Chapter 6 - Pregnancy and Childbirth Flashcards
1
Q
Conception
A
- Fertilization of the egg by the sperm
2
Q
How many sperm are released on average per ejaculation
A
- Between 200 and 400 million sperm
- 3 millilitres/ 1 teaspoon
- Only 200 to 300 get near the egg
3
Q
How long do sperm live in the vagina
A
- Typically 48 hours
- Can live for as long as 8 days
4
Q
How far can sperm swim
A
- 1 to 3 cm every hour
- Once arrived at the egg it is 3000 times their own lengths
5
Q
Where does fertilization of the egg occur
A
- In the fallopian tubes
6
Q
What is hyaluronidase
A
- Substance released by a sperm to help divide the “shell” on the egg so they can fertilize it
7
Q
What is a fertilized egg called
A
- Zygote
8
Q
What happens when the egg is fertilized
A
- It travels from the fallopian tube and implants itself in the uterus
9
Q
How long does the process of fertilization/implantation take
A
- About five days
10
Q
Pregnancy detection methods
A
- The absence of menstruation
- High basal body temperature that stays high for two week after ovulation
- Chemical human chorionic gonadotropin (HCG) tests in the women’s urine
- Pelvic/Cervix exams (later on)
11
Q
Basal body temperature
A
- Lowest body temperature while you’re resting
12
Q
Placenta
A
- Organ that connects the fetus to the uterine wall for gas and nutrient exchange
- Produces HCG
- Secretes hormones like estrogen and progesterone
- Keeps circulatory systems separate
13
Q
Nägele’s rule
A
- Calculation for expected due date
- Take the date of the first day of your last period
- Subtract three months
- Add 7 days
- Then add a year
- Usually born within a span of 10 days from this date
14
Q
The embryonic stage/First Trimester
A
- First 8 weeks of pregnancy dated from the first day of the last menstrual period (so really about 12 weeks)
- Placenta and amniotic sac develop during this stage
15
Q
Amniotic sac
A
- Sac filled with amniotic fluid that helps to protect the embryo from outside damage and harmful temperature changes
16
Q
What develops in the first month of gestation
A
- Major organs and organ systems
17
Q
What develops in the second month of gestation
A
- The umbilical cord becomes visible
- Facial features
- Hands
- Feet
- Body tissue
- Major blood vessels
- Liver, pancreas, and kidneys
18
Q
What happens in the third months of gestation
A
- Embryo starts to be referred as the fetus
- Human physical traits like limbs and fingers
- Testicular tissue develops
- Biological sex
- Nails, hair follicles, and eyelids
- Very vulnerable tome for the baby
19
Q
Effects of pregnancy in the first trimester
A
- Tenderness, tingling sensations, or fullness of breast
- Nausea
- Fatigue
- Appetite changes (Cravings, revulsions, etc.)
- Frequent urination, irregular bowel movements, and increased vaginal secretion
20
Q
When can fetal movement be detected
A
- Around 13 to 16 weeks
- Primiparous women: First or second time pregnant
- Primiparous women may have to wait until 18 to 20 weeks to feel movement
21
Q
Effects of pregnancy during the second trimester
A
- Indigestion
- Constipation
- Placenta generates hormones to produce breast milk
- Breast and nipples enlarge, nipples get darker
- Stretch marks
- Generally report feeling well and better than the first trimester
22
Q
What happens to the baby in the third trimester
A
- Fetal development of the brain and nervous system are complete
- Fetus skin is wrinkled and covered with down like hair to help regulate body temperature
- Down like hair is typically lost by the eighth month
- Settles into the head down position, which is know as the cephalic presentation
23
Q
Effects of pregnancy during the third trimester
A
- Most uncomfortable
- Shifting centre of gravity
- Backache, leg cramps
- Frequent urination
- Shortness of breath
- Edema/Swelling or hands and feet
- Varicose veins in legs
- Hemorrhoids
- Weight gain is around 25 to 35 pounds per pregnancy
24
Q
Can trans men get pregnant
A
- If they retain their ovaries and uterus and stop taking testosterone they can
- When T is stopped, their menstrual cycle and fertility are likely to return within a few weeks or months
25
Q
Issues trans men are faced with when proceeding through pregnancies and postpartum
