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PREGNANCY. Conception: Three trimesters = nine months = prenatal period Healthy vs. at risk pregnancies Importance of intrauterine environment. Stages of Childbirth Normal vs. complicated childbirth, mismanagement. Perinatal period: from beginning of labour to 72 hrs. postpartum

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PREGNANCY

Conception:

  • Three trimesters = nine months = prenatal period

    • Healthy vs. at risk pregnancies

    • Importance of intrauterine environment


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  • Stages of Childbirth

  • Normal vs. complicated childbirth, mismanagement.

  • Perinatal period:

    • from beginning of labour to 72 hrs. postpartum

  • Breastfeeding:

    • advantages for infant


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  • Conception:

    • Necessary:

      • sperm count

      • vaginal mucus

      • open Fallopian tubes

      • normal ovulation

      • normal hormonal levels


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  • 23rd pair of chromosomes: sex chromosomes

  • Male sperm smaller and faster

  • Vaginal pH (acid, neutral or alkaline)

  • Ovulatory mucus (vaginal) mid-cycle provides

    • right pH

    • sugars (nutrients)

    • conveyor


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  • Only a few hundred sperm arrive where egg is, in the Fallopian tube, and surround ovum.

  • Only one (usually) penetrates ovum

  • Stages of uterine development:

    • zygote:

      • 1-14 days

    • embryo:

      • 3-8 weeks

    • fetus:

      • 9-40 weeks


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  • Natural method of conception can fail

  • Most common reason:

    • STDs in both men and women, which lead to infertility (e.g. blocked Fallopian tubes or vas deferens)

  • Reproductive technology can help infertile couples

  • Most recent dramatic technology:

    • cloning


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  • More Established Reproductive Technologies:

    • Artificial Insemination:

      • Introducing sperm into woman’s vagina or uterus by artificial means

        • single woman

        • husband low sperm count

        • husband dead

        • husband infertile: donor sperm


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  • More Established Reproductive Technologies (Cont’d):

    • IVF: in vitro fertilization:

      • test tube or Petri dish is used to mix gametes; once dividing, surgically implanted into woman’s uterus

        • can use both parents’ gametes

        • one parent plus donor’s

        • can be implanted in surrogate’s uterus (“rent-a-womb”)


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  • Testing the Conceptus for Abnormalities:

    • amniocentesis (11-14 weeks)

    • CVS: chorionic villus sampling (villi) (6-8 weeks)

      • ultrasound (12-16 weeks)

      • fetoscopy

      • blood test


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  • Physical and Psychological Changes During Pregnancy:

    • Woman:

      • 1st trimester:

        • enlarged, tender breasts

        • amenorrhea

        • nausea (⅓ severe,⅓ mild, ⅓ none)

        • sleepiness (⅔)

        • aversion to some foods, odors

        • increased urinary frequency (hormonal)

        • mixed emotions, ambivalence, anxiety and exhilaration


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  • Physical and Psychological Changes During Pregnancy (Cont’d):

    • Woman:

      • 2nd trimester:

        • “quickening”

        • increased girth

        • well-being

        • mostly positive outlook, energy

        • preparatory behaviors, prenatal classes

        • some who rejected pregnancy accept it


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  • Physical and Psychological Changes During Pregnancy (Cont’d):

    • Woman:

      • 3rd trimester:

        • large abdomen, awkward

        • lost sleep due to:

          • frequent urination (weight of uterus on bladder)

          • difficulty turning over in bed

          • activity of fetus

        • anxiety increases (delivery, birth defects)

        • differences between fit and unfit women


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  • Physical and Psychological Changes During Pregnancy (Cont’d):

    • Woman:

      • 3rd trimester (Cont’d):

        • possible pregnancy complications:

          • edema

          • proteinuria

          • hypertension

          • diabetes

          • threatened early labor, etc.

        • moodiness, irritability, tiredness

        • not universal


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  • Physical and Psychological Changes during Pregnancy (Cont’d):

    • Man:

      • economic worries

      • feeling left out

      • “couvade”:

        • actual changes in hormonal levels

        • before birth more prolactin and cortisol

        • after birth, less testosterone

        • related to paternal role


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  • TERATOGENS:

    • anything that causes birth defects (teratos = monster)

    • Critical vs. sensitive periods

    • Maternal Diseases:

      • Rubella

      • Toxoplasmosis (cat’s feces, raw meat)

      • CMV

      • AIDS


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  • TERATOGENS (Cont’d):

    • Radiation

    • Chemicals:

      • absorbed through lungs or skin

    • High Temperature:

      • hot bath

    • General Environmental Pollution:

      • what we eat, drink, breathe, touch


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  • TERATOGENS (Cont’d):

    • Drugs:

      • prescription, e.g. DES, thalidomide

      • OTC

      • “recreational”, illegal

      • caffeine

      • aspirin, etc.


