MODULE 1 Maternal and Child Health Goals and Standard

FRAMEWORK FOR MATERNAL AND CHILD  the UN and the WHO established a millennium health
HEALTH NURSING goals in an effort to improve health worldwide.
 established in 2000 and reviewed every 10 Years.
Goals and Philosophies of Maternal and Child Health  The two main national health goals set every 10
Nursing years:
Primary Goal: a. To increase quality and years of healthy life
Promotion and maintenance of optimal family health. b. To eliminate health disparities

Scope of practice: Global Health Goals:

a. Preconception health care  To end poverty and hunger.
b. Care of women during the three trimesters of  To achieve universal primary education.
pregnancy and the puerperium  To promote gender equality and empower women.
c. Care of infants during the perinatal period  To reduce child mortality.
d. Care of children from birth to late adolescent  To improve maternal health.
e. Care in a variety of hospital and home care settings.  To combat HIV/AIDS, malaria, and other diseases.
 To ensure environmental sustainability.
Philosophy of Maternal and Child Health Nursing  To develop a global partnership for development.
1. Family centered
A new objective added in 2010
2. Community centered
 Recommends that 100% of prelicensure programs
3. Evidence based
in nursing must include:
4. Challenging role for nurses
 core content on counseling for health promotion
and disease prevention
MCN can be visualized within a framework in which
 cultural diversity including for (LGBT) populations
nurses use the:
 evaluation of health sciences literature
1. Nursing Process  environmental health, public health systems and
2. Nursing Theory global health
3. Quality and Safety Education for Nurses (QSEN)
competencies and Research to care for families The 2020 National Health Goals are intended:
during the childbearing and childrearing years.  To help citizen more easily understand the
4. Through the Four Phases of Health Care: importance of health promotion and disease
A. Health Promotion prevention.
B. Health Maintenance  To encourage wide participation in improving health
C. Health Restoration in the next decade.
D. Health Rehabilitation
Roles and responsibilities of maternal and child
1. Nursing Process nurse
• a scientific form of solving nursing problem.  Considers the family as a whole and as a partner in
• serves as the basis for assessing, formulating a care when planning or implementing or
nursing diagnosis, planning, implementing and evaluating the effectiveness of care.
evaluating care.  Serves as an advocate to protect the rights of all
family members including the fetus.
2. Nursing Theories
• Are designed to offer helpful ways to view patients so  Demonstrates a high degree of independent
nursing activities can be created to best meet nursing functions.
patient’s needs:  Promotes health and disease prevention
a. Calista Roy’s theory  Serves as an important resource for families during
b. Dorothea Orem’s theory childbearing and child-rearing.
c. Patricia Benner’s theory  Respects personal, cultural and spiritual attitudes
and beliefs.
3. Quality and Safety Education for Nurses (QSEN)  Encourages developmental stimulation during both
• the goal of this QSEN is to address the challenge of health and illness.
preparing future nurses with the abilities  Assesses family for strengths as well as specific
necessary needs or challenges.
• to continuously improve the quality and safety of the  Encourages family bonding through rooming in and
health care systems in which they work family visiting in maternal and child healthcare
setting.
QSEN Competencies Required for MCN  Encourages early hospital discharge options to
• Patient Centered reunite families as soon as possible.
• Teamwork & Collaboration  Encourages families to reach out to their
• Evidence- Based Practice community.
• Quality Improvement
• Safety UN Sustainable Development Goals
• Informatics  building on the principle of “leaving no one behind”
 the new Agenda emphasizes a
4. Research  holistic approach to achieving sustainable
 Nursing Research development for all.
• the systematic investigation of problems that have  the Sustainable Development Goals (SDGs) also
implications for nursing practice usually carried out by explicitly include disability and persons with
nurses. disabilities 11 times.
• Nursing Research can influence nursing practice
 The high numbers of persons with disabilities who are
disproportionately represented among the world’s most
marginalized groups have a profound significance with
respect to the implementation of the SDGs. Eighty per
cent of persons with disabilities live in developing
countries, and the failure to include and integrate them
in all development activities will mean failure to achieve
the SDGs.

SDGs throughout its 15-year lifespan with
objectives to:
 Raise awareness of the 2030 Agenda and the
achievement of the SDGs for persons with
disabilities;
 Promote an active dialogue among stakeholders on
the SDGs with a view to create a better world for
persons with disabilities; and
 Establish an ongoing live web resource on each SDG
and disability.
GOAL 1: End poverty in all its forms everywhere
Targets:
• Implement nationally appropriate social protection
systems and measures for all, including floors, and by
2030 achieve substantial coverage of the poor and the
vulnerable.
• By 2030, ensure that all men and women, in particular
the poor and the vulnerable, have equal rights to
economic resources, as well as access to basic
services, ownership and control over land and other
forms of 13 property, inheritance, natural resources,
appropriate new technology and financial services,
including micro-finance.
• By 2030, build the resilience of the poor and those in
vulnerable situations and reduce their exposure and
vulnerability to climate-related extreme events and
other economic, social and environmental shocks and
disasters.
• Ensure significant mobilization of resources from a
variety of sources, including through enhanced
development cooperation, in order to provide
adequate and predictable means for developing
countries, in particular least developed countries, to
implement programmes and policies to end poverty in
all its dimensions.
• Create sound policy frameworks at the national,
regional and international levels, based on pro-poor
and gender-sensitive development strategies, to
support accelerated investment in poverty
eradication actions
GOAL 2: End hunger, achieve food security and
improved nutrition and promote sustainable
agriculture
Targets:
 By 2030, end hunger and ensure access by all
people, in particular the poor and people in
vulnerable situations, including infants, to safe,
nutritious and sufficient food all year round.
 By 2030, double the agricultural productivity and
incomes of small-scale food producers, in
particular women, indigenous peoples, family
farmers, pastoralists and fishers, including
through secure and equal access to land, other
productive resources and inputs, knowledge,
financial services, markets and opportunities for
value addition and non-farm employment
 By 2030, ensure sustainable food production
systems and implement resilient agricultural
practices that increase productivity and
production, that help maintain ecosystems, that
strengthen capacity for adaptation to climate
change, extreme weather, drought, flooding and
other disasters and that progressively improve
land and soil quality
 By 2020, maintain the genetic diversity of seeds,
cultivated plants and farmed and domesticated
animals and their related wild species, including
through soundly managed and diversified seed
and plant banks at the national, regional and
international levels, and promote access to and
fair and equitable sharing of benefits arising from
the utilization of genetic resources and
associated traditional knowledge, as
internationally agreed
 Increase investment, including through
enhanced international cooperation, in rural
infrastructure, agricultural research and
extension services, technology development and
plant and livestock gene banks in order to enhance
agricultural productive capacity in developing
countries, in particular least developed countries.

