Fetal Development Flashcards
Stages of fetal development
-Preembryonic stage
-Embryonic stage
-Fetal stage
Preembryonic stage
-Fertilization AKA conception (union of ovum and sperm); cleavage –> morula
-Blastocyst (inner cell mass) and trophoblast (outer cell mass)
-Implantation (7-10 days after conception)
Gametogenesis
-Gametes (ovum or sperm) are produced
-Come together to form zygote
Embryonic stage
-End of 2nd week (day 15) thru 8th week
-Basic structures of major body organs and main external features
-Most susceptible to teratogens, infections, radiation, nutritional deficiencies
Major bodily structure development (table 10.1)
-Week 3: brain, spinal cord, heart, GI tract, neural tube, leg and arm buds
-Week 4: brain differentiates, limb buds
-Week 5: heart rhythm, eyes and ears, cranial nerves, muscles innervated
-Week 6: lungs, fetal circulation, liver produces RBC, brain, primitive skeleton, CNS, brain waves
-Week 7: trunk straightens, nipples, hair follicles, elbows, toes, legs move, diaphragm, mouth w/ lips, tooth buds
-Week 8: intestines, facial features, heart, resembles human, placenta works, eyelids form but sealed shut
-Weeks 9-12: sexual differentiation, buds for all teeth form, GI activity, face and neck, urogenital tract, RBC production in liver, urine excretion, gender determined week 12, limbs lengthen, digits form, movement of limbs, kicks, swallowing reflex
-Weeks 13-16: fine hair (lanugo), bones harden, active mvmt, sucking motions, amniotic fluid swallowed, external genitalia, nails, weight quadruples, fetal mvmt felt (quickening)
-Weeks 17-20: rapid brain growth, heart tones, kidneys secret urine, vernix caseosa forms, thick hair, brown fat to maintain temp, nails, muscles
-Weeks 21-24: brows and lashes, hand grasp, startle reflex, alveoli, lungs produce surfactant
-Weeks 25-28: fetus reaches length of 15 in, eyelids open, fingerprints set, subq fat, blood formation in bone marrow, head-down position, response to light and sound, sucks thumb, shuts eye
-Weeks 29-32: body fat, CNS, rhythmic breathing, pupillary light reflex, storage of Fe, Ca, P
-Weeks 33-38: testes, lanugo disappears, strong hand grasp reflex, body fat, earlobes, nails, breast buds, mother supplies antibodies, full term at 38 weeks, head-down position
Fetal stage
-End of 8th week until birth
-Average pregnancy is 280 days from 1st day of LMP
-Longest period
Embryonic layers
-Ectoderm
-Mesoderm
-Endoderm
Ectoderm
-Forms CNS, special senses, skin, glands
-Outside protective layers
Mesoderm
-Forms skeletal, urinary, circulatory, and reproductive organs
-Internal body systems
Endoderm
-Forms respiratory system, liver, pancreas, and digestive system
-Epithelial lining of organs
Fxns of the placenta
-Interface btwn mother and fetus
-Making hormones to control mother’s physiology
-Protecting fetus from immune attack from mother
-Removing waste products from fetus
-Inducing mother to bring more food to the placenta
-Producing hormones that mature into fetal organs
-Precursor is trophoblasts
Oligohydramnios vs hydramnios
-Oligohydramnios: amniotic fluid < 500 mL at term
-Hydramnios: amniotic fluid > 2,000 mL at term
Hormones produced by placenta
-hCG (present in pregnancy tests)
-Human placental lactogen (hPL) or human chorionic somatomammotropin (hCS)
-Estrogen
-Progesterone
-Relaxin
Umbilical cord
-Formed from the amnion
-Lifeline from the mother to the growing embryo
-Contains 1 large vein and 2 small arteries
-Wharton jelly surrounds the vein and arteries to prevent compression
-At term, the average umbilical cord is 22-in long and about 1-in wide
Role of amniotic fluid
