Pregnancy Problems, Complications, and Anomalies

1. Pregnancy Problems, Complications, and Anomalies

2. Pregnancy Problems and Complications • Although most pregnancies are normal, some pregnancies do have complications. • Today we will cover: • Birth Anomalies • Prenatal Testing • Ectopic Pregnancy • Multiple Births • Rh Factor • Spontaneous Abortion (Miscarriage)

3. Birth Anomalies • Almost everyone is born with some type of imperfection. Most, such as a birthmark, are relatively minor. Some babies are born with more serious problems. • A birth anomaly presents in infancy or later in life and is caused by events before birth, whether inherited, or acquired that affects the structure or function of the body.

4. Birth Anomalies • There are three basic factors that influence birth Anomalies: • Heredity: inherited from parents • Environment: factors surrounding the parent / child • A combination of heredity and the environment.

5. Genetic Anomalies • This term refers to anomalies that are truly hereditary. They are passed from parents to their offspring by the reproductive cells (sperm and egg). These traits are carried by the genes. If either of the prospective parents know that their families have genetic abnormalities, they should consult their family physician, who in turn may refer them to a genetic counselor.

6. Genetic Anomalies • Cystic Fibrosis • Down Syndrome • Phenylketnuria (PKU) • Sickle Cell Anemia • TaySach’s Disease • Hemophelia • Muscular Dystrophy • Adrenoleukodystrophy • Fragile X Syndrome

7. Birth Anomalies • Some anomalies caused by environmental factors: • Cerebral Palsy • Spina Bifida • FASD • Some anomalies may be caused by both: • Cleft Lip / Palate • Club Foot

8. Birth Anomalies • Some are caused by infections during pregnancy: • Toxoplasmosis • Fifth’s disease • Cytomegalovirus

9. Birth Anomalies • … However, the causes of about 60% of birth anomalies are currently unknown. • A single abnormal gene can cause birth anomalies and every human being has about 100,000 genes.

10. Birth Anomalies • We cannot change our heredity or the genes we pass onto children, but we can change some of the environmental factors. • These may include: • Diet • Disease or infections of the mother • Harmful substances ingested by the mother • Exposure to outside hazards such as radiation

11. Can birth anomalies be prevented? • While the causes of most birth anomalies are not known, there are a number of steps a woman can take to reduce her risk of having a baby with a birth anomaly. • Visit a health care provider for a pre-pregnancy check up. Especially if a woman has health problems • When pregnant take daily multivitamin containing 400 mg of the B-vitamin folic acid • Avoid alcohol, drugs, smoking, prescription or over-the-counter medications that haven’t been approved by a doctor.

12. Can some birth anomalies be diagnosed before birth? • Some birth anomalies can be diagnosed before birth. • Neural tube anomalies (spina bifida) • Down syndrome or other chromosome abnormalities • Inherited metabolic disorders • Heart defects • Gastrointestinal and kidney malformations • Cleft lip or palate • Certain birth anomalies of the limbs • Congenital tumors

13. Can some birth anomalies be diagnosed before birth? • Some prenatal tests that can be taken are: • Ultrasound • Amniocentesis • Chorionic villus sampling

14. Can birth anomalies be treated before birth? • Advances in prenatal therapy now make it possible to treat some birth anomalies before birth. • Prenatal surgery – urinary-tract blockages, rare tumors in the lungs, spina bifida

15. Ultrasounds • A technique that uses sound waves to show a picture of a baby (fetus) in the womb. • Ultrasound works by bouncing sound waves off the developing fetus. Echoes from the waves are converted into an image – called a sonogram – on a monitor. The technique is sometimes sonography.

17. Used for the following reasons: • Rule out an ectopic pregnancy • Confirm more than one baby • Verify due date • Evaluate fetal growth • Identify possible miscarriage • Determine causes of bleeding • Help perform other prenatal diagnostic tests • Diagnose certain birth anomalies • Check fetal well-being late in pregnancy • Help to select delivery method

18. Amniocentesis • A small sample of amniotic fluid surrounding the fetus is removed and examined to detect certain birth Anomalies (Rh disease, and strength of the lungs of the fetus) • Done in the second trimester - A thin, hollow needle inserted through the woman’s belly and uterus and some of the amniotic fluid is removed.

20. Chorionic Villus Sampling • Requires taking a small piece of the chorionic villi, which are wisps of tissue that attach the pregnancy sac to the wall of the uterus. The villi contain the same tissue makeup as the fetus. • First, the vagina and cervix are thoroughly cleansed with an antiseptic. • Then, using ultrasound as a guide, a physician inserts a thin tube through a woman’s vagina and cervix to the villi, and uses gentle suction to remove a small sample.

