Conception, Pregnancy & Childbirth

Question 1

Male Fertility Issues

Answer 1

• Sperm: low count/irregularities, poor motility
• Chronic conditions: diabetes, SCI, etc…
• STI and other infections
• Trauma to testes
• Autoimmune response: antibodies that affect sperm
• Hormones: pituitary imbalance and/or thyroid conditions
• Toxins, Tobacco, Drugs, Alcohol
• High temperature
• Hernia repair
• Undescended testicles
• Mumps after puberty

Question 2

Female Fertility Issues

Answer 2

• Irregular Ovulation
• Obstruction or malformation of the reproductive tract (STI etc…)
• Endometriosis
• Toxins, Tobacco, Drugs, Alcohol
• Chronic Conditions — Diabetes, SCI etc…
• Hormone: pituitary imbalance and/or thyroid conditions
  Infections
• Polycystic Ovary Syndrome
• Body weight, Eating Disorders, Excessive Exercise
• Abnormal Pap smears
• Multiple pregnancy losses
• Age

Question 3

Menstrual Cycle

Has four phases…

Answer 3

1. Proliferation Phase (9 days)
2. Ovulatory Phase
3. Secretory (Luteal) Phase (14 days)
   endometrium thickens; secretion and blood increase due to follicle’s manufacture of progesterone
   estrogens and progesterone decrease suddenly
4. Menstrual Phase (5 days)
   surface of endometrium is sloughed off; bleeding occurs

Question 4

Proliferation Phase

Answer 4

• begins with the end of menstruation
• lasts 9-10 days
• egg develops and endometrium proliferates
• also known as the follicular stage when certain ovarian follicles mature
• ovaries prepare for ovulation

Question 5

Ovulatory Phase

Answer 5

• A Graafian Follicle ruptures and releases a mature ovum. The other ripening follicle degenerate and are reabsorbed
• Occasionally 2 ovum are released = fraternal
• Ovulation is set in motion when estrogen levels reaches critical levels.
• Basal body temperature usually dips slightly at ovulation and raised by 0.5C on the day following ovulation
• estrogens reach peak level in blood, causing ovary to release egg

Question 6

Secretory (Luteal) Phase

Answer 6

• Approximately 15 days
• Graafian follicle become the corpus luteum
• Progesterone and Estrogen levels peak around the 20 or 21st day of cycle causing the glands in the endometrium to secrete nutrients that would sustain a fertilized ovum.
• If no fertilization occurs the corpus luteum decomposes and hormone level fall.

Question 7

Menstrual Phase

Answer 7

• approximately 5 days
• Uterine lining (endometrium) is sloughed off into the menstrual flow.
• Caused by the drop in estrogen and progesterone levels.
• Menstruation is the passing of the lining through the cervix and vagina

Question 8

Menstrual Cycle

Answer 8

• Rising estrogen and LH surge leading up to ovulation
• In the follicular part of the cycle, the lining of the uterus develops
• In the Secretory (luteal) phase it is maintained by the elevated progesterone secreted by the corpus luteum

Question 9

Prediction Ovulation: Charting basal body temperature

Answer 9

• typically there is a small drop in early morning temperature just prior to ovulation.
• the temperature then rises significantly afterwards

Question 10

Prediction Ovulation: Assessing cervical mucus

Answer 10

• women can examine and track the consistency of cervical mucus throughout their cycle.
• cervical/vaginal mucus becomes clear, slippery and stretchy, (egg whites) on the days just prior to ovulation

Question 11

Pregnancy Tests

Answer 11

• tests designed to detect human chorionic gonadotropin (hCG)
• women produce hCG soon after conception
• hCG can be detected in the urine approximately 3rd week of pregnancy
• blood test can detect hCG as early as the 8th day

Question 12

Length of Pregnancy

Answer 12

• most people think of pregnancy as lasting nine month
• it is actually 280 days, usually calculated from the first day of the last menstrual period
• date pregnancy from date of fertilization which is usually 2 weeks after the beginning of the last menstrual cycle
• normal gestation is 266 days or 38 weeks
• most babies are born +/- 10 days

Question 13

Prenatal Development

Answer 13

• Germinal Stage: conception to implantation
• Take the Zygote 3-4 days to reach the uterus
• Takes another 3-4 days for the zygote to implant (wander in the uterus)
• Within a few days the cells take on the form of a fluid filled ball of cells class blastocyst.