Disability and Poverty
• There is a strong bidirectional link between poverty
and disability. Poverty may cause disability through
malnutrition, poor healthcare, and dangerous living
conditions. Case studies in developing countries show
that higher disability rates are associated with higher
rates of illiteracy, poor nutritional status, lower
immunization coverage, lower birth weight, higher
rates of unemployment and underemployment, and
lower occupational mobility.
• Disability can cause poverty by preventing the full
participation of persons with disabilities in the
economic and social life of their communities,
especially if the appropriate supports and
accommodations are not available.
GOAL 3: Ensure healthy lives and promote well-
being for all at all ages
Targets:
 By 2030, reduce the global maternal mortality
ratio to less than 70 per 100,000 live births
 By 2030, end preventable deaths of
newborns and children under 5 years of age, with
all countries aiming to reduce neonatal mortality
to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per
1,000 live births
 By 2030, end the epidemics of AIDS,
tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne
diseases and other communicable diseases
 By 2030, reduce by one third premature mortality
 from non-communicable diseases through
prevention and treatment and promote mental
health and well-being
 Strengthen the prevention and treatment of
substance abuse, including narcotic drug abuse
and harmful use of alcohol
 By 2020, halve the number of global deaths and
injuries from road traffic accidents 3.7
 By 2030, ensure universal access to sexual and
reproductive health-care services, including
for family planning, information and education,
and the integration of reproductive health into
national strategies and programmes
 Achieve universal health coverage, including
financial risk protection, access to quality
essential health-care services and access to
safe, effective, quality and affordable
essential medicines and vaccines for all
 By 2030, substantially reduce the number of
deaths and illnesses from hazardous
chemicals and air, water and soil pollution and
contamination
 Strengthen the implementation of the World
Health Organization Framework Convention on
Tobacco Control in all countries, as appropriate
 Substantially increase health financing and the
recruitment, development, training and
retention of the health workforce in
developing countries, especially in least
developed countries and small island
developing States
 Strengthen the capacity of all countries, in
particular developing countries, for early
warning, risk reduction and management of
national and global health risks
GOAL 4: Ensure inclusive and equitable quality
education and promote lifelong learning
opportunities for all
Targets:
 By 2030, ensure that all girls and boys complete
free, equitable and quality primary and secondary
education leading to relevant and Goal-4 effective
learning outcomes
 By 2030, ensure that all girls and boys have a
access to quality early childhood development, care
and preprimary education so that they are ready for
primary education
 By 2030, ensure equal access for all women and
men to affordable and quality technical, vocational
and tertiary education, including university
 By 2030, substantially increase the number of youth
and adults who have relevant skills, including
technical and vocational skills, for employment,
decent jobs, and entrepreneurship
 By 2030, eliminate gender disparities in education
and ensure equal access to all levels of education
and vocational training for the vulnerable,
including persons with disabilities, indigenous
peoples and children in vulnerable situations
 By 2030, ensure that all youth and a substantial
proportion of adults, both men and women, achieve
literacy and numeracy
 By 2030, ensure that all learners acquire the
knowledge and skills needed to promote
sustainable development , including, among
others, through education for sustainable
development and sustainable lifestyles, human
rights, gender equality, promotion of a culture of
peace and non- violence, global citizenship and
appreciation of cultural diversity and of culture’s
contribution to sustainable development
 By 2020, substantially expand globally the number
of scholarships available to developing
countries, in particular least developed countries,
small island developing States and African countries,
for enrolment in higher education, including
vocational training and information and
communications technology, technical,
engineering and scientific programmes, in
developed countries and other developing
countries
 By 2030, substantially increase the supply of
qualified teachers, including through
international cooperation for teacher training in
developing countries, especially least developed
countries and small island developing states
GOAL 5: Achieve gender equality and empower
all women and girls
Targets:
 End all forms of discrimination against all women
and girls everywhere
 Eliminate all forms of violence against all women
and girls in the public and private spheres,
including trafficking and sexual and other types of
exploitation
 Eliminate all harmful practices, such as child,
early and forced marriage and female genital
mutilation
 Recognize and value unpaid care and domestic
work through the provision of public services,
infrastructure and social protection policies and
the promotion of shared responsibility within the
household and the family as nationally
appropriate
 Ensure universal access to sexual and
reproductive health and reproductive rights
as agreed in accordance with the Programme of
Action of the International Conference on
Population and Development and the Beijing
Platform for Action and the outcome
documents of their review conferences
 Undertake reforms to give women equal rights to
economic resources, as well as access to
ownership and control over land and other
forms of property, financial services,
inheritance and natural resources, in accordance
with national laws
 Enhance the use of enabling technology, in
particular information and communications
technology, to promote the empowerment of
women
 Adopt and strengthen sound policies and
enforceable legislation for the promotion of
gender equality and the empowerment of all
women and girls at all levels
GOAL 6: Ensure availability and sustainable
management of water and sanitation for all
Targets:
 By 2030, achieve universal and equitable access
to safe and affordable drinking water for all
 By 2030, achieve access to adequate and
equitable sanitation and hygiene for all and end
open defecation, paying special attention to
the needs of women and girls and those in
 vulnerable situations
 By 2030, improve water quality by reducing
p oll u tio n , elimin a ti ng dumping and
minimizing release of hazardous chemicals and
materials, halving the proportion of untreated
wastewater and substantially increasing
recycling and safe reuse globally
 By 2030, substantially increase water-use
efficiency across all sectors and ensure
sustainable withdrawals and supply of
freshwater to address water scarcity and
substantially reduce the number of people
suffering from water scarcity
 By 2030, implement integrated water
resources management at all levels, including
through transboundary cooperation as
appropriate
GOAL 7: Ensure access to affordable, reliable,
sustainable and modern energy for all
Targets:
 By 2030, ensure universal access to affordable,
reliable and modern energy services
 By 2030, increase substantially the share of
renewable energy in the global energy mix
 By 2030, double the global rate of improvement
in energy efficiency
 By 2030, enhance international cooperation to
facilitate access to clean energy research and
technology, including renewable energy, energy
efficiency and advanced and cleaner fossil- fuel
technology, and promote investment in energy
infrastructure and clean energy technology
 By 2030, expand infrastructure and upgrade
technology for supplying modern and
sustainable energy services for all in developing
countries, in particular least developed countries,
small island developing States, and land- locked
developing countries, in accordance with their
respective programmes of support
GOAL 8: Promote sustained, inclusive and
sustainable economic growth, full and productive
employment and decent work for all
Targets:
 Sustain per capita economic growth in accordance
with national circumstances and, in particular, at
least 7 per cent gross domestic product growth per
annum in the least developed countries
 Achieve higher levels of e co nomic
productivity through diversification,
technological upgrading and innovation, including
through a focus on high-value added and labor-
intensive sectors
 Promote development-oriented policies that support
productive activities, decent job creation,
entrepreneurship, creativity and innovation, and
encourage the formalization and growth of micro-,
small- and medium- sized enterprises, including
through access to financial services
 Improve progressively, through 2030, global
resource efficiency in consumption and production
and endeavor to decouple economic growth
from environmental degradation, in accordance
with the 10-year framework of programmes on
sustainable consumption and production, with
developed countries taking the lead
 By 2030, achieve full and productive
employment and decent work for all women and
men, including for young people and persons with
disabilities, and equal pay for work of equal value
