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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
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)
  • Second reason becoming more common:
    • age
  • Third reason:
    • low number of follicles with eggs at birth (not all women are born with the same number, and not all women have the same rate of ova loss
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  • Fourth reason:
    • levels of anti-mullerian hormone (AMH). AMH is produced by the ovaries (and by testes in men). In females, it interferes with FSH, such that not more than one ovum matures per cycle. Elevated AMH correlates with lower ovarian reserve: earlier loss of fertility. So, AMH can tell you what time it is in your biological clock. Blood test available.
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  • Reproductive technology can help infertile couples
  • Most recent dramatic technology:
    • Cloning
  • 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
        • lesbian couple
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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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PREGNANCY
  • 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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PREGNANCY
  • 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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PREGNANCY
  • 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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PREGNANCY
  • 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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PREGNANCY
  • TERATOGENS (Cont’d):
    • Maternal age:
      • no more obstetrical complications (if healthy)
      • increased Down’s syndrome
    • Paternal age: Increasing evidence:
      • autism (over 40)
      • schizophrenia (over 50)
      • cognitive problems
      • miscarriage
      • fertility down
      • other effects
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  • TERATOGENS (Cont’d):
    • All these teratogenic variations can:
      • affect maternal-infant interaction

and cause

      • 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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PREGNANCY
  • 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
    • Orgasm will only trigger labour if baby ready to be born
    • Mechanism: oxytocin
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  • Review oxytocin functions:
    • orgasm
    • uterine contractions
    • bonding
    • milk ejection reflex
    • when people touch each other oxytocin is released