A
- Struggle with identities
- Gender dysphoria
- Managing perceptions
- May call breast feeding “chest feeding”
- Variability in the time they become pregnant and their ability to lactate
26
Q
Is sexual activity safe throughout pregnancy
A
- Generally speaking yes
- The amniotic sac and mucous plug protects any bacteria from the vagina to enter the uterus
- Orgasm may cause contractions so the doctor may tell some people not to do it
- Sexual interest and satisfaction may decline during the first and third trimester, but may increase in the second
27
Q
Midwives
A
- Trained to assist during an uncomplicated birth
- They provide the pregnant person and their partner with prenatal care and birth education
- Can help with postpartum care of both the parent and baby for the first six weeks
28
Q
Douala
A
- Trained labour coach who can provide emotional and physical support during pregnancy, labour, and delivery
- In addition to the physician, nurses, midwife, and the person’s partner
29
Q
Delivery options
A
- Vaginal birth
- C sections
30
Q
Forceps
A
- Tong like instrument with cup shaped ends that grasp the baby’s head so the baby can be pulled out through the birth canal
31
Q
Vaccum extractor
A
- Cup shaped suction device that attaches to the baby’s head to extract the baby through the birth canal
32
Q
Engagement
A
- The beginning of the descent of the fetus
- Occurs a few weeks before the onset of labour
- Also called “dropping”
- Turns so that the widest part of its head is positioned against the pelvic bones
33
Q
Effacement
A
- The thinning and shortening of the cervix late in pregnancy or during labour
- Prepares you for dilatation
34
Q
Water breaking
A
- Happens in about 12% of women
- If labour doesn’t start within 24 hours you must be induced to prevent infection
- The membranes of the amniotic sac rupture prematurely releasing fluid
35
Q
Stage 1 of a vaginal birth
A
- Can last a few hours to more than one day
- Go to the hospital when the contractions are four to five minutes apart
- Contractions begin to help efface and dilate the cervix
- Uses three stages of cervix dilation to decide where we are in this process: Early phase, active phase, and transition/final phase
36
Q
How is cervix dilation used to define the three phases of the first stage of childbirth
A
- Early Phase: Cervix dilates up to 4cm and contractions occur every 15 to 20 minutes lasting 45 to 60 seconds
- Active Phase: Cervix dilates to 8cm and contractions become more frequent and intense
- Final Phase/Transition: Shortest and most difficult, typically lasts less than 30 minutes, cervix fully dilates
37
Q
Stage 2 of vaginal birth
A
- Begins when the cervix is fully dilated
- Can last from a few minutes to a few hours
- Pushing starts
38
Q
Episiotomy
A
- Incision of the perineum to help with passage of the baby
- No longer do it because it proved to have no effect on maternal outcomes
39
Q
Stage 3 of vaginal birth
A
- May last a few minutes to an hour
- Sometimes referred to as the placental phase because it’s when the placenta detaches from the uterus and is expelled along with the fetal membranes as “afterbirth”
40
Q
Pain management with Vaginal Births
A
- Tools like birthing balls, controlled breathing, soaking in a tub, walking, massage or distraction techniques, TENS machines
- Childbirth prep classes
- Drugs, narcotics, epidurals, spinal blocks
41
Q
C-Section
A
- Involve an incision being made through the abdomen and the wall of the uterus
- Beyond 15% of births
42
Q
What is a Vitamin K injection in baby used for after birth
A
- To help ensure proper blood clotting
43
Q
Hormones after the expulsion of the placenta
A
- Significant reductions in the birthing parent’s levels of estrogen and progesterone
44
Q
Postpartum blues
A
- Mild depression, tearfulness, anxiety, and/or irritability occurring in the first few days after delivery
- Occurs in up to 80% of women
- Usually lasts a couple of weeks and then resolves
45
Q
Postpartum depression (PDD)
A
- Severe depression occurring within the first year after giving birth
- 10 to 20% experience this during the first year and can last months or even years
- Rates are believe to be much higher
46
Q
