Chapter 3 Nurs 201

location effects on prenatal care and delivery of babies

-In Europe and Asia, nurse-midwives and certified midwives have been the primary caretakers of pregnant women and newborns for many years -in the United States, physicians provide prenatal care and deliver babies for 92% of women

Duchenne and Becker Muscular Dystrophy

- 1/3000 males births

nursing care and planning parenthood

-50% of pregnancies in US unplanned -Preconception care -Nursing care: --Conception planning --Feelings about pregnancy and parenthood --Sensitivity to patients' perceptions of pregnancy and parenthood

examples of autosomal recessive disorders

-Cystic Fibrosis (1/2500 Caucasian births, carrier freq ~1/25) -PKU (1/15,000, carrier freq ~1/60) -Sickle cell disease (1/365 of Black or African American births, carrier freq ~1/13) -40% of all congenital hearing loss (10% due to GJB2 gene/Connexin 26 protein)

examples of chromosomal translocation conditions

-Down syndrome (1/800 live births. Risk increases with advanced maternal age) -Turner syndrome - 45,X (1/2000 girls) -Sex chromosome: 47,XXY; 47,XYY; 47,XXX -Chromosome deletions/duplications -0.5% of all newborns have a chromosomal abnormality

prenatal behavior

-Fetuses can differentiate between familiar and novel stimuli by 32 to 33 weeks -Newborns can remember prenatal stimuli and react accordingly -Very active fetuses tend to be active children who can be labeled "hyperactive" later on

what do genetic counselors do?

-Provide information and support to families who have relatives with birth defects or genetic disorders and to families who may be at risk for a variety of inherited conditions -discuss natural history of genetic conditions, management recommendations, analyze inheritance patterns and risks of recurrence and review available options with the family -provide supportive counseling to families -serve as patient advocates -serve as educators and a resource to other health care professionals and the general public -engage in research activities related to the field of medical genetics and genetic counseling

drugs used during labor and delivery include

-analgesics= medication that may be given during labor to reduce pain -sedatives or tranquilizers = administered to reduce anxiety during labor and delivery -anesthesia = used during labor and delivery to block pain either totally (general anesthesia) or in certain protions of body (local anesthesia such as epidural)

causes of preterm and LBW babies

-biological stress mechanisms -access to prenatal and primary care -racism (African-Americans 2-4 times as likely to have LBW and preterm infants due to socially-driven issues such as disrespect and discrimination within healthcare affecting women of color) -lack of education (mitigated by race) -poverty (preterm and LBW linked to numerous socioeconomic status factors including income, and housing etc.) -complexity

important maternal teratogens and their effects

-cancer which could cause fetal or placental tumor in fetus -toxoplasmosis which could cause brain swelling, spinal abnormalities in fetus -chicken pox which could cause scars, eye damagein fetus -parvovirus which could could anemia in fetus -hep B which cold hepatitis in fetus -chlamydia which could cause conjunctivitis, pneumonia in fetus -tuberculosis which could cause pneumonia or tuberculosis in fetus

Neurofibromatosis type 1

-caused by mutations on the NF1 gene -one of the most common single gene disorders in man -incidence of 1 in 2600-3000 individuals (50% are familial or inherited) -diagnosis based on clinical criteria: ->Café au lait macules -> freckling ->Peripheral or plexiform ->neurofibroma ->Lisch nodules ->Optic glioma ->Distinct osseous lesion ->Affected first degree relative

third trimester (28 weeks- beginning of labor)

-colostrum (helps babies regulate temp and grow) in preparation for nursing -emotional connection between mother and baby grows -fetal hiccups and thumb-sucking visible on sonogram -fetus has regular activity and rest periods care= weekly visits, ultrasound to assess position, pelvic exam to check cervical dilation problems= increased BP, bleeding, bladder infection, premature labor

stage 1 of labor

-dilation and effacement: the cervix (the opening at the bottom of the uterus) must open up like the lens of a camera (dilation) and also flatten out (effacement). -cervix must normally be dilated to about 10 centimeters -women delivering a first child, stage 1 may last as few as 3 hours or as many as 20 divided into stages: -latent (early) phase -> contractions are far apart and typically are not too uncomfortable -active phase - > begins when the cervix is 4 to 6 centimeters dilated and continues until dilation has reached 8 centimeters; contractions are closer together and more intense -transtion -> 7 to 10 centimeters= last 2 centimeters of dilation are achieved; contractions are closely spaced and strong, that women typically find the most painful; shortest phase

When do chromosomal differences become physical differences between males and females?

4 and 8 weeks following conception -dependent on if androgens are present

genotype

unique genetic blueprint thatt characterizes each individual

nursing care of the pregnant person

-education: nutrition, sleep -assessment: vital signs, weight gain, mental health -emotional support: experience of pregnancy, life and role transition

other factors that call for c-section include

-fetal distress during labor -labor that fails to progress in a reasonable amount of time -a fetus that is too large to be delivered vaginally - age concerns or maternal health conditions that may be aggravated by vaginal delivery (e.g., cardiovascular disease, spinal injury) or may be dangerous to a vaginally delivered fetus (e.g., herpes)

fetal brain development

1. neuronal migration: migrating neurons consist only of cell bodies = the part of the cell that contains the nucleus and carries out the cell's vital functions -when they reach final destinations in the fetal brain, the neurons begin to develop synapses= tiny spaces between neurons across which neural impulses travel from one neuron to the next. -synapse formation requires the growth of axons, tail-like extensions that can grow to be several feet in length, and dendrites, branches that extend out from the cell body 2. synapse formation: between the 10th and 15th weeks, fetal behavior indicates that synapse formation is proceeding rapidly. (For instance, the fetus exhibits distinct periods of activity and rest and begins to yawn) 3. major structures take shape: Glial cells are the "glue" that hold the neurons together to give shape to the brain's major structures. By the 26th week, glial cell development is sufficient to give the fetal brain a more mature appearance.

milestones of first trimester

-missed period: prenatal care= confirmation of pregnancy serious problem = ectopic pregnancy -breast enlargement: prenatal care = calculation of due date serious problem = abnormal urine or blood tests -abdominal thickening: prenatal care= blood and urine tests serious problem= increased blood pressure -montly doctor visits to monitor vital conditions, uterine growth, weight gain, sugar and protein urine serious problem= malnutrition other serious problems: bleeding and miscarriage

autosomal dominant inheritance

-multiple generations are affected -males and females are equally likely to be affected -male to male transmission occurs -each offspring of an affected parent has a 50% chance of being affected and a 50% chance of being unaffected

heart beats per minute (Apgar scale)

-score 0 = 0% -score 1 = <100% -score 2= >100%

prescription and over-the-counter drugs

-some pregnant women must take drugs to treat health conditions that may be threatening to their life and childs - pregnant women may have to take drugs that may be harmful like medications that treat heart conditions and diabetes, control asthma symptoms, and some kinds of psychiatric drugs -physicians weigh the benefits of medication against potential teratogenic effects and look for a combination of drug and dosage that will effectively treat the mother's health condition while placing her unborn child at minimal risk -many pregnant women take over-the-counter medicines without consulting doctor and while msot are safe, experts advise pregnant women to discuss the medicines they usually take with physicians at the outset of their pregnancies -doctors will advise them on which of the substances are safe and which are risky. Often, too, physicians can suggest safer alternatives which are likelier older drugs that have been thoroughly tested

correlations between fetal brain development and behavior

1. 5-10 weeks: neural proliferation -> twitches; moves arms and legs 2. 10-20 weeks: neuronal migration -> moves head; breathing movements; opens mouth, yawns, sucks and swallows, walking movements, sleep cycles 3. 20-30 weeks: synapse formation, growth, myelination -> pain reactions, cry expressions, reactions to sound, blink reflex, visual fixation

