CARE OF THE MOTHER, CHILD AND ADOLESCENT  Quality and Safety Education for nurses

(WELL - CLIENTS) (QSEN)

NCM 107 FOUR PHASES OF HEALTH CARE

Learning Objectives  Health promotion

 Health maintenance
At the end of the of the course the students
 Health restoration
can;
 Health rehabilitation
1. Identify the specific goals and philosophy of maternal QSEN
and child health nursing and apply these to nursing
ROBERT WOOD JOHNSON FOUNDATION
practice.
Challenged nursing leaders to;
2. Identify 2020 National Goals as an important guide to
understanding the health of the nation and goals that  improved the quality nursing care by describing
nurses can help the nation achieve. what constitutes good nursing care.

3. Describe the evolution, scope, competencies, and  to build into prelicensure and graduate program
professionals’ roles of nurses in maternal and child in nursing that KSA necessary to help achieve
health nursing. level of care.

4. Describe family - centered care and ways maternal QSEN SIX COMPETENCIES
and child nursing
 Patient-centered care
4. Describe family - centered care and ways maternal  Teamwork and collaborative
and child nursing could be made both more family  Quality improvement
centered and respectful of diversity.  Informatics
 Safety
5. Using the nursing process, plant nursing care that
includes the six competencies of quality & safety
A. GOALS AND PHILOSOPHIESOF MATERNAL AND
Education for nurses Practice, Quality improvement,
CHILD HEALTH NURSING
safety, and Informatics.
The medical term “ OBSTETRIC” or care of woman
6. Define and use common statistical terms used in the
during child birth is derived from the
field, such as infant and maternal mortality
Greek word “ obstare, which means “ To keep watch”
7. Use critical thinking to identify areas of nursing care
that could benefit from additional research or Pediatrics = derived from the Greek word “pais “
application of evidenced - based practice. meaning child.

8. Integrate knowledge of maternal and child health The primary goal of maternal and child health nursing
nursing with the interplay of nursing process, the six care ;
competencies of QSEN, and Family Nursing to achieve
• The promotion and maintenance of optimal
quality maternal and child health nursing care.
family health to ensure cycles of optimal
Framework for Maternal and Child Health Nursing childbearing and childrearing.

FRAMEWORK FOR MCHN The goals of maternal and child health nursing care are
;
MCHN can visualized within a framework in which
nurses use: • Preconceptual health care

 Nursing process
 Nursing theory
• Care of women during three trimesters of pregnancy American Nurses Association / Society of Pediatric
and the puerperium (the 6 weeks after childbirth, Nurses Standards of Care and Professional
sometimes termed the fourth trimester of pregnancy) Performance.

• Care of children during the perinatal period (6 B. Maternal and Child Health Goals and Standards.
weeks before conception to 6 weeks after birth)
Main objective of MCHN
Care in settings as varied as the birthing room,
the pediatric intensive care unit, and the home - is to improve MATERNAL and NEWBORN
• Care in settings as varied as the birthing room, the HOW?
pediatric intensive care unit, and the home
2020 NATIONAL HEALTH GOALS
Philosophy of Maternal and Child Health Nursing
American Nurses Association/Society of Pediatric
Maternal and child health nursing is family centered; Nurses Standards of Care and Professional
assessment data must include a family and individual Performance
assessment.
Standards of Care
Maternal and child health nursing is community
centered; the health of families depends on and Comprehensive pediatric nursing care focuses
influences the health of communities. on helping children and their families and communities
achieve their optimum health potentials. This is best
Maternal and child health nursing is research oriented, achieved within the framework of family-centered care
because research is the means whereby critical and the nursing process, including primary, secondary,
knowledge increases. and tertiary care coordinated across health care and
community settings.
Philosophy of Maternal and Child Health Nursing cont.. Standard I: Assessment
Standard II: Diagnosis
Both nursing theory and evidence-based practice
Standard III: Outcome Identification Standard IV:
provide a foundation for nursing care. Planning
A maternal and child health nurse serves as an advocate Standard V: Implementation
to protect the rights of all family members, including Standard VI: Evaluation
Standards of Professional Performance
the fetus.
Standard I: Quality of Care
Maternal and child health nursing includes a high Standard II: Performance Appraisal
degree of independent nursing functions, because Standards of Professional Performance
teaching and counseling are so frequently required. Standard III: Education
Standard IV: Collegiality
Promoting health is an important nursing role, because
this protects the health of the next generation. Standards of Professional Performance
Philosophy of Maternal and Child Health Nursing cont..
Standard V:Ethics The pediatric nurse’s assessment,
Pregnancy or childhood illness can be stressful and can actions, and recommendations on behalf of children
alter family life in both subtle and extensive ways. and their families are determined in an ethical manner.
Standard
Personal, cultural, and religious attitudes and beliefs
influence the meaning of illness and its impact on the Standard VI: Collaboration
family. Circumstances such as illness or pregnancy are Standards of Professional Performance
meaningful only in the context of a total life.
Standard VII: Research
Maternal and child health nursing is a challenging role
Standard VIII: Resource Utilization
for a nurse and is a major factor in promoting high-level
wellness in families.
Association of Women’s Health, Obstetric, and Imogene King = Nursing is a process of action,
Neonatal Nurses Standards and Guidelines reaction, interaction, and transaction; needs are
identified based on client’s social system, perceptions,
Standards of Professional Performance
and health; the role of the nurse is to help the client
Standard I: Quality of Care
achieve goal attainment.
Standard II: Performance Appraisal
Standard III: Education Madeleine Leininger = The essence of nursing is care.
Standards of Professional Performance cont. To provide transcultural care, the nurse focuses on the
Standard V: Ethics study and analysis of different cultures with respect to
caring behavior.
The nurse’s decisions and actions on behalf of patients
Florence Nightingale =The role of the nurse is viewed
are determined in an ethical manner.
as changing or structuring elements of the
Standard VI: Collaboration environment such as ventilation, temperature,
odors, noise, and light to put the client into the best
The nurse collaborates with the patient, significant
opportunity for recovery.
others, and health care providers in providing patient
care. Betty Neuman = A person is an open system that
interacts with the environment; nursing is
Standard VII: Research
aimed at reducing stressors through primary,
The nurse uses research findings in practice. secondary, and tertiary prevention

