Transcript prenatal development, birth, and newborns` readiness for life

PRENATAL DEVELOPMENT,
BIRTH, AND NEWBORNS’
READINESS FOR LIFE
• Prenatal Development
– Development that occurs between the moment of conception
and the beginning of the birth process
• Development occurs in the mother’s uterus and the
degree of safety depends on:
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(1) Mother’s age
(2) Health
(3) Food quality
(4) Drug Intake
(5) Chemical/Environ. Exposure
• Human growth occurs more rapidly during the prenatal
period than any other period of human development
FROM CONCEPTION TO
BIRTH
• Development begins in the fallopian tube
when a sperm penetrates the wall of an
ovum…This union forms a zygote
• Gestational Period (266 days)
– From conception (zygote) to readiness for birth
(fetus of some 200 billion cells)
PERIODS OF PRENATAL
DEVELOPMENT
• Germinal (zygote) Period
– Lasting from conception until the developing organism
becomes firmly attached to the wall of the uterus
• Embryo Period
– Lasting from the 3rd through the 8th prenatal week. During
which the major organs and anatomical structures take shape
• Fetus Period
– Lasting from the 9th prenatal week until birth. During this
period, all major organ systems begin to function and the fetus
grows rapidly
The Germinal Period (2 weeks)
• While traveling down the fallopian tubes towards the
uterus, cell division occurs thru mitosis.
• Continued cell division (60 to 80 cells) eventually
forms a blastocyst. Generally occurs within 4 days of
conception.
• As a result of continued cell differentiation
– The inner layer of the blastocyst (embryonic disk) becomes
the embryo
– The outer layer of cells develops into tissues that protect and
nourish the embryo
IMPLANTATION
• The Blastocyst approaches the uterus (6 to 10 days) and
attaches itself to the wall of the uterus thru small burr
like tendrils which tap into the mother’s blood supply.
– Only about half of all fertilized ova are firmly implanted.
– Half of those that firmly implant are genetically abnormal, fail
to develop, or implant in an area that is not conducive.
Resulting in miscarriages.
– 3 out of 4 zygotes fail to survive the initial stage of prenatal
development.
DEVELOPMENT OF SUPPORT SYSTEMS
• Once implanted, the blastocyst’s outer layer rapidly forms 4 major
support structures that protect and nourish the organism
– Amnion—a watertight membrane that surrounds the developing embryo,
serving to regulate its temperature and to cushion it against injuries
– Chorion—surrounds the amnion and eventually becomes the lining of the
placenta
– Placenta—an organ formed from the lining of the uterus and the chorion,
that provides for respiration and nourishment of the unborn child and the
elimination of its metabolic waste
– Umbilical cord—a soft tube containing blood vessels that connects the
embryo to the placenta
THE PERIOD OF THE EMBRYO
2 wks to 2 months
• The embryonic disk differentiates into 3 cell layers:
– Ectoderm—outer layer which becomes the nervous system,
skin, hair
– Mesoderm—middle layer which becomes muscle, bones,
circulatory system
– Endoderm—inner layer which becomes digestive, lungs,
urinary tract, vital organs (pancreas, liver)
EMBRYO CONTINUED
• In the 3rd week after conception
– A portion of the ectoderm folds into a neural tube (brain and
spinal cord)
• By the end of the 4th week
– The heart has formed and has begun to beat.
– Eyes, ears, nose, and mouth are also beginning to form.
– Buds which will eventually become arms and legs begin to
form
• 30 days after conception the embryo is only about ¼ of an inch. But
10,000 times larger than that of the zygote
EMBRYO CONTINUED
• During the 2nd month
– The embryo starts to appear human. Circulatory system is independent. Liver
and spleen producing blood from the yolk sac.
– A primitive tail appears which eventually becomes enclosed by protective
tissue. Forming back bone or coccyx
• Between the 5th and 7th week
– Eyes have corneas and lenses, ears are well formed, skeletal system
developed. Limbs and muscular system developing.
– Development is occurring in a proximodistal and cephaloclaudal manner
• During 7th and 8th week
– Sexual development begins to appear (indifferent gonads/genital ridges).
• Male, gene on Y chromosome triggers chemical reaction to produce male
testicles.
• If female, gonads will receive no instruction and will produce ovaries
THE PERIOD OF THE FETUS
(2-9 months)
• All of the structures which will be present when the baby is born
are formed at the end of 2 months.
– Body systems become interconnected. Nervous and Muscular system allow
for kicking, twisting of body
– Digestive and Excretory allow for swallowing, digest nutrients, urination
– Sexual differentiation increasing rapidly.
• Male testes secrete testosterone—hormone responsible for the development of
penis and scrotum. In the absence of testosterone, female genitals are
developed.
• By end of 3rd month, sex can be determined by ultrasound. The reproductive
systems already contain immature ova and sperm cells.