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  • TERATOGENS (Cont’d):

    • Smoking:

      • nicotine

        • CO:

          • 200 times more affinity to Hgb than oxygen

      • oxygen supply compromised (5% less)

      • decreases sperm motility:

        • lower fertility

      • less progesterone:

        • miscarriages

      • placental problems

      • higher morbidity and mortality

        • from 9/1000 to 33/1000

      • higher rates of cleft palate and hare lip


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  • TERATOGENS (Cont’d):

    • Alcohol:

      • FASD (fetal alcohol spectrum disorder)

        • brain abnormalities:

          • learning difficulties

          • ADDH

          • mental retardation, etc.

        • possible damage to eyes, ears, immune system, internal organs, joints, limbs

        • low birth weight

        • increased prematurity, miscarriage and stillbirth risk


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  • TERATOGENS (Cont’d):

    • Alcohol:

      • FASD (fetal alcohol spectrum disorder) (Cont’d)

        • growth retardation

        • facial and cranial malformations

        • dose and timing related

        • no safe dose

        • there is no cure for FASD

        • leading cause of preventable mental retardation


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  • TERATOGENS (Cont’d):

    • Dose Related:

    • Interactions: hard to tell main effects

      • Possible effects:

        • miscarriage

        • stillbirth

        • low birth weight

        • irritability, hard to soothe

        • shorter attention span (learning)

        • tremors

        • digestive difficulties


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  • TERATOGENS (Cont’d):

    • Possible effects (cont’d):

      • organ malformation

      • sluggishness

      • future cancers

      • visual impairment

      • skeletal malformation

      • brain development

      • genital abnormalities

      • prematurity


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  • TERATOGENS (Cont’d):

    • Possible effects (cont’d):

      • respiratory difficulties

      • illnesses

      • microcephalia

      • heart defects

      • breach births (more C-sections)


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  • TERATOGENS (Cont’d):

  • THERE ARE NO TOTALLY SAFE DRUGS!

    • Most vulnerable:

      • brain, CNS

        • learning problems

        • ADHD

    • Most common mechanism:

      • oxygen deprivation


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  • TERATOGENS (Cont’d):

    • Maternal stress:

      • acute or chronic (worse)

        • adrenaline, corticosteroids:

          • compromise oxygen supply for infant

      • after birth:

        • digestive problems

        • low birth weight

        • irritability


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  • TERATOGENS (Cont’d):

    • Maternal age:

      • no more obstetrical complications (if healthy)

      • increased Down’s syndrome

    • Other effects of these variables:

      • affect maternal-infant interaction

      • abuse

      • neglect

      • rejection


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  • Maternal Nutrition:

    • First trimester:

      • usually not an issue – special cases

    • Second trimester:

      • quality

    • Third trimester:

      • quality and quantity

    • Important:

      • Folic acid: prevents neural tube defects (eg. spina bifida)


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  • Maternal Nutrition (Cont’d):

    • Infant Optimal Weight:

      • 7½ - 8 lbs. (European stock)

    • Low Birth Weight:

      • 5½ lbs. or 2,500 g

    • Montreal Diet Dispensary, Agnes Higgins:

      • 500 extra daily calories:

        • 1 qt. milk

        • 1 egg

        • 1 orange


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  • Prenatal Care Essential:

    • Toxemia:

      • increased blood pressure

      • fluid retention

      • edema

      • can lead to eclampsia (fatal)

    • Gestational Diabetes


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  • Sex During Pregnancy

  • Woman’s comfort with own body important:

    • 1st Trimester:

      • tiredness, nausea

    • Male partner:

      • MOTHER image

      • fear of damaging baby


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  • Sex During Pregnancy (Cont’d):

    • 2nd Trimester:

      • buoyant, well-being, vaginal mucus

    • Individual differences:

      • some women feel sexy, others not

      • about 5th month: belly. Unattractive?


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  • Sex During Pregnancy (Cont’d):

    • 3rd Trimester:

      • abdomen large, awkward

      • new positions for sex

      • edema, tiredness, lack of sleep, too hot, hard to breathe


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  • Sex During Pregnancy (Cont’d):

    • Important:

      • Level of fitness, activity, diet, general health

      • Colostrum: some men uncomfortable

      • Issue of “fatness”

      • Fear of premature labor

      • Some men turned off


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