The Prenatal Period of Growth and Development

What are the major developments of the fetus at 3 months?

-12 weeks: vocal cords start to form -eyes start moving closer together -ears shift to their normal place on the side of the head -intestines move further in -liver begins to function -pancreas produces insulin

What are the major developments of the fetus at 6 months?

-Appearance becoming more like a newborn -Taste buds begin to form -Little creases have appeared on palms (a term baby has many creases on hands an feet) -Muscular coordination of hands improves as it sucks its thumb -Lungs are developing cells that produce surfactant (a lubricant so the walls of the lungs can expand. Preemies don't have surfactant and thus need a lot of support to breathe). -Fetus is officially considered viable. -Lanugo: fine, downy hair all over the baby's body. -Vernix: White, creamy substance that covers the skin and protects it while being in a water environment. Covers the body, in creases of arms and legs, and sheds off as the fetus gets closer to term, though it may still be seen in the creases).

What are the major developments of the fetus at 7 months?

-Eyebrows and eyelashes are now very noticeable -Hair on head is growing longer -Eyes are completely formed at 28 weeks -Body is getting plump and rounded, muscle and bone are forming -Muscle tone is improving -Lungs are capable of breathing (a baby born at 28 weeks may not need to be intubated but may need oxygen) -Can recognize voices

What are the major developments of the fetus by 5 months?

-Fetal heart grows stronger -Legs reach their relative size -Immunities are being transferred (so mon needs to be in good physical condition to pass on immunities. This is a form of passive immunity. If the mom's immune system is deficient, the fetus' immunities will be deficient). -Nerve cells for taste, smell, hearing, seeing, and touch are developing. -Fetus may startle (by loud noise, sudden exposure to object) -Uterus starts to develop in female. Will have six million eggs, only 1 million present at birth.

Describe stage one of labor/parturition.

-From the onset of true labor contractions until the cervix is completely dilated at 10 cm. Cervix softens/thins out and starts to open. -The uterine contractions cause the cervix to dilate, and the amniotic sac may rupture. -Usually lasts 6-24+ hours depending on the number of previous deliveries.

What are the major developments of the fetus at 8 months?

-Not moving around as much, but fetal movement should still be felt. -All five senses are working by week 32 -Toenails are completely formed -Periods of dream sleep (REM) starting, seen with rapid eye movement.

Describe the second stage of labor/parturition?

-Period from maximal cervical dilation until the birth of the baby. -Lasts minutes to an hour. -Contractions becomes more intense and frequent. -Mom needs to use her muscles to bear down and with the contractions brings the baby out. Full dilation has occurred. -Baby is in head down/anterior presentation. No more cervix. Head is exposed.

What are the major developments of the fetus by 4 months?

-Rudiments of all organ systems are functioning (not yet at optimum level) -From now on, the fetal development is primarily a matter of growth -Fat starts forming under the skin -Baby and placenta are now about the same size -Heartbeat may be heard with external monitor/ultrasound. -Genitals have developed enough for gender to be determined. -Heart is pumping about 6 gallons of blood per day and beats at a rate about double the adult heart rate (120-160 is a normal fetal heart rate). -Swallowing, sucking, blinking, hiccupping -Fetus is using breathing muscles

What are the major developments of the fetus at 9 months (36-40 weeks)?

-The only organ still to mature is the lungs -May drop into the birth canal (at 36 weeks if first birth/primipara, others drop when labor starts) -Fat is dimpling at elbows and knees, forming creases in the neck and wrists -Skin is growing smoothly -Fully developed pair of kidneys -Liver has begin processing some waste products -Between now and birth gain an ounce a day.

Describe the fetus of 40 weeks+.

-Vernix has vanished, traces in creases -15% of the body is fat -60-75% of body is water -Small breast buds present on both sexes -Now weighs 7.6 pounds (3462 g) and is 20.2 inches (51.2 cm) long. -Palm and sole creases show in a more mature baby.

What are the major purposes/functions of the amniotic fluid?

1) Cushion 2) Protects from injury 3) Sterile environment. Also helps to maintain body temperature

What are the three layers of the blastocyst?

