NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

TYPES OF SEXUAL ORIENTATION 1. HETEROSEXUALITY: one who finds sexual fulfillment with a mem e! of the o""osite sex. #e$ause inte!est in the o""osite sex and sexual !elationshi"s ma% e&in as ea!l% as the e&innin& of "u e!t%. '1()1* Y!s old.+ , H- "!o.ide!s need to "!o.ide info!mation on safe sex "!a$ti$es as ea!l% as this a&e fo! the info!mation and the /nowled&e to e most hel"ful. *. HO0OSEXUALITY: is findin& sexual fulfillment wit a mem e! of his1he! own sex. 2h% homosexual &ende! identit% de.elo"s is un/nown, althou&h most indi.iduals who a!e homosexual !e"o!t a !eali3ation that the% a!e 4diffe!ent5 e.en as ea!l% as efo!e "u e!t%. It is "!o a l% du!in& thei! adoles$en$e in see/in& a sense of identit% that the% !eali3e that the !eason the% feel 4diffe!ent 4is e$ause the% a!e homosexual. It is im"o!tant that health $a!e "!o.ide!s e sensiti.e to thei! needs in this time of identit% fo!mation. The!e is a hi&he! sui$ide !is/ found in &a% and les ian adoles$ents e$ause of eithe! fea! of so$ial sti&ma, o! ha.in& the tu!moil of identit% $onfusion. 6. #ISEXUALITY: "eo"le who a!e isexual a$hie.e sexual satisfa$tion f!om oth homosexual and hete!osexual !elationshi"s. 7a% and isexual men ha.e a hi&he! !is/ fo! a$8ui!in& ST9:s. The !ole of the H- "!o.ide! is to ensu!e that suffi$ient info!mation and /nowled&e a out HI; and ST9:s a!e &i.en. <. TRA=SSEXUALITY: a t!anssexual indi.idual is one who, althou&h of 1 iolo&i$ &ende! feels as if he1 she should e of the o""osite &ende!. Su$h "eo"le ma% unde!&o sex $han&e so the% a""ea! $osmeti$all% as the sex the% en.ision themsel.es to e. Althou&h the "e!son e$omes $a"a le of sexual inte!$ou!se in this new !ole, the% a!e in$a"a le of !e"!odu$tion. STAGES OF FETAL DEVELOPMENT: fetal &!owth and de.elo"ment is di.ided into 6 "e!iods: 1. "!e) em !%oni$) 1st * wee/s e&innin& with fe!tili3ation *. em !%oni$) f!om wee/s 6)> 6. fetal) f!om wee/ > th!ou&h i!th

FERTILIZATION: the union of the o.um and the s"e!mato3oon. Usuall% o$$u!s in the distal thi!d "o!tion of the fallo"ian tu e. life s"an of s"e!m $ell) <>)?* hou!s life s"an of e&& $ell) *<)<* hou!s an e@a$ulation of semen a.e!a&es *.Aml of fluid $ontainin& A()*((million s"e!m $ells "e! ml. at the time of o.ulation, the!e is a de$!ease in the thi$/ness of the $e!.i$al mu$ous ma/in& it easie! to e "enet!ated % the s"e!m $ell. S"e!m $ells de"osited in the .a&ina du!in& inte!$ou!se &ene!all% !ea$h the $e!.ix within B( se$onds and the oute! end of the fallo"ian tu e within A minutes afte! de"osition. S"e!m $ells mo.e % means of thei! fla&ella 'tails+ and with the hel" of ute!ine $ont!a$tions th!ou&h the $e!.ix, the od% of the ute!us, to the fallo"ian tu es, and to the waitin& o.um. A "!oteol%ti$ en3%me 'HYALURO=I9ASE+ a$ts to dissol.e the la%e! "!ote$tin& the o.um, ma/in& it easie! to "enet!ate. Immediatel% afte! the "enet!ation of the s"e!m $ell to the o.um, the $h!omosomal mate!ial of the s"e!m and the o.um fuse. The !esultin& st!u$tu!e is $alled the CY7OTE. De!tili3ation de"ends on at least 6 fa$to!s: a. matu!ation of oth the s"e!m and the o.um . a ilit% of the s"e!m to !ea$h the o.um $. a ilit% of the s"e!m to "enet!ate the o.um

