Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
Lesson Title: HUMAN REPRODUCTION AND CARE OF Materials:
THE DEVELOPING FETUS Pen, paper, index card, book, and class
List
Learning Targets:
At the end of the module, students will be able to: References:
1. Describe the process of Fertilization and Implantation.
2. Describe the products of conception. Pilliteri, Adele and Silbert-Flagg, JoAnne
3. Explain fetal circulation. (2018) Maternal and Child Health
4. Describe the growth and development of the fetus by Nursing, 8th Edition. USA: Lippincott
gestational week.
Williams and Wilkins
A. LESSON PREVIEW/REVIEW
Instruction: Match the following terminology to its correct definition.
Nature of Inheritance Definition Answer
1. Bisexual A. Male-identified individuals who are sexually attracted to male.
B. Someone who finds sexual fulfillment with a member of his or
2. Cisgender
her own sex
3. Transgender C. Individuals feel that their gender and their sex do not match
4. Homosexual D. Individuals feel that their gender and their sex match.
5. Gay E. An individual attracted to both men and women.
B. MAIN LESSON
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
I. FERTILIZATION: THE BEGINNING OF PREGNANCY ⎯ All sperm that achieve capacitation cluster around
⎯ It is the union of the ovum and a spermatozoon, in the ovum.
the outer 3rd of the fallopian tube, in the ampullar ⎯ HYALURONIDASE (proteolytic enzyme) is released
segment by the sperm & dissolves the protective CORONA
RADIATA.
⎯ Ovum is capable of fertilization for 24h (48h at the
⎯ The large number of sperms provide enough
most)
enzymes to dissolve the corona cells
⎯ Sperm is functional for 48h up to 72h ⎯ Upon entry, cell membrane changes composition to
⎯ Critical time for sexual intercourse is about 72h (48h become impervious to other sperm
before ovulation + 24h) ⎯ HYDATIDIFORM MOLE- multiple sperm enter
leading to abnormal growth
⎯ Mature ovum is surrounded by the ZONA ⎯ After entry, chromosomal material fuse forming a
PELLUCIDA (ring of mucopolysaccharide fluid) and ZYGOTE
the CORONA RADIATA (circle of cells); both serve ⎯ X-sperm + X ovum = female (XX); Y-sperm + X
to increase the bulk of the ovum and serve as ovum = male (XY)
buffers against injury ⎯ Factors determining fertilization
⎯ Mature ovum is extruded from the GF during ✔ equal maturation of both sperm and ovum
ovulation & propelled into the fallopian tube by
currents initiated by the fimbriae ✔ ability of the sperm to reach the ovum
⎯ Movements of the tube cilia and peristaltic waves ✔ ability of the sperm to penetrate the zona
help propel the ovum along the length of the tube. pellucida and cell membrane and achieve
⎯ Ejaculation of 2.5 ml of semen contains 50 to 200M fertilization
sperm ⎯ Mitosis, or CLEAVAGE or MITOSIS, begins within
⎯ During ovulation, cervical mucus is thin making the 24 hours & continue at a rate of 1/22 hrs.
sperm able to penetrate it ⎯ When the zygote reaches the body of the uterus, it
⎯ Sperms reach the cervix within 80 seconds & the has 16 to 50 cells, is bumpy in appearance
outer end of the fallopian tube within 5 minutes after (MORULA- Lat. Morus or Mulberry)- DAY 3
deposition. (ORGASM) ⎯ Morula multiplies and floats free in the uterine cavity
⎯ Sperm move by wavelike movement of the flagella for 3 to 4 days
and uterine contractions through the cervix, body of
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
the uterus into the fallopian tube toward the waiting ⎯ Large cells tend to collect at the periphery of the
ovum (PHONONES/SONG OF THE SPERM) ball, leaving a fluid space surrounding an inner cell
⎯ CAPACITATION- changes in the plasma membrane mass and is termed a BLASTOCYST which
of the sperm head, which reveal the sperm-binding attaches to the endometrium
receptor sites ⎯ Parts of the Blastocyst: Trophoblast, embryoblast
(inner cell mass) and blastocyst cavity
II. IMPLANTATION or NIDATION III. EMBRYONIC AND FETAL STRUCTURES
⎯ Implantation (NIDATION) or contact between the A. THE DECIDUA
blastocyst and the endometrium occurs 8 to 10 days ⎯ After fertilization, corpus luteum in the ovary
after fertilization continue to function dt influence of HCG secreted
⎯ After 3rd or 4th day of free-floating (8 days since by the trophoblast cells
ovulation), the last residues of the corona radiata ⎯ ENDOCRINE Functions:
and zona pellucida are shed ⎯ PROLACTIN- promotes milk production
⎯ RELAXIN (peptide hormone- relaxes CT of
symphysis pubis & pelvic ligaments, promotes
cervical dilatation
⎯ PROSTAGLANDINS- potent, hormone-like fatty
acid
⎯ Endometrium continues to grow in thickness and
vascularity & is termed DECIDUA (Lat. Falling off
3 PARTS OF THE DECIDUA
1. DECIDUA BASALIS- lies directly under the embryo
(or the portion where the trophoblast cells are
establishing communication with maternal blood
3 Phases of Implantation: vessels)
✔ APPOSITION- blastocyst brushes against the 2. DECIDUA CAPSULARIS- portion that stretches or
endometrium (secretory phase of MC) encapsulates the surface of the trophoblast
✔ ADHESION- blastocyst attaches to the surface of 3. DECIDUA VERA- the remaining portion of the uterine
the endometrium lining
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
✔ INVASION- blastocyst settles down into the soft 1. As the embryo grows, it pushes the D. Capsularis
folds of the endometrium receiving nourishment of before it like a blanket & later, as it enlarges, comes
glycogen, mucoprotein from the endometrial glands into contact and fuses with the opposite uterine wall.
