CH. 5 – PRENATAL CARE •  The prenatal period, which lasts about 280 days, is the shortest stage in

the life span, but also the most critical time for a child’s development •  Proper prenatal care is crucial for all mothers-to-be. •  The March of Dimes encourages mothers to “be good to your baby before

it is born” •  As soon as a woman believes she is pregnant, she should seek prenatal

care •  Starting good prenatal care early in pregnancy greatly reduces the risk of

complications •  SIGNS OF PREGNANCY • A woman cannot feel the sperm and ovum unite, nor can she feel cells divide

as the baby begins to develop. Her body, however, immediately begins to nourish and protect the new life. • Hormones trigger changes in some of the woman’s organs • Knowing the signs of pregnancy help a woman recognize these changes.

SIGNS OF PREGNANCY - PRESUMPTIVE Presumptive Signs-Signs that could be signs of pregnancy, or they could

be signs of another condition

Amenorrhea (Menstruation Stops)

If the woman is usually regular in her menstrual cycle, a delay of 10 or more days is a sign

Nausea Nausea is present in about ½ to 2/3 of all pregnancies. Because it often occurs in the morning hours, it is call morning sickness. Nausea may happen at any time of the day. Nausea occurring at the same time daily from weeks 4 to 12 is a sign

Tiredness Many women feel tired during the first few months of pregnancy

Frequency of Urination The growing uterus puts pressure on the bladder. Hormones may also cause more frequent urinatoin

Swelling and Tenderness of the

Breasts This is often the first sign women note

Skin Discoloration Stretch marks may be seen as the breasts and abdomen enlarge. Darkening of skin may occur on the face and nipples.

SIGNS OF PREGNANCY - PRESUMPTIVE Presumptive Signs-Signs that could be signs of pregnancy, or they could

be signs of another condition

Internal Changes

Doctors often note softening of the cervix (goodell’s sign). There may also be a softening of the lower part of the uterus (Hegar’s sign) and a bluish tinge to the vagina and cervix due to circulatory congestion (chadwick’s sign). The uterus is also enlarged with irregular areas of firmness and softness (Piskaceks sign)

Other Signs Other symptoms include backache, groun pains, dizziness, abdominal swelling, leg cramps, varicose ceins, and indigestion.

SIGNS OF PREGNANCY – POSITIVE SIGNS (DEFINITELY CAUSED BY PREGNANCY)

HCG (Human Chorionic

Gonadatrophin)

HCG is a hormone found in the blood and urine of pregnanct women. Lab tests may detect the homrone’s presence as early as the first 2 weeks of pregnancy.

Fetal Heartbeat This can be heard through a special device at 12 weeks and through a stethoscope at 16 weeks

Fetal Movement Spontaneous movement begins at 11 weeks, but is not felt until 16-18 weeks

Fetal Image This may be seen with ultrasound scanning

Fetal Shape The baby’s shape my be felt through the abdominal wall

Uterine Contractions A doctor may note these painless contractions

MEDICAL CARE •  Medical care is the best way to make chilbearing safe and

successful. •  If a woman believes she is pregnant, she should make an

appointment with a doctor as soon as possible. •  Many women choose to visit obstetricians, or doctors who

specialize in pregnancy and childbirth.

THE FIRST APPOINTMENT The first prenatal appointment sets a foundation for medical care

throughout pregnancy. It is a good idea for the couple to go to the visit together. They can share

important information with the doctor and learn much about what to expect in the months ahead.

First, the doctor will gather general information, such as: age and health history of each parent

Next, the doctor will ask details about the woman’s menstrual cycle and any past pregnancies

The doctor will also answer any questions the couple has about pregnancy

THE FIRST APPOINTMENT The visit continues with a complete physical exam for mom that includes: weight, height, pulse, and blood pressure The doctor will also check her breasts and perform a pelvic exam The doctor will measure the woman’s pelvis to be sure it is large enough to allow the baby’s head through during delivery.

