Unit 2: Prenatal Growth and Development

Question 1

Female Fertility:

Answer 1

Average menstrual cycle is 28 days, day one is first day
In the average cycle, the ovum is released around day 14
Shedding of the uterine lining (menstruation) occurs approximately 14 days after ovulation, when an ovum fails to get fertilized (a woman is most fertile 11-14 days after her menstrual cycle begins)
This cycle repeats every 28 days or so throughout a woman’s reproductive lifetime
Female fertility is not always fertile

Question 2

Conception:

Answer 2

Also called fertilization, this is the moment a sperm penetrates an ovum
Once fertallized the ovum attaches to the wall of the uterus (where the lining of blood vessels and other tissue nourishes the developing child)
Menstruation stops for the duration of the pregnancy

Question 3

When Can Conception Occur:

Answer 3

Only when a living egg and sperm are in the same place at the same time
An ovum could potentially survive about 24-48 hours after being released from an ovary
Sperm can survive up to 5 days inside a female’s body
Taking into account the lifespan of both egg and sperm, conception can typically occur anywhere from day 11-16 of a woman’s cycle
The time frame to conceive is difficult to pinpoint as women don’t always know the exact moment an ovum is released
Many factors can affect ovulation timing so it is possible to get pregnant anywhere in a woman’s cycle

Question 4

Methods of Contraception: Abstinence

Answer 4

Function: No sexual intercourse
Disadvantages: None
Effectiveness: 100%

Question 5

Methods of Contraception: Oral Contraceptive - Hormone pill taken daily

Answer 5

Function: Prevents monthly release of ovum

Disadvantages: Prescription is needed, can cause weight gain, headaches, mood changes, Health risks for women who are over 35, smoke or have a family history of some diseases

Effectiveness: 94%-97%

Question 6

Methods of Contraception: IUD - Small plastic or metal device inserted into uterus

Answer 6

Function: Prevents pregnancy by interfering with implantation of fertilized ovum

Disadvantages: Doctor must insert. Increases risk of pelvic infection, may increase menstrual flow and cramping

Effectiveness: 94%

Question 7

Methods of Contraception: Male Condom - Latex sheath fits over penis

Answer 7

Function: Traps semen, reduces risk of sexually transmitted diseases

Disadvantages: Can break or slip off, can only be used once, damaged by hot or cold and petroleum products

Effectiveness: 86% - 90%

Question 8

Methods of Contraception: Natural family planning - System determines when ovum is likely to be released

Answer 8

Function: Prevents pregnancy by avoiding intercourse during fertile period

Disadvantages: Requires accurate record keeping, illness or irregular menstrual cycle can throw off calculations. Errors easily can be made.

Effectiveness: 80% - 90%

Question 9

Infertility

Answer 9

Couples who have been trying to conceive for over a year (if not over the age of 35, for over 6 months) without luck are considered infertile

There are many different factors that can affect fertility for both males and females, and once a couple is considered infertile they will undergo a series of medical tests to find the reason for infertility.

Question 10

Possible causes of infertility

Answer 10

Endometriosis
Emotional stress
Alcohol, tobacco, or drug use
Anorexia or starvation diets
Pelvic inflammatory disease (caused by abortion and STDS)
Polycystic ovary syndrome
Secondary infertility (possible result from a first pregnancy or delivery)
Male infertility

Question 11

Infertility Treatment: Fertility Drugs

Answer 11

Successes: About 20 to 60 percent of
women who use fertility drugs get pregnant.

Cost: Pills cost as little as that are 50mg each to $100 for higher dosage pills.

Question 12

Infertility Treatment: Surgery

Answer 12

Successes: About 40 to 60 percent of women

Cost: Medicare covers the cost of laparoscopic surgery in Canada

Question 13

Infertility Treatment: Artificial Insemination and Donor Insemination

Answer 13

Sucesses: About 5 to 25 percent of women who undergo artificial insemination conceive

Cost: $400-650

Question 14

Infertility Treatment: In Vitro Fertilization

Answer 14

Successes: Between 28 and 35 percent of women who try in vitro fertilization conceive

Cost: This procedure usually costs between $7,750 - $12, 250 ($250 for semen analysis
$2500 - $7000 for medication and $5000 for the IVF

