Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
369 Cards in this Set
- Front
- Back
|
What is the def of infertility?
|
Heterosexual couple who have had regular (3xaweek) unprotected sex for a year or more w/o getting pregnant or being unable to maintain a pregnancy
|
|
|
What percent of married couples of child-bearing age in the USA are considered infertile?
|
15%
|
|
|
What percent of cases are due to the mother?
|
35%
|
|
|
% of cases due to father?
|
35%
|
|
|
% of cases due to both?
|
20
|
|
|
% of cases unknown?
|
10%
|
|
|
What percent of causes of infertility can be diagnosed?
|
90%
|
|
|
What percent of diagnosed cases can be treated successfully?
|
50-60%
|
|
|
Rate of infertility between 20-24
|
4.1%
|
|
|
|
|
|
|
Rate of infertility between 30-34
|
9.4%
|
|
|
Rate of infertility between 35-39
|
19.7%
|
|
|
What are the causes of female infertility?
|
failure to ovulate, tubal blockage, failure to implant, pregnancy loss (miscarriage), reduced sperm transport, antibodies to sperm
|
|
|
What is the main cause of female infertility for women over 40?
|
Failure to ovulate. Hypothalamus (GNRH) or pituitary (LH, FSH) may not be functioning adequately
|
|
|
Tx of failure to ovulate
|
1) GnRH stimulatory agonists can induce ovulation.
2) Anti-estrogen CLOMID taken orally and it inhibts the negative feedback of estrogens on GnRH, FSH, and LH secretion 30-50% success 3) Human menopausal gonadotrpin which contains LH and FSH followed by hCG results in 50-70% success |
|
|
What are the symptoms of POlycystic Ovary Disease?
|
Obesity, hirsutism, virilization, anovulation, infertility, amenorrhea, increased insulin resistancea nd increased rates of type 2 diabetes
|
|
|
What are the mechanisms leading to Polycystic OVary disease?
|
combination of obesity and elevated levels of androges leads to extraglandular aromatization to produce incerased estrogen. INCREASED level of ESTROGEN causes NEGATIVE feedback on FSH which prevents maturation of follicles and NO graafian, and NO ovulation. 2) elevated E causes + feedback on LH which results in an INCREASE in ANDROGEN production in the ovaries
|
|
|
What are the mechanisms leading to Polycystic Ovary disease?
|
Decrease in FSH, Increase LH, increase Adrenal and ovarian androgens, Increase acyclic estrone (produced by aromatization), decrease cyclic estradiol
|
|
|
What is the 2nd leading cause of infertility in females?
|
Tubal blockage: blockage in oviduct blocks the passage of sperm or ova (scarring from STI), ENDOMETRIOSIS: condition where endometrium tissue grows outside of the uterus such as inside the oviduct where it can cause scarring and blockate
|
|
|
Tx of tubal blockage?
|
Gas (CO2 or air) injected into tubes/ transcervcal ballon tuboplasty: balloon is inserted into obstructed tube and is inflated; SURGICAL repair by LAAROSCOPY
|
|
|
Absence of implantation, what happens?
|
normal preembryo may reach the uterus, but the uterine surface is not receptive to implantation; this problem can be treated effectively in some women by priming the uterus with appropriate doses of E and P
|
|
|
What % OF ALL FERTILIZED EGGS DO NOT Complete development and many lost before or soon after implantation before they realize that they are pregnant? (miscarriage)
|
50-75%
|
|
|
What % of known pregnancies end in miscarriage?
|
15%
|
|
|
What are most miscarriages caused by?
|
chromosomal abnormalities, others have normal chromosomes but can occur for immunological reasons (MHC) antigens.
|
|
|
What happens with reduced sperm transport/antibodies to sperm?
|
Female repro tract may not allow transport of sperm due to HOSTILE CERVICAL MUCUS (alleviated with estrogen). Females vagina can be HIGHLY ACIDIC which kills sperm. can be remedied with ALKALINE DOUCHES
|
|
|
What is characterized as Male infertility?
|
Low sperm count, poor sperm transport
|
|
|
Low sperm count: what causes it?
|
LEADING cause of infertility: inadequate functioning hypothalamus or pituitary gland may result in oligospermia or azzospermia (absence of sperm); can be treated with GnRH stimulatory agonists, gonadotropins, or anti-estrogen CLOMIPHENE (clomid)
|
|
|
Why does low sperm count occur?
|
may not respond to gonadotropins b/c: physical injury, cryptochodism, past infection of testes (MUMPS), exposure to radiation,chemotherapy, exposure to environmental toxins, smoking, xenoestrogens, anabolic steroids, excessive alcohol consumption, tight underwear, STI's
|
|
|
What percent of infertile men produce antibodies against their own sperm b/c at some time sperm had entered the body tissues outside of the repro tract
|
8-13%
|
|
|
What percent of men are infertile b/c they are missing party of the Y chromosme?
|
1 in 1000
|
|
|
What are the 3 criteria of male fertility?
|
1) greater or equal to 20million/ml of sperm
2) 40% of 20 million have to be able to swim 3) 60% have to have normale size and shape |
|
|
What are some techniques of fertilization?
|
Artificial insemination (AI), In vitro fertilization (IVF), Pre-implantation genetic diagnosis (PGD), gamete or zygote intra-fallopian transfer (GIFT), Surrogate mothers and gestational carriers
|
|
|
What is Artificial insemination?
|
When sperm are introduced into a women's reproductive tract by means other than coitus, donor sperm may be from mom's partner, or sperm bank. Put sperm into a vial or ejaculate into a special condom during intercourse
|
|
|
What is Invitro fertilization?
|
Egg retrieval is achieved by ovarian stimulatoin with gonadotropins or CLOMID; ultrasound identifies mature follicles from which eggs can be harvested; mom's egg is fertilized by sperm OUTSIDE of the body in a petri dish; fertilized eggs are incubated for 5 days when the preembryo becomes a blastocyst; 2-3 tiny preembryos inserted into CERVIX; any remaining eggs/preembryos can be FROZENfor future IVF
|
|
|
Success rate of IVF?
|
25-30%
|
|
|
What percent of births resulting from IVF are multiple babies?
|
35-40%
|
|
|
What is PGD?
|
genetic testing of a single cell taken from a preembryo prior to transfer of the embryo to the uterus during IVF; SCREEN preembryos for INHERITED GENETIC DISORDERS, COST of ea. IVF/PGD = over 20,000 dollars
|
|
|
What is GIFT or ZIFT?
|
Used for women with BLOCKED oviducts or infertile couples who want to avoid fertilization outside of the body. VIA LAPAROSCOPY, egg and sperm or zygote are inserted into OVIDUCT proximal to the point of blockage so that fertilization and implantation can occur. SUCCESS RATE = 25-30%
|
|
|
Surrogate mothers & gestational carriers? what are they/
|
Surrogate mother: inseminated by sperm of donor father, gets pregnant and delivers the child, and gives the child to the couple with whome she has a contract. SURROGATE MOM= BIOLOGICAL mother. Gestational carrier: PREEMBRYO implanted in her uterus and she gestates and delivers this baby for the couple or person. NOT GENETICALLY RELATED
|
|
|
What is fertilization?
|
CONCEPTION: fusion of the nucleus of a haploid gamete male sperm and a haploid female ovum to form a diploid individual; while TRAVELING, both the sperm and the ova go through important physical and biochemical changes
|
|
|
What happens during semen release?
|
Sperm leave epididymus and enter the VAS DEFEERENTIA where they are stored and transported. Sperm travels up vas def and mixes with seminal plasma in the ejaculatory duct to form semen
|
|
|
How many sperm are produced each day?
|
200 million
|
|
|
Secretions of which male accessory glands produce seminal plasma
|
Prostate gland and seminal vesicle
|
|
|
What does seminal plasma contribute and what are its components?
|
maintenance, maturation, and transport of sperm; PROSTAGLANDINS (sperm motility), CITRIC ACID and ASCORBIC ACID, BICARBONATES, FRUCTOSE, CARNITINE, glycerylphosphocholine, zinc, ATP
|
|
|
What do seminal fluid in sperm do?
|
Prostaglandins contract smooth muscles in the vas def, thus aiding sperm passage during ejac
|
|
|
How many sperm in a single ejaculate?
|
40-500 million avg of 180 million
|
|
|
What % of ejaculated sperm are structurally or biochemically abnormal and not capable of fertilization
|
30%
|
|
|
Sperm count has decreased by what percentage a year over the past 50 years?
|
1%
|
|
|
What are some human semen characteristics?