Urine and blood tests will be done The blood tests check for blood type as well as anemia, which is a condition caused by lack of iron, and diseases that can harm an unborn child. Some women may also have their blood sugar level checked.

THE FIRST APPOINTMENT The doctor will advise the couple on health habits (most pertaining to mom),

some of which are directed towards dad (ex. Smoking) At the end of the check up, the obstetrician estimates the due date for the

baby’s birth, which is now given as the expected week of birth. This may be adjusted later.

Usually the doctor sees a pregnant woman once a month during the first 6 months of pregnancy. Visits increase to twice a month during the 7 and 8 months. During the 9th month, once a week or more.

Each appointment is important and having a doctor monitor the pregnancy lessens the discomforts and increases the confidence of the couple

THE UNBORN BABY’S ENVIRONMENT As soon as conception takes place, the baby begins to form traits

from both the mother and the father These inherited traits, or genetic factors, are merged into a unique

person. These will influence the child’s growth and development throughout

life, however, development is not solely determined by only genetic factors.

Immediately after conception, the environment begins to influence the baby’s traits.

Environmental factors are those factors caused by a persons surroundings. The prenatal environment is the mother’s body and this will affect the baby.

FACTORS THAT AFFECT THE BABY’S HEALTH

An unborn baby depends on the mother for a healthy start Some women are called HIGH-RISK mothers-to-be This describes a pregnant woman with environmental factors that do not promote a healthy pregnancy.

FACTORS THAT AFFECT THE BABY’S HEALTH Some of these factors are: Mom’s Environmental Factors: Mother’s Age:

§ In regard to health, the ideal time for a woman to have a baby is between ages 21 and 28.

§ Teens and women over 36 are high-risk § Teens are still growing themselves, so their bodies cannot always

meet the needs of babies. § Very young teens tend to have babies who are Premature, ( born

too soon) have low birthweight (babies who weigh less than 5 1/2 lbs. @ birth, have disabilities or are born stillborn (not living)

§ Women over 36 have a higher rate of babies with: health problems, disabilities, and disorders

Mother’s Physical Health Mother’s pre-pregnancy health greatly affects the outcome of

pregnancy Mother’s Health affects the baby’s health before and after birth If there are any problems that affect pregnancy, they should be

discussed with the doctor, who should monitor these problems more closely. They may:

§ Do special testing § Give medications § Adjust treatments for the safety of the unborn Being underweight or overweight can lead to serious health problems

for mom and baby

FACTORS THAT AFFECT THE BABY’S HEALTH

FACTORS THAT AFFECT THE BABY’S HEALTH – RH FACTOR The Rh factor is a protein substance found in the red blood cells of about 85% of the

population § People who have it are called Rh positive (Rh+) § People who don’t are called Rh negative (Rh-) §  In 12% of all parent couples, a problem is caused for baby when dad is Rh+ and

mom is Rh-. The baby can inherit the blood type from the father and may develop Rh disease, which is a type of anemia that destroys the baby’s red blood cells § This DOES NOT affect the first Rh+ unborn, however, the babies Rh+ cells

enter the mothers bloodstream during pregnancy in about 4% of cases These cells are foreign to mom’s Rh- system, so her body tries to fight these cells by making antibodies. This results in mom having immunity to the blood cells of her future Rh+ babies.

§ These antibodies cross the placenta and if the baby has Rh+ blood, the antibodies destroy the babies red blood cells.

§ If this happens, a vaccine called anti-Rh-immune greatly reduces the risk of Rh disease

§ An Rh- mom receives the vaccine within 72 hours after the birth of each Rh+ baby. This blocks the growth of antibodies in moms body and is almost 100% effective.

RH FACTOR

FACTORS THAT AFFECT THE BABY’S HEALTH Mothers Emotional Health Positive thoughts and feelings are important for a woman to have

a healthy baby Negative feelings can stimulate the nervous system and the flow

of adrenaline Both control heart rate, breathing, and muscle tension When mom is under stress, adrenaline crosses the placenta to

the baby, carrying stress signals. The unborn baby can handle some stress, however, if it is severe,

long-lasting, or frequent, the mother may have a more difficult delivery and a baby that is smaller, fussy, or overactive

HEALTH HABITS DURING GPREGNANCY HEALTH HABITS DURING PREGNANCY Good health habits are always important and during pregnancy,

certain health habits change. A woman may have to: Eat more of some foods Take vitamin supplements Be more cautious about her physical activities Give up active sports.

