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Questions and Answers
What is a common indication for a cesarean section?
What is a common indication for a cesarean section?
Which stage of labor includes the delivery of the placenta?
Which stage of labor includes the delivery of the placenta?
What characteristic is assessed when using the Apgar Test?
What characteristic is assessed when using the Apgar Test?
What condition can result from oxygen deprivation at birth?
What condition can result from oxygen deprivation at birth?
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Which of the following describes the 'active phase' of labor?
Which of the following describes the 'active phase' of labor?
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What does the term 'small-for-gestational age' refer to?
What does the term 'small-for-gestational age' refer to?
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Which of the following is a potential problem at birth that involves cranial bleeding?
Which of the following is a potential problem at birth that involves cranial bleeding?
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What is typically assessed in the Neonatal Behavioral Assessment Scale?
What is typically assessed in the Neonatal Behavioral Assessment Scale?
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What is the primary purpose of the Apgar test?
What is the primary purpose of the Apgar test?
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What is the correct order of the stages of prenatal development?
What is the correct order of the stages of prenatal development?
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What defines monozygotic twins?
What defines monozygotic twins?
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Which of the following is a risk factor for multiple births?
Which of the following is a risk factor for multiple births?
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During which week of the embryonic stage does the neural tube begin to close?
During which week of the embryonic stage does the neural tube begin to close?
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What is the outcome of maternal consumption of alcohol during pregnancy?
What is the outcome of maternal consumption of alcohol during pregnancy?
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What does the cephalocaudal principle of growth indicate?
What does the cephalocaudal principle of growth indicate?
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Which germ layer develops into the circulatory and muscular systems?
Which germ layer develops into the circulatory and muscular systems?
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What is the primary characteristic of superfetation?
What is the primary characteristic of superfetation?
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Which of the following teratogens is associated with causing facial and limb deformities?
Which of the following teratogens is associated with causing facial and limb deformities?
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At what stage can the mother first feel fetal movements?
At what stage can the mother first feel fetal movements?
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What does ‘organogenesis’ refer to?
What does ‘organogenesis’ refer to?
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What condition can result from high maternal stress levels during pregnancy?
What condition can result from high maternal stress levels during pregnancy?
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How does maternal malnutrition during pregnancy affect the fetus?
How does maternal malnutrition during pregnancy affect the fetus?
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What typically marks the transition from the embryonic stage to the fetal stage?
What typically marks the transition from the embryonic stage to the fetal stage?
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Study Notes
Prenatal Development Stages
- Germinal Stage (Weeks 1-2):
- Conception: Sperm fertilizes the egg.
- Mitosis: Cell division.
- Cleavage: Rapid cell division creates a solid ball of cells known as a morula.
- Blastulation: Morula develops into a blastocyst.
- Embryoblast: Inner cell mass that develops into the embryo.
- Embryonic disk: Forms within the embryoblast and will become the embryo.
- Trophoblast: Outer layer that will become the placenta.
- Embryoblast: Inner cell mass that develops into the embryo.
- Implantation: Blastocyst implants in the endometrium of the uterus.
- Ectopic pregnancy: Blastocyst implants outside the uterus.
Multiple Births
- Monozygotic (Identical Twins): Develop from one fertilized egg that splits.
- Dichorionic-diamniotic: Each twin has a separate placenta and amniotic sac.
- Monochorionic-diamniotic: Each twin has a shared placenta, but separate amniotic sacs.
- Monochorionic-monoamniotic: Each twin has a shared placenta and amniotic sac.
- Conjoined Twins: Monozygotic twins that haven't completely separated, resulting in shared body parts.
- Multizygotic (Fraternal Twins): Result from two separate eggs fertilized by two separate sperm.
- Sesquizygotic (Semi-Identical Twins): Result from one egg that splits and then is fertilized by two different sperm.
- Superfetation: Woman becomes pregnant while already pregnant.
- Heteropaternal superfecundation: Woman becomes pregnant by two different men during the same cycle.
Risk Factors for Multiple Births
- Fertility Drugs: Stimulate follicle-stimulating hormone (FSH) which increases the production of eggs.
- In Vitro Fertilization: Multiple eggs are implanted in the uterus.
- Heredity: Some families have a genetic predisposition for multi-zygotic births.
- FSHB gene: Produces follicle-stimulating hormone. Higher levels can increase fertility and chance of multi-zygotic births.
- Age of Mother: Women over 35 have an increased chance of having twins.