Question 15

Roads to Parenthood:

Answer 15

Biological Parenthood
Adoption
Legal guardianship
Becoming a foster parent

Question 16

Understanding Heredity

Answer 16

An ovum and sperm cell contain 23 chromosomes each
When they unite they create a single cell with 23 pairs of chromosomes (46)
As the celll divides every resulting cell will contain copies of those 46 chromosomes
Each chromosome contains thousands of genes
Since genes come together in random combinations, every person is unique

Question 17

Determining Male or Female

Answer 17

X and Y chromosomes determine the sex of a baby
XX = Female
XY = Male
Mother provides the X
Father provides the X or Y
50% chance that the baby will be either sex

Question 18

Dominant and Recessive Genes

Answer 18

Dominant genes are stronger (brown eyes)
Dominant genes show effect even if there is one copy of that gene in the pair
Recessive genes are weaker (blue eyes)
To be expressed, recessive genes must be inherited by and from both parents

Question 19

Multiple Births

Answer 19

Most common cause is fertility treatments but may be hereditary
Twins are born once in every 89 births
Triplets are born once in every 7900 births
One mother in 705 000 has quadruplets
Fraternal twins are born when a woman produces two or more ova during the same menstrual cycle
Identical twins are conceived if a single fertilized cell divides and separates

Question 20

What is Genetic Disease?

Answer 20

A disorder caused by genetic factors and especially abnormalities in the human genetic material (Genome)

Question 21

Inheritance

Answer 21

Used to describe a trait given to you or passed on to you from one of your parents.

Examples of inherited traits would be eye colour or blood type.

Question 22

Chromosome Abnormalities

Answer 22

Chromosomes are stick like structures in the center of each cell (the nucleus) that contains your genes
Problems involving chromosome material cause about 6 percent of all birth defects

Question 23

Single Gene Defects

Answer 23

A defect in a gene is seen about 7.5% of all birth defects
Genes determine your traits

Question 24

Multifactorial Inheritance

Answer 24

Many factors (multifactorial) are involved in causing a birth defect
Factors are usually in genetic and environmental
About 20% of all birth defects are the result of multifactorial inheritance

Question 25

Multiple Births

Answer 25

Most common cause is fertility treatments but may be hereditary
Twins are born once in every 89 births
Triplets are born once in every 7900 births
One mother in 705 000 has quadruplets
Faternal twins are born when a woman produces two or more ova during the same menstrual cycle
Identical twins are conceived if a single fertilitized cell divides and seperates

Question 26

Prenatal Test: Ultrasound

Answer 26

The use of ultrasonic waves for diagnostic or therapeutic purposes, specifically to image an internal body structure or to monitor a developing fetus

Question 27

Prenatal Test: Amniocentesis

Answer 27

Is a specialized test that involves taking a sample amniotic fluid from your uterus and examining it in the laboratory to see where your baby has any abnormalities.

Question 28

Prenatal Test: Chorionic Villus Sampling (CVS)

Answer 28

Removal of a small piece of placenta tissue from uterus during early pregnancy to screen the baby for genetic defects.

Question 29

Genetic Counselling:

Answer 29

Helps parents who have concerns about diseases and disorders
Offers expert info about heredity and inherited disorders
Genetic Counsellors are specialist trained in diagnosing genetic conditions
Counselling cannot prevent birth defects
Counselling helps couples make informed decisions

Question 30

Early Signs of Pregnancy

Answer 30

A missed menstrual period
Bloating or mild ache in the lower abdomen
Feeling tired, drowsy or faint
Comfort or tenderness in breasts
Periods of nausea, especially early in the day
Food cravings

Symptoms may be caused by something other than pregnancy, a woman may take a pregnancy test to be sure (which can detect pregnancy before any of the symptoms arise)

Question 31

How long does pregnancy actually last?

