Reproduction: My nursing lab

Ovulatory phase

-Occurs midway through the reproductive cycle. -At this point LH rises markedly and estrogen decreases. A blister-like projection (stigma) forms on the wall of the follicle, which ruptures, releasing the mature ovum.

Follicular phase

-This phase begins with the first day of menstruation and ends about midway through the cycle (days 1-14 of a 28-day cycle). -Under the influence of increased levels of FSH and LH, 6-12 graafian follicles within the ovary are stimulated. Each graafian follicle contains an immature ovum. -The follicles secrete estrogen, which accelerates the follicle's maturation process. One follicle matures faster than the others, secreting high levels of estrogen, which suppresses FSH secretion. This process blocks maturation of the other follicles

Pelvic cavity

A curved canal that is longer posteriorly than anteriorly. Amenable to adjustment. Maternal position alters the angle of the sacral curve

Coccyx

A small bone that forms the inferior end of the vertebral column. The posterior border of the pelvic outlet. May be flexible in pregnancy .

Pelvic outlet

Assessed according to the transverse distance between the ischial spines and the angle of the pubic arch

Pelvic inlet

Assessed in terms of three anteroposterior measurements -The diagonal conjugate, extending from the subpubic angle to the sacral promontory, 11.5 cm on average -The obstetric conjugate, extending from the sacral promontory to 1.5 cm below the pubic crest -The conjugate vera, extending from the sacral promontory to the top of the symphysis

Prophase

Chromosomes evolve into individual structures

how is sexuality related to reproduction?

Contraception Family planning Sexually transmitted infections Anatomic changes Changes in relationship dynamics

Interphase

DNA within the cell duplicates itself so that the genetic material is doubled

Fetal circulation

Deoxygenated blood leaves the fetus through the two umbilical arteries, which divide into multiple branches as they enter the placenta. Oxygenated, nutrient-laden blood returns to the fetus via the umbilical vein.

how is comfort related to reproduction

Discomforts of pregnancy Labor pain Surgical pain with cesarean birth

week 3 level of embryonic development

Ectoderm has started to develop the brain and spinal cord. The gastrointestinal tract is developed from the endoderm. A rudimentary heart has developed and has started to beat.

week 8 level of embryonic development

Embryo is approximately 1 in. and has a definite human form. Eyes begin to fuse. External genitalia begin to differentiate. The rectal passage opens. All systems continue to refine themselves.

week 5 level of embryonic development

Embryo is approximately 3/8 in. in length. The head is growing because of the rapidly developing brain. The heart has four chambers

week 6 level of embryonic development

Embryonic length is approximately 1/2 in. The liver is beginning to form red blood cells. Facial development becomes more defined. Arms and legs become more clearly defined.

week 4 level of embryonic development

Embryonic shape becomes cylindrical, forming a "C." The upper respiratory tract begins to develop, and the ears and eyes form.

fetal development: weeks 35-37

Fetal body and extremities are filling out lanugo is starting to disappear by 36 weeks, fetal weight is 2,500-2,750 g (5 lb, 12 oz to 6 lb, 11.5 oz) with a length of 16-19 inches (42-48 cm).

fetal development: weeks 17-20

Fetal heart tones are audible with an electronic fetal monitor vernix begins to develop deposits of brown fat are beginning to develop eyebrows and eyelashes are forming quickening occurs by 20 weeks, fetal length is 8 inches with a weight of about 435 g.

Sacroiliac joints

Fibrous joints that articulate the medial aspects of the ischia and the lateral aspects of the sacrum. Become loose and mobile in pregnancy under the influence of pregnancy hormones.

how is nutrition related to reproduction?

First-trimester nausea and vomiting Maternal weight gain and physiologic metabolic changes Increased maternal folic acid, protein, water, and iron requirements Breastfeeding

sacrum

Five fused vertebrae that make up the wedge-shaped inferior portion of the vertebral column. The angle of the lumbar curve increases at its point of articulation with L5, creating an anterior eminence called the sacral promontory

the three phases of the ovarian cycle.