1) Ectoderm: becomes skin and nervous system 2) Endoderm: will become the digestive and respiratory system 3) Mesoderm: Will become the muscle and skeletal systems

What are the four cognitive-perceptual pattern maternal development tasks?

1) Ensuring safe passage: Decides prenatal care options, becomes more protective of self/fetus. 2) Ensuring acceptance of the child: seeks the receptivity of the partner and others. 3) Bonding to her unknown child: a complex process as she integrates the fetus as part of herself but also as a separate being (fantasies, nesting). Now is concerned with possible bonding with the baby. If the mother feels ambivalent, it is the nurse's job to encourage conversation. 4) Learning to give of herself: examines the meaning of giving. Gets gifts or herself and for the baby.

What are the physical changes that occur during the pregnancy?

1) Fertilization 2) Implantation 3) Embryonic or fetal growth 4) Placental development and functioning 5) Maternal changes related to the process of pregnancy

What are three factors that contribute to conception?

1) Health of egg 2) Health of sperm 3) Hormone levels

What are Gordon's 11 functional health patterns?

1) Health perception-health management pattern 2) Nutritional-metabolic pattern 3) Elimination pattern 4) Activity-exercise pattern 5) Sleep-rest pattern 6) Cognitive-perceptual pattern 7) Self-perception-self concept pattern 8) Roles-relationships pattern 9) Sexuality-reproductive pattern 10) Coping-stress tolerance pattern 11) Values-beliefs pattern

What are the six hormones that influence prenatal growth and development?

1) Human Chorionic Gonadotropin (hCG) 2) Progesterone 3) Estrogen 4) Relaxin 5) Human Chorionic Somatotropin 6) Human Placental Lactogen

What three entities must be considered when considering the physiological and psychological aspects of pregnancy?

1) The pregnant woman 2) The developing fetus 3) The family

What are the functions of the placenta?

1) Transfer gases 2) Transport nutrients 3) Excretion of wastes 4) Hormone production 5) Formation of a barrier (incomplete and non selective; alcohol, steroids, narcotics, anesthetics, some antibiotics, and some organisms can cross).

How large is the fetus at six months?

1.3 pounds (600g) and 11.8 inches (30cm)

How long after fertilization does germination occur?

10-14 days after fertilization

What is the average size of a 3 month fetus?

2.13 inches (5.4 cm), and 0.49 ounce (14gm).

How large is the fetus at 7 months?

2.2 pounds (1005 g) and 14.8 inches

A woman will likely conceive within __________ of ovulation.

24 hours

How long can a secondary oocyte be fertilized after ovulation?

24 hours after fertilization

How long after conception does cell division start?

24-36 hours

How large is the fetus at 8 months?

3.75 pounds (1702g), 16.7 inches (42.4 cm)

How large is the fetus at 4 months?

4.57 inches (11.6 cm), 3.53 ounces (100g).

For how long is sperm viable within the female reproductive tract?

48 hours

How large is the fetus at 5 months?

6.46 inches and 10.58 ounces.

How long is a pregnancy?

9 solar months 10 lunar months 40 weeks

What is pica?

A psychobehavioral disorder characterized by the ingestion of nonfood substances such as dirt, clay, laundry, starch, ashes, plaster, raw rice, paint chips, coffee grounds, and ice. Can negatively influence the quality of a pregnant woman's nutrition during pregnancy.

What is the health perception-health management pattern of a pregnant woman?

A view of pregnancy as an illness versus as a natural, healthy state. Healthy/Natural: Active participant in social circle and career. Will seek out a provider with similar views. Looks for holistic prenatal care. Illness: Withdraw from social obligations or work. May make unhealthy pregnancy choices or even deny pregnancy.

What vessels are found in the umbilical cord?

AVA: Two arteries, one vein.

How many conceptions are lost or not supported by the proper hormones?

About 1/3--a woman may not even know that she conceived.

How large is the fetus at 9 months?

Average size is 18.66 inches and 5.78 pounds

What position should the baby be in for labor?