22. Two Months

23. Placenta Conditions • The placenta is an unborn baby’s lifeline. It forms from the same cells as the embryo, and attaches to the inner wall of the uterus. • The placenta forms connections with the mother’s blood supply, from which it transfers oxygen and nutrients to the baby.

24. Placenta Conditions • It also connects with the baby’s blood supply, from which it removes wastes and transfers them to the mother’s blood (her kidneys then dispose of the waste.) • It produces hormones that play a role in triggering labor and delivery, and protects the unborn baby from infections and potentially harmful substances.

25. Placenta Conditions • Two complications that can occur with the placenta are: • Placenta Abruption • Placenta Previa

26. Placenta Abruption • Placenta Abruption – (unknown cause) the placenta peels away from the uterine wall partially or completely before delivery. It can deprive the baby from oxygen and nutrients and cause bleeding in the mother that can endanger the mother and baby. If it is severe c-section delivery follows.

27. Placenta Abruption http://www.youtube.com/watch?v=WiKWk_0UbDY

28. Placenta Previa • Placenta Previa – low-lying placenta that covers part or all of the inner opening of the cervix. This placement of the placenta can block the baby’s exit from the uterus. A • As the cervix begins to thin and dilate in preparation for labor, blood vessels that connect the abnormally placed placenta to the uterus may tear, resulting in bleeding.

29. Placenta Previa • During labor and delivery, bleeding can be severe, endangering mother and baby. As with placental abruption, this can result in a premature baby. A woman diagnosed with placenta previa usually stays in the hospital until delivery and has a c-section.

30. Placenta Previa http://www.youtube.com/watch?v=dFkIoeiN_lo&feature=related

31. Ectopic Pregnancy • The egg attaches to the wall of the fallopian tube (or other surrounding tissue) instead of the uterine wall. The fetus produces enzymes that allow it to implant in varied types of tissues, and thus an embryo implanted in places other than the uterus can cause great tissue damage in its efforts to reach a sufficient supply of blood. An ectopic pregnancy is a medical emergency, and, if not treated properly, can lead to death.

32. Ectopic Pregnancy http://www.youtube.com/watch?v=HsYHtczWiWI

33. Multiple Births • The problem that might occur and does cause problems is simply the space. The uterus can only hold so much and multiple births (because of the lack of space) usually cause the mother to deliver before the babies are fully matured.

34. Rh FACTOR • The Rh factor is a substance found in the Red Blood cells of most people. Such people are said to be “Rh positive”. There are some people, however, who lack the Rh factor (“Rh negative”). Both conditions are inherited and both are considered normal. Rh factor is only a problem among mothers who have Rh negative blood. If the baby she is carrying has Rh positive blood, then the mother’s body will develop antibodies that destroy the red blood cells of the baby. These antibodies can cause complications from the baby having jaundice to stillbirth.

35. Rh FACTOR • However, early detection of problems can dramatically reduce complications. The development of antibodies becomes a problem with the second baby the mother gives birth to because the mother’s body does not develop many antibodies in the first pregnancy. When a physician treats a mother who is Rh-, he/she will give her a shot to neutralize any Rh+ blood cells that may have passed into the mother’s bloodstream to prevent the antibodies from being formed. After the birth of each positive baby, the shot, Roghamm, must be given.

36. Rh Factor

37. Spontaneous Abortion / Miscarriage • When the baby is involuntarily expelled from the body of the woman before it is viable (capable of surviving on its own), it is clinically termed a “spontaneous abortion”. You may be more familiar with the household term “miscarriage”. A spontaneous abortion should not be confused with a voluntary abortion, which is terminating the pregnancy by mechanical means.

38. Spontaneous Abortion / Miscarriage • Usually a spontaneous abortion (miscarriage) is nature’s way of eliminating an abnormal pregnancy. • Generally occurs in 1 out of every 5 pregnancies. • Experts suggest that approximately 60% of spontaneous abortions are a result of chromosomal problems.

39. Some common causes of spontaneous abortions are: • INFECTIONS: any type of acute infection carried in the body may be dangerous to the fetus. • OLD OR AGED OVUM: fertilized just before it dies. • DEFECTIVE IMPLANTATION: the placenta breaks loose due to a lack of hormones. • ECTOPIC PREGNANCY • CORD ACCIDENTS: the umbilical cord may be torn off or twisted.

