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SPHU 3600 EXAM 2 GUIDE WITH
COMPLETE SOLUTION
Gestational Age - ANSWER age of an unborn baby, usually dated from the first day of an expectant mother's last menstrual cycle Fetal Age - ANSWER actual age of the baby, number of weeks since conception What are the three periods of the first trimester? - ANSWER Germinal, Embryonic, Fetal Weeks 1-2 - ANSWER Germinal Period Germinal Period - ANSWER - zigote --> blastocyst
- from fertilization to implantation in the uterus Weeks 3-8 - ANSWER Embryonic Period Embryonic Period - ANSWER - blastocyst divides rapidly
- heart starts beating by week 5
- by end, all essential body structures are formed (ie. lung, liver, brain, pancreas, etc) Weeks 9-10 - ANSWER Fetal Period Fetal Period - ANSWER - face is developing
- eyelids close
- fingernails and external genitalia developing
When does the second trimester happen? - ANSWER weeks 11- First Part of 2nd Trimester - ANSWER - kidneys are formed and make urine
- digestive system
- translucent skin
- sucking reflex Second Part of 2nd Semester - ANSWER - nervous system matures
- begins to hear sounds
- baby gaining fat
- external genitalia are visible, 2nd trimester ultrasound When is the third trimester? - ANSWER 26-38 weeks 3rd Trimester: 26-31 weeks - ANSWER - bones hardening (except skull)
- breating
- kicking starts
- eyes open 3rd Trimester: 32-36 weeks - ANSWER - body fat increases
- skin becomes pink and smooth
- CNS developed, baby can survive outside the womb
- starts positioning in head-down position 3rd Trimester: 37-38 weeks - ANSWER - fat being added on body
- final lung development
Lautarescu Reading on Maternal Stress - ANSWER purpose: examine the effects of prenatal stress on the development of the fetal and child brain findings: prenatal stress can lead to changes in the structure and function of the fetal and child brain, particularly in areas related to emotion regulation, stress response, and cognitive function. These changes may result in long-term effects on behavior and cognitive ability, including increased risk for mental health disorders such as anxiety and depression why important: need for early intervention and support for pregnant women experiencing stress to mitigate the effects of prenatal stress on fetal and child development Marx Reading - ANSWER purpose: investigate how fetuses respond to maternal voice and touch during pregnancy findings: fetuses are able to perceive and respond to stimuli, such as maternal voice and touch, as early as 23 weeks gestation (touch more so than voice), responses increase over time why important: maternal voice and touch may play an important role in fetal development, developing fetus is capable of learning and adapting to its environment even before birth How does the mother's pituitary gland change during pregnancy? - ANSWER inhibition of FSH and LH, production of prolactin and oxytocin How does the mother's respiratory system change during pregnancy? - ANSWER shift from abdominal to thoracic breathing, increase in oxygen consumption How does the mother's urinary system change during pregnancy? - ANSWER
elongation of uterers, increase kidney size, increase urine volume and flow How does the mother's cardiovascular system change during pregnancy? - ANSWER blood volume increases, heartbeat increases, RBCs increase How does the mother's blood pressure change during pregnancy? - ANSWER slightly declines How does the mother's gastro-intestinal system change during pregnancy? - ANSWER constipation, decreased muscle relaxation How does the mother's placenta change during pregnancy? - ANSWER produces progesterone, estrogen, and relaxin hormones How does the mother's breasts change during pregnancy? - ANSWER blood volume increases, milk ducts growing, nipple darken and discharge, areola bumps How does the mother's uterus change during pregnancy? - ANSWER increases 20x its original weight, increased amount of muscle, tissue, blood vessels, nerves, second month = oval, mid-gestation = round, term = elongated Maternal Weight During Pregnancy - ANSWER people at a normal BMI should gain 25-35 pounds, lower BMI should gain more and higher BMI should gain less Maternal Obesity - mother has increased risk of... - ANSWER gestational diabetes, preeclampsia, preterm birth, c-section delivery