 By 2020, substantially reduce the proportion of youth
not in employment, education or training
 Take immediate and effective measures to eradicate
forced labour, end modern slavery and human
trafficking and secure the prohibition and
elimination of the worst forms of child labour,
including recruitment and use of child soldiers, and
by 2025 end child labour in all its forms
 Protect labour rights and promote safe and secure
working environments for all workers, including
migrant workers, in particular women migrants, and
those in precarious employment
 By 2030, devise and implement policies to promote
sustainable tourism that creates jobs and promotes
local culture and products
 Strengthen the capacity of domestic financial
institutions to encourage and expand access to
banking, insurance and financial services for all
 Increase Aid for Trade support for developing
countries, in particular least developed countries,
including through the Enhanced Integrated
Framework for Trade-Related Technical Assistance
to Least Developed Countries
 By 2020, develop and operationalize a global
strategy for youth employment and implement
the Global Jobs Pact of the International Labour
Organization
GOAL 9: Build resilient infrastructure, promote
inclusive and sustainable industrialization and foster
innovation
Targets:
 Develop quality, reliable, sustainable and resilient
infrastructure, including regional and trans
border infrastructure, to support economic
development and human well- being, with a
focus on affordable and equitable access for all
 Promote inclusive and sustainable
industrialization and, by 2030, significantly raise
industry’s share of employment and gross
domestic product, in line with national
circumstances, and double its share in least
developed countries
 Increase the access of small-scale industrial and
other enterprises, in particular in developing
countries, to financial services, including
affordable credit, and their integration into
value chains and markets
 By 2030, upgrade infrastructure and retrofit
industries to make them sustainable, with
increased resource-use efficiency and
greater adoption of clean and environmentally
sound technologies and industrial processes,
with all countries taking action in accordance with
their respective capabilities
 Enhance scientific research, upgrade the
technological capabilities of industrial sectors in
all countries, in particular developing countries,
including, by 2030, encouraging innovation and
substantially increasing the number of research
and development workers per 1 million people
and public and private research and development
spending
 Facilitate sustainable and resilient
infrastructure development in developing
 countries through enhanced financial,
technological and technical support to African
countries, least developed countries, landlocked
developing countries and small island
developing States 18
 Support domestic technology development,
research and innovation in developing
countries, including by ensuring a conducive
policy environment for, inter alia, industrial
diversification and value addition to
commodities
 Significantly increase access to information and
communications technology and strive to
provide universal and affordable access to the
Internet in least developed countries by 2020
GOAL10: Reduce inequality within and among countries
Targets:
 By 2030, progressively achieve and sustain income
growth of the bottom 40 per cent of the population at
a rate higher than the national average
 By 2030, empower and promote the social,
economic and political inclusion of all, irrespective
of age, sex, disability, race, ethnicity, origin, religion
or economic or other status
 Ensure equal opportunity and reduce
inequalities of outcome, including by
eliminating discriminatory laws, policies and
practices and promoting appropriate
legislation, policies and action in this regard
 Adopt policies, especially fiscal, wage and social
protection policies, and progressively achieve
greater equality
 Improve the regulation and monitoring of global
financial markets and institutions and strengthen the
implementation of such regulations
 Ensure enhanced representation and voice for
developing countries in decision-making in global
international economic and financial institutions in
order to deliver more effective, credible,
accountable and legitimate institutions
 Facilitate orderly, safe, regular and
responsible migration and mobility of people,
including through the implementation of planned
and well-managed migration policies
 Implement the principle of special and differential
treatment for developing countries, in particular
least developed countries, in accordance with
World Trade Organization agreements
 Encourage official development assistance and
financial flows, including foreign direct investment, to
States where the need is greatest, in particular
least developed countries, African countries, small
island developing States and landlocked developing
countries, in accordance with their national plans
and programmes
 By 2030, reduce to less than 3 per cent the
transaction costs of migrant remittances and
eliminate remittance corridors with costs higher than
5 per cent
GOAL 11: Make cities and human settlements inclusive,
safe, resilient and sustainable
Targets:
 By 2030, ensure access for all to adequate, safe and
affordable housing and basic services and upgrade
slums
 By 2030, provide access to safe, affordable,
accessible and sustainable transport systems
for all, improving road safety, notably by expanding
public transport, with special attention to the needs of
those in vulnerable situations, women, children,
persons with disabilities and older persons
 By 2030, enhance inclusive and sustainable
urbanization and capacity for participatory, integrated
and sustainable human settlement planning and
management in all countries
 Strengthen efforts to protect and safeguard the world’s
cultural and natural heritage
 By 2030, significantly reduce the number of deaths
and the number of people affected and substantially
decrease the direct economic losses relative to
global gross domestic product caused by disasters,
including water-related disasters, with a focus on
protecting the poor and people in vulnerable
situations
 By 2030, reduce the adverse per capita
environmental impact of cities, including by paying
special attention to air quality and municipal and other
waste management
 Support positive economic, social and
environmental links between urban, peri- urban and
rural areas by strengthening national and regional
development planning
 By 2020, substantially increase the number of cities
and human settlements adopting and implementing
integrated policies and plans towards inclusion,
resource efficiency, mitigation and adaptation to
climate change, resilience to disasters, and develop
and implement, in line with the Sendai Framework for
Disaster Risk Reduction 2015-2030, holistic disaster
risk management at all levels
 Support least developed countries, including through
financial and technical assistance, in building
sustainable and resilient buildings utilizing local
materials
#Envision2030 Goal 12: Responsible Consumption
and Production
GOAL12: Ensure sustainable consumption and
production patterns
Targets:
 Implement the 10-year framework of
programmes on sustainable consumption and
production, all countries taking action, with developed
countries taking the lead, taking into account the
development and capabilities of developing countries
 By 2030, achieve the sustainable management and
efficient use of natural resources
 By 2030, halve per capita global food waste at the
retail and consumer levels and reduce food losses
along production and supply chains, including post-
harvest losses
 By 2020, achieve the environmentally sound
management of chemicals and all wastes throughout
their life cycle, in accordance with agreed
international frameworks, and significantly
reduce their release to air, water and soil in order to
minimize their adverse impacts on human health a
n d the environment
 By 2030, substantially reduce waste generation
through prevention, reduction, recycling and reuse
 Encourage companies, especially large and
transnational companies, to adopt sustainable
practices and to integrate sustainability information
into their reporting cycle
 Promote public procurement practices that are
sustainable, in accordance with national policies and
priorities
 By 2030, ensure that people everywhere have the
relevant information and awareness for sustainable
development and lifestyles in harmony with nature
 Support developing countries to strengthen their
scientific and technological capacity to move
towards more sustainable patterns of consumption
and production
 Develop and implement tools to monitor
sustainable development impacts for
sustainable tourism that creates jobs and promotes
local culture and products
 Rationalize inefficient fossil-fuel subsidies that
encourage wasteful consumption by removing
market distortions, in accordance with national
circumstances, including by restructuring taxation
and phasing out those harmful subsidies, where they
exist, to reflect their environmental impacts, taking
fully into account the specific needs and conditions
of developing countries and minimizing the possible
adverse impacts on their development in a
manner that protects the poor and the affected
communities
#Envision2030 Goal 13: Climate Action
GOAL13: Take urgent action to combat climate change
and its impacts
Targets:
 Strengthen resilience and adaptive capacity to