Cephalic/vertex presentation

Describe the elimination pattern of the pregnant woman.

Common discomforts of pregnancy are due to the enlarging uterus and hormonal influences. Urinary frequency, constipation (if not taking in enough fluids), hemorrhoids (a lot of pressure rom uterus on pelvis and lower organs). Urinating frequently first because of hormones, and at the end because of less space in the bladder. Anticipatory guidance: prevent complications and cope with changes; increase fiber and fluid intake, eat more fruits and vegetables.

Describe the process of implantation.

Day 6 after ovulation, the blastocyst implants in the endometrial lining. The blastocyst secretes enzymes that allows it to penetrate the endometrial wall, which nourishes the blastocyst for about a week after implantation. 8-12 days after fertilization, the blastocyst secretes hCG, which keeps the corpus luteum active until the placenta can produce estrogens and progesterone. The inner cell pass forms two cavities: the yolk sac and the amniotic cavity. In humans, the yolk sac produces blood cells and future sex cells. The amniotic cavity becomes the cavity where the embryo floats. Fluid is produced from fetal urine and secretions from the skin, respiratory tract, and amniotic membranes. It is a sterile environment. The amniotic fluid encases the growing blastocyst/fetus, acts as a cushion, protects from injury, provides a sterile environment.

Describe the gestation period of pregnancy.

Divided into three trimesters. First trimester starts out as a zygote, then morula, blastocyst, and after implantation, an embryo. The embryonic phase of development lasts from fertilization until the 8th week of gestation, when it becomes a fetus. By day 35 the heart is beating, and eye and limb buds are present. 37-40 weeks is full term.

Describe the elimination pattern of the fetus.

Elimination through the placenta: Carbon dioxide, water, urea. Urine is in the amniotic fluid, which is a sterile environment.

After being a zygote, a growing conceptus up to 8 weeks of age is called the....

Embryo

What is human placental lactogen's main role in pregnancy?

Ensures adequate fetal nutrition, increases insulin resistance, and stimulates production of growth hormones.

Describe the sleep-rest pattern of pregnant women.

Fatigue is significant during pregnancy. Rest periods during the day and a good night's sleep is needed. Their sleep is often interrupted by frequent urination, postural discomfort....

What is fertilization?

Fertilization is when the pregnancy begins with the union of a sperm and egg.

Describe the values-beliefs pattern of a pregnant woman.

Fulfillment versus a fear of losing herself. Shifting relationships in being a mother and with friends. There is also a shift in values of the self and of the partner. There is an influence/changing of spiritual values. The woman may find new meaning in pregnancy. She may follow spiritual influences on pregnancy care decisions.

Describe a pregnant woman's nutritional-metabolic pattern.

Good nutrition is essential for proper growth and development and to keep mom's immune status at an optimal level. It can be affected by pre-pregnancy nutrition, finances, and culture. The best nutritional teaching occurs before pregnancy. There must be an assessment for nutritional disorders like pica. It is recommended that the mother gain 25-35 pounds and eat 300+ calories a day (varies if the mother is already over/underweight). She should eat a well-balanced diet with the six food groups. Daily, she should drink 8-10 glasses of water and eat 70 g of protein (important for brain growth). She should increase her vitamins and minerals, especially folic acid (deficiency is related to spinal cord defects). Prenatal vitamins are important. There also need to be fats and carbs in the diet for energy needs.

Why is mom a high fall risk at the end of pregnancy?

Having weight centered in the front of the body predisposes the mom to falling.

What hormone is responsible for a positive pregnancy test?

Human Chorionic Gonadotropin (hCG). It is produced by the placenta and found in a pregnant woman's urine and blood. It triggers a positive pregnancy test with a 97% accuracy.

What is the function of human placental lactogen (HPL)/human chorionic somatomammotropin?

Human placental lactogen is a polypeptide placental hormone. Its structure is similar to that of human growth hormone. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus.

What is an ectopic pregnancy?

Implantation anywhere outside the uterus is called an ectopic pregnancy. If there is an obstruction in the fallopian tube or the musculature of the tube does not move the fertilized egg down, there may be an ectopic pregnancy.