|
Creamy texture with gray-yellow color; avg volume = 2.5-3.5ml AFTER 3 DAYS of ABSTINENCE
|
|
|
What is the size of sperm?
|
40-250 micrometers long
|
|
|
What is the structure of sperm?
|
sperm head, neck, midpiece (contains mitochondria which produces energy for tail movement), and TAIL
|
|
|
What is the structure of the sperm head?
|
Elongated haploid nucleus surrounded by nuclear membrane; ACROSOME: membrane bound vesicle external to nucleus that fits over the head of the sperm like a cap; ACROSOME is full of ENZYMES important in the penetration of the ovum
|
|
|
What is the structure of the sperm flagella?
|
Flagellum is made of MIDPIECE and TAIL configured in a 9_2 arrangement of microtubules; provides PROPULSIVE FORCE allowing locomotion of sperm cell and penetration of ovum
|
|
|
Sperm transport order
|
vagina->cervix-> uterus-> uterotubal junction -> oviduct isthsmus-> oviduct ampullary-isthmic junction which is the MOST COMMON SITE OF FERTILIZATION
|
|
|
How many sperm make it to the uterus out of the 40-500 million that is delivered into the vagina?
|
less than a million
|
|
|
How many sperm make it to the oviduct out of the 40-500 million that is delivered into the vagina?
|
100-1000
|
|
|
How many sperm make it to the egg?
|
20-200
|
|
|
What happens to semen in the vagina?
|
1) increases vaginal pH to 7.2 increasing sperm motility, 2) Semen coagulation: after 1 min, semen becomes thicker which may prevent sperm loss from vagina, 3) Semen liquefaction: about 20 min after, semen again liquefies which enables sperm to swim faster toward cervix, 4) Female orgasm includes vaginal wall muscular contractions that produce pressure in vagina that is greater than in uterus which creates pressure that facilitates sperm movement through cervix, 5) Female orgams can also cause cervical os to DILATE which allows sperm to pass through more easily
|
|
|
What happens to sperm in cervix?
|
The cervical canal is lined by folds and crypts with tiny cervical fibers. Mucus is THICK and fibers are densely packed during most of menstrual cycle. Shortly before ovulation, E rises causing mucus to become MORE LIQUID and the GAP between the fibers to become WIDER
|
|
|
What happens to sperm in uterus?
|
uterine fluid is watery but SPARSE; sperm climb up the uterine wall by beating their TAILS; however, uterine muscle contractions and CILIA movement play more important role in facilitating SPERM transport up uterine wall
|
|
|
What happens with Oxytocin in the uterus?
|
Stimulation of cervix by penis during sex stimulates release of OXYTOCIN from women's post pit gland. OXYTOCIN enhances force of rhythmic waves of UTERINE muscle contractions which help move sperm to the uterotubal junction. 1/2 go into right, and 1/2 go into left
|
|
|
What happens to sperm and ovum in oviduct?
|
On entrance of spern into ISTHMUS of oviduct, sperm tail beating is reduced, and they WAIT for ovulation to occur. After ovulation, sperm move up to the AMPULLARY-ISTHMIC junction where it meets the OVUM that has travelled from ovary through the oviductal infundibulum and ampulla.
|
|
|
What does E do to cilia?
|
increase in cilia number
|
|
|
What does P do to cilia?
|
increases cilia BEATING and EGG TRANSPORT
|
|
|
What do Oviductal cilia in the DEEP RECESSES do?
|
beat cilia toward the OVARY to help move sperm (sperm travels in RECESSES)
|
|
|
What do Oviductal cilia in the RIDGES do?
|
beat cilia toward the uterus to help move the EGG (egg travels along RIDGES)
|
|
|
What is sperm capacitation?
|
freshly ejac sperm is not capable of fertilization; sperm capacitation during journey through female repro tract, the sperm matures and gains ability to FERTILIZE egg and INCREASES tail movements of SPERM
|
|
|
What does the egg do to facilitate sperm movement?
|
Eggs produce CHEMICALS that attract SPERM and influence their swimming motion; Human sperm have at least 20 CHEMICAL receptor molecules on its head
|
|
|
What is the order of sperm passage once it reaches the egg?
|
CUMULUS OOPHORUS -> ZONA PELLUCIDA -> attachment to EGG PLASMA MEMBRANE -> CORTICAL REACTIN -> COMPLETION of 2nd meiotic division -> FORMATION/FUSION OF SPERM/EGG pronuclei
|
|
|
What happens @ the CUMULUS OOPHORUS?
|
layer of loosely packed follicle cells that surround the ovulated ovum; as sperm enters, enzyme HYALURONIDASE on the sperm head dissolves HYALURONIC ACID, cementing material between cells, which enables sperm to reach ZONA PELLUCIDA
|
|
|
What happens @ the ZONA PELLUCIDA?
|
extracellular matrix composed of 3 glycoproteins (ZP1,ZP2, ZP3). Receptors on SPERM PLASMA MEMBRANE attach to ZP3 which triggers sperm head to undergo the ACROSOMAL reaction, in which hydrolytic enzymes are released from ACROSOME which degrades the ZP and creates a TUNNEL through which SPERM MOVES
|
|
|
What happens when sperm penetrates the egg?
|
CALCIUM IONS are released into egg cytoplasm; sudden increase in CA triggers egg activation with CORTICAL GRANULE RELEASE and completion of 2nd stage of meiosis in egg before fertilization occurs
|
|
|
What is the cortical reaction?
|
Once a sperm penetrates an egg, a defense is MOUNTED to prevent another sperm from penetrating. CORTICAL granules under the egg cell membrane release ENZYMES that debilitate ZP3 and ZP2 which prevents ATTACHMENT of additional sperms preventing POLYSPERMY. 1st step in biochemical and physical changes known as EGG ACTIVATION
|
|
|
What are the components of EGG ACTIVATION?
|
cortical reaction, completion of meiosis, increase in EGG METABOLISM, synthesis of protein, RNA,and DNA
|
|
|
What happens during completion of 2nd stage of meiosis?
|
ovulated egg is still arrested in 2nd meiotic stage but penetration of egg by sperm initiates egg activation resulting in completion of 2nd meiotic division (INCREASE in CA, release of CORTICAL GRANULE)
|
|
|
How does the sperm pronuclei form?
|
After sperm nucleus enters egg, its nuclear membrane breaks down, sperm DNA re-condenses as a result of exposure to egg cytoplasm, a new membrane is formed to enclose the sperm pronucleus.
|
|
|
What happens when sperm pronucleus and egg pronucleus comes together?
|
cell membranes breakdown and SYNGAMY occrus with the merging of the 2 haploid genomes to form a DIPLOID ZYGOTE. the resulting diploid zygote cell divides mitotically to produce a 2-celled preembryo consisting of 2 identical daughter cells called BLASTOMERES
|
|
|
Each sperm brings how many mitochondria into the egg?
|
100. They disappear after fertilization. All mitochondria inherited from MOTHER.
|
|
|
What is a zygote and what does it form?
|
Zygote divides mitotically to form 2 daughter cells called BLASTOMERES. cell type differentiation emerges from mitotic cell division
|
|
|
What is Gastrulation?
|
the process of cell movements by which a developing embryo forms distinct GERM LAYERS from the embryonic disc that later grows into particular organs
|
|
|
Which weeks are preembryo development?
|
1-2 weeks: developing organism btwn fertilizationa nd complete implantation; Implantation initiated 7 days after fertilizaton and as late as 10 days; implantation is complete after 2nd week
|
|
|
Which weeks are embryo development?
|
3-8. prenatal stage between estab of implantation at end of 2nd week through 8th week after fertilization
|
|
|
Which weeks are fetus development?
|
9-BIRTH.
|
|
|
What is the biological age since conception?
|
38 weeks from fertilization to birth; 3 trimesters ea. around 3 months long.
|
|
|
What is the gestational age def in clinical medicine?
|
day 1 of last menstrual period which is approximately 2 weeks longer than duration since conception. 40 weeks(280 days)
|
|
|
What are presumptive signs of pregnancy?
|
missed menstrual period with coitus, nausea in the morning, increase in size and tenderness of breasts; darkening of areola around nipples
|
|
|
What are probably signs of pregnancy?
|
increase in size of abdomen, missed consecutive menstrual cycles, increase n freq of urination, POSITIVE HEGAR'S SIGN: uterine cervix becomes softer by 6th week of pregnancy; POSITIVE PREG TEST
|
|
|
What is the general public definition of the onset of pregnancy?