Development Principles
- Cephalocaudal principle: Growth progresses from head downward.
- Proximodistal principle: Growth starts from the center portion of the body outward.
Embryonic Stage (Weeks 3-8):
- Germ Layers:
- Ectoderm: Develops into the epidermis (skin), hair, nervous system.
- Mesoderm: Develops into muscle tissue, circulatory system, urinary system, reproductive system, bone, and the dermis (inner layer) of the skin.
- Endoderm: Develops into the digestive system and respiratory system.
Embryonic Stage Milestones
- Week 3: Cells begin specializing (differentiation), neural tube formation, primitive heart and kidney forerunners develop, digestive system begins to form.
- Week 4: Neural tube swells into the brain, spots for the eyes appear, visible backbone and ribs, muscle cells move to their positions, face starts to take shape, endocrine system development.
- Week 5: Embryo is about ¼ inch long, rapid arm and leg growth, visible fingers, corneas and lenses in eyes, lungs begin to develop, heart beats, inner ears form.
- Week 6: Electrical activity in the brain, embryo moves to external stimuli, neural tube closes and separates into brain parts (forebrain, midbrain, hindbrain), neurons and synapses developing in the spinal cord, leg buds appear.
- Week 7: Embryo is about 10mm long, spontaneous movement, limbs are fully developed, visible skeleton, bones begin to harden, muscles mature, semi-upright posture, completely formed ears, fully formed umbilical cord.
- Week 8: Embryo is about 1 inch long, liver and spleen function, organs produce blood cells, well developed heart, functioning digestive and urinary systems.
Fetal Stage (Weeks 9-40):
- Weeks 9-12: Fingerprints, grasping reflex, facial expressions, swallowing and breathing amniotic fluid, urination, genitalia appear, alternating periods of rest and activity.
- Weeks 13-16: Hair follicles, response to mother's voice and loud noises, 8-10 inches long, weighs 6 ounces.
- Weeks 17-20: Fetal movements felt by the mother, heartbeat detectable with a stethoscope, lanugo covers body, eyes respond to light, eyebrows formed, fingernails appear, sex is identified by ultrasound.
- Weeks 21-24: Vernix (oily substance) protects the skin, lungs produce surfactant (critical for respiratory function), viability becomes possible but most born now do not survive.
- Weeks 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.
- Weeks 29-32: Rapid growth, acquiring antibodies from the mother, fat deposited under skin, 16-17 inches long, weighs 4 pounds, excellent chance of survival if born now.
- Weeks 32-36: Movement to a head-down position for birth, lung maturation, 18 inches long, weighs 5-6 pounds, virtually 100 percent chance of survival, able to distinguish between familiar and novel stimuli.
- Weeks 37-38: Full-term status, 19-21 inches long, weighs 6-9 pounds.
Influences on Prenatal Development
- Mother's Diet:
- Folic acid (Vitamin B9): Crucial for neurological development. Deficiency can lead to spina bifida.
- Mother's Age: Older mothers have a higher risk of complications and disabilities in their offspring.
- Maternal Emotions: Stress and anxiety can affect the fetus.
- Support for the Mother: Social support and a healthy environment are beneficial for the baby.
Teratogens
- Drugs:
- Alcohol: Fetal alcohol syndrome, cognitive deficits, heart damage, retarded growth.
- Aspirin: Deficits in intelligence, attention, and motor skills.
- Caffeine: Lower birth weight, decreased muscle tone.
- Cocaine and Heroin: Retarded growth, irritability.
- Marijuana: Lower birth weight, less motor control.
- Nicotine: Retarded growth, possible cognitive impairments.
- Tobacco: Learning problems, antisocial behavior.
- Inhalants: Premature labor, problems like those of fetal alcohol syndrome.
- Prescription Drugs:
- Accutane (Vitamin A): Facial, ear, heart deformities.
- Streptomycin: Deafness.
- Penicillin: Skin disorders.
- Tetracycline: Tooth deformities.
- Diet Pills: Low birth weight.
- Thalidomide: Limb malformations, facial paralysis, sight and hearing loss.
- Maternal Diseases:
- AIDS: Frequent infections, neurological disorders, death.
- Chlamydia: Premature birth, low birth weight, eye inflammation.
- Chicken Pox: Spontaneous abortion, developmental delays, mental retardation.
- Cytomegalovirus: Deafness, blindness, small head, mental retardation.
- Genital Herpes: Encephalitis, enlarged spleen, improper blood clotting.
