NURS 330Human Reproductive Health

April 13, 2015

Fertilization

Also referred to as conception Occurs in the Fallopian tube Oocyte = mature ovum is viable

for 12-24 hours Sperm are viable 2 to 3 days in

woman’s body

The zygote

Once fertilized, the egg is called a zygote. Zygote travels four days to the uterus

Divides rapidly Identical (Monozygotic) Twins

One egg fertilized by one sperm but divides into two separate masses

Fraternal (Dizygotic) Twins Two separate eggs fertilized by two separate

sperm

Implantation The zygote reaches the uterine cavity about

3 days after fertilization

Implantation occurs 7 days after fertilization

Zygote now becomes a blastocyst

Sex of a Child

Determined at the time of fertilization

Differences are genetically determined by the chromosomes that each possesses in the nuclei of the cells

Development of Reproductive Organs

Undifferentiated Stage First eight weeks

At 12 Weeks Female Male

At 36 Weeks Female Male

Pregnancy

266 days – 270

About nine months

Embyronic Period From implantation until the 8th week of

pregnancy (gestation), the blastocyst is now known as an Embryo

Embryo Prenatal organism from implantation on

uterine wall to 8th week of pregnancy During this period, internal and

external structures begin to form No external indication of sex of embryo

The Embyronic Period (cont) Yolk sac

first element seen in the gestational sac during pregnancy, usually at 5 weeks gestation

Placenta Develops at the site of implantation Secretes human chorionic gonadotropin (hCG)

Effect on ovaries Effect on corpus luteum

Nourishment, oxygen, elimination of waste products

Umbilical cord Connects the developing embryo to the placenta Waste products are removed from the embryo and nutrients are

transported from the mother through the placenta

The Embyronic Period (cont)

Amniotic sac Protective membrane around the fetus

Amniotic fluid watery liquid surrounding and cushioning

a growing embryo within the amnion. allows the fetus to move freely without

the walls of the uterus being too tight against its body.

Fetal Period From the 8th week of gestation to

delivery, at about 40 weeks.

The embryo is now known as a fetus

When internal and external structures (organs that developed during the embryo period) grow and mature

Prenatal Sex Differentiation (cont)

Nature is predisposed toward female development. Female development requires no added hormones.

For a male to develop, the testes must produce large amounts of testosterone between the 6th and the 12th week of the prenatal period.

For the vast majority, sex differentiation occurs flawlessly and normal genitalia develop. However, in rare instances, problems may occur.

Prenatal Care

Health care during pregnancy before the baby is born

Good prenatal care Protects the mother’s health

Nutrition, diet, exercise Enhance probability of having a

healthy baby

Pregnancy Tests

All pregnancy tests look for a special hormone in the urine or blood that is only present when a woman is pregnant. This hormone, human chorionic gonadotropin

(hCG), is also called the pregnancy hormone. HCG levels increase significantly following

implantation

Blood test detects HCG sooner than Urine tests 7 days vs. 2 weeks

Trimesters

First: 0 – 13 Weeks Second: 14 – 26 Weeks Third: 27 – 40 Weeks

Early Pregnancy Signs and Symptoms

Symptoms: missed period, breast tenderness, etc

Hegar’s Sign: softening of the uterus just above the

cervix, purplish hue of labia minora, vagina and cervix

Pregnancy Symptoms

First trimester 2/3rds of pregnant women experience

nausea, vomiting, fatigue and painful swelling of the breasts

Second trimester Most nausea and vomiting subside, fetal

movements = quickening Braxton Hicks - False Labor

Pregnancy Symptoms

During the third trimester pressure on the internal organs

causes heartburn, acid reflux and frequent urination.

Edema causes swelling of ankles, face, hands and feet.