-Helps maintain a constant body temperature for the fetus
-Permits symmetric growth and development
-Cushions the fetus from trauma
-Allows umbilical cord (no nerve endings) to be mostly free of compression
-Promotes fetal movement to enhance musculoskeletal development
Fetal circulation
-Blood from placenta to and thru the fetus then back to placenta
-Oxygenated blood must travel thru shunts to reach fetus
-Highly oxygenated blood to heart, brains –> shunts away from lungs, liver
-Large volumes of oxygenated blood are not needed d/t placenta taking over fxns of lungs and liver
-Blood w/ highest oxygen content goes to heart, head, neck, upper limbs
-Blood w/ lowest oxygen content goes to placenta
Shunts during fetal life
-Ductus venosus
-Ductus arteriosus
-Foramen ovale
Shunt closure
-Supposed to be open during fetal development for circulation
-When baby gasps after birth, shunts should close
-If shunts don’t close, a murmur will be heard
-Not a problem if as/s
-Problem is deoxygenated and oxygenated blood mix and cause cyanosis or fatigue
Ductus venosus
Connects umbilical vein to inferior vena cava
Ductus arteriosus
Connects main pulmonary artery to aorta
Foramen ovale
Anatomic opening btwn R and L atrium
Genetics and advances in genetic knowledge
-Pharmacogenomics: study of genetic and genomic influences on pharmacodynamics and pharmacotherapeutics
-Perinatal care
-Genetic testing
-Gene therapy
Genetics vs genomics
-Genetics: scrutinizes fxns of single genes and their role in inheritance
-Genomics: address genes and their interrelationships
Human Genome Project
-International 13-year effort started in 1990 to produce a comprehensive sequence of human genome
-Goal: map, sequence, determine fxn of all human genes
-Genome: person’s genetic blueprint determining genotype and phenotype
Inheritance: genes
-Individual units of heredity of all traits
-Organized into long segments of DNA that occupies location on chromosome
-Determines phenotypes and genotypes
Inheritance: chromosome
Long, continuous strand of DNA carrying genetic info
Inheritance: Karyotype
-Pictorial analysis of #, form, size of chromosomes
-Commonly uses WBC and fetal cells in amniotic fluid
-Chromosome numbered from largest to smallest 1-22, sex chromosomes designated X and Y
Patterns of inheritance
-Mendelian or monogenic disorders: autosomal dominant/recessive, x-linked dominant/recessive
-Multifactorial disorders
-Nontraditional inheritance
Nontraditional inheritance
-Pattern doesn’t follow rules of mendelian inheritance
-Mutations manifest in unusual ways
-Can’t be predicted by traditional inheritance patterns
-Ex: mitochondrial inheritance, genomic imprinting
Multifactorial inheritance
-Trait or health problem caused by more than 1 factor, usually both genetic and environmental
-Birth defects, diabetes, cardiac disease, autism, height, weight, eye color
Monogenic vs mendelian disorder
-Monogenic: phenotypes conferred by variation in single gene, include autosomal dominant/recessive, x-linked dominant/recessive
-Mendelian: highly penetrant monogenic diseases in which correlation btwn genotype and phenotype is strong, are rare
-Patterns in family over multiple generations
Autosomal dominant inheritance
-Trait is expressed if only 1 copy of defective gene is present
-1 parent is affected, other isn’t
-50% of children will be affected
-Marfan syndrome, huntington’s, neurofibromatosis, achondroplasia, polycystic kidney disease
Autosomal recessive inheritance
-Trait is expressed if 2 copies of defective gene are present
-Both parents are carriers
-50% of children will be carriers
-25% of children will be affected
-25% of children will be unaffected