climate-related hazards and natural disasters in all
countries
 Integrate climate change measures into national
policies, strategies and planning
 Improve education, awareness-raising and human
and institutional capacity on climate change
mitigation, adaptation, impact reduction and early
warning
 Implement the commitment undertaken by
developed-country parties to the United Nations
Framework Convention on Climate Change to a goal
of mobilizing jointly $100 billion annually by 2020
from all sources to address the needs of developing
countries in the context of meaningful mitigation
actions and transparency on implementation and
fully operationalize the Green Climate Fund through
its capitalization as soon as possible
 Promote mechanisms for raising capacity for
effective climate change-related planning and
management in least developed countries and small
island developing States, including focusing on
women, youth and local and marginalized
communities
#Envision2030 Goal 14: Life Below Water
GOAL 14: Conserve and sustainably use the oceans,
seas and marine resources for sustainable development
Targets:
 By 2025, prevent and significantly reduce marine
pollution of all kinds, in particular from land-based
activities, including marine debris and nutrient
pollution
 By 2020, sustainably manage and protect marine
and coastal ecosystems to avoid significant adverse
impacts, including by strengthening their resilience,
and take action for their restoration in order to
achieve healthy and productive oceans
 Minimize and address the impacts of ocean
acidification, including through enhanced scientific
cooperation at all levels
 By 2020, effectively regulate harvesting and end
overfishing, illegal, unreported and unregulated
fishing and destructive fishing practices and
implement science-based management plans, in
order to restore fish stocks in the shortest time
feasible, at least to levels that can produce
maximum sustainable yield as determined by their
biological characteristics
 By 2020, conserve at least 10 per cent of coastal and
marine areas, consistent with national and
international law and based on the best available
scientific information
 By 2020, prohibit certain forms of fisheries subsidies
which contribute to overcapacity and overfishing,
eliminate subsidies that contribute to illegal,
unreported and unregulated fishing and refrain
from introducing new such subsidies, recognizing
that appropriate and effective special and differential
treatment for developing and least developed
countries should be an integral part of the World Trade
Organization fisheries subsidies negotiation
 By 2030, increase the economic benefits to Small
Island developing States and least developed
countries from the sustainable use of marine
resources, including through sustainable
management of fisheries, aquaculture and tourism
 Increase scientific knowledge, develop research
capacity and transfer marine technology, taking
into account the Intergovernmental
Oceanographic Commission Criteria and Guidelines
on the Transfer of Marine Technology, in order to
improve ocean health and to enhance the
contribution of marine biodiversity to the development
of developing countries, in particular small island
developing States and least developed countries
 Provide access for small-scale artisanal fishers to
marine resources and markets
 Enhance the conservation and sustainable use of
oceans and their resources by implementing
international law as reflected in UNCLOS, which
provides the legal framework for the
conservation and sustainable use of oceans
and their resources, as recalled in paragraph 158 of
The Future We Want
#Envision2030 Goal 15: Life On Land
GOAL 15: Protect, restore and promote sustainable use
of terrestrial ecosystems, sustainably manage forests,
combat desertification, and halt and reverse land
degradation and halt biodiversity loss
Targets:
 By 2020, ensure the conservation, restoration and
sustainable use of terrestrial and inland freshwater
ecosystems and their services, in particular forests,
wetlands, mountains and drylands, in line with
obligations under international agreements
 By 2020, promote the implementation of sustainable
management of all types of forests, halt
deforestation, restore degraded forests and
substantially increase afforestation and reforestation
globally
 By 2030, combat desertification, restore degraded
land and soil, including land affected by
desertification, drought and floods, and strive to
achieve a land degradation-neutral world
 By 2030, ensure the conservation of mountain
 ecosystems, including their biodiversity, in
order to enhance their capacity to provide benefits
that are essential for sustainable development
 Take urgent and significant action to reduce the
degradation of natural habitats, halt the loss of
biodiversity and, by 2020, protect and prevent the
extinction of threatened species
 Promote fair and equitable sharing of the benefits
arising from the utilization of genetic resources and
promote appropriate access to such resources, as
internationally agreed
 Take urgent action to end poaching and trafficking of
protected species of flora and fauna and address
both demand and supply of illegal wildlife products
 By 2020, introduce measures to prevent the
introduction and significantly reduce the impact of
invasive alien species on land and water ecosystems
and control or eradicate the priority species
 By 2020, in teg ra te ec os ys tem and biodiversity
values into national and local planning, development
processes, poverty reduction strategies and
accounts
 Mobilize and significantly increase financial
resources from all sources to conserve and
sustainably use biodiversity and ecosystems
 Mobilize significant resources from all sources
and at all levels to finance sustainable forest
management and provide adequate incentives to
developing countries to advance such management,
including for conservation and reforestation
 Enhance global support for efforts to combat
poaching and trafficking of protected species,
including by increasing the capacity of local
communities to pursue sustainable livelihood
opportunities.
#Envision2030 Goal 16: Peace, Justice and Strong
Institutions
GOAL 16: Promote peaceful and inclusive societies for
sustainable development, provide access to justice for
all and build effective, accountable and inclusive
institutions at all levels
Targets:
 Significantly reduce all forms of violence and related
death rates everywhere.
 End abuse, exploitation, trafficking and all forms of
violence against and torture of children.
 Promote the rule of law at the national and
international levels and ensure equal access to
justice for all.
 By 2030, significantly reduce illicit financial and arms
flows, strengthen the recovery and return of stolen
assets and combat all forms of organized crime.
 Substantially reduce corruption and bribery in all
their forms.
 Develop effective, accountable and
transparent institutions at all levels.
 Ensure responsive, inclusive, participatory and
representative decision-making at all levels.
 Broaden and strengthen the participation of
developing countries in the institutions of global
governance.
 By 2030, provide legal identity for all, including birth
registration.
 Ensure public access to information and protect
fundamental freedoms, in accordance with national
legislation and international agreements.
 Strengthen relevant national institutions, including
through international cooperation, for building
capacity at all levels, in particular in developing
countries, to prevent violence and combat terrorism
and crime.
 Promote and enforce non-discriminatory laws
and policies for sustainable development.
GOAL 17: Strengthen the means of implementation and
revitalize the global partnership for sustainable
development
Targets:
1. Finance
 Strengthen domestic resource mobilization,
including through international support to
developing countries, to improve domestic
capacity for tax and other revenue collection
 Developed countries to implement fully their
official development assistance commitments,
including the commitment by many developed
countries to achieve the target of 0.7 percent of
ODA/GNI to developing countries and 0.15 to
0.20 ODA/GNI percent of ODA/GNI to least
developed countries ODA providers are
encouraged to consider setting a target to
provide at least 0.20 per cent of ODA/GNI to
least developed countries.
 Mobilize additional financial resources for
developing countries from multiple sources
 Assist developing countries in attaining long- term
debt sustainability through coordinated policies
aimed at fostering debt financing, debt relief and
debt restructuring, as appropriate, and address
the external debt of highly indebted poor
countries to reduce debt distress
 Adopt and implement investment promotion
regimes for least developed countries
2. Technology
 Enhance North-South, South-South and
triangular regional and international
cooperation on and access to science,
technology and innovation and enhance
knowledge sharing on mutually agreed terms,
including through improved coordination among
existing mechanisms, in particular at the United
Nations level, and through a global technology
facilitation mechanism
 Promote the development, transfer,
dissemination and diffusion of
environmentally sound technologies to
developing countries on favorable terms,
including on concessional and preferential terms,
as mutually agreed
 Fully operationalize the technology bank and
science, technology and innovation capacity-
