Fetal Environment The placenta begins to form
A. Amnion at implantation; the structure
1. Encloses the amniotic cavity 5. By week 10 to 12, genetic testing can be
2. Is the inner membrane that done via chorionic villus sampling
forms about the second week
of embryonic development
3. Forms a fluid-filled sac that surrounds the
embryo and later the fetus
B. Chorion
1. Is the outer membrane enclosing the amniotic
cavity
2. Becomes vascularized and forms the fetal part
of the placenta
C. Amniotic fluid
1. Con sists of 800 to 1200 m L by the end of
pregnancy
2. Surrounds, cushions, and protects the fetus and
allows
for fetal movement
3. Maintains the body temperature of the fetus
4. Contains fetal urine and is a measure of
fetal kidney function
5. The fetus modifies the amniotic fluid
through the processes of swallowing,
urinating, and movement of fluid through the
respiratory tract.
D. Placenta
1. The placenta provides for the exchange of
nutrients
and waste products between the fetus and mother.
2. The placenta begins to form at implantation; the
structure is complete by week 12
3. It produces hormones to maintain pregnancy
and
assumes full responsibility for the production of
these
hormones by the twelfth week of gestation.
4. In the third trimester, transfer of maternal
immunoglobulin provides the fetus with passive
immunity to certain diseases for the first few
months after birth.
, Birth rate: The number of births per 1,000 population.
Fertility rate: The number of pregnancies per 1,000 women of childbearing age.
Fetal death rate: The number of fetal deaths (over 500 g) per 1,000 live births.
Neonatal death rate: The number of deaths per 1,000 live births occurring at birth or
in the first 28 days of life.
Perinatal death rate: The number of deaths during the perinatal time period
(beginning when a fetus reaches 500 g, about week 20 of pregnancy, and ending about
4 to 6 weeks after birth); it is the sum of the fetal and neonatal rates.
Maternal mortality rate: The number of maternal deaths per 100,000 live births that
occur as a direct result of the reproductive process.
Infant mortality rate: The number of deaths per 1,000 live births occurring at birth or
in the first 12 months of life.
Childhood mortality rate: The number of deaths per 1,000 population in children aged
1 to 14 years.
Cultural Culture-specific values are norms and patterns of behavior unique to one culture.
Competency Culture universal values refers to values, norms, and patterns shared across almost all
Terminology cultures.
for Nurses Ethnicity refers to the cultural group into which a person was born, although the term
, is sometimes used in a narrower context to mean only race.
Race, a social construct, refers to a category of people who share a socially recognized
physical characteristic, often skin color or facial features. It can also refer to a group of
people who share the same ancestry.
Acculturation refers to the loss of ethnic traditions because of disuse.
Cultural assimilation means people blend into the general population or
adopt the values of the dominant culture.
Ethnocentrism is the belief one’s own culture is superior to all others.
Cultural awareness is being aware cultural differences exist.
Cultural competence is respecting cultural differences or diversity.
Cultural humility is a lifelong process of self-reflection and self-critique that begins,
not with an assessment of a patient’s beliefs, but rather with an assessment of your
own.
Genital herpes Genital herpes simplex virus (HSV) is a sexually transmitted infection spread by
intimate contact. The first time a woman contracts an HSV infection, systemic
involvement occurs. The virus spreads into the bloodstream (viremia) and, if a woman
is pregnant, can cross the placenta to a fetus, thus posing substantial fetal risk
Acyclovir (Zovirax) or valacyclovir (Valtrex) can both be safely administered to women
who develop lesions during pregnancy as well as to their newborns at birth
Either drug is recommended daily as prophylaxis at 36 weeks of pregnancy to prevent
a lesion at the time of birth. The primary mechanism for protecting a fetus, however, is
disease prevention. Urging women to practice safer sex is important to lessen their
exposure to this and other sexually transmitted infections.
Condoms
Gonorrhea Gonorrhea is transmitted by Neisseria gonorrhoeae, a gram-positive diplococcus,
which thrives on the mucous membrane of the vagina or penis (O’Connor & Shubkin,
2012). In males, symptoms include urethritis (pain on urination and frequency of
urination) and a urethral discharge, which appear after a 2- to 7-day incubation period.
Untreated, the infection spreads easily among sexual partners and may spread to the
testes, scarring the tubules and causing permanent sterility. It often occurs
concurrently with a chlamydial infection.
(Rocephin) plus 7 days of oral doxycycline (Vibramycin) or azithromycin (Zithromax) is
the current recommended therapy because this treatment regimen is effective for
gonorrhea, chlamydia, and syphilis
Syphilis Syphilis, a sexually transmitted infection, is of great concern for the maternal–fetal
population. Despite the availability of accurate screening tests and proven medical
treatment, it is growing in incidence; it places a fetus at risk for intrauterine or
congenital syphilis
If left untreated beyond the 18th week of gestation, hearing impairment, cognitive
challenge, osteochondritis, and fetal death are possible.
Benzathine penicillin G, given intramuscularly in two sites, is effective therapy. For the
, adolescent who is sensitive to penicillin, either oral erythromycin or tetracycline can be
given for 10 to 15 days.
