Wk 3: Conception, fetal dev., genes, fertility, adoption, surrogacy Flashcards
1
Q
chromosomes
A
- You have 46 total
- 23 pairs
- sex chromosome is the 23rd one
2
Q
Haploid vs diploid chromosomes
A
- Haploid = Only sex chromosomes which are called gametes. They have a single set of unpaired chromosomes.
- Diploid = The presence of two complete sets of chromosomes in an organisms cells. 23 pairs.
3
Q
Karyotype
A
- A picture of all a person’s chromosomes
- Homologous = same genes arranged in the same order
4
Q
Homologous pairs
A
- having the same position, value, or structure
- Chromosomes come in homologous pairs
- Matching genes = one in each parent
- Gene for eye color for example
5
Q
DNA - deoxyribonucleic acid
A
- Carries genetic info
- Genes = rungs of the ladder.
- Give physical characteristics
- A chromosome has 100 to 1000s of genes
- More than one gene may be responsible for a trait. ie 3 genes for eye color.
6
Q
Traits
A
- Gene is a segment of dna that determines a trait
- Traits are determined by the genes on the chromosomes
7
Q
The work of chromosomes
A
- chromosome 14: Premature birth, slow growth before and after birth, short stature, small hands and feet, early onset of puberty
- c. 21: intellectual disablity, delayed dev., characteristic facial features such as down syndrome
- c. 22: Workings of the immune system, CHD, schizophrenia, cancers including leukemia
8
Q
Allele
A
- Every trait has at least two alleles
- ## They are the different possibilities for a given trait
9
Q
Dominant and recessive genes
A
- Dominant: prevents recessive from showing
- Recessive: a gene does not show even thought it is present. Must have two recessives to express gene
10
Q
Homo vs heterozygous
A
- Homo: RR or rr (both d or r)
- Hetero: Rr (combo of D and r)
- Refers to alleles in this case
11
Q
Chrome. mutations
A
- Less common than gene mutations…gene: CF, sickle anemia, celft palate.
- Chromosome mutations are more drastic: down syndrome, turner syndrome
- Caused by failure of homologous chromes. to separate during meiosis
- Pairs no longer look the same
12
Q
Terms of chromosome mutation
A
- Deletion
- Duplication
- Inversion
- Translocation
- Miscarriage may happen in these cases
13
Q
Examples: down syndrome
A
- Trisomy 21. 47 chromosomes
- extra chromosome pair at #21.
- Flattened nose and face
- Spacing of the toes, simean crease that goes all along the hand
14
Q
Mosaicism
A
- a condition in which cells within the same person have a different genetic makeup
- can affect any type of cell, including:
- Blood cells
- egg and sperm cells
- Skin cells - caused by an error in mitosis very early in dev. of fetus. Ex of mosaicism: turners, or down.
15
Q
X-linked recessive. Sex linked to mother.
A
- Means females carry the disorder
- females have a 50% chance of being a carrier
- Males have 50% chance of exhibiting the disorder when born to a carrier mother
- Besides hemophilia A & B, color blindness, and “fragile X syndrome”, are examples of this disorder
16
Q
Autosomal recessive pattern
A
- The gene in question is located on one of the numbered, or non-sex, chromosomes
- Diseases only expressed when 2 copies of the recessive allele are inherited
- Subsequent pregnancies carry same risk percentage as the first one:
- transmission not related to gender
- Marrying blood relative increases risk of this disease: 25% chance child will have it, 50% child is carrier, 25% chance child is neither carrier or diseased
17
Q
Autosomnal Dominant
A
- Only one abnormal gene from one paren tis necessary for disease/disorder manifestation
- The affected parent has 50% chance of having a child with the disorder
- Occurrence not affected by gender and occurs in each generation
- Normal or unaffected individual does not transfer/transmit disorder to offspring
18
Q
Examples of autosomnal dominant diseases
A
- Huntington disease
- Polycystic kidney disease
- Polydactyly
- Achondroplasia
- Neurofibromatosis
19
Q
Genetic counseling is:
A
- Estimation of risk:
1. occurrence of risk:- parents are known to be at risk for producing a child with disease
- Recurrence risk:
- once they have produced a child with disease
- Interpretation of risks
- parents are known to be at risk for producing a child with disease
20
Q
Punnet square
A
- One parent on top
- one on the side
- Each box is 25%
21
Q
The four symbols of a pedigree
A
- Circle = female
- Square = male
- Triangle = Stillborn
- Diamond = Miscarriage
22
Q
Gamete has how many total chromosomes ?
