CLAIRE GANTUANGCO01

8/14/2019 CLAIRE GANTUANGCO01

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CLAIRE GANTUANGCO 01-22-10

BSN-4C FPC MRS. ARENDAIN, RN,RM, MAN

Development

Main article: Prenatal development

9 weeks of gestation: condition at start of fetal stage

Artist's depiction of fetus 11 weeks after fertilization. The crown-rump length is 1.25

inches.[7]

The fetal stage commences at the beginning of the 9th week.[1] At the start of the fetal

stage, the fetus is typically about 30 mm (1.2 inches) in length from crown to rump, and

weighs about 8 grams.[1]The head makes up nearly half of the fetus' size.[8] Breathing-like

movement of the fetus is necessary for stimulation of lung development, rather than for

obtaining oxygen.[9]

The heart, hands, feet, brain and other organs are present, but are onlyat the beginning of development and have minimal operation.[10][11]

Fetuses are not capable of feeling pain at the beginning of the fetal stage, and will not beable to feel pain until the third trimester.[12] At this point in development, uncontrolled

movements and twitches occur as muscles, the brain and pathways begin to develop.[13]

16 to 25 weeks after fertilization

A woman pregnant for the first time (i.e. a primiparous woman) typically feels fetal

movements at about 21 weeks, whereas a woman who has already given birth at least two

times (i.e. a multiparous woman) will typically feel movements by 20 weeks.[14]

By theend of the fifth month, the fetus is about 20 cm (8 inches).

26 to 40 weeks of gestation

Artist's depiction of fetus at 40 weeks after fertilization, about 20 inches (51 cm) head to

toe.

The amount of body fat rapidly increases. Lungs are not fully mature. Thalamic brainconnections, which mediate sensory input, form. Bones are fully developed, but are still

soft and pliable. Iron, calcium, and phosphorus become more abundant. Fingernails reach
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the end of the fingertips. The lanugo begins to disappear, until it is gone except on the

upper arms and shoulders. Small breast buds are present on both sexes. Head hair

becomes coarse and thicker. Birth is imminent and occurs around the 40th week. Thefetus is considered full-term between weeks 35 and 40, [15] which means that the fetus is

considered sufficiently developed for life outside the uterus.[16] It may be 48 to 53 cm (19

to 21 inches) in length, when born. Control of movement is limited at birth, andpurposeful voluntary movements develop all the way until puberty.[17][18]

Variation in growth

See also: Birth weight

There is much variation in the growth of the fetus. When fetal size is less than expected,

that condition is known as intrauterine growth restriction (IUGR) also called fetal growth

restriction (FGR); factors affecting fetal growth can be maternal,placental, orfetal.[19]

Maternal factors include maternal weight, body mass index, nutritional state, emotionalstress, toxin exposure (including tobacco, alcohol, heroin, and other drugs which can also

harm the fetus in other ways), and uterineblood flow.

Placental factors include size, microstructure (densities and architecture), umbilicalblood flow, transporters and binding proteins, nutrient utilization and nutrient production.

Fetal factors include the fetus genome, nutrient production, and hormone output. Also,

female fetuses tend to weigh less than males, at full term.[19]

Fetal growth is often classified as follows: small for gestational age (SGA), appropriate

for gestational age (AGA), and large for gestational age (LGA).[20]

SGA can result in lowbirth weight, although premature birth can also result in low birth weight. Low birth

weight increases risk for perinatal mortality (death shortly after birth), asphyxia,

hypothermia, polycythemia, hypocalcemia, immune dysfunction, neurologicabnormalities, and other long-term health problems. SGA may be associated with growth

delay, or it may instead be associated with absolute stunting of growth.

Viability

Main article: Viability (fetal)

Stages inprenatal development, showing viability and point of 50% chance of survival at

bottom. Weeks and months numberedby gestation.

