Chapter 3 Prenatal Development Birth and the Newborn Baby Preeclampsia

Prenatal Development

At present we turn our attention to prenatal development which is divided into three periods: The germinal period, the embryonic flow, and the fetal period. The post-obit is an overview of some of the changes that take place during each period.

The Germinal Menstruum

The germinal period (virtually 14 days in length) lasts from conception to implantation of the fertilized egg in the lining of the uterus. At ejaculation millions of sperm are released into the vagina, but merely a few reach the egg and typically just one fertilizes the egg. In one case a single sperm has entered the wall of the egg, the wall becomes hard and prevents other sperm from entering. After the sperm has entered the egg, the tail of the sperm breaks off and the head of the sperm, containing the genetic data from the father, unites with the nucleus of the egg. It is typically fertilized in the top section of the fallopian tube and continues its journey to the uterus. Every bit a event, a new cell is formed. This cell, containing the combined genetic information from both parents, is referred to as a zygote.

Figure two.7: Sperm and ovum at conception.⁶⁰

During this time, the organism begins cell segmentation through mitosis. Later v days of mitosis in that location are 100 cells, which is now called a blastocyst. The blastocyst consists of both an inner and outer group of cells. The inner group of cells, or embryonic disk will become the embryo, while the outer group of cells, or trophoblast, becomes the support system which nourishes the developing organism. This stage ends when the blastocyst fully implants into the uterine wall (U.S. National Library of Medicine, 2015).

Effigy ii.8: The cycle of fertilization.⁶¹

Mitosis is a fragile process and fewer than one half of all zygotes survive beyond the outset two weeks (Hall, 2004). Some of the reasons for this include: the egg and sperm do not join properly, thus their genetic material does non combine, there is too little or damaged genetic textile, the zygote does not replicate, or the blastocyst does non implant into the uterine wall. The failure rate is college for in vitro conceptions. The effigy beneath illustrates the journeying of the ova from its release to its fertilization, prison cell duplication, and implantation into the uterine lining.⁶²

The Embryonic Period

Starting the third week, the blastocyst has implanted in the uterine wall. Upon implantation this multi-cellular organism is called an embryo. Now claret vessels abound forming the placenta. The placenta is a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord.

During this period, cells go along to differentiate. Growth during prenatal development occurs in two major directions: from caput to tail called cephalocaudal evolution and from the midline outward referred to as proximodistal evolution. This means that those structures nearest the head develop before those nearest the anxiety and those structures nearest the torso develop before those away from the center of the body (such as easily and fingers). You will encounter that this pattern continues after nascency.

The head develops in the quaternary week and the forerunner to the heart begins to pulse. In the early stages of the embryonic period, gills and a tail are apparent. Nevertheless, by the finish of this stage they disappear and the organism takes on a more man appearance.

Figure two.nine: A human embryo.⁶³

About twenty per centum of organisms neglect during the embryonic period, normally due to gross chromosomal abnormalities, often before the mother fifty-fifty knows that she is pregnant. It is during this stage that the major structures of the body are taking grade, making the embryonic period the fourth dimension when the organism is virtually vulnerable to the greatest amount of harm if exposed to harmful substances. Prospective mothers are not oftentimes aware of the risks they introduce to the developing embryo during this time. The embryo is approximately 1 inch in length and weighs nearly 4 grams at the end of eight weeks. The embryo can move and respond to touch on at this time.⁶⁴

The Fetal Menstruum

From the ninth week until birth (which is xl weeks for a full-term pregnancy), the organism is referred to every bit a fetus. During this stage, the major structures are continuing to develop. By the tertiary month, the fetus has all its body parts including external genitalia. The fetus is nigh 3 inches long and weighs about 28 grams. In the following weeks, the fetus will develop hair, nails, teeth and the excretory and digestive systems will go on to develop.

Effigy ii.10: A human fetus.⁶⁵

During the quaternary - sixth months, the eyes become more than sensitive to light and hearing develops. The respiratory system continues to develop, and reflexes such every bit sucking, swallowing and hiccupping, develop during the 5th month. Cycles of sleep and wakefulness are present at this time as well. The showtime run a risk of survival exterior the womb, known equally the historic period of viability is reached at nearly 24 weeks (Morgan, Goldenberg, & Schulkin, 2008). Many practitioners hesitate to resuscitate before 24 weeks. The bulk of the neurons in the brain have developed past 24 weeks, although they are still rudimentary, and the glial or nurse cells that support neurons continue to grow. At 24 weeks the fetus can feel pain (Regal College of Obstetricians and Gynecologists, 1997).