IMPLANTATION: - On$e fe!tili3ation is $om"lete, the 3%&ote mi&!ates towa!ds the od% of the ute!us. This usuall% ta/es 6)< da%s. 9u!in& this time, mitoti$ $ell di.ision1 $lea.a&e e&ins. The 1 st $lea.a&e o$$u!s a out *< hou!s. #% the time the 3%&ote !ea$hes the od% of the ute!us, it al!ead% $onsists of 1E)A( $ells. At this sta&e, e$ause of its um"% outwa!d a""ea!an$e, it is te!med as the 0ORULLA 'mul e!!%+. - The mo!ulla $ontinues to multi"l% as it floats f!ee in the ute!ine $a.it% fo! 6)< mo!e da%s. At this sta&e, the st!u$tu!e is $alled a #LASTO-YST. It is this st!u$tu!e that atta$hes to the endomet!ium of the ute!us. - Im"lantation o$$u!s a""!oximatel% >)1( da%s afte! fe!tili3ation. - Then these 6 sta&es follow: 1. The lasto$%st !ushes a&ainst the endomet!ium 'a""osition+.

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NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

*. it atta$hes to the su!fa$e of the endomet!ium 'adhesion+ 6. and then settles down into the soft folds of the endoment!ium 'in.asion+ The im"lantation "oint is usuall% hi&h in the ute!us, on the "oste!io! su!fa$e. If the "oint of im"lantation is low in the ute!us, the &!owin& "la$enta ma% o$$lude the $e!.ix, and ma% ma/e the deli.e!% of the fetus diffi$ult 'FLA-E=TA FRE;IA+ EM#RYONI% AND FETAL STRU%TURES

