ASSIGNMENT 1

UNIT 1

I. Answer the following questions:

1. What are the important milestone of fetal growth and development.

Pregnancy is in and of itself a milestone for mothers and soon-to-be parents, but there are also
many existing milestones all throughout the course of the 40 weeks pregnancy time.
Additionally, distinct changes in the baby, and the mother takes place, varying for every
trimester. Now, let’s go over every milestone.

The first trimester, generally regarded as first three months of pregnancy, will span from
conception to 12 weeks. During this trimester, the baby will change from a small grouping of
cells to a fetus that is starting to develop features. At the end of the fourth gestational week,
baby-in-the-making is a ball of cells called a blastocyst. The blastocyst already contains a full set
of DNA, which determines sex, eye color, and other traits. Moreover, has officially become an
embryo and is about the size of a poppy seed. Finally, at the end of eight gestational week, baby's
tiny heart begins to beat – at twice the rate of yours. His entire "body" is only about the size of a
sesame seed. Facial features (like eyes and nostrils) are beginning to form, and little buds appear
where arms and legs will develop. Furthermore, arms and legs are growing, and now has little
fingers, as well as a nose and upper lip. About 5/8 of an inch long and weighs hardly anything
about four-hundredths of an ounce. Following this, we are down to the end of 12th gestational
week wherein eyes have developed, although eyelids are fused shut for now. Lost the "tail" and
is starting to look more human. The embryo has become a fetus. His vital organs – such as
kidneys, intestines, brain, and liver – are starting to function. Tiny fingernails and toenails are
starting to form. Baby is almost fully formed and size is just over 2 inches long and weighs about
half an ounce. Bones are beginning to harden, and her genitalia are developing externally. You
can hear your baby's heartbeat at a prenatal check-up.

This middle section of pregnancy is often thought of as the best part of the experience. By the
second trimester, any morning sickness is probably gone and the discomfort of early pregnancy
has faded. You may also start to feel movement as your baby flips and turns in the uterus. During
this trimester, many people find out the sex of the baby through an ultrasound around 20 weeks.
Upon reaching the end of 16th gestational week, baby's kidneys are producing urine, and then
releases it into the amniotic fluid, can make facial expressions and may have discovered thumb-
sucking. In addition, has the ability to see light that filters in from outside your womb, even
though her eyelids are still shut. The baby's sex may be detectable at your mid-pregnancy
ultrasound, which typically happens between 16 and 20 weeks. At the tail end of 20th week,
spontaneous fetal movements are sensed by the mother, baby can hear your heartbeat and sounds
that come from outside your body. Skin is wrinkly and is covered by a protective, waxy coating
and measures about 6 inches from head to bottom and weighs about 8 1/2 ounces. At last, for the
end of 24th gestational week, baby's sense of movement has developed, so he can feel the
mother’s motion. Sense of hearing continues to improve as well as the taste buds are developing.
Brain is growing very quickly, and hair may be growing, too. Almost a foot long and weighs just
over a pound. Lungs are developing but won't be fully functional for several more weeks,
"practicing" for life on the outside by inhaling and exhaling amniotic fluid, sleeping and waking
up at regular intervals, opening and closing his eyes, and sucking his fingers.

Third trimester is the final part of pregnancy. The countdown begins. Each week of this final
stage of development, helps your baby prepare for childbirth. Throughout the trimester, the baby
will gain weight quickly, adding body fat that will help after birth. Remember, that the typical,
full-term pregnancy is 40 weeks, therefore, pregnancy can take 9 months and up to 10 months.
It’s also possible that you can go past your due date by a week or two (41 or 42 weeks). With the
end of the 28th week, baby may be dreaming. Has eyelashes, and eyesight is improving. Billions
of neurons are developing in the brain. Weighs about 2 1/4 pounds and is about 15 inches long,
head to heel. Following that, at 32nd gestational week, baby is starting to plump up in
preparation for birth and has grown little fingernails and toenails; Almost 17 inches and weighs
about 3 3/4 pounds. For the 36th week, baby's lungs and central nervous system are continuing to
develop. Her skin has become soft and smooth, filling out and getting even rounder. Almost 18
inches long and weighs about 4 3/4 pounds. At this point, most fetuses turn into a vertex
presentation. Lastly, the finish line, end of 40th gestational week, baby is now considered full-
term and is ready for life outside the womb. The average weight of a newborn is about 7 1/2
pounds, and the average length is about 20 inches.

