MATERNAL AND CHILD NURSING
TOPIC 3: HUMAN CONCEPTION & FETAL DEVELOPMENT
SLRC COMPREHENSIVE REVIEW | (August 9, 2022)
Lecturer: Alexander D. Arucan
Reference Lecture: None
SEXUAL RESPONSE
EXPLORE
● EXcitement
○ Foreplay
○ Longest period
○ Sympathetic nervous system
● PLateau
○ Reached just before orgasm
● ORgasm
○ Shortest period
○ Females have longer orgasm
● REsolution
○ Resting phase
○ Refractory period - males cannot
be stimulated for the next 10-15
minutes
○ Parasympathetic nervous system
STAGES OF FETAL DEVELOPMENT
joZEF
● Zygote: fertilization - 2 weeks
● Embryo: implanted ovum; 2 wks - 8 wks
○ 1st 8 weeks: organogenesis
takes place
● Fetus: 8 weeks to Term (37-42 wks)
○ @8th week: placenta takes over
from corpus luteum
○ Function of the placenta: acts as
lungs of the fetus
PRE-EMBRYONIC STAGE
Blastomeres
UTERUS
● Union of sperm cell and egg cell in the
ampulla (Fertilization) → cell division /
mitosis
○ Zygote: first human cell
(Fertilization-2 weeks)
■ Monozygotic: identical
twins; usually same sex
■ Dizygotic: fraternal twins
○ Blastomere: 4; inside fallopian
tube
○ Morula: 16 mulberry mass
○ Cell division in the fallopian tube
4 days → travel to uterus, 4 days
● ImplanTation
○ Average 7-10 days
○ Naegel’s rule +7 refers to this
○ Blastocyst (in the uterus) →
embryo
○ Trophoblast → placenta
Day Stage
1 Fertilization - union of sperm (XY) and
egg cell (XX) (ampulla) = 46
chromosomes
2 Zygote - 1st human cells (undergoes
mitosis) = 2 cells
3 Blastomere = 4 cells
4 Morula = 16 mulberry mass
7-10 Implantation in the uterus (Blastomere
becomes Blastocyst)
14 Blastocyst becomes Embryo
days Trophoblast becomes Placenta
● Outside the uterus
Blastocyst
Lanugo 4 mos
● Inside the uterus
● will become embryo
Trophoblast
● will become the placenta

EMBRYONIC STAGE Quickening 18-20 FIFTHoscope

● After implantation at fundus & wks (5
fetoscope mos)
Germ Layers Vernix 6 mos verSIX
● MESoderm caseosa
Don’t MESS with my HEART, MUSCLES,
VAGINA, and KIDNEYS Testes 7 mos
○ Heart descends
○ Reproductive system on scrotum
○ Musculoskeletal system
○ Kidneys
○ Ears (murag heart)

Subcutane 8 mos subcutEIGHTneous

ous fat

● Doppler: as early as 8 weeks

● Endoderm
● Lanugo: 4th month
Tay
○ Thyroid ○ Fine downy hair
○ Thymus ● Quickening and fetoscope: 18-20 wks
*fifthoscope
○ GI Tract
● Vernix caseosa - 6 month
○ RespI tract *Vernix = verSIX
○ Liver (atay) ● Testes descends on scrotum = 7th
○ Tonsils (ni tatay) months- undescended testes
● Ectoderm *Cryptorchidism - failure of testes to descend →
Ec = External repair through orchidopexy or orchidoplasty
○ Hair, skin, nails ● Subcutaneous fat (insular): 8th month
○ CNS *subcuteightnous
● Sex reveal: 2nd month
● Sex dixtinguishable (__): 3rd month
● Sex distinguishable (UTZ): 4th month
FETAL STAGE

