Making Babies Exam 2 Study Guide PDF

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Notes for Exam 2 of Making Babies...

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Pregnancy Overview ● Calories: 300 extra calories per day ● Weight (healthy weight) ○ One baby: 25-35 lbs ○ Twins: 37-54 lbs ● Major hormones ○ Progesterone ■ Thickens the endometrium ■ Suppresses development of new follicle ■ Inhibits uterine contractions ● Placenta ○ Trophoblast → chorion → placenta ○ Begins metabolic exchange between mother and embryo at 4-5 weeks gestation ○ By week 14, placenta is a discreet organ ● Trimesters ○ Pregnancy: 40 weeks ○ First trimester: last menstrual period - 14 weeks ■ 5-6 weeks: detectable heart rate ■ 10 weeks: major organs grossly developed, now called fetus ■ Size @ end: 1 oz, 3 in (lemon) ○ Second trimester: 14 - 28 weeks ■ Fairly good chance of survival if born at end of second trimester ■ Detailed development of organs and fetal growth continues ■ 26 weeks: hearing and eyes reopen ■ Size: 2 lbs, 14 in (waxy yellow turnip- rutabaga) ○ Third trimester: 28 - 40 weeks/estimated due date ■ Fetal growth and development continues ■ Fat stores improve survival ■ Size: 6-9 lbs, 19-21 in ● Maternal changes ○ Cardiac ■ Blood volume increases 40-45% ■ Heart rate increases ■ Blood pressure decreases ■ Heart displaced, murmur ○ Respiratory ■ Increased oxygen consumption by 15-20% ■ Nasal stuffiness

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■ Nosebleeds ■ Decreased lung volume as fetal size increases Gastrointestinal ■ Increased saliva ■ Nausea (morning sickness until about 12 weeks) ■ Increased metabolism ■ Bloating, gas, constipation ■ Reflux Musculoskeletal ■ Loose, more relaxed (progesterone) ■ Backache (fetal position, weight gain) ■ Center of gravity changes ■ Rectus abdominis separation Skin ■ Linea Nigra: dark line down from belly button ■ Chloasma: mask of pregnancy ■ Striae: stretch marks ■ Spider veins, varicose veins ■ Increased hair growth, sweat ■ Pregnancy glow- smoother, more supple Vaginal ■ pH: 3.5 - 6.0 (pre-pregnancy: 3.8 - 4.2) ■ Altered flora ■ Gradual softening, stretching Uterine ■ 2 oz to 2.5 lbs ■ Capacity: 10 ml to 5000 ml ■ Braxton Hicks contractions: mild, irregular Cervical ■ Soft (Goodell’s sign) ■ Vascular (Chadwick’s sign) ■ Mucous plug Neurological ■ May have decreased concentration and memory ■ Sleep changes ■ Eyes: increased intraocular pressure Weight ■ Gain 25-35 lbs ● 1st trimester: 3.5-5 lbs

● 2nd trimester: 12-15 lbs ● 3rd trimester: 12-15 lbs ○ Hyperemesis Gravidarum ■ Severe morning sickness ■ Treatment: antihistamines ○ The quickening ■ When mother feels fetal movement ■ 18-20 weeks for primigravida (first pregnancy) ■ 16 weeks for multigravida (second/third pregnancy) Unplanned/Unintended Pregnancy ● Options ○ Maintain pregnancy, surrender parental rights (adoption) ○ Terminate pregnancy (abortion) ○ Maintain pregnancy, become a parent ● Adoption ○ Permanent transfer of parental rights ○ Legal and emotional process ○ Professional counseling is strongly encouraged for both legal and emotional support ○ “Good faith” adoptions: not legally binding, ex. Grandparents care/guardianship/financially support child ○ Adoptive family requirements ■ A home study evaluation ■ State criminal check ■ References ○ Adoption options ■ Agency adoption ● Social worker coordinates adoption plans ● Arranges legal consultation ● Provides counseling ■ Private adoption ● Attorney coordinates adoption plans ● Provides legal consultation ● May arrange counseling ○ Types of adoption ■ Open adoption ● All parties meet, know each other’s full contact info ● Ongoing contact and updates about child after adoption ■ Semi-open adoption