|
1-2 days after a missed menstrual period or when the pregnancy test is +, which is on avg 2 weeks after conception (when hCG is detectable)
|
|
|
What are positive signs of pregnancy?
|
Detection of fetal heartbeat, feeling the fetal movement, visualization of fetus by ULTRASOUND or FETOSCOPY
|
|
|
What happens during a pregnancy test?
|
HCG hormone is producted by blastocyst and placenta of embryo and fetus. HcG has similar activity to LH. Detection of hCG hormone present in blood and urine indicates pregnancy. Most urine tests are not able to detect hCG until 15 days after conception or one day after missed menses. You can have false + tests
|
|
|
What happens during preembryo development
|
zygote undergoes mitotic divisions to become MORULA, which is a ball of 16-32 cells, by 3rd day of fertilziation. Preembryo continues to divide as it passes down the oviduct to the uterotubal junction. MOVEMENT of preembryo is faciliated by the beating of OVIDUCTAL CILIA in the uterine direction. 3-4 days after fertilization the preembryo enters the uterus and is a mass of cells called the BLASTOCYST.
|
|
|
What is a blastocyst?
|
ball made of single outer layer of cells (TROPHOBLAST) just inside the ZP surrounding a fluid-filled cavity BLASTOCOEL
|
|
|
What is the inner cell mass in blastocyst?
|
clump of cells near one end of blastocyst underneath the trophoblast layer. The inner cell mass gives rise to the embryo and also is the source of embryonic stem cells
|
|
|
When does implantation occur?
|
7 days after conception (could be as long as 10 days)
|
|
|
The uterus has to be what in order for implantation to occur?
|
been primed with amts. of E and P at the right time. The corpus luteum secretes modest levels of estrogen and high levels of progesterone which primes uterus and makes the uterus more VASCULAR,SECRETORY, and ready for implantation. surrounding the blastocyst
|
|
|
How long does a non-implanted blastocyst rest in the uterine cavity?
|
2-3 Days
|
|
|
On what day after conception does the uterus secrete a PROTEAZE ENZYME that dissolves the ZP?
|
DAY6
|
|
|
PROGESTERONE also causes the uterus to secrete what?
|
protease enzyme that DISSOLVES the ZP
|
|
|
When the ZP is completely dissolved, what part of the blastocyst attaches to the uterine wall and penetrates the endometrium (IMPLANTATION INITIATION)
|
Inner cell mass
|
|
|
When does IMPLANTATION INITIATION OCCUR?
|
7 days after fertilization (can be as long as 10 days)
|
|
|
What does the blastocyst release that interact with the endometrium and allow the process to proceed normally?
|
Signaling MOLECULES
|
|
|
What does the trophoblast differentiate into?
|
An outer syncytiotrophoblast and an inner cytotrophoblast.
|
|
|
What does the syncytiotrophoblast secrete that breakdown the cells of the uterine endometrium
|
PROTEASES
|
|
|
What is the deciduoma response?
|
Cells of uterine stroma multiply rapidly and form a cap over blastocyst which makes implantation complete. Uterine tissue grows around and over blastocyst
|
|
|
The trophoblast/syncytiotrophoblast penetrates what?
|
the EPITHELIUM and then STROMA of uterus.
|
|
|
The blastocyst penetrates further into stroma and what appears and the blastocoel becomes what?
|
The amniotic cavity appears and the blastocoel (inner cell mass) becomes the yolk sac cavity
|
|
|
What full of maternal blood develop within the syncytiotrophoblast?
|
SINUSOIDS
|
|
|
What is the preembryonic sequence?
|
Day 0: conception with zygote formation, day 1: 2 blastomere cells, day 3: morula (16-32 cells), day 4: early blastocyst, day 5: late blastocyst, day 6: blastocyst (inner cell mass) attaches to ENDOMETRIUM, day 7: implantation begins (may begin on day 10; day 8: amniotic cavity and embyonic disc form; day 9: uterine sinusoids develop; day 10: implantation complete; day 15: 1st missed menses/positive preg test.
|
|
|
How come implantations are not routinely rejected by the mother's tissue if fetal cellsa re genetically different than those of the mother?
|
The common HISTOCOMPATABILITY MOLECULES (HLA'S) found on most nucleated cells are NOT found on placental cells
|
|
|
Soon after implantation the inner cell mass differentiates into bilaminar what? which consists of what 2 layers?
|
EMBRYONIC DISC: epiblast and hypoblast.
|
|
|
the hypoblast, epiblast, and trophoblast contribute to development of what which sustains the embryo during intrauterine development?
|
EXTRAEMBRYONIC MEMBRANES
|
|
|
Which layer gives rise to the embryo proper
|
EPIBLAST
|
|
|
Epiblast splits into what 3 layers?
|
ECTODERM,MESODERM, and ENDODERM
|
|
|
What does the ectodermal eventually form?
|
NERVOUS SYSTEM, EPIDERMIS of skin, hair, nails, and tooth enamel
|
|
|
What does the mesodermal eventually form?
|
SKELETON, NOTOCHORD that develops into vertebral column, MUSCLES, HEART AND CIRCULATORY SYSTEM, KIDNEYS, GONADS, and DEEP LAYERS OFTHE SKIN
|
|
|
What does the endodermal eventually form?
|
DIGESTIVETUBE and the LIVER, GALL BLADDER, PANCREAS, and RESPIRATORY TUBE including LUNGS
|
|
|
The inner cell mass produces which of the extraembryonic membranes?
|
YOLK SAC (vestigal in humans), ALLANTOIS (mainly vestigial in humans), AMNION
|
|
|
The 4th membrane is derived from what?
|
CHORION derived from CYTOTROPHOBLAST
|
|
|
What is the yolk sac?
|
Endoderm-lined membrane that surrounds the BLASTOCOEL (yolk sac cavity) vestigal and non-functional in humans and degenerates early in embryonic development in humans (important in birds)
|
|
|
What is the amnion?
|
Grows over FORMING EMBRYO, fills with amniotic fluid which SUPPORTS and PROTECTS the FETUS against MECHANICAL SHOCK and provides WATER and other materials to fetus
|
|
|
The amniotic fluid gets bigger and bigger? How big?
|
8 weeks, 5-10ml, 20 weeks 250 ml, 38 weeks, 1000-1500 ml, 40weeks/term 500-1000 ml. AMNIOTIC FLUID SECRETED AND ABSORBED at a maximal rate of 300-600ml/hour
|
|
|
What is the chorion?
|
Derived from the CYTOTROPHOBLAST, and surrounds the embryo after 1 month of development; EVENTUALLY FUSES WITH THE AMNION; forms an important component of the PLACENTA
|
|
|
What is the placenta and what does it do?
|
NUTRIENT, RESPIRATORY, and EXCRETORY ORGAN for the fetus; fetus receives oxygen, glucose, growth factors, and other nutrients and eliminates CO2 and other waste products.
|
|
|
Molecules larger than what weight will not pass through the chorionic villi and into fetal blood vessels
|
500 molecular weight
|
|
|
Late in pregnancy, LARGE protein maternal antibodies are what?
|
Actively PUMPED into fetal circulation by PLACENTA CELLS
|
|
|
Human placenta is what b/c chorionic villi are directly bathed by MATERNAL BLOOD?
|
HEMOCHORIAL
|
|
|
Fingerlike projections of the cytotrophoblast extend through the syncytiotrophoblast and toward the VASCULAR UTERINE STROMA on which day
|
DAY 14 and SINUSOID POOLS of maternal blood bath the chorionic villi
|
|
|
How does blood flow from placcenta to fetus?
|
1) Contents of maternal blood (glu and oxy) diffuse from UTERINE SINUSOIDS through thin wall of ea. CHORIONIC VILLUS and into FETAL VESSELwithin ea. villus and travel to the FETUS via the umbilical vein. 2) opposite, the fetal WASTE products (CO2) leave the fetal blood via umbilical arteries and diffuse across villi into mother's blood to be excreted
|
|
|
What happens after week 4 to the placenta?
|
20% of inner uterine wall is covered by the placenta
|
|
|
What happens after week 20 to the placenta?
|
50% of the uterine wall is covered by placenta which weighs 200gm, while fetus weighs 500 grams
|
|
|
What happens after week 40 to the placenta?
|
700 gms which has 285 liters of blood that pass through each day
|
|
|
The stratum functionalis of endometrium is transformed into what of the pregnant uterus as the fetus and placenta grow?
|
DECIDUA basalis: maternal part of placenta; decidua CAPSULARIS: result of deciduoma response with overgrowth of endometrium; DECIDUA PARENTALIS: endometrium not directly connected to the fetus
|
|
|
The fetus resides within what?