Question 14

Embryonic Stage

Answer 14

• Implantation to 8th week

- Major organs systems begin to differentiate

Question 15

Fetal Stage

Answer 15

• 9th week to birth

- By about the 9th or 10th week the fetus starts to response to outside world

Question 16

First Trimesters: conception — 12 weeks

Answer 16

The first trimester is from conception through 12 weeks, Conception through the 10th week is referred to as the embryonic period.

• Around the twenty first day the heart begins to start beating.
• This is the critical period of time when all of the major organs and structures are forming — brain, heart, lungs, eyes, ears, arms and legs
• Harmful substances that are ingested can affect the normal growth and development of the fetus
• Around the twenty first day the heart begins to start beating.

Question 17

Second Trimesters: 12-16 weeks

Answer 17

• Is a period of rapid growth for the fetus 8cm (3inches)
• Sexual differentiation is beginning to show
• Brain development is very rapid
• Fingers, toes and nails are formed
• Eyes almost fully developed, but lids fused — this happens to - protect nerve fibres
• Heartbeat can be heard with Doppler

Question 18

Second Trimesters: 16 weeks

Answer 18

• The baby can feel pain; the fetus may suck its thumb
• The baby makes crying movements
• 15cm and 100gm
• Strong heartbeat
• It moves about, swallows amniotic fluid, and has periods of sleep and wakefulness

Question 19

Second Trimesters: 24 weeks

Answer 19

• 28-35cm and 500gm
• Eyelids separated
• Skin wrinkled and red
• Heavy protective creamy coating (vernix)
• May survive if born, but need intensive care, high rate of disability

Question 20

Second Trimesters: 28 weeks

Answer 20

• 38cm and 1100gm
• Very wrinkled — no fat yet
• Organs begin to mature and the bones have fully grown but are still soft
• Lungs have not fully grown however it begins to make breathing movements
• The eyelids have finally opened.
• Better survival if born — still need lots of intensive care
• Mom beginning to feel less nausea and fatigue increased energy and wellbeing
• Uterus lifts out of pelvis — less pressure on bladder
• Week 12+ — Pigmentation: linea nigra, mask of pregnancy, breasts dark
• Increased vaginal discharge (milky)
• Week 16+ — Breast fluid: clear, yellow colostrum

Question 21

Third Trimester: 29 weeks — Birth

Answer 21

• Major organs developed, time of growth in weight and storage of materials e.g., vitamins, minerals, fatty acids
• The brain has grown rapidly
• Most organs have fully grown expect the lungs
• The kicks and movements of the fetus are now strong enough to be seen and felt on the outside
• The skin is now less wrinkled and red
• Fetus has moved to the birth position
• During the last month of pregnancy, the baby can gain as much as half a pound a week
• The mother may not feel the fetus move as much because it has filled up much of the room, your midwife or doctor may instruct you in fetal movement counts.
• Week 34+ Awkwardness, Depression, Heartburn, Hemorrhoids, Pelvic Pain, Difficulty Sleeping, Stuffy Nose
• Week 37 -, pressure on bladder, increased pelvic pain, Lightening (baby descends into the pelvis)

Question 22

Prenatal Care

Answer 22

• Choosing a caregiver: obstetrician, family doctor, midwife
• First Visit: history, physical, blood work, lab work
• Next Visits: weight, blood pressure, growth of uterus, baby’s heart beat, baby’s position, urine — glucose & protein, education

Question 23

Routine Prenatal Tests by Gestation

Answer 23

11-16 weeks: genetic screening
18 weeks: ultrasound
24-28 weeks: repeat blood tests, diabetes screen
28-30 weeks: Rh immune globulin to Rh negative women
36 weeks: Group B Strep
41 weeks: non-stress test, biophysical profile