● Birth parent receives adoptive family profile but may not meet ● May send pictures/cards after adoption. Possibly formal visits ■ Closed adoption ● Birth parents choose adoptive family through an agency/lawyer ● Families do not meet and have limited profile info ● No contact/updates with birth parent after adoption ○ Surrender of parental rights ■ Birth mother is legal guardian until Surrender of Parental rights is signed ■ It is a permanent agreement ■ Must occur at least 72 hours after birth to ensure the mother is emotionally prepared to sign ■ If father is named on birth certificate he must sign too ● Not required to have father on birth certificate in NH ○ Same-sex couples ■ Protected by Every Child Deserves a Family Act of 2015 ■ All states allow LGBTQ+ and single parent adoption but laws vary and some states specify husband and wife ● Pregnancy termination ○ Fetus can feel pain: not sure prior to 29 weeks gestation ○ Roe vs Wade ■ First trimester (LMP - 14 wks): abortion allowed based on judgement of patient and care provider ■ Second trimester (14-28 weeks): each state may choose to regulate the abortion procedure in ways that are ‘reasonable related to pregnant woman’s health ■ Third trimester (28-EDD): state may choose to limit or even prohibit abortion. It may not impose restrictions that interfere with the life or health of the pregnant woman ■ January 22, 1973 ■ Landmark 7-2 decision by US Supreme Court that declared a pregnant woman is entitled to have an abortion until the end of the first trimester of pregnancy without any interference by the state ■ Norma McCorvey: never had an abortion, filed under the name Jane Roe to challenge Texas statute that made abortion illegal ○ First trimester abortion poses low/no risk of:

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■ Infertility ■ Ectopic pregnancy ■ Miscarriage ■ Birth defects ■ Breast cancer ■ Mental health problems ■ Preterm delivery/low birth weight ■ Chance of death from abortion before 9 weeks: 1 in 1 million Reasons for termination ■ Majority already have children and reportedly understand the responsibilities of parenthood ■ Inability to care for or afford a child ■ Each year, about 10,000-15,000 abortions occur among women whose pregnancies resulted from rape or incest Factors contributing to the decline in the number of abortion providers ■ Anti-choice harassment and violence ■ Social stigma/marginalization ■ Professional isolation/peer pressure ■ The ‘graying of providers’ ■ Inadequate economic/other incentives ■ Perception of abortion as an unexciting field of medicine Complications of unsafe abortion ■ Estimated 5 million women are hospitalized each year for treatment of abortion-related complications, such as hemorrhage and sepsis Methods of first trimester abortion ■ Two medication options ● RU486 (Mifepristone) ● MTX (Methotrexate) ● Misoprostol is also required with both options to induce contractions ■ Two surgical options ● MVA (Manual Vacuum Aspiration) ● D&C (Dilation and Curettage) ■ Mifepristone (RU486) ● Blocks progesterone/breaks down endometrium ● Taken orally at clinic up to 9 weeks after LMP ● Within 3 days after taking it, vaginal misoprostol is taken at home (causes cramping and bleeding) ● Antibiotics may also be given to prevent infection

● 97% effective, less than half abort within 5 hours after misoprostol ● Developed in 1988- France and China ● Approved in U.S. in 2000 ■ Methotrexate (MTX) ● Teratogenic to embryo (interrupts development) ● Taken orally up to 7 weeks LMP ● Requires misoprostol (cramping, bleeding) ● Less effective and less common in U.S. ■ MVA (Manual Vacuum Aspiration) and D&C ● Done at clinic/hospital up to 12 weeks LMP ● 99% effective, low risk ● Complete within minutes ● May use sedation if desired ● Less private than medical abortion ○ Risks of medical abortion ■ Hemorrhage ■ Uterine or pelvic infection ■ Misdiagnosed/unrecognized ectopic pregnancy ■ Incomplete abortion or ongoing pregnancy, requires surgical abortion procedure ○ Risks of surgical abortion ■ Hemorrhage ■ Uterine or pelvic infection ■ Uterine perforation ■ Cervical laceration ■ Misdiagnosed/unrecognized ectopic pregnancy ■ Incomplete abortion or ongoing pregnancy, requires second surgical abortion procedure ○ Comparison of types of abortion ■ Medical ● Usually avoids invasive procedure ● Usually avoids anesthesia ● Days to weeks to complete ● Available during early pregnancy ● High success rate (95%) ● Bleeding not commonly perceived as light ● Requires follow-up to ensure completion of abortion ● Patient participation throughout a multiple step process