1. The decidua- afte! fe!tili3ation, im"lantation ha""ens in the endomet!ium of the ute!us. The de$idua, the la%e! that thi$/ens in o!de! to $ushion the e&& does not slide off ut instead $ontinues to &!ow in thi$/ness. The de$idua has 6 se"a!ate a!eas: a. de$idua asalis) the "a!t of the endomet!ium l%in& di!e$tl% unde! the em !%o . de$idua $a"sula!is) the "o!tion of the endomet!ium that st!et$hes o! en$a"sulates the t!o"ho last $. de$idua .e!a) the !emainin& "o!tion of the ute!ine linin& *. chorionic villi- on$e im"lantation is a$hie.ed, the t!o"ho lasti$ la%e! of the $ells of the lasto$%st e&in to matu!e !a"idl%. As ea!l% as the 11th o! 1*th da%, fin&e! li/e "!o@e$tions o! $ho!ioni$ .illi !ea$h out f!om the sin&le la%e! of $ells into the ute!ine endomet!ium. ) The oute! la%e! of the $ho!ioni$ .illi de.elo"s into a se"a!ate ho!mone "!odu$in& s%stem "!odu$in& the followin&: a. H-7 'human $ho!ioni$ &onadot!o"in+ this is the 1st ho!mone to e "!odu$ed. It $an e found in mate!nal lood and u!ine as ea!l% as the time of the fi!st missed menst!ual "e!iod until a out the 1((th da% of "!e&nan$%. . est!o&en: "!ima!il% ESTRIOL $ont!i utes to the mothe!:s mamma!% &land de.elo"ment in "!e"a!ation fo! la$tation and it also stimulates ute!ine &!owth to a$$ommodate the de.elo"in& fetus. $. "!o&este!one: is essential to maintain the endomet!ial linin& of the ute!us du!in& "!e&nan$%. This ho!mone also a""ea!s to de$!ease $ont!a$tilit% of the ute!ine mus$les du!in& "!e&nan$%, thus "!e.entin& "!ematu!e la o!. d. Human "la$ental la$to&en: is a ho!mone with eithe! &!owth "!omotin& and la$to&eni$ o! mil/ "!odu$in& "!o"e!ties. It is "!odu$ed as ea!l% as the E th wee/ of "!e&nan$%. It "!omotes mamma!% &land &!owth in "!e"a!ation fo! la$tation in the mothe!. It also se!.es to !e&ulate mate!nal &lu$ose, -HO=, and fat le.els so that ade8uate le.els of these a!e alwa%s a.aila le to the fetus. 6. Placenta- the "la$enta 'Latin fo! "an$a/e+ a!ises out of t!o"ho last tissue. It se!.es as the fetal lun&s, /idne%s, &ast!ointestinal t!a$t, and as a se"a!ate endo$!ine o!&an th!ou&hout "!e&nan$%. A "la$enta wei&hs <(()E((&. <. Umbilical cord) fun$tions to t!ans"o!t ox%&en and nut!ients to the &!owin& fetus f!om the "la$enta and to !etu!n the waste "!odu$ts of the fetus to the "la$enta. This is a out *()*1 in$hes lon& and *$m thi$/. - The ul/ of the $o!d is a &elatinous mu$$o"ol%sa$$ha!ide $alled 2HARTO=:s GELLY whi$h &i.es the $o!d od% and "!e.ents "!essu!e on the .ein and a!te!ies. - The um ili$al $o!d has no ne!.e su""l% A. membranes and amniotic fluid) the amnioti$ mem !ane and the $ho!ioni$ mem !ane $o.e! the fetal su!fa$e of the "la$enta and &i.e that su!fa$e it:s t%"i$al shin% a""ea!an$e. - The amnioti$ mem !ane "!odu$es, and su""o!ts the amnioti$ fluid. - A de$!ease in the amount of the amnioti$ fluid is te!med as OLI7OHY9RA0I=OS - =o!mal amount of amnioti$ fluid is >(()1*((ml. - Amnioti$ fluid is sli&htl% al/aline with a "H of a out ?.* - The amnioti$ fluid is an im"o!tant "!ote$ti.e me$hanism fo! the fetus: a. it shields a&ainst "!essu!e o! a low to the mothe!:s a domen . It "!ote$ts the fetus f!om $han&es in tem"e!atu!e, e$ause li8uid $han&es tem"e!atu!e mo!e slowl% than ai!. $. It aids in mus$ula! de.elo"ment e$ause it allows f!ee mo.ement of the fetus d. It "!ote$ts the um ili$al $o!d f!om "!essu!e, "!ote$tin& fetal ox%&enation. FETAL DEVELOPMENT MILESTONES: THIS FART OD THE HA=9OUT IS YOUR A99ITIO=AL REA9I=7 ASSI7=0E=T - The len&th of the "!e&nan$% is &ene!all% measu!ed f!om the fi!st da% of the last menst!ual "e!iod ' 7ESTATIO=AL A7E + e"d of &'e (&' )es&$&!o"$l wee*

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NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