Standards of Professional Performance cont. Dorothea Orem =The focus of nursing is on the
individual; clients are assessed in terms of ability to
Standard VIII: Resource Utilization complete self-care. Care given may be wholly
The nurse considers factors related to safety, compensatory (client has no role); partly compensatory
effectiveness, and cost in planning and delivering (client participates in care); or supportive-educational
patient care. (client performs own care).

Standard IX: Practice Environment Ida Jean Orlando = he focus of the nurse is interaction
with the client; effectiveness of care depends on the
The nurse contributes to the environment of care client’s behavior and the nurse’s reaction to that
delivery within the practice settings. behavior. The client should define his or her own needs.
Standard X: Accountability Rosemarie Rizzo Parse = Nursing is a human science.
The nurse is professionally and legally accountable for Health is a lived experience. Man-living-health as a
his/her practice. The professional registered nurse may single unit guides practice.
delegate to and supervise qualified personnel who Hildegard Peplau = The promotion of health is viewed
provide patient care. as the forward movement of the personality; this is
C. THEORIES RELATED TO MATERNAL CHILD accomplished through an interpersonal process that
includes orientation, identification, exploitation, and
NURSE resolution.
Theorist and the Major Concepts of Theory Martha Rogers = The purpose of nursing is to move the
client toward optimal health; the nurse should view the
Patricia Benner =Nursing is a caring relationship.
client as whole and constantly changing and help
Nurses grow from novice to expert as they practice in
people to interact in the best way possible with
clinical settings.
the environment.
Dorothy Johnson =A person comprises subsystems that
Sister Callista Roy = The role of the nurse is to
must remain in balance for optimal functioning. Any
aid clients to adapt to the change caused by
actual or potential threat to this system balance is a
illness; levels of adaptation depend on the
nursing concern.
 degree of environmental change and state of need to be addressed, human sexuality also has
coping ability; full adaptation includes significant meaning and value in each individual's life.
physiologic interdependence.
Reproductive Biology
D. Roles and Responsibilities of Maternal Child Nurse
 Reproductive physical maturity and the capacity
E. WHO'S 17 Sustainable Development Goals for human reproduction begin during puberty, a
period of rapid growth and change experienced
Reproductive and Sexual Health
by both males and females. Puberty is not an
A. Concept of Unitive and Procreative Health isolated event, but a process which takes place
over several years.
PROCREATION
 During puberty, the hypothalamus (a gland
 The process by which one produces others of its located at the base of the brain which regulates
kind by reproduction temperature, sleep, emotions, sexual function
 The act of begetting or engendering offspring. and behavior) produces hormones
 Is the biological process by which new offspring
individual are produced from their parents.  These hormones stimulate the gonads, the
 It is the fundamental feature of all known life. reproductive glands (the testes in males and the
ovaries in females) to produce testosterone
THEORIES: (males) and estrogen and progesterone
(females).
. Charles Darwin's Theory of Evolution
Male puberty
Natural selection is Darwin’s most famous theory; it
states that evolutionary change comes through the  Generally occurs between the ages of 13-15
production of variation in each generation and  Characterized by the secretion of the male
differential survival of individuals with different hormone testosterone, which stimulates
combinations of these variable characters spermatogenesis
 And the development of secondary sexual
APES INTO HUMANS characteristics
2. God’s creation of Adam and Eve Female puberty