Question 24

Genetic Screening

Answer 24

• Maternal serum screen (16-20 weeks)
• neural tube defects
• down syndrome and other major chromosomal disorders
• Chorionic villous sampling (11-13 weeks)
• Amniocentesis (15-20 weeks)

Question 25

Folic Acid

Answer 25

- Promotes the development of the brain stem, spinal cord, and red blood cells - Need is greatest in the first month of pregnancy - Recommended amount: 0.4 - 1.0mg daily & 4-5mg if at risk - Risk: family history of neural tube defects - Arthritis drugs with methotrexate - Inflammatory bowel disease - Recommend — prenatal supplement with folic acid

Question 26

Iron

Answer 26

- Deficiency: fatigue, cardiovascular - RDA - 27mg/day - Take with foods high in Vitamin C - Caffeine inhibits the absorption — avoid drinking coffee, tea, cole, chocolate with meals - Avoid taking with calcium

Question 27

Calcium

Answer 27

- Important for development of bones and proper muscle function - Recommended intake: 1000 - 1300mg daily - If you do not drink milk or eat dairy products: - Drink calcium fortified beverages like orange juice, soy beverage - Eat tofu, canned sardines or salmon with the bones

Question 28

Vitamin D

Answer 28

- increases the absorption of calcium - required for both bone development and for maintaining the strength of the mother’s bones - Recommended: 400 IU - Sunlight during the summer, but during the winter we get very little

Question 29

Essential Fatty Acids

Answer 29

- Dietary fatty acids need for - proper fetal neural and visual development - maintenance of pregnancy - Sources: Fish, Canola, Flax Oil, Nuts, Seeds - Maintenance of pregnancy — may decrease the risk of preterm birth

Question 30

Water

Answer 30

- Carries nutrients to cells - Carries away waste products - Keeps you cool - Drink at least 48-64 ounces “straight” or as other fluids (eg. milk, soup)

Question 31

Caffeine

Answer 31

``` Maximum — 300mg/day Why Worry? - Some appears in the breast milk - Crosses the placental barrier - May stimulate the fetus or baby - High intake increases the risk of premature delivery ```

Question 32

Artificial Sweeteners

Answer 32

``` Appear “safe” but use in moderation - Aspartame - Sucralose - Acesulfame Potassium Not Safe (effect on fetus unknown) - Saccharin - Cyclamate ```

Question 33

Alcohol

Answer 33

- No safe level of alcohol for an unborn baby - Impacts physical development and brain growth - Regular drinking increases the risk of miscarriage - Risks include Fetal Alcohol Spectrum Disorder (a permanent condition) and low birth weight

Question 34

Smoking: Pregnancy

Answer 34

- Premature rupture of membranes - Placenta previa - Placental abruption - Preterm birth - Birth complications - Haemorrhage

Question 35

Smoking: Infant

Answer 35

- SIDS - Respiratory problems - Ear infections - Hospitalization

Question 36

Signs of Labour

Answer 36

- Lightening or Engagement: Relieving the pressure - Effacement: Ripening of the cervix - Dilation: Opening of the cervix - Bloody show: Loss of mucus plug - Nesting: Spurt of energy - Rupture of membranes: Your water breaks - Contractions: When labor pains being

Question 37

First Stage of Birth

Answer 37

- Dilation and effacement of the cervix - Latent (0-3cm) - Active - Transition (8-10cm)

Question 38

Second Stage of Birth

Answer 38

- Pushing - Descent of baby through birth canal - Episiotomy - Birth of the baby

Question 39

Episiotomy

Answer 39

- performed when babies head has crowned - usually performed when the baby’s shoulders are too wide to emerge without tearing or if baby is in distress (heartbeat drops) - rates have drop from 1/2 vaginal births to about 1/3

Question 40

Third Stage of Birth

Answer 40

- Placenta is expelled - Uterus begins to contact - 5 to 60 minutes

Question 41

Breastfeeding

Answer 41

- provides optimal nutrition, immunological and emotional benefits for the child’s growth and development - Breastfeeding is on the rise 2001 — 81.5% 2005 — 87%