At the end of the <th wee/ of &estation, the human em !%o is a !a"idl% &!owin& fo!mation of $ells ut does not !esem le a human ein& @ust %et. len&th is (.?A ti 1 $m wei&ht is <((m& the s"inal $o!d is fo!med and fused at the mid"oint late!al win&s that will fo!m the od% a!e folded fo!wa!d to fuse at the midline head folds fo!wa!d and e$omes "!ominent, $om"!isin& a out 116 of the enti!e st!u$tu!e the a$/ is ent so that the head almost tou$hes the ti" of the tail &'e r+d!,e"&$ry 'e$r& $ e$rs $s $ ro,!"e"& -+l)e o" &'e $"&er!or s+rf$.e a!ms and le&s a!e ud li/e st!u$tu!es !udimenta!% e%es, ea!s, and nose a!e dis$e!ni le e"d of &'e /&' )es&$&!o"$l wee* len&th is *.A $m o! 1 in$h wei&ht is *(& or)$"o)e"es!s !s .o, le&e the hea!t with .al.es and a se"tum eats !h%thmi$all% fa$ial featu!es a!e dis$e!ni le ext!emities ha.e de.elo"ed e0&er"$l )e"!&$l!$ $re rese"& -+& se0 !s "o& d!s&!")+!s'$-le -y s!, le o-ser1$&!o" the "!imiti.e tail is !e&!essin& a domen a""ea!s la!&e as fetal intestines a!e &!owin& !a"idl% so"o)r$, s'ows $ )es&$&!o"$l s$. e"d of &'e 23&' )es&$&!o"$l wee* 4 2s& &r!,es&er5 len&th is ?)B $m wei&ht is <A& nail eds a!e fo!min& on hands and toes s"ontaneous mo.ements a!e "ossi le althou&h a!e too faint to e felt % the mothe! so,e refle0es s+.' $s &'e -$-!"s*! refle0 $re rese"& one ossifi$ation $ente!s a!e fo!min& tooth uds a!e "!esent se0 !s d!s&!")+!s'$-le -y o+&s!de $ e$r$".e /idne% se$!etion has e&un, althou&h u!ine ma% not e "!esent %et in the amnioti$ fluid 'e$r& -e$& !s $+d!-le -y $ Do ler e"d of 26&' )es&$&!o"$l wee* len&th is 1()1? $m wei&ht is AA)1*( & fe&$l 'e$r& so+"ds $re $+d!-le w!&' $" ord!"$ry s&e&'os.o e l$"+)o 4f!"e '$!r o" -$.* $"d $r,s of &'e -$-y w'!.' ser1es $s $ so+r.e for !"s+l$&!o"5 !s well for,ed li.e! and "an$!eas a!e fun$tionin& fe&+s $.&!1ely sw$llows $,"!o&!. fl+!d7 de,o"s&r$&!") $" !"&$.& -+& +".oord!"$&ed sw$llow!") refle0 e"d of 38&' )es&$&!o"$l wee* len&th is *A $m wei&ht is a!ound **6& s"ontaneous felt mo.ements $an e felt % the mothe! anti od% "!odu$tion is "ossi le hai! fo!ms in$ludin& in e%e !ows and hai! on head ,e.o"!+, !s rese"& o" + er !"&es&!"e #row" f$& -e)!"s &o -e for,ed -e'!"d &'e *!d"eys7 &'e s&er"+,7 $"d &'e os&er!or "e.*. T'!s $!ds !" &'er,ore)+l$&!o" $& -!r&' fe&$l 'e$r& -e$& !s s&ro") e"o+)' &o -e 'e$rd &'ro+)' &'e $-do,e" w!&' $" ord!"$ry s&e&'os.o e

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NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

1er"!0 .$seos$ -e)!"s &o for,. T'!s !s $ .'eesy w'!&e s+-s&$".e rod+.ed -y &'e se-$.eo+s )l$"ds. Def!"!&e slee $"d $.&!1!&y $&&er"s $re d!s&!")+!s'$-le

e"d of 3(&' )es&$&!o"$l wee* 4 3"d &r!,es&er5 len&th is *>)6E$m wei&ht is a out AA(& $ss!1e $"&!-ody &r$"sfer fro, ,o&'er &o fe&+s $s &'e 38&' wee* of )es&$&!o" me$onium is "!esent as fa! as the !e$tum $.&!1e rod+.&!o" of l+") s+rf$.&$"& -e)!"s e%e !ows and e%elashes a!e well defined e%elids "!e.iousl% fused sin$e the 1*th wee/ now o"en + !ls $re .$ $-le of re$.&!") &o l!)'&