"So God created man in His Own Image, in The Image of  Generally occurs between the ages of 9-13,
God He created him; male and female He created them.  Results in ovulation and menstruation, which
God blessed them and said to them, "Be fruitful and involve cyclic hormonal changes in estrogen and
increase in number; fill the earth and subdue it. progesterone.
THE PROCESS OF REPRODUCTION  And the development of secondary sexual
A. SEXUAL INTERCOURSE characteristics
B. CONCEPTION B. Female/ Male Reproductive System
C. PREGNANCY
D. BIRTH The female reproductive system
Human reproduction
EXTERNAL GENITALIA
Sexual and Reproductive Development
VULVA
Human beings are sexual throughout life. Sexuality Vulva or Pudenda
encompasses more than sexual behavior - it is not only Mons Pubis or Mons Veneris
the physical, but the mental and spiritual as well.  Labia Majora
Sexuality is a core component of personality and a Labia Minora
fundamental part of human life. While the problems Clitoris
usually associated with sexual behavior are real and Vestibule
 Bartholin’s Glands The female reproductive system
Skenes’s Glands
INTERNAL STRUCTURE
Vaginal Orifice
Hymen UTERUS
Urethral Meatus
Vulva or Pudenda refers to the entire female genitalia. “THE WOMB”
Mons Pubis is a fold of fats above the symphysis pubis b. Uterus
that is an important obstetrical landmark and protects
the symphysis pubis from trauma. Hallow muscular, pear-shaped organ with three layers:
endometrium,myometrium, perimetrium
 It is richly supplied with sebaceous
glands located between the bladder and rectum and consisting
of five parts: fundus, corpus/body,cornua,isthmus, and
 “Escutcheon” curly hair cervix
o Labia Majora are thick folds of adipose tissues Functions:
originating from the mons and terminating in
Menstruation – sloughing away of the endometrium
the perineum.
layers with bleeding from torn vessels.
o Its functions is to provide covering and
Pregnancy – development of embryo and fetus after
protection to the external organs
fertilization;it houses and nourishes the growing baby.
located under it
Labor – powerful contractions of muscular uterine wall
o Labia Minora are two thin folds of connective
that propels the products of conception into the vaginal
tissues that joins anteriorly to form the prepuce
canal.
and posteriorly to form the fourchette
FALLOPIAN TUBE
o It is moist highly vascular, sensitive and
richly supplied with sebaceous glands Functions:
Skene’s Gland are a pair of gland also known as Site of normal fertilization
“paraurethral and minor vestibular gland”
Ducts through which ova travel from ovaries to the
Vaginal Orifice or introitus is the external opening of uterus; sperm from uterus to the ovary
the vagina located just below the urethral meatus.
OVARY
o The Grafenburg or the G Spot is a very
ACCESSORY STRUCTURE
sensitive area located at the inner
anterior surface of the vagina. External structure
o Urethral Meatus the external opening of the Nipple – raised, pigmented area of the breast
female urethra is located just below the clitoris
Areola – pigmented area of the skin surrounding the
Skene’s Gland are a pair of gland also known as nipple
“paraurethral and minor vestibular gland”
Montgomery’s tubercles – sebaceous glands of the
Vaginal Orifice or introitus is the external opening of areola
the vagina located just below the urethral meatus.
Male Reproductive
o The Grafenburg or the G Spot is a very System
sensitive area located at the inner
Male Reproductive System
anterior surface of the vagina.
Andrology: the study of male reproductive organs.
o Urethral Meatus the external opening of the
female urethra is located just below the clitoris
Primary reproductive function: production and sperm by maintaining temperature lower than the
transport of sperms through and out of the genital tract body.
into the female genital tract
The internal structures
The primary direct function of the male reproductive
a.Testes
system is to provide the male gamete or spermatozoa
for fertilization of the ovum. Two small oval male gonads and contain hundreds of
tiny seminiferous tubules where sperm cells are
The major reproductive organs of the male can be
produced suspended in the scrotum
grouped into three categories.
Functions: secretion of male sex hormones (androgens)
1.The first category is sperm production and storage.
and site of spermatozoa production in the mature male
2.The second category is the ejaculatory fluid producing
Endocrine function:
glands which include the seminal vesicles, prostate, and
the vas deferens. a.Hypothalamus:
3.The final category are those used for copulation, and b.APG:
deposition of the spermatozoa (sperm) within the male,
these include the penis, urethra, vas deferens, and c. Testes: interstitial Cells of Leydig are the cells
Cowper's gland. stimulated by the LH to syntheize testosterone from
cholesterol
The external structures
d. Testosterone homone production is by the
a.Penis: the male organ of copulation, elogated and interstitital cells of leydig.
cylindrical consisting of a shaft and a glans
Testosrone are reponsible for the production of sex
The penile shaft consist of three columns of erectile drive and potency
tissue:
Develops secondary sex characteristics:
1.Corpora cavernosa: two lateral columnlocated on  larger, more muscular stature
either side and infront of the urethra  deepened voice
2.Corpus spongiosum a posterior column which  facial and body hair
contains the urethra. The tip is expanded to form the  broad shoulders
glans penis. And a skin flap (prepuce /foreskin) that  and development of an adam's apple.
covers the glans penis in circumcied males Together with FsH, stimulates sperm production