building mechanism for least developed
countries by 2017 and enhance the use of
enabling technology, in particular information and
communications technology
3. Capacity building
 Enhance international support for implementing
effective and targeted capacity-building in
developing countries to support national plans to
implement all the sustainable development goals,
including through North-South, South-South and
triangular cooperation.
4. Trade
 Promote a universal, rules-based, open, non-
discriminatory and equitable multilateral trading
system under the World Trade Organization,
 including through the conclusion of negotiations
under its Doha Development Agenda
 Significantly increase the exports of developing
countries, in particular with a view to doubling the
least developed countries’ share of global
exports by 2020
 Realize timely implementation of duty-free and
quota-free market access on a lasting basis for
all least developed countries, consistent with
World Trade Organization decisions,
including by ensuring that preferential rules of
origin applicable to imports from least developed
countries are transparent and simple, and
contribute to facilitating market access
5. Systemic Issues
Policy and Institutional Coherence
 Enhance global macroeconomic stability,
including through policy coordination and policy
coherence
 Enhance policy coherence for sustainable
development
 Respect each country’s policy space and
leadership to establish and implement policies
for poverty eradication and sustainable
development
Multi-stakeholder partnerships
 Enhance the global partnership for
sustainable development, complemented by
multi-stakeholder partnerships that mobilize and
share knowledge, expertise, technology and
financial resources, to support the achievement
of the sustainable development goals in all
countries, in particular developing countries
 Encourage and promote effective public, public-
private and civil society partnerships, building on
the experience and resourcing strategies of
partnerships
Data, monitoring, and accountability
 By 2020, enhance capacity-building support to
developing countries, including for least
developed countries and small island
developing States, to increase significantly the
availability of high-quality, timely and reliable
data disaggregated by income, gender, age,
race, ethnicity, migratory status, disability,
geographic location and other characteristics
relevant in national contexts
 By 2030, build on existing initiatives to
develop measurements of progress on
sustainable development that complement
gross domestic product, and support
statistical capacity-building in developing
countries.
MODULE 2
REPRODUCTIVE AND SEXUAL HEALTH
Procreative Health
Procreation
 process that permits two living beings to produce a
third one that is different from each of them
Reproduction
 is the biological process by which new individual
organisms are produced.
 The known methods of reproduction are broadly
grouped into two main
Types of Reproduction:
Asexual reproduction
 an individual can reproduce without involvement with
another individual of that species
Sexual reproduction
 requires the involvement of two individuals, typically
one of each sex.
 During production in humans, each parent transmits to
the child one of the two copies of his or her genetic
material, located on the parent's 23 pairs of
chromosomes
 The transfer is made by the parent's gametes,
reproductive cells that contain only 23 chromosomes
as a result of a special kind of cell division: meiosis.
REPRODUCTIVE SYSTEM
Female Reproductive System
External Genitalia
 Collectively called Vulva (Pudenda)
 Refers to the externally visible structure of the female
reproductive system extending from symphysis pubis
to the perineum
1. Mons Pubis (mons veneris)
 fatty pad over the symphysis pubis; cushions &
protects pubic bone
2. Labia Majora (labium majus)
 longitudinal folds of pigmented skin extending
from mons pubis to the perineum; covered with
thick, curly hair
 Escutcheon
3. Labia Minora (smaller lips)
 hairless folds of tissue within the labia majora,
extending from clitoris to the fourchette
4. Clitoris
 small (approx. 1-2 cm) rounded organ of erectile
tissue at the upper end of labia minora
 Prepuce - Skin covering
 Smegma - epidermal secretion with strong odor
5. Vestibule
 almond-shape space between the labia minora,
clitoris and fourchette
- contains structures
A. Urethral meatus
 Skene's glands (paraurethral glands)
B. Vaginal introitus
 Bartholin's glands (vulvovaginal glands)
C. Hymen
 crescent-shaped membrane
6. Fourchette
 thin fold of tissue formed where labia minora
meet
 Episiotomy site
Internal Genitalia
1. Vagina
 organ of copulation / "birth canal”
 hollow, musculomembranous canal
 (8-12 cm) 4cm diameter
 Fornix
o anterior, posterior and lateral
o space surrounding the cervix
 Doderlein's bacilli- keep vagina acidic
Functions of the Vagina:
1) Organ of copulation
2) Passage in delivery & menstrual blood
3) Secretory duct during menstruation
2. Uterus
 "the womb”
 pear-shaped, hollow muscular organ
  anteverted, directed forward 7-8 cm long  ilium (crest of ilium)
Functions of the uterus:  ischium (ischial tuberosity)
1) menstruation  pubis
2) environment for pregnancy  sacrum - wedge shaped, forms the back part
3) labor & delivery of the pelvis
Layers:  coccyx
1) Perimetrium/parametrium (outermost)
2) Myometrium (middle layer) Pelvic Sections:
 layers of smooth muscle fibers that  false pelvis
interlaces  larger, shallow
 contraction  lies above the inlet
 "living ligature”  aids in supporting abdominal viscera
3) Endometrium (innermost)  true pelvis
 rich in gland and blood vessels  low, deep
 sloughs off as menstruation  pelvic inlet
Parts of Uterus: o entrance to the true pelvis
1) Corpus (body)  midpelvis
 main contractile portion o mid portion of pelvis; contains ischial spine
 forms bulk of muscles  pelvic outlet
 uppermost part (FUNDUS) o exit of the true pelvis
 Important role of funds in OB: *Linea Terminalis
2) Isthmus
 joins the corpus to the cervix Measurements:
 contains uterine canal  Diagonal conjugate
 anterior sacral promontory to the INFERIOR
margin of symphysis pubis
3. Cervix
 forms the main opening of the uterus  12.5 - 13 cm
 True conjugate
o 2-4 cm long  Conjugate Vera
o operculum  from anterior sacral promontory to the
 internal os - opens into uterine cavity SUPERIOR margin of symphysis pubis
 external os - opens into vagina  11 - 11.5 cm
Uterine ligaments:  Obstetric Conjugate
 Broad  Sacral promontory to INNER SURFACE of
o 2 wing-like structures that extends from the lateral symphysis pubis
margin to the uterus to the pelvic walls  10.5 - 11 cm
 Round  Biischial diameter
o 2 fibrous cords from the uterine walls that helps  distance between ischial spines
hold the uterus in its forward position  10 cm
 Uterosacral  Tuberischial diameter
o 2 cord like folds of the peritoneum from the lower  transverse diameter of outlet
cervix to the sacrum  8 cm
* Transverse - Mackenrodt’s Ligaments (or Cardinal
Ligaments) Breast - Mammary Glands
Parts:
4. Fallopian tubes  Acini cells - milk-producing cells
 “salphinges”  Collecting duct/ Lactiferous duct
 serves as a passageway for the expelled ovum  Lactiferous sinus - storage
 10-12 cm long  Nipples
Parts of the fallopian tube:  Areola - * Montgomery's Tubercles
a. interstitial - part of tube that lies in the uterine wall Hormones:
b. isthmus - part that is cut or sealed during tubal  Prolactin
ligation; attach tube to uterus  hormone for milk production Oxytocin
c. ampulla- site of fertilization  hormone for milk expression
d. infundibulum
 most distal portion Male Reproductive System External Genitalia
 its funnel-shaped opening encircled with  Mons pubis
*Fimbriae
 area over symphysis pubis
 finger-like projections which anchor the ovary to  Penis
the fallopian tube
 organ of urination & copulation
o Shaft
5. Ovaries
 corpus spongiosum
 female gonads
 the sex glands sized and shaped like almonds  corpus cavernosa
Functions of ovaries:  Glans penis - distal end of organ
1) Ovulation  Prepuce - protects glans at birth
2) Secretion of hormones  Scrotum
o Estrogen  wrinkled pouch of thin skin, covering a tight
o Progesterone muscle
Pelvis  protects the testes from trauma and changes in
 passageway of fetus temperature
o Cremasteric reflex
 formed by:
 protect testes and maintain the
 the innominate bones
 temperature of the testes 2 degrees Secondary sex characteristics
lower than body temperature.  Features not essential for reproduction but attract
the sexes to each other
Internal Genitalia
1. Testes Male Sexual Response
male sex glands or gonads  erection of the penis, allowing it to penetrate the
2-3 cm wide that lie in the scrotum female vagina
 ejaculation, expelling semen into the vagina
Parts: Ejaculation
Semineferous tubules
 Initiated by sympathetic nerve impulses
 site of spermatogenesis  The ducts and accessory glands contract, emptying
Leydig's / interstitial cells
their contents into the urethra.
 secretes testosterone  The urethral sphincters constrict.
Sertoli cells  The bulbospongiosus muscles of the penis contract
 provide nourishment to the sperm rapidly and rhythmically, propelling semen from the
2. Epididymis urethra
 storage site for maturing sperm
 approx 20 ft. long Fate of Sperm Cells
 it absorbs about 90% of the fluid secreted by Capacitated:
the testis  viable for 2 days (egg: 12-24 hr)
 sperm remain stored here for 40-60 days and are  only - 100 reach the destination.
absorbed if not ejaculated prior to that time.  only one sperm fertilizes the egg