40. Some common causes of spontaneous abortions are: • PLACENTA PREVIA • PLACENTA ABRUPTION • TOXEMIA: near the 24th seek, the mother gets swelling, puffy fingers, and feet. The body doesn’t use the protein correctly, which results in albumin (protein in the urine). This can cause convulsions, stillbirths, or maternal death. • HEMORRHAGE: usually caused by a placenta abruption or placenta praevia.

41. Spontaneous Abortion / Miscarriage • Most spontaneous abortions occur in the first trimester (the first 12 weeks). The baby usually dies two to four weeks before it is expelled. • If all of the products of conception are not completely expelled, it may be necessary for the doctor to perform a “D and C” (dilation and curettage). The walls of the uterus are scraped gently with surgical instruments to remove the remaining tissue.

42. Contributing Factors • Factors that contribute to Problems / Complications in Pregnancy: • Over 35 years of age. • Overweight • Underweight • Jewish decent • African American • Smoker • Drinks alcohol during pregnancy

43. Contributing Factors • Uses prescription drugs • Has used street drugs • Takes vitamins • Drinks caffeine • Has had exposure to chemicals • Live in a home built before 1955 • Constant exposure to cats • Has had x-rays during pregnancy • Health Problems

44. Contributing Factors • No immunizations against rubella • Rh factor • Last birth was less than 12 month ago • Has had a baby with a low birth weight • Has had 3 or more miscarriages • Has had more than 5 pregnancies • Has had a still born baby

45. Contributing Factors • There are so many contributing factors that a person cannot blame themselves for a miscarriage. • They are common. They do happen. It is generally nobody’s fault. • If a woman has had three or more miscarriages, there is more concern of something being wrong. • Testing may be able to identify a treatment to make the next pregnancy more successful.

46. Assignment • Research one thing you learned from today’s class in more detail (specific genetic anomalies, a pregnancy complication, placenta condition or prenatal test method. • Create a fact sheet / poster to educate someone about your chosen topic. • This should be done on the computer in power point or word format.

47. Choices of Topics • Cystic Fibrosis • Down Syndrome • Phenylketnuria (PKU) • Sickle Cell Anemia • TaySach’s Disease • Hemophelia • Muscular Dystrophy • Adrenoleukodystrophy • RH Factor • Toxoplasmosis • Fifth’s disease • Cytomegalovirus • Cerebral Palsy • Spina Bifida • Cleft Lip / Palate • Club Foot

48. Assignment • Fact sheet should include basic information, at least 2 pictures, and an interesting fact or two. • Fact sheet should include a header or footer of where you got your information (small font as to not take away from the beauty of your fact sheet) and your name. • You may work with 1 partner or on your own

49. Assignment • DO NOT JUST STEAL INFORMATION FROM THIS POWER POINT SLIDESHOW. DO YOUR OWN RESEARCH. • When you are finished save it under my public folder. Nikki Dirks. • I have done an example on the next slide. You may not use ECTOPIC PREGNANCY as your topic.

50. MISS DIRKS http://en.wikipedia.org/wiki/Ectopic_pregnancy ECTOPIC PREGNANCY 1 in 300 pregnancies are ectopic. What is an ectopic pregnancy? This is when the egg attaches to the wall of the fallopian tube (or other surrounding tissue) instead of the uterine wall. The fetus produces enzymes that allow it to implant in varied types of tissues, and thus an embryo implanted in places other than the uterus can cause great tissue damage in its efforts to reach a sufficient supply of blood. An ectopic pregnancy is a medical emergency, and, if not treated properly, can lead to death. DID YOU KNOW? On 19 April 2008 an English woman, Jayne Jones (age 37) who had an ectopic pregnancy attached to the omentum, the fatty covering of her large bowel, gave birth. The baby was delivered by a laprotomy at 28 weeks gestation. The surgery, the first of its kind to be performed in the UK, was successful, and both mother and baby survived. Oviduct with an ectopic pregnancy (tubal pregnancy) showing an embryo of approx. 6-7 menstrual weeks On May 29, 2008 an Australian woman, Meera Thangarajah (age 34), who had an ectopic pregnancy in the ovary, gave birth to a healthy full term 6 pound 3 ounce (2.8 kg) baby girl, Durga, via Caesarean section. She had no problems or complications during the 38 week pregnancy. Another example of a tubal pregnancy (fetus is 8 weeks gestational age, 6 weeks from conception)