Glans penis: a cone-shaped expanion of the corpus Exocrine function: the process of spermatogenesis
spongiosum that is highly senitive to sexual stimuli. begins at the seminiferous tubules of the testes which
produce the male gamete (sperm) under the influence
Function: it caries the urethra; pathway for both of the FSH and testosterone.
theurine and emen
Production of sperms by the seminiferous tubules start
Primary Function: deposit sperm in the female vagina at puberty and continuous throughout life
for fertilization of the ovum
Sperm production:
b.Scrotum:
From the primitive germ cell, the primary
A sac or pouch-like structure from root of penis, spermatogonia which are present at birth (dipliod –
suspended from the perineal region that divides into 44XY), the male spermatogonisa will develop into
two compartments one for each testis. mature spermatozoa a process called spermatogenesis.
Primary Function: A continuos process that starts at puberty and is
The scrotum surrounds and protects the two testes, completed within 72 hours.
internal structures also referred to as testicles and the Types of sperm
Androsperm • Secretes a thin, lubricating milky fluid which
enters the urethra through the ducts and helps
·Carries Y-sex chromosome
in the pasage and viablility of spermatozoa.
·Fast moving
·Smaller, weaker, short-lived f.Urethra
·Dies in acid
A thin tube which extends through the penis and carries
Gynosperm
semen and urine outside of the body, not
·Carries X-sex chromoome simultaneously.
·Slower
g.Cowper's glands
·Bigger, stronger, long-lived
·Acid-resistant Also called the bulbourethral glands are found on each
• Sperm parts side of the urethra, just below the prostate gland.
Head Secrete small amount of lubricating fluid
Body §Life span
Tail ·Can survive in the female reproductive tract up to 72
hours; believed to be healthy and highly fertile for only
§Sex determination: The two chromosomes of the 23rd
about 24 hours
pair (XX or XY) are called the sex chromosomes.
·Development take approximately 70 days and remains
·Y: smaller and carry only the genes for males
in the epididymis for 12 to 26 days for maturation
·X: larger sex chromosome in the sperm
MENSTRUATION
Carries several genes other than those for sexual trait
Is the periodic discharge of blood and mucosal
and are called sex-linked.
tissue from the inner lining of the uterus through
Female have 2 X chromosome(XX) the vagina.

To produce female child each parent mut contribute Episodic uterine bleeding in response to cyclic hormonal
an X chromosome changes

Male have 1 X chromosome and 1 Y chromosome (XY) Brings an ovum to maturity and renews uterine tissue
bed
To produce a male child, the mother contribute an X
chromosome and the father mut contribute the Y
MENSTRUAL CYCLE
chromosome
Is the monthly series of changes a woman's body goes
b.Epididymis
through in preparation for the possibility of pregnancy. 
• Is a soft, cord-liked, coma-shaped body which
Periodic series of changes that recur in the uterus and
rests on the surface of the testes where sperm
associated organs beginning at puberty and ending at
mature and are stored
menopause
c.Vas deferens
Taken from the first day of menstruation to the first day
Narrow tubes which carry sperm away from the testes of the next menstruation
to the ejaculatory duct.
Basis for menstrual cycle is 6-12 month graphing.
e.Prostate gland
Menarche – first menstrual period that occurs typically
• The prostate gland located below the bladder at age 12 but may occur as early as 9 or as late as 17.
(the structure that stores urine) and lies
Thelarche – is the development of the breast buds that
between rectum and symphysis pubis
occur at puberty.
Adrenarche – is the development of pubic & axillary  increases water content of uterus
hair due to androgen stimulation Progesterone

Characteristic of Menstrual Blood:  inhibits secretion of LH

 relaxes smooth muscles thereby
 Does not appear to clot
decreases contractions of uterus
 Dark red as that of venous blood  causes cervical secretion of thick mucus
 maintain thickness of endometrium
 Offensiveness ( Fleshy stale odor)  allows pregnancy to be maintained =
Characteristics of the Menstrual cycle Hormone of Pregnancy
 prepares breasts for lactation
average 28 days Prolactin
23 to 35 days not usual  stimulates secretion of milk
Duration of Menstrual flow average flow: Oxytocin
2-7 days / 1-9 days not normal  stimulates uterine contractions during
Amount of menstrual flow is Difficult to estimate; birth and compress uterine blood
average 30 to 80 ml. per menstrual period; saturating a vessels and control bleeding
pad in less than an hour is considered heavy bleeding.  stimulates let-down or milk-ejection
reflex during breastfeeding
Four body structure involved in the physiology The menstrual cycle can be divided into the following
of the menstrual cycle: parts:

Reproductive Hormones: 1. Ovarian cycle

• Gonodotropin-Releasing Hormone (GnRH) 2. Uterine cycle

 Stimulates release of FSH and LH OVARIAN CYCLE

initiating puberty and sustaining Phase 1 :The Follicular phase
menstrual cycle.
Days 1 through 13
• Follicle-stimulating Hormone (FSH)
It's called the follicular phase because growth or
 stimulate growth and maturation of maturation of the egg is taking place inside the follicle, a
graafian follicle before ovulation small sac where the egg matures.
 thins the endometrium
Luteinizing Hormone (LH) Ovulation occurs around day 14 of the cycle

 stimulates final maturation of graafian Phase 2 : The Luteal phase

follicle Days 14 through 28
 stimulates transformation of graafian
follicle into corpus luteum Time of ovulation until the first day of menstruation,
 thickens the endometrium
It is a structure that grows in the ovary where a mature
Estrogen
egg was released at ovulation.
 stimulates thickening of the
The luteal phase has a more precise timeline and
endometrium; causes suppression of
usually is only 12-16 days from the day of ovulation
FSH secretion
OVULATION
 responsible for the development of
secondary sex characteristics An egg (ovum) lives 12-24 hours after leaving the ovary
 stimulates uterine contractions
Normally only one egg is released each time of  Is the time after menstruation and before the
ovulation next ovulation,
 The lining of the uterus increases rapidly in
Ovulation can be affected by stress, illness or disruption thickness and the uterine glands multiply and
of normal routines grow.
Some women may experience some light blood spotting
WHAT HAPPENS DURING MENSTRUAL CYCLE?
during ovulation
PITUITARY GLAND
Implantation of a fertilized egg normally takes place 6-
12 days after ovulation • Follicle Stimulating Hormone (F.S.H.)
Each women is born with millions of immature eggs that • Luteinizing Hormone (L.H.).
are awaiting ovulation to begin
OVARIES stores thousands of  follicles
A menstrual period can occur even if ovulation has not
occurred Ovarian follicles are the basic units of female
reproductive biology.
Ovulation can occur even if a menstrual period has not
occurred  They contain single oocyte (immature ovum or egg).

Some women can feel a bit of pain or aching, near the These eggs/ova are developed only once
ovaries during ovulation. This is called every menstrual cycle
"MITTLESCHMERZ" Discomforts of Menstruation
If an egg is not fertilized, it disintegrates and is absorbed Breast tenderness and feeling of fullness
into the uterine lining
Tendency towards fatigue
Sperm can live in a woman's body up to 5 days after
intercourse, though more often 2 days. Temperament and mood changes – because of
hormonal influence and decreased levels of estrogen
Pregnancy is most likely if intercourse occurs anywhere and progesterone
from 3 days before ovulation until 2-3 days after
ovulation. Discomfort in pelvic area, lower back and legs

Uterine Cycle Retained fluids and weight gain

The Menstrual phase (bleeding phase) Abnormalities of Menstruation

 Days 1 to 4 (may last for 3 to 5 day)  Amenorrhea – absence of menstrual flow

 The terminal phase of the menstrual cycle  Dysmenorrhea – painful menstruation
 Characterized by vaginal bleeding  Oligomenorrhea – scanty menstruation
 About 25 – 60 ml of blood equivalent to 0.4 -1.0  Polymenorrhea – too frequent menstruation
mg of iron lost each day of the cycle  Menorrhagia -excessive menstrual bleeding
 Metrorrhagia – bleeding between periods of
The Secretory phase (luteal phase) less than 2 weeks
 Hypomenorrhea – abnormally short
 Days 14 through 28 menstruation
 Is the time after ovulation  Hypermenorrhea – abnormally long
 When an egg is not fertilized, the corpus luteum menstruation
gradually disappears, estrogen and
progesterone levels drop, and the thickened CARE OF THE FETUS
uterine lining is shed. FETAL DEVELOPMENT
The Proliferative phase (follicular phase) "Life is present from the moment of conception."
 Days 5 through 14; last about 9 days
 The regenerative phase
ASSESSMENT OF THE FETAL GROWTH AND THE PROCESS
DEVELOPMENT
Each month inside your ovaries, a group of eggs starts
PURPOSE to grow in small, fluid-filled sacs called follicles.
Eventually one of the eggs erupts from the follicle
 Predict the outcome of the pregnancy
(ovulation). It usually happens about two weeks before
 Manage the remaining weeks of the pregnancy
your next period.
 Plan possible complication at birth
 Plan for problems that may occur in the Fertilization:
newborn infant.
- Also referred to conception and impregnation.
 Decide whether to continue the pregnancy
 Find conditions that may afffect future The fusion of the sperm cell nucleus with the egg cell
pregnancies. nucleus to produce a zygote (fertilized egg)