What are the three primary germ layers and what do they give rise to?

In between the yolk sac and the amniotic cavity is the embryonic disc, which gives rise to the primary germ layers: 1) Endoderm (inside): visceral organs like the heart, lungs, liver, kidneys 2) Mesoderm (middle): muscles and skeletal system 3) Ectoderm (outside): skin and nervous system

Describe the activity-exercise pattern of the fetus.

In early pregnancy, there are spontaneous movements that are reflexive. There is quickening at 16 weeks. "Kick Counts" are when the mother monitors how often the baby moves after quickening to monitor fetal activity.

Where can fertilization take place?

In the outer one-third of the uterine tube. Can take place in the abdominal cavity.

What is the role of estrogen in pregnancy?

Increase uterine blood flow and increase uterine and breast growth.

What are Braxton-Hicks contractions?

Intermittent, painless contractions which can come 10 to 20 minutes apart. They do not dilate the cervix or lead to labor. They become more frequent as gestation progresses, and can be mistaken for the onset of labor.

How is the pregnancy divided?

Into three trimesters.

What is the role of progesterone in pregnancy?

Maintains the uterus in a quiet state throughout the pregnancy to prevent labor contractions from occurring too early.

In order for conception to occur, a woman...

Must have a certain basal body temperature and fallopian tubes free of adhesions or obstructions.

Describe the activity-exercise pattern of pregnant women.

Need physical activity, at least 30 minutes a day of aerobic exercise. Avoid high risk sports. Sexual activity is okay unless there are specific restrictions.

Describe the coping-stress tolerance patterns of the pregnant woman.

Perception of stressors and coping for all life aspects are affected. Anxiety is greatest in the first (losing pregnancy) and third (nearing delivery) trimesters. Anxiety may decrease blood flow to the uterus/fetus and be demonstrated through psychosomatic complaints/behaviors, dreams/fantasies, smoking/substance abuse. Stress relieving strategies like meditation, relaxation, and guided imagery are encouraged.

Describe the roles-relationships pattern of a pregnant woman.

Pregnancy affects the entire family. If the pregnant woman is without a partner, she may feel isolated and be dependent on family. A partner may feel possible resentment (lack of attention), financial stress, and can potentially abuse the woman as a result. They can be concerned about their role as a partner. Children have a changed relationship with their mother, and less attention from their parents. Extended family or grandparents may be reminded of their own aging and feel resentment, especially if their advice is not taken. Or, there may be a new closeness.

Which two hormones support implantation, growth of the fetus, and nourishing the endometrial lining?

Progesterone and estrogen

Describe the role of progesterone in pregnancy.

Progesterone production is triggered by the process of fertilization and then implantation. It stimulates the formation of endometrial cells called the decidua, which provide nutrition for the embryo.

What is the fourth stage of labor?

Recovery

Which hormone is responsible for a decrease in gastric motility in the pregnant woman and for the separation of the symphysis pubic?

Relaxin

Which hormone has an affect on the smooth muscle?

Relaxin--it makes the esophageal sphincter more relaxed, which is why mom gets heartburn. It also relaxes the cartilage in the pelvis so that the baby can pass.

What is Nagele's rule? How is it used?

The estimated date of delivery is determined by using Nagale's rule. 1) Add 7 days to the first day of the woman's last menstrual period. 2) Subtract 3 months. Ex: If the first day of the last menstrual period was Oct 10, we add 7 days to get Oct 17, and then go back three months to get July 17th as the due date.

Describe the third stage of labor.

The expulsion of the placenta. -Usually occurs within 15 minutes after the birth of the baby but can range from 5 to 60 minutes. -The uterus contracts again to help the placenta separate from the wall of the uterus.

What is a fertilized egg called? How long does it take the fertilized egg to travel down the fallopian tube? How long does it remain in the endometrial layer of the uterus?

The fertilized egg is called the zygote. It takes about 6 days for the zygote to travel down the fallopian tube. The zygote stays in the endometrial layer of the uterus for 5 days, receiving nutrients.

