Test 1: Birth - 3 mos Flashcards
Teratogens
Agents or factors that cause malformation of an embryo or fetus. Common teratogens include certain drugs, alcohol, and infections.
Relevance: Teratogens can lead to developmental anomalies that may affect physical therapy interventions. Understanding potential teratogens helps therapists anticipate and address developmental issues early.
Lanugo
Fine, soft hair covering the body of a fetus, usually present around the 5th month of gestation.
Relevance: Lanugo is typically shed before birth. The presence or absence of lanugo in premature infants can give clues about gestational age and development, influencing physical therapy assessments.
Quickening
The first movements of the fetus felt by the mother, usually occurring around 18-20 weeks of pregnancy.
Relevance: Quickening is a sign of fetal development and activity. Physical therapists may consider fetal movement patterns when evaluating maternal health and advising on exercises.
Vernix Caseosa
A white, cheesy substance that covers the skin of the fetus, providing protection and lubrication.
Relevance: Vernix caseosa usually disappears after birth. It’s important to note its presence and condition during newborn assessments as it can affect skin care practices.
Linea Nigra
A dark vertical line that appears on the abdomen of pregnant women due to hormonal changes.
Relevance: This is not directly relevant to physical therapy but understanding maternal changes helps in providing comprehensive care and counseling.
Chloasma (Melasma)
Dark pigmentation patches on the face of pregnant women, often called the “mask of pregnancy.”
Relevance: Similar to linea nigra, it’s primarily of dermatological concern but understanding these changes helps therapists in holistic care of the pregnant patient.
Braxton-Hicks Contractions
Irregular, usually painless contractions of the uterus that occur during pregnancy, often described as “practice contractions.”
Relevance: These contractions are a normal part of pregnancy, but distinguishing them from true labor contractions is crucial for physical therapists providing prenatal care and exercises.
Relaxin
A hormone that increases flexibility in the pelvis and prepares the body for childbirth.
Relevance: Increased flexibility can affect joint stability. Physical therapists need to be aware of relaxin’s effects when designing safe exercise programs for pregnant patients.
Nesting Instinct
A surge of energy and the urge to prepare the home for the baby’s arrival.
Relevance: This psychological and physical preparation phase may impact a pregnant patient’s activity levels and stress. It can be considered when planning physical activity and stress management strategies.
Lightening
The dropping of the baby into the pelvis in preparation for birth.
Relevance: Lightening can affect the mother’s posture and mobility. Physical therapists might need to adjust interventions based on changes in the mother’s center of gravity.
Effacement
The thinning of the cervix during labor.
Relevance: Effacement is part of the labor process, influencing the type of physical support and positioning strategies that may be needed during labor.
Crowning
The stage during childbirth when the baby’s head becomes visible at the vaginal opening.
Relevance: Physical therapists may assist with perineal support and techniques to manage labor pain during this stage.
Episiotomy
A surgical incision made in the perineum to facilitate childbirth.
Relevance: Post-episiotomy, physical therapy might focus on pelvic floor rehabilitation and perineal care.
Apgar Score
A quick test performed on a newborn at 1 and 5 minutes after birth to assess their physical condition and need for immediate medical care.
Relevance: The Apgar score helps determine the newborn’s immediate physical health, which is crucial for planning any early intervention if needed.
Fontanelles
Soft spots on a baby’s skull where the bones have not yet fused.
Relevance: Fontanelles are assessed for normal development and head shape, which is important for identifying potential cranial abnormalities.
Normal Variance
Molding of the Head
The shaping of the baby’s head during delivery to fit through the birth canal.
Relevance: Molding is normal and typically resolves within a few days. Physical therapists should monitor head shape and development, especially in cases of prolonged or difficult labor.
Normal Variance
Caput
Swelling of the baby’s head caused by pressure during delivery.
Relevance: Caput usually resolves without intervention, but therapists should monitor it to ensure proper recovery and head shape.
Normal Variance
Cephalohematoma
Accumulation of blood between the baby’s skull and the periosteum, typically from a traumatic delivery.
Relevance: Cephalohematoma can lead to abnormal head shape or developmental issues; physical therapy might include cranial molding techniques if necessary.
Normal variant
Facial Asymmetry
Uneven appearance of the face, which can occur due to various factors including birth trauma.
Relevance: Facial asymmetry may affect feeding or developmental milestones, and physical therapists might work with the baby to address any related functional issues.
Normal variant
Milia
Small white cysts on a newborn’s face caused by clogged sweat glands.
Relevance: Milia are harmless and typically resolve on their own. Physical therapists should be aware of these conditions to avoid unnecessary concern.
Normal variant
Conjunctival Hemorrhages
Small areas of bleeding in the whites of the eyes, often caused by the pressure of delivery.
