Consume: {Folic Acid (400μg)}, {Calcium, magnesium, vitamin C, vitamin E (+25-50%)}, {Iron (+200-400%)}

Do Not Consume: Alcohol, smokables, illegal drugs

Human Chorionic Gonadotropin

(HCG)

Maintains Corpus Luteum

Placenta is established

starts to produce progesterone and estrogen

Hollow

Holds "inner cell mass" which will turn into the placenta

Identical: fertilized egg slits into two

Fraternal: two eggs/two sperm

3 Options

1. Single placenta, two amniotic sacs. 20% of all twins

2. Single placenta, single amniotic <1% of all twins. May result in siamese twins.

3.Two placentas, two amniotic sacs. 9% of all twins

Dizygotic Twins

Means two eggs + two sperm

7% of all twins

Two Kinds

1. Single placenta, two amniotic sacs

2. Two placentas, two amniotic sacs

-Twins are from different fathers

-Woman had ovulated again in the case of dizygotic twins

In first 13 weeks

(Week 8)

- placenta is established

- By Week 8 embryo measures 22-24 mm, weighs 1 gram, fingers and toes appear; ear buds on head

weeks 14-24

(Beginning and week 16)

- Characterized by improvement in how you feel

- Week 16: Fetus is 13-17cm. Weighs 100 grams

-Week 28: length 37 cm, 1kg. Fetus covered by Vernix Caseosa (white cheesy substance). 1/2 pre-mes live.

+Lungs still have no surfactant

- Week 32: Weight 1.7 Kg, length is 42cm, mst premies live

-Week 36: Weight 2.5 Kg. Length 47cm

-Week 40: Full term. Ave length 50cm. Ave weight 3-3.7kg, Skin still covered by vernix

Uterus: Gets about 500x bigger

Cervix: softens

Ovaries: Produce Relaxin (makes pelvic gurdle relax)

Vagina: Increased blood flow

Breasts: grow and develop

Heart: Heart rate goes up 10-15 bpm. Blood Pressure tends to drop

Skin: Skin "glows" because of estrogen. Chloasma (darkening cheeks). Linea Negra: (Dark line from belly ro fundus)

Kidneys and urine: More protein

Metabolism: Water retention and thirst increase. Protein met. increases. Carbs and fat are used differently

Weight Gain: ~20ibs

(Toxins that effect reproduction)

-Androgenic Agents

-Thalidomide

-Infectious agents

*Cytomegalovirus, Rubella, Toxoplasmosa Gondii

-Theraputic Radiation

Effects on Baby

Adrogenic Agents

Masculinization of female fetus

Labial Fusion and clitoral hypertrophy

Effects on baby

Thalidomide

Limb malfunction

Cardiac and gastrointestinal malformations

Effects on Baby

Cytomegalovirus

Effects on Baby

Rubella

Effects on Baby

Toxoplasmosa Gondii

Regular visits once per month until 7th month.

Twice per month until 9th month

Once per week in 9th month

*Complete blood count (CBC)

*STI, HIV, and hepatitis

*Blood type, RH

*Toxoplasmosis test

*Varicalla (chicken pox)

*Alphafetaprotein (AFP)

*Glucose

*Ultrasound

Alphafetalprotein test

(AFP)

-Mandated in Ca

-Produced by fetus under distress. Monitored in maternal blood

-Detection of neural defects: Spinal Bifida, Ancephaly, microcephally 

3 Types

1. Chorionic Villus Sampling

2. Amniocentesis

3. Cardiocentesis: Percutaneous Umbilical Cord Blood Sampling

- 10-12 week

- Benefit 

*Earlier in pregnancy

*Higher risk of fetal loss (1-1.5%)

-Two Kinds

*Transcervical

*Transabdominal

-15-23 weeks

-Transabdominal

-Benefit

*Detection of abnormalities

-Risk

*Infection (fetal loss <1%)

-Amniotic Fluids

*Fetal cells that have been sluffed off

*Waste products

Cardiocentesis

(Percutaneous Umbilical Cord Blood Sampling (PUBS))

-Similar to amniocentesis, needle through abdomen

-Similar to CVS, sampling fetal blood (Through umbillical cord)

-Performed after 20 week

-Benefit:

*Diagnostic blood gasses, infection, and karyotyping.

*Theraputic (intrauterine transfusion), fetal anemia, parvovirus B19.)

-Risk

* infection (fetal loss 1-2%)

Chromosomal and genetic defect testing

-Triple X

-Turners Syndrome

-xyy or xyy

-18 trisomy

-Edwards Syndrome

- Sexual Characteristics underdeveloped, often short.

-Taller than siblings, hearing difficulties 

18 Trisomy

(Edward's Syndrome)

-Mental deficiency

-Growth retardation

-90% die infancy

21 Trisomy

(Down Syndome)

-Mental Deficency 

-Flat nasal Bridge

-Protruding tounge 

-Congenital heart defects

Most Common Problem

-Cause: Iron deficiency due to increase in volume w/out increae in hemoglobin

-Treatment: Eat iron rich foods (red meats, soy beans, stark green veggies)

-Ectopic Pregency

-Spontaneous Abortion

-Molar Pregnancy

-Life threatening

-Fetus stuck in fallopean tube or cervix

-Symptoms

*Similar to pregnancy

*No Embryo

-Diagnosed 

*High HCG levels w/ no uterine enlargement. Ulterasound

*Treatment: Chemotherapy (methotrexate) or surgery

-Fetal loss at less than 20 weeks.

