ANATOMY & CONCEPTION

Ns.Wulan Novika Ambarsari.,MAN

Anatomical Landmarks

 Female

 Male
External Structures
Internal Structures
Midsagital View
Uterus
Uterine Ligaments
Pelvic Bones
Female Pelvis
Pelvic Types
Muscles of the Pelvic Floor
Male: External and Internal
Structures
Testis
Testis
Sperm
Female Reproductive Cycle

 Ovulation
 Menstruation
 Menarche
 Climacteric
 Menopause
Female Reproductive Cycle
 Conception and Fetal
Development

 Nine Month Miracle

 Miracle of Life
 Internet sites
 Conception
 Fertility

 Sexual intercourse

 Pregnancy
 Genetics
 Chromosomes
 Autosomal
 Sex
 Chromosomal syndromes
 Modes of inheritance
 Patterns of Inheritance
 Dominant

 Recessive

 X-linked
 Nursing Responsibilities
 Identify families at risk
 Education
 Liaison
 Support / Crisis intervention
 Continuity of care
 Teratogens
 Tobacco
 Alcohol
 Marijuana
 Cocaine
 Heroin
 Anticonvulsants
 Anticoagulants
 Acne medications
 Reproductive Ethics
 Maternal-fetal conflict
 Abortion
 Intrauterine fetal surgery
 Reproductive assistance
 Embryonic stem cell research
 Human genome project
 Cord blood banking
 Fertilization
 One spermatozoon enters the ovum
 Two nuclei containing the parents’
chromosomes merge
 Occurs in the outer third of the fallopian
tube
 Sex is determined
 Multifetal Pregnancy
 Dizygotic twinning -- fraternal

 Monozygotic twinning -- identical

 Implantation
 Nidation
 Gradual process
 Occurs between 6th / 7th and 10th days
 Upper part of posterior uterine wall
 Placenta develops
Fertilization and Implantation
 Amniotic Membranes
 Amnion (inner)
 Chorion (outer)
 Enclose fetus in amniotic fluid
 Protects fetus from infectious organisms
Amniotic Sac
 Amniotic Fluid
 Clear, slightly yellow, alkaline fluid
 Approximately 1 liter at term
 Derived from
 Maternal plasma
 Cells of the amnion
 Fetal fluids from lung, skin, fetal urine
Functions of Amniotic Fluid
 Cushions fetus from trauma
 Facilitates fetal movement
 Facilitates symmetrical growth
 Regulates intrauterine temperature
 Provides source of oral fluid
 Cushions umbilical cord
 Receptacle for fetal substances
 Placenta / Function
 Fully functional by week 12
 Respiration
 Nutrition
 Waste removal
 Protection
 Endocrine
Placenta
Placenta After Delivery
 Umbilical Cord
 One vein
 Two arteries
 Wharton’s jelly
 Amnion
Placenta and Cord
Umbilical Cord
12 weeks
18 Weeks
4 Months
5 Months
30 Weeks
40 Weeks
 Fetal Development
 Preembryonic or ovum

 Embryonic

 Fetal
 Fetal Circulation
 Ductus venosus

 Ductus arteriosus

 Foramen ovale
Fetal Circulation
 Factors Affecting Fetal
Development
 Exposure to teratogens

 Maternal health habits and lifestyle

 Paternal health habits and exposure to

environmental influences
Physiological Changes During
Pregnancy
 Uterus
 Ligaments
 Cervix
 Chadwick’s
 Goodell’s
 Hegar’s
 Breast
 Montgomery tubercles
 Skin
Circulatory System
 Increases up to 50%
 Pseudoanemia
 Iron requirements increased
 Increase in size
 Blood pressure changes
 Fibrinogen increases
 Mechanical circulatory effects
Supine Hypotension Syndrome
Respiratory System
 Thoracic cage
 Oxygen consumption increases
 Hyperventilation
 Respiratory alkalosis
 Mucosal edema
Digestive System
 Nausea / vomiting
 Constipation
 Flatulence / heartburn
 Gallstones
Urinary System
 Kidneys
 Function increases
 Renal threshold for sugar reduced
 Bladder and ureters
 Blood supply increased
 Pressure
 Atonia
Joints, Bones, Teeth, and Gums
 Pelvic cartilages
 Gait
 Uterus
 Posture changes
 Teeth
 Gums
Endocrine System
 Placenta
 HCG
 HPL
 Estrogen
 Progesterone
 Pituitary
 Adrenal
 Thyroid
 Signs of Pregnancy