– All of these developments in a mere 3 months (1st trimester) and when the fetus
is only 3 inches long and weighs less than an ounce
THE SECOND TRIMESTER
• Motor activities become refined actions such as thumb sucking
or kicking strong enough to be felt by the mother
• Heartbeat can be detected using a stethoscope and the hardening
skeleton can be detected with ultrasound
• Nails harden, skin thickens, eyebrows, eyelashes, and scalp hair
appears
• The fetus is now covered by a white cheesy substance called
vernix (protects skin from chapping) and a fine layer of body
hair called lanugo (helps vernix stick to the skin)
• By the end of 2nd trimester, fetus visual and auditory senses become
functional
THE THIRD TRIMESTER
• All organs mature rapidly/ preparing the fetus for birth
• 7 months from conception
– Fetuses reach the age of viability (a point by which survival
outside of the mother’s uterus may be possible)
• Signs of viability.
• Organized and consistent heart rate activity
• Gross motor activity
• Sleepiness/waking activity (Determined thru fetal monitoring
techniques).
– However, children born prematurely still require oxygen assistance
because of immature air sacs in the lungs called pulmonary alveoli
3rd Trimester Continued
• By the end of 7 months
– Fetus weighs nearly 4 pounds and 16 inches long.
– A month later, the fetus has grown an extra pound or two and
grown a inch or two longer due to fat accumulation
(regulation of body temp).
– By the middle of the 9th month, fetal activity slows and sleep
increases
• Fetus is now so large that the most comfortable position is head down
at the base of the uterus/ limbs curled in a fetal position
ENVIRONMENTAL INFLUENCES ON
PRENATAL DEVELOPMENT
• Teratogens
– External agents such as viruses, drugs, chemicals, and
radiation that can harm a developing embryo or fetus
by causing physical deformities, severely restricting
growth, blindness, brain damage, and even death
• About 95% of newborn babies are perfectly
normal and that many of those born with defects
have mild, temporary, or reversible problems
Key Points About Teratogens
• The effects of teratogens are worst on a body part during the period when that
structure is forming or growing most rapidly
– Not all embryos or fetuses are equally affected by a teratogen (genes and
prenatal care play a vital role)
– Similar defects can be caused by different teratogens
– A variety of defects can result from a single teratogen
• The longer the exposure to or higher the dose of a teratogen, the greater the
severity of harm
• Embryos/fetuses can be affected by fathers and mothers exposure to
teratogens
• The long-term effects of a teratogen often depend on the quality of the
postnatal environment
Sensitive Periods
• A period during which an organism is highly
susceptible to certain environmental influences.
– Teratogens may still have impact but greater exposure may
be required.
• Most organs and body parts are forming during the
period of the embryo (3 to 8 wks).
– Therefore, exposure during this period may have serious
consequences.
– This is also the time when a woman may not even know that
she is pregnant that the embryo is most vulnerable to
teratogens.
Maternal Diseases
• Some diseases are small enough to cross the placental barrier and affect
developing embryo (immature immune system)
– Rubella (German measles)—mothers who contract this early in pregnancy delivered
babies who were blind, deafness, cardiac abnormalities, and mental retardation (most
serious during 1st tri but impactful during 2nd.
– Toxoplasmosis—caused by a parasite found in animals. Generally causes severe eye
and brain damage. Even abortion.
– Sexually Transmitted Diseases—most common teratogens and generally more
hazardous.
• Syphillis—can cause eye, ear, bone, heart, brain damage
• Genital Herpes—kill about 1/3 affected newborns, cause blindness, brain damage,
neurological disorders
• AIDS—worldwide, nearly 4 million women of childbearing age carry this virus and can
transmit it to their young. ZDV an antiviral drug used to treat aids improve longevity of
life however, those affected by aids will eventually die due to complication
Continued
• The Thalidomide Tragedy
– Drug used in the 1960s to reduce the occurrence of morning
sickness.
– Pretests with rats revealed no harmful effects
– Thousands of women who used this drug in the 1st trimester
produced severe deformities: eyes, ears, noses, and hearts.
• Many developed Phocomelia
– A structural abnormality in which all or parts of limbs were missing and
the feet and hands may be attached directly to the torso (similar to
flippers)
Fetal Alcohol Syndrome
• Causes microcephaly (small head)
• Malformations to heart, limbs, joints, and face
• FAS babies display excessive irritability,
hyperactivity, seizures, and tremors. Generally,
smaller and lighter than most babies.
• Physical and cognitive growth lags
Continued
• Lithium
– Produces heart defects when taken during 1st trimester
• Sex hormones found in contraceptives—heart defects
and mild deformations
• Diethylstilbestrol (DES)
– Used mid 1940’s to 1965—synthetic hormone formally
prescribed to prevent miscarriages, found to produce cervical
cancer in female offsprings and genital tract abnormalities in
males
CIGARETTE SMOKING
• Cigarette smoking found to cause
spontaneous abortion.
– Low birth weight
• Increased in respiratory infections
• Poorer cognitive performance
KEY QUESTIONS
• Should we pass laws surrounding alcohol
consumption and pregnancy?
