Exam 1 - Fetal Development and Nutrition during Pregnancy

Question 1

Pregnancy

Answer 1

• 10 Lunar Months, 9 Calendar Months, 40 Weeks, 280 Days

- Length of Pregnancy computed from the first day of the last menstrual period

Question 2

Naegele’s Rule

Answer 2

• • Determine the first day of the last menstrual period

- - subtract 3 months, add 7 days and adjust year

Question 3

Intrauterine Development

Answer 3

o	Ovum/preembryonic (days 1--14)
o	Embryo (2-8 weeks)
o	Fetus (9 weeks ~ delivery)

Question 4

Amniotic Fluid

Answer 4

• Cushions the embryo and fetus
• Controls Temperature
• Promotes symmetrical growth
• Prevents fetal adherence to the amnion
• Allows freedom of movement
• Circulating volume at 10 weeks 30ml
• Circulating volume at 20 weeks 350 ml
• Circulating volume at term 800-1000 ml

Question 5

Umbilical Cord

Answer 5

• • Formed about the 5th week
• • Two Arteries carry deoxygenated blood from the embryo to be oxygenated by the placenta
• • One Vein returns oxygenated blood from the placenta to the embryo
• • At term ranges from 30-90cm long and 2cm wide

Question 6

Fetal Period (9 wks to delivery)

Answer 6

• All Major systems present in their basic form
• Dramatic growth and refinement of structures occurs
• Teratogens less likely to damage already formed structures
• CNS is still vulnerable throughout entire pregnancy

Question 7

Viability

Answer 7

• Viability possible at 20 weeks although survival more likely after 24 weeks
• A 24 week gestation baby is about the size of a beanie baby and weighs in at about 1.5 lbs

Question 8

Summary of Fetal Circulation

Answer 8

• Blood oxygenated in placenta
• Returns to fetus through U vein
• Passes through Ductus venosis to inferior vena cava
• From IVC to RA
• Shunts through FO into LA and enters systemic circulation
• Deox blood returns to fetal heart (RA) via SVC
• Travels through Tricuspid valve to RV and then into Pulmonary arteries
• From Pulm arteries through Ductus Arteriosis to Descending Aorta
• From Descending Aorta to Umbilical arteries back to placenta for oxygenation

Question 9

Respiratory System

Answer 9

• 4th-17th week larynx, trachea, bronchi, and lung buds form
• 16th-24th week bronchi and terminal bronchioles enlarge, vascular structures and primitive alveoli are formed
• 24th-birth more alveoli form
o Type I and II alveolar cells produce surfactant which is present in adequate amounts for survival by 32 weeks

Question 10

Determining Fetal Lung Maturity

Answer 10

• Lecithin/Sphingomyelin (L/S) present in surfactant
• Surfactant is detectable at approx. 21 weeks
• L/S present in a ratio of 2:1 in mature fetal lungs
o Specimen obtained from amniotic fluid via amniocentesis
o In conditions that slow down fetal lung maturity a ratio of 3:1 is necessary. PG (phosphatidylglycerol) test may also be done.

Question 11

Betamethasone IM

Answer 11

injection given to women in PTL to accelerate fetal lung maturation)

Question 12

Cause of Deceleration of fetal lung maturity

Answer 12

o Pre-existing DM or Gestational DM

o Chronic glomerulonephritis

Question 13

Renal System

Answer 13

• 5th week kidneys form
• 9th week begin to function
• Excretes urine to form majority of amniotic fluid
• Not an organ of excretion until after birth

Question 14

Oligohydramnios

Answer 14

(too little amniotic fluid) indicative of renal dysfunction

Question 15

Sensory Awareness

Answer 15

• 20 weeks: distinguishes taste
• 24 weeks: responds to sound
• Fetus reacts to temperature changes
• Fetus can see
• Eyelids open in the third trimester.

Question 16

Reproductive and Musculoskeletal Systems

Answer 16

• 7th week sex differentiation occurs
• 9th week distinguishing characteristics appear and are fully differentiated by the 12th week, although difficult to see by ultrasound.
• Will be able to see clearly via ultrasound on the 20th week

Question 17

Integumentary

Answer 17

• 4th week skin development begins
• Vernix Caseosa (thick, white, cheesy substance) covers and protects skin and is thickest at 24 weeks and thinnest at term
• Lanugo appears at 12 weeks (fine downy hair) and thins and disappears by term gestation

Question 18

Immunologic Systems

Answer 18

• IgG crosses placenta to provide passive immunity
• Fetus produces IgM by the end of the first trimester
• IgA not produced by fetus but is present in colostrum

Question 19

Quickening

Answer 19

• 16-20th week “Quickening” occurs (mother can feel baby moving or fluttering)
o Sometimes occurs earlier in multipara or later in primipara

Question 20

Dizygotic

Answer 20

two separate ova are released and fertilized, not identical, two amnions, two chorions, and two placentas which may be fused

Question 21

Monozygotic

Answer 21

developed from one fertilized ovum and are identical. Most often, there are two amnions, one chorion, and one placenta

Question 22

Congenital

Answer 22

– condition present at birth

– Congenital disorders may be inherited, may be caused by environmental factors, or by inadequate maternal nutrition

Question 23

Recommendations for Total Weight Gain

Answer 23

normal BMI (19.8-26 BMI) = 25-35 lbs

Pattern: 3.5 lbs during first trimester, then second and third 0.5 to 1 lb per week

Low BMI 29 = >= 15 lbs

Question 24

FALSE ANEMIA

Answer 24

increase in plasma dilutes RBC’s which results in a decreased concentration of Hgb and Hct

Question 25

Iron supplements

Answer 25

• • recommended starting at 12 weeks gestation
• • Iron should be taken on an empty stomach with a beverage high in ascorbic acid such as orange juice to enhance absorption
• • Iron supplementation not for everyone (Ex. high levels of iron assoc w/ GDM)

Question 26

Folic Acid or Folate

Answer 26

important in adequate amounts prior to conception (400 mcg)
• Prevents Neural Tube Defects
• Found in green leafy veggies, broccoli, legumes, etc.

Question 27

WIC

• The WIC target population are low-income, nutritionally at risk

Answer 27

o Pregnant women (through pregnancy and up to 6 weeks after birth or after pregnancy ends).
o Breastfeeding women (up to infant’s 1st birthday)
o Nonbreastfeeding postpartum women (up to 6 months after the birth of an infant or after pregnancy ends)
o Infants (up to 1st birthday). WIC serves 45 percent of all infants born in the United States.
o Children up to their 5th birthday.

Question 28

Benefits of WIC

Answer 28

o Supplemental nutritious foods
o Nutrition education and counseling at WIC clinics
o Screening and referrals to other health, welfare and social services
• Nutrition Related Discomforts of Pregnancy

Question 29

Tx for Nausea and Vomiting

Answer 29

o Eat dry starchy foods on awakening
o Separate fluids from solids
o Eat protein rich food before bed
o Avoid spicy and high fat foods

Question 30

Tx for Constipation

Answer 30

o Eat high fiber foods
o Drink plenty of fluids (have to balance w fiber)
o Physical Activity

Question 31

Pyrosis (heart burn)

Answer 31

o Eat small frequent meals

o Don’t lie down right after eating