ro-$-ly -e)!"s $s e$rly

e"d of &'e 3/&' )es&$&!o"$l wee* len&th is 6A)6>$m wei&ht is a out 1*((& l+") $l1eol! -e)!" &o ,$&+re $"d s+rf$.&$"& .$" -e de&e.&ed !" &'e $,"!o&!. fl+!d &es&es -e)!" &o des.e"d !"&o &'e s.ro&$l s$. fro, &'e lower $-do,!"$l .$1!&y !" ,$les the lood .essels of the !etina a!e hi&hl% sus$e"ti le to dama&e f!om hi&h o* $on$ent!ations e"d of &'e 93"d )es&$&!o"$l wee* len&th is 6>)<6$m wei&ht is a out 1E((& su $utaneous fat e&ins to e de"osited fe&+s !s $w$re of &'e so+"ds o+&s!de &'e ,o&'er:s -ody $.&!1e ,oro refle0 !s rese"& deli.e!% "osition ' .e!tex o! !ee$h+ ma% e assumed i!on sto!es that "!o.ide i!on du!in& the time that the a % will in&est onl% mil/ afte! i!th a!e e&innin& to de.elo" f!")er"$!ls )row $"d re$.' $& &'e e"d of &'e f!")er&! s e"d of &'e 96&' )es&$&!o"$l wee* len&th is <*)<B$m 2ei&ht is 1B(()*?((& 'A)El s.+ od% sto!es of i!on, &l%$o&en, $al$ium and $a! oh%d!ates a!e au&mented Additional amounts of su $utaneous fats a!e de"osited. Sole of the foot has onl% 1 o! * $!eases $om"a!ed to the full $!is $!oss "atte!n that will e e.ident at te!m Amount of lanu&o "!esent e&ins to diminish Mos& -$-!es w!ll &+r" !"&o $ 1er&e0 os!&!o" or 'e$d dow" rese"&$&!o" d+r!") &'!s ,o"&' e"d of &'e (8&' )es&$&!o"$l wee* 4 9rd &r!,es&er5 len&th is <>)A*$m wei&ht is a out 6(((& '?)>l s.+ fetus /i$/s a$ti.el%) ha!d enou&h to $ause the mothe! some dis$omfo!t Fe&$l 'e,o)lo-!" -e)!"s !&s .o"1ers!o" &o $d+l& 'e,o)lo-!". A& -!r&'7 $-o+& 38; of 'e,o)lo-!" w!ll -e $d+l& !" .'$r$.&er 1er"!0 .$seos$ !s f+lly for,ed fin&e! nails extend o.e! the fin&e!ti"s .re$ses o" &'e soles of &'e fee& .o1er $& le$s& 3<9 of &'e s+rf$.e of &'e foo& )in "!imi"a!as' 1st time mothe!s+ the fetus often sin/s into the i!th $anal du!in& these last * wee/s &i.in& the mothe! a feelin& that he! load is ein& li&htened.. This e.ent is te!med as LIG=TENING. It is a fetal announ$ement that the 6 !d t!imeste! of "!e&nan$% has ended and i!th is at hand.

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NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

P=YSIOLOGI% %=ANGES IN PREGNAN%Y SHI=: As the ute!us $han&es in si3e, the a dominal wall must st!et$h to a$$ommodate it. This st!et$hin& $an $ause !u"tu!e and at!o"h% of small se&ments of the $onne$ti.e la%e! of the s/in. This leads to "in/ o! !eddish st!ea/s 'STRIAE 7RA;I9ARU0+ a""ea!in& on the sides of the a dominal wall and sometimes on the thi&hs. The um ili$us is also st!et$hed that it e$omes o lite!ated and smooth e$ause it has een "ushed so fa! outwa!d. Ext!a "i&mentation also a""ea!s on the a dominal wall. A !own line 'LI=EA =I7RA+ !unnin& f!om the um ili$us to the s%m"h%sis "u is ma% also e "!esent. 9a!/ened a!eas ma% also a""ea! on the fa$e "a!ti$ula!l% on the $hee/s and a$!oss the nose ' 0ELAS0A+ o! the Imas/ of "!e&nan$%: All these a!e due to the melano$%te stimulatin& ho!mones se$!eted % the "ituita!%. This ho!mone le.el de$!eases afte! "!e&nan$% and the on$e da!/ened a!eas a&ain li&hten. ;as$ula! s"ide!s a!e sometimes seen on the thi&hs of the woman du!in& "!e&nan$%. This is $aused % an in$!ease in the le.el of est!o&en du!in& "!e&nan$%.