Between the 7th - ninth months, the fetus is primarily preparing for birth. Information technology is exercising its muscles and its lungs begin to expand and contract. The fetus gains about 5 pounds and 7 inches during this terminal trimester of pregnancy, and during the 8th month a layer of fat develops under the pare. This layer of fat serves every bit insulation and helps the baby regulate trunk temperature later nascence.

At around 36 weeks the fetus is well-nigh set for birth. It weighs almost 6 pounds and is virtually 18.5 inches long. By week 37 all of the fetus's organ systems are developed enough that it could survive outside the mother's uterus without many of the risks associated with premature birth. The fetus continues to gain weight and abound in length until approximately forty weeks. By then the fetus has very little room to movement around and birth becomes imminent. The progression through the stages is shown in the following effigy.⁶⁶

Figure 2.11: The development of a fetus.⁶⁷

Monozygotic and Dizygotic Twins

Monozygotic or identical twins occur when a fertilized egg splits autonomously in the offset ii weeks of development. The result is the creation of two split, only genetically identical offspring. That is, they possess the same genotype and frequently the same phenotype. Near one-third of twins are monozygotic twins.

Sometimes, however, two eggs or ova are released and fertilized by two separate sperm. The result is dizygotic or congenial twins. These two individuals share the same corporeality of genetic textile as would whatsoever two children from the same mother and father. In other words, they possess a different genotype and phenotype.

Older mothers are more likely to have dizygotic twins than are younger mothers, and couples who apply fertility drugs are also more likely to give nascence to dizygotic twins.⁶⁸

Figure 2.12: Monozygotic Twins⁶⁹

Effigy 2.13: Dizygotic Twins^lxx

Teratogen

Expert prenatal care is essential to protect confronting maternal and fetal/infant mortality and birth complications. The embryo and fetus is almost at risk for some of the most severe problems during the first three months of development. Unfortunately, this is a fourth dimension at which many mothers are unaware that they are pregnant. Today, we know many of the factors that tin can jeopardize the health of the developing child. The study of factors that contribute to birth defects is chosen teratology. Teratogens are environmental factors that can contribute to nascency defects, and include some maternal diseases, pollutants, drugs and booze.

Factors influencing prenatal risks: There are several considerations in determining the type and amount of harm that might result from exposure to a item teratogen (Berger, 2005). These include:

• The timing of the exposure: Structures in the body are vulnerable to the nigh severe damage when they are forming. If a substance is introduced during a item construction's critical period (time of evolution), the harm to that structure may be greater. For example, the ears and artillery accomplish their critical periods at about vi weeks later on formulation. If a mother exposes the embryo to certain substances during this period, the arms and ears may be malformed. (see figure below)

• The corporeality of exposure: Some substances are not harmful unless the amounts achieve a sure level. The disquisitional level depends in function on the size and metabolism of the mother.

• The number of teratogens: Fetuses exposed to multiple teratogens typically have more problems than those exposed to but one.

• Genetics: Genetic makeup also plays a role on the impact a particular teratogen might have on the child. This is suggested by fraternal twins exposed to the same prenatal environment, merely they do non feel the same teratogenic effects. The genetic makeup of the mother can also have an event; some mothers may be more resistant to teratogenic effects than others.

• Being male or female: Males are more probable to experience damage due to teratogens than are females. It is believed that the Y chromosome, which contains fewer genes than the X, may have an affect.⁷¹

Figure 2.14: The development of an embryo into a fetus.⁷²

There are four categories of teratogens:

1. Physical teratogens: These could be saunas, hot tubs, or infections that raise a significant woman'south body temperature to 102 degrees Fahrenheit or higher. This is associated with neural tube defects, spontaneous abortions, and diverse cardiovascular abnormalities.

2. Metabolic weather condition affecting pregnant females: Metabolic weather condition are abnormalities in the chemical process of producing free energy from food, and thereby affect the development and office of the body. If a meaning woman is malnourished, and so her fetus likely lacks the nutrients essential for its evolution. These include: malnutrition, diabetes, and thyroid disorders.

3. Infections: Unlike maternal infections, including rubella virus, herpes simplex virus, and syphilis can cause congenital abnormalities in fetuses.