Normal weight gain 20 – 25 lbs

Diagnostic Tests during Pregnancy

Amniocentesis Genetic test - examination of chromosomes in amniotic

fluid Done during the 2nd trimester (16th week)

Chorionic Villus Sampling Genetic test – sample of villi from the chorion Done during the 1st trimester (weeks 8 and 12)

Diagnostic Tests during Pregnancy

Ultrasound (Sonogram) Picture of the internal structure of the fetus Commonly used to estimate gestational age of

the fetus. Also used as a guide during amniocentesis and

CVS

Alpha-fetoprotein (AFP): Blood test - examination of the mother’s blood

can detect spinal cord defects (spina bifida; also used to screen for Down’s Syndrome)

Done during weeks 16 and 18

Postpartum Period

The period consisting of the months or weeks immediately after childbirth.

It is a time when the woman adjusts, both physically and psychologically, to the process of childbearing

Marker events Postpartum Blues Postpartum Depression Postpartum Psychosis Breastfeeding

Postpartum blues or baby blues

Common – 50 – 70% women after pregnancy

State of short-term dysphoria that my accompany the feelings of happiness and excitement that follow the baby’s birth

Only lasts a few days

Symptoms include:Bouts of crying Mild Confusion

IrritabilityMemory Lapses Mood swings Fatigue

Postpartum Depression (PPD)

Not so common: 8% – 20% of women after pregnancy

More severe than baby blues. Extreme sadness and feelings of worthlessness

and inadequacy as a mother May become suicidal Most women improve on their own in 3 - 6 months

Others may require psychological intervention Symptoms include:

Insomnia Digestive problems Unusual weight loss

Postpartum Psychosis

Rare Serious disorder that probably has underlying

psychological causes Requires psychological evaluation and

treatment Marked by extreme highs and lows Symptoms

Extremely agitated Paranoid Delusions & hallucinations

Breastfeeding

Facilitates uterine contractions Colostrum

Produced in late pregnancy and for about 48 hours after birth

Contains no “milk” Contains many nutrients and

antibodies that are valuable for the newborn

Pregnancy Conditions/Complications

Spontaneous Abortion or Miscarriage Ectopic Pregnancy Preeclampsia/Eclampsia Gestational Diabetes Placenta problems

Abruption, previa

Pregnancy Conditions/Complications

High Risk Pregnancies: Mother's health Mother’s Age

Teenage mothers (17 and younger) Mothers over 35 years of age

Health of the fetus (baby) Complications unique to pregnancy

Teratogens

Substances that can be dangerous to the health of the baby

Cause defects because they cross the placenta

Greatest teratogenic effect during the first trimester

Active Teratogens

Passive Teratogens

Active or Passive Teratogen?

Second hand smoke Cigarette smoking Alcohol consumption Air pollution Marijuana use Fumes from parking garage Use of Over the Counter meds Fumes from cleaning supplies Caffeine

Name Effect on Pregnancy

Effect on Fetus

Other Comments

Caffeine Decreases blood flow across placentaLowers amount of O2 and nutrients available to baby

Low birth weight babies

Excessive use may

lead to miscarriage

2 – 3 cups/day pose no risk

Tobacco Miscarriage, premature birth, vaginal bleeding, placenta previa, placenta abruption, premature rupture of membranes

Low birth weight, m After birth, babies born to mothers who smoke have an increased risk of death

Alcohol Miscarriage, stillbirth Fetal Alcohol Syndrome, Death

Leading cause of birth defects

Name Effect on Pregnancy

Effect on Fetus

Other Comments

Marijuana Increased heart rate and blood pressure of mother

Can slow the amount of blood that gets to the fetusPossible low birth weight, premature birth

Studies being done to understand long-term effects of marijuana on babiesSmoking before preg – no harm to baby

Cocaine Same as aboveMay damage the placenta; more likely to tear away from the wall of the uterusSerious complications – miscarriage, prematurity

Same as above Abnormalities in baby’s heart beatLow birth weight babiesMore likely to have long-term development and growth problemsSIDs (more likely)

Can cause brain damage, birth defects in heart, urinary tract and limbsEven very occasional use can cause problems

Name What is it? Effect on Fetus

Other comments

Fetal Alcohol Syndrome (FAS)