3. Vas deferens/ Ductus deferens Refractory Period

 passage way for sperm from epididymis to  a period following ejaculation and lasting anywhere
seminal vesicles from 10 minutes to a few hours
 Vasectomy  impossible to attain another erection and orgasm

4. Ejaculatory duct PHYSIOLOGY OF MENSTRUATION

 allows the sperm to enter the urethra ad then Menstruation
exit the body  periodic shedding of blood, mucus & epithelial cells
 passes the prostate gland from uterus

5. Accessory structures Menstrual Cycle

 Seminal vesicles  Time between the beginning of one period &
o located along the lower posterior surface of the beginning of next period.
bladder  Menstrual cycles begin at menarche and end with
o 30% semen produced menopause.
 Prostate gland  An episodic uterine bleeding in response to cyclic
o surrounds the prostatic urethra hormonal changes
o 60% semen produced
 Bulbourethral gland Purpose:
o Cowper’s gland  bring ovum to maturity & renew uterine tissue bed
o located below the prostate responsible for its growth
o 5% semen production
Four Structures Involve:
6. Urethra 1. Hypothalamus: Releases the GnRH
 passageway for urine and semen 2. Pituitary Gland: Anterior Pituitary gland
 18-20 cm hollow tube  Adenohypophysis
Semen (seminal fluid)  Produces Two hormones: FSH & LH
 thick, whitish fluid ejaculated by the man during 3. Ovary: Premordial follicles is activated by FSH until
orgasm it matures termed as Graafian follicle. With the
 alkaline
increase of LH from the PG - "Ovulation" takes
 mixture of secretion from epididymis, seminal
vesicle, prostate, and bulbourethral gland. place (on the 14 day).
 Corpus luteum
Major constituents of semen:
 yellow body produces lutein which is rich
 Sperm
with Progesterone
 Fructose
 if with fertilization, corpus luteum remains for 16
 Clotting and anticoagulant factors
to 20 weeks of gestation
 Prostaglandins
 Spermine  if fertilization does not occur, the unfertilized
Sperm cells from epididymis are present at a count of ovum atrophies after 4-5 days and the corpus
50-120 million sperm/ml luteum regresses after 8-10 days of ovulation
< 20-25 million/ml = infertility (sterility) and gradually turned into "corpus albicans"
Prostaglandins (white body)
produced by the prostate and seminal vesicles 4. Uterus: (Undergo uterine changes)
stimulate peristaltic contractions of the female The Changes has Four Phases:
reproductive tract that may help draw semen into the A. First phase (Proliferative)
uterus  immediately after menstrual flow, first 4-5
Spermine days of the cycle
 a is a base that reduces acidity of the female  also called Estrogenic, Follicular, or
vagina, increasing the survival rate of sperm Postmenstrual.
 B. Second Phase (Secretory)
 6-14 days Components of Menstrual Flow:
 also termed as Progestational, Luteal,  Blood
Premenstrual the lining of the endometrium  Mucin
is rich with capillaries and thick, vascular,  Fragments of endometrial tissue
spongy layers  Atrophied and unfertilized ovum
C. Third phase (Ischemic)
 15-28 days Characteristics of Menstrual Cycle:
 Average length - 28 days
 at 8- 10 days, the corpus luteum begins to
 Average flow - 2-7 days
regress  Normal color - dark red
 the endometrium of the uterus begins to  Average flow - 30-80 ml.
degenerate (approx. at day 24 or 25 of the  Menarche - first menstrual period
cycle)  Menopause - marks end of reproductive life as a
 Capillaries rupture result of estrogen depletion
D. Fourth phase (Menses)  Climacteric - transitional period during which
 actual menstrual flow - which is the end of  ovarian function & hormonal production decline
a defined menstrual cycle (35v/o)
 the only external marker of the cycle,

OVARIAN CYCLE
Ovulation
 expulsion of an ovum from the ovary on spontaneous rupture of a mature follicle as a result of cyclic ovarian and
pituitary endocrine function
 It usually occurs on the fourteenth day after the first day of the last menstrual period and often causes brief, sharp
lower abdominal pain on the side of the ovulating ovary
 rupture of graafian follicle & formation of the ovum
 occurs 14 days before the onset of menstruation
o 28 day cycle
o 20 day cycle
o 45 day cycle

Sexual Response Pattern

1. EXCITEMENT - 1st phase
 Physical & Psychological stimulation causes parasympathetic nerve stimulation
o that leads to arterial dilation and venous constriction in the genital area;
o with resulting vasocongestion and increasing muscular tension
 vaginal lubrication
 vaginal barrel lengthens and distends
WOMEN
 cervix and fundus are pulled upward
 clitoris increase in size
 erection
MEN
 scrotal skin becomes congested and thick
BOTH there is an increase HR, RR and BP
2. PLATEAU – 2nd stage; the entry & coitus phase
 clitoris retracts under the hood
WOMEN
 vagina becomes greatly engorged along with labia minora
 pre-orgasmic emission
MEN  testes continues to elevate until they are situated close to the body
to facilitate ejaculatory pressure
3. ORGASM - 3rd stage climax
 strong vaginal contractions
WOMEN
 (8-15 contractions at interval of 0.8’’)
 occurrence of ejaculation (3-7 propulsive ejaculatory contractions at
MEN same interval with women)
 shortest stage of sexual response cycle
4. RESOLUTION - 4th stage - phase of relaxation
o the reproductive organs return to their unstimulated state
WOMEN  female has no refractory period
MEN  REFRACTORY PERIOD: ( 30 min )
 MODULE 3: Third Trimester
CARE OF THE MOTHER AND THE FETUS DURING  feelings of awkwardness & clumsiness
THE PERINATAL PERIOD  fears & tension about labor
PREGNANCY  spurt of energy during the last month.
 PARA - the number of pregnancies that have reached TASK:
viability (20 weeks), regardless of whether the  preparing for parenthood
infants were born alive  arranging for infant’s care
 MULTIPARA - a woman who has carried two or more  developing economic patterns
pregnancies to viability  reevaluation of household assignments
 PRIMIPARA - a woman who has given birth to one  acquisition of knowledge about pregnancy, childbirth
child past age of viability and parenthood
 GRAND MULTIPARA - a woman who has carried five  expectant Father
or more pregnancies
 GRAVIDA - a woman who is or has been pregnant PHYSIOLOGIC Changes of Pregnancy
 PRIMIGRAVIDA - a woman who is pregnant for the 1. Breasts
first time  increase in size
 MULTIGRAVIDA - a woman who has been pregnant  enlarged Montgomery’s tubercles
previously  veins become prominent
 NULLIGRAVIDA - a woman who has never been and  precolostrums can be expressed from nipples as early
is not currently pregnant as 12th-14th weeks

Maternal Adaptation During Pregnancy 2. Uterus

Diagnosis of Pregnancy (Affirmation & confirmation of  increase in vascularity
Pregnancy)  presence Hegar’s sign
 enlarged - ( 50 to 1000 grams )
Presumptive Signs:  amenorrhea
1. Amenorrhea
2. Fatigue 3. Cervix
3. Nausea & Vomiting  formation of mucus plug or
4. Breast changes
 operculum
5. Urinary Frequency
6. Darkening of face, breast and abdomen  presence of Goodell’s sign
7. Quickening
4. Vagina
Probable Signs:  Chadwick’s sign
1. Uterine changes: Chadwicks,  Leukorrhea - whitish, viscous vaginal discharge or an
2. Goodell’s, Hegar’s, Enlargement of uterus increase in the amount of normal vaginal secretions.
3. Ballottement
5. Cardiovascular System
4. Pregnancy Test
 increase in blood volume
5. Braxton Hicks
 increase in cardiac output
Positive Signs:  varicosities
1. Heart -Starts to beat as early as 24th day  supine hypotension
2. FHB - Audible at 10th to 12th week by doppler,  edema of lower extremities
18th to 24th week by stet at 120-160 beats/ min.  palpitations
3. Other sounds: Funic Souffle and uterine Souffle  physiologic anemia
4. Fetal Outline and Movement: UTZ and X-ray shows  increase in WBC, fibrinogen
fetal skeleton 14th to 20th week of pregnancy.  heart rate increases 10- 15 beats / min.