ASSESSMENT OF THE FETAL GROWTH AND FERTILIZATION

DEVELOPMENT  Is the union of an ovum and spermatozoon
 Health history . Usual occurs in the outer third of the fallopian tube .
 Physical Examination Termed tha appullar portion
 Estimating Fetal health
 Fetal growth SITE OF FRTILIZATION
 Assessing fetal well being OVA
HEALTH HISTORY
 Released from the Graffian Follicle
Assess the mother;  Will be surrounded by a ring of
 pre prenancy illness ( DM, BA, CA HPN) mucopolysaccharide fluid (Zona pellucida) and a
circle of cell (Corona Radiata)
 Drugs
 Moves from the ovary to the fallopian tube
 Nutritional intake
through the cilia and peristaltic movement of
 Personal habbits (eg, cigarette smoking ect.)
fallopian tube
 Exposure to teratogens SPERM
PHYSICAL EXAMIANTION
 Per ejaculation, 2.5ml semen containing 50-
Assess mother the following; 200M spermatozoa is release (AVE
 Weight 40Msperm/ejaculation)
 Moves through the cervix, uterus, fallopian tube
 General appearance
because of their flagella and uterine
 Bruises ( may indiacte intimate partner
contractions
violence)
 Undergoes CAPACITATION 9cnages in the
DEVELOPMENT
plasma membrane of the sperm head to reveal
• Pre embryonic – 1st 2 weeks, beginning with sperm binding receptors sites) before
fertilization penetrating into corona radiata

• Embryonic – week 3 through 8 Steps in fertilization

1. Sperm to penetrates egg using enzymes to break
• Fetal – from 8 through birth
through eggs protective layer.
- Full term: 38-42 weeks
2. Once inside the egg, the nuclear membrane of both
- Preterm: < 38 weeks the sperm and egg rupture and the genetic
material of the egg and sperm are combined.
- Post-term: > 42 weeks
The new cell created by fertilization is called a ZYGOTE.
THE FERTILIZATION PROCESS
Fertilization is the joining of two sex cells (haploid) to  Lining of digestive tract
create a new individual which is a genetic combination  Lining of trachea, bronchi, and lungs
of both parents (diploid).  Liver, pancreas
Once the zygote is formed it begins to grow in cell  Thyroid, parathyroid, thymus, urinary
number through the process of bladder
The outer layer of the blastocyst forms a membrane
MITOSIS that protects and nourishes the developing embryo.
In a fertilized egg or zygote this mitotic division is called The embryo is known as the amniotic sac.
cleavage
Chorion - outer fetal membrane, formed from the
trophoblast ( maternal side of placenta)
As the Morula moves into the uterus from the fallopian
tube it becomes a hollow structure known as a Amnion - originates in the blastocyst during early stages
blastocyst of development, expands as the fetus grows until it
slightly adheres to the chorion ( fetal side of placenta)
The blastocyst secretes an enzyme and breaks through
the uterus wall in a process known as Amniotic sac - formed by 2 fetal membranes (chorion,
amnion)
IMPLANTATION
Amniotic Sac
Implantation
Contains fluid (amniotic fluid) that protects fetus by
- 7 days or 5 days
giving it a stable environment and absorbing shock
after fertilization, the trophoblast burrows into
AMNIOTIC FLUID - formed by the secretion of: 1.
the endometrium (upper part of uterus), embedding
amniotic cells
the fertilized egg into the uterine lining
2. lungs and skin of fetus
Decidua - what the endometrium is called after
implantation 3. fetal urine
The cluster of cells known as the blastocyst divides into - 98% water, but also contains glucose, protein, sodium,
3 layers in a process of GASTRULATION urea, creatinine, lanugo, vernix caseosa
These layers will become all of the organs and tissues of - slightly alkaline, replaced approximately every 3 hours
the embryo.
- amniotic cells and the fetus urinating and swallowing
Germ Layers regulate the secretion and reabsorption of the fluid
Ectoderm (Outer layer) Functions of amniotic fluid:
 Nervous system including brain, spinal cord  Never stagnant
and nerves
 Serves to protect fetus
 Lining of the mouth, nostrils, and anus
 Epidermis of skin, sweat glands, hair, nails o Shields against pressure; equalizes the
 Germ Layer
Mesoderm (Middle Layer ) pressure around the fetus; cushions the
fetus from external compression
 Bones and muscles
o Protects from temperature changes; . provides
 Blood and blood vessels
constant temperature and fluid for the fetus to
 Reproductive and excretory systems
swallow
 Inner layer (dermis) of skin
 Germ Layers o Protects umbilical cord
Endoderm (Inner Layer)
o allows freedom of movement for the fetus
 o lubricates the membrane and the fetus  Connects the left and right atria
 Bypassing fetal lungs
PLACENTA AND UMBILICAL CORD
 Obliterated after birth to become fossa
PLACENTA- formed by the : ovalis
Umbilical Vein
1. chorionic villi at the base of the implanted fertilized
ovum and the decidua basalis  Brings oxygenated blood coming from
the placenta to the heart and liver
2. endometrium at the side of implantation  Becomes ligamentum teres
By the 3rd week of pregnancy the placenta begins to Umbilical arteries
form in the uterus.  Carry unoxygenated blood from the
The placenta is the connection between the mother and fetus to placenta
the embryo which provides a supply of oxygen and  Become umbilical ligaments after birth
nutrients, while keeping the mother and embryo’s Ductus venosus
blood supplies separate.  Carry oxygenated blood from umbilical
PLACENTA vein to IVC
 Bypassing fetal liver
Fully functional by the 12th week  Becomes ligamentum venosum after
2 sides of placenta: birth
Ductus arteriosus
1. maternal side which is irregular and is
 Carry oxygenated blood from
divided into subdivisions called pulmonary artery to aorta
cotyledons  Bypassing fetal lungs
2. fetal side covered by amnion, so it is smooth and Blood from the placenta is carried to the fetus by the
shiny umbilical vein. About half of this enters the fetal ductus
venosus and is carried to the inferior vena cava, while
 SCHULTZ
the other half enters the liver proper from the inferior
 DUNCAN
border of the liver. The branch of the umbilical vein that
Umbilical cord - a structure that connects the fetus to supplies the right lobe of the liver first joins with the
the placenta. portal vein.