3 core clinical areas of genetic counseling

1. prenatal/preconception: work with pregnant women, couples planning a pregnancy, couples who are at risk for having a baby with a genetic condition, couples who have experienced pregnancy loss 2. pediatric: help parents, families, children and teenagers who have/may have genetic conditions, intellectual disability, birth defects, family history of a genetic condition 3. adult/cancer: counsel adults with medical and genetic conditions, or a family history of a condition such as cancer, Huntington disease, Alzheimer disease

Rubella (German Measles)

viral infection that causes a short-lived reaction in adults but may be deadly to a fetus. -most infants exposed to rubella in the first trimester show some degree of hearing impairment, visual impairment, and/or heart deformity -possible effects of rubella are so severe that doctors now recommend that all women of childbearing age be vaccinated against the disease -however, vaccine may also be teratogenic, so doctors suggests that women wait at least 1 month after recieving vaccine to begin trying to conceive

maternal viral diseases

viruses pass through placental filters (which prevents many potentitally harmful microorganisms from entering fetal bloodstream) and attack embyro or fetus directly -viruses affect fetus same way as they would pregnant women, but the risk of long-term damage is greater for fetus

genetic testing

benefits: -may provide explanation for the history of cancer -results may assist with medical management decisions -may provide info for family members considerations: -psychological impact -a normal result could give false reassurance -questions about insurance or employer discrimination limitations: -negative result is most informative when familial mutation is known -testing may not be able to detect all gene changes -variants of unknown significance

types of cancer removals

breast cancer:::: -prophylactic mastectomy and/or oophrorectomy -chemoprevention: -> In a retrospective study, tamoxifen reduced the risk for breast cancer by 62% in healthy women with BRCA2 pathogenic variant -> Tamoxifen was associated with a 41%-50% reduction in the risk of developing contralateral breast cancer -breast feeding for a cumulative total of more than one year reduced the risk for breast cancer ovarian cancer :::::: -prophylactic oophrorectomy -oral contraceptive use has been associated with a reduction in ovarian cancer risk of 14%-38%

maternal development

calculating EDD: -Naegele's method (first day of last menstral period -> go forward 1 year then subtract 3 months) -ultrasound dating (most reliable in 1st trimester; not as reliable in 2nd and 3rd) 1st trimester: -Conception and implantation -Physical changes -Prenatal care is crucial (crucial development happens in 1st trimester) -Risks - miscarriage, ectopic pregnancy (develops outside uterus and fallopian tubes) 2nd trimester: -physical changes -risks: gestational diabetes, miscarriage, premature labor 3rd trimester: -weekly visits -risks: blood pressure, bleeding, bladder issues, premature labor

chronic illnesses like heart disease, diabetes, and lupus

can also affect prenatal development negatively -fetal-maternal medicine manages the pregnancies of women who have chronic condtions in ways that will support the health of both mother and fetus (for instance: pregnancy often makes it impossible for a diabetic woman to keep her blood sugar levels under control -> erratic blood sugar levels may damage the fetus's nervous system or cause it to grow too rapidly) -to prevent this, a fetal-maternal specialist must find a diet, a medication, or a combination of the two that will stabilize the mother's blood sugar but will not harm the fetus -also fetal-maternal specialists help women who have epilepsy balance their own need for anticonvulsant medication against possible harm to the fetus.

gametes

cells that unite at conception = sperm and ovum -contain 23 single (unpaired) chromosmes

genomic imprinting

chemical label that identifies each gene in a person's body as having come from their father or mother -could possibly "turn on" an atypical developmental process or "turn off" a normal one -may evoke responses in other genes or tissues in the developing individual's body that set the process of atypical development in motion -may be important in diseases appearing later in life

deoxyribonucleic acid (DNA)

chemical material that makes up chromosomes and genes

factors that predict development in preterm infants for many years following birth

child's birth weight and gestational age -lower birth weight and earlier gestational age are associated with long-term developmental delays -premature infants who experienced breathing problems, infectious illnesses, or brain injuries during the first few weeks are more likely to experience long-term developmental delays than premature infants who did not have such difficulties -important for parents to know that their responses to a child contribute to how rapidly she develops

mitochondrial inheritance

children inherit genes that are carried in structures called mitochondria in woman's eggs

expressivity

degree to which any gene influences phenotypes varies from person to person (example:all individuals who have the gene for curly hair don't have equally curly hair)

cesarean section

delivery of an infant through a surgical abdominal and uterine incision -prevent maternal and fetal complications, and, no doubt, save lives

proximodistal pattern

development happens in an orderly way from the center of the body outward to the extremities (example: ribcage develops before fingers and toes)

cephalocaudal pattern

development proceeds from the head down (example= brain is formed before reproductive organs

long-term effects of drug use during labor

no consistently observed effects from analgesics and tranquilizers beyond the first few days, and only hints from a few studies of long-term effects of anesthesia -If you are a new mother who received medication during childbirth, bear in mind that your baby is also drugged, and that this will affect her behavior in the first few days. If you allow for this effect and realize that it will wear off, your long-term relationship with your child is likely to be unaffected

doulas

nonmedical person who assists a woman before, during, or after childbirth, as well as her partner and/or family, by providing physical assistance, and emotional support -are NOT healthcare providers and have no medical training -associated with lower rates of C/S and epidurals and increased rates of vaginal delivery, exclusive breastfeeding, and patient satisfaction

enviromental hazards

number of substances found in the environment may have detrimental effects on prenatal development -women who work with mercury are advised to limit their exposure to this potentially teratogenic substance -Consuming large amounts of fish may also expose pregnant women to high levels of mercury (because of industrial pollution of the oceans and waterways); fish may also contain elevated levels of another problematic industrial pollutant known as polychlorinated biphenyls, or PCBs -for this reason, researchers recommend that pregnant women limit their consumption of fish, especially fresh tuna, shark, swordfish, and mackerel -pregnant women are advised to avoid: -lead -> found in painted surfaces in older homes, pipes carrying drinking water, lead crystal glassware, and some ceramic dishes -arsenic -> found in dust from pressure-treated lumber -cadmium -> found in semiconductor manufacturing facilities -anesthetic gases -> found in dental offices, outpatient surgical facilities, and hospital operating rooms -solvents -> alcohol and paint thinners -parasite-bearing substances -> animal feces and undercooked meat, poultry or eggs

heterozygous

one dominant and one recessive gene

respiratory distress syndrome (hyaline membrane disease)

the poorly developed lungs of infants with this disease cause serious breathing difficulties -those born more than 6 weeks early -in 1990, physicians began treating this problem by administering surfactant (a chemical that makes it possible for the lungs to exchange oxygen and carbon dioxide in the blood) to preterm neonates, and this therapy has reduced the rate of death among very-low-birth-weight infants