-CF, sickle cell disease, PKU, tay-sachs disease
X-linked dominant inheritance
-Affected mother –> 50% of sons and daughters affected
-Affected father –> daughters only affected
-hypophosphatemic rickets, fragile x syndrome
X-linked recessive inheritance
-Carrier mother
-Sons affected
-Deformities like enlarged wrists and knees, impaired growth
Chromosomal abnormalities of #
-Monosomies
-Trisomies
-Polyploidy
Monosomies
-1 copy of a chromosome instead of pair
-All fetuses spontaneously abort in early pregnancy
Trisomy
-3 of a chromosome
-Trisomy 21 (down syndrome), trisomy 18 (edward syndrome), trisomy 13 (patau syndrome)
-Palmar line straight across
Polyploidy
-Increase in # of haploid sets (23) of chromosomes
-Results in early spontaneous abortion
-Ex: triploidy –> 69 chromosomes per cell
Chromosomal abnormalities of structure
-Deletions
-Inversions
-Translocations
-Cri du chat syndrome (cry resembles a cat’s, short arm of chromosome 5 is missing)
-Fragile X syndrome (gaps in X chromosome)
Sex chromosome abnormalities
-Turner syndrome (portion of X chromosome is missing): masculine presenting females, webbed hand and feet
-Klinefelter syndrome (XXY): feminine presenting men, testes never distend
-Usually sterile
Potential misuse of genetic info
-Risk profiling
-Privacy and confidentiality breaches
-Workplace discrimination and access to health insurance
-Loss of autonomy
-Possible injustices w/ risk determination years before disorder occurs
Genetic evaluation and counseling
-Pts who are at risk of inherited disorder are advised of consequences and nature of disorder, probability of developing it, options for management and family planning to prevent, avoid, or ameliorate it
-Ideal time: before conception
Nursing roles in genetic counseling
-Beginning preconception counseling process and referring for further genetic info
-Family hx
-Scheduling genetic testing
-Explaining purposes, risks/benefits of all screening and dx tests
-Discussing costs, benefits, risks of using insurance
-Potential risks of discrimination
-Ethical, legal, social issues
-Safeguarding privacy and confidentiality
-Monitoring emotional rxns after receiving info
-Providing emotional support
-Referrals to support groups
People who may benefit from genetic counseling
-Women who are pregnant after age 35
-Paternal age over 50
-Previous children, parents, close relatives w/ inherited disease
-Incest
-Pregnancy screening abnormality
-Stillborn w/ congenital anomalies
-2+ pregnancy losses
Presumptive s/s of pregnancy (subjective, mother can see, not reliable bc can be caused by other conditions)
-Fatigue
-Breast tenderness
-N/V
-Amenorrhea
-Urinary frequency
-Hyperpigmentation of skin
-Fetal movements (quickening)
-Uterine enlargement
-Breast enlargement
Probable s/s of pregnancy (objective, detected on physical exam)
-Braxton Hicks contractions (false contractions, prepare body for birth by toning uterine muscles)
-Positive pregnancy test
-Abdominal enlargement
-Ballottement (used to feel for fetus in uterus)
-Goodell sign (cervix softens d/t increased blood flow)
-Chadwick sign (bluish discoloration of vulva, vaginal tissue, or cervix)
-Hegar sign (softening of cervix and uterus)
Positive s/s of pregnancy (confirms fetus is growing in uterus)
-Ultrasound verification of embryo or fetus (4-6 weeks)
-Fetal mvmt felt by experienced clinical (20 weeks)
-Auscultation of fetal heart tones via Doppler (10-12 weeks)
Select pregnancy tests
-Agglutination inhibition tests (qualitative)
-Immunoradiometric assay
-Enzyme-linked immunosorbent assay (ELISA)
Agglutination inhibition tests
-Specimen: urine