HEALTH HABITS DURING GPREGNANCY NUTRITION During the first week, the baby is fed entirely on the content of the ovum’s yolk

sac After embedding, the fertilized egg feeds on mucous tissues that line the womb By the 12th week, the baby completely depends on the mother for food. Scientists now feel a woman needs essential nutrients throughout her life to

prepare for pregnancy Good nutrition before pregnancy builds nutrient stores in her body Pregnant teens under 17 have more nutrition problems because they’re still

growing and their bodies haven’t had enough time to build up these stores Good nutrition during pregnancy is vital and there is a direct link between what a

pregnant woman eats and: Her weight gain as well as the baby’s The infant’s growth The infant’s mental capacity The infant’s physical performance

HEALTH HABITS DURING GPREGNANCY NUTRITION (continued) Diets for pregnant and nursing mothers provide more calcium, iron,

folic acid, and protein than those for nonpregnant women Folic acid prevents birth defects of the baby’s brain (anencephaly)

and spine ( spina bifida) Caffeine intake should be limited during pregnancy (Coffee, tea, pop,

chocolate, etc.) Should not exceed the amount of caffeine in one cup of coffee.

HEALTH HABITS DURING GPREGNANCY WEIGHT GAIN Experts suggest women gain between 25 - 35pounds in pregnancy More should be gained for multiples (Ex: 40-45 lbs. for twins) Exact amount depends on mom’s height and prepregnancy weight Pregnant women need to eat 300 extra calories per day starting in her

4th month of pregnancy (more calories for multiples). Weight gain during pregnancy is not all store as fat Too much weight gain can put stress on the heart A woman should steadily gain a health amount of weight during her

pregnancy: First 3 months = about 4 pounds total 4 to 9 months = About 3 - 4pounds per month (with most of the weight

gain occurring from 7 to 9 months).

WEIGHT GAIN

7.5 2 1.5 2 3.5 1.5 4 4 26

HEALTH HABITS DURING GPREGNANCY WEIGHT GAIN Experts suggest women gain between 25 - 35pounds in pregnancy More should be gained for multiples (Ex: 40-45 lbs. for twins) Exact amount depends on mom’s height and prepregnancy weight Pregnant women need to eat 300 extra calories per day starting in her

4th month of pregnancy (more calories for multiples). Weight gain during pregnancy is not all store as fat Too much weight gain can put stress on the heart A woman should steadily gain a health amount of weight during her

pregnancy: First 3 months = about 4 pounds total 4 to 9 months = About 3 - 4pounds per month (with most of the weight

gain occurring from 7 to 9 months).

HEALTH HABITS DURING GPREGNANCY WEIGHT GAIN Experts suggest women gain between 25 - 35pounds in pregnancy More should be gained for multiples (Ex: 40-45 lbs. for twins) Exact amount depends on mom’s height and prepregnancy weight Pregnant women need to eat 300 extra calories per day starting in her

4th month of pregnancy (more calories for multiples). Weight gain during pregnancy is not all store as fat Too much weight gain can put stress on the heart A woman should steadily gain a health amount of weight during her

pregnancy: First 3 months = about 4 pounds total 4 to 9 months = About 3 - 4pounds per month (with most of the weight

gain occurring from 7 to 9 months).