A
- 23 total chromosomes. Haploid!
- So each sperm and egg has 23 chromosomes !
23
Q
Fetal growth and development
A
- after sperm enters egg, within 38 hours, cell division begins
- by the 10th day the embryo embeds in the uterus
24
Q
Know
A
- zygote is the name of the fertilized egg
- Morula: 16 cells.
- Blastocyst: After morula, by 5th or 6th day. bunch o’ cells.
- Embryo until 8th week
- then fetus till birth
25
Q
By which day does the embryo implant in the uterus
A
By the 10th day
26
Q
Intervillus space in placenta
A
- where oxygen is absorbed, and baby’s CO2 is offput (gas exchange)
- Their blood does not mix, but chemicals can pass
- Spiral arteries involved
27
Q
Fetal growth chart
A
- Heart: wk 6 - 8
- Upper limbs: 6 - 8
- Eyes: wk 8 and past
- First 7 - 8 wks: the entire structure of the fetus
- 12 - 16 wks and after: its formed, and then they grow and mature.
28
Q
landmark devs. 6, 7, 8th wks
A
- 6 wks: heart beat
- 7 wks: essential organs start to form
- 8 wks: Size of a grape
29
Q
landmark devs. wk 12, 16, 20:
A
- 12 wks: 2 1/2 inches long
- 16 wks: 4 & half inches long
- 20 wks: 6 inches long, yawns makes faces
30
Q
landmark dev. wk 24
A
- 9 inches long
- Hiccups
- sucks thumb or toe
31
Q
Infertility
A
- Defintion: for women up to age 35, failure to get pregnant within one year of trying
- After age 35, failure to get pregnant after 6 months of trying
- Infertility does not include miscarrying or being unable to carry a baby to childbirth
32
Q
The most common overall cause of female fertility is the…
A
- ….failure to ovulate, which occurs in 40% of women with fertility issues
- Not ovulating may be a cause of:
- Primary ovarian insufficiency
- Polycystic ovary syndrome
33
Q
Infertility - male causes
A
- Male factors: decreased sperm count
- increased scrotal heat
- Impaired sperm motility/movement
- Smoking
- Steroids, prednisone, antihypertensives
- Tagamet can affect spermatogenesis
- Diabetes can cause vascular damage
34
Q
Female factors of infertility
A
- Age (over age 35 for women or over 40 for men)
- Anovulation can ocur for many reasons:
1. Hypothyroidism
2. Poor health
3. Consistent strenuous exercise (marathon runner etc)
35
Q
Female factors of infertility (pt. 2)
A
- PID w/ scarring or adhesions
- STDs
- Weight problems
- Eating disorders
36
Q
Female factors of infertility (pt. 3)
A
- Uterine problems: fibroids/benign tumors may block fallopian tube entrance or could decrease space available for pregnancy implantation
- Endometriosis: Implantation of endometrial cells outside of uterus and may block fallopian tubes
- Cervical problems; Infection can increase mucous decreasing sperm motility. - stenosis
- cervical polyps
37
Q
Infertility Assessment
A
- Complete hist for the couple:
1. previous illnesses
2. hist, meds, mensrtual hist
3. Track temp and track ovulation
38
Q
See table 5-1, p. 107 for assessments with infertility
A
39
Q
Medical tx for infertlity
A
- Laparoscopic or laparotomy to deal with adhesions, fibroids, endometriosis
- Be familiar with possible fertility meds such as clomid or pergonal which causes over-stimulation of ovaries, so requires close medical observation & frequent ultrasounds
40
Q
NRSG interventions r/t infertility
A
- Show compassion and willingness to listen
- Avoid telling couple how they’re supposed to feel
- Provide emotional support
- Accept resistance one partner may show
- Regarding tx options - be clear with pt edu, which should involve spouse/significant other
- Provide accurate info and avoid false hopes
41
Q
Infertility can negatively impact a marriage
A
- Blaming who’s at “fault”
- Refusing to allow for in-vitro fertilization
- Refusing to adopt
- Refusing to allow for surrogacy
42
Q
Adoption
A
- is a lifelong process
- The process is not a one time event
- The adoption itself is a one-time event, but the effects of living with adoption are lifelong
43
Q
History
A
- Informal adoptions prior to 1917
- Farmers had too many kids. Neighbor offers to take one and raise it for help on their own farm.