-Ex: pregnosticon, gravindex
-Result: hCG present –> agglutination not occurring = positive pregnancy
-Elevation of hCG corresponds to morning sickness period of approximately 6-12 weeks during early pregnancy
-95% accuracy
Immunoradiometric assay
-Specimen: blood serum
-Ex: neocept, pregnosis
-Result: measures ability of blood sample to inhibit binding of radiolabeled hCG to receptors
-99% accuracy
ELISA
-Specimen: blood serum or urine
-Ex: OTC home/office pregnancy tests
-Result: uses an enzyme to bond w/ hCG in urine if present
-Reliable 4 days after implantation
-99% accuracy if hCG-specific
Reproductive system adaptations: uterus
-Increase in size, weight, length, width, depth, volume, overall capacity
-Pear shape to ovoid shape; positive Hegar sign
-Enhanced uterine contractility; Braxton Hicks contractions
-Ascent into abdomen after 1st 3 months
-Fundal height (starting 20 weeks’ gestation at level of umbilicus (20 weeks = 20 cm); reliable determination of gestational age until 36 weeks gestation
Fundal height
-Top of uterus
-Correlated w/ gestational weeks most accurately btwn 18-32 weeks
-Obesity, hydramnios, uterine fibroids interfere w/ accuracy of correlation
Reproductive system adaptations: cervix
-Firm prior to pregnancy to protect uterus
-Softening (goodell sign) for future delivery
-Mucus plug formation
-Increased vascularization (chadwick sign)
-Ripening (softening, effacement) occurs about 4 weeks before birth (in a normal pregnancy)
-Fetal begins to descend at 40 weeks (lightening)
Reproductive system adaptations: vagina
-Increased vascularity w/ thickening
-Lengthening of vaginal vault
-Secretions more acidic, white, thick; leukorrhea (fights yeast/alkaline environment)
-Candida albicans is a common occurrence
Reproductive system adaptations: ovaries
-Enlargement until 12th-14th week of gestation
-Cessation of ovulation at weeks 6-7 when placenta takes over
Reproductive system adaptations: breasts
-Increase in size and nodularity to prepare for lactation; increase in nipple size, becoming more erect and pigmented
-Production of colostrum: antibody-rich, yellow fluid that can be expressed after the 12th week; conversion to mature milk after delivery
Reproductive system adaptations
-Liver gets pushed up
-Stomach compressed (doesn’t gain as much weight, smaller appetite)
-Bladder compressed (increased urinary frequency)
GI system adaptations
-Gum: hyperemic, swollen, friable, bleeding d/t increased estrogen causing blood vessel proliferation
-Ptyalism (hypersalivation); may chew gum or suck on hard candies
-Dental problems; gingivitis
-Decreased peristalsis and smooth muscle relaxation
-Constipation + increased venous pressure + pressure from uterus = hemorrhoids
-Slowed gastric emptying (may cause stones), heartburn (pyrosis)
-Prolonged gallbladder emptying
-Peanut butter for protein
-N/V
Cardiovascular system adaptations
-Increased in blood volume (50% above pregnancy levels) correlates w/ fetal weight
-Increase in cardiac output; increased venous return; increased heart rate
-Slight decline in bp until mid-pregnancy (nose/gum bleeds common), then returning to prepregnancy levels
-Increase in # of RBCs; plasma volume > RBC leading to hemodilution (physiologic anemia)
-Increase in Fe demands (Fe supplements), fibrin and plasma fibrinogen levels, some clotting factors, leading to hypercoagulable state
Respiratory system adaptations
-Breathing more diaphragmatic than abdominal
-Increase in O2 consumption
-Chest circumference increase
-Congestions 2ndary to increased vascularity
Renal/urinary system adaptations
-Dilation of renal pelvis
-Increase in length and weight of kidneys