-AR9IO;AS-ULAR: #lood loss at a no!mal .a&inal deli.e!% is a out 6(()<((ml whe!eas lood loss f!om a $aesa!ean i!th is mu$h hi&he! at a out >(()1(((ml. almost all women need i!on su""lements du!in& "!e&nan$% e$ause of the followin& !easons: a. women ha.e a $om"a!ati.el% low i!on sto!a&e of less than A((m& e$ause of thei! monthl% menst!ual loss . The fetus !e8ui!es a out 6A()<((m& of i!on in o!de! to &!ow. $. I!on a so!"tion ma% e de$!eased du!in& "!e&nan$% as a !esult of de$!eased &ast!i$ a$idit%, so additional i!on is "!es$!i ed du!in& "!e&nan$% to "!e.ent anemia. 2omen should also in$!ease thei! inta/e of foli$ a$id 's"ina$h, as"a!a&us, and le&umes+ to hel" !edu$e the !is/ fo! neu!al tu e defe$ts in the fetus. To handle the in$!ease in lood .olume, a woman:s $a!dia$ out"ut in$!eases. The ha!t !ate in$!eases % 1( eats "e! minute 9u!in& the 6!d t!imeste!, lood flow to the lowe! ext!emities is im"ai!ed e$ause of the "!essu!e of the ex"andin& ute!us to the a!te!ies and .eins of the lowe! ext!emities, whi$h slows the $i!$ulation to the a!ea. This leads to edema, and .a!i$osities to the !e$tum, .ul.a, and le&s. 9es"ite the in$!ease in lood .olume in "!e&nan$% 'HYFER;OLE0IA+ the lood "!essu!e does not no!mall% !ise e$ause of the in$!eased hea!t a$tion. 2hen a woman lies su"ine, the wei&ht of the ute!us "!esses on the .ena $a.a o st!u$tin& the lood flow f!om the lowe! ext!emities. This !esults to a de$!eased lood flow to the hea!t and in tu!n HYFOTE=SIO=. This is dan&e!ous e$ause it $an lead to fetal HYFOXIA. ' Inte!.ention: L side L%in&+ RESFIRATORY: 0ost women would $om"lain of 9O# o! sho!tness of !eath as the "!e&nan$% "!o&!esses. #e$ause as the ute!us enla!&es, "!essu!e is "ut on the dia"h!a&m, and ultimatel% on the lun&s. #!eathin& !ate also e$omes mo!e !a"id du!in& "!e&nan$% '1>)*( !eaths "e! min.+ The mothe! ma% also $om"lain of Istuffiness: o! $on&estion of the naso"ha!%nx. This is no!mal e$ause of the in$!ease in the le.els of est!o&en. #REAST:

#!east $han&es ma% e one of the fi!st "h%siolo&i$ $han&es a woman will feel du!in& "!e&nan$% e$ause of the $han&e in the le.els of est!o&en and "!o&este!one. A feelin& of fullness, tin&lin&, o! tende!ness in the !east ma% e felt e$ause of the in$!eased le.els of est!o&en. As "!e&nan$% "!o&!esses, !east si3e also in$!eases e$ause of the h%"e!"lasia of the mamma!% al.eoli The a!eola also da!/ens in $olo! and its diamete! in$!eases f!om a out 6.A$m to A1 ?.A$m The se a$eous &lands of the a!eola ' 0O=T7O0ERY5S TU#ER-LES+ enla!&e. The se$!etions f!om these hel" "!e.ent the ni""les f!om $!a$/in& and d!%in&.

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NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

#% the 1Eth wee/ of "!e&nan$%, -OLOSTRU0 o! the thin hi&h "!otein fluid that is the "!e$u!so! of !east mil/ $an e ex"elled f!om the ni""les.