autosomes

22 pairs of chromosomes other than the sex chromosomes that contain most of the genetic information for new individual

sex chromosomes

23rd pair of chromosomes which determines sex of the individual

first trimester

-first day of last menstrual period to 12 weeks -pregnancy begins when the zygote implants itself in the lining of the woman's uterus (womb) -zygote sends out chemical messages that cause the woman's menstrual periods to stop -some of the chemicals are excreted in her urine, making it possible to diagnose pregnancy within a few days after conception -other chemicals cause physical changes, such as breast enlargement. -the cervix thickens and secretes mucus that serves as a barrier to protect the developing embryo from harmful organisms that might enter the womb through the vagina -the uterus begins to shift position and put pressure on the woman's bladder, causing her to urinate more often. This and other symptoms, like fatigue and breast tenderness, may interfere with sleep. -early symptom of pregnancy is morning sickness—feelings of nausea, often accompanied by vomiting, that usually occur in the morning -prenatal care during the first trimester is critical to prevent birth defects because all of the baby's organs form during the first 8 weeks. -early prenatal care can identify maternal conditions, such as sexually transmitted diseases, that may threaten prenatal development. -doctors and nurses urge women to abstain from using drugs and alcohol early in prenatal development, when such behavior changes may prevent birth defects - important to the pregnant woman's health. (For example, a small number of zygotes implant in one of the fallopian tubes instead of in the uterus, a condition called ectopic pregnancy. Early surgical removal of the zygote is critical to the woman's future ability to have children) -about 15% of pregnancies end in miscarriage, or spontaneous abortion. -From woman's POV, early miscarriage is similar to a menstrual period, although feelings of discomfort and blood loss are usually greater. -medical care is always necessary after a miscarriage because the woman's body may fail to completely expel the embryo.

stage 4 of labor: recovery

-first hour after delivery is essential for bonding and initiation of breastfeeding

examples of recessive genes

-flat feet -thin lips -fine hair -red hair -blond hair -type O blood

examples of dominant genes

-freckles -coarse hair -dimples -nearsightedness -broad lips -types A and B blood -dark hair

genetic facts

-genetic does not always mean "inherited". A child can have a genetic condition even if no one else in the family has the same condition. -gene mutations can be benign or cause human disease. -there is a 3-5% background risk for each pregnancy to result in a child with a birth defect or genetic condition. -all humans are carriers of ~4-8 recessive (nonworking) genes. Recessive = "hidden" so we usually don't know which recessive genes we carry unless our child/family member is identified with a recessive, genetic condition

autosomal recessive inheritance

-greatest recurrence risk is among siblings of affected individual -males and females are equally likely to be affected -if parents are both carriers of mutations in the same recessive gene, each pregnancy has a 25% of inheriting both normal genes, a 50% chance of being a carrier, and a 25% chance of inheriting both gene mutations and being affected -ethnic background and cosanguinity may influence the likelihood of a specific recessive disease

examples of polygenic (many genes)

-height -body type -eye color -skin color -personality

prevalence of genetic conditions

-humans have 20,000 - 25,000 genes -functions are unknown for over 50% of discovered genes -5-10% of all cancers have hereditary component -10% of the chronic diseases (heart, diabetes, arthritis) which occur in the adult populations have a significant genetic component -50% of intellectual disability has genetic basis -there are more than 6,000 known single-gene disorders, which occur in about 1 out of every 200 births

X-linked recessive inheritance

-incidence of the condition is much higher in males than females -all daughters of affected males will be carriers -the condition is never transmitted directly from father to son -sons of carrier females have a 50% chance of being affected and a 50% chance of being unaffected with each pregnancy -daughters of carrier females have a 50% chance of being a carrier and a 50% chance of inheriting the normal copy of the gene

solutions to racism in prenatal care

-increased attention to bias within healthcare -prenatal care -political options: --increase access to primary care across lifespan --increase workforce diversity --research funding -social options: --increased access to higher education

infant injuries during birth

-infants may dislocate their shoulders or hips during birth -experience fractures, and in others, nerves that control facial muscles are compressed, causing temporary paralysis on one side of the face -complications are usually not serious and resolve themselves with little or no treatment

tobacco

-infants of mothers who smoke grow more slowly in the womb and are on average about half a pound lighter at birth than infants of nonsmoking mothers -prenatal exposure to tobacco may also have long-term effects on children's development -for instance, some studies suggest that there are higher rates of learning problems and antisocial behavior among children whose mothers smoked during pregnancy

important drug-related teratogens and their effects

-inhalants which could cause problems similar to those of fetal alchol spectrum disorder in fetus; premature labor -accutane/vitamin A which could cause facial, ear, heart deformities in fetus -streptomycin which could cause deafness in fetus -penicillin which could cause skin disorders in fetus -tetracycline which could cause tooth deformities in fetus -diet pills which could cause low birth weight in fetus

pedigree and family history of genetic counseling

-interpret family history to assess the chance of disease occurrence or recurrence -obtain directed family history in pedigree form using standard symbols, including: -> the patient's first degree (children, siblings, parents) and second degree (grandparents, grandchildren, aunts, uncles, nieces, nephews) relatives, and further removed as appropriate -> status of current pregnancies -> ethnic background -> presence of consanguinity (relatedness)

direct to consumer testing (DTC)

-is becoming more prevalent and easier to access -> 23andMe -> cost can range from less than $100 to a few thousand dollars (sometimes can be offered for free as long as the consumer agrees to buy other products from the seller) goals: -ethnicity information -personal characteristics -disease susceptibility

variability in labor and delivery

-length of gestation: 37-42 weeks -length of labor: 1-72+ hours -position of baby -interventions: epidural/other pain, and cesarean delivery

what are the problems with cesarean deliveries?

-major surgery -infection, blood loss, injury, adhesions, uterine rupture -slower recovery -challenges to infant bonding and care-giving -costs to healthcare system (society) -risks to future pregnancies (placenta accreta) -TOLAC/VBAC not always available, particularly in low-resource areas

second trimester

-week 12 through week 24 -morning sickness usually disappears, resulting in increases in appetite -pregnant women gain weight and uterus expands to accommodate a fetus that is growing rapidly; begin to "show" -begins to feel the fetus movements, usually between 16th and 18th weeks -doctors monitor both the mother's and baby's vital functions and keep track of the growth of the baby in womb -ultrasound tests are usually performed and the sex of baby can be determined by 12th week -monthly urine tests check for gestational diabetes, a kind of diabetes that happens only during pregnancy -Women who have any kind of diabetes, including gestational diabetes, have to be carefully monitored during the second trimester because their babies may grow too rapidly, leading to premature labor or a baby that is too large for vaginal delivery. -The risk of miscarriage drops in the second trimester. However, a few fetuses die between the 13th and 20th weeks of pregnancy.