Follicular phase Ovulatory phase Luteal phase

Maternal circulation

Gas and nutrient exchange between mother and fetus occurs within the intervillous spaces inside the cotyledons (lobes) of the placenta. Oxygenated maternal blood spurts into the intervillous spaces via endometrial arterioles, bathing the chorionic villi. Deoxygenated blood returns to the maternal circulation through the endometrial venules for waste elimination and reoxygenation.

fetal development: weeks 21-24

Grasp reflex and startle reflex are present lungs begin to produce surfactant foot- and fingerprints have developed fetal viability increases after 23 weeks' gestation, although risk of morbidity or mortality or both is high fetal length is about 11 inches with a weight of 1 lb 10 oz by 24 weeks.

The female reproductive cycle involves interplay among what three cycles

Hypothalamic-pituitary Ovarian Endometrial

Ischemic phase

If fertilization does not occur, the corpus luteum begins to degenerate. Estrogen and progesterone levels fall, causing necrosis of the epithelial cells of the endometrium. These actions result in the start of menstruation.

week 7 level of embryonic development

Limbs begin to elongate and become better defined. Eyes are shifting from a lateral to a forward location. The palate is nearing completion, and the tongue is forming. The intestines herniate into the umbilical cord.

Amniotic fluid functions to

Maintain a constant embryo or fetal temperature in utero Serve as a source of fetal oral fluid Prevent adherence of the embryo or fetus to the amnion Allow freedom of movement to promote embryonic or fetal growth and development Cushion the embryo or fetus from trauma Keep the umbilical cord free from compression

how does metabolism relate to reproduction

Maternal weight gain and physiologic metabolic changes Changes in maternal activity level Gestational diabetes mellitus Neonatal glucose requirements

the 4 phases of the endometrial cycle

Menstrual phase Proliferative phase Secretory phase

Menstrual phase

Occurs on days 1-6 of the cycle. Fertilization has not occurred. Estrogen and progesterone levels are falling off. Endometrial lining sloughs off and menstruation begins.

Luteal phase

Occurs on days 15-28 of a 28-day cycle. After ovulation the remaining follicle is known as the corpus luteum, which persists for approximately 12-14 days, producing estrogen and progesterone to help prepare the endometrium for a fertilized ovum. If the ovum is fertilized, it secretes chorionic gonadotropin, which causes the corpus luteum to persist, secreting estrogen and progesterone to accept and support the pregnancy. If fertilization does not occur, the corpus luteum regresses and the levels of estrogen and progesterone decrease, thus stimulating the anterior pituitary to secrete FSH and LH, causing menstruation

Abnormal variations of amniotic fluid volume include

Oligohydramnios—amniotic fluid volume of less than 50% of the amount expected for gestational age or less than 400 mL at term; caused by inadequate placental perfusion, premature rupture of membranes, abnormal fetal kidney development, lack of fetal urinary excretion, or post-term pregnancy. Hydramnios or polyhydramnios—excess of amniotic fluid that could exceed 2,000 mL at term, caused by maternal diabetes mellitus, multifetal gestation, or chromosomal abnormalities.

morula

On its 3-day journey through the fallopian tube to the uterus, the zygote performs rapid mitotic divisions called cleavage. It divides into two cells; then four; then eight until they form a ball of about 16 cells The morula is contained in the zona pellucida

how does oxygenation relate to reproduction?

Physiologic changes in the maternal respiratory system Fetal circulation and the transition to neonatal circulation

how is perfusion related to reproduction?

Risk of gestational hypertension Physiologic alterations in the maternal cardiovascular system Fetal surveillance for assessing placental function

Secretory phase

Takes place during days 15-26. Endometrium continues to thicken under the influence of estrogen and progesterone from the corpus luteum. It becomes increasingly vascular and is filled with glandular secretions that will nourish a fertilized ovum.

