nurs 330 human reproductive health april 13, 2015
TRANSCRIPT
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NURS 330Human Reproductive Health
April 13, 2015
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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
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The zygote
Once fertilized, the egg is called a zygote. Zygote travels four days to the uterus
Divides rapidly Identical (Monozygotic) Twins
One egg fertilized by one sperm but divides into two separate masses
Fraternal (Dizygotic) Twins Two separate eggs fertilized by two separate
sperm
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Implantation The zygote reaches the uterine cavity about
3 days after fertilization
Implantation occurs 7 days after fertilization
Zygote now becomes a blastocyst
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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
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Development of Reproductive Organs
Undifferentiated Stage First eight weeks
At 12 Weeks Female Male
At 36 Weeks Female Male
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Pregnancy
266 days – 270
About nine months
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Embyronic Period From implantation until the 8th week of
pregnancy (gestation), the blastocyst is now known as an Embryo
Embryo 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
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The Embyronic Period (cont) Yolk sac
first element seen in the gestational sac during pregnancy, usually at 5 weeks gestation
Placenta Develops at the site of implantation Secretes human chorionic gonadotropin (hCG)
Effect on ovaries Effect on corpus luteum
Nourishment, oxygen, elimination of waste products
Umbilical cord Connects the developing embryo to the placenta Waste products are removed from the embryo and nutrients are
transported from the mother through the placenta
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The Embyronic Period (cont)
Amniotic sac Protective membrane around the fetus
Amniotic fluid 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.
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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
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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.
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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
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Pregnancy Tests
All pregnancy tests look for a special hormone in the urine or blood that is only present when a woman is pregnant. 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
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Trimesters
First: 0 – 13 Weeks Second: 14 – 26 Weeks Third: 27 – 40 Weeks
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Early Pregnancy Signs and Symptoms
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
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Pregnancy Symptoms
First trimester 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
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Pregnancy Symptoms
During the third trimester 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
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Diagnostic Tests during Pregnancy
Amniocentesis 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)
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Diagnostic Tests during Pregnancy
Ultrasound (Sonogram) 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
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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 Postpartum Blues Postpartum Depression Postpartum Psychosis Breastfeeding
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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 Mild Confusion
IrritabilityMemory Lapses Mood swings Fatigue
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Postpartum Depression (PPD)
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
Others may require psychological intervention Symptoms include:
Insomnia Digestive problems Unusual weight loss
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Postpartum Psychosis
Rare Serious disorder that probably has underlying
psychological causes Requires psychological evaluation and
treatment Marked by extreme highs and lows Symptoms
Extremely agitated Paranoid Delusions & hallucinations
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Breastfeeding
Facilitates uterine contractions Colostrum
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
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Pregnancy Conditions/Complications
Spontaneous Abortion or Miscarriage Ectopic Pregnancy Preeclampsia/Eclampsia Gestational Diabetes Placenta problems
Abruption, previa
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Pregnancy Conditions/Complications
High Risk Pregnancies: Mother's health Mother’s Age
Teenage mothers (17 and younger) Mothers over 35 years of age
Health of the fetus (baby) Complications unique to pregnancy
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Teratogens
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
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Active Teratogens
Passive Teratogens
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Active or Passive Teratogen?
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
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Name Effect on Pregnancy
Effect on Fetus
Other Comments
Caffeine Decreases blood flow across placentaLowers amount of O2 and nutrients available to baby
Low birth weight babies
Excessive use may
lead to miscarriage
2 – 3 cups/day pose no risk
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
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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 fetusPossible low birth weight, premature birth
Studies being done to understand long-term effects of marijuana on babiesSmoking before preg – no harm to baby
Cocaine Same as aboveMay damage the placenta; more likely to tear away from the wall of the uterusSerious complications – miscarriage, prematurity
Same as above Abnormalities in baby’s heart beatLow birth weight babiesMore likely to have long-term development and growth problemsSIDs (more likely)
Can cause brain damage, birth defects in heart, urinary tract and limbsEven very occasional use can cause problems
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Name What is it? Effect on Fetus
Other comments
Fetal Alcohol Syndrome (FAS)
Heavy drinking during pregnancy can cause FASAbout 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 faceSmaller at birth; may never catch upMental retardationHeart defectsHearing loss or vision problems
Limited knowledge about the effects of consumption at low levelsEven a few drinks ( 1 or 2) may increase a woman’s risk for these problemsSafe consumption – no alcohol
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Labor & DeliveryPreparing for Labor
Woman may experience burst of energy Lightening and engagement of fetus
descent of fetus into pelvic region Cessation of weight gain Dilation and effacement (thinning) of cervix
bloody show (due to bursting capillaries) mucus plug expelled
Rupture of amniotic sac (the water breaking)
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Stage I Early phase
mild-moderate contractions dilate cervix 0–3 cm
Active phase moderate contractions dilate cervix 3–7 cm
Transition intense contractions dilate cervix 7–10
cm
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Stage II Early or Rest phase
brief lull with no urge to push
Active or Decent phase pushing during contractions Moves baby down the birth canal
Transition or Crowning and Birth phase
head and body delivered
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Stage III & Stage IV
Stage III Placental phase Placenta is delivered
Stage IV Recovery phase Mother and baby checked for
complications
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Episiotomy
The cutting of the perineum that allows more room for the baby to be delivered
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Drugs During Labor Analgesics
Tranquilizers or narcotics Help a woman relax and give some pain relief
Anesthesia Lumbar epidural Eliminates sensation from the belly down May sometimes prolong or even stop labor
Risks associated with drugs Can cross the placental barrier to the baby Temporary side effects
Irregular or slowed heart beats Higher rates of jaundice Breathing problems
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Cesarean Section Most common when
fetus in the breech position labor difficult or abnormal fetus is distressed woman had a previous c-section
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Breech Positions
By 36 weeks of pregnancy, most fetuses turn into a head-down, 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
The buttocks are down near the birth canal Frank
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.