PSYCHOLOGICAL Changes of Pregnancy 6. Respiratory System

First Trimester  increase O2 demand
 Ambivalence  dyspnea
 fear  displacement of the diaphragm
 fantasies about motherhood & about having a  nasal stuffiness & or congestion
“dreamchild
 possible decrease in sex drive 7. Gastrointestinal System
 morning sickness and pyrosis
TASK:  ptyalism
 accepting the pregnancy  softening of gums
 “I am pregnant”  pica
 constipation
Second Trimester
 alternate feelings of emotional well-being and lability 8. Urinary System
 acceptance of pregnancy
 urinary stasis
 possible increase in sex drive
 urinary frequency
 adjustment to change in body image  asymptomatic bacteriuria
TASK:
 accepting the baby  reduced bladder tone
 “A baby is growing inside me”
9. Musculoskeletal System Hyaluronidase
 Lordosis (pride of pregnancy) • proteolytic enzyme released by the spermatozoa
 characteristics waddle • acts to dissolve layer of cells protecting the ovum
 diastasis recti – overstretching & separation of the corona radiata
abdominal vasculature. • cells that encircles the zone pellucida
zona pellucida
10. Integumentary System • protective covering of the ovum
 chloasma/melasma
 linea nigra 2. Conception / fertilization /Impregnation
 striae gravidarum  the beginning of pregnancy
 erythematous changes on palms and face  the union of ovum and sperm
 diaphoresis Zona reaction
 ovum becomes impenetrable to other sperm
11. Endocrine System  fertilization is never a certain occurrence because it
 secretion of estrogen and progesterone by the depends on at least three separate factors:
corpus luteum during the first 3 months o Equal maturation of both sperm and ovum
 slight hyperthyroidism and hyperplasia of the thyroid o Ability of the sperm to reach the ovum
gland o Ability of the sperm to penetrate the zona pellucida
 increased size of parathyroid and cell membrane and achieve fertilization
 increased melanocyte stimulating hormone
 addition of the placenta as an endocrine gland *life span of ovum – 24-48 hours
 gradual increase of Insulin increase BMR *life span of sperm – 48-72 hours
 suppression of FSH/LH
 increase production of growth hormone Sex Determination
 ovum – 23 chromosomes:
 production of Oxytocin late in pregnancy o 22 autosomes
 production of Prolactin o 1 x sex chromosome
 sperm – 23 chromosomes:
*Couvade Syndrome o 22 autosomes
 group of physiological & behavioral manifestation o 1 x or y sex chromosome
experienced by the husband
 are often the result of stress, anxiety & empathy for
the pregnant women

STAGES OF FETAL DEVELOPMENT

Typically Divided into Three Periods:
1. Preembryonic
2. Embryonic
3. Fetal

*Common Terms Used to Describe Fetal Growth: Zygote

Ovum o fertilized ovum to implantation
 from ovulation to fertilization o single cell, the product of fertilization
Zygote
 from fertilization to implantation 3. Implantation
Embryo  Takes 8-10 days after fertilization
 from implantation to 5- 8 weeks  Zygote migrates at 3-4 days toward the body of
Fetus the uterus
 from 5-8 weeks until term  (+) mitotic cell division = Cleavage [24h]
Conceptus o Blastomere – 2nd day
 developing embryo and placental structures o Morula – 3rd day (16-50 cells); Mulberry
throughout pregnancy o Blastocyst
Age of viability - 4th day
 the earliest age at which fetuses survive if they are - signals differentiation of embryo
born is generally accepted as 24 weeks or at the - mass of cells form to a periphery with fluid
point a fetus weighs more than 500–600g space
Trophoblast – outer portion
STAGES OF FETAL DEVELOPMENT Embryoblast – inner portion
1. Prefertilization
 ovum moves to the ampulla by means of peristaltic
 By the 3rd or 4th day of free floating (7-10 days)
movement o the blastocyst brushes against the uterine
 sperms move into the ampulla (part of the fallopian
endometrium called “Apposition”
tube) by means of their tail o then attaches to endometrium called “Adhesion”
 before the sperm can penetrate the ovum, the cap o and finally settles down into the soft folds of the
must be removed
endometrium called “Invasion “
capacitation
 Implantation
• physiologic removal of the acrosome o the process wherein the zygote burrows into
• final process that sperm must undergo to be ready the endometrium
for fertilization
 Acrosome Reaction
 EMBRYONIC AND FETAL STUCTURES
The Decidua
 Because of the influence of human chorionic
gonadotropin (HCG), a hormone secreted by the
 trophoblast cells, the corpus Luteum continues to
function after fertilization
 the endometrium, instead of sloughing off, continues 4.
to grow in thickness and vascularity. It is now called
Decidua.
Chorionic Villi
 fingerlike projections that reach out from the
trophoblast cells into the uterine endometrium to begin
formation of the placenta.
 this is about the 11th or 12th day after fertilization
 at term nearly 200 are formed
3. Progesterone
Functions:
 maintains the endometrial lining for its growth
 reduce the contractility of the uterus during pregnancy,
thus preventing premature labor.
4. Human Placental Lactogen
Functions:
 both growth-promoting and with lactogenic
properties (milk producing)
 regulates maternal glucose, protein and fat levels to
ensure adequate amount of these are always available
to the fetus.
ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS
The Membrane
 the chorionic villi on the medial surface of the
trophoblast gradually thin and leave the medial surface
of the smooth structure which eventually becomes the
chorionic membrane
 Support the sac that contains amniotic fluid

Amniotic Membrane/ Amnion

The Placenta
 arises out of the trophoblast tissue (fusion of chorionic
villi and decidua basalis
 endocrine organ throughout pregnancy
 functions of the Placenta:
o source of oxygen and nutrients for the fetus
o important hormone-producing system
Functions:
 offer support to the amniotic fluid.
 produces the amniotic fluid.
 it produces a phospholipid that initiates the
formation of prostaglandins
The Amniotic Membranes
 dual-walled sac with the chorion as the outmost part
and the amnion as the innermost part
 the two fuse together as the pregnancy progresses,
and by term, they appear to be a single sac.

The Amniotic Fluid

 dual-walled sac with the chorion as the outmost part
and the amnion as the innermost part
 the two fuse together as the pregnancy progresses,
and by term, they appear to be a single sac.