The lower limit of viability is approximately five months gestational age, and usually

later.[21]
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Human fetus, age unknown

There is no sharp limit of development, age, or weight at which a fetus automaticallybecomes viable.[22] According to data years 2003-2005, 20 to 35 percent of babies born at

23 weeks of gestation survive, while 50 to 70 percent of babies born at 24 to 25 weeks,

and more than 90 percent born at 26 to 27 weeks, survive. [23] It is rare for a baby

weighing less than 500 gm to survive.[22]

When such babies are born, the main causes ofperinatal mortality is that the respiratory

system and the central nervous system are not completely differentiated.[22] If given

expert postnatal care, some fetuses weighing less than 500 gm may survive, being arereferred to as extremely low birth weightorimmature infants.[22]Preterm birth is the most

common cause of perinatal mortality, causing almost 30 percent of neonatal deaths.[24]

Fetal pain

Main article: Fetal pain

Fetal pain, its existence, and its implications are debated politically and academically.According to the conclusions of a review published in 2005, "Evidence regarding the

capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely

before the third trimester."[12][25]However, there may be an emerging consensus among

developmental neurobiologists that the establishment ofthalamocortical connections" (atabout 26 weeks) is a critical event with regard to fetal perception of pain. [26] Nevertheless,

because pain can involve sensory, emotional and cognitive factors, it is "impossible to

know" when painful experiences may become possible, even if it is known whenthalamocortical connections are established.[26]

Whether a fetus has the ability to feel pain and to sufferis part of the abortion debate.[27]

[28] For example, in the USA legislation has been proposed by pro-life advocates thatabortion providers should be required to tell a woman that the fetus may feel pain during

the abortion procedure, and require her to accept or decline anesthesia for the fetus.[29]
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Circulatory system

Main article: Fetal circulation

Diagram of the human fetal circulatory system.

The circulatory system of a human fetus works differently from that of born humans,

mainly because the lungs are not in use: the fetus obtains oxygen and nutrients from the

woman through theplacenta and the umbilical cord.[30]

Blood from the placenta is carried to the fetus by the umbilical vein. About half of thisenters the fetal ductus venosus and is carried to the inferior vena cava, while the other

half enters the liver proper from the inferior border of the liver. The branch of the

umbilical vein that supplies the right lobe of the liver first joins with the portal vein. Theblood then moves to the right atrium of the heart. In the fetus, there is an opening

between the right and left atrium (theforamen ovale), and most of the blood flows from

the right into the left atrium, thus bypassingpulmonary circulation. The majority of bloodflow is into the left ventricle from where it is pumped through the aorta into the body.

Some of the blood moves from the aorta through the internal iliac arteries to the umbilical

arteries, and re-enters the placenta, where carbon dioxide and other waste products fromthe fetus are taken up and enter the woman's circulation.[30]

Some of the blood from the right atrium does not enter the left atrium, but enters the right

ventricle and is pumped into the pulmonary artery. In the fetus, there is a special

connection between the pulmonary artery and the aorta, called the ductus arteriosus,

which directs most of this blood away from the lungs (which aren't being used forrespiration at this point as the fetus is suspended in amniotic fluid).[30]

Postnatal development

Main article: Adaptation to extrauterine life

With the first breath after birth, the system changes suddenly. The pulmonary resistance

is dramatically reduced ("pulmo" is from the Latin for "lung"). More blood moves from

the right atrium to the right ventricle and into the pulmonary arteries, and less flowsthrough theforamen ovale to the left atrium. The blood from the lungs travels through the

pulmonary veins to the left atrium, increasing the pressure there. The decreased right
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atrial pressure and the increased left atrial pressure pushes the septum primum against theseptum secundum, closing theforamen ovale, which now becomes thefossa ovalis. This

completes the separation of the circulatory system into two halves, the left and the right.

The ductus arteriosus normally closes off within one or two days of birth, leaving behind

the ligamentum arteriosum. The umbilical vein and the ductus venosus closes off withintwo to five days after birth, leaving behind the ligamentum teres and the ligamentum

venosus of the liver respectively.
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There's a lot more to getting pregnantthan just having intercourse sometime in the middle of yourcycle and hoping to see that positive pregnancy test insteadof your period.