■ Surgical ● Involves invasive procedure ● Allows use of sedation if desired ● Complete in a predictable period of time ● Available during early pregnancy ● High success rate (99%) ● Bleeding commonly perceived as light ● Does not require follow up in most cases ● Patient participation in a single step process ○ Second trimester abortions ■ D&E (Dilation and Evacuation) ■ Late term abortion ■ 14-24 weeks gestation ■ 88% of all abortions occur within the first 12 weeks of pregnancy, 1.5% are done after 21 weeks ■ Illegal in many states Prenatal Testing ● Most accurate screening test for chromosomal abnormalities: Sequential Integrated Screen ● Help to prevent neural tube defects: taking Folic Acid during pregnancy ● Risks of testing ○ No risks for screening ○ Risks of miscarriage for diagnostic tests ● Choices after abnormal test results ○ Terminate the pregnancy ○ Continue the pregnancy ■ Pursue potential interventions that may exist ■ Begin planning for a child with special needs ○ Continue pregnancy and surrender for adoption ● Routine maternal blood tests ○ @ initial prenatal visit (8-10 weeks) ■ Blood type and RH factor ■ Anemia or thalassemia ■ Thyroid function ■ Rubella immunity ■ Hepatitis B, Syphilis, HIV ○ @ 24-28 weeks ■ Gestational diabetes screen ■ May repeat some initial tests

● Maternal cervical tests ○ At initial visit ■ Cervical cancer (PAP smear, HPV) ■ STIs (Chlamydia, Gonorrhea) ■ Visible HSV or HPV lesions ● Maternal urine screen ○ At each prenatal visit ■ Glucose: diabetes ■ Protein: pre-eclampsia ■ Ketones: dehydration ■ WBC/blood: infection ● Maternal vaginal-rectal test ○ Group B streptococcus @ 36 weeks ■ Bacteria (not an STI) ■ Usually asymptomatic ■ May cause serious neonatal infections and possible death ● Optional prenatal tests ○ Ultrasound ○ Screening tests ■ Alpha-FetoProtein (AFP) ■ First Trimester Combined Test ■ Quadruple Screen ■ Integrated/Sequential Test ■ Cell-Free DNA (cfDNA) ○ Diagnostic tests ■ Chorionic Villus Sampling (CVS) ■ Amniocentesis ■ Fetal Blood Sampling (PUBS) ● Screening: reveals possibility of a problem or abnormality ● Diagnostic: determines with certainty if there is a problem or abnormality ● To screen or diagnose: ○ Fetal characteristics ■ Size, sex, gestational age, presentation ○ Placental characteristics ■ Placement, bleeding, amniotic fluid ○ Fetal abnormalities ■ Genetic: CF, Tay-Sachs, Sickle Cell ■ Chromosomal: Down’s, Trisomy 21, Edward’s, Trisomy 18 ■ Structural: Neural Tube Defects, Cardiac, etc.

● Chromosomal abnormalities ○ Include extra chromosome in specific pair ■ Trisomy 18: Edward’s Syndrome ■ Trisomy 21: Down Syndrome ● Neural tube defects ○ Defects of spine or brain during fetal development ○ Spina bifida ○ Anencephaly ● Screening tests ○ Alpha Fetoprotein (AFP) ■ Screening maternal blood test ■ Chromosomal abnormalities ■ Neural tube defects ■ Most accurate at 15-20 weeks ■ High false-positive rate leads to unnecessary worry and invasive procedures ■ Newer, more accurate screening options ○ First Trimester Combined Test ■ Two-part test at 10-13 weeks ■ Fetal ultrasound of nuchal translucency (neck folds) ■ Maternal Blood Test (hCG and PAPP-A) ■ Screen for chromosomal abnormalities, NOT neural tube defects ■ If positive may do CVS for diagnosis ○ Quad Screen ■ Maternal blood test at 15-20 weeks ■ Measure four markers: AFP, hCG, Estriol, Inhibin-A ■ Screens for chromosomal abnormalities and Neural Tube Defects ■ Fancier AFP with better results ○ Sequential Integrated Screen ■ Results from 2 separate tests ● First trimester combined test results and… ● Quad screen results ■ Screens for chromosomal abnormalities and neural tube defects ○ Cell-Free DNA (cfDNA) ■ Maternal blood test at 10-22 weeks ■ Identifies fetal DNA in mother’s blood ■ Screens for chromosomal abnormalities, NOT neural tube defects ● Diagnostic tests ○ Chorionic Villus Sampling (CVS)

