Developmental Milestones

Question 1

What are the 3 periods in prenatal development?

Answer 1

Ovular Period or Germinal Period- first 2 weeks following ovulation
Embryonic Period – 3rd week following ovulation and extends up to 10 weeks of gestation
Fetal Period – begins after 8th week following conception and ends with delivery

Question 2

Describe the fetal period.

Answer 2

Ranging from 8-9 weeks to delivery
Brain grows the fastest (sensitive period up until this point)
Limb buds form
Sex organs form
Bones and muscles
Hair
Eyes form
TONS OF DEVELOPMENT

Question 3

What two ways can you determine gestational age?

Answer 3

LMP- age since Last Menstrual Cycle
- Technically off by about 2 weeks (over estimates the age)
- With this technique, it lasts 40 weeks
- Issues with memory
Post Conception (fertilization) Age
- From exact time of conception
- Lasts 38 weeks

Question 4

What is placental abruption?

Answer 4

Placental abruption (abruptio placentae) is an uncommon yet serious complication of pregnancy.
Placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. This can decrease or block the baby’s supply of oxygen and nutrients and cause heavy bleeding in the mother.
Placental abruption often happens suddenly. Left untreated, it endangers both the mother and the baby.
Symptoms include vaginal bleeding, belly pain, and back pain in the last 12 weeks of pregnancy.

Question 5

What is placenta previa?

Answer 5

In most pregnancies, the placenta attaches at the top or on the side of the uterus. In placenta previa, the placenta attaches low in the uterus. The placenta might partially or completely covers the cervix. Placenta previa can cause severe bleeding in the mother before, during or after delivery.
Placenta previa risk factors include a previous delivery, age older than 35, and a history of previous surgeries, such as a cesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Bed rest is recommended. A cesarean section is often needed.

Question 6

What are teratogens?

Answer 6

A teratogen isanything a person is exposed to or ingests during pregnancy that’s known to cause fetal abnormalities.
Period of risk (4-8 weeks critical periods)

Question 7

What are the categories of teratogens?

Answer 7

Medications/Drugs
Maternal Infections (Torches)
Chemicals
Maternal disorders
Reproductive Traits

Question 8

Exposure to teratogens during pregnancy can cause…

Answer 8

Low birth weight
Developmental delays
Loss of pregnancy
Cognitive delays
Growth delays

Question 9

What are TORCHes infections?

Answer 9

T - toxoplasma gondii
O - other
R - rubella
C - cytomegalovirus
He - herpes
S - syphillis

Question 10

Describe the first few weeks of

Answer 10

Everything is developing
4 weeks-heart tube forms
- Neural system begins (neural Defects)
- Intestines, lungs, liver and kidneys
- Sex organs
- Buds to be limbs
Week 8- goes from embryo to fetus

Question 11

What are the body functions in a fetus?

Answer 11

Mental Function
Based on fetal behavior and movement
Correlation to brain function after birth
KANET test

Question 12

What are fetal behavioral states?

Answer 12

F1: quiescent state (quiet sleep)
F2: frequent gross body movements
F3: continuous eye movement. This state was disputed.
F4: Vigorous body movements and FHR accelerations.

Question 13

Describe sensory function and pain during development.

Answer 13

8 weeks gestation
- respond to touch by crying, grimacing, retracting

24 weeks gestation
- respond to sound

25 weeks gestation
- vestibular system allows them to right themselves in the womb

Question 14

Describe the cardiopulmonary system during development.

Answer 14

Heart is one of the first systems to start functioning (21 days)
In utero-works from the placenta
Within seconds of birth
- Breathing on their own
- Shift from maternal to infant circulation requires closure of the ductus arteriosus

Question 15

Describe the shift in circulation that occurs within seconds of birth.

Answer 15

Ductus arteriosus
Pulmonary trunk and aorta
Usually closes within hours of birth
35 weeks and younger sometimes trouble

Question 16

Describe the neuromuscular system during development.

Answer 16

Development occurs
- Cephalocaudal
- Proximodistal
Fetal movements are well documented
- Startles, stretches
- Hiccups
- Paradoxical breathing
- Twitches
- Head movement
- Periods of rest and movement
- Slowing of movement as they get too big
* See this in preemies as the approach 36 weeks

Question 17

What happens at 9 weeks?

Answer 17

Now a fetus

Question 18

What happens at 12 weeks?

Answer 18

Able to tell sex based on visual appearance
Spontaneous movement begins
Gut starts to work- begin to swallow amniotic fluid

Question 19

What happens at 16 weeks?

Answer 19

Hands and feet (fingernails)
Reflexes begin

Question 20

What happens at 20 weeks?