⎯ Invasion is possible since trophoblast cells produce
proteolytic enzymes.
⎯ As invasion continues it establishes an effective
communication network with the blood system of the
endometrium
⎯ Implantation is usually high in the uterus, at the
posterior portion
⎯ Occasionally, vaginal spotting occurs with
implantation because capillaries are ruptured by the
implanting cells
⎯ Once implanted, zygote is an EMBRYO
B. THE CHORIONIC VILLI
⎯ Trophoblastic layer of blastocyst matures rapidly & on the 11th to 12th day, miniature villi or probing fingers
called CHORIONIC VILLI reach out into the endometrium
⎯ At term, almost 200 villi have formed
⎯ Chorionic villi have a center core of loose connective tissue surrounded by a double layer of trophoblast cells
⎯ Central core of chorionic villi contains fetal capillaries.
⎯ Outer portion has 2 layers: syncytiotrophoblast & cytotrophoblast
1. SYNCYTIOTROPHOBLAST- outer layer or syncytial layer
✔ produce HCG, somatomammotropin (human placental lactogen) hormone, estrogen & progesterone
2. CYTOTROPHOBLAST or LANGHANS LAYER- inner layer, present at 12 days gestation
✔ protection from infections of spirochetes of syphilis
✔ this layer disappears between the 20th & 24th week
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
C. THE PLACENTA- Lat. For pancake FUNCTIONS OF THE PLACENTA
⎯ Arises from the trophoblast tissue
⎯ Serves as fetal lungs, kidneys, GIT, a separate Endocrine Function
endocrine organ throughout the pregnancy 1. HUMAN CHORIONIC GONADOTROPIN
⎯ 15 to 20 cm in diameter & 2 to 3 cm in depth at ⎯ 1ST hormone,
term, covering about half the surface area of the ⎯ found in blood & urine as early as 1st missed MP
internal uterus (shortly after implantation) through 100th day of
pregnancy
⎯ (-) for HCG within 1 to 2 weeks after birth
Functions of HCG:
⎯ ensure that corpus luteum continues to produce
E/P
⎯ suppresses maternal immunologic response to
prevent rejection of placental tissue
⎯ structure of HCG is similar to LH so if fetus is
male, it influences testes to produce testosterone
⎯ 8th week- outer layer of placenta begins to
produce P so CL is no longer needed, and HCG
levels decrease
2. ESTROGEN
Fetal Circulation ⎯ 2ND product of syncytial cells of placenta
⎯ 12th day of gestation- maternal blood begins to ⎯ contributes to mammary gland development
collect at the intervillous spaces of the uterine ⎯ stimulates uterine growth to accommodate
endometrium surrounding the chorionic villi growing fetus
⎯ 3rd week- O2 and nutrients like glucose, amino
acids, fatty acids, minerals, vitamins & water diffuse 3. PROGESTERONE
from the maternal blood through the layers of the ⎯ Maintains endometrial lining; present in serum by
chorionic villi to the capillaries and are transported to 4th week due to corpus luteum
the developing embryo ⎯ after placental synthesis (12th week),
PROGESTERONE rises progressively
Note: no direct exchange of blood between embryo & ⎯ reduce contractility of uterine muscles preventing
mother, only by selective osmosis through the chorionic premature labor
villi; chorionic villi layer is 1 cell thick and minute breaks
occasionally allow occasional fetal cells to cross plus
other enzymes like alpha-fetoprotein from the fetal liver. 4. HUMAN PLACENTAL LACTOGEN (HUMAN
CHORIONIC SOMATOMAMMOTROPIN)
⎯ Almost all drugs and alcohol perfuse across the ⎯ growth-promoting and lactogenic (milk-producing)
placenta. ⎯ produced by the placenta at 6th week, peaking at
⎯ Chorionic villi increase in number forming increasingly term
complex communication network with the maternal ⎯ present in maternal serum & urine
blood; intervillous spaces become larger, separated ⎯ promotes mammary gland growth
by partitions or septa
⎯ regulates maternal glucose, protein & fat levels so
⎯ Mature placenta has 30 segments called
COTYLEDONS which makes the maternal side that adequate amounts re always available to the
appear rough & uneven fetus
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
⎯ BRAXTON HICKS contractions, barely noticeable, aid THE UMBILICAL CORD