Proliferative phase

Takes place on days 7-14, as the ovum is maturing. Endometrium thickens and is nourished by uterine spiral arteries and veins. The cervix produces copious amounts of thin, slippery mucus to aid sperm travel.

Telophase

The cell divides, resulting in two daughter cells, each containing its own nucleus with 46 chromosomes and the same genetic makeup as its parent.

fetal development: weeks 25-29

The central nervous system is complete enough to provide some regulation of body functions lungs are capable of gas exchange if the fetus were to be born at this time fused eyes open; additional subcutaneous fat deposits are in place fetal length is 24-25 inches (35-38 cm) with a weight of 1,200 g (2 lb, 10 oz).

Anaphase

The chromatids, or arms of the chromosomes, separate and move to opposite poles of the cell.

Metaphase

The chromosomes line up between the two poles of the cell in preparation for splitting.

The process of shunting highly oxygenated blood to the heart and brain is accomplished via three transient shunts specific to fetal circulation includes what?

The ductus venosus allows most of the highly oxygenated blood from the umbilical vein to flow directly into the inferior vena cava, bypassing the liver. A small amount of oxygenated blood will enter the liver to nourish the tissue. Blood travels up the inferior vena cava, entering the heart's right atrium, and passes through the foramen ovale, allowing a right-to-left shunting of blood into the left atrium. Blood then flows into the left ventricle and then into the aorta. The right atrium also receives blood from the superior vena cava, flowing then into the right ventricle. From the right ventricle, blood is directed toward the lungs. Remember that the lungs are deflated, so only a small amount of blood is necessary to maintain lung tissue. Most of the blood is shunted through the ductus arteriosus into the descending aorta to the lower body. Blood then makes its way to the placenta through the two umbilical arteries for reoxygenation and waste elimination.

fetal development: weeks 30-34

The fetal lungs may be mature and are actively producing the surfactant that will allow alveolar expansion.

fetal development: weeks 9-12

The fetus has a crown-to-rump length of about 1 inch and weighs approximately 0.5-1 oz the large head measures one-half the length of the body spontaneous movements begin to occur genitals are well differentiated kidneys begin to produce urine RBCs are produced by the liver.

fetal development: weeks 13-16

The fetus is about 3.6 inches long and weighs about 2 oz lanugo begins to develop the fetus is actively moving and makes sucking motions meconium is present in the gut lungs continue to develop blood vessels are visible through transparent skin.

fetal development: weeks 38-41.5

The fetus is now considered full term fetal weight is 3,000-3,600 g (6 lb, 10 oz to 7 lb, 15 oz) with a length of 19-21 inches (48-52 cm) lanugo is sparse, appearing mostly on shoulders vernix caseosa is disappearing and is now found mostly in body creases and groin the fetus fills the entire uterus.

fetal development: week 42 or greater

The fetus is now considered post-term; amniotic fluid volume diminishes and placental function diminishes, either or both of which can result in fetal and neonatal morbidity and death.

illium

The largest and most superior of the pelvic bones. The "hip bones" are the iliac crests.

acetabulum

The lateral fusion point of the ilium, ischium, and pubis. The socket that articulates with the femoral head.

As the morula enters the uterine cavity, its pre-embryonic development proceeds as follows:

The morula's intracellular fluid increases, forming a central fluid cavity around a cell mass called the blastocyst, which will become the embryo and the embryonic membrane (amnion). The outer layer of cells around the fluid cavity replaces the zona pellucida and is called the trophoblast, which will become the outer membrane, or the chorion. The chorion will overlay the amnion, and these will form the amniotic sac that encases the products of conception and hold the amniotic fluid. Seven to 10 days after fertilization, the blastocyst implants in the uterine wall, which has been biochemically prepared by luteinizing hormone. The trophoblast produces enzymes and other factors that allow it to penetrate the uterine lining until it is completely engulfed. On days 10-14 after fertilization, the cells of the blastocyst have differentiated and become three distinct layers: the ectoderm, endoderm, and mesoderm, from which the placenta and all fetal organ systems will arise. The lining of the uterus thickens at the implantation site and the trophoblast grows extensions into the lining that will become the chorionic villi. After implantation the uterine lining beneath the blastocyst is called the decidua basalis. The decidua basalis develops the vascular and connective tissue network of the maternal side of the placenta. As the vascular and connective tissue networks of the placenta develop, the stalk connecting the blastocyst to the yolk sac fuses with the villous network and forms the umbilical cord.