Heavy drinking during pregnancy can cause FASAbout one half of babies born to women who drink heavily have FAS

Facial deformities – small head, thin upper lip, small eyes, small nose, flattened looking faceSmaller at birth; may never catch upMental retardationHeart defectsHearing loss or vision problems

Limited knowledge about the effects of consumption at low levelsEven a few drinks ( 1 or 2) may increase a woman’s risk for these problemsSafe consumption – no alcohol

Labor & DeliveryPreparing for Labor

Woman may experience burst of energy Lightening and engagement of fetus

descent of fetus into pelvic region Cessation of weight gain Dilation and effacement (thinning) of cervix

bloody show (due to bursting capillaries) mucus plug expelled

Rupture of amniotic sac (the water breaking)

Stage I Early phase

mild-moderate contractions dilate cervix 0–3 cm

Active phase moderate contractions dilate cervix 3–7 cm

Transition intense contractions dilate cervix 7–10

cm

Stage II Early or Rest phase

brief lull with no urge to push

Active or Decent phase pushing during contractions Moves baby down the birth canal

Transition or Crowning and Birth phase

head and body delivered

Stage III & Stage IV

Stage III Placental phase Placenta is delivered

Stage IV Recovery phase Mother and baby checked for

complications

Episiotomy

The cutting of the perineum that allows more room for the baby to be delivered

Drugs During Labor Analgesics

Tranquilizers or narcotics Help a woman relax and give some pain relief

Anesthesia Lumbar epidural Eliminates sensation from the belly down May sometimes prolong or even stop labor

Risks associated with drugs Can cross the placental barrier to the baby Temporary side effects

Irregular or slowed heart beats Higher rates of jaundice Breathing problems

Cesarean Section Most common when

fetus in the breech position labor difficult or abnormal fetus is distressed woman had a previous c-section

Breech Positions

By 36 weeks of pregnancy, most fetuses turn into a head-down, or vertex position. This is the normal and safest fetal position for birth.

A fetus with the feet, buttocks, or legs pointing down toward the cervix is said to be in breech position

Types Complete

The buttocks are down near the birth canal Frank

buttocks are in place to come out first during delivery Footling

One leg (single footling) or both legs (double footling) are stretched out below the buttocks. The leg(s) are in place to come out first during delivery.

Seven Essential Features of Human Reproduction

1. Liberation from an ovum, or egg2. Internal fertilization of the ovum by spermatozoa,

or sperm cells3. Transport of the fertilized egg to the uterus4. Implantation of the blastocyst in the wall of the

uterus5. Formation of a placenta and maintenance of the

unborn child during the entire period of gestation6. Birth of the child and expulsion of the placenta7. Suckling and care of the child

Video: Having a Healthy Baby

Menopause Permanent cessation of menstruation. Results from a loss of ovarian function

Represents the end of a woman’s reproductive life

Estrogen production decreased by 80% or more

Average age of menopause: 45 - 55 As early as 40 years As late as late 50s.

Menopause

Natural Occurs naturally after the woman’s

supply of follicles has been depleted and menstruation ends completely

Surgical Can be induced if the ovaries are

surgically removed or destroyed by x-rays.

Estrogen depletion can lead to:

Osteoporosis Loss of bone mass

Increased risk of heart disease

Symptoms of Menopause

An array of symptoms, including:-Hot flashes -Headaches-Changes in mood -Dizziness-Depression -Lack well-being-Nervousness -Breast atrophy -Vaginal Dryness -Psychological

Can last from six months to more than five years after the onset of menopause

Remedies: Over-the-counter

Painkillers such as aspirin, ibuprofen (Advil, Motrin)

Relief of menopausal symptoms Lubricants

Vaginal dryness Vitamin E

Helps with hot flashes

Alternative Therapies

Acupuncture, meditation and relaxation techniques

Herbal or natural remedies Pros

Some women report great benefits with these practices

Cons Not regulated Quality is not controlled Some can contain toxic metals

Dietary and Lifestyle Factors

Mineral-rich Fruits and Vegetables High in magnesium and potassium and can help

preserve bones Many help protect against heart disease and

cancers Effects of fiber

Important for the heart Phytoestrogens

These are plant estrogens found in soy Intake can result in lower risk for diseases

associated with estrogen Avoid fast foods and Limit salts

Hormone Replacement Therapy (HRT)