in maintaining pressure in the intervillous spaces by ⎯ Arising from the chorion & amnion, it provides a
closing off the veins during contraction circulatory pathway that connects the embryo to the
⎯ UTERINE PERFUSION and placental circulation is CV of the placenta
efficient when the woman lies on her left side lifting ⎯ Function: transport O2 & nutrients to the fetus from
the uterus away from the inferior vena cava, the placenta & to return waste products to the
preventing blood from being trapped in her lower placenta
extremities ⎯ 55 cm (21 in) long at term & 2 cm (3/4 in) thick
⎯ At term, placenta weighs 400 to 600g (1 lb), 1/6 of ⎯ WHARTON’S JELLY- gelatinous
baby’s weight mucopolysaccharide which gives the cord body &
prevents pressure on the Blood volume
⎯ Outer surface is covered with amniotic membrane
⎯ AVA (2 umbilical arteries, 1 umbilical vein)
⎯ Single vein & artery- anomalies of the kidneys & heart
⎯ Rate of blood flow through the cord is rapid, 350 ml/min at term- unlikely that the cord will twist
⎯ No nerve supplies
E. THE PLACENTAL MEMBRANES THE AMNIOTIC FLUID
⎯ Fetus continually swallows AF, from the intestine,
enters the bloodstream then to the umbilical arteries
to the placenta
⎯ Volume at term: 800 to 1200 ml
⎯ Slightly alkaline: pH 7.2
⎯ If unable to swallow (esophageal atresia or
anencephaly), HYDRAMNIOS occurs (> 2000 ml or
pockets of fluid >8 cm on UTZ
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 6
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
OLIGOHYDRAMNIOS- reduction in the amount of AF (<
300 ml or no pocket o UTZ > 1 cm) may be due to kidney
disturbance
Functions of Amniotic Fluid:
⎯ shields fetus from pressure or blow to the abdomen
⎯ Regulates temperature
⎯ Aids in muscular development since it allows fetus
to move freely
⎯ Protects umbilical cord from pressure thus
protecting the fetal O2 supply
THE AMNIOTIC MEMBRANE
⎯ Chorionic Villi on the medial surface of the
trophoblast (those not involved in implantation since
they don’t touch the endometrium) gradually
become thin, making the surface smooth (chorion
leave or smooth chorion)
⎯ Smooth chorion becomes the CHORIONIC
MEMBRANE (outermost fetal membrane) which
supports the sac that contains amniotic fluid, and the
inner layer becomes the AMNIOTIC MEMBRANE or
AMNION
⎯ 2nd membrane lining the chorionic membrane forms
beneath the chorion
⎯ Covers the fetal surface making it typically shiny
Functions of Amniotic Membrane:
⎯ supports and produces amniotic fluid,
⎯ produces phospholipids that initiate formation of
prostaglandins that initiate labor by producing
contractions
IV. ORIGIN AND DEVELOPMENT OF ORGAN ECTODERM
SYSTEMS ⎯ CNS (brain & spinal cord)
1. STEM CELLS ⎯ Peripheral Nervous System
2. 1ST 4 days of life- TOTIPOTENT STEM CELLS- so ⎯ Skin, hair, nails
undifferentiated they have the potential to form a ⎯ Sebaceous glands
complete human being
⎯ Sense organs
3. Next 4 days, cells begin to differentiate & slate to
become specific body cells- PLURIPOTENT STEM ⎯ Mucous membranes of anus, mouth & nose
CELLS ⎯ Tooth enamel
4. Next few days, MULTIPOTENT CELLS- highly ⎯ Mammary glands
specific
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 7
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
5. PRIMARY GERM LAYERS
6. At implantation, blastocyst has differentiated with 2 MESODERM
separate cavities appear in the inner structure: ⎯ Supporting structures (connective tissue, bones,
a. 1.) a large one, AMNIOTIC CAVITY, cartilage, muscle, ligaments and tendons)
which is lined with the ECTODERM ⎯ Dentin of the teeth
b. 2.) smaller cavity, the YOLK SAC, lined ⎯ Upper portion of the urinary system (kidneys &
with ENTODERM CELLS ureters)
7. YOLK SAC- supply nourishment only until ⎯ Reproductive system
implantation after which ⎯ Heart
8. it serves as a source of RBCs until the hematopoietic ⎯ Circulatory System
system is mature enough to take over; then it ⎯ Blood cells
atrophies leaving only a thin white streak discernible ⎯ Lymph vessels
in the cord at birth
9. Between the amniotic cavity & the yolk sac a 3rd layer
ENTODERM
of primary cells, the MESODERM, forms.