|
UTERINE WALL, not the UTERINE CAVITY
|
|
|
What is the umbilical cord?
|
connects the fetus with the placenta
|
|
|
What is the umbilical cord dervied from?
|
BODY STALK connecting embryo and CHORION
|
|
|
How long is the umb cord at birth?
|
0.3-1 inches in diameter and 20-22 inches long and is covered with AMNIOTIC MEMBRANE
|
|
|
How many umbilical arteries carry de-oxygenated fetal blood to the placenta?
|
2
|
|
|
How many umbilical veins carries oxygenated blood from placenta to the fetus?
|
1
|
|
|
Vessels within the umb cord are cushioned by a gelatinous substance called...
|
WHARTON'S JELLY
|
|
|
What are dizygotic fraternal twins?
|
2 genetically distinct zygotes form and 2 embryos implant into uterus. They implant 2 separate placentas, chorions, and amnions, OR implant close together, single placenta, fused chorions and 2 amnions
|
|
|
What are Monozygotic identical twins?
|
develops when inner cell mass of blastocyst divides, producing 2 embryos with a single placenta and chorion but TWO AMNIOTIC SACS. In some cases, splitting of early morula produces monozygotic twins with separate amnions, chorions, and separate or fused placentas
|
|
|
What is the frequency of dizygotic twin pregnancy?
|
varies by ethnicity, heredity, maternal age, parity, and fertility drugs. ethnic differences due to variations in FSH; 1/20 in yoruba, 1/80 in black, 1/100 in white, 1/155 in Japan
|
|
|
Heredity of which parent is more important for twins?
|
mother
|
|
|
When does rate of twinning peak?
|
at age 37 when FSH levels are highest. 0% of twinning at puberty
|
|
|
Rate of twinning increases or decreases with parity?
|
increases; the more children a women has had the greater the likelihood her next preg will be twins
|
|
|
Increased fecundity and higher rate of dizygous twins reported in women who conceive within how long after stopping oral contraceptives?
|
1 month due to sudden release of pituitary gonadotropin in amounts greater than usual during the 1st spontaneous cycle after stopping oral contraceptives
|
|
|
Use of what increase the rate of dizygotic trizygotic pregnancies
|
fertility enhancing drugs like CLOMID
|
|
|
What is the frequency of monozygotic twin pregnancy?
|
1/250 worldwide and largely independent of ethnicity, age, heredity, and parity
|
|
|
Increased risk of monzygotic twins associated with what?
|
Delayed transport through the fallopian tube, women who have recently been on combination oral contraceptives b/c they cause decreased tubal motility; minor trauma to blastocyst during assisted reproductive techniques
|
|
|
If division occus in the 1st 72 hours after conception, before chorion and morula form...
|
2 embry0os with 2 chorions, 2 amnions, and one or 2 placentas
|
|
|
If division occurs between days 4-8 after conception, after chorrion and inner cell mass form..
|
2 embryos with one chorion, 2 amnions, and one placenta
|
|
|
If division occurs after day 8 after chorion and amnion have already formed,
|
2 embryos with a single chorion, amnion, and placenta will develop
|
|
|
If division occurs after day 14 that is after the chorion, amnion, and embryonic disk have been formed
|
cleavage is incomplete and conjoined twins are formed
|
|
|
By the end of the 2nd week post-conception
|
the preembryo develops into a flattened embryotic disc consisting of 3 germ layers: ectoderm,mesoderm and endoderm.
|
|
|
During week 3-8
|
embryonic period during which all major internal and external structures take shape/ also very sensitive to disturbances (teratogens, mutagens) that could result in death or congenital malformations
|
|
|
What happens during week 3?
|
development of flat, trilaminar embryonic disc begins to CURL under to form SAUSAGE-LIKE SHAPE. Ectoderm forms dermal layer and nervous system. Endoderm lines the inner tube which forms gut/intestine. Mesoderm sandwiched between these layers. Neural tube develops along embryo back and develops spinal cord and brain from ectoderm. LUMPS (somites) form along either side of neural tube which develop into the vertebrae, ribs, and muscles in the back
|
|
|
What happens during week 4?
|
2mm long embryo with C shape at beginning of week 4. Eyes began to form on head, inner ear development begins, pharyngeal arches develop in NECK area which will develop into JAWS, ear and other structure, HEART FORMS and begins beating, TINY ARM AND LEG BUDS develop
|
|
|
What happens during week 5?
|
RAPID GROWTH OF BRAIN: arm buds flatten and hands become paddle shaped, 1 cm in length by the end of this week
|
|
|
What happens during week 6?
|
eyes become pigmented, exterior ears began to form, head brain continues to grow, leg bud becomes paddles shaped, hand rays indicate positions of digits, distinct tail is still present
|
|
|
What happens during week 7?
|
Toe rays form indicated position of digits, rapid development of GUT tube causes intestines to protrude into the umbilical cord to produce an umbilical HERNIATION, TAIL is DIMINISHED!, HANDS FURTHER DEVELOP
|
|
|
What happens during week 8?
|
1.25 inches long by this week 8. eyelids have grown to meet each other and fuse so eyes are closed. fingers and toes can be clearly seen, webbing still exists; tail disappeared; embryo now begins to look human; brain, spinal cord, and peripheral nerves are all developed
|
|
|
What happens during the fetal period week9-birth?
|
organ systems est in the embryonic period continue to develop and differentiate; PERIOD OF RAPID GROWTH
|
|
|
week 11
|
ovaries in female
|
|
|
Week 12: (end of first trimester)
|
fetal heart rate can be heard with a stethoscope, fetus can react to stimuli and fetal movements begin; however mom cannot yet feel these movements; All body parts and organs are present.Definitive signs of male and female gender are present.
|
|
|
Month 4-5 gestation
|
mom can began to feel fetus moving
|
|
|
Week 13
|
testicles in male
|
|
|
15 weeks
|
fingers
|
|
|
4 months
|
He can hear sounds, face will be well-developed, can SUCK THUMB (4.5 months)
|
|
|
16 weeks
|
PENIS
|
|
|
18 weeks
|
male/female gender is evident, arms and legs punch and kick, fingernails develop
|
|
|
week 21
|
visible clitoris in between labia
|
|
|
2nd trimester (end of month 6)
|
skin covered with protective layer of fatty secretions called VERNIX CASEOSA; skin grows layer of DOWNY HAIR (LANUGO)
|
|
|
3rd trimester
|
fetus adds layers of FAT and loses its WRINKLED appearance; LUNGS MATURE
|
|
|
What is the limiting factor for survival of premature infants?
|
lung development
|
|
|
What is the youngest premature infant that has survived have been a biological gestation age of what post conception (clinical medicine gestational age of 23 weeks).
|
21 weeks, the fetus is 400 grams in weight; most born at this age and size do not survive
|
|
|
Fetal digestive/urinary systems where is it derived from?
|
derives nutrient's from mo's BLOOD via the umbilical VEIN in from of GLUCOSE, AA, FATTY ACIDS, vitamins, salts, and minerals. CO2 and waste products are delivered to placenta by UMBILICAL ARTERIES
|
|
|
What about fetal kidneys?
|
FUNCTIONAL throughout fetal period and produce 450 ml of URINE a day late in pregnancy which is excreted into AMNIOTIC FLUID. in late pregnancy, the fetus swallows about 500 ml of AMNIOTIC FLUID each day
|
|
|
What about fetal circulatory system?
|
The placenta is the oxygenating unit for fetus. When oxygenated blood enters the right side of the fetal heart from UMBILICAL VEIN, it travels up the PULMONARY TRUNK and bypasses the lungs by moving through the DUCTUS ARTERIOSIS to the AORTA
|
|
|
Deoxygenated blood reaches the placenta via?
|
UMBILICAL ARTERIES where it releases CO2 and picks up O2
|
|
|
Blood is exchanged between the R and L side of the heart through passage of blood through hole called?
|
FORAMEN OVALE between R and L Atria (close at birth)
|
|
|
Blood is transported from RIGHT VENTRICLE directly to the aorta via
|
DUCTUS ARTERIOSIS (close at birth)
|
|
|
What percent of preembryos/embryos die within the 1st 3 weeks of life?
|
50%
|
|
|
Is conceptus typically lost before the women knows that she is pregnant?
|
yes
|
|
|
What percent of confirmed pregnancies are miscarried?
|
15-20%
|
|
|
CHROMOSOMAL abnormalities account for what percent of spontaneously aborted preembryos/embryos/fetuses?
|
42%
|
|
|
Chromosomal abnormalities occur in how many newborns?
|
1/200
|
|
|
Which viruses harm embryo or fetus?
|
VIRUSES: HIV, CHICKENPOX, HERPES SIMPLEX, MUMPS, RUBELLA, PAROVIRUS
|
|
|
Which bacteria harm embryo or fetus?
|
SYPHILIS, TB, and TYPHOID
|
|
|
When are main effects of teratogens, mutagens, and other agents that damage fetuses occur?
|
4-7th week gestation
|
|
|
What are some examples of teratogens/mutagens and other agents?
|
mercury, lead, cadmium, arsenic, PCBS, DDT, benzene, carbon tetrachloride, alcohol/fetal syndrome, TOBACCO, recreational intoxicants, some pharaceuticals
|
|
|
How do you evaluate a fetus?
|
1) ULTRASOUND: can detect fetal heart rate by EIGHT WEEKS!: used to assess fetal anatomy and movement and placenta position.