Standard treatment for preventing many of the health problems that develop after menopause because of estrogen loss

May use estrogen alone or in combination with forms of progesterone If hysterectomy – estrogen alone If uterus is present – estrogen + progestin

HRT (cont) Refers to providing a woman who has

gone through menopause with hormones that her body has stopped producing.

Symptom relief in 80% of women

Does not prevent certain other problems associated with menopause such as thinning hair

How is HRT Administered?

1. Orally2. Transdermal (Skin)3. Vaginally

Benefits of HRT Relief of uncomfortable symptoms that may

occur with menopause Hot flashes, vaginal dryness, osteoporosis

Prevention of bone loss improves balance; protects against falling

Improve cholesterol levels Increasing blood flow and reducing blood

pressure Protects against stroke

Reduces risk of heart disease Help prevent mental breakdown after menopause

Risks for HRT

Depends on three factors: treatment prescribed whether the woman has a uterus how long hormones are taken

with short-term therapy of less than 5 years, there appear to be few risks of treatment

Risks of HRT Breast cancer Uterine Cancer & Other Reproductive Cancers

Estrogen alone Heart Attack

Within the first two years in women with pre-existing conditions

Strokes Within the first two years in women with pre-existing

conditions Blood clots Endometriosis

Side Effects of HRT

Not medically serious but bothersome

Estrogen breast tenderness, edema, nausea,

headache, and breakthrough bleeding Progestin

Fluid retention, acne, premenstrual-like symptoms, anxiety, depression, and irritability

Who gets HRT?

Not every menopausal woman First women should consider herbs,

nutritional support, balanced diet, and exercise

HRT should come in second place and not last longer than five years

Menopause and Bone Density

Osteoporosis Disease of the skeleton in which bones

become brittle and prone to fracture Bone loses density Major risk factor for fracture in the spine and

hip

After menopause Extreme speed-up of bone breakdown

(resorption)

Male Climacteric Syndrome

Male climacteric Best name Indicates a decline in testosterone

Aka Male Menopause May be an inappropriate term as it indicates drop

in hormones Aka Aging Male Syndrome (AMS) or

Andropause Does not cause infertility Occurs when testosterone production fall Occurs in men ages 40 and 55

The role of Testosterone A hormone that helps maintain sex

drive, sperm production, pubic and body hair, muscle, and bone. Testosterone levels decrease over time. This decline is normal in healthy males as they age.

Common Symptoms of Male Climacteric Syndrome

Symptoms as a result of a decline in testosterone levels

Depression, nervousness

Insomnia Feeling fat/weight

gain

Decreased libido Erectile

Dysfunction Easily fatigued Poor concentration

and memory Flushes and sweats

Diagnosis of Testosterone Deficiency

Testosterone Level Test Test in the AM when testes produce

more testosterone Blood test See an Endocrinologist, hormone

specialist

Testosterone Replacement Therapy

An option for men whose natural testosterone level is not within the normal range

Becoming increasingly popular but unsure of the following: If it relieves symptoms of men with low

testosterone. how low testosterone levels affect men's health. if testosterone therapy increases the risk of

prostate cancer. if testosterone therapy is safe

Testosterone Replacement Therapy

Benefits/Risks Still being researched

Mid-term

Mon, 4/20/15 Covers lectures 3/30/15 – 4/13/15 Study Guide will be distributed in class

on 4/13/15 50 Questions –

Each worth 2 points Multiple Choice, T/F, Fill-in-the-blank,

Matching Scranton 882 is needed

Prep for In-Class Assignment

Separate sheet of paper Write your Name, Date and In-class

Assignment # Write legibly Use blue or black ink

Questions will be asked in class Must turn in your assignment to the

instructor