4. Drugs and chemicals: When pregnant females ingest or absorb these, they may crusade a diverseness of different effects based on specific amanuensis, amount of exposure, and timing. This category includes: radiation, heavy metals (including lead), insecticides and herbicides, prescription and over the counter drugs, illicit and recreational drugs, booze, cigarettes, nicotine, caffeine, and even some vitamins.⁷³

While there are many, many potential teratogens, the following tables look at the effects of some different types of teratogens. The risks of exposure vary based on lifestyle and wellness. The effects may vary profoundly depending on the factors mentioned previously. Protection and prevention will vary based on the method of exposure.

Table 2.vii: Drugs as Teratogens

Teratogen	Potential Effects
Caffeine	Moderate amounts of caffeine (200 mg or around 12 ounces of java) appear to be prophylactic during pregnancy. Some studies have shown a link betwixt higher amounts of caffeine and miscarriage and preterm birth.74
Tobacco	Tobacco use has been associated with low birth weight, placenta previa, preterm delivery, fetal growth restriction, sudden baby death syndrome, cleft lip or palate, and later health problems (such every bit loftier blood pressure and diabetes).75
Alcohol	At that place is no safe amount of alcohol a woman tin can potable while pregnant. Booze tin slow down the baby's growth, touch the baby'southward encephalon, and cause nascence defects, and may results in fetal booze spectrum disorder (FASD). The effects tin can be mild to astringent. Children born with a severe form of FASD tin have abnormal facial features, severe learning disabilities, behavioral problems, and other problems.76
Cocaine	Cocaine use has connected with low birth weight, stillbirths, spontaneous abortion, placental abruption, premature nascence, miscarriage, and neonatal abstinence syndrome (fetal addiction leads the newborn to experiences withdrawal).77
Marijuana	No amount of marijuana has been proven safe to apply during pregnancy. Heavy use has been associated with encephalon damage, premature nascence, and stillbirth.78
Heroin	Using heroin during pregnancy tin cause birth defects, placental abruption, premature birth, low birthweight, neonatal forbearance syndrome, still birth, and sudden infant death syndrome.79
Over-the-Counter (OTC) medication	Some OTC medications are safe to use during pregnancy and others may crusade health problems during pregnancy. Pregnant women should consult their health care provider before using OTC medications.80
Prescription drugs	Some prescription drugs can cause nativity defects that change the shape or role of one or more parts of the body that can affect overall health. Meaning women should consult their health care provider before discontinuing or starting new medications.81
Herbal or dietary supplements	Except for some vitamins, little is known about using herbal or dietary supplements while significant. Most often there are no good studies to prove if the herb can cause harm to you or your baby. Also, some herbs that are safety when used in pocket-size amounts as food might exist harmful when used in large amounts as medicines.82

Table 2.8: Environmental Teratogens

Teratogen	Potential Effects
Atomic number 82	Exposure to loftier levels of atomic number 82 before and during pregnancy can lead to loftier blood pressure, problems with fetal encephalon and nervous system development, premature birth, low birthweight, and miscarriage.83
Mercury	Exposure to mercury in the womb tin cause brain harm and hearing and vision problems.84
Radiations	Exposure to radiation during pregnancy (especially betwixt 2 and eighteen weeks of pregnancy) can slow growth, cause nascency defects, affect brain development, crusade cancer, and cause miscarriage.85
Solvents	These chemicals include degreasers, paint thinners, stain and varnish removers, paints, and more Maternal inhalation of solvents can crusade fetal exposure than may crusade miscarriage, boring fetal growth, premature birth, and birth defects.86

Tabular array 2.nine: Maternal Infections as Teratogens

Teratogen	Potential Effects
Rubella	Congenital infection (becoming infected while in the womb) can damage the development of the eyes, ears, center, and brain and result in deafness.87
Zika	Congenital infection tin can crusade microcephaly and other severe brain abnormalities.
Varicella (chicken pox)	Congenital infection tin cause a astringent form of the infection affecting the eyes, limbs, pare, and central nervous arrangement.88
Sexually transmitted infections	Infections such every bit HIV, gonorrhea, syphilis, and chlamydia tin be passed from the mother during pregnancy and/or delivery.89
Listeria	Pregnant women are more than susceptible to this food-borne illness. Built infection can crusade miscarriage, stillbirth, premature labor, and neonatal sepsis.ninety