The Umbilical Cord

 formed from the fetal membranes, the amnion and
chorion
Functions:
ENDOCRINE FUNCTION OF THE PLACENTA: 1.  provides a circulatory pathway that connects the
1. Human Chorionic Gonadotropin
embryo to the chorionic villi of the placenta.
 first hormone to be produced by placenta  to transport oxygen and nutrients to the fetus from the
 present in maternal blood and urine as early as
placenta and to return waste products from the fetus
before the first missed menstrual period (on the 6th
to the placenta.
or 7th day after implantation) and its peak level @  Length: 53 cm
about 16th day of pregnancy then diminished its level
 Contains: Arteries and Veins
by the 20th week
Functions: - Wharton’s Jelly
 hCG’s purpose is to act as a fail-safe measure to Function of Wharton’s Jelly:
ensure the corpus luteum of the ovary continues to - Amniotic Membrane
produce progesterone and estrogen so the - Rate of blood flow
endometrium of the uterus is maintained. - Nerve supply
 hCG also may play a role in suppressing the
maternal immunologic response so placental tissue Amniotic Fluid/Liquor Amnii
is not detected and rejected as a foreign substance Functions:
 protective mechanism for the fetus
2. Estrogen (estriol)  it shields against pressure or blow to the mother’s
Functions:
 contributes to the development of mammary gland in abdomen
 it protects the fetus from changes in temperature
preparation for lactation after birth
 stimulates the uterus to grow to accommodate the  it aids muscular development because it allows the
fetus to move
developing fetus
 protects the umbilical cord from the pressure,
protecting fetal oxygenation.
Average amount:
- Polyhydramnios
- Oligohydramnios
 Ph - Alkaline
 from the beginning of fetal growth, development
proceeds in a CEPHALOCAUDAL (head to tail)
direction which continues after birth
 at the time of implantation, the blastocyst already has
differentiated to a point at which three separate
layers of these cells are present: the ectoderm, the
endoderm, and the mesoderm
Primary Germ Layers
 at the time of implantation, the blastocyst forms 2
separate cavities appear in the inner structure:
 a large one, the AMNIOTIC CAVITY
 a smaller cavity, the Yolk Sac
 between the amniotic cavity and the yolk sac forms
a third layer of primary cells the mesoderm.
Origin of Body Tissue
 each germ tissue develops into distinctive body
systems
1. Ectoderm
 the nervous system (CNS – Brain & Spinal Cord,
PNS)
 skin, hair, nails, and tooth enamel
 sense organs
 mucous membranes of the anus, mouth and
nose
 mammary glands
2. Mesoderm
 supporting structures of the body (connective
tissue, bones, cartilage, muscle, ligaments, and
tendons)
 upper portion of the urinary system (kidneys &
ureters)
 reproductive system
 heart, lymph and circulatory system and blood
cells
3. Endoderm
 lining of the pericardial, pleura, and peritoneal
cavities
 lining of the gastrointestinal tract, respiratory
tract, tonsils, parathyroid, thyroid, and thymus
glands
 lower urinary system (bladder & urethra)
Cardiovascular System
 one if the first systems to become functional in
intrauterine life
 its development is a progression from simple blood
cells
Respiratory System
 3rd week of life - the respiratory and digestive tracts
exist as a single tube
 end of 4th week - septum begins to divide
esophagus & trachea
 7th week of life - the diaphragm is starting to divide
the thoracic cavity from the abdomen
 24th to 28th week - alveoli and capillaries begin to
form surfactant - a lipoprotein produce by alveolar
cells
Two components:
4. Nervous System
 by the 3rd week of gestation - a neural plate is
apparent in the developing embryo (forming the CNS
& PNS)
 all parts of brain form in uteru
 brain waves can be detected on an
electroencephalogram (EEG) by the 8th week
5. Endocrine System
 as soon as endocrine organs mature in intrauterine
life, function begins
 the function of endocrine organs begins along with
neurosystem development.
o fetal pancreas
o thyroid / parathyroid glands
o fetal adrenal glands
Digestive System
 by the 4th week - digestive tract separates from the
respiratory tract and after that, begins to grow
extremely rapidly.
 by 16th week- meconium starts to form.
Components:
 GIT is sterile before birth
 the liver is active but still immature at birth
 sucking and swallowing reflex are not mature until
about 32 weeks or weighs 1500 g.
Musculoskeletal System
 by 11th week - seen to move by ultrasound (utz)
 quickening by 20th week
Reproductive System
 by 6th week - the gonads are formed
 Testosterone is produced from wollfian duct or
mesonephric duct
 male genitalia is developed
 on the 8th week female hormones is produced from
mullerian duct or paranephric duct – female
genitalia is formed.
Urinary System
 end of 4th week - rudimentary kidney is present
 by 12th week - urine is formed
 by 16th week - urine is excreted in the amniotic fluid
 at term - urine is being excreted at the rate of
500ml/day
Integumentary System
 at 36th weeks - skin appears thin and translucent
and fat begins to be deposited
 lanugo - soft, downy hairs
 vernix caseosa - a white-cream cheese like
substance
Immune System
 by 3rd trimester - maternal antibodies cross the
placenta
 the level of passive immunity is peak at birth
Fetal Circulation
 contains mixed blood with less than maximal O2
concentration; the only exception is the umbilical vein
upon its immediate entrance into the liver
 fetus receives O2 thru the placenta since the lungs
do not function as organs of respiration; to meet this
situation, the fetal circulation contains special vessels
SPECIAL VESSELS OF A FETAL CIRCULATION
1. Ductus Venosus
 is a connection between the umbilical vein &
ascending vena cava, bypassing the fetal liver.
2. Ductus Arteriosus
 a connection between the pulmonary trunk & aorta,
bypassing the fetal lungs.
3. Foramen Ovale
 is an opening between the right & left atria during
fetal life, also bypassing the fetal lungs.
MILESTONES OF FETAL GROWTH AND
DEVELOPMENT
Conception
 The sperm fertilizes the ovum, which then divides and
burrows into the uterus
End of 4th Gestational Week
 Human embryo is a rapidly growing formation cells but
does not resemble a human being yet.
 Spinal cord formed & fused at midpoint.
 Head will shortly fold forward & become prominent,
comprising about 1/3 of the entire structure.
 Back is bent so the head touches the tip of the tail.
 Heart appears as a prominent bulge on the anterior
surface.
 Arms and legs are bud-like structures.
 Rudimentary eyes, ears, and nose are discernible.
 Length is 0.75 cm to 1 cm.
 Weight is 400 mg.
End of 8th Gestational Week
 Length is 2.5 cm (1 in.)
 Weight is 20 grams
 Organogenesis is complete.
 Heart has a septum & valves & is beating rhythmically
 Facial features are definitely discernible.
 Legs, arms, fingers, toes, elbows, & knees have
developed.
 External genitalia are present but male & female are
not distinguishable by simple observation.
 Primitive tail is undergoing retrogression.
 Abdomen appears large as fetal intestine is growing
rapidly.
 A sonogram done at this time demonstrates a
gestational sac & is diagnostic of pregnancy.
End of 12th Gestational Week (First Trimester)
 Length is 7 to 8 cm.
 Weight is 45 grams.
 Nail beds are forming on fingers & toes.
 Capable of spontaneous movements although too
faint to be felt by the mother.
 Some reflexes, such as Babinski reflex are present
 Bone ossification centers begin to form
 Tooth buds are present.
 Sex is distinguishable on outward appearance.
 Urine secretion begins but may not yet be evident in
amniotic fluid.
 Heartbeat is audible through Doppler Technology
End of 16th Gestational Week
 Length is 10 to 17 cm.
 Weight is 55 to 120 g.
 Fetal heart sounds are audible by an ordinary
stethoscope.
 Lanugo is well formed
 Liver & pancreas are functioning.
 Fetus actively swallows amniotic fluid; urine is present
in amniotic fluid
 Sex can be determined by ultrasonography.
End of 20th Gestational Week
 Length is 25 cm.
 Weight is 223 g.
 Spontaneous fetal movements sensed by the mother.
 Antibody production is possible
 Hair, including eyebrows, forms on the head; vernix
caseosa begins to cover the skin.
 Meconium is present in the upper intestine.
 Brown fat begins to form behind the kidneys, sternum,
& posterior neck.
 Passive antibody transfer from mother to fetus begins.
 Definite sleeping & activity patterns are
distinguishable.
End of 24th Gestational Week (Second Trimester)
 Length is 28 to 36 cm.
 Weight is 550 g.
 Passive antibody transfers from mother to fetus (if
born before will have no natural immunity).
 Vernix Caseosa begins to form.
 Meconium present as far as the rectum.
 Active production of lung surfactant begins.
 Eyelids, previously fused since the 12th week, now
 open; pupils react to light.
 Membrane that had fused the eyelids dissolves so
eyes can now open & pupils are capable of reacting
to light.
 Low-end age of viability. (or 601g.)
End of 28th Gestational Week
 Length is 35 to 38 cm.
 Weight is 1200 g.
 Lung alveoli are almost mature; surfactant can be
demonstrated in amniotic fluid.
 In male fetus, the testes begin to descend into the
scrotal sac from lower abdominal cavity.
 Blood vessels of the retina are extremely susceptible
to damage from high oxygen concentrations

End of 32nd Gestational Week

 Length is 38 to 43 cm.
 Weight is 1600 g.
 Subcutaneous fat beg. to be deposited in fetus.
 Fetus responds by movement to sounds outside the
mother’s body
 Active Moro reflex is present.
 In some cases, has assumed delivery position.
 Iron stores begin to be built.
 Fingernails reach the end of fingertips.

End of 36th Gestational Week

 Length – 42-48 cm
 Weight is 1,800-2,700g (5-6 lb).
 Body stores of glycogen, iron, carbohydrate, and
calcium are deposited.
 Additional amounts of subcutaneous fat are
deposited.
 Sole of the foot has only one or two crisscross
creases compared with a full crisscross pattern
evident at term.
 Amount of lanugo begins to diminish.
 Most fetuses turn into a vertex (head down)
presentation during this month.

End of 40th Gestational Week (Third Trimester)

 Length is 48 to 52 cm.
 Weight is 3000 g. (7- 7.5 lbs.)
 At this time, the sole of the foot has only one or two
crisscross creases.
 Lanugo begins to diminish
 Kicks actively
 Vernix Caseosa is fully formed.
 Fetal hemoglobin begins its conversion to adult
hemoglobin.
 Fingernails extend over the tips of fingers.
 Creases on the soles of the feet cover at least 2/3 of
the surface.
 Lightening for primiparas (experience by the women
as the fetus sinks into the birth canal and giving the
pregnant woman a feeling that her load is being
lightened).