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115 Cards in this Set
- Front
- Back
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How long can frozen sperm still result in pregnancy?
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20 yrs +
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Artificial Insemination
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form of ARTs
-transfer of sperm into the female reproductive tract |
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Intra-uterine Insemination
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form of ARTs
-transfer of sperm directly into the uterus |
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In-Vitro Fertilization (in glass, test tube baby)
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procedure joining egg and sperm outside woman's body
-once successfully joined its transferred to uterus |
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Gamete
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sperm or egg cell
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ART
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Assisted Reproductive Technologies
-eggs need to be harvested for majority of procedures |
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Clomid
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oral medication, increases egg production and chance of pregnancy
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Zygote
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combination of sperm and egg- fertilized
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Embryo
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once zygote begins to divide
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Transfer of 5 day old blastocysts
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allows nature to weed out abnormal chromosomes
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Gamete Intra-fallopian transfer
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transfer of unfertilized eggs and sperm into the fallopian tube
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Zygote Intra-fallopian transfer
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transfer of fertilized eggs into fallopian tube
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Pre-implantation Genetic Diagnosis
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removing a cell from an early embryo to test for specific genetic defects and select health embryo for implantation
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Intra-cytoplasmic Sperm Injection
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injection of the sperm directly into the cytoplasm of the egg
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Sub-endometrial Embryo Delivery
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implanting the embryo directly into the endometrial lining of the uterus
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Cytoplasmic Transfer
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injecting cytoplasm from a donor egg into the cytoplasm of a recipient egg
-used for someone who has fragmented cytoplasm and habitual miscarriage |
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Nuclear Transfer
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removing the nucleus (genetic material) from a woman's egg and injecting it into a de-nucleated donor egg
-may be used for fragmented cytoplasm or habitual miscarriage |
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Egg harvesting
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hyperovulation
prevent spontaneous ovulation-shot during cycle hCG to stimulate final growth burst monitor progress with clinic visits and blood tests |
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Hyperovulation
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1-3 daily injections of hormones for 2 weeks to increase egg production
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Ectogenesis
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"artificial womb" growing a fetus through gestation n an environment outside the human female body
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Designer babies
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Using a combination of ARTs and genetic engineering to create offspring with specific attributes
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Ovarian transplant
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women with congenital disorders or post-chemotherapy may achieve fertility by donor ovary transplant
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Surrogate
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someone else carries the baby
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Dizygotic
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fraternal
2/3 2 eggs 2 sperm = 2 zygotes |
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Monozygotic
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identical
1/3 1 egg 1 sperm = divided ovum |
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Rates of twins
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increased mortality
twin rates increased due to ARTS advancing maternal age |
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Family history of twins
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women from family of twins increase risk
father has little to no effect on partner having twins -can give trait to daughter |
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Twin to twin transfusion syndrome
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share placenta and connecting vessels in the placenta
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Trizygotic
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triplets
75% occur after arts 1/8000 |
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Dangers of multifetal pregnancy
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preterm birth
intrauterine restriction congenital anomalies neuro-developmental issues obstetrical complications |
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Elective Multifetal reduction
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usually done 10-13 weeks
ultra sound used to guide needle to inject potassium chloride (vaginal or abdominal) risk of pregnancy loss and preterm labor |
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Percent of women get morning sickness
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75%
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What is pregnancy?
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Implantation - pregnancy begins
40 weeks from LMP to EDD |
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LMP
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last menstruation period
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EDD
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estimated due date
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1st trimester
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LMP - 14wks (APPLE SEED SIZE)
-heart develops first - 5-6weeks:heartbeat - 10weeks: major organs developed - 10weeks: embryo is fetus |
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2nd trimester
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14 - 28wks
-detailed development of organs and fetal growth -hearing and eyes reopen 26 weeks |
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3rd trimester
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28 - EDD
-fetal growth and development continues -fat stores improve survival |
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Gravid
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pregnant
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Primigradiva
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1st pregnancy
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Multigravida
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2nd or 3rd pregnancy
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Para
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a woman who has given birth
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Nullipara
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never given birth
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Primapara
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1st birth
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Multipara
