Pregnancy

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Pregnancy
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Development of the Embryo

• Differentiation of the embryo occurs soon after
  fertilization
• Tissues placenta
• fetus
• Cells multiply (morula) as they travel through
  the fallopian tube
• Soon, implantation is required for the zygote to
  obtain sufficient O2 and nutrients

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Nidation/Implantation

• Chorionic villi
• -finger-like extensions surrounding the
  trophoblast
• erode through the endometrium
• (now called the decidua)
• destroy the glands and stroma leaving only
  the arteries and veins

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Nidation/Implantation

• Anchoring villi
• attach themselves to the decidua
• form a sealed sinusoid
• which is filled with
• endometrial blood
• Terminal (or true) villi
• float freely to absorb
• nutrients in the blood for the
• growing cellular mass

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• Decidua Capsularis
• covers the embryo and
• becomes a layer of the
• amniotic sac
• Decidua Basalis
• is where the attachment started and it will
  become the placenta attachment area
• The rest of the intrauterine lining that is left
  is the Decidua Vera

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• The area of the sinusoid becomes the Chorion
  Frondosum, which is just another name for
  placenta

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Placenta

• A round disc-shaped tissue
• 2 to 3 cm in thickness at the umbilical cord
  attachment

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Placenta

• Four major pacental functions
• Respiratory transport of O2 and CO2 (diffusion)
• Excretory transfer of waste molecules (urea,
  etc.)
• Nutritional transport of glucose
• Endocrine production of hormones
• replaces the production from ovaries, corpus
  luteum of pregnancy pituitary
• Estrogen
• Progesterone
• HCG
• HCS
• Etc.

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Side Note

• The change over to placental hormone production
  occurs between the 8th and 12th week of pregnancy
• This is a serious period of concern for the
  growing fetus
• testing period for fetal viability

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Spontaneous Abortion

• Multiple testing periods
• abnormal development of the fetus
• inability to produce proper hormones
• lack of proper nutrients to support life
• may cause the fetal tissue to die and be expelled

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Umbilical Cord babys lifeline

• Tough tortuous shaped tube
• two (2) smaller arteries
• one (1) larger vein
• surrounded by Whartons Jelly
• attenuates pressure on the vessels
• prevents kinking of the cord

www.inksplat.net/umbilical_cord.jpg http//medicin
e.ucsd.edu/cpa/talasm/Talapoin07.jpg
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The Amniotic Fluid

• Surrounds the embryo/fetus
• Increases from 250 mL at 16 weeks to 800 mL
  around 38 weeks
• volume begins to decrease after 38 weeks
• Composed of the fluid output of the fetal kidneys
  (fetal urine) and lung secretions

www.udel.edu/Biology/Wags/histopage/colorpage/cfr/
cfras.GIF
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The Amniotic Fluid

• Very dynamic fluid
• Cleansed about every three (3) hours
• absorption through fetal swallowing
• removal at the amnio-chorionic interface and by
  intervillous space capillary action

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Terms of Pregnancy

• Gravidity
• the state of a woman being pregnant
• refers to the number of times she has been
  pregnant (any duration)
• Gravida pregnant
• Primigravida pregnant for the first time
• Multigravida pregnant again (2nd, 3rd, etc.) or
  has had 2 or more pregnancies

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Terms of Pregnancy

• Parity
• the state of a woman having given birth to a
  viable fetus
• capable of survival (even if they did not
  survive)
• does not reflect the number of babies delivered
• Primipara delivered one viable pregnancy
• Multipara has delivered 2 or more viable
  pregnancies

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Examples

• Gravida 1, Para 0
• currently pregnant for the first time
• was pregnant once and lost the pregnancy
• Gravida 1, Para 1
• delivered a viable fetus from her first pregnancy
• delivered viable twins (or more) from her first
  pregnancy

• Gravida 2, Para 0
• currently pregnant for the second time, lost the
  first pregnancy
• pregnant twice and lost both
• Gravida 2, Para 1
• pregnant for the second time, first pregnancy was
  a viable delivery
• ?
• Gravida 2, Para 2
• pregnant twice and both were viable deliveries

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Diagnosis of Pregnancy
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Diagnosis of Pregnancy

• Pregnancy Tests
• primarily work on detecting the levels of HCG in
  the blood or urine

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• Urine hCG Test
• Can do at home
• commonly used
• inexpensive, private, and easy to use
• Able to tell if you're pregnant about 2 weeks
  after ovulation
• some more sensitive urine tests claim that they
  can tell if you are pregnant as early as one day
  after a missed period (25 mIU)
• NOTE Implantation needs to occur before hCG is
  produced (generally happens 6-12 days post
  ovulation). Therefore, the earliest you can get
  a positive result on the most sensitive pregnancy
  tests is seven days after ovulation.

• Blood hCG Test
• Must see a doctor
• Can pick up hCG earlier than urine tests can
• can tell if you are pregnant about 6 to 8 days
  after ovulation
• Quantitative blood test (beta hCG test)
• measures the exact amount of hCG in the blood
• can find even tiny amounts of hCG
• very accurate
• Qualitative hCG blood test
• checks to see if the pregnancy hormone is present
  or not
• about as accurate as a urine test

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Diagnosis of Pregnancy

• Presumptive signs
• noticed by the woman
• Probable signs
• seen on examination
• Positive signs
• have to do with the baby

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Presumptive Signs

• Amenorrhea
• Morning sickness
• Breast enlargement
• TTT-tight, tender and tingling
• Abdominal enlargement
• Bladder symptoms (TWB)

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Presumptive Signs

• Skin changes
• later signs, noticed while pregnant
• Cholasma
• mask of pregnancy face color
• Linea nigra
• dark line down center of abdomen
• Areola of breast darkens
• Birthmarks and scars darken 

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Probable Sign

• Braxton Hicks sign
• intermittent contractions of the uterus after the
  third month of pregnancy
• Operculum
• mucus plug in the cervical os
• Palpable uterus above the pubis
• Ladins Hegars, McDonalds signs

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Positive Signs

• Fetal parts
• felt by external palpation using Leopolds
  maneuver
• Movement
• felt by the examiner, not the patient, during
  palpation of the abdomen
• A heartbeat
• that is 21 of that of the womans
• usually done by examination with a stethoscope

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Positive Signs

• Funic Soufflé
• murmur of umbilical blood
• heard on examination with a stethoscope
• same as the heart rate of the fetus
• Visualizing the fetal skeleton
• on x-ray or ultrasound

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Order of Events
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Order of Events
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Order of Events
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Order of Events