-Increase in GFR
-Increase in kidney activity w/ woman lying down
-Greater increase in kidney activity w/ in later pregnancy when lying on side
Musculoskeletal system adaptations
-Softening and stretching of ligaments
-Postural changes increase swayback and upper spine extension
-Forward shifting of COG
-Waddle gait
Integumentary system adaptations
-Hyperpigmentation (mask of pregnancy, facial melasma)
-Linea nigra (line down stomach d/t hormones)
-Striae gravidarum
-Varicosities in legs (elevate legs when sitting, change positions frequently, resting in L lateral position, walking daily, avoid tight clothing)
-Vascular spiders
-Palmar erythema
-Decline in hair growth
-Nails grow fast but are more brittle
Endocrine system adaptations
-Increased activity in thyroid gland (enlargement)
-Increase in prolactin, oxytocin
-Inhibition of FSH and LH
-Insulin resistance d/t hPL in 2nd half of pregnancy
-Increase in cortisol (adrenal)
-Prostaglandin secretion
-Placental secretion: hCG, hPL, relaxin, progesterone, estrogen
Hormones
-hcG: basis for pregnancy tests
-hPL or hCS: modulates metabolism, increased glucose availability to fetus
-Estrogen: enlarged breasts, uterus, external genitalia
-Progesterone: maintains endometrium, decreases contractility of uterus, stimulates metabolism and breast development, provides nourishment for early conceptus
-Relaxin: causes relaxation of pelvic ligaments, soften cervix
-Insulin: decrease in early pregnancy, crosses over placenta into fetus
Nutritional needs
-Nutritional intake affects fetal well-being and birth outcome
-Vitamin and mineral supplement daily
-Increase in protein, Fe, folate, calories
-Fe (18-27 g/day) : fetal growth, brain development, prevention of maternal anemia
-Folic acid (40-800 mcg/day): prevention of neural tube defects
-Avoid fish d/t mercury
-Avoid unpasteurized products
-Special considerations for cultural variations, gluten-free diet, lactose intolerance, vegetarianism, pica (intensive craving for nonfood items for at least 1 month, soil, clay, ice, or laundry starch) that make it harder to obtain nutrients
-Excessive calories –> difficult birth, obese baby, neonatal hypoglycemia
-Increase of 300 calories/day
Special food concerns
-Artificial sweeteners: higher NBW and obesity
-Mercury in fish: developmental complications
-Listeria: found in processed or raw milk, high mortality, treated w/ ampicillin
Maternal weight gain: healthy BMI
-25-35 lbs
-1st trimester: 3.5-5 lb
-2nd-3rd trimester: 1 lb/wk
Maternal weight gain: BMI < 19.8
-28-40 lb
-1st trimester: 5 lb
-2nd-3rd trimester: +1lb/wk
Maternal weight gain: BMI > 25
-15-25 lb
-1st trimester: 2 lb
-2nd-3rd trimester: 2-3 lbs/wk
Maternal emotional response
-Ambivalence (conflicting feelings at same time)
-Introversion (focusing on oneself)
-Acceptance (positive feelings abt pregnancy)
-Mood swings
-Changes in body image
Maternal role tasks
-Ensuring safe passage throughout pregnancy and birth
-Seeking acceptance of infant by others
-Seeking acceptance of self in maternal role to infant (binding in)
-Learning to give of oneself
Pregnancy and sexuality
-Numerous changes, possibly stressing sexual relationship
-Changes in sexual desire w/ each trimester
-Sexual health and link to self-image
Pregnancy and partner
-Family-centered emphasis
-Partner’s rxn to pregnancy and changes
-Couvade syndrome, ambivalence
-Acceptance of roles (2nd trimester)
-Preparation for reality of new role (3rd trimester)
Pregnancy and siblings
-Age-dependent rxns
-Sibling rivalry
-Sibling preparation imperative
Risks for adverse pregnancy outcomes
-Isotretinoins (acne med causes birth defects)
