Transcript January 30, 2006

April 13, 2015
NURS 330
Human Reproductive Health
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
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Identical (Monozygotic) Twins

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Divides rapidly
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

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At 12 Weeks
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First eight weeks
Female
Male
At 36 Weeks
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Female
Male
Pregnancy

266 days – 270

About nine months
Embyronic Period

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From implantation until the 8th week of
pregnancy (gestation), the blastocyst is now
known as an Embryo
Embryo

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
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
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Develops at the site of implantation
Secretes human chorionic gonadotropin (hCG)
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Effect on ovaries
Effect on corpus luteum
Nourishment, oxygen, elimination of waste products
Umbilical cord
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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

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Protective membrane around the fetus
Amniotic fluid

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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.

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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
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First: 0 – 13 Weeks
Second: 14 – 26 Weeks
Third: 27 – 40 Weeks
Early Pregnancy Signs and
Symptoms

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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

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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

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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
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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)


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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
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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
Memory Lapses
Mild Confusion
Mood swings
Irritability
Fatigue
Postpartum Depression (PPD)

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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

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Others may require psychological intervention
Symptoms include:
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Insomnia
Digestive problems
Unusual weight loss
Postpartum Psychosis
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Rare
Serious disorder that probably has underlying
psychological causes
Requires psychological evaluation and
treatment
Marked by extreme highs and lows
Symptoms

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Extremely agitated
Paranoid
Delusions & hallucinations
Breastfeeding

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Facilitates uterine contractions
Colostrum

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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

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Spontaneous Abortion or Miscarriage
Ectopic Pregnancy
Preeclampsia/Eclampsia
Gestational Diabetes
Placenta problems

Abruption, previa
Pregnancy
Conditions/Complications

High Risk Pregnancies:
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Mother's health
Mother’s Age

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Teenage mothers (17 and younger)
Mothers over 35 years of age
Health of the fetus (baby)
Complications unique to pregnancy
Teratogens
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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
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Passive Teratogens
Active or Passive Teratogen?
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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 placenta
Lowers amount of O2
and nutrients available
to baby
Low birth weight babies
Excessive use may lead
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
to miscarriage
2 – 3 cups/day pose
no risk
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
fetus
Possible low birth
weight, premature birth
Studies being done to
understand long-term
effects of marijuana
on babies
Smoking before preg
– no harm to baby
Cocaine
Same as above
May damage the
placenta; more likely to
tear away from the wall
of the uterus
Serious complications –
miscarriage, prematurity
Same as above
Abnormalities in baby’s
heart beat
Low birth weight babies
More likely to have
long-term development
and growth problems
SIDs (more likely)
Can cause brain
damage, birth defects
in heart, urinary tract
and limbs
Even 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
FAS
About 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 face
Smaller at birth; may
never catch up
Mental retardation
Heart defects
Hearing loss or vision
problems
Limited knowledge
about the effects of
consumption at low
levels
Even a few drinks ( 1
or 2) may increase a
woman’s risk for
these problems
Safe consumption –
no alcohol
Labor & Delivery
Preparing for Labor


Woman may experience burst of energy
Lightening and engagement of fetus
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Cessation of weight gain
Dilation and effacement (thinning) of cervix
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descent of fetus into pelvic region
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
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Active phase
moderate contractions dilate
cervix 3–7 cm
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Transition
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intense contractions dilate cervix 7–10 cm
Stage II
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Early or Rest phase
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Active or Decent phase
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brief lull with no urge to push
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
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Placental phase
Placenta is delivered
Stage IV

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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
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Anesthesia
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Tranquilizers or narcotics
Help a woman relax and give some pain relief
Lumbar epidural
Eliminates sensation from the belly down
May sometimes prolong or even stop labor
Risks associated with drugs

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Can cross the placental barrier to the baby
Temporary side effects
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Irregular or slowed heart beats
Higher rates of jaundice
Breathing problems
Cesarean Section

Most common when
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fetus in the breech position
labor difficult or abnormal
fetus is distressed
woman had a previous c-section
Breech Positions
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By 36 weeks of pregnancy, most fetuses turn into a headdown, 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
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Frank
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The buttocks are down near the birth canal
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.
2.
3.
4.
5.
6.
7.
Liberation from an ovum, or egg
Internal fertilization of the ovum by spermatozoa, or
sperm cells
Transport of the fertilized egg to the uterus
Implantation of the blastocyst in the wall of the
uterus
Formation of a placenta and maintenance of the
unborn child during the entire period of gestation
Birth of the child and expulsion of the placenta
Suckling and care of the child
Video: Having a Healthy Baby
Menopause

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Permanent cessation of menstruation.
Results from a loss of ovarian function

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Represents the end of a woman’s reproductive
life
Estrogen production decreased by 80% or
more
Average age of menopause: 45 - 55

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As early as 40 years
As late as late 50s.
Menopause

Natural
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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
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Loss of bone mass
Increased risk of heart disease
Symptoms of Menopause

An array of symptoms, including:
-Hot flashes
-Changes in mood
-Depression
-Nervousness
-Vaginal Dryness

-Headaches
-Dizziness
-Lack well-being
-Breast atrophy
-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)
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Lubricants
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Relief of menopausal symptoms
Vaginal dryness
Vitamin E

Helps with hot flashes
Alternative Therapies
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Acupuncture, meditation and relaxation
techniques
Herbal or natural remedies
Pros


Some women report great benefits with these
practices
Cons

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Not regulated
Quality is not controlled
Some can contain toxic metals
Dietary and Lifestyle Factors

Mineral-rich Fruits and Vegetables
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Effects of fiber

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Important for the heart
Phytoestrogens

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High in magnesium and potassium and can help
preserve bones
Many help protect against heart disease and cancers
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.
2.
3.
Orally
Transdermal (Skin)
Vaginally
Benefits of HRT

Relief of uncomfortable symptoms that may occur
with menopause
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Prevention of bone loss

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improves balance; protects against falling
Improve cholesterol levels
Increasing blood flow and reducing blood pressure

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Hot flashes, vaginal dryness, osteoporosis
Protects against stroke
Reduces risk of heart disease
Help prevent mental breakdown after menopause
Risks for HRT

Depends on three factors:

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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

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Breast cancer
Uterine Cancer & Other Reproductive Cancers
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Heart Attack

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Within the first two years in women with pre-existing
conditions
Strokes
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Estrogen alone
Within the first two years in women with pre-existing
conditions
Blood clots
Endometriosis
Side Effects of HRT

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Not medically serious but bothersome
Estrogen

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breast tenderness, edema, nausea,
headache, and breakthrough bleeding
Progestin

Fluid retention, acne, premenstrual-like
symptoms, anxiety, depression, and
irritability
Who gets HRT?

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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
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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

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Aka Male Menopause

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Best name
Indicates a decline in testosterone
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


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Symptoms as a result
of a decline in
testosterone levels
Depression,
nervousness
Insomnia
Feeling fat/weight
gain

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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
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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 –
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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

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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