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6. PREGNANCY & CHILDBIRTH. 6. “To everything there is a season, and a time to every purpose under heaven.” - Ecclesiastes -. 6. HISTORICAL DIMENSIONS. 18 th CENTURY. France – midwives England – development of instruments America – physicians “wet nurse” vs. “dry nurse”.

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6

PREGNANCY

&

CHILDBIRTH


6

“To everything there is a season, and a time to every purpose under heaven.”

- Ecclesiastes -


6

HISTORICAL DIMENSIONS

18th CENTURY

  • France – midwives

  • England – development of instruments

  • America – physicians

  • “wet nurse” vs. “dry nurse”

19th CENTURY

  • Interventions – medications, anesthesia, birthing instruments

  • Hospital births


6

20th CENTURY

  •  technology, medicalization, hospitalization

  • Controlling fertility

  • Natural-birth relaxation techniques

  • 1970s: Benefits of breastfeeding resurfaced

  • Childbirth = joy and knowledge vs. fear and ignorance


6

PREGNANCY

CONCEPTION

  • Fertilization = Sperm Cell + Egg Cell = Zygote

    • Sperm Cell: 50 million produced/day

    • Egg Cell: 1 egg released/month

    • Dizygotic Twins = Fraternal Twins

    • Monozygotic Twins = Identical Twins


6

Selected Sex Chromosome Abnormalities

  • Normal (XY)

  • Turner Syndrome (Monosomy X, XO)

  • Triple X (XXX)

  • Klinefelter Syndrome (Trisomy XXY)

  • XXY Male


6

CONFIRMING PREGNANCY

Early Signs of Pregnancy

  • Symptoms often occur in first 6 weeks

  • Missed period(s)

  • Breast swelling/tenderness

  • Fatigue

  • Queasiness or nausea/vomiting

  • Elevated body temperature

  • Mood swings

  • Frequent urination


6

HORMONAL CHANGES

A/ Fertilization:

  • Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) produced by anterior pituitary gland is surpressed

  • Pregnancy-specific hormones increase (hCG and HPL)

B/ Implantation:

  • Embryo cells secrete hCG

  • Corpus Luteum stimulated and secrete estrogen and progesterone


6

C/ After 3 Months:

  • hCG levels decrease

  • Placenta produces estrogen and progesterone

  • Fetal adrenal glands produce precursor hormone to be converted into estrogen

  • Estrogen = regulate progesterone, fetal maturation (lungs, liver, organs mature), prepare breasts for lactation

  • Progesterone = suppresses uterine contractions, stimulates alveoli of breasts

  • HPL = physical changes in maternal system to accommodate fetus


6

PHYSICAL & EMOTIONAL SYMPTOMS

1st Trimester:

  • Enlarged and tender breasts

  • Morning sickness

  • Extreme fatigue

  • Decreased interest in sex

  • Moodiness and irritability

  • Skin changes

  • Darkening of nipple and areola


6

2st Trimester:

  • Morning sickness subsides

  • Gastrointestinal problems

  • Gain majority of weight (12-14 lbs)

  • Breathing problems

  • Backache

  • Leg cramps and numbness/tingling of hands

  • Swollen and bleeding gums

  • Braxton-Hicks contractions

  • Striae gravidarum

  • Chloasma

  • Linea nigra


6

3rd Trimester:

  • Heartburn

  • Constipation

  • Leg cramps

  • Backache

  • Breathlessness

  • Braxton-Hicks contractions

  •  Leukorrhea

  •  Colostrum

  • Hemorrhoids

  • Pelvic and buttock discomfort


6

A Pregnant Woman’s Body Changes:


6

FETAL DEVELOPMENT


6

PRENATAL CARE

NUTRITION

  • Consume additional 100 calories/day during 1st trimester

  • Consume additional 300 calories/day 2nd-3rd trimester

  • Folic acid

  • Calcium

  • Iron

  •  Fluid intake

  • Weight Gain: Average 25-35 lbs. total


6

EXERCISE

  • Benefits:

  • Feel better throughout trimesters

  • Shorter labor

  • Quicker recovery

    Forms:

  • Swimming

  • Walking

  • Low-impact aerobics

  • Kegel exercises


6

AVOIDING TOXIC SUBSTANCES

Cigarette Smoking:

  • 12.2% of women smoke during pregnancy

    • Native Americans (20%)

    • Hawaiian Americans (14.4%)

    • White Americans (13.2%)

  • Complications

    •  birth-weight

    • Infertility

    • Ectopic pregnancies

    • Placental irregularities and intrauterine growth retardation

    • Sudden Infant Death Syndrome (SIDS)


6

Fetal Alcohol Syndrome:

  • 12.8% of all pregnant women drank alcohol

  • Complications…

    • Growth retardation

    • Facial malformations

    • Central nervous system dysfunction

    • Mental retardation


6

Environmental Risk:

  • Pregnant women should avoid the following as precautionary measures to protect herself and baby…

    • Pollutants

    • Toxic wastes

    • Heavy metals

    • Pesticides

    • Gases

    • Radiation treatment

    • Diagnostic X-rays

    • Heat exposure


6

Prenatal Testing:

  • Ultrasound: (6th – 12th weeks)

  • Maternal Serum Alpha-Fetoprotein Screening (MSAFP): (13th – 20th weeks)

  • Chorionic Villus Sampling (CVS): (1st Trimester)

  • Amniocentesis: (15th – 18th weeks)

  • Rh Incompatibility: (Injection of Rh immune globulin after delivery, during pregnancy, after a miscarriage, after amniocentesis)