- 1917: closed adoption law
- 1930: All states formal laws on closed adoption
- 1960/70s: open adoptions more common
44
Q
Hist. cont. Cultural shift
A
- Unplanned pregnancy, 1970s, 30% adopted
- 2000s to the present: 49% abort, 49% keep baby, 1-2% adopt out
45
Q
Adoption today
A
- Planned adoption
- Surrogacy:
- 748 in 2004
- 1448 in 2010
- 2,8007 in 2015
- Gestational carriers (surrogate workers)
- Out sourcing to foreign countries
- Unique ethical issues
46
Q
Who is involved?
A
- Birth mother
- Agency
- Social worker
- Attorney
- Adopting/intended parent
47
Q
Costs: surrogacy
A
- $80,000 to $100,000 – own eggs or frozen embryos.
- Fees to agency, gest. carrier, attorney and social worker
- Legal and medical costs and money to cover the carrier’s maternity wardrobe and travel expenses
- Costs of harvesting the egg or embryo
- Incidentals include paying the gestational surrogate for any lost wages if she is put on bed rest or day care costs for her other children
48
Q
International adoption vs private domestic adoption
A
- International: $25,000 - $50,000
- Private domestic adoption: $20,000 - $35,000 –> application fee, agency fee, home visit, background checks, birth mother’s expenses, medical expenses, rematch fee (if baby is declined), termination rights fee, and father’s termination rights fee.
49
Q
Open adoption definition
A
- Birth mother signs the baby over to the adopting parents, but also signs an agreement about future contact, wether monthly, birthdays, etc.
50
Q
Seven core adoption issues
A
- Rejection
- Guilt/shame
- grief
- Identity
- Intimacy
- Mastery/control
- Loss
51
Q
Adopted person issue:
A
- Birth family
- bio, genetic, cultural hist.
- Belonging
- security
52
Q
Birth parent loss
A
- Child
- social isolation
- body and self image
- future relationships
53
Q
Adoptive parent loss
A
- “dream” child
- immortality ….. ?!?!
- self
54
Q
Adopted person (rejection)
A
- Not keepable
- self esteem issues
- fear of abandonment
- fear of exclusion
55
Q
Guilt and shame: adopted person
A
- Tainted
- A mistake
- Different
- Defensive/angry
56
Q
Guilt and shame: birth parent
A
- a secret
- How much to share?
- Who do I tell?
- Fears judgment
- Double blind
57
Q
Grief: Adopted issues
A
- Somatic issues
- no permission to grieve
- Depression
- Acting out
- Lack of “fit”
58
Q
Intimacy: adopted person
A
- Fear of getting close
- Concerns about incest
- Missed the story of the day they were born
59
Q
Intimacy: Birth parent
A
- intimacy = loss
- At risk for multiple relationships
- Impacts relationship with other children
60
Q
Intimacy: Adoptive parent
A
- Relationship difficulties
- Child’s distance triggers fear
- Missed early opportunities
61
Q
Emotions of affected people in adoption –> not all here, review in slides
A
62
Q
baby belongs to birth mom until relinquished.