I learned this the hard way.

When I was trying to conceive, I found out that there was alot that I didn't know. Which led me to making a lot of bigmistakes which were actually preventing me from gettingpregnant.

For one thing, I had the timing all wrong. I thought Iovulated 14 days after the start of my period, but laterlearned that this is a big mistake that many women make.For most women, ovulation does not occur 14 days aftertheir period starts even though many women think this istrue. That's because most women do not have a perfect 28day cycle.

And would you believe I was using lubrication that I laterfound out can kill sperm!! That certainly wasn't helping meto get pregnant, was it?

I also had my husband "save up" his sperm thinking thiswould make him more fertile when my ovulation day came,and it turns out this actually makes him less fertile, andreduces the chance of pregnancy. Who knew??

Avoid Common Mistakes!Oh, I could go on and on about all the mistakes I wasmaking.

Luckily, after spending months researching, I uncoveredmany possible mistakes which can get in the


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way of getting pregnant, and I made a lot of changes basedon what I learned.

And guess what, I conceived my two little "bundles of joy"

(not at the same time!) soon after I madesome changes!

I wrote a little report to inform other women about thecommon mistakes I discovered which willreduce your chances of getting pregnant. I bet you'll besurprised to find that you're making atleast a few yourself!!

You can get your free copy of the "7 Mistakes Report" byclicking here. Consider it my gift to you...

I sincerely hope it helps you have your own

little "bundle of joy."

Baby dust to you...

--Beth
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GINA G. DALUMPINES 01-23-10

BSN-4C FPC MRS. ARENDAIN,RN, RM,MAN

OBSTETRICS & GYNECOLOGY

Maternal Physiology Changes During Pregnancy

The physiologic,biochemical,and anatomic changes that occur during pregnancy areextensive and may be sistemic or local..Teleologic alterations during pregnancy mantaina

healthy enviroment for the fetus without compromising the mother shealth.Although,sometimes determine small disconfort to the mother.

Gastrointestinal Tract

During pregnancy, nutritional requirements,including those for vitamins and minerals, areincreased, and several maternal alterations occur to meet this demand.The mother`s

appetite usually increases, so that food intake is greather, some women have a decreased

appetite or experience nausea and vomiting.These symptoms may be related to relative

levels of human chorionic gonadotrophin(hCG).

Oral Cavity

Salivation may seem to increase due to swallowing difficulty associated with nausea

,and ,if the pH of the oral cavity decreases, tooth decay may occur.Tooth decay duringpregnancy,however, is not due to lack of calcium in the teeth.Indeed,dentalcalciumis

stable and not mobilized during pregnacy as is bone calcium.

The gums may become hipertrofic, hiperemic and friable;this maybe due to increased

systemic estrogen. Vitamin Cdeficiency also can cause tenderness and bleeding of the

gums.The gums shoud return tonormal in the early puerperium

Gastointestinal Motility

Gastrointestinal motility may be reduced during pregnancy due to increased levels of

progesterone, which in turn decrease the production of motilin, ahormonal peptide that is

known to stimulate smooth muscle in the gut.Transit time of food throughout thegastrointestinal tract may be so much slower that more water than normal is reabsorbed,

leading to constipation.

Stomach and Esophagus

Gastric production of hidrocloric acid is variable and sometimes exaggrated, especiallyduring the first trimester. More commonly, gastric acidity is reduced. Production of the

hormone gastin increases significantly, resulting in increased sthomac volume and

decreased stomach pH. Gastric production of mucus may be increased. Esophagealperistalses is deceased, accompanid by gastric reflux because of the slower emptying

time and dilatation or relaxation of the cardiac sphincter. Gastric reflux is more prvalent

in later pregnancy owing to elevation of the stomach by the enlarged uterus.Besides
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leading to heartburn, all of these alterations as well as lying in the supine lithotomy

position, make the use of anesthesia more hazardous because of the increased possibility

of regurgitation and aspiration.