function of the pelvic floor

The muscles and tendons of the pelvic floor stabilize and support the pelvic organs. The structures of the pelvic floor work as a unit to maintain intra-abdominal pressure but function as a network of small parts in labor that can separate and stretch individually to allow passage of the fetus. The pelvic soft tissue provides resistance at key points in the descent of a fetus in labor, maintaining flexion of the fetal head so that the smallest diameters enter the pelvic outlet.

The events necessary for fertilization take place as follows:

The ovum is propelled from the ovary to the fallopian tube by estrogen-driven peristalsis A single ejaculation deposits 35 million to 200 million sperm into the upper vagina and over the cervix. Cervical mucus holds the sperm near the cervix. The whiplike motion of the sperms' tails propels them up through the cervix into the uterus. As the sperm travel they undergo capacitation, the removal of a glycoprotein coat and seminal proteins from the acrosome on the tip. The acrosome releases enzymes that break down the ovum's outer layer, the corona radiata. The sperm and ovum most commonly meet in the ampulla (distal third) of the fallopian tube. When a single sperm penetrates the corona radiata, it loses its tail and the zona pellucida of the ovum undergoes a rapid change that prevents additional sperm from entering. The nuclei of the gametes combine to form the diploid cell. The gametes are now a zygote.

Placental Circulation

The placenta serves as a conduit between maternal and fetal circulation. It has two major functions, metabolic and endocrine. Placental metabolic function involves fetal gas exchange, nutrition, and excretion.

pubis

The pubic bones form the pubic arch. Meet at the anterior midline . Are joined by strong fibrocartilage to form the symphysis pubis.

what determine the cardinal movements of the fetus through labor and birth

The shape of the true pelvis and the action of the pelvic floor muscles

ischium

The strongest and most inferior of the pelvic bones. The "seat bones" are the ischial tuberosities. The ischial spines are medial bony prominences that attach to the sacrospinous ligament. The distance between them is the narrowest pelvic diameter and a reference point for fetal descent in labor.

Development and Functions of the Placenta

The trophoblastic cells extend into the maternal tissue and form spaces in the decidua basalis that fill with maternal blood. The chorionic villi grow into these spaces and initially surround the blastocyst entirely. Some will become the vascular and connective tissue network of the fetal side of the placenta and the rest will degenerate by the 11th gestational week. As the chorionic villi develop, two layers appear: an outer layer called the syncytium, and an inner layer called the cytotrophoblast. The cytotrophoblast becomes progressively thinner and disappears around the 20th week, leaving a single layer of syncytium covering the chorionic villi. The syncytium is in direct contact with the maternal blood in the intervillous spaces. It is the functional layer of the placenta, and produces the placental hormones. By the 20th gestational week, the placenta is a roughly disc-shaped organ 14-20 cm in diameter, weighing 400-600 g. The fetal side of the placenta is smooth and shiny; contains branches of umbilical veins and arteries; and is covered with chorionic and amniotic membranes. The maternal side of the placenta connects the placenta to the endometrium. It has a red, fleshy appearance and contains multiple lobes called cotyledons. Gas and nutrient exchange takes place within the cotyledons.

Spermatogenesis

a continuous process that occurs in males from puberty to old age. It occurs simultaneously in hundreds of thousands of spermatogonia in order to produce the millions of sperm that are constantly present in the adult male's reproductive tract. After meiotic division, each new sperm contains a haploid number (23) of chromosomes—22 autosomes (body cells) and one sex cell containing either an X or Y chromosome.