Table 2.10: Teratogens from Animals/Pets

Teratogen	Potential Effects
Toxoplamosis	This parasite can be passed through cat feces and undercooked meat (especially pork, lamb, or deer meet). If the fetus is infected it tin can cause miscarriage, stillbirth, hydrocephalus, macro or microcephalus, vision issues, and damage to the nervous system.91
Lymphocytic choriomeningitis	This virus carried by rodents including mice, hamsters, and guinea pigs. If an infected mother passes information technology to her fetus it can crusade problems with encephalon development, long-term neurological and/or visual damage, and higher mortality rates after birth.92

Maternal Factors

There are additional factors that touch the issue of pregnancy for both mother and child. Let's look at these next.

Figure 2.fifteen: A significant woman relaxing in a tub.⁹³

Mothers over 35

Most women over 35 who get pregnant are in good health and have healthy pregnancies. Still, according to the March of Dimes (2016d), women over age 35 are more than likely to have an increased risk of:

• Fertility problems
• High blood pressure
• Diabetes
• Miscarriages
• Placenta Previa
• Cesarean department
• Premature birth
• Stillbirth
• A baby with a genetic disorder or other birth defects

Because a adult female is born with all her eggs, environmental teratogens can affect the quality of the eggs every bit women get older. Besides, a woman'due south reproductive system ages which tin adversely affect the pregnancy. Some women over 35 choose special prenatal screening tests, such as a maternal claret screening, to determine if there are whatever wellness risks for the baby.

Although at that place are medical concerns associated with having a child later in life, there are besides many positive consequences to beingness a more than mature parent. Older parents are more confident, less stressed, and typically married, providing family stability. Their children perform better on math and reading tests, and they are less decumbent to injuries or emotional troubles (Albert, 2013). Women who choose to expect are often well educated and atomic number 82 healthy lives. According to Gregory (2007), older women are more stable, demonstrate a stronger family unit focus, possess greater self-confidence, and have more money. Having a kid later in ane's career equals overall college wages. In fact, for every year a woman delays motherhood, she makes 9% more in lifetime earnings. Lastly, women who delay having children actually live longer.

Teenage Pregnancy

A teenage mother is at a greater risk for having pregnancy complications including anemia, and loftier blood pressure. These risks are fifty-fifty greater for those under age fifteen. Infants born to teenage mothers have a higher risk for being premature and having low birthweight or other serious health bug. Premature and low birthweight babies may have organs that are not fully developed which can result in breathing bug, haemorrhage in the brain, vision loss, serious abdominal problems, and college likelihood of dying. Reasons for these health issues include that teenagers are the least likely of all age groups to get early and regular prenatal intendance and they may engage in negative behaviors including eating unhealthy nutrient, smoking, drinking alcohol, and taking drugs.

Gestational Diabetes

Vii percentage of pregnant women develop gestational diabetes (March of Dimes, 2015b). Diabetes is a condition where the body has besides much glucose in the bloodstream.

Figure 2.16: A gestational diabetes kit.⁹⁴

Most significant women take their glucose level tested between 24 to 28 weeks of pregnancy. Gestational diabetes usually goes abroad subsequently the mother gives nascency, but it might indicate a risk for developing diabetes afterwards in life. If untreated, gestational diabetes can cause premature nascency, stillbirth, the baby having breathing issues at birth, jaundice, or low claret saccharide. Babies born to mothers with gestational diabetes tin can also be considerably heavier (more 9 pounds) making the labor and nativity process more difficult. For expectant mothers, untreated gestational diabetes tin can cause preeclampsia (high blood pressure and signs that the liver and kidneys may not be working properly) discussed subsequently in the chapter.

Risk factors for gestational diabetes include age (beingness over historic period 25), being overweight or gaining too much weight during pregnancy, family history of diabetes, having had gestational diabetes with a prior pregnancy, and race and ethnicity (African-American, Native American, Hispanic, Asian, or Pacific Islander take a higher risk). Eating healthy and maintaining a healthy weight during pregnancy can reduce the risk of gestational diabetes. Women who already have diabetes and become pregnant need to nourish all their prenatal care visits, and follow the aforementioned advice as those for women with gestational diabetes as the risk of preeclampsia, premature nascency, nascence defects, and stillbirth are the same.