⎯ Lining of pericardial, pleural & peritoneal cavities
10. Development continues until the 3 germ layers meet
⎯ Lining of the Gastrointestinal tract, respiratory
at a point called EMBRYONIC SHIELD
tract, tonsils, parathyroid,
11. Each germ layer develops into specific body systems
⎯ Thyroid, thymus glands
⎯ Lower urinary system (bladder & urethra)
CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
1.Conception occurs in the fallopian tube, the most common site of which is the:
A. Ampulla
B. Fundus
C. Uterine isthmus
D. Corpus
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The most common site of implantation is which part of the uterus?
A. Uterine fundus, posterior portion
B. Uterine isthmus
C. Uterine corpus
D. Outer portion of the uterine tube
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. The period from two weeks to two months following fertilization is the stage of the:
A. Fetus
B. Ovum
C. Embryo
D. Neonate
Answer: ________
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 8
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The following characteristics are true of the male gamete sperm except:
A. lifespan: 72 hours
B. with 23 chromosomes, 22 autosomes and a Y sex chromosome
C. produced by the testes
D. has 2 types: androsperm carries the Y-sex chromosome and the gynosperm which carries the X-sex chromosome
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Callie, 18 years of age, asks how much longer her nurse will refer to the baby inside her as an embryo. The nurse is
correct in saying that the conceptus is classified as an embryo:
A. At the time of fertilization
B. When the placenta forms
C. From implantation until 20 weeks
D. From implantation until 5 to 8 weeks
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. The pregnant client during the first trimester is susceptible to teratogens because it is the period of organogenesis. If
she was exposed to a teratogen with affinity for the ectoderm primary germ layer, the organs listed below might be
affected, EXCEPT:
A. Brain
B. ears (sense of hearing)
C. cataracts
D. heart
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Arianna tells the nurse that she is worried her baby will be born with a congenital heart disease. What assessment of
the umbilical cord at birth would be most important to detect congenital heart defects?
A. Assessing whether the ph of the Wharton’s jelly is higher than 7.2
B. Assessing whether the umbilical cord has 2 arteries and 1 vein
C. Measuring the length of the cord to be certain it is longer than 3 feet
D. Determining that the umbilical cord is neither green nor yellow stained
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 9
Care of Mother, Child, and Adolescent
(Well-Clients)
Module #6 Student Activity Sheet
Name: Class number: _______
_________________________________________________________________ Date:
Section: ____________ Schedule: ________________
________________________________________
8. Karla asks why her nurse is concerned whether the lungs of her fetus are producing surfactant. The nurse’s best
answer would be:
A. “Surfactant keeps lungs from collapsing at birth, so it aids newborn breathing.”
B. “Surfactant is produced by the fetal liver; so its presence reveals liver maturity.”
C. “Surfactant is necessary for antibody production, so it helps prevent infection.”
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. Which of the following statements is not true about the placenta?
A. It provides exchange of wastes and nutrients between the mother and the fetus.
B. It develops by the third month of gestation.
C. It allows transfer of maternal immunoglobulin
D. It allows passage of bacteria and virus.
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Which of the following are correct about the amniotic fluid EXCEPT?
A. The normal volume at the end of pregnancy is 800 to 1200 ml
B. It surrounds, cushions and protects the fetus and allows for fetal movement.
C. It maintains the body temperature of the fetus.
D. The pH of amniotic fluid is acidic, below 7.0
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
AL Activity: Minute Paper
1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 10