 Presumptive – Subjective

 Probable – Objective

 Positive -- Diagnostic
Signs of Pregnancy: S, O, or D
 Amenorrhea
 Goodell’s sign
 Fetal heart sounds
 Urinary frequency
 Positive pregnancy test
 Nausea and vomiting
 Enlargement of the abdomen
 Quickening
 Palpable fetal movements
 Braxton Hicks contractions
How would you explain the
differences between the
subjective (presumptive),
objective (probable), and
diagnostic (positive) signs of
pregnancy to an expectant
mother?
Maternal Psychosocial Changes
 First trimester
 Ambivalent
 Second trimester
 Baby becomes real
 Maternal introspection
 Third trimester
 Begins to think of baby as separate
being
 Restless
 Self-centered
Rubin’s Maternal Tasks
 Seeking safe passage
 Securing acceptance
 Learning to give of self
 Committing self to child
Paternal Psychosocial Changes
 First trimester
 Excitement over virility
 Financial concerns
 Energetic
 Exhibit symptoms with wife
 Second trimester
 More confident
 Concerns about wife’s changes /
introspection
 Third trimester
 Rivalry with fetus
 Interest in himself
 Fantasizes about child
 Factors Affecting Psychological
Response
 Body image
 Personal characteristics
 Financial situation
 Cultural expectations
 Emotional security
 Support from significant others
 Changes in sexuality
 Role of the father and siblings
 Preparation for Parenthood
 Preconception

 Childbearing decisions

 Prenatal education

 Childbirth preparation
 Childbirth Education
 Provides information on pregnancy and
childbirth to facilitate optimal decision
making
 Classes for special groups
 Importance of exercise during pregnancy
 Selection of birthing process
 Infant care
 First Trimester
 Physical and psychosocial changes of
pregnancy
 Self-care in pregnancy
 Protecting and nurturing the fetus
 Choosing a care provider and birth setting
 Prenatal exercise
 Relief of common early pregnancy
discomforts
 Second Trimester
 Planning for breast-feeding

 Sexuality in pregnancy

 Relief of common later-pregnancy

discomforts
 Third Trimester
 Preparation for childbirth
 Development of a birth plan
 Relaxation techniques
 Postpartum self-care
 Infant stimulation
 Infant care and safety
 Goals of Prenatal Care
 Safe birth
 Health promotion
 Self-care
 Provide physical care
 Provide anticipatory guidance
 Risk Factors / Reproductive
Outcomes
 Maternal age
 Parity
 Socioeconomic status
 Ethnicity
 Geographic factors
 Behavioral and Lifestyle risks
 Health risks
 Previous pregnancies
 Role of Nurse
 Physical assessment
 Identify and reevaluate risk factors
 Teach self-care
 Nutrition counseling
 Promote family’s adaptation to pregnancy
 Prenatal Visits
 Every 4 weeks for first 28 to 32 weeks

 Every 2 weeks from 32 to 36 weeks

 Every week from 36 to 40 weeks

 Terminology
 Gravida  Multipara
 Nulligravida  Nullipara
 Primigravida  Abortion
 Multigravida  Gestational age
 Para  Fertilization age
 Primipara
 Nomenclature
 G = number of pregnancies
 T = number of term deliveries
 P = number of preterm deliveries
 A = number of abortions
 L = number of living children
 M = number of multiple births
 Nägele’s Rule

First Day of Last Menstrual Period

Minus 3 months
Plus 7 days
Identify the causes and interventions
for each discomfort of pregnancy:
 Heartburn  Fatigue
 Hemorrhoids  Backache
 Urinary frequency  Constipation
 Nausea / vomiting  Varicose veins
 Leg cramps  Edema
 Vaginal discharge  Dyspnea
Why is a positive
pregnancy test not a
positive sign of
pregnancy?
 Routine Lab Tests
 Blood grouping  Hg electrophoresis
 Rh factor and  HIV screen
antibody screen  Hepatitis B screen
 CBC  UA
 H&H  PAP test
 VDRL, RPR, or  Cervical culture
STS  MSAFP
 Rubella titer  Maternal blood
glucose
 TB skin test
Prenatal Laboratory Tests:
Normal or Abnormal ?