Some women call the period after pregnancy the “fourth trimester,” and it’s essential to not
forget to keep taking care of yourself during this period despite most of your focus is directed
naturally being on the baby. Getting through each milestone is an awe-inspiring achievement and
at the same time, a challenging process. Salute to all mothers, indeed.
2. What are the common teratogens and their effects on fetus

A teratogenic agent is a chemical, infectious agent, physical condition, or deficiency that, on

fetal exposure, can alter fetal morphology or subsequent function. Teratogenicity depends upon
the ability of the agent to cross the placenta. Certain medications such as heparin cannot cross
the placenta due to its high molecular weight and are therefore not teratogenic. The embryo is
most susceptible to teratogenic agents during periods of rapid differentiation. The stage of
development of the embryo determines susceptibility to teratogens. The most critical period in
the development of an embryo or in the growth of a particular organ is during the time of most
rapid cell division.

One of the most commonly used teratogens is alcohol. Alcohol consumption, at any point
during pregnancy, may lead to neurocognitive and behavioral difficulties that can last a lifetime.
In extreme cases, can lead to fetal death, but also can result in Fetal Alcohol Spectrum Disorders
(FASD), which is an umbrella term for the range of effects that can occur due to alcohol
consumption during pregnancy (March of Dimes, 2016). The most severe form of FASD is Fetal
Alcohol Syndrome (FAS). Children with FAS share certain physical features such as flattened
noses, small eye holes, and small heads. Cognitively, these children have poor judgment, poor
impulse control, higher rates of ADHD, learning issues, and lower IQ scores. These
developmental problems and delays persist into adulthood (Streissguth et al., 1996) and can
include criminal behavior, psychiatric problems, and unemployment (CDC, 2016). Based on
animal studies, it has been hypothesized that a mother’s alcohol consumption during pregnancy
may predispose her child to like alcohol (Youngentob et al., 2007). Another widely used
teratogen is tobacco, the fetus is exposed to dangerous chemicals including nicotine, carbon
monoxide and tar, which lessen the amount of oxygen available to the fetus. Oxygen is important
for overall growth and development. Tobacco use during pregnancy has been associated with
low birth weight, ectopic pregnancy, placenta previa, placenta abruption, preterm delivery,
stillbirth, fetal growth restriction, sudden infant death syndrome (SIDS), birth defects, learning
disabilities, and early puberty in girls (Center for Disease Control, 2015). Taking Over-the-
counter Drugs is also teratogenic. A woman should not be taking any prescription drug during
pregnancy unless it was prescribed by a health care provider. Some prescription drugs can cause
birth defects, problems in overall health, and development of the fetus. There are Teratogenic
drugs such as cocaine, ecstasy and other club drugs, heroin, marijuana, and prescription drugs
that are abused. It is difficult to completely determine the effects of a particular illicit drug on a
developing child because most mothers use more than one substance and have other unhealthy
behaviors. However, several problems seem clear. The use of cocaine is connected with low
birth weight, stillbirths and spontaneous abortion. Heavy marijuana use is associated with
problems in brain development (March of Dimes, 2016). If the mother used an addictive drug,
the baby can get addicted to the drug before birth and go through drug withdrawal after birth,
also known as Neonatal Abstinence Syndrome (March of Dimes, 2015). Other complications of
illicit drug use include premature birth, smaller than normal head size, birth defects, heart
defects, and infections. Additionally, babies born to mothers who use drugs may have problems
later in life, including learning and behavior difficulties, slower than normal growth, and die
from Sudden Infant Death Syndrome. Children of substance abusing parents are also considered
at high risk for a range of biological, developmental, academic, and behavioral problems,
including developing substance abuse problems of their own (Conners, et al., 2003). Another
common example of teratogens are Pollutants. There are more than 83,000 chemicals used in the
United States with little information on the effects of them during pregnancy (March of Dimes,
2016). An environmental pollutant of significant concern is lead poisoning, which is connected
with low birth weight and slowed neurological development. The chemicals in certain pesticides
are also potentially damaging and may lead to birth defects, learning problems, low birth weight,
miscarriage, and premature birth (March of Dimes, 2014). Radiation is another environmental
hazard. Exposure to radiation can slow the baby’s growth, cause birth defects and cancer, affect
brain development and result in miscarriage. Common teratogenic maternal infections involve
Toxoplasmosis which can cause premature birth, stillbirth, and can result in birth defects to the
eyes and brain. While most babies born with this infection show no symptoms, ten percent may
experience eye infections, enlarged liver and spleen, jaundice, and pneumonia; Rubella, also
called German measles, has been associated with a number of birth defects. If the mother
contracts the disease during the first three months of pregnancy, damage can occur in the eyes,
ears, heart or brain of the unborn child. Deafness is almost certain if the mother has German
measles before the 11th week of prenatal development and can also cause brain damage;
Sexually Transmitted Diseases such as Gonorrhea, syphilis, and chlamydia are sexually
transmitted infections that can be passed to the fetus by an infected mother. It can cause
premature birth, premature rupture of the amniotic sac, an ectopic pregnancy, birth defects,
miscarriage, and still births (March of Dimes, 2013). Most babies become infected with STDS
while passing through the birth canal during delivery, but some STDs can cross the placenta and
infect the developing fetus. One of the most potentially devastating teratogens is HIV. One of the
main ways children under age 13 become infected with HIV is via mother-to-child transmission
of the virus prenatally, during labor, or by breastfeeding (CDC, 2016).

