1. Fertilization and Pregnancy

2. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 2 What is the approximate annual cost of raising a child born today? A. $5000 B. $8000 C. $12,000  C. According to the U.S. Dept. of Agriculture, it costs more than $12,500 per year (on average) to raise a child born n 1995 to the age of 2. The cost jumps every 2 to 3 years. It will cost more than $250,000 (on average) to raise a child to age 18.

3. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 3 What is the leading cause of female infertility? A. Growths in the uterus B. Exposure to radiation C. Blocked fallopian tubes caused by STDs  C. If left untreated, the STDs gonorrhea and chlamydia can lead to tubal scarring and blockage. Leading causes of male infertility include low sperm count and poor sperm motility, usually as a result of injury, infection, birth defects, or subjecting the testes to high temperatures. One recent study linked repeated use of laptop computers with increased scrotal temperature and potential effects on male fertility.

4. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 4 Cigarette smoking before or during pregnancy is linked to which of the following? A. higher rates of infertility among men and women B. Increased risk of low birth weight among infants C. Decreased likelihood of having a mal infant D. Increased risk of attention-deficit/hyperactivity disorder among children exposed in utero  All four. Smoking has many negative effects on infants and on the reproductive systems of both men and women. The reduction in male births associated with smoking may result from problems with sperm quality, especially those sperm cells with a Y chromosome.

5. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 5 The position in which babies sleep has a significant impact on their risk of dying from sudden infant death syndrome (SIDS). True or False?  True. The rate of SIDS in the United States has dropped over 50% since 1992, when an education campaign called “Back to Sleep” was implemented to teach parents and caregivers to put babies to bed on their backs instead of their stomachs.

6. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 6 Statistics  An estimated half of the approximately 4.1 million babies born every year in the U.S. are from unintentional pregnancies.  The average age of first-time U.S. mothers has increased steadily since 1970 from 21.4 to 25.1 years.

7. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 7 Deciding to Become a Parent  Physical health and age  Financial circumstances From birth to 18 years old costs $250,000  Relationship with your partner  Education, career and child care plans  Emotional readiness  Social support  Personal qualities  Philosophical or religious beliefs

8. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 8 Preconception Care 1.Preexisting medical conditions? 2.Prescription drug/OTC drug use? 3.Prior pregnancy or delivery problems? 4.Age? 5.Smoking, alcohol or other drug usage? 6.Any infections? 7.Diet? 8.Family history of genetic disorders?

9. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 9 Female Terms to know:  Ovum – egg; female sex cell  Ovary – produce eggs and sex hormones Thousands of egg cells are stored here  Follicle – saclike structure within the ovary where the eggs mature  Fallopian Tube – (Oviduct) where egg travels from ovary to the uterus; the site of fertilization  Uterus – where egg attaches and develops  Endometrium – inner lining of the uterus  Vagina – opening to the uterus  Cervix – separates the vagina from the uterus  Zygote – fertilized egg

10. Male Terms to know:  Sperm – male sex cell  Testicles/Testes – produce hormones and sperm cells About 1,000 tubules where sperm are produced  Scrotum – the sack that holds the testes  Epidydimus – tube where sperm are held inside the testes  Vas Deferens – tube that opens into the urethra inside the penis  Prostate Gland and Cowper’s Gland – produce a mixture of fluids called semen  Testosterone – hormone that stimulates male sexual characteristics Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 10

11. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 11 Understanding Fertility  Conception involves the fertilization of a women’s ovum by a man’s sperm Each month a women’s ovaries release an egg It takes approximately 4 or more days for the egg to travel through the fallopian tube Eggs alternate between the two fallopian tubes each month The egg continues to travel into the uterus and out the cervix and vagina.  This process is called ovulation

12. Fertility  If the woman has intercourse during ovulation: During a man’s ejaculation millions of sperm travel into the woman’s vagina, into the cervix and uterus The sperm continue into the woman’s fallopian tube to meet the egg Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 12

