PREGNANCY 1st and 2nd Trimesters

PREGNANCY 1st and 2nd Trimesters
Presentation lecture from: Orangecoastcollege

* General
o Sonography used after 4-5 weeks
o Events prior to this time:
1. Ovulation
2. Fertilization
3. Implantation
4. Placentation
5. Embryonic Development

OVULATION
A. Definition: a cyclic event controlled by two hormones (FSH and LH) that occurs monthly

1. ~ 20 ova begin maturing
2. Only one completes the maturation process
Phase??
3. After ovulation, ovum moves into uterine tube
4. If fertilized, the zygote begins to divide
5. Implantation begins in ~6 days

FERTILIZATION
A. Definition: penetration of the ovum by one spermatozooan

1. Hyaluronidase (from acrosome):enzyme that allows penetration
2. Lack of acrosome/enzyme: infertility
3. Polyspermy: More than one sperm penetrates ovum

B. Sperm and ovum are haploid (N)
C. Genetic material in nuclei fuses to form zygote (2N)
D. Zygote begins cell division (mitosis!) immediately
E. Differentiation: prior to reaching uterus, zygote has developed into morula
+ Cells continue to divide, form blastula or blastocyst
# trophoblast
# inner cell mass or blastoderm
G. Trophoblast will give rise to placenta
H. Inner cell mass will give rise to the embryo
1. Ectoderm (outer layer or “outer skin”)
2. Endoderm (inner layer or “inner skin”)
3. Mesoderm (middle layer or “middle skin”)


Primary Germ Layers

Implantation
The Uterus
Perimetrium
Myometrium
Endometrium
Placenta & Fetal Membranes
Placental formation
Chorion Frondosum
Formation of Umbilical Vessels
Fetal membranes
Umbilical Cord
Anomalies
Meckel’s Diverticulum
May indicate fetal demise, premature rupture of membranes
Omphalocele
Ectopic Pregnancy
Metastatic Carcinomas
Spread via lymph circulation
Rectouterine Pouch (of Douglas) or cul-de-sac
Hydrocephaly
Hydrocephalus
Anencephaly:
Porencephaly
Doppler U/S of the Circle of Willis in utero
Circle of Willis
Fetal circle of Willis: 3D U/S
Ultrasound-guided Prenatal Diagnosis
Amniocentesis and CVS
Pelvic masses
Uterine Anomalies
Uterus bicornis
Uterus didelphys
Uterus unicornis

PREGNANCY 1st and 2nd Trimesters.ppt

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High Risk Pregnancy

High Risk Pregnancy
Presentation By:Susan Sienkiewicz

Adolescent Pregnancy: Contributing Factors
Implications of Adolescent Pregnancy
Socioeconomic:
* reliance on welfare
* cycle repeats itself

Maternal health:
* CPD
* PIH
* anemia
* nut deficits
* mortality

Fetal Health:
* LBW
* prematurity
* resp complications
* cp
* cognitive deficits
* death

Adolescent Pregnancy: Assessment
* Risks
* fundal height
* # of sexual partners
* knowledge of infant care/needs
* family unit/support system
* baseline VS/weight

IMPLICATIONS OF DELAYED PREGNANCY
* Pre-existing conditions
* Preterm labor SGA/LBW
* IUGR
* PIH Abruption
* C-section
* Uterine fibroids PP hemorrhage
* Chromosomal abnormalities


DELAYED PREGNANCY: ASSESSMENT
* Pre-existing conditions
* Fundal height
* Anxiety
* Psychosocial issues

TYPES OF SPONTANEOUS ABORTIONS
Spontaneous Abortion Management
Threatened
Inevitable
Incomplete
Missed
Post Abortion Education
SITES OF ECTOPIC PREGNANCY
S & S Ectopic Pregnancy
Surgical Management of Ectopic Pregnancy
Med Mgmt of Ectopic PG
MTX
S & S Hydatiform Mole
Therap. Mgmt: vacuum aspiration & curettage
Spontaneous Abortion Matching – Choose all that apply.
Medical Mgmt of Placenta Previa
Mom stable,fetus immature
Fetus > 36 wks
S&S Abruptio Placentae
Med Mgmt of Placental Abruption
Placental Bleeding
Thromboplastin release
Clot formation (systemic response)
clotting factors (fibrinogen, plts, PTT, FDP)
inability to form clots
profuse bleeding
Hemorrhagic Conditions: Abruption & DIC
ASSESSMENT
The Pathological Processes of Pre-eclampsia
S&S Pre-eclampsia
Treatment of Pre-eclampsia
Mild: diastolic
Severe: diastolic
S&S Eclampsia/HELLP Syndrome
* Eclampsia
* HELLP Syndrome
Treatment of Eclampsia/HELLP Syndrome
* Bedrest
* Meds
* Delivery
Assessment: Hypertensive Disorders of Pregnancy
Risk Control Strategies for Hypertensive Disorders of Pregnancy
Incompetent Cervix
Treatment
Premature Labor/Rupture of Membranes
Nursing Care for PTL/PROM
Postterm Pregnancy
Disorders of Amniotic Fluid
Risks of Multifetal Gestation
(Fetal) S&S Rh Incompatibility
Sequence of Assessments for Rh Sensitization
Blood Test for Type & Rh Factor
Management of Rh Incompatibility
Prenatal
Hyperemesis Gravidarum
Glucose Tolerance Test
Gestational Diabetes is diagnosed with FBS > 105 or with 2 of the following BS results:
Effects of Pre-Existing DM
* Maternal
* Fetal
Treatment of Pre-existing DM
Effects of Gestational Diabetes
Diabetes: Patient Education
PPCM: Manifestations
PPCM: Energy Management
PPCM: Cardiac Care
PPCM: Patient Education
Sickle Cell Disease
Systemic Lupus Erythematosis
AIDS
Treatment:
CASE STUDY