Answer 20

Tiny person- all parts are there and size ratio
Hair
Lanugo
Vernix caseosa
First flutters by mom

Question 21

What happens at 22 weeks?

Answer 21

Viability in US

Question 22

What happens at 24 weeks?

Answer 22

Eyes are formed and open

Question 23

What happens at 25 weeks?

Answer 23

Viable baby

Question 24

What happens at 28 weeks?

Answer 24

Most reflexes are present (not suck)
May cry, breath, swallow and suck thumb
Viable lungs

Question 25

What happens from 28-33 weeks?

Answer 25

Fat!
Issues with temperature regulation

Question 26

What happens at 32 weeks?

Answer 26

Can live without support
Suck reflex

Question 27

Describe a full term infant.

Answer 27

Weigh about 3.4 KG or 7.5 #
FAT
Thermoregulation is working
Can sustain feeding
Can poop (eliminate waste)
Breath when separated from placenta

Question 28

Describe VLBW and/or very preterm.

Answer 28

weight <1,500mg or gestational age <32 weeks
Continue feeding with expressed breast milk
Give vitamin K
Kangaroo Mother Care

Question 29

Describe LBW and/or preterm.

Answer 29

weight 1,500-2,000g or gestational age 32-37 weeks
KMC
Counsel on optimal breastfeeding and infection prevention
Give vitamin K
Follow up visits every week for 6 weeks

Question 30

Describe normal birthweight and/or term.

Answer 30

weight >2,500g or gestational age >37 weeks
Counsel on optimal breastfeeding and infection prevention
Give vitamin K
3 follow up visits

Question 31

What are 2 main causes of LBW?

Answer 31

Early delivery
Poor fetal growth

Question 32

What can cause early delivery?

Answer 32

Carrying more than one baby such as twins or triplets
Previous preterm birth
Previous abortions
Smoking or exposure to second hand smoke
Stress and lack of support
Infection- some infections in pregnant women, such as bladder or vaginal infections, can cause labor to start early
Stress
Exposure to harmful substances
Oligohydramnios-lack of amniotic fluid

Question 33

What can cause poor fetal growth?

Answer 33

Use of alcohol, drugs and smoking
Exposure to second hand smoke
Poor nutrition - women who do not gain at least 22lb (10 kg) are 2-3 times more likely to have a LBW baby
Being under weight before becoming pregnant
Mothers age at time of pregnancy - women under 20 and over 45 are more likely to have a LBW baby.
Stress, exhaustion or lack of rest
Abuse and /or family violence
Living in poverty

Question 34

What are the types of spina bifida?

Answer 34

spina bifida occulta
myelomeningocele
meningocele

Question 35

What is spina bifida occulta?

Answer 35

It’s the mildest and most common type. Results in a small separation or gap in one or more of the bones of the spine (vertebrae). Many people who have spina bifida occulta don’t even know it, unless the condition is discovered during an imaging test done for unrelated reasons.

Question 36

What is spina bifida myelomeningocele?

Answer 36

Myelomeningocele is a severe type of spina bifida in which the membranes and the spinal nerves protrude at birth, forming a sac on the baby’s back. The exposed nervous system may become infected, so prompt surgery is needed after birth.

Question 37

What is spina bifida meningocele?

Answer 37

This rare type of spina bifida is characterized by a sac of spinal fluid bulging through an opening in the spine. No nerves are affected in this type, and the spinal cord isn’t in the fluid sac. Babies with meningocele may have some minor problems with functioning, including those affecting the bladder and bowels.

Question 38

What is anencephaly?

Answer 38

A baby born with an underdeveloped brain and an incomplete skull.
Anencephaly is a defect in the formation of a baby’s neural tube during development. A baby born with anencephaly might be stillborn or survive only a few hours to a few days after birth.
The main symptom is unconsciousness.
There is no cure for anencephaly. Treatment aims at making the baby as comfortable as possible.

Question 39

When is cleft palate and lip still a risk?

Answer 39

Weeks 5-6 you have a risk of developing cleft palate and lip.
Ossification starts at 6-7 weeks

Question 40

What do we know about prenatal developmet?

Answer 40

1. When does life begin?
   - Biological life-matter for science
2. When are obligated to protect life?
   - Physiological and ethical issue
3. How do we as health professionals respond to disagreements between 1 and 2?
   - Remain informed and understand what you are talking about

Question 41

What is the controversy surrounding stem cells?

Answer 41

Can be maintained in cultures for years.
They come from aborted fetus
Can also come from
- Cord blood
- Amniotic fluid
- Possibility of taking adult living cells and reverting them