2) MULTIPLE SERUM MARKER TEST FROM MATERNAL BLOOD: hCG, alpha fetoprotein, and estriol levels can estimate likeliood that a fetus has DOWN SYNDROME, (not definitive though) |
|
|
What is AMNIOCENTESIS?
|
Fetal evaluation method for women over 34 years or women with family history of genetic disorder. performed between 14th-16th week of pregnancy (biological) or 16-18 weeks (clinical). NEEDLE inserted through ABDOMINAL and uterine walls into AMNIOTIC FLUID with ultrasound guidance. CELLS AND AMNIOTIC FLUID EVALUATED FOR CHROMOSOMAL ABNORMALITIES
|
|
|
What is Chorionic villus sampling?
|
Fetal evaluation for women over 34 yeras, or women with family history of genetic disorders. Performed between 8-10 week of pregnancy (biological) or 10-12 weeks (clinical). NEEDLE inserted into VAGINA and CERVIX into uterine cavity using ultrasound. CHORIONIC CELLS removed from placenta and ANALYZED. this has a higher risk of inducing miscarriage than with AMNIOCENTESIS. CVS gets results EARLIER than AMNIO, which is preferable if the pregnancy is going to be terminated based on the test results
|
|
|
What percentage of all induced abortions in the USA are in the 1st trimester?
|
87%; TAKING PILL, or surgical abortion that uses ASPIRATION and INSTRUMENTS to empty contents of UTERUS
|
|
|
What is embryonic period abortion in the 1st trimester within the first 35 days induced by?
|
PROSTAGLANDINS and MIFEPRISTONE. MIFEPRISTONE = RU486 acts by preventing PROGESTERONE ACTION BY BLOCKING PROGESTERONE RECEPTORS. Sometimes taken with prostaglandin vaginal suppository to soften the cervix to facilitate the release of MISCARRIAGE out of cervix
|
|
|
What is the most frequent used method of abortion in the 1st trimester in the USA?
|
vacuum aspiration, done in 5-11th week after conception. VACURETTE TUBE is placed through cervix into uterus and is connected to a SUCTION DEVISE. Endometrium can be scraped with CURETTE
|
|
|
When is DILATION and CURRETE
|
done in 8-14 weeks after conception. Cervix DILATED with LAMINARIA which is a brown algae. ENDOMETRIUM scraped with CURETTE which is inserted through the cervix
|
|
|
What happens with abortion in the 2nd trimester?
|
Cervix dilated with LAMINARIA inserted into cervix which absorbs MOISTURE and expands and DILATES CERVIX. ADMINISTRATION of INTRA-AMNIOTIC SALINE, UREA, GLUCOSE, OR PROSTAGLANDIN alone or in combination to terminate PREGNANCY and induce delivery. Performed after 12th week post conception. UTERINE contents removed using SUCTION, CURETTES, and FORCEPS
|
|
|
What happens with abortion in the late 2nd trimester and 3rd trimester?
|
Dilation and extraction referred to as "PARTIAL BIRTH ABORTION" and has been typically performed in the late 2nd trimester and early 3rd trimester. BAN in certain areas of the world.
|
|
|
What reduces the development of neural tube defects in infants of pregnant women
|
DAILY FOLIC ACID in MULTIVITAMIN
|
|
|
How much weight should a pregnant woman gain?
|
25 pounds
|
|
|
What are sources of weight gain?
|
maternal fat, breast and uterine growth, placenta, amniotic fluid, increased maternal blood volume, fetus is on avg. 7.5 lbs at birth
|
|
|
As fetus enlarges
|
the uterus increases in size
|
|
|
What are some physiological changes in pregnant women?
|
Increased blood volume, increased cardiac output/volume of blood, increased HEART RATE, kidneys increase in size and increase filtration rate by 50%, INCREASED RESPIRATORY RATE with increased ratio of O2and CO2, which facilitates transfer of O2 to and removal of CO2 from fetal blood through placenta
|
|
|
What is toxemia?
|
maternal complications of pregnancy, develops in last 2 months of pregnancy in 6-7% of pregnancies int he US
|
|
|
What is Preeclampsia?
|
EARLY TOXEMIA: weight gain, edema (fluid accumulation in tissues), HIGH BLOOD PRESSURE, PROTEINURIA (protein in urine)
|
|
|
What is Eclampsia?
|
SEVERE TOXEMIA: above symptions along with CONVULSIONS, COMA, and even DEATH
|
|
|
What is gestational diabetes mellitus
|
occurs in less than 1% of pregnancies; as some pregnant women gain weight, their tissues develop resistance to insulin which results in a significant rise in maternal and fetal glucose levles; higher glucose levels in fetus cause them to grow unusually LARGE (MACROSOMIA) which makes it difficult or impossible to be delivered VAGINALLY
|
|
|
What is ectopic pregnancy?
|
Implantation in the OVIDUCT b/c scarring in oviduct interferes with preembryos ability to travel to the uterus. ; implanted embryo can't develop into a VIABLE FETUS and puts mother's health and life in danger, requires SURGICAL REMOVAL of embryo and placenta
|
|
|
What maintains development of placenta?
|
implantation induces corpus luteum to continue functioning and produce large amts of P and E during 1st trimester
|
|
|
What supports maternal appetite, fat deposition, and breast enlargement?
|
Steroids from corpus luteum in early pregnancy
|
|
|
Secretion of what by cells of the cytotrophoblast begins as soon as 2 days after implantation which contributes to the persistence of the corpus luteum through the 1st trimester
|
hCG
|
|
|
After FIFTH week of pregnancy, the hCG in placenta stimulates the placenta to secrete what which provide HORMONAL support to the mother thorughout the entire pregnancy?
|
PROGESTERONE as well as 3 different estrogens, estradiol, estriol, and estrone
|
|
|
How is estrogen secreted by placenta?
|
Mother provides cholesterol-> progesterone to fetus and mother -> proge from placenta goes into fetal blood -> fetal adrenal glands (fetal zone) -> DHEA -> fetal liver -> 16-OH DHEA-SULFATE -> placenta ->ESTRIOL
|
|
|
What other hormones does the placenta produce?
|
prolactin, corticotropin, thyrotropin, endorphins, oxytocin (similar to pituitary glands)
|
|
|
Placenta secretes what whichas effects similar to prolactin and growth hormone?
|
human placental lactogen (hPL), HIGH in maternal blood late in pregnanc which slightly increases maternal and fetal blood glucose. Along with P and E, helps prime MAMMARY glands for milk production
|
|
|
During gestation what is the hormone progression of total estrogen, placental weight, hPL,Prog, and hCG
|
hCG peaks @ early pregnancy and the declines and slight peak later. Everything else increases until 40 weeks.
|
|
|
What is released by the corpus luteum and the placenta and levels rise steadily during pregnancy?
|
RELAXIN relaxes connective tissue connecting the 2 pubic bones (pubic SYMPHYSIS) so that fetus can pass through birth canal more easily at delivery. prepares cervix to SOFTEN and dilate before and during labor
|
|
|
Which hormones are involved in labor/birth initiation?
|
INCREASE RELAXIN, increase CRH, Increase CORTISOL, increase in E/P ratio, increase in prostaglandins, increase in oxytocin
|
|
|
What does an increase in CRH production from the placenta result in?
|
increase cortisol production (positive feedback loop), increase MATURATION OF FETAL ORGANS in preparation of birth, increase in PROSTAGLANDIN PRODUCTIN (+ feedback), increase in E/P ratio
|
|
|
Increased cortisol from the fetal adrenal glands causes...