HEALTH HABITS DURING GPREGNANCY HYGIENE PRACTICES Many doctors suggest pregnant women do the following: Dental Check-Ups -Recent studies show a link between gum disease in pregnancy

and early birth Avoid very cold or hot baths and hot tubs Wear comfortable clothes and low-heeled shoes Replace tub baths with showers or sponge baths during the last 4 to 6 weeks of

pregnancy to help prevent internal infection as well as possible falls. REST AND SLEEP Many doctors advise 8-9 hours of sleep a night In addition, pregnant women also need a 15-30 minute rest (with or without

sleep) during the day. Many women feel most tired during the first few last few weeks of pregnancy

HEALTH HABITS DURING PREGNANCY PHYSICAL ACTIVITY AND EXERCISE Unless told otherwise by her doctor, a pregnant woman can and

should be active. It helps: Keep with within normal limits Strengthens muscles women use in delivery Increases energy Relieves tension

Many doctors advise mothers-to-be to avoid: contact sports activities that jolt the pelvic region activities that could result in falls

HEALTH HABITS DURING PREGNANCY PHYSICAL ACTIVITY AND EXERCISE Unless told otherwise by her doctor, a pregnant woman can and

should be active. It helps: Keep with within normal limits Strengthens muscles women use in delivery Increases energy Relieves tension

Many doctors advise mothers-to-be to avoid: contact sports activities that jolt the pelvic region activities that could result in falls

CH. 5 - PT. 4 - COMPLICATIONS OF PREGNANCY Pregnant women can greatly reduce the chance of problems in their pregnancies by receiving prenatal care, following doctors advice, and

practicing good health habits. Complication can occur in ANY pregnancy

Complications in pregnancy require immediate medical treatment to protect the health of mom and baby

PROBLEM CAUSE SYMPTOMS

ECTOPIC PREGNANCY

DEVELOPMENT OF

THE FETUS OUTSIDE OF THE UTERUS

BLOCKED FALLOPIAN TUBE

SPOTTING AND CRAMPING

UTERUS DOES NOT

ENLARGE AS IT SHOULD

RUPTURE OF FALLOPIAN TUBE

PROBLEM CAUSE SYMPTOMS

TOO MUCH AMNIOTIC FLUID

UNCONTROLLED DIABETES

MULTIPLE PREGNANCY

INCOMPATIBLE BLOOD TYPES

CONGENITAL PROBLEMS

EXCESSIVE PRESSURE ON MOMS BODY

BREATHING PROBLEMS

CONGENITAL

PROBLEMS IN THE NEWBORN

TOO LITTLE AMNIOTIC FLUID

CONGENITAL PROBLEMS

GROWTH PROBLEMS

DEATH OF FETUS

FETAL MOVEMENT SLOWS OR STOPS

BLEEDING LATE IN PREGNANCY

PLACENTA ABRUPTIO/PREVIA

VAGINAL OR CERVICAL

INFECTION

BLEEDING (OFTEN HEAVY)

PROBLEM CAUSE SYMPTOMS

PLACENTA ABRUPTIO

PLACENTA BECOMES

DETACHED FROM THE UTERINE WALL BEFORE IT SHOULD

UNKNOWN

OCCURS MORE IN MOMS WHO SMOKE, HAVE HIGH BLOOD

PRESSURE, HAVE HAD PREVIOUS CHILDREN OR A

HISTORY OF DETACHED PLACENTAS, SUFFERED

INJURY TO THE ABDOMEN, OR ARE CARRYING MULTIPLES

BLEEDING

CRAMPING

ABDOMINAL TENDERNESS

PLACENTA PREVIA

PLACENTA ATTACHES ITSELF TO

THE UTERUS NEAR OR COVERING THE

CERVIX RATHER THAN IN THE UPPER

HALF OF THE UTERUS

SCARRING OF THE UTERINE WALL FROM A PRIOR

PREGNANCY

TUMORS OF THE UTERUS

MORE COMMON AMONG MOMS WHO SMOKE, USE DRUGS, ARE

OLDER THAN 35 AND ARE CARRYING MULTIPLES

BRIGHT RED BLEEDING WITHOUT

PAIN OR TENDERNESS OF

THE ABDOMEN

PROBLEM CAUSE SYMPTOMS

PREGNANCY-INDUCED

HYPERTENSION

MULTIPLE FETUSES

TEEN PREGNANCY OR PREGNANCY OF WOMAN OVER

40

HIGH BLOOD PRESSURE

KIDNEY DISEASE

SUDDEN SWELLING OF HANDS AND

FACE

HIGH BLOOD PRESSURE

HEADACHE

DIZZINESS

FEVER

IRRITABILITY

PROTEIN IN URINE

A

CONGENITAL PROBLEMS A congenital problem is a physical or biochemical problem in a baby