Answer 31

Pregnancy is divided into three trimesters (lasting approximately 3 months)
Pregnancy is assumed to be 9 months, but it is normally measured in weeks
Expecting mothers are assigned a due date, which is an estimated date of birth. This due date is 40 weeks from the first day of the woman’s last menstruation.
A woman can give birth from 38-42 weeks, and the baby will be considered “full term” Women rarely give birth on their actual due date

Question 32

First Trimester (Week 1-12)

Answer 32

Week 6: The baby’s brain and spinal cord begin to form from the neutral tube. The heart and other organs start to develop.
Week 7: The baby’s face and brain growth, and nostrils form.
Week 8: The baby’s nose and upper lip form, along with the trunk of the neck begins to straighten
Week 9: The baby’s arms grow and elbows appear. Their toes are now visible. Eyelids form.
Week 10: The baby can now bend their elbow, toes and finger, lose their webbing and the umbilical cord is visible
Week 12: The baby’s fingernails develop. The baby’s face now has a more developed profile.

Question 33

Second Trimester (Week 13-27)

Answer 33

Week 14: The baby is as big as a navel orange, it stands up straight as the neck gets longer, and the fetus has a straightened-out appearance.
Week 16: The baby’s eyes begin working, the baby may be capable of making a few expressive frowns and squints. The baby can also see reception (light and darkness).
Week 17: Fingerprints of the baby’s toes and fingertips begin forming
Week 18: The baby has mastered yawning and hiccuping.
Week 20: Now is the chance to find out what sex the baby is, a scan is usually scheduled between 18-22 weeks
Week 21: At this week, the baby can taste the food the mother eats (taste buds develop).

Question 34

Third Trimester (Week 28-birth)

Answer 34

Week 27: hears sounds
Week 30: moves the head up and down
Week 40: fetus descends into the pelvis ready for birth
Week 25: increased fat under the skin makes the fetus look less wrinkled
Week 30: their vision will continue to develop inside
Week 25: the baby is growing hair

Question 35

Prenatal Medical Specialist: General Practitioner GP” (family doctor)

Answer 35

Confirms pregnancy and refers the pregnant woman to an obstetrician, many cases a woman may not see her OB until she is 20 weeks’

Question 36

Prenatal Medical Specialist: Obstetrician “OB-GYN” (doctor specializing in delivering babies)

Answer 36

Gynecologists (doctors who specialize in the female reproductive system) who choose to study obstetrics
Majority of births in Canada are delivered by obstetricians, who are able to preform vaginal or cesarean section births

Question 37

Registered Midwife

Answer 37

Medically covered in Ontario, midwives care for women with low-risk pregnancies and deliver the babies, if complications arise, a woman is transferred to an OB

Question 38

Prenatal Check-ups

Answer 38

Once pregnancy is confirmed, check-ups are often:
Every 4 weeks from 1-6 months
Every 2 weeks from 7-8 months
Every week from 8-9 months until birth

Question 39

Each visit a medical professional may:

Answer 39

Chart the mother’s weight and measure belly length
Take a urine sample
Complete an internal or external examination
Check the baby’s heartbeat using a fetal doppler
Discuss symptoms/concerns

Question 40

Prenatal Testing

Answer 40

Once pregnancy is confirmed, a woman will be offered several medical and laboratory tests throughout the pregnancy:
Diagnostic ultrasound (to check for proper growth and development (usually at around 12 weeks and 20 weeks)

Blood tests (to check for anemia, Rh incompatibility, STI’s other communicable viruses like the fifth disease)

Urine Tests (checks for substance use and protein levels)

Genetic screening tests

Glucose screening (to check for gestational diabetes)

Group B Streptococcus (GBS) screening and possibly other vaginal swabs (to test for bacteria that could require antibiotics during labour)
Bacteria may be present in the canal

Question 41

Discomforts experienced during Pregnancy

Answer 41

Nausea - “Morning Sickness”, rarely lasts beyond the 4th month, a doctor should be notified if severe and prolonged nausea occurs (hyperemesis gravidarum)

Sleepiness/Exhaustion - due to hormonal changes, women feel less tired in middle months, but the tiredness returns in the last few months

Heartburn - burning feeling in the upper stomach

Shortness of breath - occurs later in pregnancy due to pressure on lungs from growing baby

Development of varicose (swollen) - veins in legs, exercise, rest, and elevation can help

Muscle cramps - in the legs, Can be relieved by stretching and rest.
Lower back pain - due to a shift in the center of gravity, in some cases during the

Question 42

Warning Signs (when a doctor should be called)