Small and Large Bowel ann Appendix

The large and small bowel move upward and laterally,the appendix is displaced

superiorly in the right flank area. These organs return to the normal positions in the early

puerperium.

As noted previouly, motility is generally decreased an gastrointestinal tone is decreased.

Gallblader

Gallblader function is also altered during pregnancy because of the hypotonia of the

smooth muscle wall. Emptying time is slowed and often incomplete. Bile can become

thick, and bile stasis may lead to gallstone formation.

Liver

There are no apparent morphologic changes in the liver during normal pregnancy, but

there are functional alterations. Serum alkaline phosphatase activity can double, probably

because of inceased placental alkaline phosphatase isoenzimes. Thus, a decrease in the

albumin/globulin ratio occurs normally in pregnancy.

Kidneys and Urinary Tract

Renal Dilatation

During pregnancy , each kidney increases in leagth by 1-1,5cm, with a concomitant

increase in weight.The renal pelvis is dilated.The ureters are dilated above the brim of the

bony pelvis.The ureters also elongate, widen, and become more curved.Thus there is anincrease in urinary stasis, this may lead to infection and may make tests of renal function

difficult to interprete.

The absolute cause of hydonephrosis and hydroureter in pregnancy is unknown, theremay be several contributing factors:1-Elevated progesterone levels may contribute to

hypotonia of the smooth muscle in the ureter. 2-The ovarian vein complex in the

suspensory ligament of the ovary may enlarge enough to compress the ureter at the brimof the bony pelvis, thus causing dilatation above that level. 3-Dextorotation of the uterusduring pregnancy, may explain why the right ureter is usually more dilated than the left.

4-Hyperplasia of smooth muscle in distal one-third of the ureter may cause reduction in

the luminal size. Renal Function

The glomerular filtration rate(GFR) increases during pregnancy by about 50% .The renalplasma flow rate increases by as much as 25-50%. Urinary flow and sodium excretion

rates in late pregnancy can be alterated by posture, being twice as great in the lateral

recumbent position as in the supine position.

Even thought the GFR increased dramaticallyduring pregnancy, the volume of the urinepassed each day is not increased. Thus, the urinary system appears tobe even more

efficient during pregnancy.

With the increase inGFR, there is an incease in endogenous clearence of creatinine.Theconcentration of creatinine in serum is reduced in proportion to increase in GFR, and

concentration of blood urea nitrogen is similarly reduced.


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Glucosuria during pregnancy is not necessarily abnormal, may be explained by the

increase in GFR with impairment of tubular reabsortion capacity for filtered

glucose.Increased levels of urinary glucose also contribute toincreased susceptibility ofpregnant women to urinary tract infection.

Proteinuria changes litlle during pregnancy and if more than 500mg/24h is lost,a deseaseprocess shoud be suspected

Levels of the enzime renine, which is produced in kidney, increase early in the firsttrimester, and continue toarise until term. This enzime acts on its substrate

angiotensinogen, to first form angiotensin1 and then angiotensin2, which acts as a

vasoconstrictor.Normal pregnant are resistent to the pressor effect of elevated levels of

angiotensin2 but those suffering from preeclampsia are not resistant, this is one of thesome theories to explain this desease.

Blader As the uterus enlarges, the urinary blader is displaced upward and flattened in the

anterior-posterior or diameter.Pressure from the uterus leads to inceased in urinaryfrequency. Blader vascularity increases and muscle tone decreases, incresin capacity up

to 1500ml.

Hematologic System

Blood Volume `

Perhaps the most striking maternal phisiologic alteration occurring during pregnancy is

the increase in the blood volume. The magnitude of the increases varies according to thesize of woman, the number of pregnancies she has had, the number of infants she has

delivered, and whether there is one or multiple fetuses.The increases in blood volumeprogress until term;the average increase in volume at term is 45-50%. The increase is

needed for extra blood flow to the uterus, extra metabolic needs of fetus, and increased perfusion of others organs, especially kidneys. Extra volume also compensate for

maternal bllod loss delivery. The average blood loss with vaginal delivery is 500-600ml,

and with cesarean section is 1000ml.