13. Fertility  Only one of those sperm can permeate the woman’s egg The sperm meets the egg in the fallopian tube The sperm releases an enzyme that does not allow any other sperm to permeate the egg also  If the sperm permeates the woman’s egg fertilization takes place. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 13

14. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 14 Development  As soon as fertilization occurs, the zygote starts to undergo cell division that begins the growth process.  It continues to divide as it travels through the fallopian tube and to the uterus.  Upon reaching the uterus, the cluster of cells now known as a blastocyst becomes implanted in the endometrium (lining of the uterus). This is where the eventual fetus will develop until birth

15. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 15 Fertilization and Early Development of the Embyro

16. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 16 Genetics  The ovum (egg) carries the hereditary characteristics of the mother and her ancestors; the sperm carries those from the father and his ancestors.  Each egg and sperm contain 23 chromosomes, each of which contains genes.  The fertilized egg or zygote will contain all 46 chromosomes

17. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 17 Twins or Multiples?  The usual course of events is that one egg and one sperm unite to produce one fertilized egg and one baby.  Fraternal Twins - If the ovaries release two (or more) eggs during ovulation and if both eggs are fertilized, twins will develop.  Identical Twins – If the fertilized egg divides into two cells that develop separately, shared genetic material will be split, twins will grow and develop.

18. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 18 Pregnancy  13 week trimesters for 38-40 total weeks or 266 days  Early Tests Can be performed as early as 2 weeks after fertilization Home pregnancy kits sold OTC include a small sample of red blood cells called Human chorionic gonadotropin (HCG) Woman adds a small amount of her urine Instructions must be followed carefully

19. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 19 Fetal Development  First Trimester Blastocyst – for first 2 weeks  Inner cells divide into three layers  One layer – inner body parts  Middle layer – muscle, bone, blood, kidneys, and sex glands  Third layer – skin, hair, and nervous tissue Embryo – At end of second week  All major body structures are formed between 2nd and 9th week Fetus - At 2nd Month

20. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 20 Early signs and symptoms Missed menstrual period Softening of the uterus  Hegar’s sign found during pelvic exam Slight bleeding Nausea Breast tenderness Increased urination Sleepiness, fatigue and emotional upset

21. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 21 Continual Change in the Women’s Body  Uterus size grows  Around the Forth Month Breast changes Muscles and Ligaments loosen Weight Gain

22. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 22 Changes During the Later Stages of Pregnancy  Increased needs from the fetus are placed on the mother  Braxton hicks contractions Preliminary contractions  Lightening When baby settles into pelvic bones with head down, causing the uterus to sink down 2 inches  Emotional responses to Pregnancy

23. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 23

24. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 24 Fetal Development  Placenta Network of blood vessels called chorionic villi Allows a 2-way exchange of nutrients and waste materials between the mother and fetus Brings oxygen and nutrients to the fetus and transports waste products out Does not provide a perfect barrier between fetal and maternal circulation  Some blood cells are exchanged and certain substances such as alcohol pass freely from maternal circulation through placenta to the fetus  Umbilical cord The cord connecting the placenta and fetus, through which nutrients pass  Amniotic sac A membranous pouch enclosing and protecting the fetus, containing amniotic fluid

25. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 25

26. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 26 Fetal Development  Second Trimester Fetus grows to about 14 inches and 2 pounds  Third Trimester Fetus gains protective fat layers, Respiratory and Digestive organs develop

27. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 27 Diagnosing Fetal Abnormalities  Ultrasonography (Ultrasound) High frequency sound waves  Amniocentesis Fluid removal from the uterus  Chorionic Villus sampling Removal of tiny section of chorionic villi  Triple marker screen (TMS) Maternal blood test  Fetal programming Amniocentesis, CVS, and TMS Chromosomal, genetic and other abnormalities

28. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 28 The Importance of Prenatal Care  Regular medical checkups  Blood tests  Prenatal nutrition  Avoidance of drugs, and other environmental hazards Alcohol Tobacco Caffeine Drugs and chemicals STD’s and other infections

29. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 29 The Importance of Prenatal Care  Activity and exercise After 20 weeks avoid lying on your back Modify the intensity Avoid any potential for mild abdominal trauma Avoid heat stress Unusual symptoms Resume prepregnancy exercise gradually Kegal Exercises  Preparation for childbirth

30. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 30 Complications of Pregnancy and Pregnancy Loss  Ectopic pregnancy  Spontaneous Abortion, or miscarriage  Preeclampsia/eclampsia  Low-birth Weight (LBW) 5.5 LBS.  Infant Mortality SIDS  Coping with loss

31. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 31 Childbirth  Choices in childbirth Who is going to assist with delivery? Where is the baby going to be delivered?

32. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 32 Labor and Delivery  Entire process 2-36 hours.  First stage of Labor. 13 hours for a first birth. Cervix is completely dilated (10 centimeters) Hormonal changes. Contractions. (30 seconds and occur every 15-20 minutes) Mucus plug is expelled and amniotic sac may rupture. Transition.

33. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 33 Childbirth  Second Stage of Labor Baby slowly pushed into birth canal Baby squeezes through pelvis Head is usually delivered first Umbilical cord is cut  Third Stage of Labor Delivery of the placenta  Apgar Scale of the Baby

34. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 34 Pain Relief During Labor and Delivery  Childbirth preparation courses Breathing and relaxation techniques Lamaze or Bradley  Epidural  Narcotics Fentanyl or demeral Provide less pain relief than a epidural

35. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 35 Cesarean Deliveries  About 29% of babies born in the U.S.  Surgical removal of the baby Baby’s head too large Mother has a serious health condition Mother who is overweight or diabetes Difficult labor Fetal distress Dangerous infections 90% of cesarean mothers will have subsequent deliveries by cesarean

36. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 36 Postpartum Period  3 months following childbirth.  Critical family adjustment.  Vaginal delivery leave hospital 1-3 days.  Cesarean section 3-5 days.  Breastfeeding Just over 70% of mothers breast-feed Lactation begins about 3 days post childbirth Colostrum prior to lactation  Postpartum depression.

37. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 37 Infertility  Millions of couples have difficulty conceiving.  Affects 10-20% of the reproductive- age population in the U.S.  Although the focus is usually on women… 30-40% of contributing factors are male 10-30% of infertile couples, both the male and female have problems

38. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 38 Infertility  Women Blocked fallopian tubes Pelvic Inflamm. Disease Endometriosis Hormonal imbalance Uterine Growths Allergic responses to sperm Smoking Alcohol Toxic chemicals or radiation  Men Low sperm count Poor motility Blocked passageways Toxic substances Smoking Drugs Testicular injury Infections Birth defects High Temperatures

39. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 39 Infertility Treatment  Intrauterine insemination Artificial intrauterine insemination  Success rate about 60%  IVF,GIFT, and ZIFT In vitro fertilization (IVF)  Eggs and sperm mixed in lab then put in uterus  Used by women with blocked oviducts Gamete intrafallopian transfer (GIFT)  Sperm and egg placed in oviducts before fertilization Zygote intrafallopian transfer  Eggs fertilized then put in oviducts when cells begin to divide  Success rates vary from 27% to 51%  Cost is between $8,000 and $12,000 per procedure and may require 5 or more cycles to produce one live birth  Increased chance of multiple births which increases rate of complications

40. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 40 Infertility  Surrogate Motherhood  Emotional Responses to Infertility

41. Pregnancy and Childbirth

42. Chapter 8 ©2008 McGraw-Hill Companies. All Rights Reserved. 42 Before conception and in the early weeks of pregnancy, adequate intake of which of the following nutrients can reduce the risk of spina bifida and other neural tube defects? A. Iron B. Folic acid C. Calcium  B. It is recommended that all reproductive- age women consume folic acid from fortified foods and/or supplements each day to reduce the risk of spina bifida and other neural tube defects.