URI=ARY: alte!ations in fluid !etention, and !enal, u!ete!, and ladde! fun$tion U!ina!% f!e8uen$% is also noted to $han&e. 9u!in& the 1 st t!imeste!, and du!in& the last * wee/s of "!e&nan$% to a !ate of 1()1* time of .oidin& "e! da%. -han&es in the u!ina!% s%stem !esult f!om the followin&: a. effe$ts of est!o&en and "!o&este!one a$ti.it% . $om"!ession of the ladde! and u!ete!s % the &!owin& ute!us $. in$!ease lood .olume d. "ostu!al influen$es Dluid !etention is also seen du!in& "!e&nan$%. This !in&s a out edema es"e$iall% in the lowe! ext!emities. 2ate! is !etained du!in& "!e&nan$% to aid in the in$!ease in lood .olume and to se!.e as a !ead% sou!$e of nut!ients fo! the fetus. A#9O0I=AL 2ALL A=9 7IT: As the ute!us $ontinues to &!ow in si3e, it dis"la$es the stoma$h and intestines towa!ds the a$/ of the a domen. This "ushin& "!essu!e ma% $ause a de$!ease in the "e!istalti$ mo.ement leadin& to hea!t u!n, $onsti"ation, and flatulen$e. #e$ause lood is also d!awn to the ute!us, de$!eased lood su""l% to the &ast!ointestinal t!a$t is de$!eased and ma% $ause a de$!ease in the &ast!i$ motilit%. This is $aused % RELAXI=, a ho!mone "!odu$ed % the o.a!ies. F!o&este!one also has an effe$t on smooth mus$les 'intestines+ ma/in& them less a$ti.e. 0o!nin& si$/ness $an e noti$ed at the time H-7 and "!o&este!one le.els e&in to !ise... This ma% e also att!i uted to the de$!ease in &lu$ose le.els of the mothe! e$ause the &!owin& fetus utili3es &!eat 8uantities of &lu$ose as it de.elo"s. Hea!t u!n !esults f!om the !eflux of the stoma$h $ontents into the eso"ha&us as a !esult of the u"wa!d "ushin& of the ute!us to the stoma$h #e$ause of RELAXI=, whi$h !elaxes the eso"ha&eal s"hin$te!, hea!t u!n ma% also e felt The!e ma% also e in$!eased sali.a fo!mation 'HYFERFTYALIS0+ e$ause of the in$!eased le.els of est!o&en. SHELETAL -al$ium and "hos"ho!ous needs a!e in$!eased du!in& "!e&nan$% e$ause the fetal s/eleton must e uilt The!e is &!adual softenin& of the "el.i$ li&aments to fa$ilitate the "assa&e of the a % du!in& i!th 2ide se"a!ation of the s%m"h%sis "u is as mu$h as 6)<mm % the 6* nd wee/ of "!e&nan$% ma% o$$u!, ma/in& the woman wal/ with diffi$ult%. The woman also $han&es he! $ente! of &!a.it% e$ause of the wei&ht of the fetus, to ma/e am ulation easie!. 'LOR9OSIS+ REFRO9U-TI;E Ute!us len&th &!ows f!om a""!oximatel% E.A)6*$m de"th in$!eases f!om *.A)**$m width ex"ands f!om <)*<$m wei&ht in$!eases f!omE()1(((& -e!.ix softens du!in& "!e&nan$% tu!ns f!om "ale "in/ to .iolet lue in $olo! a tena$ious linin& of mu$ous fills the $e!.i$al $anal ' OFER-ULU0+ whi$h a$ts to seal out a$te!ia du!in& "!e&nan$% and hel" "!ote$t the fetus f!om infe$tion ;a&ina $han&es in $olo! f!om li&ht "in/ to da!/ .iolet O.a!% no "!odu$tion of DSH and LH so o.ulation does not o$$u! E=9O-RI=E: Fla$enta "!odu$tion of hi&h le.els of H-7, est!o&en, "!o&este!one, and !elaxin