A
- No guarantees this will happen
- Oregon law protects rights of pregnant women until relinquishment
63
Q
Labor & adoption
A
- Avoid intake interview with everyone present…I.E. Birth mom, her support person, + adoptive family
- Best: interview mom in private:
- Request all visitors to leave
- “what do you want?”
- “How can I support you?”
64
Q
Birth plan
A
- Usually have one. Look at it!
- Share info with other members of the healthcare team taking care of her
- Explain when/what is happening
65
Q
Time with baby
A
- Past was “out of sight, out of mind”
- Very important for birth mom to have quiet time with baby
- Encouraged to name baby, or choose together with involved adoptive family
66
Q
Relinquishing
A
- Cannot make a legal commitment until after delivery
- Usually at the time of mom’s discharge
- Formal papers are signed - many variations, dependent on hospital –>
- Relinquishing forms
- Hospital forms
- Wall goes up as placement happens
67
Q
relinquishing cont: Handoff
A
- Agency or attorney
- If to family, in the presence of…
- Requires proper photo ID and paperwork
- Placement ceremony, entrusting the care for this baby to the adoptive parents
68
Q
After discharge - adoption - coping
A
- 1 - 3 months usually most difficult
- Open adoption: see baby if appropriate, call adoptive parents
- Next few months continue to be difficult: Seeing adoptive family loving and caring for baby, observing baby thrive, personal life shifting back to “normal”
69
Q
Surrogacy
A
- Traditional surrogacy
- Gestational carriers (surrogate workers):
- Rate grew 89% in just 4 years. between 2004 - 2008 from 738 to 1400
- Income: $12,000 - $25,000 per pregnancy (0.50 per hour)
- Cost to intended parents: $40,000 - $120,000
- Many are military wives
70
Q
Outsourcing to foreign countries
A
- Unique ethical issues: women serving as surrogates come from families of the lowest income brackets - exploitation fo vulnerable women?
71
Q
Surrogacy definition: traditional
A
- Baby is biologically related
- Woman’s egg, donated sperm
- Artificial insemination (AI)
- She agrees to carry the child to term and thereafter relinquish her parental rights to the child
72
Q
Surrogacy: Gestational carriers
A
- Baby is not biologically related
- In-vitro fertilization
73
Q
Know slide 105 definitions!! … IVF:
A
- In vitro fertilization
- Removal of one or more eggs from a woman’s ovaries just before ovulation
-The eggs are then placed with sperm and fertilization takes place - The fertilized egg is then transferred to the woman for fertilization
74
Q
TDI
A
- Therapeutic donor insemination
- Formerly known as AID
- This involves the use of donor sperm to fertilize a woman’s egg, typically through artificial insemination
75
Q
GIFT definition
A
- Gamete intra fallopian transfer
- This procedure involves removal of the egg just before ovulation, then placement of the egg and sperm together into the woman’s fallopian tube, where fertilization will occur
76
Q
Egg donation
A
a woman donates her eggs for use by another woman in IVF or GIFT procedures
77
Q
Sperm donation
A
A man donates sperm for TDI
78
Q
Legal matters
A
- This is not an adoption, so we don’t say adoption parents
- we use “intended parents” when talking about genetic parents
- Declaratory judgment of parent
- Gestational carrier’s wishes are primary
- Unless parent’s have signed a Medical Power of Attorney for Medical decision making
79
Q
ID bands - check your hospital’s policy
A
- Surrogate: the newborns will be issued one set of ID bands
- The surrogate will be issued a corresponding ID band
- The final ID band is to be designated by the surrogate
80
Q
Gestational carrier w/ ID bands
A
- The newborn(s) will be issued two sets of ID bands
- One set for the gestational carrier and one set for the intended parents with their surname instead of the gestational carrier’s
81
Q
Birth certificate
A
- Oregon state law requires the name of the surrogate/gestational carrier on the birth certificate
- Leave the father’s name blank if the surrogate/gestational is married. If she is not married, the name of the adoptive father is put on the form
82
Q
Pathophysiology Mosaicism
A
- Mitosis goes bad
- may miscarriage
- 50% cells could be abdormal
- if happens later could be less severe