Postpartum psychosis (PPP)
A
- Psychosis occurring within the first three months of postpartum
- 0.2% of women but it requires immediate medical care
47
Q
Sexuality during the postpartum period
A
- Undergoes significant changes
- There are many issues reported with having sex again like dyspareunia, vaginal dryness, and decreased sexual desire
- Fears of sex after the physical trauma of birth
- Should wait about 6 weeks to have sex to make sure you don’t get an infection or tear again
48
Q
Breastfeeding
A
- Has been thought to have more benefits on the child than they actually does
- Can help with immunity
- There are maternal benefits as well like a reduction in bleeding, delayed resumption of ovulation, and improved bone remineralization
- Breastfeed exclusively for 6 months and then introduce some solids
49
Q
Physiology of breastfeeding
A
- Starts with the creation of colostrum, a substance that is high in nutrients as well as antibodies that protects the baby from infection
- Two or three days after delivery prolactin is released to stimulate the production of milk
- Oxytocin is produced when breastfeeding begins and it is needed to eject the milk from the breasts
- Prolactin is produced until breastfeeding ends
50
Q
Breastfeeding and mensturation
A
- Exclusive breastfeeding delays the resumption of regular menstrual cycles
- Therefore, exclusive breastfeeding can be an effective contraceptive mesure (2% failure rate)
51
Q
Breastfeeding and sexuality
A
- Originally thought breastfed babies were more likely to haver higher levels of sexual interest even though they delayed returning to intercourse
- New studies find breastfeeding may lead to decrease sexual desire due to hormones and many factors, more likely to have sexual problems, and negative experiences with nipple sensitivity and milk leaking
52
Q
Ectopic Pregancy
A
- Occurs when a fertilized egg implants somehwere other than the inner lining of the uterus
- The most common reason is that the egg is unable to make its way through the fallopian tube into the uterus
- They may spontaneously abort, or they may grow and rupture which may cause abdominal pain, cramping, and/or vaginal bleeding
- 2% of all first-trimester pregnancies in the US and account for 6% of all pregnancy-related maternal deaths
53
Q
Miscarriage / Spontaneous Abortion
A
- Most occur within the first 20 weeks of gestation
- About 25% of pregnancies are miscarried by the sixth week following the last menstrual period
- The most common reason is for the presence of a defect in the embryo or fetus
- 50% of women will suffer from some form os psychological morbidity following the loss
54
Q
Rh Incompatibility
A
- Condition in which the antibodies from the pregnant person’s blood destroys red blood cells in the fetus
- Rh negative blood is pregnant with a fetus with rh postive blood (from the fathers blood)
- If they mix in utero, the fetus can have fetal anemia, intellectual disabilities, or death
- Can get RhoGAM injections to prevent miscarriage
55
Q
Eclampsia
A
- Life threatening complication of pregnancy that is characterized by the presence of seizures
56
Q
Pregnancy-Induced hypertension
A
- High blood pressure associated with the pregnancy
57
Q
Pre-eclampsia
A
- High blood pressure
- Elevated levels of edema (fluid retention and swelling)
- Proteinuria (protein in urine)
- If severe can develop vision problems, headaches, and abdominal pain
- Develops around the 20th week
58
Q
How can you help reduce congenital anomalies resulting from defects in brain or spinal cord
A
- AFP levels in pregnant person’s blood
- Maternal serum AFP screening in second trimester
- Sonographic examination: Diagnostic imaging using ultrasound to visualize the developing fetus
- Amniocentesis: Invasive method involving inserting a needle through the abdomen into the uterus and withdrawing a sample of amniotic fluid
- CVS: Inserting a thin catheter through the cervix and into the uterus to obtain a sample of chorionic villi
59
Q
Preterm Birth
A
- Before 37 complete weeks of gestation
- Primary cause of neonatal and infant mortality
- Accounts for a major proportion of neonatal morbidity (respiratory failure, long term motor/cognitive, etc.)