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Ms. A r!l A""e D. #$l$"o"

NCM 101 Lecture Notes PRELIMS Handout 4 _____________________

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Fituita!% 7land in$!ease le.els of &!owth ho!mones, and melano$%te stimulatin& ho!mones) $ausin& s/in "i&ment $han&es Late in "!e&nan$%, the "oste!io! "ituita!% ho!mone "!odu$es OXYTO-I= whi$h will late! e needed du!in& la o!. Ad!enal 7lands In$!ease "!odu$tion of aldoste!one and $o!ti$oste!oids whi$h aid in the su""!ession of inflammato!% !ea$tion) so the woman:s od% would not !e@e$t the fetus &!owin& in he! wom . Also hel"s !e&ulate &lu$ose meta olism in the mothe! DANGER SIGNS OF PREGNAN%Y:

1. VAGINAL BLEEDING) a woman should !e"o!t .a&inal leedin& no matte! how sli&ht, e$ause a lot of the se!ious leedin& $om"li$ations a!ise f!om sli&ht s"ottin&. The nu!se should as/ the woman how she dis$o.e!ed he! s"ottin&. It $ould e "ossi le that leedin& f!om hemo!!hoids $ould e misinte!"!eted as s"ottin&. Assessment is .e!% im"o!tant to !ule out if the s"ottin& needs fu!the! e.aluation o! not. *. PE !I!TENT V"#ITING) 1x o! *x of .omitin& "e! da% is not un$ommon du!in& the 1 st t!imeste!. Howe.e!. Fe!sistent and f!e8uent .omitin& is not no!mal. 'HYFER E0ESSIS 7RA;I9ARU0+ .omitin& "ast the 1*th wee/ of "!e&nan$% is not no!mal. This is dan&e!ous e$ause it de"letes the fetus of its nut!itional su""l%. 6. $%ILL! AND &EVE ) this ma% e indi$ati.e of an int!aute!ine infe$tion and should e $he$/ed immediatel% <. !UDDEN E!$APE "& &LUID & "# T%E VAGINA ) ma% indi$ate "!ematu!e !u"tu!e of mem !anes. This ma% $ause the ute!ine $a.it% to e o"en to infxn, so it e$omes a th!eat to oth mothe! and a %. - This ma% also $ause the um ili$al $o!d to "!ola"se 'out f!om the ute!us and into the .a&inal $anal+ if the $o!d is $om"!essed % the fetal head, this ma% $!eate immediate dan&e! to oth. A. ABD"#INAL or $%E!T PAIN!) a dominal "ain ma% e indi$ati.e of an e$to"i$ "!e&nan$%, se"a!ation of the "la$enta, o! "!ete!m la o!. -hest "ains ma% e indi$ati.e of "ulmona!% em olus, whi$h ma% follow a $om"li$ation su$h as th!om o"hle itis. Se.e!e $hest o! a dominal "ain should the!efo!e "!om"t immediate assessment and inte!.ention. E. P EGNAN$' INDU$ED %'PE TEN!I"N) 'FIH+ this situation needs immediate assessment and !e8ui!es that the mothe! e monito!ed th!ou&hout he! "!e&nan$% so as not to endan&e! the life o! the life of the a %. si&ns of FIH in$lude the followin&: a. !a"id wt. &ain ' o.e! *l s "e! wee/ in the *nd t!imeste!+ . swellin& of the fa$e and fin&e!s $. flashes of li&ht o! dots efo!e the e%es d. dimness o! u!!in& of .ision e. se.e!e $ontinuous heada$he f. de$!ease in u!ine out"ut ?. IN$ EA!E " DE$EA!E IN &ETAL #"VE#ENT) A fetus no!mall% mo.es mo!e o! less the same amount e.e!%da%. An unusual in$!ease o! de$!ease in this mo.ement su&&ests eithe! that the fetus !es"onds to the need fo! ox%&en, o! the fetus is in dist!ess.

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Ms. A r!l A""e D. #$l$"o"