embryonic stage

-weeks 3-8 = organogenesis -development of placenta, umbilical cord, yolk sac and amnion -neural tube development and development of chief organs -organs that are required for survival outside the womb develop -begins at implantation, approximately 2 weeks after conception, and continues until the end of week 8 -the embryo's cells are starting to specialize and come together to form the foundations of all the body's organs (example: neurons form a structure called the neural tube= brain and spinal cord develop, primitive heart, forerunners of kindeys, and three sacs that will become digestive system develop by week 3) -week 4, the end of the embryo's neural tube swells to form the brain, spots that will become the eyes appear on the embryo's head, and its heart begins to beat. The backbone and ribs become visible as bone and muscle cells move into place. The face starts to take shape, and the endocrine system begins to develop. -week 5, embryo is about 1/4 inch long, 10,000 times larger than the zygote. Its arms and legs are developing rapidly. Five fingers are visible on its hands. Its eyes have corneas and lenses, and its lungs are beginning to develop. -week 6, embryo's brain begins to produce patterns of electrical activity, and it moves in response to stimuli -week 7, embryos begin to move spontaneously. They have visible skeletons and fully developed limbs. The bones are beginning to harden, and the muscles are maturing; embryo can maintain a semi-upright posture. The eyelids seal shut to protect the developing eyes. The ears are completely formed, and x-rays can detect tooth buds in the jawbones. -during week 8, liver and spleen begin to function -> allowing the embryo to make and filter its own blood cells. Its heart is well developed and efficiently pumps blood to every part of the body. The embryo's movements increase as the electrical activity in its brain becomes more organized. Connections between the brain and the rest of the body are also well established. The embryo's digestive and urinary systems are functioning. -By the end of week 8, organogenesis—the technical term for organ development—is complete

fetal stage

-weeks 8-38 -organ structures and functions are refined in the third stage, the body grows from 1 to 20 inches in length, weight incresases from 1/4 oz to 7 pounds -neuronal proliferation -viability at week 24 -full-term at week 27 - begins at the end of week 8 and continues until birth -few babies born as early as week 20 or 21 survive - By the end of week 22, 20% to 33% of babies have attained viability, the ability to live outside the womb -by end of week 23, the babies chance of survival increases from 38% to 58%; by week 24, 58% to 87% survive - extra weeks probably allow time for lung function to become more efficient because most premature babies today are treated with drugs that accelerate lung development. -As a result, survival rates of even the earliest-born preemies have greatly increased since the turn of the 21st century

second trimester (12-24 weeks)

-weight gain -"showing" -fetal movements felt (16-18wks) -increased appetite care= monthly provider visits continue; ultrasound (13wks= sex of the baby or earlier) problems= gestational diabetes; Rh incompatibility; increased blood pressure; Miscarriage (↓, 13-20wks); premature labor (21 wks)

second trimester milestones

-weight gain: prenatal care= monthly doctor visits continue serious problem = gestational diabetes -"showing": prenatal care= ultrasound to measure fetal growth and locate placenta serious problem= excessive weight gain -fetal movements felt: serious problem= increased blood pressure -increased appetite: serious problem= Rh incompatibility of mother and fetus other serious problems: premature labor and miscarriage

third trimester milestones

-weight gain: prenatal care= weekly visits beginning at 32nd week serious problem= increased BP -breast discharge: prenatal care= ultrasound to assess position of fetus serious problem = bleeding -treatment of RH incompatibility if needed serious problem = premature labor -pelvic exams to check for cervical dilation serious problem = bladder infection

think critically about DTC

-what are you hoping to get out of testing? Is this the best company/test to get to that goal? -> The results are only as good as the data available; there are limitations to what the lab will test for -Will this influence health behavior changes for you? ->Evidence of this has been lacking -What can/will the company do with your data? -> read the consent forms and privacy policy thoroughly -What do you plan on doing with the data afterwards? -> be cautious when using third-party DNA anlaysis companies -Know what is being tested and what the limitations are -> 23andMe and BRCA1/2 testing -False positive rates -> 40% of 49 DTC reports they reanalyzed using clinical grade lab testing were actually false positive -Get confirmation in a clinical setting with a genetics expert before seeking treatment

first trimester (LMP-12 weeks)

-zygote implants in the uterus -cervix thickens and secretes mucus to protect embryo -uterus shifts and puts pressure on bladder -missed period; breast enlargement care= regular prenatal care critical at this period problems=ectopic pregnancy, bleeding, miscarriage

differences in male and female fetuses

1. physcial maturation: male fetuses are larger and grow more rapidly than female fetuses do. However, female infants are about 1-2 weeks ahead in bone development at birth, even though newborn boys are typically longer and heavier. -female superiority in skeletal development persists through childhood and early adolescence, allowing girls to acquire many coordinated movements and motor skills, especially those involving the hands and wrists, earlier than boys. -the gap between the sexes gets wider every year until the mid-teens, when boys catch up and surpass girls in general physical coordination 2. problems in prenatal development: boys are more vulnerable to all kinds of prenatal problems. Many more boys than girls are conceived—from 120 to 150 male embryos to every 100 female ones—but more of the males are spontaneously aborted. -At birth, there are about 105 boys for every 100 girls. Male fetuses also appear to be more sensitive to factors such as maternal drug use, malnutrition, and stress -one reason for this difference is that the placentas of female fetuses are larger and better developed than those of male fetuses which nourishes the fetus and protects him or her from some negative external influences.

four alternatives on where to deliver babies in industrialized world

1. traditional hospital maternity unit (98.9% of babies born in US) out of hospital births= 1.1% of U.S. births 2. birth center or birthing room located within a hospital, which provides a more homelike setting for labor and delivery and often allows family members to be present throughout 3. a free-standing birth center (26.2% of out of hospital births), like a hospital birth center except that it is located apart from the hospital, with delivery typically being attended by a midwife rather than (or in addition to) a physician 4. the mother's home (67.2% of out of hospital births): home delivers are encourage for uncomplicated pregnancies and the women has recieved good prenatal care

cause of multiple births

1. women are far more likely to naturally conceive twins and other multiples after age 35 2. women over 35 are more likely than younger women to experience difficulty becoming pregnant and, thus, are more likely to be treated with fertility-enhancing drugs (likelier to deliver multiplies)

genes

A segment of chromosome that influences a particular feature or developmental pattern -segment of DNA that encodes a protein product

examples of autosomal domiant diseases

Neurofibromatosis, Achondroplasia, Kabuki syndrome, Marfan syndrome, Huntington Disease, Waardenburg syndrome, Stickler syndrome, Many types of cancer, predisposition syndromes including Familial Adenomatous Polyposis (FAP)

chromosomal and genetic tests

Other tests, including chorionic villus sampling (CVS) and amniocentesis, can be used to identify chromosomal errors and many genetic disorders prior to birth -With CVS, cells are extracted from the placenta and used in a variety of laboratory tests during the early weeks of prenatal development -With amniocentesis, which is done between weeks 14 and 16 of a woman's pregnancy, a needle is used to extract amniotic fluid containing fetal cells -Fetal cells filtered out of the fluid are then tested in a variety of ways to diagnose chromosomal and genetic disorders -Both tests are associated with an increased risk of miscarriage. -CVS is used most often when a medical condition in the mother necessitates early diagnosis of fetal abnormalities -amniocentesis carries a lower risk of miscarriage and fetal injury than CVS does; usually the preferred prenatal diagnostic technique and is routinely recommended as a screening tool for Down syndrome and other chromosomal abnormalities in pregnant women over age 35.

what are the three stages of prenatal development?