- has 2 arteries and 1 vein (AVA) The blood then moves to the right atrium of the heart.
In the fetus, there is an opening between the right and
- 2 arteries carry deoxygenated blood from the fetus to left atrium (the foramen ovale), and most of the blood
the placenta flows through this hole directly into the left atrium from
the right atrium, thus bypassing pulmonary circulation.
- 1 vein carries oxygenated blood to the fetus, along
with nutrients, hormones etc The continuation of this blood flow is into the left
ventricle, and from there it is pumped through the aorta
Fetal Development
into the body. Some of the blood moves from the aorta
Fetal Circulation through the internal iliac arteries to the umbilical
arteries, and re-enters the placenta, where carbon
In the fetal circulatory system, the umbilical vein
dioxide and other waste products from the fetus are
transports blood rich in O2 and nutrients from the
taken up and enter the maternal circulation.
placenta to the fetal body.
Some of the blood entering the right atrium does not
Special Structures:
pass directly to the left atrium through the foramen
Foramen Ovale ovale, but enters the right ventricle and is pumped into
the pulmonary artery. In the fetus, there is a special Week 10 - head growth slows, islets of langerhans
connection between the pulmonary artery and the differentiated, bone marrow forms, rbc produced;
aorta, called the ductus arteriosus, which directs most bladder sac forms, kidneys make urine
of this blood away from the lungs
( wt-14g,L 5-6cm C – H )
Umbilical arteries
Week 11 - tooth buds appear, liver secretes bile;
 Carry unoxygenated blood from the urinary system functions, insulin forms in
fetus to placenta pancreas

Week 12 - lungs takes shape, palate fuses, heart

 Become umbilical ligaments after birth
beat heard with Doppler, ossification
Ductus venosus established, swallowing reflex present; external
genitalia, male or female distinguished
Carry oxygenated blood from umbilical
vein to IVC Week 16 - meconium forms in bowels, scalp hair
 Bypassing fetal liver appears, frequent fetal movement, skin thin and pink
 Becomes ligamentum venosum after ,sensitive to light, 200 ml of amniotic fluid
birth
Week 28 -subcutaneous fat deposits begin; lanugo
Ductus arteriosus
begins to disappears, nails appear, eyelids open and

Carry oxygenated blood from close ; testes begin to descend
pulmonary artery to aorta
Week 32 - more reflexes present, CNS direct rhythmic
 Bypassing fetal lungs
breathing movement/ partially controls body
DEVELOPMENT OCCURS IN SYSTEMATIC MANNER
temperature, begins storing iron, calcium
 FROM HEAD TO TOE phosphorus;ratio of lungs surfactant lecithin
 FROM PROXIMAL TO DISTAL and sphingomyelin is 1.2:2
 FROM GENERAL TO SPECIFIC
Week 36 - a few creases on soles of feet, skin less
 or described in general term of TRIMESTER
st
wrinkled, fingernails reach fingertips, sleep-wake cycle
1 trimester - 12 weeks
fairly definite, transfer of maternal antibodies
2nd trimester - 13 to 27 weeks
rd
3 trimester - 28 to 40 weeks Week 38 - L/S ratio 2:1