ILLICIT DRUGS
• Marijuana
– Found to have few physical defects. Babies display tremors,
sleep disturbances, lack of interest in the environment in early
life
• Heroin
– Few physical defects, increased risk for miscarriages,
premature deliveries, SIDS
• 1st month is difficult for these babies but start to normalize
• Cocaine
– Increased risk for physical defects.
– Problems with blood restriction/pressure.
– Miscarriages/premature births
MATERNAL CHARACTERISTICS
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Mothers generally advised to gain 25/30 pounds. Doctors now focus on a healthy (high protein
and calorie) and nutritious diet
– Severe malnutrition stunts growth. Also, additional effects depends on the trimester
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Malnourished babies show cognitive defects/behavioral problems later in childhood. Imbalance of
brain cells
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Continue malnutrition after birth leads to irritability which affect the parent/child attachment and
reduce the amount of facilitated play and supportive interaction that could foster healthy social and
emotional development
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Small amounts of zinc and magnesium have been found to improve placenta & reduce difficult
pregnancies
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Folic acid found to prevent down syndrome, spinal bifida, anencephaly, and other defects of the
neural tube (most women consume less than half the recommended daily amount needed)
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Massive campaigns to produce awareness but controversial due to the assumption that more is
better
MOTHERS EMOTIONAL WELL-BEING
• Prolonged stress can have a detrimental impact on fetal
development.
– Stress produces chemical responses that is released in the blood
and pass the placental barrier. Consequently, causing
premature delivery, low birth, stunted growth
• Stress may also weaken the mother’s immune system,
consequently, increase the risk of impactful diseases
• Stress appears to be most impactful when the mother has
poor coping skills. Other concerning factors:
– Ambivalent/negative about their marriage or pregnancy
– No social support systems
Mother’s Age
• The safest time to bear a child appears to be around age
16 to age 35 (SIDS, LBW, Down Syndrome)
– Younger teens are at risk because they are likely impoverished,
high levels of stress, and have little access to supervised
prenatal care
– Teen moms are generally not at risk when they receive
adequate prenatal care
– Older moms risk spontaneous abortion, genetic dysfunctions
• Adequate prenatal care is the key among all moms irrespective of age
THE BIRTH PROCESS
• Child birth is a 3 stage process
– 1st stage—the period of the birth process lasting from
the first regular uterine contractions until the cervix
is fully dilated
– 2nd stage—the period during which the fetus moves
through the birth canal and emerges from the
mother’s body
– 3rd stage—expulsion of the placenta
The Baby’s Experience
• Babies are born under stress but their own stress
hormones enable them to withstand the stressors of the
birthing process.
• Generally babies born blush in color due to oxygen
deprivation. They also pass thru a narrow cervix and
birth canal (resulting flattened noses, misshapen
foreheads, and mild bumps and bruises
• Generally about 20 inches long and weights about 7 to
7.5 pounds
APGAR TEST
• An assessment for the newborn’s heart rate,
respiration, color, muscle tone, and reflexes
that is used to gage perinatal stress and to
determine whether a neonate requires
immediate medical assistance.
– Score range 0-10 with 7 being normal.
Generally done at birth and 5 minutes later to
determine improvement.
Neonatal Behavioral Assessment Scale
• A test that assesses a neonate’s neurological integrity
and responsiveness to environmental stimuli
• Typically administered few days after birth. Measures
the strength of 20 inborn reflexes, changes in infant’s
state, and reactions to comforting and other social
stimuli
– Low scores due to slow responses may be indication of brain
damage
– If reflexes are good but sluggish or irritable when responding
to social stimuli—indication that they may need more playful
stimulation
The Social Environment
Surrounding Birth
• Only 20 years ago, most hospitals barred
fathers from delivery rooms and quickly
removed babies once they were born
• Today, 99% of children are born in
hospitals.
Parent’s Experience
• Some research that the first 6 to 12 hours are a
sensitive period for emotional bonding between
parents and the newborn
• Postpartum Depression
– Hormone changes in the mother sometimes cause
depression. Elevated and extended depression leads to
the diagnosis. Occurs in 10% on new moms
• New fathers display engrossment. Intense
fascination.
Birth Complications
• 3 birthing complications that can affect development:
– Anoxia (oxy deprivation)
– Low birth weight
– Premature delivery
• ANOXIA (occurs in 1% of cases)
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Breech babies at risk due to tangling of umbilical cord
Detachment of umbilical cord
Birth sedatives cross placenta
Genetic incompatibility between Rh positive fetus and Rh
negative mother
– Delayed motor and mental development (3 to 7yrs)
Low Birth Weight
• Due to such factors as drug usage and
malnourishment. Tends to be higher among
low-income women from ethnic minority
groups due to elevated levels of stress and
poor education about prenatal care
• Increased risk of SIDS, generally due to
respiratory distress syndrome (irregular
breathing patterns)
Premature Births
• Preterm babies
– Babies born more than 3 weeks before due date
• Small-for-date babies
– Infants whose birth weight is far below normal,
even when born close to their normal due dates