germinal, embryonic, fetal

uterus

the pear-shaped abdominal organ that is the site of prenatal development -unfertilized ovum gradually disintegrates and is expelled as part of the menstrual fluid

chromosomal translocation

When part of one chromosome breaks off and attaches to another non homologous, chromosome reasons to test for chromosomal translocation include: -A child born with two or more major birth defects -A fetus with a major structural anomaly on U/S -Unexplained intellectual disability especially in a person with dysmorphic features -Ambiguous genitalia -Multiple pregnancy losses -Family history of intellectual disability and individuals with multiple congenital anomalies -Unexplained infertility

Trisomy 21 (Down Syndrome)

a condition in which an individual has three copies of chromosome 21 -approximate incidence of 1 in 800 -most common pattern of malformation in man -children have intellectual disability, distinctive facial features, and undersized brains, and they are at high risk for other physical abnormalities such as congenital heart defects (50% of babies) -all individuals have developmental delay and some degree of intellectual disability -risk of bearing child with Down syndrome is greatest for mothers over 35 and increases the older the mother is -although due to higher fertility rate in younger women, 80% of children with Down syndrome are born to women under 35 years of age

Huntington's disease

a devastating autosomal condition from a dominant gene that causes the brain to deteriorate and affects both psychological and motor functions -now a blood test to identify the Huntington's gene

attention-deficit/hyperactivity disorder

a disorder in which children are more physically active, impulsive, and/or less attentive than their peers

amnion

a fluid-filled sac in which the baby floats until just before it is born

neurodevelopmental disorders

a group of conditions in which individuals' neurological development follows an atypical pattern, result from multifactorial inheritance -include conditions such as attention-deficit/hyperactivity disorder

dominant-recessive pattern

a pattern of inheritance in which a single dominant gene influences a person's phenotype but two recessive genes are necessary to produce an associated trait

polygenic inheritance

a pattern of inheritance in which many genes influence a trait -many polygenic traits in which the dominant-recessive pattern is also at work (example= skin color and eye color have dominat colors but blended colors are possible)

Klinefelter syndrome

a sex-chromosome anomaly which has an XXY sex chromosome pattern that results in boys who usually look no different than their peers but have indeveloped testes and as adults, very low sperm production -many have language and learning disabilities -At puberty, these boys experience both male and female changes

critical periods in embryonic and fetal stages

a specific period in develoment when certain body systems are especially sensitive to some particular kind of experience lke teratogens -if drugs or infections interfere with development during a critical period, a particular body structure will not form properly

yolk sac

a structure that produces blood cells until the embryo's blood-cell-producing organs are formed

very low birth weight (VLBW)

below 1,499 grams

cost of preterm and low birth weight babies

accounts for: -50% of all newborn hospitalizations -30% of all pediatric hospitalizations -15K and average 12 day hospital stay per LBW birth

maternal risk factors

age, diet, chronic illnesses, enviromental hazards, maternal emotions

low birth weight (LBW)

all neonates weight 3.3-5.5 lbs (1,500 - 2,499grams) -display markedly lower levels of responsiveness at birth and in the early months of life -300k + babies born LBW in 2011

ovum

an egg cell produced by a women each month from one of her two ovaries roughly midway between menstrual periods

tubal ligation

an operation in which the fallopian tubes are surgically closed, immediately after birth often undergo a cesarean delivery

placenta

an organ that allows oxygen, nutrients, and other substances to be transferred between the mother's and baby's blood -specialized structures in placenta bring the mother's and baby's blood close to each other without allowing them to mix.

third trimester

at 25 weeks to beginning of labor -weight gain and abdominal enlargement -women's breats may begin to secrete a substance called colostrum in preperation for nursing -most women begin to feel more emotionally connected to the fetus -individual differences in fetal behavior, such as hiccupping or thumb-sucking, sometimes become obvious during the last weeks of pregnancy -these behaviors may be observed during ultrasound tests that produce increasingly clear images of the fetus -most women notice that the fetus has regular periods of activity and rest. -monthly prenatal doctor visits continue in the third trimester until week 32, when most women begin visiting the doctor's office or clinic once a week. -monitoring of blood pressure is especially important, as some women develop a life-threatening condition called toxemia of pregnancy during the third trimester. This condition is signaled by a sudden increase in blood pressure and can cause a pregnant woman to have a stroke.

zygote

at conception, chromosomes in ovum and sperm combine to form 23 pairs in entirely new cell

natural childbirth

commonly used to refer to women's choose to avoid drugs altogether during childbirth includes several components: 1. women selects someone (usually father) to serve as labor coach 2. women take prepared childbirth classes that pschologically prepare the woman and her labor coach for the experience of labor and delivery 3. believing baby will benefit from natural childbirth provides the woman with the motivation she needs to endure labor without the aid of pain-relieving medication 4. relaxation and breathing techniques provide her with behavioral responses that serve to replace the negative emotions that typically result from the physical discomfort of contractions; women focuses attention on breathing rather than pain

protein

complex organic compound composed of hundreds or thousands of amino acids

trisomy

condition in which a child has three copies of a specific autosome

sex-linked disorders

disorders caused by genes found on the X chromosome -more likely to affect males than females because males have only one X chromosome -most disorders are caused by dominant genes that usually don't experience symptoms until adulthood

autosomal disorders

disorders caused by genes located on the autosomes (chromosomes other than sex chromosomes) -most disorders are caused by recessive genes that are diagnosed in infancy or early childhood

trisomy 13 and 18

disorders have more severe effects than trisomy 21 -few children live past the age of 1 year -chances of having a child with one of these disorders increase with a woman's age.

labor

divided into three stages -first stage is much longer than second and third

factors contributing to the effects particular teratogen has on prenatal development

duration and intensity of teratogen exposure -greatest damage during organ system's most rapid development= first 8 weeks -single, brief exposure to even the most powerful teratogen may have little or no impact on development -if a single exposure is particularly intense—that is, if the "dose" of the teratogen is high—then it may be sufficient to cause damage -exposures of low intensity may be harmful if they occur over an extended period -for this reason, special precautions must be taken by pregnant women who are likely to be exposed to even minimal doses of radiation or other potentially harmful substances that are a part of their everyday working environments

Zygotes containing two X chromosomes

female

sex differences in utero

females: -rapid skeleton development -more sensitive to external stimulation males: -more vulnerable in utero -more physically active -higher rates of miscarriage: 120-150: 100 conception, 105: 100 at birth

brain maturation

fetal behavior is directly related to brain maturation. As a result, health professionals can gain insight into the neurological health of a particular fetus by observing prenatal behavior via ultrasound.

what is labor triggered by?

fetal signal from proteins associated from lung maturityy found in the fetus's lungs -indicates whether they are capable of surviving outside the womb

mitochondria

found in the fluid that surrounds the nucleus of the ovum before it is fertilized

what is the other main factor that determine susceptibility to teratogens?

genes in fetus that moderate or block the effects of some kinds of harmful substances like teratogens

congenital adrenal hyperplasia

genetic disorder that causes female embryos to develop male-appearing external genitalia