|
cortisol from fetal adrenal glands -> + feedback loop with the CRH in placenta, -> fetal pituitary gland -> ACTH -> fetal adrenal gland -> CORTISOL (contribute to initiation of labor)
|
|
|
CRH acts in the fetal zone of fetal adrenal gland to induce DHEA production which leads to...
|
MORE ESTROGEN PRODUCTION by the placenta. increase E/P ration helps initiate labor b/c increases uterine contractility
|
|
|
Prostaglandins increase when?
|
during last month of pregnancy and directly stimulate uterine contraction
|
|
|
CRH stimulates production of prostaglandins from where?
|
fetal membranes
|
|
|
High levels of prostaglandins have positive feedback loop with what?
|
CRH production by the placenta
|
|
|
What also stimulates prostaglandin production?
|
Increase in E/P
|
|
|
Where is oxytocin secreted by?
|
posterio pituitary gland and probably PLACENTA
|
|
|
What helps increase oxytocin secretion and increase oxytocin receptors in the uterus
|
Increase in E/P, and uterine contractions then stimulate more oxytocin.
|
|
|
Oxytocin stimulates what production from the uterus?
|
Prostaglandins
|
|
|
What is the fetal ejection reflex?
|
stimulation of OXYTOCIN release by mechanical stimulation of the uterus, cervix, or vagina resulting in FURTHER UTERINE contractions
|
|
|
How can labor be induced?
|
exogenous OXYTOCIN (PITOCIN given intraveneously) and/or PROSTAGLANDINS (intravenously, orally, or as a vaginal suppository).
|
|
|
Why give pitocin?
|
Women is post-term and labor is not spontaneously progressing. Need to deliver a baby before term b/c of possible risks to fetus and/or mother. Also given to mothers whose labor is not progressing fast enough
|
|
|
When is the due date of birth?
|
40 weeks from the 1st day of the last menstrual period (clinical) based on approximation that conception occurs on avg 2 weeks after 1st day of last period.
|
|
|
What is the normal range of birth due date?
|
2 weeks before 40 week sand 2 weeks after
|
|
|
What is the difference between female and male birth?
|
female infants tend to be born a few days earlier than male babies
|
|
|
Women with shorter follicular phases, shorter menstrual cycles in pregnancy tend to deliver babies...
|
earlier
|
|
|
Women who exercise during pregnancy...
|
deliver their babies earlier
|
|
|
When is the seasonal birth peak in north america?
|
FALL which corresponds to high conception rates in the winter and low conception rates during the hottest months of the year; during WARMEST months, males have lower sperm count and lower testosterone
|
|
|
What happens 2-3 weeks before delivery in the pelvic cavity of a woman?
|
they can feel their fetus drop into pelvic cavity
|
|
|
In the last weeks of pregnancy, what types of contractions do women feel?
|
Braxton-Hicks: mild, irregular uterine contractions, but NOT labor
|
|
|
What are the stages of labor and delivery?
|
1) cervical effacement and dilation.
2) fetus leaves uterus and passes through cervix and vagina. delivery of fetus 3) delivery of placenta |
|
|
In primiparous women, when does effacement occur?
|
before dilation
|
|
|
In multiparous women, when does effacement occur?
|
Effacement and dilation occur together
|
|
|
How long is labor usually in primiparous women?
|
8-14 hours
|
|
|
How long is labor in multiparous women?
|
4-9 hours
|
|
|
Length of labor and delivery can be up to how long and still be normal?
|
24 hours
|
|
|
What are male and female pelvic differences?
|
Females have larger, more oval pelvic inlet, wider pubic symphysis, wider pubic arch (greater than 90 degrees), outward turning of ISCHIAL TUBEROSITIES) (LARGER pelvic OUTLET)
|
|
|
What causes cervical effacement?
|
uterine contractions at regular intervals become strong enough
|
|
|
How long do uterine contractions last during cervical effacement/dilation?
|
30-60 seconds and occur every 5-20 minutes.
|
|
|
What is cervical effacement?
|
thinning of the normally thick walls of the cervix and retraction of the cervix UPWARD
|
|
|
What does the cervical mucus plug do around the initiation of effacement?
|
It becomes dislodged along with a asmall amount of blood (blood show)
|
|
|
What weakens the amniotic sac causing it to break releasing the fluid?
|
Enzyme
|
|
|
When contractions become how frequent is the women instructed to come into the hospital unless they are going to have a home birth?
|
less than 5 minutes apart
|
|
|
What happens during the stage 1 effacement of labor?
|
length of contraction = 30-60seconds every 5-20 minutes. Duration of effacement: variable depending on person.
|
|
|
What happens during stage 1 of labor?
|
Cervical dilation; pre-labor cervical os is 0.3 cm, while fully dilated can be 10 cm in diameter just before going into 2nd stage of labor. As dilation increases, contractions tend to be progressively more painful
|
|
|
What happens during early dilation stage 1
|
open cervix from 0-7 cm. Intensity: stronger than effacement and gradually more painful. Length of contraction s is less than or equal to 60 sec. Duration = 5-9 hours (primiparous); 2-5 hours (multiparous)
|
|
|
What happens during stage 1 labor: transition dilation contractions
|
purpose: complete opening of cervix from 7 to 10 cm. Intensity is progressively stronger and more painful contractions; length of contraction: 60-90 seconds; interval of contractions: 1 minute; duration = really short
|
|
|
What happens during stage 2 of labor?
|
full cervical dilation to 10 cm and full effacement; fetus passes through cervix and vagina; uterine contractions move fetus through birth canal
|
|
|
What happens during stage 2: movement of fetus out of uterus through cervix and vagina?
|
Intensity: less strong than during transition phase: length of contractions (60 sec), interval of contractions = 1-3 minutes; duration 30 minutes to 2 hours (longer with 1st baby)
|
|
|
What is Epiosotomy:
|
cut made in the PERINEAL skin with the intention to reduce tearing as baby is delivered
|
|
|
What is an epidural:
|
pain medicine (OPIATE) is injected into outside membranes outside the DURA of the spinal cord: NUMB sensations in the body below the site of injections
|
|
|
PUDENDALblock
|
analgesic is injected around the PUDENDAL nerve on each side of the vagina
|
|
|
What are other medications during labor?
|
intravenous, and oral analgesics, tranquilizers, and anxiolytics
|
|
|
What is given to induce/augment uterine contractions?
|
intravenous pitocin
|
|
|
largest diameter of newborn body is the head
|
13 inches
|
|
|
What is crowning?
|
top of head appears just before delivery
|
|
|
How is the baby delivered?
|
Head is delivered FACE down and then the infant head/trunk rotates to facilitate the shoulder/arm delivery.
|
|
|
With the first breath, what closes so that the infant blood from the right side of the heart is pushed through the lungs to be oxygenated?
|
ductus arteriosis
|
|
|
What shunts blood around the fetal liver?
|
ductus venosus
|
|
|
What happens post delivery?
|
umbilical cord is cut and clamped; antibacterial drops put into infants eyes to prevent infection with chlamydia/gonorrhea; circumcision may be done in the first 48 hours of life on males
|
|
|
Stage 3 of labor: delivery of placenta
|
15-30 minutes after delivery of the infant, the placenta is delivered.
|
|
|
What can be harvested from cord blood of placenta
|
Hematopoietic stem cells
|
|
|
What occurs immediately after delivery of placenta?
|
uterine bleeding
|
|
|
What stimulates release of oxytocin which can decrease the post-delivery uterine bleeding?
|
breast feeding/ nippling
|
|
|
What is the typical fetal position?
|
cephalic presentation with the head down in the pelvic cavity
|
|
|
What is the breech position?
|
fetus has head up and and feet, buttock, or knees extending outwards
|
|
|
What is the transverse position?
|
fetus is positioned sideways or transversely in pelvis
|
|
|
When is forceps delivery and vacuum extraction used?
|
when infant is not progressing in the 2nd stage of labor due to abnormal fetal position or other reasons
|
|
|
What happnes during forceps delivery?
|
2 curved steel blades are placed around the infants head and are gently rotated and pulled to facilitate delivery
|
|
|
What happens during vacuum delivery?
|
suction cup is attached to fetus head and fetus is pulled out
|
|
|
When is C sectiond one?
|
when fetus is in distress, difficulty with vaginal delivery, breech, or other abnormal position, or maternal preference.
|
|
|
How is C section done?