6

Chorionic Villus Sampling Procedure


6

Amniocentesis Procedure


6

COMPLICATIONS

MISCARRIAGE

  • 16% of all pregnancies

  • Pregnancy ends before 20th week of gestation

  • Bleeding and cramping

  • Cervix dilates and embryo is released

ECTOPIC PREGNANCY

  • 1 in every 40-100 pregnancies

  • Occurs 7th-8th week of pregnancy

  • Fertilized egg grows outside uterine cavity

  • Abdominal pain, spotting, ruptured fallopian tube, PID


6

PREMATURE LABOR

  • 10% of all babies are born early

  • If starts before 37th week

  • Normal labor lasts for 38 - 42 weeks

  • Warning signs…

    • Vaginal bleeding

    • Abdominal pain

    • Persistent nausea, vomiting

    • Unusual thirst

    • Fever/chills

    • Facial, feet, or finger swelling

    • Vaginal fluid leaks

    • Severe continuous headaches


6

GENETIC DISORDERS & CONGENITAL ABNORMALITIES

  • Cystic Fibrosis

  • Down Syndrome

  • Sickle Cell Anemia

  • Phenylketonuria (PKU)

  • Tay-Sachs Disease

  • Spina Bifida


6

INFECTIONS

  • Gonorrhea, Chlamydia, Syphilis  Miscarriages

  • Bacterial Vaginosis (BV)  birth weight,  risk HIV

  • Perinatal Transmission of AIDS AZT

  • Cytomegalovirus (CMV)   birth size, brain damage, developmental problems, enlarged liver, hearing and vision impairment, malformations

  • Group B Streptococcus (GBS)  sepsis, pneumonia, meningitis, long-term disabilities, death


6

CHILDBIRTH

PREPARATION


6

LABOR & DELIVERY

3 Distinctive Signs of Labor:

  • Uterine Contractions = every 5 minutes

  • Rupture of the Membranes = leak of fluids

  • Body Show = passage of mucous plug of cervix

  • = cervix dilates

Other Signs:

  • Diarrhea

  • Backache

  •  Braxton-Hicks contractions


6

3 STAGES OF LABOR


6

DILATION THROUGH STAGES OF LABOR


6

PAIN RELIEF IN CHILDBIRTH

  • Tranquilizers and Analgesics

  • Anesthetics

    • Epidural = injected through catheter beside spinal cord

    • Spinal = injected directly into spinal canal

    • Pudendal = injected into area around vagina and perineum


6

CESAREAN DELIVERY

  • Surgical incisions made in both the wall of the mother’s abdomen and her uterus

  • Reasons:

    • Cephalopelvic Disproportion

    • Multiple Births

    • Placenta Previa

    • Fetal Distress

      • Abruptio Placentae

      • Prolapsed Cord


6

BREASTFEEDING

THE FEMALE BREAST


6

BENEFITS OF BREASTFEEDING

For Baby:

  • Breast milk is highly nutritious

  • Breast milk contains enzymes to aid in infant digestion

  • Breast milk contains antibodies to protect against infection

  •  infant episodes of diarrhea

  •  infant cases of upper respiratory, ear and urinary infections

  • protect against type 1 diabetes, Crohn’s disease, SIDS, chronic digestive disease, childhood cancers

    For Mom:

  • Uterus returns to normal size more quickly

  • Return to pre-pregnancy weight more quickly

  •  risk of ovarian and breast cancer, osteoporosis


6

COMPLICATIONS OF BREASTFEEDING

  • Do not breastfeed if mother…

    • HIV infected

    • Untreated active TB

    • User of alcohol, tobacco, or other drugs

    • Undergoing cancer therapy/radiation treatment

  • Mothers may experience difficulties if…

    • Inverted, flat, raw, or cracked nipples

    • Severely swollen breasts

    • Problems with infant latching-on

    • Pain during latching-on

    • Mastitis


6

INFERTILITY

CAUSES

  • Female Infertility = 25% to 35% of couples

  • Male Infertility = 25% to 35% of couples

    • Azoospermia, Oligospermia

DIAGNOSIS

  • Ovulation Test and Cervical Mucus Test

  • Postcoital Test

  • Blood Test

  • Hysterosalpingogram, Laparoscopic Surgery


6

TREATMENT

  • Improve quality of cervical mucus = Estrogen

  • Stimulate ovulation = Clomid, GnRH

  • Assisted Reproductive Technologies (ART)

    • In Vitro Fertilization (IVF)

    • Gamete Intrafallopian Transfer (GIFT)

    • Zygote Intrafallopian Transfer (ZIFT)

    • Intracytoplasmic Sperm Injection (ICSI)

    • Egg Donation

    • Embryo Transfer

    • Host Uterus

    • Surrogacy


6

EMOTIONAL EFFECTS OF INFERTILITY

  • Anger and resentment towards partners

  • Guilt and blame towards oneself

  • Depression and frustration

  • Miscommunication

  • Confusion

  • Grief

  • Despair

  • Loss of control


6

EPIDEMIOLOGY

LIVE BIRTH RATES PER 1,000 WOMEN IN SPECIFIC GROUPS, U.S.


6

BREASTFEEDING

  • In 1993 = 58.1% mothers breastfed

  • In 1998 = 64% mothers breastfed

    • Whites = 68%, Hispanics = 66%, Blacks = 45%

INFERTILITY

  • 15% of U.S. women of childbearing age sought treatment for infertility

  • In 2000 = 35,025 babies were born using ART


6

INFORMED DECISION MAKING

CHOICES OF ART PROCEDURES IN U.S., 2000


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