High Blood Pressure (Hypertension)

Hypertension is a condition in which the pressure level against the wall of the arteries becomes too high. There are two types of loftier blood pressure during pregnancy, gestational and chronic. Gestational hypertension only occurs during pregnancy and goes away after birth. Chronic high blood pressure refers to women who already had hypertension earlier the pregnancy or to those who developed it during pregnancy and it did not go away after nascency.

Figure 2.17 – A adult female having her blood pressure taken.^[Image by rawpixel on Unsplash

According to the March of Dimes (2015c), about 8 in every 100 meaning women accept loftier claret force per unit area. High blood pressure during pregnancy tin cause premature birth and low birth weight (nether 5 and a half pounds), placental abruption, and mothers tin can develop preeclampsia.

Rh Disease

Rh is a poly peptide found in the blood. Nearly people are Rh positive, meaning they have this poly peptide. Some people are Rh negative, meaning this protein is absent. Mothers who are Rh negative are at risk of having a baby with a form of anemia called Rh affliction (March of Dimes, 2009). A father who is Rh-positive and mother who is Rh-negative can excogitate a infant who is Rh-positive. Some of the fetus's claret cells may become into the mother'south bloodstream and her immune organisation is unable to recognize the Rh factor.

The allowed system starts to produce antibodies to fight off what it thinks is a foreign invader. Once her body produces immunity, the antibodies can cross the placenta and start to destroy the scarlet claret cells of the developing fetus. As this procedure takes time, frequently the first Rh positive baby is non harmed, but as the mother'south body will continue to produce antibodies to the Rh gene across her lifetime, subsequent pregnancies tin can pose greater chance for an Rh positive baby. In the newborn, Rh disease tin can atomic number 82 to jaundice, anemia, center failure, encephalon damage and death.

Weight Gain during Pregnancy

According to March of Dimes (2016f), during pregnancy most women need only an additional 300 calories per day to aid in the growth of the fetus. Gaining too little or too much weight during pregnancy can be harmful. Women who gain besides trivial may accept a infant who is low-birth weight, while those who gain as well much are likely to have a premature or large baby. There is also a greater adventure for the mother developing preeclampsia and diabetes, which can cause further problems during the pregnancy.

The table beneath shows the healthy weight gain during pregnancy. Putting on the weight slowly is best. Mothers who are concerned about their weight gain should talk to their health care provider.

Tabular array 2.11: Weight Gain during Pregnancy

If you were a good for you weight before pregnancy:	If you were underweight earlier pregnancy:	If you were overweight before pregnancy:	If y'all were obese before pregnancy:
Proceeds 25-35 pounds	Gain 28-xxx pounds	Gain 12-25 pounds	11-20 pounds
i-4½ pounds in the 1st trimester	1-4½ pounds in the 1st trimester	1-iv½ pounds in the 1st trimester	one-4½ pounds in the 1st trimester
1 pound per week in the 2nd and 3rd trimesters	A niggling more than than 1 pound per week thereafter	A petty more ½ pound per week in 2nd and tertiary trimesters	A footling more than ½ pound per week in second and 3rd trimesters
Note:
Mothers of twins or higher lodge multiples need to proceeds more than in each category.

Stress

Feeling stressed is mutual during pregnancy, merely high levels of stress can cause complications including having a premature baby or a low-birthweight babe. Babies born early or too small are at an increased take a chance for health bug. Stress-related hormones may crusade these complications by affecting a woman's immune systems resulting in an infection and premature birth. Additionally, some women deal with stress by smoking, drinking booze, or taking drugs, which can lead to problems in the pregnancy. Loftier levels of stress in pregnancy take besides been correlated with problems in the babe's encephalon evolution and immune system functioning, every bit well equally childhood problems such equally trouble paying attention and beingness afraid (March of Dimes, 2012b).

Depression

Low is a pregnant medical condition in which feelings of sadness, worthlessness, guilt, and fatigue interfere with ane's daily functioning. Depression tin can occur before, during, or subsequently pregnancy, and 1 in 7 women are treated for depression quondam betwixt the year before pregnancy and year afterward pregnancy (March of Dimes, 2015a). Women who accept experienced depression previously are more likely to have low during pregnancy. Consequences of low include the baby being born premature, having a low birthweight, being more irritable, less agile, less attentive, and having fewer facial expressions.

Almost 13% of pregnant women have an antidepressant during pregnancy. Information technology is important that women taking antidepressants during pregnancy discuss the medication with a health intendance provider as some medications can cause harm to the developing organism.