Red BloodCels The increase in red blood cel mass is about 33%. Since plasma volume

increases early in pregnancy and faster than red blood cell volume, the hematocrit falls

until the end of the second trimester, when the increase in the red blood cells is

synchronized with the plasma volume increase. The hematocrit then stabilizes or may

increase slightly near term.Iron

With the increase in red blood cells, the need for iron for the production of

hemoglobin,naturally increases. If supplemental iron is not added to the diet, irondeficiency anemia will result. Maternal requiriments can reach 5-6mg/d in the latter half

of pregnancy. If iron is not readly available, the fetus uses iron from maternal stores.

Thus, the production of fetal hemoglobin is usually adequate even if the mother is serelyiron deficient. Therefore anemia in the newborn is rarely a problem; instead, maternal

iron deficiency more commonly may cause preterm labour and late spontaneus abortion,

incresing the incidence of infant wastage and morbidity.

White Blood Cells

The total blood leukocite count increases during pregnancy from a prepregnancy level of

4300-4500/mL to 5000-12000/mL in the last trimester, althought counts as hight as

16000/mL have been observed in the last trimester.Counts as hight as 25000-30000/mL

have been noted in anormal patient during labor. Lymphocite and monocyte numbers stay


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essencially the same throughout pregnancy; polymorphonuclear leucocytes are the

primary contributors to the increase.

Clotting Factors

During pregnancy, levels of several essential coagulation factors isincrease.Therearemarked increases in fibrinogen and factor8. Factors VII, IX, X, and XII also increased but

to alesser extend.

Fibrinolytic activity is depressed during pregnancy and labor, although the precise

mechanism is unkown. The placenta may be partially responsible for this alteration infibrinolytic status.Plasminogen levels increase concomitantly with fibrinogens levels,

causing an equilibrationof clotting and lysing activity.

Clearly, coagolation and fibrinolytic sistems undergo major alterations during pregnancy.

Understanding these physiologic changes is necessary to manange two of the more

serious problems of pregnancy: hemorrage and thromboembolic desease, both caused bydisorders in the mechanism of hemostasis.

Cardiovascular System

Position and Size of Heart

As the uterus enlarges and the diaphragm becomes elevated, the heart is displaced

upward and somewhat to the left with rotation on its long axis, so that the apex beat ismoved laterally. Cardiac capacity increases by 70-80mL; this may be due to increased

volume or hyperthophy of cardiac muscle.The size of the heart appears to increase by

about 12%

Cardiac Output

Cardiac output increases approximately 40% during pregnancy, reaching its maximum at

20-24 weeks gestation and continuing at this level until term. The increase in output can

be as much as1,5L/min over the non pregnant level. Cardiac output is very sensitive tochanges in body position. This sesitivity increases with leghthening gestation,

presumably because the uterus impinges upon the inferior vena cava, thereby decreasing

blood return to the heart.

Blood Pressure

Systemic blood pressure declines slightly during pregnancy. There is a little change insystolic blood pressure, but ddiastolic pressure is reduced (5-10mmHg) from about 12-26

weeks.Diastolic pressure increases thereafter to prepregnancy levels by about 36 weeks.

The obstruction posed by the uterus on the inferior vena cava and the pressure of fetalpresentig part on the commom illiac vein can result in decreased blood return to the heart.

This decreases cardiac output, leads to a fall in blood pressure, and causes edema in the

lower extremities.

Peripheral Resistence Peripheral resistence equals blood pressure divided by cardiacoutput. Because blood pressure either decreases or remain the same during pregnancy and

cardiac output increases appreciably, there is good evidence that peripheral resistence

declines markedly. The elevated venous pressure returns toward normal if the woman lies

in the lateral recumbent position.

Effects of the Labor on the Cardiovascular System


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