Answer 42

Vaginal bleeding
Unusual weight gain
Excessive thirst
Reduced or painful urination
Severe abdominal pain
Persistent headaches
Severe vomiting
Fever
Swelling of face, hands, ankles
Blurred vision or dizziness
Prolonged backache

Question 43

Dangers and Complications

Answer 43

Caffeine intake should be limited

X-rays should be avoided during pregnancy

Preeclampsia (type of high blood pressure) symptoms need to be monitored closely as they can turn into eclampsia which can cause severe seizures and a coma to the mother and lack of oxygen to the baby

Symptoms: sudden weight gain, puffiness in hands and face, blurred vision

Gestational Diabetes can develop in some women only until the baby is out, this is what the glucose test is for

Many STIs can be transmitted from mother to baby or cause other effects on the fetus, which is why it is a part of routine prenatal screening

Question 44

What are Teratogens?

Answer 44

Danger to the fetus, an agent which can cause birth defects, it is usually something in the environment that the mother may be exposed to during her pregnancy

Examples:
Substance Use (Alcohol, Cannabis, Smoking, Illegal Drugs)

Medications (over-the-counter should always be taken after consulting with a medical professional)

Viral Infections (Rubella, Chickenpox, or toxoplasmosis from cat litter or feces)

Chemical hazards or fumes

Question 45

What is Miscarriage?

Answer 45

A miscarriage is the natural, spontaneous expulsion of the fetus from the uterus before 20 weeks of gestation

It is more common within the first 12 weeks of pregnancy
Approximately 1 in 6 pregnancies end in a miscarriage, so it is more common than we realize

Question 46

What is stillbirth?

Answer 46

A stillbirth is also a loss, but after 20 weeks

At this point, labour may need to be induced to expel the fetus

Question 47

Early Signs of Labour

Answer 47

The show or “bloody show”

The amniotic sac holding the fluid around the baby has broken (the “water” breaking)

In this instance, delivery should be within 24-48 hours to protect the baby from infection
When the uterus contracts, it pushes the fetus against the cervix, called contractions

Earlier in labour, the time between contractions is longer (with 20-30 minutes between them) but becomes shorter as labour progresses

Hospitals usually do not admit a woman in labour unless she satisfies the 5-1-1 rule (contractions that are 5 minutes apart, 1 minute in length, and last for at least 1 hour)

Question 48

Getting Induced

Answer 48

Some women do not experience natural signs of early labour, may require an OB/midwife to induce labour. Some ways a woman can be induced are:
Breaking of the amniotic sac
Ripening of the Cervix
Giving an IV medication to force contractions

Question 49

First Stage of Labour

Answer 49

First Stage of Labour (baby is ready to come out): The cervix is normal in size and shape at the start
Effacement - Thinning of the cervix
Contractions - Get stronger, last longer and are close together as labour progresses
Transition - The cervix has fully dilated to 10cm and the baby’s head slips out of the uterus into the birth canal

Question 50

Second Stage of Labour

Answer 50

Second Stage of Labour (baby coming out):
Crowning - the top of the head appears at the opening of the birth canal
The baby’s head emerges, and the rest of the body slips out

Question 51

Third Stage of Labour

Answer 51

Third Stage of Labour (delivery): The woman gives birth to the placenta no longer needed by the baby

Question 52

Complications

Answer 52

If a woman cannot push the baby out itself, the doctor can use forceps or a vacuum extractor

In a breech delivery = baby is born feet and buttocks first

A caesarean section (c-section: where a baby is delivered by cutting through the mother’s abdominal cavity) may be needed in the following circumstances:
Labour is too long and threatens the life of the mother and child
The baby’s heart rate drops
Placenta previa (the placenta covers the opening of the uterus)
A woman’s pelvis is too small, or she has multiple births

Question 53

The Newborn Baby

Answer 53

Eyes can be state-blue/gray or brown, individual eye colour does not develop until the baby is weeks or months old

Drops are placed in baby’s eyes to avoid infection (can sometimes cause swelling)

Newborn skin is covered in vernix (white creamy substance) that protects the fetus’ skin while in utero

Skin may look transparent, at first it can be blue until the baby starts taking in oxygen

The APGAR test is performed on the newborn to ensure that it is healthy and responsive. A score of 7 or above means the baby is healthy, a score below 4 could mean resuscitation is necessary