Recognition of human teratogens offers the opportunity to prevent exposure at critical periods
of development and prevent certain types of congenital malformations and abnormalities. In
general, drugs, food additives, and pesticides are tested to determine their teratogenicity to
minimize exposure of pregnant women to teratogenic agents.
3. Discuss how to solve for the AOG, EDD and the obstetrical history using GTPAL.

Gestational age is the common term used during pregnancy to describe how far along the
pregnancy is, defined as the best obstetrical estimate (OE) of the newborn’s gestation in
completed weeks based on the birth attendant’s final estimate of gestation, irrespective of
whether the gestation results in a live birth or a fetal death. This estimate of gestation should be
determined by all perinatal factors and assessments. To solve for the Age of Gestation, total the
number of days since Last Menstrual Period to the present day divided by 7. For example, a
pregnant mother comes to the clinic for an initial prenatal check-up. She said that her last
menstrual period was on August 17, 2020. Present day is October 24, 2020. The month of
August has 31 days, therefore, 31 minus 17 equals to 14 days then add the remaining 30 days for
September and the 24 days for October. The sum is 68 days divided by 7, the gestational age is 9
weeks and 7 days. Additionally, McDonald’s rule can also be used for the computation of AOG.
By simply adding the funding height (in cm) and plus 4. For example, Fundic Height recorded is
at 25 cm, 25 plus 4 equals to 29 weeks or 6 months. There are also anatomical landmarks that
can be used as a general reference point. At 12 weeks it is slightly above the symphysis pubis; 20
weeks at the level of umbilicus; 36 weeks if below the xiphoid process and 32 to 40 weeks
maintains same level due to lightening on the 40th week.

Estimated due date (EDD or EDC) is the date that spontaneous onset of labor is expected
to occur. The due date may be estimated by adding 280 days (9 months and 7 days) to the first
day of the last menstrual period (LMP). This is the method used by "pregnancy wheels". The
accuracy of the EDD derived by this method depends on accurate recall by the mother, assumes
regular 28-day cycles, and that ovulation and conception occurs on day 14 of the cycle. Another
method is to use Naegele’s rule. For Last Menstrual Period between April to December, count
backwards 3 months from first day of Last menstrual period and add 7 days then plus 1 year
while if the Last Menstrual Period falls between January to March, add 9 months and 7 days.
From the aforementioned example, let’s get her estimated due date. LMP on August 17, 2020,
minus 3 months, we’ll have May as the month, adding 7 days to 17 equals to 24 days. And 2020
plus a year is 2021. The estimated due date is May 24, 2021.

Obstetric history taking involves a series of methodical questioning of an obstetric patient

with the aim of developing a diagnosis or a differential diagnosis on which further management
of the patient can be arranged. GTPAL system calculates the obstetric history of a woman in
terms of the number of times she had been pregnant, the number of term births, the number of
premature births, the number of abortions, and the number of living children she currently has. G
for Gravidity, refers to the number of times that the woman has been pregnant. T as Term births,
is the number of times the woman has given birth to babies after 37 weeks of gestation. P stands
for Premature births, it is the number of times the woman has given birth to babies before 37
weeks of gestation. Both for term and premature births, multiple gestation is considered as 1
birth. A stand for abortions, is the number of pregnancies that have been terminated (induced
abortion) or the number of pregnancies in which the fetus dies in utero before 20 weeks into the
pregnancy. If the fetus dies after 20 weeks into the pregnancy, it is considered a stillbirth. L as
Living children, refers to children who are currently living. This is where multiple gestation
births matter. For example, A mother is currently at her fourth pregnancy. Her first pregnancy
ended in a spontaneous abortion at 8 weeks, the second results in the live birth of twin boys at 38
weeks, and the third resulted in the live birth of a daughter at 34 weeks. The obstetrical history is
given as G=4, T=1, P=1, A=1, L=3.