Brazelton Neonatal Behavioral Assessment Scale (NBAS)

health professionals use scale to track a newborn's development over about the first 2 weeks following birth -examines the neonate's responses to stimuli, reflexes, muscle tone, alertness, cuddliness, and ability to quiet or soothe herself after being upset -scores on this test can be helpful in identifying children who may have significant neurological problems

genetic counselors

health professionals with specialized graduate degrees and experience in the areas of medical genetics and counseling. -most enter the field from a variety of disciplines, including biology, genetics, nursing, psychology, public health and social work. -is the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease. it integrates: -interpretation of family and medical histories to assess the chance of disease occurrence or recurrence. -education about inheritance, testing, management, prevention, resources and research. -counseling to promote informed choices and adaptation to the risk or condition

cancer genetics

hereditary -> -gene mutation is inherited in family -significantly increased cancer risk familial -> -multiple genes and enviromental factors may be involved -some increase in cancer risk sproadic -> -cancer occurs by chance or related to enviromental factors -general population cancer risk

blastocyst

hollow, fluid-filled ball

androgens

hormones signaled by SRY gene on Y chromosome that cause the male embryo to secrete horomones causing male genitals to develop -female embryos exposed to androgens can develop male-appearing external genitalia either from medications from mother or congenital adrenal hyperplasia

Newborn Screening

in Washington state, 26 conditions are screened including: -Metabolic disorder including: PKU, 5 additional Amino Acid disorders, Galactosemia, Biotinidase Deficiency, 5 Fatty Acid Oxidation disorders and 7 Organic Acid disorders -Cystic Fibrosis -Congenital Hypothyroidism -Congenital Adrenal Hyperplasia -Sickle Cell & Hemoglobinopathies -Severe Combine Immunodeficiency -X-linked Adrenoleukodystrophy (X-ALD)

age

in most cases, older mothers have uncomplicated pregnancies and deliver healthy babies, but the risks associated with pregnancy do increase somewhat as women get older -also, babies are at greater risk of weighing less than 5.5 pounds at birth -> partly explained by the greater incidence of multiple births among older mothers - infants born to women over the age of 35, whether single or multiple birth, are at increased risk of having problems such as heart malformations and chromosomal disorders -contrastingly, rates of problems of teenage mothers is higher than mothers among their 20s - teenage mothers are also more likely to be poor and less likely to receive adequate prenatal care, so it is very hard to sort out the causal factors; nevertheless, researchers have found higher rates of adverse pregnancy outcomes even among middle-class teenage mothers who received good prenatal care

blood pressure in mother

increase or decrease of blood pressure suddenly may indicate cesarean delivery

what caused the increase in cesarean rates in developed nations?

increased popularity of postbirth surgical sterilization as a means of contraception -also increase in number of older women giving birth -increases the odds in favor of the babies' postnatal health

effect of racism in prenatal care

increased risk of: -preterm birth -pre-eclampsia -low birth weight -sterotypes about black women contribute to poor care and poor outcomes -wealth, status, education do not effect these outcomes for black women

phenotype

individual's particular set of observed characteristics

cancer genetics- BRCA genes

individuals with pathogenic variants in BRCA1 and BRCA2 genes have a high risk of breast and ovarian cancer

prenatal androgens

influence the developing brain and may play a role in the development of sex differences in cognitive functioning and in the development of sexual orientation

multifactorial inheritance

inheritance affected by both genes and the enviroment (example: height = genes contribute as well as being ill, poorly nurished or emotionally neglected intelligence and personality)

lifespan health effects associated with preterm and LBW babies

maternal: -multi-generational -future pregnancies neonatal and beyond: -immediate -> respiratory distress, speech/cognition delays, and increased use of healthcare -late effects -> hypertension, diabetes, and CAD

what are physical changes in pregnancy?

internal organ shift, lordosis, and melasma

laboratory test

laboratory tests performed on fetal blood samples can assess fetal organ function, diagnose genetic and chromosomal disorders, and detect fetal infections (for instance, fetal blood tests can help doctors identify a bacterial infection that is causing a fetus to grow too slowly - > once diagnosed, infection is treated by injecting antibiotics into amniotic fluid -many tests use maternal blood, urine, and/or samples of amniotic fluid to help health-care providers monitor fetal development -also use laboratory test to assess maturity of fetal lungs -> critical when doctors have to deliver baby early because of mother's health

Tay-Sachs Disease

likely to have severe intellectual disability and be blind -Very few survive past the age of 3 -babies likely to inherit disease are born to Jewish couples of Eastern European ancestry

Zygotes containing one X chromosome and one Y chromosome

male

prenatal development

maternal and fetal development -> two patients, two experiences

short-term effects of drug use during labor

nearly all drugs given during labor pass through the placenta, enter the fetal bloodstream, and may remain there for several days -infants whose mothers have received any type of drug are typically slightly more sluggish, and spend more time sleeping in the first few weeks than do infants of mothers who do not receive anesthetics during labor and delivery

effect of prenatal diagnosis on parents-to-be

negative emotional effects of prenatal diagnosis can be moderated by providing parents-to-be with counseling and specific information about treatment at the time the diagnosis is made, rather than waiting until after the birth

preterm

neonates born before the 38th week of gestation -12% of babies born in US are preterm, LBW or both -most LBW infants and multiple fetuses are likely to result in preterm birth -possible for an infant to not be preterm and still be an LBW baby -some preterm babies weigh the typical amount for their gestational age, while others are smaller than expected

small-for-date neonates

neonates that appear to have experienced slow fetal growth and, as a group, have poorer prognoses than do infants who weigh an appropriate amount for their gestational age.

HIV (virus that causes AIDS)

one of many sexually transmitted organisms that can be passed directly from mother to fetus -virus may cross the placenta and enter the fetus's bloodstream, or the infant may contract the virus in the birth canal during delivery -about a quarter of infants born to HIV-infected mothers become infected -transmission appears to be more likely when the mother has AIDS than when she is HIV positive but not yet ill -HIV-positive pregnant women who take the drug AZT have a markedly lower risk of transmitting the disease to their children—as low as 8% -infants who acquire HIV from their mothers typically become ill within the first 2 years of life -virus weakens children's immune systems, allowing a host of other infectious agents, such as the bacteria that cause pneumonia and meningitis, to attack their bodies -even children who remain symptom free must restrict their exposure to viruses and bacteria

Y chromosome

one of the two sex chromosome -quite small and contains only a few genes

X chromosome

one of the two sex chromosomes in the human body -one of the largest chromosomes in the body and carries a large number of genes

umbilical cord

organ that connects the embryo to the placenta -vessels in the umbilical cord carry blood from the baby to the mother and back again

dizygotic twins

originate from two zygotes -no more alike genetically than any other pair of siblings, and need not even be of the same sex.