 Hemoglobin 13.6 g/dL

 Hematocrit 35%
 Rubella titer 1:6
 WBC 6,200/ mm3
 Sickle Cell screen negative
 Prenatal Self-Care Measures

 Breast tenderness
 Leg cramps
 Nausea
 Constipation
 Backache
 Risk Factors

 Definition
 Social / Personal
 Preexisting medical disorders
 Obstetric considerations
 Problems associated with current
pregnancy
 Prenatal Diagnostic Studies
 Ultrasound
 Estriol: Increases with fetal growth
 Amniotic Fluid
 Amniocentesis
 Lecithin / sphingomyelin ratio
 Fern test
 Nitrazine test
 Kick test
 Chorionic villus sampling
 Alpha feto protein level
 Level I Ultrasound
 Basic
 Detect gestational sac (5 weeks after LMP)
 Identify number of fetuses
 Document fetal life
 Detect gross fetal structural anomalies
 Estimate gestational age
 Determine fetal position
 Locate the placenta
 Estimate amniotic fluid volume
 Evaluate maternal pelvic masses
Level II Ultrasound
 Evaluate gestational age
 Measure fetal growth
 Perform specific examinations of the brain,
heart, kidney, and cord insertion
 Quantify amniotic fluid volume
 Determine placental location
 Performed after 18 weeks
List two advantages of
prenatal ultrasound
assessment for the
mother and fetus.
Tests of Fetal Well-Being
 Ultrasound
 Amniocentesis
 Nonstress Test (NST)
 Contraction Stress Test (CST)
 Breast Self-Stimulation Test (BSST)
 Danger Signs in Pregnancy
 C = Chills and fever
Cerebral disturbances
 A = Abdominal pain
 B = Blurred vision
Blood pressure
Bleeding
 S = Swelling
Sudden escape of fluid
 Nutrition During Pregnancy
 Choose foods from food guide pyramid
 Increase of 300 calories / day
 Calorie needs greater in last two trimesters
 Encourage diet high in folic acid with
supplements
 Calcium needs increase nearly 50%
 Heavy demand for iron for fetal stores
 Drink 8 to 10 glasses of water / day
Food Guide Pyramid
Vegetarianism
 Need ample and complete proteins from
dairy products and eggs
 Protein from brown rice and whole wheat,
legumes, nuts, cooked and fresh vegetables
and fruits
 Vitamin B12 supplement
 Lactose Intolerance
 Abdominal distention, discomfort, nausea,
vomiting, loose stool, cramps
 May tolerate milk in cooked form
 Cheese and yogurt
 Lactase may be prescribed
 Lactase-treated milk
 Lactose-free products
Pica
 Non-nutritive eating
 Associated with poverty and inadequate
diets
 Iron deficiency anemia
Weight Gain
 Normal: 25 -- 35 pounds
 Underweight: 28 -- 40 pounds
 Overweight: 15 -- 25 pounds
Uterine Growth During Pregnancy

F
Uterine Growth During Pregnancy
What is the average
pattern of weight gain
during each trimester of
pregnancy?
 Maternal Weight Gain
Distribution
 Fetus, placenta, amniotic fluid 11 pounds
 Uterus 2 pounds
 Increased blood volume 3 pounds
 Breast tissue 3 pounds
 Maternal stores 5-10 pounds
 Total 25-35 pounds
Medications
 Prenatal vitamins
 Iron supplements
 Folic Acid
 Antacids
 Case Study
A client, who is a primigravida in her
second trimester, has come in for a
scheduled prenatal visit. When the nurse
asks how things are going, the client
replies, “Not very well. It seems like I’m
just falling apart. I have heartburn after I
eat, my ankles swell, I’m constipated all
the time, and I think I may be getting
hemorrhoids.”