that is present at birth It may be inherited or caused by environmental factors These disabilities and diseases occur with varying degrees of

severity

PROBLEM SYMPTOMS CAUSES TREATMENT

CLEFT LIP/PALATE

NOTICEABLE AT BIRTH

CLEFT LIP: WHEN 2 SIDES OF THE UPPER

LIP FAIL TO GROW TOGETHER PROPERLY

CLEFT PALATE:

OCCURS WHEN AN OPENING REMAINS IN THE ROOF OF THE

MOUTH. THIS CREATES PROBLEMS

IN BREATHING, TALKING, HEARING,

AND EATING

VARIABLE Often caused by a number of factors working together

SMOKING and severe

DIETING may be factors

CORRECTIVE SURGERY AND

SPEECH THERAPY

PROBLEM SYMPTOMS CAUSES TREATMENT

CYSTIC FIBROSIS

A chemical failure affects lungs and

pancreas. Thick, sticky mucus forms in the

lungs, causing breathing problems. Reduced amounts of digestive juices cause poor digestion of food. An excess amount of

salt is excreted in perspiration.

RECESSIVE GENE

NO CURE Physical therapy, synthetic

digestive enzymes, salt tablets, and antibodies can

lessen the effect of the symptoms; may have

shorter than normal life span because of higher

susceptibility to respiratory diseases

DIABETES Metabolic disorders cause high blood sugar. The person feels thirsty, hungry, and weak and

usually loses weight.

A NUMBER OF FACTORS WORKING

TOGETHER

NO CURE

CAN BE CONTROLLED BY INSULIN INJECTIONS, CAREFUL DIET, AND PHYSICAL ACTIVITY.

DOWN SYNDROME

Distinct physical features are evident Slanting eyes, large misshapen forehead, oversized tongue, single crease across the palm of each hand, and varying degrees of mental retardation are typical.

CHROMOSOME ABNORMALITY More likely to occur when the mother is over 35

Special educational needs. life span may be nearly normal

HUNTINGTONS CHOREA

The brain and central nervous system gradually deteriorate when the person is between 30 and 40 years old. This causes involuntary jerking, loss of mental abilities, insanity, depression, and finally death.

DOMINANT GENE

NONE

HYDROCEPHALUS Extra fluid is trapped in

the BRAIN. The person’s head is larger than

normal.

A NUMBER OF FACTORS WORKING

TOGETHER

Surgical removal of excess fluid; without

treatment, children rarely survive

MUSCULAR DYSTROPHY

A group of disorders which damage muscles. They cause progressive weakness and finally

death

Mutations of several genes

No cure; therapy and braes other some relief

PHENYLKETONURIA (PKU)

An enzyme deficiency makes the person unable to digest a certain amino acid. The baby appears

normal at birth, but slowly develops mental retardation because the amino acid builds up in the body and causes

brain damage.

RECESSIVE GENE

A carefully prescribed diet that balances the enzyme deficiency; the effects of the disease

can usually be avoided if treatment begins within

the first 6 weeks of birth.

SICKLE-CELL

ANEMIA

Red blood cells are sickle-shaped rather than round. They cannot carry oxygen efficiently throughout the

body. People become pale, tired, and short of breath.

They have occasional pains and low resistance to

infection. Their life span is often shorter than normal.

RECESSIVE GENE often seen in people

of AFRICAN-AMERICAN decent

No cure; various treatments relieve some symptoms; blood transfusions are needed occasionally.