-Symptoms 

*Increased bleeding

*Severe Cramps

*back pain and fever

-In fetal tissue is not all removed, may turn into a cancer.

-Embryo starts to develop into uterine cysts.

 -can develop into choriocarcinoma (cancerous mass formed by fetal tissue

 Two kinds (complete and partial)

- Complete: zygote (1 egg + 1 sperm)

 -partial: 2 sperm + 1 egg

-Symptoms: Heavy bleeding, irregular heart beat, sweating, abnormal vaginal discharge (grapes)

-Treatment: Removal of "grapes". Scrape it out.

Less than 37 weeks. 

10% of pregnancies.

Account for ~25% perinatal mortality in US

-Precocious Fetal Endocrine Activation

-Placental Abruption

-Intrauterine infections

-Respiratory problems

*Chorionic lung disease (if especially younge)

-Gastrointestinal

*Inguinal hernia

-Hematalogical problems

*Anemia, jaundice

-Infections

-Cerebral Palsey, vision or hearing loss, and learning problems

*46% of premes suffer from these.

Risk Group For Premature Labor

(age)

Risk Group For Premature Labor

(Weight)

Risk Group For Premature Labor

(Genetic)

Runs in families

Short cervix (may sew shut)

Risk Group For Premature Labor

(other things)

Abnormally large amount of amniotic fluid

Smokers have 35% greater risk

Cocain and alcohol

Pre-eclampsia and Eclampsia

(Diagnosis)

-Hyper tension (140/90 or higher)

-Weight Gain (pounds per week due to water retention and swelling) edema

-Proteinuria

Pre-eclampsia and Eclampsia

(Risk Groups)

-Highest Risk if primagravida

-Later pregnancies by different dads (Unidentified male factor)

-High BMI

Pre-eclampsia and Eclampsia

(Affects on Mother)

-Affects brain and CNS

-Liver, kidneys, heart, and blood clotting

-Can result in maternal death

Pre-eclampsia and Eclampsia

(Effect on Fetus)

-Loss of circulation in mother causes placental abruption. Reduces O₂

-

Pre-eclampsia and Eclampsia

(Treatment)

-Induce labor or Cesarean

-Bed Rest

-Directly due to pregnancy

-Still makes insuline, but have an insuline resistance because placental lactogen is interferring with insuline.

Gestational Diabetes

(Effects on Mother)

-Gives what is like type 2 diabetes

Gestational Diabetes

(Effects on Fetus)

-Macrosomia- big body. baby is obese. 13-15 ibs

-Lung maturation delay

-Cerebral Palsey

-Still Birth

Gestational Diabetes

(Testing)

-Check blood sugar

-Glucose challenge test

Gestational Diabetes

(Risk Groups)

-Polycystic ovaries

-Family history

-Age

-Obesity

-2X if a smoker

-Placental Abruption

*Bleeding with pain

-Placental Previa

*Bleeding without pain

*Placenta in the way of the cervix and baby

Third Trimester Bleeding

(Treatment)

Cesarian

parturition

Triggers for Labor

(Step 1)

Fetal brain (hypothalamus and pituitary) signal adrenal glands to produce DHEAS

Triggers for Labor

(Step 2)

Triggers for Labor

(Step 3)

-Rising estrodiol (specific form of estrogen)

*Increased maternal production of oxytocin

*Increased oxytocin receptors in myometrium 

*Increased prostoglandin production leading to uterine contractions

-Earliest steps: Can be minutes to days

*Irregular contractions

*Fetus desends into canal

*Cervix begins to soften

Stage One (Dilation)

Stage Two (Expulsion/ Delivery)

Stage Three (Placental Delivery)

Stage Four (Bonding)

-Phase 1: Crowning

*Head pressing on perineum

*Episiotomy: Cut perineum

+Medio-lateral: Slants away from rectum

+Maedian: Directly back towards rectum

Phases Of Stage 1 (Dilation)

(Phase 1)

-Phase 1: Latent Early

* 12-14 hours 

* Cervix Effaces (thins) completely (100%)

+Effacement measured 0-100%

+Dilation measured 0-10 cm

Phases Of Stage 1 (Dilation)

(Phase 2)

-Phase 2: Active Labor

*Behavior changes to "work"

*Cervix dilates (4-8cm)

*Contractions get longer and more frequent

*Friedman Curve

+Early, active, transition

*Fetus helps by pushing with one foot

Phases Of Stage 1 (Dilation)

(Phase 3)

-Phase 3: Transition

*15mins to 2hrs

*Cervix dilated 7-10cm

*Monitoring 

+Maternal- Blood pressure, temperature, proteinuria, contractions (via external or internal pressure probes)

+Fetus- sonogram or doppler heart monitoring and scalp probe.

Phases Of Stage 2 (Expulsion/ Delivery)

(Phase 2)

- Phase Two: (Birth)

*Birth: head completely out

*Apgar Score: Breathing, muscle, abd skin tone

-Placental Delivery

*With in 5-30 minutes after birth

*occasionally requires manual removal

*High risk of maternal bleeding

+Uterine massage

+Pitocin

*Cord blood type

+RhoGam if needed

~If baby is Rh+ and mother is Rh-, second baby may be attacked by antibodies

~May make antibodies in breastmilk

First 13 weeks

(Week 12)

- By Week 12

*fingers and toes fully formed, have nails, external genetailia appear, fetus is 7-9 cm and weighs 14 grams

weeks 14-24

(week 20)

- Week 20: Quickening (baby movments) felt. Lanugo (white downy hair) covers body, heartbeat audible

weeks 14-24

(Week 24)