Bacterial Bacterial vaginosis is defined as the absence or deficiency of lactobacilli in the vaginal
Vaginosis flora and it occurs frequently among woman of childbearing age (Parma, Vanni, Bertini,
et al., 2014). An intensely pruritic vaginal discharge appears milky-white to gray and
has a fishlike odor. Microscopic examination of the discharge shows gram-negative
rods adhering to vaginal epithelial cells (termed clue cells). Like trichomoniasis,
bacterial vaginosis can increase a woman’s susceptibility to other STIs, such as herpes
simplex virus (HSV), chlamydia, and gonorrhea, as well as HIV
The treatment is oral or vaginal metronidazole for 7 days. The woman’s sexual partner
should also be treated to prevent recurrence of the infection
CDC Asymptomatic infection is common among both men and women. To detect
recommendati chlamydial infection, health care providers frequently rely on screening tests.
on for Annual screening of all sexually active women aged <25 years is recommended, as is
chlamydia screening of older women at increased risk for infection (e.g., women aged ≥25 years
who have a new sex partner, more than one sex partner, a sex partner with
concurrent partners, or a sex partner who has an STI) (149). In a community-based
cohort of female college students, incident chlamydial infection was also associated
with BV and high-risk HPV infection (785). Although chlamydia incidence might be
higher among certain women aged ≥25 years in certain communities, overall, the
largest proportion of infection is among women aged <25 years (141).
Doxycycline 100 mg orally 2 times/day for 7 days
Alternative Regimens
Azithromycin 1 g orally in a single dose
Levofloxacin 500 mg orally once daily for 7 days
Adolescent An adolescent must accomplish certain developmental tasks to advance to the next
Pregnancies stage of maturity. These developmental tasks include:
Seeking economic and social stability
Adjusting to sexually maturing bodies and feelings
Developing a personal value system
Building meaningful relationships with others (Fig. 20.6)
Becoming comfortable with their changing bodies
Working to become independent from their parents
Understanding abstract ideas
Learning to verbalize conceptually (CDC, 2019r)
Nursing Management
For adolescents, as for all women, pregnancy can be a physically, emotionally, and
socially stressful time. The pregnancy is often both the result of and cause of social
problems and stressors that can be overwhelming. Teen mothers often present with
depression, social complexity, and inadequate parenting skills. Nurses must support
adolescents during the transition from childhood into adulthood, which is complicated
by the emergence into motherhood. Assist the adolescent in identifying family and
friends who want to be involved and provide support throughout the pregnancy
A. Amnion at implantation; the structure
1. Encloses the amniotic cavity 5. By week 10 to 12, genetic testing can be
2. Is the inner membrane that done via chorionic villus sampling
forms about the second week
of embryonic development
3. Forms a fluid-filled sac that surrounds the
embryo and later the fetus
B. Chorion
1. Is the outer membrane enclosing the amniotic
cavity
2. Becomes vascularized and forms the fetal part
of the placenta
C. Amniotic fluid
1. Con sists of 800 to 1200 m L by the end of
pregnancy
2. Surrounds, cushions, and protects the fetus and
allows
for fetal movement
3. Maintains the body temperature of the fetus
4. Contains fetal urine and is a measure of
fetal kidney function
5. The fetus modifies the amniotic fluid
through the processes of swallowing,
urinating, and movement of fluid through the
respiratory tract.
D. Placenta
1. The placenta provides for the exchange of
nutrients
and waste products between the fetus and mother.
2. The placenta begins to form at implantation; the
structure is complete by week 12
3. It produces hormones to maintain pregnancy
and
assumes full responsibility for the production of
these
hormones by the twelfth week of gestation.
4. In the third trimester, transfer of maternal
immunoglobulin provides the fetus with passive
immunity to certain diseases for the first few
months after birth.
, Birth rate: The number of births per 1,000 population.
Fertility rate: The number of pregnancies per 1,000 women of childbearing age.
Fetal death rate: The number of fetal deaths (over 500 g) per 1,000 live births.
Neonatal death rate: The number of deaths per 1,000 live births occurring at birth or
in the first 28 days of life.
Perinatal death rate: The number of deaths during the perinatal time period
(beginning when a fetus reaches 500 g, about week 20 of pregnancy, and ending about
4 to 6 weeks after birth); it is the sum of the fetal and neonatal rates.
Maternal mortality rate: The number of maternal deaths per 100,000 live births that
occur as a direct result of the reproductive process.
Infant mortality rate: The number of deaths per 1,000 live births occurring at birth or
in the first 12 months of life.
Childhood mortality rate: The number of deaths per 1,000 population in children aged
1 to 14 years.
Cultural Culture-specific values are norms and patterns of behavior unique to one culture.
Competency Culture universal values refers to values, norms, and patterns shared across almost all
Terminology cultures.
for Nurses Ethnicity refers to the cultural group into which a person was born, although the term
, is sometimes used in a narrower context to mean only race.
Race, a social construct, refers to a category of people who share a socially recognized
physical characteristic, often skin color or facial features. It can also refer to a group of
people who share the same ancestry.