|
mother receives spinal anesthesia, general anesthesia, or acupuncture; abdominal incision made below the navel in the midline and the incision continues through the uterine wall and the infant is removed. Recovery time much longer than vaginal delivery
|
|
|
History of Birthing
|
In anthropological studies, 70 cultures around the world, there are NO examples where women deliver on their backs. WOMEN MIDWIVES deliver babies
|
|
|
What contributed to the reduction of the midwife activities?
|
increase in the importance of medical licensing in the USA and Europe in the 1800s. Midwives did not have a system of formal licensing
|
|
|
In germany around 1900, system was developed to put women into sleep during labor and delivery...what did they do?
|
mrophine: injection for pain in labor; scopolamine; for an amnesiac effect to allow mother to disassociate fromt he labor and birth pain; chloroform or ether to put mom to sleep during the delivery
|
|
|
In germany, how was horizontal position developed?
|
along with anesthesia the horizontal position for women to lay on backs was adopted so women's arms could be more easily restrained and tied down and their legs could be strapped to stirrups b/c they would thrash and move around even though they were unconscious
|
|
|
How was forceps delivery developed?
|
women would deliver unconscious b/c of anesthesia and could not push the baby out.
|
|
|
How was episiotomy developed?
|
to facilitate inserting forceps into vagina and around the babies head. scissiors cut of perineum, which gave more room for the forceps to be inserted into the vagina around the babies head.
|
|
|
What happens after delivery for mothers who have been anesthesized?
|
mothers were unconsciousness at delivery and would not see baby for several hours after delivery
|
|
|
Pre-1900, what percent of babies delivered in hospitals?
|
5%
|
|
|
By 1936 what percent of babies delivered in hospitals?
|
75%
|
|
|
By 1970, what % of babies delivered in hospitals?
|
99%
|
|
|
When was family-centered care in delivery room developed?
|
1970s
|
|
|
When was rooming in of infants with mom in hospital developed?
|
1980s
|
|
|
What are advantages of delivery in upright/crouched position?
|
Uses benefits of gravity to increase strength of uterine contractions and decrease length of labor and thus, decrease likelihood of C section. Also INCREASES SURFACE AREA of pelvic opening/birth canal by 33-38%. Decrease PRESSURE on MOTHERS AORTA (largest artery) which increases blood supply to the fetus and decreases fetal stress
|
|
|
Mothers who labor/deliver on backs ...
|
OPPOSITE of all above
|
|
|
What is an advantage of rupturing membranes to progress labor?
|
decrease total length of labor by 40-120 minutes
|
|
|
What are disadvantages of rupturing the membrane?
|
1) There is a 24-hour time clock otherwise bacteria can invade.
2) Intact membranes which contain amniotic fluid function as a barrier that provides cushion during labor as the baby descends 3) Ruptured membranes lack protective barrier and increase chance that a baby will have a cephalohematoma (hemorrhage between scalp and bones of skull) 4) Mothers' report that after membranes are ruptured, they feel like they lose control 5) If labor progresses too quickly, causes SEVERE pain, EPIDURAL for pain, DECREASE uterine contractions, labor does not progress, C-SECTION. If labor does progress, PITOCIN (OXYTOCIN) is given, if labor does not, C-section |
|
|
How is continuous heart monitoring of infant achieved?
|
by screwing a small monitor into the fetal scalp.
|
|
|
what did monitoring fetal heart rate do?
|
Doubled the C-Section rate but resulted in no reduction in the incidence of cerebral palsy; prevents mom from walking during labor, decrease beneficial effects of gravity on labor, increase length of labor, increase rate C-section (2X)
|
|
|
What is flexible monitoring of fetal heart rate?
|
check fetal heart rate with stethoscope every 10-15 minutes; short monitor strip given every 30 minutes
|
|
|
When oxytocin given
|
Increase pain of contractions, increaselikelihood of taking pain medicines and increased pain of contractions
|
|
|
Opiates are given to do what
|
to numb \pain of uterine contractions during delivery. which decreases mothers own endogenous production of endorphins, decrease ability to feel push, decrease sense of control over labor, decrease sense of accomplishment of delivering her baby, decrease production of oxytocin and decrease mothers ability to push, increase C section.decrease mothers production of oxytocin may decrease mothers feelings of attachment to newborn baby
|
|
|
What percent of mothers who receive epidural early in labor develop a fever as high as 103-104
|
1/3. INFANTS also have fever and since it is not known whether the fever is from the epidural or infection the infant must receive a septic WORK up which involves BLOOD CULTURE, SPINAL TAP, and 3 days of intravenous antibiotics waiting for the culture results
|
|
|
What does epidural analgesia do to maternal infant bonding?
|
INTERFERES WITH IT
|
|
|
What are some methods that can be applied to turn the fetus around into the dead down position?
|
external cephalic version and internal applied by midwives; MOXIBUSTION with stimulation of acupoint BL 67 by using heat generated by buring CHINESEHERBAL preparations (on 5th toe)
|
|
|
In 1970, there was a what percent C section rate in the USA
|
25-30%
|
|
|
What is a bond?
|
Unique relationship between 2 people that endures time
|
|
|
What is bonding?
|
tie between parent and infant
|
|
|
What is attachment?
|
feelings that bind one person to another in either direction
|
|
|
Spitz showed that absence of loving care-taking/affection led to...
|
Decrease infant growth, and increased death
|
|
|
What are benefits of vaginal delivery for the infant?
|
1) stimulates infant to prepare her/him to adjust to aerobic environment/
2) squeezes fluid out of infant's lungs |
|
|
What are some hormones that are produced during vaginal delivery for the infant that helps them?
|
1) Norepinephrine, epinephrine stimulates the cardiovascular system and facilitates immediate adjustment to aerobic environment
2) Beta-endorphins facilitates attachment of infant parents |
|
|
C-section results in?
|
more fluid in babies lungs and lower levels of epinephrine and beta-endorphins
|
|
|
What are the levels of beta-endorphins in mom and infant @ birth & post partum?
|
PEAK levels, beta-endorphins facilitate bonding and attachment between infant and parents.
|
|
|
What does epidural anesthesia do to the mom and infant at birth & post partum?
|
Decrease endogenous beta-endorphin levels, decrease ability of mother to bond to infant, increase incidence of post-partum depression, and increase incidence of DEPRESSION in mothers @ 6 months.
|
|
|
What does oxytocin do to mom & infant at birth?
|
Facilitates bonding and attachment between infant & parents. levels are 10mcg/dl minutes after birth.
|
|
|
What does infant touching and massaging mom's nipple do to mother's oxytocin level?
|
increases
|
|
|
What does infant suckling mom's nipple do to mother's oxytocin level?
|
Increases mothers oxytocin level dramatically and facilitates bonding/attachment between infant and mother, also INCREASES MILK EJECTION and DECREASES post-partum bleeding in mother
|
|
|
What does massaging the nipple of a mother do to labor?
|
Increases endogenous production of oxytocin and increases progression of labor
|
|
|
What is the Quiet Alert State?
|
40 min. out of the 1st hour of life, babies are in this state. Babies rarely move and their eyes are WIDE open and if given the opportunity they look directly at the mother or father and may touch the parents skin. Motor activity is MINIMAL and baby's energy is focused on SEEING, hearing, responding, and deepening its level of bonding and attachment. During the FIRST WEEK about 10% of 24 hour day the baby is in receptive quiet alert state
|
|
|
What are standard hospital practices immediately after delivery?
|
separate baby from mo very soon after to examine, weigh, bathe, give VITAMIN K, apply eye ointment, and draw blood glucose from baby. Prevents baby from being with mother during important period
|
|
|
Where should baby be placed immediately after delivery?
|
be dried off with a soft warm towel and immediately placed on the mothers abdomen and chest for skin-skin contact.
|
|
|
It is best not to use soap and water on baby, why?
|
smell of amniotic fluid soothes the newborn
|
|
|
What do mothers soft warm skin, caressing hands, and mothers body do for the baby?
|
soothing and comforting and provides heat for the baby as well as warms up the baby faster than an incubator
|
|
|
If baby is given the opportunity to be with mother immediately after delivery?
|
Will touch, smell, lick, and latch onto breast by her/his own efforts and start breast feeding in early minutes of life. This can be disturbed by labor analgesia and c-section
|
|
|
Women who nipple newborn in the 1st hour of life have..
|
easier time breast feeding, breast feed more frequently, and breast feed more months of babies life
|
|
|
Study in Guatemala, what were the control and study groups?
|
Control: mothers and newborns wo receive standard obstetrical newborn care
Study: mothers and newborns allowed to be undisturbed together in a quiet room for the 1st hour after birth |
|
|
What happened with the study group (guatemala)?