■ 11-13 weeks ■ Transabdominal or transvaginal ■ Chromosomal abnormalities and genetic disorders, NOT neural tube defects ■ Paternity testing: 99% accurate ○ Amniocentesis ■ 15-18 weeks ■ Neural tube defects: spina bifida, anencephaly ■ Chromosomal disorders: trisomy 21, 18, 13 ■ Genetic disorders: cystic fibrosis ■ 3rd trimester to test lung maturity ■ Results may take up to a month ○ Fetal Blood Sampling (PUBS) ■ 18+ weeks ■ Chromosomal abnormalities ■ Fetal malformations ■ Blood disorders ■ Fetal infection ■ Fetal platelet count in the mother ■ Fetal anemia ■ Isoimmunization Pregnancy Complications ● Global leading cause of maternal death: Pre-eclampsia and Eclampsia ● Rh sensitization (Isoimmunization) ○ Mother’s antibodies attack and destroy fetal cells ○ Fetal outcomes ■ Destruction of red blood cells ■ Low oxygen levels ■ Jaundice ■ Immature red blood cells ■ Enlarged spleen, liver, and/or heart ■ Excess fluid ■ Organ failure ■ Death ○ Prevention and treatment ■ If mom is Rh negative: ● Injection of rH immunoglobulin (RhIg) called RhoGam at 28 weeks

■ After delivery, if baby;s blood type is Rh+, mother receives another RhoGam injection within 72 hours ● Placenta Previa ○ Symptoms ■ May be asymptomatic ■ 1st/2nd trimester spotting ■ Painless heavy bleeding later in pregnancy (after 28 weeks) ■ Cramping with onset of bleeding ○ Prevention: none, Diagnosis: ultrasound, Treatment: Cesarean section ○ Outcomes ■ Maternal ● Hemorrhage ● Shock ● Blood clots ● Death ● C-section ● Blood transfusions ■ Fetal ● Hemorrhage ● Anemia ● Prematurity ● IUGR- Intrauterine Growth Restriction due to poor blood flow ○ 90% of placenta previas identified on ultrasound before 20 weeks resolve before delivery ○ Is present in about half of all pregnancies around 16 weeks ● Placental Abruption ○ Premature separation of the placenta from the uterine wall ○ Anytime after 20 weeks of pregnancy ○ Symptoms ■ Abdominal pain/uterine contractions ■ Back pain ■ Bleeding (may be concealed) ■ Fetal heart rate irregularities ○ Tests ■ Ultrasound ■ Blood tests ○ Treatment ■ Dependent on severity ■ IV Fluids

■ Blood transfusion ■ Monitor fetus and mother ■ Steroids to aid in lung maturity if mother and fetus stable ■ Possible emergency C-section ○ Outcomes ■ Maternal ● Excessive blood loss ● Coagulation disorder ● Maternal shock ● Hysterectomy ● Maternal death ● Emergency C-section ■ Fetal ● Hypoxia ● Asphyxia ● Low birth weight ● Prematurity ● Perinatal fetal death ● Gestational Diabetes ○ Normal pregnancy hormones hinder mother’s insulin from working normally, mother cannot produce enough insulin to carry glucose from blood into cells, blood glucose levels are too high ○ Glucose crosses placenta/insulin does NOT cross placenta ○ Excess glucose stored as fat = macrosomia (big baby) ○ Diagnosis ■ Glucose Challenge Test ● Routine for all women 16-28 weeks ● If abnormal, GTT ■ Glucose Tolerance Test ○ Treatment ■ Prenatal care ■ Self blood glucose monitoring ■ Diet management ■ Exercise ■ Possible insulin injections ○ Outcomes ■ Maternal ● Possible C-section ● Risk of later developing type 2 diabetes