Week 40 - lanugo only on shoulders and upper back;

EMBRYONIC STAGE
creases cover sole, vernix mainly in folds of skin,
Week 4 - (wt 0.4g, length is 4- 6mm), half the size of a ear cartilage firm, less active, limited space,
pea, brain differentiates, G.I. tract begins to form, limbs ready to be born
buds appear
System development
Week 5 - cranial nerves present, muscles have
 All systems in the fetus begin forming by the
innervation ( L 6-8mm)
8th week
Week 6 - fetal circulation established. Liver produces  Cardiovascular system – primitive heart begins
red blood cells, CNS forms, primitive kidney forms, lung to beat on the 21st day following conception
buds present, cartilage forms, primitive skeleton forms, ,the 1st to function in the embryo;
muscles differentiate.  Congenital malformation may develop during
the 6th to 8th weeks
Week 7 - eyelids form, palate and tongue form
ASSESSING FETAL WELL BEING
stomach formed, diaphragm formed, arms and legs
move (L 22-28mm) Fetal heart rate

Fetal Stage Fetoscope

Week 9 - fingers and toenails form; eyelids fuse shut • Doppler

Daily fetal movements count ( kicks count)  Between 28 and 40 weeks, the total pockets of
amniotic revealed by sonogram average 12 to
 Fetal kick count 15 cm .
 Quickening- Movement felt by the  Hydramnios- amount greater than 20 to 24
mother. cm( excessive fluid , perhaps caused by inability
of the fetus to swallow)
 Occurs approx. 18 - 20 weeks of  Oligohydramnios - amount of amniotic fluid
pregnancy. less than 5 to 6 cm . ( perhaps cause by poor
perfusion and kidney failure.
 Peaks- 28 to 38 wks TERATOGENS
The pregnant woman reports at least 10 movements in A “teratogen” is any exposure that can cause harm to
12 / hours. an unborn or breastfeeding baby.
Absence of fetal movements precedes intrauterine fetal RISK
death by 48 hours.
BIRTH DEFECTS
• Rhythm Strip Testing record - assessing FHR for  3-5%
whether a good baseline rate and both long-  will increase if expose to teratogens.
and short- term variability are present. Record MISCARRIAGE
FHR for 20 min.  25%
• Nonstress Testing- measure the response of the  Decreases to 10% on the eighth week
FHR to fetal movement.  Will increase upon teratogenic
exposure
• Ultrasonography- measure the response of the Chemical Teratogens
sound waves againts solid object
 Cigarette Smoking 
ASSESSING FETAL WELL BEING cont.
 Miscarriage
Doppler Umbilical Velocity- measure the velocity at  Stillbirth
which red blood cells in the uterine and fetal vessel  low birth weight
travel.  premature birth
 Sudden Infant Death Syndrome (SIDS)
Placental Grading for matury- placenta can be graded
 possible increase in developmental delays
by ultrasound based on the particular amount of
 1% risk for cleft palate
calcium deposited its presentin the base.
 and failure to thrive
0 : between 12 and 24 weeks Viruses, Bacteria & Protozoa

1 : 30 to 32 weeks Other common teratogens

2 : 36 weeks HUMAN SEXUALITY

3 : 38 weeks (Because fetal lungd are apt to be measure SEXUALITY

by
 Includes feelings, attitudes and actions
38 weeks, a grade 3 placenta suggests that fetus is  Has both biologic and cultural components
mature.  Encompasses and gives direction to a person’s
physical emotional social, and intellectual
responses throughout life
ASSESSING FETAL WELL BEING cont.  Each person is born a sexual being.
 Gender identity and gender role behavior
 Amniotic Fluid Volume- measure the the
evolve from and usually conform to societal
amount of amniotic fluid to estimate fetal
expectations within a person’s culture.
health.
SEXUALITY AND SEXUAL IDENTITY
Sex refers to a person’s biological status and is typically
categorized as male, female, or intersex (i.e., atypical
combinations of features that usually distinguish
male from female)

Gender refers to the attitudes, feelings, and behaviors

that a given culture associates with a person’s
biological sex.

Biologic gender – denotes chromosomal development:

XX, XY

Gender role - is the male or female behavior, a person

exhibits, which again, may or not be the same as
biologic gender or gender identity.

Gender identity /sexual identity

refers to “one’s sense of oneself as male, female, or

transgender”.

inner sense a person has of being male or female

• Gender role - behavior a person

conveys about being male or female
(may or may not be the same as
biologic gender or gender identity)

Sexual orientation refers to the sex of those to whom

one is sexually and romantically attracted.

Categories of sexual orientation typically have

included :

 attraction to members of one’s own sex (gay

men or lesbians),
 attraction to members of the other sex
(heterosexuals),
 and attraction to members of both sexes
(bisexuals)