Acculturation refers to the loss of ethnic traditions because of disuse.
Cultural assimilation means people blend into the general population or
adopt the values of the dominant culture.
Ethnocentrism is the belief one’s own culture is superior to all others.
Cultural awareness is being aware cultural differences exist.
Cultural competence is respecting cultural differences or diversity.
Cultural humility is a lifelong process of self-reflection and self-critique that begins,
not with an assessment of a patient’s beliefs, but rather with an assessment of your
own.
Genital herpes Genital herpes simplex virus (HSV) is a sexually transmitted infection spread by
intimate contact. The first time a woman contracts an HSV infection, systemic
involvement occurs. The virus spreads into the bloodstream (viremia) and, if a woman
is pregnant, can cross the placenta to a fetus, thus posing substantial fetal risk
Acyclovir (Zovirax) or valacyclovir (Valtrex) can both be safely administered to women
who develop lesions during pregnancy as well as to their newborns at birth
Either drug is recommended daily as prophylaxis at 36 weeks of pregnancy to prevent
a lesion at the time of birth. The primary mechanism for protecting a fetus, however, is
disease prevention. Urging women to practice safer sex is important to lessen their
exposure to this and other sexually transmitted infections.
Condoms
Gonorrhea Gonorrhea is transmitted by Neisseria gonorrhoeae, a gram-positive diplococcus,
which thrives on the mucous membrane of the vagina or penis (O’Connor & Shubkin,
2012). In males, symptoms include urethritis (pain on urination and frequency of
urination) and a urethral discharge, which appear after a 2- to 7-day incubation period.
Untreated, the infection spreads easily among sexual partners and may spread to the
testes, scarring the tubules and causing permanent sterility. It often occurs
concurrently with a chlamydial infection.
(Rocephin) plus 7 days of oral doxycycline (Vibramycin) or azithromycin (Zithromax) is
the current recommended therapy because this treatment regimen is effective for
gonorrhea, chlamydia, and syphilis
Syphilis Syphilis, a sexually transmitted infection, is of great concern for the maternal–fetal
population. Despite the availability of accurate screening tests and proven medical
treatment, it is growing in incidence; it places a fetus at risk for intrauterine or
congenital syphilis
If left untreated beyond the 18th week of gestation, hearing impairment, cognitive
challenge, osteochondritis, and fetal death are possible.
Benzathine penicillin G, given intramuscularly in two sites, is effective therapy. For the
, adolescent who is sensitive to penicillin, either oral erythromycin or tetracycline can be
given for 10 to 15 days.
Bacterial Bacterial vaginosis is defined as the absence or deficiency of lactobacilli in the vaginal
Vaginosis flora and it occurs frequently among woman of childbearing age (Parma, Vanni, Bertini,
et al., 2014). An intensely pruritic vaginal discharge appears milky-white to gray and
has a fishlike odor. Microscopic examination of the discharge shows gram-negative
rods adhering to vaginal epithelial cells (termed clue cells). Like trichomoniasis,
bacterial vaginosis can increase a woman’s susceptibility to other STIs, such as herpes
simplex virus (HSV), chlamydia, and gonorrhea, as well as HIV
The treatment is oral or vaginal metronidazole for 7 days. The woman’s sexual partner
should also be treated to prevent recurrence of the infection
CDC Asymptomatic infection is common among both men and women. To detect
recommendati chlamydial infection, health care providers frequently rely on screening tests.
on for Annual screening of all sexually active women aged <25 years is recommended, as is
chlamydia screening of older women at increased risk for infection (e.g., women aged ≥25 years
who have a new sex partner, more than one sex partner, a sex partner with
concurrent partners, or a sex partner who has an STI) (149). In a community-based
cohort of female college students, incident chlamydial infection was also associated
with BV and high-risk HPV infection (785). Although chlamydia incidence might be
higher among certain women aged ≥25 years in certain communities, overall, the
largest proportion of infection is among women aged <25 years (141).
Doxycycline 100 mg orally 2 times/day for 7 days
Alternative Regimens
Azithromycin 1 g orally in a single dose
Levofloxacin 500 mg orally once daily for 7 days
Adolescent An adolescent must accomplish certain developmental tasks to advance to the next
Pregnancies stage of maturity. These developmental tasks include:
Seeking economic and social stability
Adjusting to sexually maturing bodies and feelings
Developing a personal value system
Building meaningful relationships with others (Fig. 20.6)
Becoming comfortable with their changing bodies
Working to become independent from their parents
Understanding abstract ideas
Learning to verbalize conceptually (CDC, 2019r)
Nursing Management
For adolescents, as for all women, pregnancy can be a physically, emotionally, and
socially stressful time. The pregnancy is often both the result of and cause of social
problems and stressors that can be overwhelming. Teen mothers often present with
depression, social complexity, and inadequate parenting skills. Nurses must support
adolescents during the transition from childhood into adulthood, which is complicated
by the emergence into motherhood. Assist the adolescent in identifying family and
friends who want to be involved and provide support throughout the pregnancy