■ Fetal ● Macrosomia ● Shoulder dystocia ● Neonatal hypoglycemia (low blood sugar) ● Respiratory Distress Syndrome ● Perinatal mortality ● Childhood obesity ● At risk for type 2 diabetes in adulthood ● Hypertensive Disorders ○ Gestational Hypertension ■ High blood pressure ■ Treatment ● Close monitoring ● Education about symptoms of preeclampsia ● Possible low dose aspirin ● Consider delivery early ■ Usually resolves within 3 months postpartum ○ Pre-Eclampsia ■ Gestational HTN (hypertension) plus one or more: ● Proteinuria ● Low platelet count ● High serum creatinine ● High liver transaminases ● Pulmonary edema ● Cerebral or visual symptoms (blurred vision, flashing lights, sparks) ■ Symptoms: hypertension AND ● Protein in urine ● Abnormal labs ● Swelling (ankles and hands) ● Sudden onset of severe headaches ● Hyperreflexia ● Sudden weight gain ● Upper right abdominal pain ● Excessive nausea and vomiting ■ Diagnosis ● Frequent blood pressure checks ● Urine test for protein ● Blood tests

● History of pre-existing conditions ■ Management ● Bedrest, side-lying ● Quiet environment/low stimuli ● Anti-hypertensive medications ● Magnesium Sulfate ■ Outcomes ● Maternal ○ Impaired kidney function ○ Impaired liver function ○ Placental abruption ○ Blood clotting problems and stroke ○ HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) ● Fetal ○ IUGR (Intrauterine Growth Restriction) ○ Prematurity ○ Fetal death ○ Eclampsia ■ Preeclampsia with a seizure ■ More women die from preeclampsia than eclampsia, one is not more serious than the other Fetal Assessment ● Fetal kick counts ○ Mother counts number of fetal kicks (movement) over time ○ No cost, no side effects ○ Decreased fetal movement- decreased oxygen ○ Fetal activity peaks with maternal hypoglycemia, NOT right after mother eats ○ Why ■ Assess fetal well-being ■ Should be 10 movements in less than 2 hours ○ How ■ Mother rests on her left side, stays aware ■ Same time each day and after activity/exercise ■ Begin time with first fetal movement, stop when 10 movements are felt ○ If adequate ■ Reassuring

■ Continue ○ If inadequate ■ May indicate decreased oxygen and compromised fetus ■ Next step: Non-Stress Test ● Non-Stress Test ○ Most common fetal assessment ○ Measures fetal heart rate in response to fetal movement ○ Usually after 32 weeks gestation ○ Reasons ■ Failed fetal kick counts ■ Maternal or fetal risk or complication ■ Intrauterine Growth Restriction ■ Post dates (overdue) ■ Trauma ○ How ■ Electronic fetal monitor x 20-30 minutes to assess FHR, fetal movement, and uterine activity ■ May be inaccurate if ● Fetus is immature ● Fetus sleep cycle ● Maternal sedation ○ Results ■ Non-reactive ■ Next step: BioPhysical profile for further assessment, CST ● BioPhysical Profile ○ Assesses 5 indicators of fetal well-being ■ Fetal heart rate ■ Fetal breathing movements ■ Fetal body movements ■ Fetal muscle tone ■ Amount of amniotic fluid ○ How ■ Ultrasound x 30 mins to assess 5 indicators ■ Scoring for each of 5 indicators ● 2 points for each normal result ● 0 points for abnormal result ○ Interpretation ■ 8-10: normal result ■ 6: suspect lack of adequate oxygen

■ 4: suspect lack of adequate oxygen, if over 36 weeks- deliver, if under 36 weeks- Lung Maturity Test ■ 0-2: deliver promptly ● Contraction Stress Test (CST) ○ Only needed to assess if fetus can tolerate stress of labor contractions ○ Not needed if c-section is planned ○ Why ■ To assess fetal tolerance of stress from labor ○ How ■ Monitor fetal heart rate response to contractions (stress) ■ Induce contractions until by one of 2 methods ● Nipple stimulation which releases of natural oxytocin to cause contractions ● IV pitocin (synthetic oxytocin)...