Describe what occurs in the germinal stage of development.

The fertilized egg, known as a ZYGOTE, then moves toward the uterus, a journey that can take up to a week to complete. Cell division begins approximately 24 to 36 hours after conception. Cell division continues at a rapid rate and the cells then develop into what is called a blastocyst. Finally, the blastocyst arrives at the uterus and attaches to the uterine wall in a process called implantation, which may be 6-10 days after fertilization. If it doesn't embed, the lining will shed with the next menstrual period.

Describe the sleep-rest pattern of the fetus.

The fetus has four cyclical states of activity: complete wakefulness, drowsy wakefulness, rapid eye movement, and quiet sleep. There are increasing levels of quiet sleep and quiet alertness as the fetus develops.

Describe the cognitive-perceptual pattern of the fetus.

The fetus has functional senses of vision, hearing, taste, smell, touch, proprioception, and vestibular sense. At 25 weeks they can respond to sudden noise/movement.

What is quickening?

The first movement of the fetus felt by the mother, usually occurring during the fourth or fifth month of pregnancy. By month 7, the fetus is quite active. During the last month, the fetus is left active, usually due to lack of space.

What are the roles of the placenta?

The placenta is an organ that serves to prevent the direct exchange between the blood of the fetus and the blood of the mother. It also functions as an endocrine gland, manufacturing and secreting hormones that play a vital role in maintaining the pregnancy. It produces estrogen, progesterone, human chorionic gonadotropin, and human placental lactogen.

What is implantation?

The process of attachment and placental formation. A pregnancy has not occurred until successful implantation has happened.

In order to fertilize the egg, what must the sperm be like?

The sperm must be uniform in size, be normally formed, possess high motility, and have the ability to secrete enzymes that dissolve the membrane around the egg.

What is infertility?

The union of sperm and egg requires several crucial factors which are not completely understood. The absence of one or more of these factors may result in infertility, or the failure to achieve pregnancy despite sexual activity over a period of more than one year.

Which substances can and cannot pass through the placenta?

The unique structure of the placenta permits the exchange of certain molecules but prevents fetal and maternal blood supplies from mixing for most of the pregnancy. Substances with larger and heavier molecules (such as heparin or insulin) normally do not pass through the placenta to the fetus, but lighter molecules (such as anesthetic gases, oxygen, carbon dioxide, and electrolytes) readily cross the placenta.

Describe the cognitive-perceptual pattern for pregnant women.

The woman experiences psychological and cognitive changes. Progesterone affects mood as they focus on their child. It causes her to be more introverted and passive. They also have increased sensitivity and analysis of experiences. There is an increase in mood swings/variability. They are transitioning to motherhood (influenced by maternal/infant variables and context).

Describe the sexuality-reproductive pattern of the pregnant woman.

The woman's changing body image may influence her feelings on sexuality. She may also have concerns about the effect of intercourse on her pregnancy. Furthermore, there may be a potential for sexual dissatisfaction. The nurse's role is to provide accurate information to facilitate intimacy needs during pregnancy and to provide support.

How long is the "window" for intercourse to result in fertilization?

Three days: two days before ovulation and one day after.

What are the chorionic villi?

Throughout most of gestation, increasing placental development allows maternal blood to flow through the intervillous spaces and fetal blood to flow through the chorionic villi.

What is the main role of human chorionic gonadotropin?

To sustain estrogen and progesterone production in early pregnancy, and it is also the hormone detected in pregnancy tests.

T/F: Not every conception reaches full term.

True. Conception just means there is a potential to have a fetus. A high percentage of fertilized eggs may not implant or proceed to the next stage of development.

When does the embryonic period of pregnancy occur?

Week 2-8 after fertilization.

Describe the embryonic stage of pregnancy.

Week 2-8 after fertilization: Begins after implantation and continues until cell differentiation has been mostly completed. Structures important to the support of the embryo develop, including the placenta and umbilical cord.

Why is a late labor concerning?

When pregnancy goes beyond 42 weeks, placental function has decreased, posing concerns about the wellbeing of the fetus.