stage weeks 28-34 | testes descend (males) subcutaneous fat deposits begin CNS maturation increases heart rate variability |
| Intrauterine Development: fetal stage weeks 33-38 | visual acuity 20/600 lungs and CNS mature continued weight gain fetus prepares for birth |
| Placenta #1 | Temporary organ acts as a circulatory interface between gestational parent and embryo/fetus. Forms at site of blastocyst implantation. Attaches with finger-like projection: chorionic villi |
| Placenta #1 | Expands over inner surface of uterus until about 20 weeks' gestation. Approximately 2.5 to 3cm thick and 38-51 cm in diameter when fully developed. Fetal surface smooth and translucent: shiny schultz |
| Placenta #1 | Maternal side has red, meaty appearance: dirty duncan Serves three primary functions: circulation, protection, and hormone production |
| Placenta #2 | Placenta secretes hormones to support the pregnancy |
| Umbilical cord | Arises from the fetal side of the placenta. Serves as a conduit for blood traveling to and from the embryo/fetus At birth 55 cm long and 2 cm in diameter on average. |
| Umbilical cord | Contains one large vein that carries oxygenated blood to the embryo/fetus and two smaller arteries that carries deoxygenated blood to the placenta. AVA - artery vein artery |
| Umbilical cord | The umbilical cord is covered in wharton jelly, which helps support and protect vessels. Often appears twisted, likely from fetal movement. |
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