Paternal Affect

The age of fathers at the time of conception is also an important cistron in wellness risks for children. According to Nippoldt (2015), offspring of men over 40 face an increased risk of miscarriages, autism, nascence defects, achondroplasia (bone growth disorder) and schizophrenia. These increased health risks are idea to be due to accumulated chromosomal aberrations and mutations during the maturation of sperm cells in older men (Bray, Gunnell, & Smith, 2006). However, similar older women, the overall risks are modest.

In addition, men are more likely than women to work in occupations where hazardous chemicals, many of which have teratogenic effects or may cause genetic mutations, are used (Cordier, 2008). These may include petrochemicals, lead, and pesticides that tin cause abnormal sperm and lead to miscarriages or diseases. Men are also more likely to be a source of second mitt fume for their developing offspring. Equally noted earlier, smoking by either the mother or around the female parent tin hinder prenatal evolution.⁹⁵

Figure ii.17: A USDA employee pouring hazardous chemicals into a storage container.⁹⁶

Prenatal Cess

A number of assessments are suggested to women every bit part of their routine prenatal care to observe conditions that may increase the chance of complications for the mother and fetus (Eisenberg, Murkoff, & Hathaway, 1996). These can include blood and urine analyses and screening and diagnostic tests for birth defects.

Figure 2.18: A adult female receiving an ultrasound.⁹⁷

Ultrasound is i of the master screening tests done in combination with blood tests. The ultrasound is a test in which sound waves are used to examine the fetus. At that place are two general types. Transvaginal ultrasounds are used in early pregnancy, while transabdominal ultrasounds are more common and used after ten weeks of pregnancy (typically, 16 to 20 weeks).

Ultrasounds are used to check the fetus for defects or problems. Information technology can too find out the historic period of the fetus, location of the placenta, fetal position, movement, animate and middle charge per unit, amount of amniotic fluid in the uterus, and number of fetuses. Most women have at least 1 ultrasound during pregnancy, only if problems are noted, additional ultrasounds may be recommended.

When diagnosis of a nascency defect is necessary, ultrasounds aid guide the more than invasive diagnostic tests of amniocentesis and chorionic villus sampling. Amniocentesis is a procedure in which a needle is used to withdraw a small corporeality of amniotic fluid and cells from the sac surrounding the fetus and later on tested.

Figure two.19: Amniocentesis.⁹⁸

Chorionic Villus Sampling is a procedure in which a small sample of cells is taken from the placenta and tested. Both amniocentesis and chorionic villus sampling have a risk of miscarriage, and consequently they are not done routinely.⁹⁹

Complications of Pregnancy

There are a number of mutual side effects of pregnancy. Not everyone experiences all of these, nor to the same degree. And although they are considered "pocket-sized", this is not to say that these problems are not potentially very uncomfortable. These side furnishings include nausea (particularly during the starting time three-4 months of pregnancy as a result of higher levels of estrogen in the arrangement), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia, constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). These are minor bug.

Just there are also serious complications of pregnancy which can pose wellness risks to female parent and child and that often crave hospitalization.

Hyperemesis gravidarum is characterized by severe nausea, vomiting, weight loss, and possibly dehydration. Signs and symptoms may too include vomiting many times a day and feeling faint. The exact causes of hyperemesis gravidarum are unknown. Run a risk factors include the first pregnancy, multiple pregnancy, obesity, prior or family unit history of HG, trophoblastic disorder, and a history of eating disorders. Handling includes drinking fluids and a bland diet. Medication, intravenous fluids, and hospitalization may be required. Hyperemesis gravidarum is estimated to affect 0.iii–2.0% of pregnant women. Those affected take a depression risk of miscarriage simply a higher risk of premature nativity.

Ectopic Pregnancy occurs when the zygote becomes attached to the fallopian tube earlier reaching the uterus. Most 1 in 50 pregnancies in the United States are tubal pregnancies and this number has been increasing considering of the higher rates of pelvic inflammatory disease and Chlamydia (Carroll, 2007). Intestinal pain, vaginal bleeding, nausea and fainting are symptoms of ectopic pregnancy.