anoxia

oxygen deprivation -can result in death or brain damage, but doctors can prevent long-term effects by acting quickly to surgically deliver infants who experience distress

neuronal proliferation

pace of neural formation in the fetus picks up dramatically between the 10th and 18th weeks -between the 13th and 21st weeks, the newly formed neurons migrate to the parts of the brain where they will reside for the rest of the individual's life

postpartum assessment

parent: -blood pressure, temp, fundal tone, bleeding, and breastfeeding neonate: -APGAR= respiration (speed and effort), heart rate, tone, reflexive response, and color -transition to extra-uterine life= temperature, blood sugars, and feeding

prenatal screening for adverse health conditions

part of routine prenatal care, and physicans have a remarkable set of tools available to treat these conditions before the child is born

mitochondrial genes

passed only from mother to child - several serious disorders, including some types of blindness, are transmitted in this way

certified midwives

people who have training in midwifery but are not nurses -most received training in other health-care professions, such as physical therapy, before becoming certified midwives

homozygous

people whose chromosomes carry either two dominant or two recessive genes

pregnancy

physical condition in which a woman's body is nurturing a developing embryo or fetus

nursing care of the parent/baby dyad in labor

pregnant person: -labor progress -contraction pattern -vital signs -emotional support baby: -fetal heart tones= variability, heart rate, accelerations

reflexive response when feet exposed to stimuli (Apgar)

score 0= none score 1= some score 2= crying; withdrawl of feet from stimulus

drugs

substances that can be teratogenic and adversly affect prenatal development -effects of drugs on prenatal development have proven challenging due to pregnant women taking multiple drugs -in addition, other factors: maternal stress, lack of social support, or poverty and poor prenatal care, also often accompany illegal drug use and alcohol consumption during pregnancy

alchol

pregnant women should not drink alchol at all because: -6-year-olds who were prenatally exposed to alcohol are smaller than their non-alcohol-exposed peers -alcohol can even adversely affect an ovum prior to ovulation or during its journey down the fallopian tube to the uterus -a zygote can be affected by alcohol even before it has been implanted in the uterine lining -significant risk of delivering infants with fetal alcohol spectrum disorder (FASD): children are generally smaller than normal, with smaller-than-typical brains; frequently have heart defects and hearing losses, and their faces are distinctive, with a somewhat flattened nose and often an unusually long space between nose and mouth; As children, adolescents, and adults, they are shorter than normal and have smaller heads, and their intelligence test scores indicate mild intellectual disability.

prenatal development (gestation)

process that transforms a zygote into a newborn

gene mutations

produce changes in a single gene -missense mutation: changes one DNA base pair -> subsitutes amino acid for another -nonsense mutation: changes one DNA base pair -> stops building protein -insertion mutation: changes number of DNA bases by adding piece of DNA-> protein may not function properly -deletion mutation: changes number of DNA bases by removing piece of DNA -> may alter function of resulting protein(s)

stage 3 of labor

quite breif and the delivery of placenta (afterbirth) and other material from uterus -great amount of variability from one woman to another in the length of each phase of labor -three phases are longer among women delivering a first child than among those delivering a second child.

which harmful gene= recessive or dominant would be more likely to cause a defect or disorder of some kind?

recessive

Sickle-Cell disease

recessive disorder that causes red blood cell deformities where the blood can't carry enough oxygen to keep the body's tissues healthy -individuals with sickle-cell trait carry a single recessive gene for sickle-cell disease, which causes a few of their red blood cells to be abnormal meaning doctors can identify carriers of the sickle-cell gene -West African and African American infants are more likely to have sickle-cell disease

Phenylketonuria (PKU)

recessive gene causes a baby to have problems digesting the amino acid phenylalanine -phenylalanine builds up in the body due to deficiency of phenlalanine hydroxylase which causes intellectual disabilites, fair skin, seizures, smaller head sizes and rashes -like many other recessive disorders, PKU is associated with ethnicity = Caucasian babies are more likely to have the disorders

certified nurse-midwives

registered nurses who have specialized training that allows them to care for pregnant women and deliver babies

identical twins (monozygotic)

result when a single zygote, for unknown reasons, separates into two parts, each of which develops into a separate individual -have identical genes

reasons for not considering cancer removals

risk is not precise based on ascertainment bias of studies: -> Many studies determining risk are from analyzing families with strong cancer family histories: -Genotype/Phenotype correlations -Other risk factors such as environmental or epigenetics risk reduction from non-surgical options may be good enough for some individuals

respiration (Apgar scale)

score 0 = absent score 1 = weak cry score 2= strong cry

color of lips, palms, soles of feet (Apgar)

score 0= blue score 1= pink with bluish edges score 2= pink

muscle tone (Apgar)

score 0= limp score 1= some degree of muscle contraction indicated by flexed arm and leg joints score 2= all joints of arms and legs strongly flexed

hemophilia

serious sex-linked recessive disorder that causes the blood to lack the chemical components that causes blood to clot -factor VIII deficiency (1/7,500 male births) -bleeding doesn't stop naturally

Turner Syndrome

sex chromosomal anomaly that occurs in single-X pattern which causes individuals to be anatomically female but show stunted growth -higher risk than others of having malformations of internal organs such as the heart and kidneys -Without hormone therapy, most individuals with Turner syndrome do not menstruate or develop breasts at puberty

what sex chromosome determines the sex of child?

sex chromosome in sperm because ova carry X chromosomes and half of male sperms carry X chromosomes and other half carry Y chromosomes

fragile-X syndrome

sex-linked disorder where individual has an X chromosome with a "fragile," or damaged, spot -1/2500- 1/4000 males; female carrier frequency = 1/130 - 1/250 -fragile-X syndrome can cause intellectual disability that becomes progressively worse as a child gets older

red-green color blindness

sex-linked recessive disorder that causes difficulty distinguishing between the colors red and green when these colors are adjacent

illegal drugs

significant numbers of pregnant women the world over take various illegal drugs -infants of marijuana smokers weigh less, on average, than infants of nonsmokers; at age 6, children who experience prenatal exposure to marijuana are shorter on average and tend to have lower IQ scores -heroin and methadone can cause miscarriage, premature labor, and early death; 60-80% of babies born to heroin- or methadone-addicted women are addicted to these drugs as well -addicted babies have high-pitched cries and exhibit withdrawal symptoms, such as irritability, uncontrollable tremors, vomiting, convulsions, and sleep problems -degree to which heroin and methadone affect development depends on the quality of the environment in which babies are raised: if babys mother stops drugs -> develop normally -use of cocaine by pregnant women is linked to many kinds of developmental problems in their children -most cocaine-using pregnant women are poor and abuse multiple substances, making it difficult to separate the effects of cocaine from those of poverty and other drugs -cocaine can lead to pregnancy complications, such as disruption of placental function and premature labor, that may adversely affect the developing fetus

fetal distress

some babies during birth go into fetal distress which is signaled by a sudden change in heart rate -most cases, doctors don't know why a baby experiences fetal distress -One known cause is pressure on the umbilical cord (for instance: cord becomes lodged between head and cervix -> blood vessels collapse and blood can no longer be carried to and from baby -> baby experiences anoxia)

slow labor progresses

some women remain in stage 1 for more than 24 hours -can happen if the infant's head is in a position that prevents it from exerting enough pressure on the cervix to force it open -in cases, surgery is indicated because continuing labor can cause permanent damage to the mother's body.

