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Pregnancy & Delivery

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by Jennifer Dever on 17 March 2014

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Transcript of Pregnancy & Delivery

Pregnancy & Delivery
Fertilization & early development
The Placenta
Develops from the chorion & the uterine tissue, acts as a transfer vehicle & synthesis center
Has 2 umbilical arteries & 1 umbilical vein
Connected to network of capillaries within the chorinic villi
Produces human chorionic gonadotropin (hCG), to signal the corpus luteum to release large amounts of progesterone and estrogens

For a woman who has regular menstrual cycles and is sexually
active, a period delayed by more than a few days to a week is
suggestive of pregnancy

Maternal changes during pregnancy
Acrosomal Reaction
Egg Activation
-Zygote
Cleavage
Morula
Blastocyst
Day 5: zona pellucida dissolved
Trophoblast forms chorion & amnion
Inner cell mass gives rise to embryo
Day 7: implantation begins, trophoblast cells in contact w/endometrium secrete enzymes that erode an area large enough for the tiny embryo
Embryo works its way into connective & vascular tissues, all further development takes place within the endometrium
Fitzgerald et al., 2008
Pregnancy Terminology:
Embryo = fertilization to 8 weeks
Fetus = 8 weeks to birth
Gestation = how far along the fetus is, determined by the 1st day of the last period
Trimesters -
1st = first 12 weeks
2nd = 12 weeks to 24 weeks
3rd = 24 weeks to delivery
Previable = infant delivered prior to 24 weeks
Preterm = infant delivered from 24 to 37 weeks
Term = 37 to 42 weeks
Postterm = > 42 weeks
Signs of pregnancy
Uterus increases ~2,000 to accommodate the developing fetus, growth accomplished by growth of smooth muscle cells, & elongation of blood vessels.
Braxton Hicks contractions – beginning in 1st trimester, painless irregular contractions of uterus.



Cardiovascular – cardiac output increases 30 to 50%
Pulmonary – tidal volume increases 30 to 40%
Gastrointestinal – Nausea & vomiting occur in > 70% of all pregnancies. Due to elevated estrogen, progesterone and hCH levels. Should resolve by 16 weeks gestation
Stomach has prolonged gastric emptying times, which can cause reflux
Enlarged bowl leads to increased water absorption and constipation
Renal – kidneys increase and ureters dilate increasing urinary frequency, edema occurs in 25% of pregnant women
Hematology – plasma volume increases by 50%, hypercoagulability
Musculoskeletal - change in center of gravity can lead to a shift in posture and lower back strain
Relaxation of joints to increase size of pelvic cavity may cause discomfort
Dermatologic – spider angiomata, hyperpigmentation of nipples, stretch marks
During pregnancy the breasts enlarge as the ducts and alveoli increase in # and size
Prolactin production suppressed during pregnancy by estrogen and progesterone feedback

Labor & Delivery
Labor = contractions that cause cervical change in either effacement or dilation
“false labor” = irregular contractions that yield little or no cervical change
Stages
Onset of labor until effacement and dilation of cervix is complete
Full dilation until delivery
After delivery, ends with delivery of placenta
Cervical examination
Dilation – how open the cervix is an the internal os
Closed = 0 cm, fully dilated = 10 cm
Labor may be induced via prostaglandins, oxytocic agents, mechanical dilation or artificial rupture of membranes; Only if fetus is in stress, not desire of mom

Why a C-Section???
Failure to progress to labor
Pelvis too small, uterus doesn’t generate enough pressure during contractions or presentation is breech
Placenta previa or cord prolapse
Active herpes lesions
Prior uterine surgery
Obstructions of birth canal (fibroids)

provides nutrients and oxygen for fetus via diffusion across the placental barrier into the bloodstream of the fetus & removes wastes which mom excretes
Acts as an endocrine organ, secreting estrogens and progesterone to maintain pregnancy umbilical cord develops & connects the embryo to the placenta
Mother's Body Undergoes MAJOR changes:
Complications

PIH
Preeclampsia / Eclampsia
Gestational Diabetes
Ectopic pregnancy
Placenta previa
Miscarriage
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