-Alc misuse (FAS)
-Antiepileptic drugs
-Diabetes (preconception, birth defects)
-Folic acid deficiency (neural tube defects)
-Hepatitis B (vaccinations prevents infection)
-Hypothyroidism
-Maternal phenylketonuria
-Rubella seronegativity
-Obesity
-Oral anticoagulant
-STI (fetal death)
-Smoking (preterm birth, LBW)
Preconception care and dx testing
-Amniocentesis
-Biophysical profile
-Chorionic villus sampling (CVS)
-Natural childbirth
-Perinatal education
-Preconception care
-Immunization status
-Underlying conditions
-Sexual practices
-Nutrition and lifestyle
-Psychosocial issues
-Meds and drug use
-Support system
1st prenatal visit
-Establish rapport
-Focus on education for overall wellness
-Detection and prevention of potential problems
-Health hx, physical exam, labs
-Support groups (centering)
Comprehensive health hx
-Reason for care: suspicion of pregnancy, date of last menstrual period, s/s, urine/blood test for hCG
-Past medical, surgical, personal hx
-Menstrual, obstetric, gynecologic hx
Menstrual hx
-Age at menarche
-Days in cycle
-Flow characteristics
-Discomforts
-Use of contraception
-Date of last period (LMP)
-Calculation of expected date of birth or delivery (EDB/EDD) using nagele’s rule, birth calculator or wheel, ultrasound
Nagele’s rule
-Calculation of birth date
1) Use 1st day of LNMP
2) Subtract 3 months
3) Add 7 days
4) Add 1 year
Obstetric hx
-Gravida: pregnant woman
-Prima/secundigravida
-Para: woman who has produced 1 or more viable offspring carrying a pregnancy 20 weeks or more
-Primi/multi/nullipara
GTPAL
-Gravida: current pregnancy
-Term births: # of pregnancies ending > 37 weeks gestation
-Preterm births: # of preterm pregnancies ending > 20 weeks or viability but before completion of 37 weeks
-Abortions: # of pregnancies ending before 20 weeks or viability
-Living children: # of children currently living
Physical exam: head to toe
-Head and neck: swelling, enlarged lymph nodes
-Chest: increased HR in 2nd trimester, increase in RR, breast self-exam teaching
-Abdomen,: linea nigra, funal height
-Extremeties: edema d/t to HTN normal in 3rd trimester, DVT causes pain in calf upon ambulation
Physical exam: pelvic
-Genitalia
-Bimanual exam
-Pelvic shape: gynecoid, android, anthropoid, platypelloid
-Pelvic measurements: diagonal conjugate, true obstetric conjugate, ischial tuberosity
Lab test
-Urinalysis
-CBC
-Blood typing
-Rh factor (Rh negative mother receives rhoGAM at 28 weeks and again after birth)
-Rubella titer
-Hepatitis B surface antigen
-HIV, VDRL, RPR testing
-Cervical smears
-Ultrasound
Follow-up visit schedule
-Every 4 weeks up to 28 weeks
-Every 2 weeks 29-36 weeks
-Every week 37 weeks to birth
Follow-up visit assessment
-Weight and BP
-Urine testing for protein, glucose, ketones, nitrites
-Fundal height
-Quickening/fetal mvmt
-Fetal HR
Fetal assessment
-Ultrasonography 12.6
-Doppler flow studies
-Alpha-fetoprotein analysis
-Marker screening tests
-Nuchal translucency screening
-Amniocentesis 12.7
-CVS
-PUBS
-Nonstress test; contraction stress test
-Biophysical profile
Alpha-fetoprotein analysis
-Blood sample
-Increased levels indicate neural tube defect, turner syndrome, TOF, hydrocephalus
-Decreased levels indicate trisomy 21 or 18
Amniocentesis
-Fluid separated from sac
- Chromosome analysis identifies CF, sickle cell disease
CVS
-Specimen from placenta
-Detects sickle cell anemia, down syndrome, duchenne muscular dystrophy, CF
PUBS
-Needle into umbilical vessel using ultrasound
-Identifies hemophilia A, infection, acid-base status
FNT
-Intravaginal ultrasound that measures fluid collection in subq space btwn skin and cervical spine of fetus