diet

specific nutrients are vital to prenatal development: -folic acid= a B vitamin found in beans, spinach, and other foods -> Inadequate amounts of this nutrient are linked to neural tube defects, such as spina bifida (spinal cord is exposed through openong in backbone) -> potential negative effects of insufficient folic acid occur in the very earliest weeks of pregnancy, before a woman may know she is pregnant; important for women to obtain at least 400 micrograms of this vitamin daily -take in sufficient overall calories and protein to prevent malnutrition -> women with malnutrition especially during the final 3 months, has an increased risk of delivering a low-birth-weight infant who will have intellectual difficulties in childhood -> researchers have recently identified prenatal malnutrition, along with a variety of obstetrical complications, as an important risk factor in the development of mental illnesses in adulthood -impact of maternal malnutrition appears to be greatest on the developing nervous system—a pattern found in studies of both humans and other mammals -there have been cases in which prenatal malnutrition has been severe enough to cause the death of the fetus or newborn -> infants had smaller brain and fewer, smaller neurons -studies of adults whose mothers were malnourished during pregnancy suggest that the detrimental effects of prenatal malnutrition can persist throughout the lifespan

maternal emotions

stressful psychological states such as anxiety and depression lead to changes in body chemistry -In a pregnant woman, these changes result in both qualitative and quantitative differences in the hormones and other chemicals that may affect the fetus -Some studies have shown an association between maternal stress hormones and reduced rates of fetal growth and other indicators of fetal health

chromosomes

strings of genetic material; composed of one large continous DNA molecule -every cell in human body contains 23 pairs of chromosomes

teratogens

substances such as viruses, alcohol, medications, illegal drugs, toxins etc. that cause birth defects to an embryo or fetus -can cause deviations in prenatal development -exposure is at greatest risk during first 8 weeks of gestation

other sexually transmitted diseases (STDs)

syphilis, genital herpes, gonorrhea, and cytomegalovirus cause a variety of birth defects -the bacterium that causes syphilis is most harmful during the last 26 weeks of prenatal development and causes eye, ear, and brain defects -Genital herpes is usually passed from mother to infant during birth; one third of infected babies die, and another 25-30% experience blindness or brain damage. Thus, doctors usually deliver the babies of women who have herpes surgically -Gonorrhea, which can cause the infant to be blind, is also usually transmitted during birth. For this reason, doctors usually treat the eyes of newborns with a special ointment that prevents damage from gonorrhea. -cytomegalovirus (CMV), a less well-known sexually transmited virus, in herpes group; as many as 60% of all women carry CMV, but most have no recognizable symptoms. Of babies whose mothers are infected with CMV, 1-2% become infected prenatally or from breast-feeding. About 2,500 babies born each year in the United States display symptoms of CMV and have a variety of serious problems, including deafness, central nervous system damage, and intellectual disability

neonate

term for babies between birth and 1 month

gonads

testes in males and ovaries in females -development depends on the presence or absence of androgens

stage 2 of labor

the delivery; lasts less than an hour and rarely takes longer than 2 hours the mother will normally have the urge to help the infant emerge by "pushing." -if the cervix is fully dilated, the mother is encouraged to push, and stage 2 begins -baby's head moves past the stretched cervix, into the birth canal, and finally out of the mother's body -Most women find this part of labor markedly less distressing than the transition phase because at this point they can assist the delivery process by pushing

germinal stage

the first 2-week period of gestation that begins at conception to implantation -blastocyte implants and specialization of cells -structures are needed to support prenatal life -cells specialize rapidly into those that will become the fetus's body and those that will become the structures needed to support its development; by 4th day, zygote contains dozens of cells -day 5, cells become a blastocyst where cells becoming embryo begin to clump -day 6/7, blastocyst comes in contact with uterine wall -day 12, blastocyst is completly buried in uterine tissue -> implantation -cells of blastocyt outer wall combine with cells in uterine lining to begin creating placenta -placenta secretes chemical messgaes that stop mother's menstrual periods and keep placenta connected to uterus; other hormones allow bones of pelvis to become more flexible, induce breast changes and increase mother's metabolism rate -at same time, blastocytes inner cells begin to specialize that will become umbilical cord, yolk sac, and amnion -12th day, cells tht will become embyros's body are formed

locus

the same place on the same chromosome in every individual of the same specices where a gene controlling some specific characteristic always appears (example: locus of gene determines person's blood type is on chromosome 9)

trimesters

three arbitrary periods, each lasting 3 months, that pregnancy is customarily divided -facilitate an organized presentation of the milestones and events of pregnancy

fallopian tube

tube through which unfertilized ova travels from the ovaries to the uterus -if during intercourse and ovum is in fallopian tube, sperm may travel through vagina, cervix, uterus and fallopian tuve to penetrate wall of ovum

fraternal twins

twins that come from two sets of ova and sperm -2/3 of twins

imaging

ultrasonography has become a routine part of prenatal care in the United States because of its usefulness in monitoring fetal growth -During the second trimester of pregnancy, ultrasound tests allow doctors to identify the fetus's sex, to diagnose fetal deformities and growth problems, and to determine the fetus's position in the uterus. Fetoscopy involves insertion of a tiny camera into the womb to directly observe fetal development. Fetoscopy makes it possible for doctors to correct some kinds of defects surgically -has made such techniques as fetal blood transfusions and bone marrow transplants possible -also used to take samples of blood from the umbilical cord and to perform prenatal surgery

Apgar scale

used to assess a neonate's health status on five factors immediately after birth -lower a newborn's score is -> greater risk of neonatal death meaning low scores call for immediate medical intervention -overall max score of 10 is unusual after birth due to most infants having somewhat blue fingers and toes -usually 5 minutes after birth, however, 85-90% of infants score 9 or 10 -score of 7 or better indicates that the baby is in no danger -score of 4, 5, or 6 usually means that the baby needs help establishing normal breathing patterns -score of 3 or below indicates a baby in critical condition

milestones of fetal stage

week 9-12: fingerprints develops -graspong reflex; facial expressions; swallong and rhythmic breathing of amniotic fluid; urination; genitalia; alternating periods of physical activity and rest week 13-16: hair follicles develop -responsed to mother's voice and loud noises; 8-10 inches long; weighs 6 oz week 17-20: fetal movments felt by mother -heartbeat detectable with stethoscope; hair (lanugo) covers body; eyes respond to light introduced into womb; eyebrows and fingernails develop; 12 inches week 21-24: vernix (oily substance) protects skin -lungs produce surgactant (vital to respiratory function); viability becomes possibly week 25-28: recognition of mother's voice -regular periods of rest and activity; 14-15 inches long; weighs 2 pounds; good chance of survival if born now week 29-32: very rapid growth -antibodies acquired from mother; fat deposited under skin; 16-17 inches long; weighs 4 pounds; excellant chance of survival if delivered week 32-36: movement to head-down position for birth - lungs mature; 18 inches long; weighs 5-6 pounds; vitrually 100% chance of survival if delivered week 37: full term status -19-21 inches long; weighs 6-9 pounds

chromosomal error or chromosomal anomaly

when a child has too many or too few chromosomes

breech presentation

when an infant's feet or bottom is delivered first -complelling reason for a c-section because it is associated with collapse of the umbilical cord

effects of parental and education suppport on LBW and small-for-date

with adequate parental and educational support, the majority of LBW babies who weigh more than 1,500 grams (about 3 pounds) and who are not small-for-date neonates catch up to their peers within the first few years of life, although they do so at widely varying rates -those below 1,500 grams remain smaller than normal and have significantly higher rates of long-term health problems, lower intelligence-test scores, and more problems in school

milestones of pregnancy

with use of milestones, prenatal health-care providers can monitor the health of both mother-to-be and fetus

are sex-linked disorders more common in males than in females?

yes because diseases involves recessive gene on X chromosome -females most likely have a dominant gene on other X chromosome that prevents disease unlike men