SPINA BIFIDA

A condition that causes partial paralysis due to an

incompletely formed SPINAL CORD

HEREDITY AND ENVIRONMENTAL

FACTORS CORRECTIVE SURGERY

AND PHYSICAL THERABY

TAY-SACHS DISEASE

A LACK OF A SPECIFIC CHEMICAL IN THE BLOOD

RESULTING IN AN INABILITY TO PROCESS

AND USE FATS. LEADS TO SEVERE BRAIN DAMAGE AND DEATH, OFTEN BY AGE TWO OR THREE

YEARS

Recessive gene often seen in people

of Eastern European Jewish

Decent

NONE

PRE-TERM BIRTH This is a delivery that occurs before 37 weeks of pregnancy and account

for almost 13% of live births in the U.S. These births are increasing and are possibly due to more multiple births

and to teen moms and older mothers-to-be The main cause of death in the first month of life and can trigger many

problems, such as: cerebral palsy, chronic lung disease, and delays in

development Take an emotional and financial toll on families Studies are now looking at a hormone (progesterone) as a way to prevent

them

MISCARRIAGE This is the forcing out of the baby from the mother’s body before the

20th week of pregnancy. The medical term for this is spontaneous abortion

Stillbirth is the loss of the fetus after 20 weeks of pregnancy In stillbirth, the baby is born dead

About 15 % of all known pregnancies end in the loss of the baby Some occur before the couple even know they are pregnant

Miscarriage is most common in the first 3months. Most result from congenital problems of the fetus as well as in

pregnancies with complications and certain diseases May also occur as a result of mother’s habits such as: smoking,

drinking, or using drugs. This occurring does not mean a couple will never have a baby, but it

does increase the risk for a second miscarriage.

MONITORING THE BABY’S DEVELOPMENT This helps the doctor determine: The baby’s heath and age as well as size and gender If there is more than one baby It will also indicate the baby’s position before delivery.

BLOOD TEST A blood test, called a triple-screen , is given at 12 weeks. § This measures 3 different items and screens for: § Neural tube defects, down syndrome, and other sever

abnormalities § Depending on the results, other tests may be given.

Other blood tests are used to check for conditions such as STI’s and at 6 or 7 months, they screen for gestational diabetes

ULTRASOUND This is a test in which sound waves bounce off the fetus to produce an

image of the fetus inside the womb The picture this produces is called a sonogram The technician holds a tool (transducer) over a mothers abdomen and

this emits sound waves, which are deflected or absorbed at different rates depending on what they are hitting (bone, organ tissue, blood, or water)

These differences are changed into electrical impulses and produces a visual image of the fetus on a computer monitor. This can show whether the baby seems to be developing correctly or not.

A new 3-D ultrasound can help specialists look at the severity of structural defects (EX: the thickness of a fluid-filled area behind the fetuses neck which can confirm Down Syndrome early in pregnancy)

CHORIONIC VILLUS SAMPLING This is a procedure for finding abnormalities in the unborn Performed by testing a small sample of the chorion, which will later

develop into the fetal part of the placenta Used between 10 and 12weeks of pregnancy to detect serious

problems A hollow tube is inserted through the vagina into the uterus and

guided to the chorion. A small sample of the villi is suctioned off and analyzed for congenital problems

This runs a slight risk of infection, which can result in miscarriage

AMNIOCENTESIS A prenatal test to check for the presence of over 100 congenital problems, such

as Downs Syndrome, Tay-Sachs Disease, and Sickle-Cell Anemia

A medical specialist inserts a needle through the abdominal wall into the uterus. An ultrasound is done simultaneously to position the needle. The specialist draws a small amount of fluid from the amniotic sac

This fluid has cells that the fetus has shed. These cells are kept for 3-5 weeks in a lab and then checked for congenital problems

CANNOT BE DONE until the fetus is 15 to 18 weeks. At this time, there is enough amniotic fluid. Due to lab time, the women has to wait until 20-21 weeks for results This is safe is 99% of cases. In some cases, miscarriage or premature birth may result, so it is not considered a

routine procedure and is used only when a problem is suspected or the mother-to-be is over 35.