|
1) mothers talked softly, caressed babies,
2) mothers raised voice talking to baby less frequently, 3) babies cried less through 1st year of life, 4) babies breast fed more frequently and for more months, 5) babies had lower incidence of child abuse and 6) had lower incidence of morbidity and mortality (Death Infant Syndrome SIDS) 7) reduced incidence of PARENTING INADEQUACY 8) Less likely children will be cared by adults other than parents |
|
|
What does maternal attention do to neurons and stress hormones?
|
1) Neglected animals: neurons died @ twice the rate
2) Presence of mother reduces stress hormones 3) mother animals licking infants triggers a dramatic reduction in the levels of STRESS HORMONES |
|
|
What does mother physical comfort do to hormones?
|
Increase production of biochemicals and Decrease production of CRH (corticotropin releasing hormone)
|
|
|
What did the research on ROMANIAN ORPHANS by HARVARD researchers find?
|
children raised w/o being hugged or stroked,
1) INCREASED production of STRESS HORMONES (cortisol) 2) impairs GROWTH and DEVELOPMENT of brain & body 3) Serious neg long-term effects on LEARNING AND MEMORY 4) PERMANENT CHANGES IN THE WAY THE ORPHAN BEHAVES 5) BEHAVIORAL PROBLEMS (withdrawn, apathetic, prone to illness) |
|
|
What does high level of cortisol do?
|
LOW scores on tests of mental/motor ability, slow growth and behavioral retardation/ CHANGES IN THE HIPPOCAMPUS
|
|
|
What is the primary sex ratio?
|
ratio of male to female conceptions
|
|
|
What is the secondary sex ratio?
|
ratio of male to female births
|
|
|
More maternal stress leads to...
|
lower ratio of male to female births (more likely to have a spontaneous miscarriage or abortion if fetus is male vs. fem)
|
|
|
What happened in scandinavia between 1895-1914?
|
COLDER average winters followed by reduction in ratio of male to female births
|
|
|
What happened post 9/11 attack?
|
increase rate of male infant miscarriages compared to female miscarriages resulting in a significant reduction in primary sex ratio. Reduction in NY more than in CA
|
|
|
What is the survival rate of males compared to fem?
|
LOWER
|
|
|
What about European American vs. African American infants' survival rates?
|
LOWER
|
|
|
The beneficial peptides, hormones, and immunoglobulins in cows milk are what?
|
PASTEURIZED and BROKEN DOWN
|
|
|
Human Breast Milk are free of what?
|
contaminating bacteria that cause DIARRHEA (important in developing coutnries where un-boiled water may be used to prepare cows formula
|
|
|
What does prolactin stimulated by nippling do?
|
SUPPRESSES OVULATION
|
|
|
Lactating mothers who breast feed infants @ least 10 times a day are likely to what?
|
SUPPRESSES OVULATION; less than 6 times a day, unlikely to suppress ovulation
|
|
|
What are components in human breast milk?
|
protein, carbohydrates, fats (FATTY ACIDS: omega 3, DHA (docosahexaenic acid) and AA (arachidonic acid) RICH SOURCE), vitamins, minerals, growth factors and neuropeptides(enhance development of brain, liver, intestines, pancreas and other organs), and immunoglobulins/antibodies, hormones:
1) MELATONIN (est circadian rhythm), 2) THYROID HORMONES (alleviate hypothyroidism), 3) OXYTOCIN (bonding), 4) ENDORPHINS (facilitate loving bond) 5) MAMOTROPE DIFFERENTIATING HORMONE (foster maturation of cells of pituitary gland which supplies hormones to the body) 6) INSULIN LIKE GROWTH F 7) LEPTIN: control obesity, set the stage for weight regulating in childhood and later in life) 8) GNRH (above levels in mothers' blood, breast tissue generates this hormone, influences development of sex organs and influence brain regions that affect sexual behavior) |
|
|
What are growth factors?
|
increase endothelial cell, collagen, and smooth muscle development
|
|
|
Neuropeptides
|
peptides found in BRAIN tissue, endorphins, enkephalins
|
|
|
Breast milk & hormones
|
breast is the post-birth counterpart of placenta that picks up where the placenta leaves off and provides supply of GROWTH Factors and HORMONES essential for optimal development. HUMAN BREAST TISSUE also produces NEUROPETIDES & HORMONES
|
|
|
What is COLOSTRUM?
|
yellowish fluid that breast secretes for 2-4 days after delivery that is rich in HORMONES/GROWTH F, PROTEIN, MINERALS, AND IMMUNOGLOBULINS.
|
|
|
By week 3-4 what happens to breast milk?
|
gradually develops into "mature" breast milk"
|
|
|
Surface areaof intestine is increased in whom due to breast milk?
|
breast feeding infants and lactating mothers
|
|
|
What are good dietary sources of omega 3?
|
walnuts, nuts, grains, flax seed, hemp oil, vegetables, salmon, mackerel, sardines, tuna, trout
|
|
|
What is beneficial about omega 3 to infants?
|
1) enhance neurological and visual development in infants (especially premature infants) b/c brain development occurs rapidly in early months. cow's formula do not have enough omega 3 fatty acids
2) better PROBLEM SOLVING SKILLS at 10 months 3) better MOTOR and COGNITIVE performance and VISION |
|
|
Where is omega 3 fatty acids derived from?
|
PURE VEGETARIAN ALGAE
|
|
|
Babies who are fed with cow's milk are at increased risk for?
|
Allergies, atopic dermatitis/Eczema, Increased risk for intestinal distrubances/feeding difficulties (diarrhea, intestinal bleeding, colic, spitting up milk)
|
|
|
How is breast milk related to IQ
|
HIGHER IQ and BETTER BRAIN DEVELOPMENT
|
|
|
How is breast milk related to DISEASES?
|
DECREASE the incidence and severity of numerous diseases
1) Sudden infant death syndrome SIDS 2) Allergic diseases 3) insulin-dependent DIABETES MELLITUS 4) INFLAMMATORY bowel disease (crohn's disease, ulcerative colitis) 5) Chronic digestive diseases 6) Lymphona 7) lower respiratory infection (pneumonia) 8) otitis media 9) bacteremia 10) bacterial meningitis 11) botulism 12) UTI 13) necrotizing enterocolitis 14) Growth of protozoans (bile salt stimulated LIPASE -> kills Giardia lamblia and Entamoeba histolytica) 15) Viruses (rotavirus, polio, influenza, mumps, vaccinia, encephalitis) |
|
|
What is the mechanism for breast milk and preventing rotavirus?
|
Glycoprotein lactoadherin binds to rotavirus and inhibits its replication and thus DECREASE rotavirus infection in humans (ROTAVIRUS is the most COMMON CAUSE of DIARRHEA in INFANTS)
|
|
|
breast milk & stool pH
|
pH is LOWER inhibiting bacterial growth
|
|
|
Intestinal flora in breast milk
|
Inhibits growth of strains of E COLI
|
|
|
Xanthine oxidase in breast milk
|
NITRIC OXIDE inhibits growth of E. COLI and SALMONELLA
|
|
|
IgA in breastmilk (immunoglobulin)
|
prevents bacterial adherence to epithelial cell surfaces, prevents E COLI
|
|
|
INTERLEUKIN 6 in COLOSTRUM
|
increase in MONONUCLEAR MACROPHAGE cells, which produce COMPLEMENT, LYSOZYME, LACTOFERRIN (iron binding whey protein inhibits E COLI in INTESTINES)
|
|
|
T lymphocytes and B lymphocytes and Breast milk
|
Breast milk transfers T lymphocyte IMMUNITY prevent TB
|
|
|
What are main causes of INFANT mortality in tropical countries?
|
DIARRHEA and DEHYDRATION, LUNG INFECTIONS (PNEUMONIA, BRONCHITIS), MALARIA
|
|
|
What is the LARGEST single contributor to increased infants survival rates in the USA in the 1st half of the 20th century?
|
enhanced hygiene with microbiologically clean water, and enhanced maternal-child nutrition, and development of PENICILLIN, other antibacterials, and immunizations but to a less degree than CLEAN WATER
|
|
|
Obesity and pregnancy
|
Obesity causes INCREASED risk of pregnancy; obesity increased dramatically over the past 20 years, causing higher rates of TYPE 2 DIABETES MELLITUS, HYPERTENSION, and CARDIOVASCULAR DISEASE
|
|
|
How long should you breast feed for?
|
2 years
|
|
|
Beta carotene?
|
diet rich in this is good for mothers and infant health
|