- Linked to low birth weight because they gain weight near the end
- Rates have been increasing
- Several maternal factors and carrying more than one fetus
60
Q
A
60
Q
Anoxia
A
- Umbilical cord provides oxygen to fetus
- It may get compressed or wrapped around the babies neck
- Can deprive oxygen from the fetus
- May need emergency c-section
61
Q
Stillbirth
A
- Babies who are born dead after 28 weeks and who weigh at least 500 grams
- Increased psych difficulties for the mom
- Rates are decreasing
62
Q
Infertility
A
- Biological inability to achieve pregnancy either after
- One year of unprotected sex for women under 34, or
- Six months for women over 35
63
Q
Primary Infertility
A
- A couple who has never been able to conceive
64
Q
Secondary infertility
A
- Couple has difficulty conceiving but has been able to conceive in the past
- whether or not the pregnancy ended in a miscarriage
65
Q
Impaired fecundity
A
- Couples who have achieved pregnancy at least twice in the past but in which the pregnant person has trouble staying preg
66
Q
Male infertility
A
- 1/10 men
- Usually because of low sperm count (below 10 million sperm/mL)
- Irregularly shaped sperm , chronic disease, low sperm motility, injury, etc.
67
Q
Reasons for low sperm count
A
- Frequent ejaculations
- Tight underwear
- Frequent hot baths
- Use of electric blankets
- Anything that can increase scrotal temperatures really
68
Q
Female infertility
A
- Affects about 1/12 women between 15 and 45 years old
- Usually because of irregular ovulation or irregular cycles
- Obstructions or malformations in the reproductive tract
- Hormone problems
- Age
- Ect.
69
Q
Psychological impact of infertility
A
- Can lead to feelings of anger, confusion, sadness, anxiety, shame, depression, insecurity, inadequacy, and a sense of failure
- Typically worse in women
- May make men feel less masculine
70
Q
Likelihood of pregnancy resulting from ART
A
- Assisted reproductive technology
- Resulting in pregnancy and live birth delivery is about 30%
71
Q
The first step of fertility treatment
A
- Fertility drugs
- Process known as superovulation
- Help produce eggs at a much faster rate or in larger numbers (as many as 40 in one cycle)
- Clomid: Drug that stimulates the pituitary gland to induce ovulation
- HMG Injections: directly stimulates the ovaries to produce eggs
- Risks: Ovary rupturing, multiple births, etc.
- New drugs like letrozole do similar things but are safer
72
Q
Artificial Insemination (AI)
A
- Uses a thin, flexible catheter to insert sperm directly into the vagina or uterus
- Reduces the distance sperm has to travel
- AIH: Sperm from partner
- AID: Sperm from donor
- Sperm is collected and frozen until time of ovulation
72
Q
The Assisted Human Reproduction Act
A
- Introduced in 2004 by Canadian federal government
- Goal: regulate new reproductive technologies
- The assisted human reproduction agency of Canada (AHRC) was created in 2006
- Goal: maintenance of national standards and policies surrounding eggs, sperm, and embryos in the fertility clinics across Canada
73
Q
In Vitro Fertilization (IVF)
A
- If the female reproductive tract is block we can do this
- Surgically removing eggs from the ovaries
- Fertilizing them in a lab
- Three to five days later we inject them into the uterus with intra-uternine insemination or cervix using intracervical insemination
- Intra uterine insemination in combination with fertility drugs that results in superovulation has been found to be 3 times more likely to produce pregnancy than the other options alone
- Super expensive (between 5500 to 10,000 per round)
- Very invasive
74
Q
Gamete Intrafallopian Transfer (GIFT)
A
- Similar to IVF in the way we collect the eggs
- But we drop them off in the fallopian tube to be fertilized
- Need at least one healthy fallopian tube
- Fertilization occurs naturally in the fallopian tubes so we don’t have extra frozen eggs making it better for certain religions and cultures
75
Q
Surrogacy
A
- Surrogate may become pregnant through any AHR technique
- Very expensive
75
Q
Zygote Intrafallopian Transfer (ZIFT)
A
- Combination of IVF and GIFT
- Egg is taken and fertilized
- It gets placed in the fallopian tube so it can naturally implant
76
Q
ART-Related Multiple Births
A
- 20 fold increase of having twins
- 400 increase of having triplets of quadruplets
- More than 70% of twins and 99% of higher order multiples come from fertility treatment
77
Q
Multifetal pregnancy reduction (MFPR)
A
- Removing one or more fetuses from the womb in order to increase the chance the pregnancy will continue
- Typically between 9 to 13 weeks