Human chorionic gonadotropin (hCG)

a glycoprotein that preserves the corpus luteum, making the endometrium more hospitable to the pregnancy.

Amniotic fluid

a straw-colored, slightly alkaline fluid initially formed by diffusion from maternal blood. The fluid is later maintained by the fetal urine. It contains fetal cells, lanugo, albumin, creatinine, lecithin, sphingomyelin, proteins, and enzymes. Its volume changes weekly from about 30 mL at 10 weeks, to 350 mL at 20 weeks, and to approximately 700-1,000 mL after 20 weeks

Human placental lactogen (hPL)

also known as human chorionic somatomammotropin (hCS), stimulates maternal tissue insulin resistance during the second half of pregnancy. This process is necessary to provide more glucose to the fetus.

how long does pregnancy last?

an average of 10 lunar months: 40 weeks, or 280 days: Pregnancy is calculated from the first day of the last normal menstrual period to the time of birth. Estimated date of delivery (EDD) is usually determined by this method. It is normal for the fetus to be born any time within the range of 38 to 42 weeks' gestation. Recent evidence supports induction of labor timed to accomplish delivery by 42 weeks to avoid a decline in the quality of fetal circulation.

the true pelvis

below the linea terminalis, makes up the exterior borders of the birth canal. It is further divided into three sections or planes: -Pelvic inlet -Pelvic cavity -Pelvic outlet

Chromosomal mutations

can occur during the second meiotic division

Estrogen

enlarges the uterus, external genitalia, and the ductal system of the breasts.

The cavity created by the bones of the pelvis is divided into what two sections

false pelvis and the true pelvis

four pelvic types

gynecoid, the type found in 50% of women android, found in 20% of women anthropoid, found in 25% of women platypelloid. Only 5% of female pelves are classified as platypelloid.

Variations of a woman's cycle can be due to many factors, such as:

illness excessive exercise percentage of body fat

trophoblast

initiates the placental development

embryonic stage

lasts from day 15 to week 8 postconception. It is known as a period of organogenesis. Cells progress from being identical in function (undifferentiated) to being specialized in function (differentiated). At the end of the embryonic stage (8 weeks' gestation), all major organ systems are in place and all external structures are present. These new organs and structures are most vulnerable to teratogens at this time. Exposure to teratogens can result in congenital malformations or early pregnancy loss.

The fetal stage

lasts from week 9 to delivery. This stage is considered one of maturation. All organ systems and structures are in place but will continue to refine themselves and perfect their functioning. It is important to understand that although the most vulnerable period of embryonic development has passed, exposure to teratogens in the second and third trimesters can still adversely affect fetal growth and development. The severity of the insult depends on gestational age and the type of teratogen.

pelvis: Innominate bones

made up of three fused bones: the ilium, the ischium, and the pubis

Progesterone

maintains the endometrium and reduces uterine muscle contractions to prevent spontaneous abortion. It works with estrogen to promote the growth of breast tissue for milk production, and promotes uterine secretions to provide nutrition to the developing embryo in the first weeks of pregnancy. Progesterone is also believed to suppress cellular immunity to prevent "rejection" of the placenta and embryo.

The levator ani and coccygeal muscles

make up the pelvic diaphragm. This is the central section of the pelvic floor and plays the largest role in childbirth. The levator ani consists of four muscles: The iliococcygeus, a muscular sheet overlying the sacrospinous ligament posteriorly The pubococcygeus, which runs laterally The puborectalis, which runs from one pubic bone under the rectum to the other pubic bone; it acts as a sling for the rectum The pubovaginalis, which performs the same function for the vagina.