STRUCTURES OF PREGNANCY
Doppler 8 mos

Amniotic Fluid
 ● Average: 500-1500cc ○ Immunologic function (IgG)
● Functions: *placentaG
○ Provides nourishment ○ Hormone production
○ Provides movement ■ Human Chorionic
○ Controls body temperature Gonadotropin (hCG)
○ Elimination of urine ■ Human Placental
○ Elimination of feces (meconium Lactogen (HPL) or
- blackish/greenish) Human Chorionic
● Characteristics: clear, alkaline, Somatomammotropin
500-1500cc ● Insulin antagonist
○ < 500 - oligohydramnios → “hides” insulin
■ Problem in elimination of → hyperglycemia
urine of fetus → kidney → Nsg mgmt:
problem/malformation offer insulin SQ
○ >1500 - polyhydramnios ● Insulin = mode of
■ Problem in intake → transportation of
tracheo-esophegeal glucose (source of
atresia or fistula energy).
● Safety: Do not
Umbilical Cord give OHA
(teratogenic)
● 50-55 cm ● 1st and 3rd
● Too short: leads to abruptio placenta trimester = high
● Too long: leads to nuchal of the cord insulin level
(cord coil) or cord prolapse ● 2nd tri = normal
● Covered by Wharton’s jelly insulin level (in
● Fetal circulation - AVA (2 arteries, 1 some books)
vein) ● Glucose can
○ Fetal arteries - carries bypass the
deoxygenated blood placental barrier
○ Fetal veins - carries oxygenated → acts as source
blood of energy for the
○ If 2 vessels cord only → kidney fetus → cut cord
malformation/ cardiac problem @ birth →
nourishment is cut
→ monitor for
signs of
hypoglycemia (ex
Placenta “Pancake” high pitched cry)
→ nsg mgmt:
● Functions: Breastfeed
○ Acts as fetal lungs (primary
function)
■ Diffusion: high → low
concentration
 HCG HPL
○ Opening inside the heart
between the right and left atrium
Increase causes: ● All these 3 structures close immediately
at birth after you initiate crying initiated
Nausea and +1 glycosuria -
vomiting → expected finding by:
morning sickness, ○ Foot/sole slapping
emesis gravidarum ○ Unang Yakap: Immediate drying
○ Suctioning
(+) urine pregnancy Hyperglycemia (can
test (as early as 8th cause GDM) → ● If foramen ovale does not close = Atrial
day/2nd week after offer insulin Septal Defect - opening between atrium
sexual intercourse) *(administration of OHA
is contraindicated to
○ Ventricular septal defect - if
H. mole (false
pregnancy = teratogenic opening between ventricles does
- Do not give!)
positive urine not close
pregnancy) ● If ductus arteriosus does not close =
Patent Ductus Arteriosus
Decrease causes:

Missed abortion -

Ectopic pregnancy Additional Notes

Threatened
abortion “Train hard. Fight Easy.” - Bryan Mendoza, 2022

Peak and Trough

Peak: 8th week -

(placenta takes
over)

Starts to decrease
@ 12th week
Sympa vs Parasympa
Decreased level @
16th week ● Sympa: think of a basketball player ⛹️⛹️‍♀️
● Everything inc except GI and GU

FETAL CIRCULATION Gametes

● Sperm (XY)
● Ductus venosus
○ Male
○ First structure to enter the fetal
■ Triangle-shaped
circulation
■ Longer tail → fast
○ Carries oxygenated blood from
swimmer
the placenta → bypasses liver
■ Low survivability
and inferior vena cava
○ Female
● Ductus arteriosus → connection
■ Round-shaped
between aorta and pulmonary artery
● Foramen Ovale
 ■ Shorter-tail → slow
swimmer hCG peak
■ Higher survivability
● Ovum (XX) ● 8th week: peak level of hCG
○ Monozygotic - one ovum ○ On 8th week, placenta is
(identical twins) released and takes over the
○ Dizygotic - two ova (fraternal corpus luteum (causes peak of
twins) hCG since placenta releases
hCG)
Trisomy 21 - low set ears, kidney and heart ● 12th week: starts to decrease
problems ● 16th week: lowest level of hCG
● Normal # of chromosomes: 46 *2 - 3 - 4 x 4 = hCG significant levels
● In trisomy 21 - XY/XX + 21 = 47
Nursing Management
Increased ICP in NB
PROM Cord Prolapse Nuchal of cord
● High pitched cry = early sign Life threatening
○ However, this can also be a sign
Priority: Priority and Uncoil the
of hypoglycemia d/t hunger Monitor FHT First: Position cord.
● Bulging fontanelles even when stable >160 bpm → the mother in
○ Expected/normal: bulging fetal distress Trendelenburg/
knee-chest.
fontanelles during crying
First action: Cover the Cut the cord
Crying in a NB Assess the prolapsed cord after pulsation
amniotic fluid. with wet stops.
sterile gauze (1st clamp - 2
● Language of a Child: Cry *Patient first (maintain inches from
● Expected cry of a NB: Loud and lusty before moist in cord) the base; 2nd
(full of vigor/strong) cry equipment clamp - 5
● Unexpected cry of a NB: High-pitched *Patient first inches from
before the base)
cry D/T increased ICP or hypoglycemia enquipment “Silver = 25”
(hunger)
● Priority: stable with bulging fontanels >
crying with bulging fontanels