- Rubella (German Measles): Mental retardation, damage to eyes, ears, and heart.
- Syphilis: Damage to the central nervous system, teeth, bones.
- Toxoplasmosis: (from Toxoplasma gondii) Damage to the eyes and brain, learning disabilities, spinal abnormalities.
- Tuberculosis: Pneumonia or tuberculosis.
- Hepatitis B: Hepatitis.
- Parvovirus: Anemia.
- Environmental Hazards:
- Air Pollution: Low birth weight, premature birth, lower test scores.
- Lead: Mental retardation.
- Mercury: Retarded growth, mental retardation, cerebral palsy.
- PCBs (Polychlorinated Biphenyls): Impaired memory and verbal skills.
- X-rays: Retarded growth, leukemia, mental retardation.
- Arsenic: Low birth weight, fetal loss.
- Cadmium: Decreased head circumference, low birth weight, decrease in male and female sex hormones.
- Anesthetic Gases: Miscarriage, premature birth, low birth weight.
- Solvents: Fetal malformations.
- Parasite-bearing substances: Miscarriage, pre-term labor.
How Teratogens Work:
- Genotype: The genetic makeup of the fetus influences the effects of teratogens.
- Dosage: Higher doses of teratogens generally lead to more severe effects.
- Sensitive Periods: Different organs are most vulnerable to damage at specific prenatal stages.
- Damage is selective: Teratogens often affect specific organs or functions.
- Late manifestation of damage: The effects of some teratogens may not be apparent until later life.
Labor and Delivery:
- Types of Delivery:
- Vaginal Delivery: Natural birth through the vagina.
- Assisted Vaginal Delivery:
- Forceps Delivery: Using forceps to assist in delivery.
- Vacuum Extraction: Using a suction device to assist in delivery.
- Cesarean Section (C-Section): Surgical procedure to deliver the baby through an incision in the abdomen.
Reasons for C-Section:
- History of C-Section Delivery:
- Labor is not progressing:
- Multiple Births:
- Umbilical Cord Prolapse: The umbilical cord is compressed before the baby is born.
- Placenta Previa: The placenta is positioned too low in the uterus.
- Placental Abruption: The placenta detaches from the uterine wall.
- Breech Birth: The baby is born feet or buttocks first.
- Shoulder Presentation: The baby is born with one shoulder first.
- Fetal Macrosomia: The baby is larger than average.
- Fetal Distress: Changes in heart rate, low amniotic fluid, less fetal movement.
- Uterine Fibroid: Noncancerous growths in the uterus.
Stages of Labor:
- Stage 1: Dilation and Effacement: The cervix dilates and thins.
- Early (latent) phase:
- Active Phase:
- Transition:
- Stage 2: Delivery of the Baby:
- Crowning: The baby's head is visible at the vaginal opening.
- Stage 3: Afterbirth: The placenta is delivered.
Assessing the Neonate:
-
Apgar test: Assesses the newborn's health at 1 minute and 5 minutes after birth.
- **Appearance:** Skin color. - **Pulse:** Heart rate. - **Grimace:** Reflex irritability. - **Activity level:** Muscle tone. - **Respiratory effort:** Breathing. -
Neonatal Behavioral Assessment Scale (NBAS): Assesses the newborn's reflexes, state, and other behaviors.
Potential Problems at Birth:
- Respiratory Distress Syndrome: Difficulty breathing in pre-term infants due to underdeveloped lungs.
- Anoxia: Lack of oxygen to the brain, can lead to brain damage.
- Rh Factor Incompatibility: Mother is Rh negative and the baby is Rh positive.
- Cranial Bleeding and Brain Damage: Can occur from assisted vaginal delivery.
Birth Weight:
- Low Birth Weight (LBW): Less than 2500 grams (5.5 pounds).
- Very Low Birth Weight (VLBW): Less than 1500 grams (3.3 pounds).
- Extremely Low Birth Weight (ELBW): Less than 1000 grams (2.2 pounds).
- Small for Gestational Age (SGA): Baby is smaller than expected for the stage of gestation.
Social Environment:
- Mother's Experience:
- Maternity Blues: Brief period of sadness and emotional upset after childbirth.
- Postpartum Depression: More severe and prolonged depression after childbirth.
- Father's Experience:
- Engrossment: Intense emotional bonding with the baby.
- Sibling Experiences: Siblings may have mixed emotions about the arrival of a new baby.
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