-Identifies anomalies such as trisomies 13, 18, 21
-FNt > 3 mm –> abnormal
-Thickness in nuchal skin
Level 3 ultrasound/fetal scan
-Sound waves to visualize fetus
-Early eval of structural changes
Triple and quad screening test
-Alpa-fetoprotein, estriol, beta-hCG, inhibin A
-Identifies risk for down syndrome, neural tube defects, chromosomal disorder
-Elevated hCG w/ low estriol = increased risk for trisomy
Preimplantation genetic dx
-IVF testing
-Identifies genetic alterations that can cause disease
-Genes w/o alterations are transferred into women’s uterus
cffDNA
-Prenatal test using maternal plasma that holds a mix of maternal and fetal DNA
-Determines fetal sex in pregnancies at risk for sex-linked condition
1st trimester discomforts
-Urinary changes (pelvic floor exercises, avoid caffeine)
-Fatigue (full night of sleep, nap in afternoon)
-N/V (avoid empty stomach, dry crackers in morning, small meals, don’t brush teeth right after eating, acupressure wristbands, avoid fatty foods)
-Breast tenderness (larger bra, wear bra to sleep)
-Constipation (increase fluids, decrease sugary sodas, avoid cheeses and carbs)
-Nasal stuffiness, bleeding gums, epistaxis
-Cravings
-Leukorrhea (keep perineal area clean and dry, avoid tight clothing, cotton underwear)
2nd trimester discomforts
-Backache
-Varicosities of vulva and leg (avoid curling toes, drink fluids, change position every 2 hours)
-Hemorrhoids (increase fluids, warm sitz baths, avoid prolonged sitting/standing)
-Flatulence w/ bloating
Nursing mgmt to promote self-care
-Personal hygiene (sweating is more profuse)
-Avoidance of saunas and hot tubs (increases baby’s HR)
-Perineal care (no panty liners)
-Dental care
-Breast care (rinse nipple w/ plain water)
-Clothing
-Exercise (150 min of moderate-intensity exercise/week)
-Sleep and rest (avoid lying supine after 4 m d/t hypotension)
-Sexual activity and sexuality (safe in absence of complications)
-Employment
-Travel (best time is during 2nd trimester, look for bleeding, passing tissue, abdominal pain, contractions, ruptured membranes, edema, headaches, visual problems when traveling)
-Immunizations and meds (MMR, hepatitis B, TDap given preconception, pregnant should not take it in case of transmission to fetus)
3rd trimester discomforts
-Return of 1st trimester discomforts
-SOB and dyspnea (improves when fetus drops into pelvis, rest w/ head elevated, lying on L side, avoid overheating)
-Heartburn and indigestion (avoid lying within 3 hours of eating)
-Dependent edema
-Braxton hicks contractions (go away when walking or resting)
Rh negative mother carrying Rh positive fetus
-Rh negative mother carrying an Rh positive fetus can cause maternal antibodies to attack Rh positive blood
-Antibodies cross placenta and destroy fetal RBCs
-Risk for acute hemolytic disease
-Rh positive blood is safer
Preparation for birth
-Perinatal education
-Childbirth education: lamaze, bradley, dick-read
-Options for birth setting: hospital, birthing suite, birth centers, home
-Options for providers: obstetrician, midwife, doula
-Feeding choices: breastfeeding vs bottle feeding
Lamaze method
-Psychoprophylactic
-Focus on breathing and relaxation techniques
Bradley method
-Partner-coached childbirth
-Focus on exercises and slow, controlled abdominal breathing
Dick-read method
-Natural childbirth
-Focus on fear reduction via knowledge and abdominal breathing techniques
Bottlefeeding dangers
-Babies fed formula within 1st 6 months more likely to receive complications
-Putting baby to bed w/ bottle can cause “baby bottle tooth decay” bc sugars in formula stay in teeth for prolonged periods