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2nd or 3rd birth
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Quickening
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when mother feels movement
18-20 weeks for primigravida 16 weeks for multigravida |
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Progesterone
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thickens the endometrium
suppresses development of a new follicle inhibits uterine contractions |
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Size of fetus
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5 weeks- appleseed
7 weeks- blueberry 10 weeks- prune 12 weeks- plum 14 weeks- lemon 16 weeks- avocado 18 weeks- sweet potato 22 weeks- papaya 27 weeks- rutabaga 28 weeks- eggplant 32 weeks- squash 36 weeks- honeydew 38 weeks- pumpkin 40 weeks- full term (6-9 lbs 19-21 in) |
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Maternal changes
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HR increases
BP decreases blood volume increases increased oxygen consumption heart displaced- mumur |
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Progesterone and Maternal changes
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musculoskeletal loose, more relaxed
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Braxton Hicks contractions
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practice contractions
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Weight gain
total and by trimester |
25-35 pounds total
1st- 3.5-5 2nd- 12-15 3rd- 12-15 |
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Goal of prenatal care
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EDD
Identify risks monitor health education |
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Amniocentesis problems
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anxiety from test
not always correct not enough info to make good decision |
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Two types of prenatal tests
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Screening and Diagnostic
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Screening
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reveals possible problems or abnormality
usually state as a "risk of" or "chance of" |
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Diagnostic
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determines with a relative certainty whether a fetus has a specific problem or abnormality
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To screen for or diagnose
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-maternal health problems
-fetal abnormalities genetic chromosomal structural -fetal characteristics size,sex,gestational age presentation, placenta, amniotic fluid -other paternity, infection |
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Health and Genetic history
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-influences what tests may be recommended beyond those routinely given to all pregnant women
-plan of care for woman or baby may change based on results |
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Urine test
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done at each prenatal visit
-bacteria, WBCs, blood (possible UTI) -glucose (possible diabetes) -protein (possible pre-eclampsia) -ketones (possible dehydration) |
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Cervical test
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at first visit
-STIs (Chlamydia & Gonorrhea) -Cervical Cancer (PAP smear) at 36 weeks -Group B Streptococcus Infection (GBS) bacteria (not STI) no symptoms in mother can cause serious infections/death in newborns can be treated at birth with IV antibiotics |
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Routine Maternal Blood Tests
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first prenatal visit (8-10wks)
-blood type and Rh factor -anemia or thalassemia -thyroid function -Rubella immunity (german measles) -Hep. B, Syphillis, HIV 24 weeks -gestational diabetes screen (GDM) |
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AFP Alpha-FetoProtein
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SCREENS FOR:
Chromosomal Abnormalities -Down Syndrome (trisomy 21) -Edwards Syndrome (trisomy 18) -Fragile X Syndrome Neural Tube Defects (NTD) -Spina Bifida -Anencephaly high false positive rates lead to unnecessary worry |
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Newer chromosomal screening tests
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1st trimester combined test (10-13weeks)
Quadruple test (15-18weeks) Full integrated test (15-18weeks) |
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1st timester combined test (10-13weeks)
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Ultrasound:
-confirms gestational age -measures "nuchal translucency"-thickness of neck fold Blood test for specific proteins/hormones -done at 10-13weeks -best for early detection of downs |
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Quadruple test (15-18weeks)
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Blood test for levels of
1. AFP+ 2. unconjugated estriol (uE3)+ 3. hCG+ 4. inhibinA |
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Full integrated test (15-18weeks)
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results of 1st trimester combined test and quadtruple test:
if positive: amniocentesis is offered for diagnosis |
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Ultrasound: 1st trimester
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confirm pregnancy
confirm heartbeat gestational age (crown-rump length) confirm molar or ectopic pregnancy placenta location (if bleeding) |
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Ultrasound: 2nd trimester
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fetal malformations
multiple pregnancies gestational age and growth intrauterine death polyhydramnios - too much amniotic fluid oligohydraminos - too little amniotic fluid sex |
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Ultrasound: 3rd trimester
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placental location (previa)
intrauterine death fetal presentation fetal movements |
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Spina Bifida
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defect in vertebrae causing spinal nerves to pertrude
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Transvaginal ultrasound
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early pregnancy
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Standard ultrasound
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2D image
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Advances ultrasound
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targets a suspected problem
more sophisticated equiptment |
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Doppler ultrasound
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detects frequency changes (blood flow)
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3D ultrasound
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special probe with 3D images
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4D ultrasound
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3D in motion
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Fetal Echocardiography ultrasound
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heart anatomy and function
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Amniocentesis detects
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neural tube defects: spina bifida, anencephaly
chromosomal disorders: trisomy 21 (downs) 13, 18, Fragile X genetic disorders: cystic fibrosis, turner syndrome |
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Amniocentesis: how
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ultrasound identifies pool of amniotic fluid
needle inserted through abdomen into uterus 1 oz of fluid withdrawn -may take up to 1 month for results |
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Amniocentesis risks
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miscarriage 1/200
infection premature rupture of membranes fetal injury |
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Chronic Villus Sampling (CVS)
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to diagnose:
chromosomal abnormalities genetic disorders does not test for NTD |
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Two methods of CVS
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-transcervical= tc-cvs
guided by ultrasound, thin catheter inserted through cervix to suction chorionic villi cells risks:higher rates -transabdominal= ta-cvs similar to amniocentesis larger sample, faster results risks: similar to amniocentesis |
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Fetal blood sampling aka Percutaneous umbilical blood sampling (PUBS)
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if diagnostic information cant be obtained through amnio, CVS or ultrasound
-chromosomal abnormalities -fetal malformations -blood disorders -fetal infection does not test for NTD ultrasound to identify structures thin needle through abdomen and uterus to umbilical cord small amount of cord blood extracted risks: miscarriage, blood loss |
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Bernsteins article
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preeclampsia and eclampsia
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Pregnancy complications
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Rh sensitivity
Gestational diabetes Placental complications Hypertensive disorders |
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Rh Sensitivity
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Blood
-Type A, B, AB, or O (no antigen) -Rh factor antigen is present (+) or not (-) 85% of world is Rh+ -Maternal and fetal circulation are separate |
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Rh Sensitization (Isommunization)
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Rh negative mother and Rh positive father:
If Rh positive fetus, mom may develop antibodies to Rh factor (become sensitized) With next Rh positive fetus: fetal blood will be attacked as foreign by maternal antibodies |
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Sensitization may occur if
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miscarriage
abortion prenatal testing - cvs or amniocentesis |
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Prevention/Treatment of Sensitization
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if mother is Rh-
injection of Rh immunoglobulin (RhIg) or RhoGam at 28 weeks gestation after deliver if baby blood type is positive then another injection is given to mother |
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Placental Complications
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placenta previa
placental abruption |
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Placenta Previa - c-section needed
placenta cant come first |
Types:
marginal- edge covering cervix complete- covering cervix lowlying- near cervix but not covering may be asymptomatic spotting or heavy bleeding later on no prevention ultrasound |
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Abruptio Placenta
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separation of placenta from uterine wall
-not common risk of hemorrage or death symtoms:pain or bleeding blood tests and ultrasounds |
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Treatment for Abruptio Placenta
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depends on severity
IV fluids blood transfusions |
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Gestational Diabetes Mellitus (GDM)
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unknown cause
starts during pregnancy and usually resolves after |
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GDM maternal and fetal process
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maternal:
-pregnancy hormones hinder mothers insulin from working normally -mother cant provide enough insulin to carry glucose from blood into cells -this results in blood having glucose levels too high fetal process: -glucose crosses placenta, insulin doesn't -excess glucose stored as fat= big baby MACROSOMNIA -more than 8lbs 13oz at term |
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Hypertensive disorders of pregnancy
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Gestational Hypertension
Pre-eclampsia Eclampsia |
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Transplanting developing embryo into lining of uterus
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sub endometrial embryo
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Hyperglycemia
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high level of glucose
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Gestational hypertension
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high BP during pregnancy
no issues before cause unknown monitoring necessary, no meds |
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Severe hypertension
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anti hypertensive meds used
risk of stroke early delivery |
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Pre eclampsia
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hypertension
protein in urine sudden weight gain urine tests leading known cause of prematurity |
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Pre eclampsia treatment
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best rest
quiet environment delivery- cure, other ways are just coping |
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Eclampsia
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seizure with preeclampsia symptoms
possible coma or death |
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Fetal assessments *****:
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heart rate-110-160
movement-not enough oxygen, less movement |
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Fetalscope
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horn or stethoscope like instrument that measures fetal heart rate
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Fetal doppler
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transmits sound waves that are reflected off of the fetal heart- measures heart rate
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Electronic fetal monitoring
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Doppler coupled with
-Tocodynamometer Measures rate and duration of contractions Worn as belt around belly Measures uterine contractions, fetal movement and fetal heart rate |
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Types of fetal assessment
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Fetal Kick Counts
Non Stress Test Biophysical Profile Contraction Stress Test |
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Fetal kick counts
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10 times/ hour is good
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Non stress test
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measures fetal heart rate in response to fetal movement
belt for uterine contractions belt to measure fetal heart rate mother presses button when she feels movement heart rate increases with fetal movement no heart accelerations-sleep,immature |
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NST interpretation
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Reactive (normal)
2+ fetal heart rate increases in 20 mins* Nonreactive monitoring for two 20 min periods neither yields adequate accelerations interventions to increase fetal activity fail |
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Biophysical profile (BPP)
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NST plus ultrasound assessment
assesses 5 ares of fetal well being 1. heart rate 2. breathing movements 3. muscle tone (fetal position=healthy) 4. body movements 5. amount of amniotic fluid 2pts for normal 0 abnormal |
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Contraction Stress test
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assesses fetal tolerance of stress
stress=uterine contractions how- monitor fetal heart rate response to contractions started by: IV pitocin nipple stimulation (try to get 3 contractions within 10 mins) |
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CST interpretation
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Negative (Normal)
Adequate contractions No concerning rate changes with contractions (no late decelerations) Positive Repetitive, persistent late decelerations Decelerations with more than half of contractions Not due to uterine hyperstimulation |