High Risk Pregnancy.ppt

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Pelvic Masses

Pelvic Masses
Preentation by:Anna Mae Smith, MPAS, PA-C
Lock Haven University

Central Pelvic Masses
* Pregnancy
* Leiomyomata - uterine fibroids
* Endometrial malignancy or uterine sarcoma
* Ovarian or other laterally located masses may present centrally
* Bladder

Leiomyomas
* benign smooth muscle tumors of the uterus
* commonly called “fibroids”
* estrogen dependent
* rarely occur before menarche or after menopause
* grow larger during pregnancy
* rarely malignant
* most common indication for pelvic surgery in women

Leiomyomas in Pregnancy
* interfere with fetal growth and nutrition
* increase the risk of
o spontaneous abortion during the first and second trimesters
o preterm labor

Epidemiology of Leiomyomas
* develop from smooth muscle cells by means of metaplasia
* cause for growth is unknown
* occurs in 20% of women of reproductive age
o most often occurs among African American women
o nulliparous women
o women older than 35
o nonsmokers
o oral contraceptive or IUD users


Classification of Leiomyomas
* submucous - protrude into the uterine cavity
* intramural - within the myometrial wall
* subserous - growing toward the serous surface of the uterus
* intraligamentous - located in the cervix or in between the folds of the broad ligament

Leiomyomas: Symptoms
* usually asymptomatic
* symptoms increase as tumors grow
* common symptoms
o pelvic pressure
o bloating
o pelvic congestion
o feeling of “heaviness”
o urinary frequency
o dysmenorrhea
o dyspareunia
o menorrhagia
o pain - less common
* may report infertility
* pregnant women complain more of pain

Leiomyomas: Physical Exam
* absence of ascites
* normal bowel sounds
* enlarged uterus that is firm and irregular but not tender
* may be mistaken for adnexal mass if situated laterally
* if mass moves with the uterus, likely to be a leiomyoma

Leiomyomas: Diagnostic Tests
* CBC to determine if anemic
* UA to r/o urinary tract infection
* Pregnancy test
* Hemoccult
* Ultrasound
* Barium enema
* IVP
* Endometrial biopsy

Leiomyomas: Differential Diagnoses
* ovarian neoplasm
* tubo-ovarian inflammatory mass
* diverticular inflammatory mass
* pregnancy
* ectopic pregnancy
* adenomyosis
* pelvic kidney
* malignancy

Leiomyomas: Treatment
Leiomyomas: Conservative Surgery
* myomectomy
* Leiomyomas: Hysterectomy
* GI Tract

Lateral Pelvic Masses
* Ovary
* Normal premenopausal ovary - 3x2x1.5cms
* Early Menopausal ovary - 2x1.5x0.5cms
* Postmenopausal ovary - 1.5x0.75x0.5cms
* GI causes
* Pelvic kidney
* PID with tubo-ovarian abscess
* Ectopic pregnancy

Ectopic Pregnancy
* Potentially life-threatening condition in which the embryo implants outside the uterine endometrial cavity.
* Leading cause of pregnancy-related death during the first trimester
* Must be considered in all sexually active women of reproductive age who have abdominal pain or abnormal vaginal bleeding

Risk Factors for Ectopic
* current IUD use
* previous tubal surgery
* history of pelvic inflammatory disease
* history of infertility
* In-utero DES exposure
* H/o STD’s
* Smoking
* Progesterone only contraception
* Use of fertility drugs

Classic Triad of Symptoms
* Amenorrhea
* Irregular vaginal bleeding
* Pelvic pain

Physical Findings of Ectopic Pregnancy
* Prior to rupture may feel nothing…usually some form of abnormal bleeding present
* Ruptured:
o Hypovolemic/orthostatic hypotension
o Peritoneal signs
o Positive CMT & adnexal tenderness
o Bulging cul-de-sac of Douglas

Ectopic Testing
Fallopian Tube
Dermoid Cyst/Teratoma
Ovary
Laparoscopy

Pelvic Masses.ppt

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