Relevance: These usually resolve on their own, but therapists should monitor for any signs of vision or developmental issues.
Normal variant
Preauricular Pits
Small pits or depressions near the front of the ear, which can be congenital.
Relevance: These are usually benign but may be associated with other congenital anomalies. Physical therapists should be aware in case they are part of a broader pattern of developmental issues.
Normal variant
Epstein’s Pearls
Small, white cysts found in the mouth of newborns, often on the roof of the mouth or gums.
Relevance: These are benign and usually resolve without treatment. Understanding their appearance helps prevent unnecessary concern.
Normal variant
Frenulum Linguae
The small band of tissue connecting the underside of the tongue to the floor of the mouth.
Relevance: A short or tight frenulum can affect feeding and speech development. Physical therapists may need to address these issues through oral motor therapy.
Normal variant
Mongolian Spots
Blue or gray patches on the skin of some infants, particularly in darker-skinned babies, which usually fade over time.
Relevance: Recognizing Mongolian spots prevents misdiagnosis of bruising or other conditions.
Normal variant
Breast Hypertrophy
Enlargement of the breasts, which can occur in both men and women, but also commonly noted in pregnant women.
Relevance: Breast hypertrophy in pregnant women may affect posture and comfort, influencing physical therapy recommendations and interventions.
Normal variant
Cutis Marmorata
A mottled, marbled appearance of the skin seen in some newborns, particularly when they are cold or distressed.
Relevance: This condition is usually temporary and associated with newborn circulation. Physical therapists should monitor skin changes to ensure proper circulation and comfort.
Normal variant
Facial Nerve Paralysis
Weakness or paralysis of the facial muscles, which can occur due to birth trauma or congenital conditions.
Relevance: Physical therapy may be needed to address motor function, facial exercises, and overall development if facial nerve paralysis is present.
Not considered pathologic unless it persists, most commonly involves only the lower part of the facial nerve
Breech Position
A fetal position where the baby is positioned feet-first or buttocks-first rather than head-first.
Relevance: Breech position can affect delivery methods and may require special considerations in physical therapy for both the newborn and the mother.
Tibial Bowing
Curvature of the tibia, often seen in newborns and usually resolves with growth.
Relevance: Tibial bowing can impact gait and alignment. Physical therapists monitor these changes and provide interventions if necessary.
Genu Recurvatum
Hyperextension of the knee joint.
Relevance: Genu recurvatum may affect mobility and alignment in infants. Physical therapy can include exercises to promote proper alignment and strengthen supporting muscles.
Congenital Amniotic Bands
Bands of fibrous tissue from the amniotic sac that can constrict or entangle parts of the developing fetus, leading to various limb or digit deformities.
Relevance: Infants with congenital amniotic bands may present with limb deformities or amputations. Physical therapists may be involved in developing individualized rehabilitation plans to address functional impairments, improve mobility, and support developmental milestones.
Intersex/Difference in Sexual Development (DSD)
A range of conditions in which an individual’s sexual anatomy or chromosomal pattern does not fit typical definitions of male or female. This can include ambiguous genitalia or discrepancies between chromosomal and anatomical sex.
Relevance: For infants with intersex traits or DSD, physical therapy might be part of a multidisciplinary approach to address any related physical or functional concerns. This can include supporting developmental milestones, addressing any physical challenges associated with the condition, and working closely with endocrinologists and other specialists.
Gestational age in weeks
4 (embryo)
Fetal Size and Development
1/8 inch (4 mm.)
fertilized egg implants on endometrium of uterus: single chambered heart beating; cell differentiation occurs; susceptible to teratogens
Gestational age in weeks
4 (embryo)
Maternal Changes
basal body temperature remains elevated after ovulation; nausea/morning sickness(~50% have); fatigue; no menstruation or slight spotting; breasts feel tight and tingly; can have positive pregnancy test
Gestational age in weeks
8
Fetal Size and Development
1 inch (28 mm.)
1 gram
very rudimentary facial features forming; arm and leg buds; highly susceptible to teratogens; primitive functioning of systems; placenta and umbilical cord forming; head makes up nearly half of embryo’s length, genetic expression of sex differentiationbegins
Gestational age in weeks
8
Maternal Changes
morning sickness worse now; mucus plug forms in cervix; breasts larger; uterus softens; frequent urination
Gestational age in weeks
12 (fetus)
Fetal Size and Development
3 1/2” (9 cm) 1/2 oz. (15 gm.)
eyelids formed, closed; genitals forming; finger/ toe nails forming; fingers well developed; kicks legs, closes fingers, bends wrist, turns head; frowns, opens/ closes mouth; organ differentiation occurring
Gestational age in weeks
12 (fetus)
Maternal Changes
morning sickness lessens by end of month; bladder pressure lessens; fetal heart tones audible by Doppler
Gestational age in weeks
16
Fetal Size and Development
6 1/2” (16 cm.)