Figure 2.twenty: An ectopic pregnancy.¹⁰⁰

Spontaneous ballgame is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another ten percent of diagnosed pregnancies. Unremarkably the trunk aborts due to chromosomal abnormalities, and this typically happens earlier the twelfth week of pregnancy. Cramping and bleeding outcome and normal periods return after several months. Some women are more likely to have repeated miscarriages due to chromosomal, amniotic, or hormonal problems, but miscarriage can also be a upshot of defective sperm (Carrell et. al., 2003).

Preeclampsia, also known as Toxemia, is characterized past a sharp rise in blood pressure, a leakage of protein into the urine as a result of kidney problems, and swelling of the easily, anxiety, and face during the third trimester of pregnancy. Preeclampsia is the nigh common complication of pregnancy. When preeclampsia causes seizures, the condition is known every bit eclampsia, which is the second leading cause of maternal death in the United States. Preeclampsia is also a leading cause of fetal complications, which include depression nativity weight, premature nascence, and stillbirth. Treatment is typically bed rest and sometimes medication. If this handling is ineffective, labor may be induced.

Maternal Mortality: Approximately 1000 women dice in childbirth around the world each 24-hour interval (Earth Health System, 2010). Rates are highest in Sub-Saharan Africa and South Asia, although there has been a substantial decrease in these rates. The entrada to make childbirth safety for anybody has led to the development of clinics accessible to those living in more isolated areas and training more midwives to assist in childbirth.¹⁰¹

Infertility and Edifice Families

Infertility

When a couple has failed to conceive a child in a year, they receive the diagnosis of infertility. Infertility affects near 10 to 15 percent of couples in the United States (Mayo Clinic, 2015). Male factors create infertility in virtually a tertiary of the cases. For men, the most common cause is a lack of sperm production or low sperm production.

Female person factors crusade infertility in another third of cases. For women, one of the almost common causes of infertility is the failure to ovulate. Another cause of infertility in women is Pelvic Inflammatory Affliction (PID), which is an infection of a adult female'due south reproductive organs (Carroll, 2007).

Both male and female person factors contribute to the remainder of cases of infertility.¹⁰²

Options for Edifice Families

At that place are numerous options to pursue parenthood and building families. Let's briefly explore some of these.

Assisted Reproductive Engineering

Assisted reproductive engineering science (Art) is the technology used to achieve pregnancy in procedures such every bit fertility medication (to stimulate ovulation), surgical procedures, artificial insemination IUI), in vitro fertilization (IVF) and surrogacy. These options are available for people who are experiencing infertility or cannot conceive children naturally (which also includes single parents, and gay/lesbian couples).¹⁰³

Intrauterine insemination: (IUI) as a type of artificial insemination involves the placement of sperm direct into the uterus at the time of ovulation, either in a natural menstrual wheel or following ovarian stimulation.¹⁰⁴

In vitro fertilization (IVF): IVF generally starts with stimulating the ovaries to increase egg product. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes identify outside the body, and the fertilized egg is reinserted into the adult female's reproductive tract, in a procedure called embryo transfer.¹⁰⁵

Figure 2.21: The IVF procedure.¹⁰⁶

Donor Gametes & Embryos: People can likewise apply sperm, ova (eggs), and embryos from donors in conjunction with ART. These donations accept identify through agencies and donor banks or betwixt private individuals. In the U.S., donors can be compensated for their donations.

Surrogacy: In surrogacy, 1 adult female (surrogate mother) carries a kid for another person/s (commissioning person/couple), based on a legal agreement before conception requiring the kid to be relinquished to the commissioning person/couple post-obit birth. In that location are different types of surrogacy which relate to whether or not the ova used to conceive the child are her ain (traditional surrogacy) or not (gestational surrogacy).¹⁰⁷

Adoption: People tin as well choose to pursue adoption to build their families (with or without experiencing infertility). Adoption can take place through the foster care system, privately, or through agencies. Adoptions tin exist domestic (inside the U.S.) or international. And they can be open (with differing amounts of contact betwixt biological/birth families and adoptive families) or airtight.

Family Built with Surrogacy

Figure 2.22: This same-sex activity couple used a surrogate.¹⁰⁸

Family unit Built through Adoption

Figure 2.23: This single mother adopted her girl.¹⁰⁹

In this affiliate we looked at:

• Heredity, including genetic disorders and chromosomal abnormalities

• Conception

• The germinal, embryonic, and fetal stages of prenatal evolution

• Influences on prenatal development including teratogens and maternal and paternal factors

• Complications of pregnancy

• Infertility and options for building families

At present let's explore nativity and the newborn baby.

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