Fertilization

occurs when a mature sperm joins with a mature ovum and they combine their genetic material to form a diploid cell that contains 46 chromosomes (44 autosomes and 2 sex cells). Ova are fertile for about 24 hours. Sperm can remain viable in the female reproductive tract for 48-72 hours but are considered fertile for only 24 hours.

deletion

occurs when a section of a chromosome is lost or broken

nondisjunction

occurs when an extra chromosome is added or deleted.

translocation

occurs when the broken segment becomes attached to another chromosome, usually its mate

how is fetal circulation is unique

oxygen and carbon dioxide gas exchange takes place across the placenta. In addition, fetal circulation has a high pulmonary vascular resistance and a low systemic peripheral resistance because the blood gas exchange takes place in the placenta. This factor allows most of the highly oxygenated blood to bypass the lungs, shunting to the heart and brain. Another unique feature of fetal circulation is fetal hemoglobin (HbF). HbF carries less oxygen than adult hemoglobin (HbA) but has a higher affinity for oxygen. This characteristic allows HbF to carry 50% higher oxygen concentrations than HbA. Because the fetal heart rate is 120-160 beats/min, cardiac output is higher and can make better use of the amount of hemoglobin available.

Prolactin

produced by the Anterior pituitary and targets the breasts - Stimulates milk production - Newborn sucking stimulates secretion to maintain milk supply

Follicle-stimulating hormone (FSH)

produced by the Anterior pituitary and targets the ovaries - Stimulates production of estrogen and progesterone -Stimulates growth and maturation of graafian follicles

Luteinizing hormone (LH)

produced by the Anterior pituitary and targets the ovaries -Stimulates final maturation of follicle - Stimulates transformation of graafian follicle into corpus luteum

Estrogens

produced by the Corpus luteum and ovaries Placenta during pregnancy and targets the Internal/external reproductive organs and breasts -Maturation of reproductive organs at puberty -Stimulates endometrium prior to ovulation - Induces growth of glandular and ductal breast tissue - Stimulates growth of long bones Stimulates growth of uterus and breast tissue during pregnancy

Progesterone

produced by the Ovaries ,Corpus luteum, and Placenta and targets the breasts and uterus -Prepares endometrium for embryo implantation -Induces growth of cells in uterine lining and fallopian tubes to nourish embryo -Prepares breasts for lactation

Oxytocin

produced by the Posterior pituitary and targets the uterus and breasts - Stimulates uterine contractions during labor - Stimulates postpartum contractions to control bleeding - Stimulates "let-down reflex" or milk ejection during breastfeeding

Testosterone

produced by the adrenal glands and ovaries - Causes growth of pubic and axillary hair at puberty - Mostly converted to estrogen

Gonadotropin- releasing hormone (GnRH)

produced my the Hypothalamus and targets the Anterior pituitary - Stimulates release of FSH and LH - Initiates puberty - Sustains reproductive cycle

function of the pelvis

protects the pelvic organs and creates a passageway for the fetus at birth

Placental metabolism functions by

synthesizing glycogen, cholesterol, and fatty acids, which serve as sources of energy for the embryo or fetus. These substances are transported by active transport, simple diffusion, facilitated diffusion, and pinocytosis

Meiosis

the cell division that occurs in gametes or reproductive cells. Meiosis occurs in two cell divisions: In the first division, the cells divide and the chromosomes replicate. In the second division, the cells split the number of chromosomes, resulting in four (instead of two) daughter cells that have 23 chromosomes each.

Oogenesis

the development of the female ovum or egg. Unlike spermatogenesis, oogenesis is not a continuous process. It begins during intrauterine life; at the time of birth, the female has all the oogonia or immature ova she will ever have (approximately 500,000).The first meiotic division occurs during fetal life and the second during ovulation.

what is the female reproductive system controlled by?

the nervous system and the endocrine system

Gametogenesis

the process of producing sperm and ova. The resultant sperm and ova each contain a haploid number (23) of chromosomes so that during fertilization, they combine their genetic material, resulting in a fertilized ovum with a diploid number (46) of chromosomes.

how can fetal RBCs can pass into the maternal circulation

via breaks in the placental membrane. Additionally, some molecules (such as viruses) and bacteria (such as Treponema pallidum, which causes syphilis) can cross the placental membrane under their own power.