4 oz. (100 gm.)
functioning liver and thyroid gland; blood forming in marrow; hair forming on head; lanugo is forming; skeletal ossification occurs and is visible on x-ray (though x-ray should be avoided); fetus begins to moveabout freely; placenta formed completely
Gestational age in weeks
16
Maternal Changes
uterus contracts (but she is unable to feel); blood volume and cardiac output increases; quickening
Gestational age in weeks
20
Fetal Size and Development
10” (25 cm.)
10 oz. (300 gm)
vernix caseosa forms on skin; period of rapid growth; finger/toe nails are formed completely; favorite position to sleep in; periods of sleep/awake like newborn; blood supply to lungs increases
Gestational age in weeks
20
Maternal Changes
fetal heart tones clearly audible by stethoscope; definite “quickening” noticed by this point.
Gestational age in weeks
24
Fetal Size and Development
12” (30 cm.)
1 1/4 lbs. (600 gm.)
skin less transparent and and wrinkled; vernix continues to accumulate; body well proportioned; eyebrows/eyelashes developing; baby can hear sounds; baby stretches, kicks and sucks thumb
Gestational age in weeks
24
Maternal Changes
period of rapid weight gain; stretch marks; drop in hemoglobin; linea nigra forms but will disappear/lighten after delivery; chloasma will appear but disappears after delivery; we know these latter 2 events are due to hormonal influences, but it is unclear why they occur.
Gestational age in weeks
28
Fetal Size and Development
14” (35-37 cm.)
2 1/2 lbs. (1000 gm.)
testes begin to descend in male fetus; eyelids open; fingerprints set; storage of subcutaneous fat begins; rapid growth continues; bones are developed but are soft and flexible; lungs have matured enough tosupportrespirationoutside the uterus (barely, more on this later)
Gestational age in weeks
28
Maternal Changes
blood volume is highest at this stage; weight gain continues; breathing may be difficult at times; heartburn; Braxton-Hicks contractions are stronger
Gestational age in weeks
32
Fetal Size and Development
16” (40-42 cm.)
4 lbs. (1700-
1800 gm.)
greater subcutaneous fat; period of rapid growth; body covered with vernix; storage of iron, nitrogen, and other nutrients
Gestational age in weeks
32
Maternal Changes
pelvic joints begin to relax due to relaxin; stretch marks deepen; heartburn common
Gestational age in weeks
36
Fetal Size and Development
18” (45-47 cm.)
5 lbs. (2000- 2500 gm.)
skin thicker and less wrinkled; subcutaneous fat accumulates; storage of maternal immunities from her past diseases
Gestational age in weeks
36
Maternal Changes
shortness of breath; ankle swelling; frequent urination; varicose veins more pronounced; baby settles into final position in mom’s pelvis, usually head down
Gestational age in weeks
(term 38-42 weeks)
Fetal Size and Development
18-22” (48-55 cm.)
7.5 lbs. (3400 gm.)
lanugo shed; body contours plump; cartilage in nose and ears well developed; male testes descended; less active since less room to move; finger and toe nails developed; eyes may have slate blue color–will have permanent color by age 3 mos. At birth: breathing rate is 35-50 b/min. and is rapid, shallow and abdominal; HR (heart rate) is 90-160 b/min, body temperature control is not well developed.
Gestational age in weeks
(term 38-42 weeks)
Maternal Changes
weight loss of 2-3 lbs, 3-4 days before labor, so shoes and rings are less tight; nesting instinct; lightening occurs; this happens about 2 weeks before labor in 1st pregnancies, but right before labor in subsequent pregnancies; with it comes less shortness of breath but more frequent urination and hips get wobbly, so is hard for mom to move around
Birth Stage 1
Early Preliminary
Preliminary
Accelerated Phase
Transition Phase
Birth Stage 1 Early Preliminary
Contractions: mild, irregular wave
Duration: 30-60 sec.
Interval: 5-20 minutes
Cervix: early effacement, recorded in %
Normal symptoms may include “bloody show”; rupture of membranes
Birth Stage 1 Preliminary
Contractions: stronger, more regular
Duration: 45-60 sec.
Interval: 2-4 minutes
Cervix—complete effacement
Dilatation: 0-3 cm.
Normal symptoms may include abdominal cramps, backache, rupture of membranes
Birth Stage 1 Accelerated Phase
Contractions: stronger, longer
Duration: 50-60 sec
Interval: 2-4 minutes
Cervix: dilatation 3-8 cm. (or 4-6 cm.)
Normal symptoms include rupture of membranes, increased backache.