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Seven Essential Features of Human Reproduction
1. Liberation from an ovum, or egg2. Internal fertilization of the ovum by spermatozoa,
or sperm cells3. Transport of the fertilized egg to the uterus4. Implantation of the blastocyst in the wall of the
uterus5. Formation of a placenta and maintenance of the
unborn child during the entire period of gestation6. Birth of the child and expulsion of the placenta7. Suckling and care of the child
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Video: Having a Healthy Baby
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Menopause Permanent cessation of menstruation. Results from a loss of ovarian function
Represents the end of a woman’s reproductive life
Estrogen production decreased by 80% or more
Average age of menopause: 45 - 55 As early as 40 years As late as late 50s.
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Menopause
Natural 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.
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Estrogen depletion can lead to:
Osteoporosis Loss of bone mass
Increased risk of heart disease
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Symptoms of Menopause
An array of symptoms, including:-Hot flashes -Headaches-Changes in mood -Dizziness-Depression -Lack well-being-Nervousness -Breast atrophy -Vaginal Dryness -Psychological
Can last from six months to more than five years after the onset of menopause
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Remedies: Over-the-counter
Painkillers such as aspirin, ibuprofen (Advil, Motrin)
Relief of menopausal symptoms Lubricants
Vaginal dryness Vitamin E
Helps with hot flashes
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Alternative Therapies
Acupuncture, meditation and relaxation techniques
Herbal or natural remedies Pros
Some women report great benefits with these practices
Cons Not regulated Quality is not controlled Some can contain toxic metals
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Dietary and Lifestyle Factors
Mineral-rich Fruits and Vegetables High in magnesium and potassium and can help
preserve bones Many help protect against heart disease and
cancers Effects of fiber
Important for the heart Phytoestrogens
These are plant estrogens found in soy Intake can result in lower risk for diseases
associated with estrogen Avoid fast foods and Limit salts
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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
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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
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How is HRT Administered?
1. Orally2. Transdermal (Skin)3. Vaginally
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Benefits of HRT Relief of uncomfortable symptoms that may
occur with menopause Hot flashes, vaginal dryness, osteoporosis
Prevention of bone loss improves balance; protects against falling
Improve cholesterol levels Increasing blood flow and reducing blood
pressure Protects against stroke
Reduces risk of heart disease Help prevent mental breakdown after menopause
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Risks for HRT
Depends on three factors: 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
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Risks of HRT Breast cancer Uterine Cancer & Other Reproductive Cancers
Estrogen alone Heart Attack
Within the first two years in women with pre-existing conditions
Strokes Within the first two years in women with pre-existing
conditions Blood clots Endometriosis
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Side Effects of HRT
Not medically serious but bothersome
Estrogen breast tenderness, edema, nausea,
headache, and breakthrough bleeding Progestin
Fluid retention, acne, premenstrual-like symptoms, anxiety, depression, and irritability
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Who gets HRT?
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
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Menopause and Bone Density
Osteoporosis 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)
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Male Climacteric Syndrome
Male climacteric Best name Indicates a decline in testosterone
Aka Male Menopause 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
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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.
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Common Symptoms of Male Climacteric Syndrome
Symptoms as a result of a decline in testosterone levels
Depression, nervousness
Insomnia Feeling fat/weight
gain
Decreased libido Erectile
Dysfunction Easily fatigued Poor concentration
and memory Flushes and sweats
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Diagnosis of Testosterone Deficiency
Testosterone Level Test Test in the AM when testes produce
more testosterone Blood test See an Endocrinologist, hormone
specialist
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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
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Testosterone Replacement Therapy
Benefits/Risks Still being researched
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Mid-term
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 –
Each worth 2 points Multiple Choice, T/F, Fill-in-the-blank,
Matching Scranton 882 is needed
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Prep for In-Class Assignment
Separate sheet of paper 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