Maternal Obesity - baby has increased risk of... - ANSWER birth defects,
Social Dimension of Pregnancy - Stigma - ANSWER - weight, race, age
Paternal/partner adaptation to pregnancy - ANSWER - increase in father involvement linked to positive child health
- ambivalence
- more likely to feel distant, alienated, excluded
Couvade Syndrome - ANSWER - somatic symptoms experienced by the father during pregnancy simulating those of the pregnant mother
- an expression of anxiety, identification with the fetus, statement of paternity, parturition envy
Adaptation for same-sex parents - ANSWER - non-inclusive societal norms result in more difficulties navigating the transition
- may feel pressure to conform to traditional gender roles
- stigma and discrimination (healthcare provider bias, legal recognition and protections)
Olza Reading - ANSWER purpose: understand the subjective experiences of women during childbirth, including their emotional and psychological responses, and to identify factors that contribute to positive or negative experiences
findings: women's psychological experiences of physiological childbirth are complex and varied, some women felt empowered/in control and others felt fear and anxiety, linked to feeling out of control. factors: social support, communication with healthcare providers, previous childbirth experiences, and cultural beliefs about childbirth
why important: importance of providing women with supportive and empowering childbirth experiences, and the need to address the psychological needs of women during the childbirth process
What are the three factors that have influenced the medicalization of childbirth? - ANSWER - cultural values/beliefs, economic pressures, social and political movements
Cultural Beliefs/Values that Influence Childbirth Practices - ANSWER - fear of childbirth (dangerous and painful, high mortality rates, inadequate sanitation/hygiene in many countries)
- trust in science and rationalism
- poorer health outcomes for marginalized communities
Feminist Movement - ANSWER - 1960s/70s
- called for women right to control their bodies
- against patriarchal nature of reproductive care
- advocated for inclusion of midwives and patient-centered approach
Name 5 contemporary challenges of maternal healthcare in the US - ANSWER
- maternal mortality
- racial and ethnic disparities
- access to care
- quality of maternal care
- postpartum care
Contemporary Challenges - Maternal Mortality - ANSWER US maternal mortality rate is 24 deaths per 100,000, Netherlands is less than 1
Contemporary Challenges - Racial/Ethnic Disparities - ANSWER Black and Native American women are 2-3x MORE likely to die from pregnancy/birth-related causes than white women
Contemporary Challenges - Access to Care - ANSWER lack of access to healthcare/adequate healthcare in rural and low-income areas
Contemporary Challenges - Quality of Care - ANSWER quality of care varies widely, some women may not receive evidence-based care
Contemporary Challenges - Postpartum Care - ANSWER lack of adequate postpartum care can lead to severe health complications, postpartum depression
Evidence for upright birthing position - ANSWER shorter push time, less use of birth assists, few babies with irregular heartbeats, same c-section probability BUT increased risk of tearing
VBAC - ANSWER vaginal birth after c-section
- some risks, but generally safe
Impact of midwife and doula-led care on delivery and pregnancy outcomes - ANSWER less c-sections, less use of instruments to assist vaginal delivery, shorter labor terms
health outcomes by providing personalized, high-quality care that is focused on the needs and preferences of individual women, midwives can help to address issues of access and affordability in maternity care, as midwifery care is often less expensive than traditional medical care
why important: article calls for increased investment in midwifery care and a shift towards a more midwife-led model of maternity care in the US. The article argues that this shift is necessary to improve maternal and infant health outcomes, reduce costs, and promote equity in access to care
What did Shannon Pfingstag say about her experience with collaborative care in Louisiana and southern states? - ANSWER Different experiences practicing in southern states versus northern states, south is not there yet!
What are the benefits of having a solid midwifery work force? - ANSWER - frees physicians to concentrate on high-risk pregnancies
- low-risk pregnancies have more personalized care, longer hospital visits, and increased psychological support
In Ledbetter's article, who called midwives a "relic of barbarism"? - ANSWER Joseph DeLee
Miscarraige - ANSWER - spontaneous pregnancy loss before 20 weeks of
gestational age (20+ weeks is considered stillbirth)
- near 30% of pregnancies, 80% happen before 13 weeks
- probability increases with maternal age
What are the four miscarriage risk factors? - ANSWER fetal, placental, maternal, environmental
Miscarraige Risk - Fetal Factors - ANSWER - genetic abnormalities (ie. missing chromosomes), defective embryo development, faulty ovarian implantation
Miscarraige Risk - Placental Factors - ANSWER premature separation of placenta, low-lying placenta, etc
Miscarraige Risk - Maternal Factors - ANSWER - age (higher risk with increased age)
- use of illicit drugs, tobacco, etc
- STI infections (gonorrhea, chlamydia)
- viral infections (ex. salmonella)
Miscarraige Risk - Environmental Factors - ANSWER - chemicals found in
birth or loss of an otherwise healthy pregnancy
- can be caused genetic disorders, previous medical procedures on the cervix (ie. dilation, conization), and prior obstetrics injuries
Treatment of Incompetent Cervix - ANSWER - procedure called cerclage (add a stitch to strengthen)
- bed rest, avoid heavy lifting
Ectopic Pregnancy - ANSWER - when fertilized egg grows outside uterus
- can be caused by damage of fallopian tube (prevents egg from reaching uterus) or hormone imbalances
- life-threatening (leading cause of first-trimester maternal death)
What are 8 ectopic pregnancy risk factors? - ANSWER 1. previous ectopic pregnancy
- previous surgery on reproductive system
- PID (pelvic inflammatory disease)
- STIs (gonorrhea, chlamydia)
- fertility treatments
- smoking (changes fallopian tube structure)
- age (women over 35 have higher risk)
- contraceptive use (specifically IUDs)
Free Radicals - ANSWER unstable molecules that can damage cells and tissues in the body
Ectopic Pregnancy Management - ANSWER - Expectant Management: observation and monitoring (can resolve without intervention)
- Surgical Management: procedure depends on if it has ruptured)
Late Pregnancy Bleeding - ANSWER - may occur after sex or cervical exam (not cause for concern)
- heavier bleeding requires treatment (because of placental abruption or placenta previa)
Placenta - ANSWER - top or side of uterus
- fetal side: surface should by shiny, grey, translucent
- maternal side: should be dark maroon
- thin placenta = placental insufficiency
- thick placenta = maternal diabetes mellitus
What are the three types of placental abnormalities? - ANSWER 1. placenta
Placenta Previa Risk Factors - ANSWER - previous c-section
- multiparity (larger placenta, aging of the uterus)
- age (over 35)
What is one possible explanation for increased risk of placenta previa in aging women? - ANSWER - blood vessels in the uterus may become less elastic, so its harder for the placenta to attach to the top of the uterus
- older women likely have higher rates of previous uterine surgery, which results in scarring that can make it harder for the placenta to attach
Placental Abruption - ANSWER placenta detaches from inner wall of the womb before delivery, which can deprive the baby of oxygen and nutrients
Placental Abruption Risk Factors - ANSWER - cocaine use
- direct trauma of abdomen (ex. car accident)
- sudden reduction of uterus size (ex. after birth of twins)
- short umbilical cord
- high parity
- previous c-section
Gestational Hypertension - ANSWER - high blood pressure that begins after
20 weeks
- can lead to preeclampsia (15-20%)
- highest prevalence in middle age women
Gestational Hypertension Risk Factors - ANSWER - pre-existing hypertension (high blood pressure)
- kidney disease
- age (34-55)
- Black and Native American women have higher rates
What happens if there's high blood pressure during pregnancy? - ANSWER less blood flow to the placenta, therefore less oxygen and nutrients to the baby
Pre-eclampsia - ANSWER - spike in blood pressure after 20 weeks
- signs: high blood pressure, protein in urine (proteinuria, edema), sudden weight gain/swelling in face and hands, headaches, vision problems
- only cure is to go through with delivery
Pre-eclampsia Risk Factors - ANSWER - possible association with vitamin D deficiency
