EMBRYOLOGY

Pregnancy

Pregnancy is the fertilization and development of one or more offspring, known as an embryo or fetus, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Childbirth usually occurs about 38 weeks after conception; in women who have a menstrual cycle length of four weeks, this is approximately 40 weeks from the start of the last normal menstrual period (LNMP). Human pregnancy is the most studied of all mammalian pregnancies. Conception can be achieved through sexual intercourse or assisted reproductive technology.

An embryo is the developing offspring during the first 8 weeks following conception, and subsequently the term fetus is used henceforth until birth. 40% of pregnancies in the United States and United Kingdom are unplanned, and between a quarter and half of those unplanned pregnancies were unwanted pregnancies.

In many societies’ medical or legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.

Complications of pregnancy

Complications of pregnancy are the symptoms and problems that are associated with pregnancy. There are both routine problems and serious, even potentially fatal problems. The routine problems are normal complications, and pose no significant danger to either the woman or the fetus. Serious problems can cause both maternal death and fetal death if untreated.

Back pain

§  Common, particularly in the third trimester when the patient's center of gravity has shifted.

§  Treatment: mild exercise, gentle massage, heating pads, paracetamol (acetaminophen), and (in severe cases) muscle relaxants or narcotics

Carpal tunnel syndrome

§  Occurs in between an estimated 21% to 62% of cases, possibly due to edema.

Constipation

§  Cause: decreased bowel motility secondary to elevated progesterone (normal in pregnancy), which causes the "smooth muscle" along the walls of the intestines to relax. Thus, making sure that the future mother will absorb as much nutrients from her diet as possible in order to nourish the fetus and herself. As a side effect the feces can get extremely dehydrated and hard to pass.

§  Treatment: increased PO fluids, stool softeners, bulking agents Drinking plenty of water and eating fruit and fiber enriched foods often help

A woman experiencing sudden defecation should report this to her practitioner.

Contractions

§  occasional, irregular, painless contractions that occur several times per day are normal and are known as Braxton Hicks contractions

§  Caused by: dehydration

§  Treatment: fluid intake

§  regular contractions (every 10-15 min) are a sign of preterm labor and should be assessed by cervical exam.

Dehydration

§  Caused by: expanded intravascular space and increased Third spacing of fluids

§  Treatment: fluid intake

§  Complication: uterine contractions, which may occur because dehydration causes body release of ADH, which is similar to oxytocin in structure. Oxytocin itself can cause uterine contractions and thus ADH can cross-react with oxytocin receptors and also cause contractions.

Edema

§  Caused by: compression of the inferior vena cava (IVC) and pelvic veins by the uterus leads to increased hydrostatic pressure in lower extremities.

§  Treatment: raising legs above the heart, patient sleeps on her side.

Gastroesophageal Reflux Disease (GERD)

§  Caused by: relaxation of the lower esophageal sphincter (LES) and increased transit time in the stomach (normal in pregnancy)

§  Treatment: antacids, multiple small meals a day, avoid lying down within an hour of eating, H2 blockers, proton pump inhibitors

Hemorrhoids

§  Caused by: increased venous stasis and IVC compression leading to congestion in venous system along with increased abdominal pressure secondary to constipation.

§  Treatment: topical anesthetics, steroids, treatment of constipation

Pica

§  cravings for nonedible items such as dirt or clay. Caused by Iron deficiency which is normal during pregnancy and can be overcome with Iron supplements or prenatal vitamins. Commonly, avoid ice chips; it may worsen anemia

Lower abdominal pain

§  Caused by: rapid expansion of the uterus and stretching of ligaments such as the round ligament.

§  Treatment: paracetamol (acetaminophen)(kulot)

Increased urinary frequency

§  Caused by: increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus. Patients are advised to continue fluid intake despite this. Urinalysis and culture should be ordered to rule out infection, which can also cause increased urinary frequency but typically is accompanied by dysuria(pain when urinating).

Varicose veins

§  Caused by: relaxation of the venous smooth muscle and increased intravascular pressure.

§  Treatment: elevation of the legs, pressure stockings

§  relieve swelling and pain with warm sitz bath.

§  Avoid obesity, lengthy standing or sitting, constrictive clothing and constipation and bearing down with bowel movements

Diastasis recti or abdominal separation

During pregnancy, many women experience a separation of their stomach muscles, known as diastasis recti. In order to understand this condition, it is important to understand the muscle that it affects. This particular condition affects the rectus abdominis muscle, that muscle that gives you a “six pack”. (See figure)

The rectus abdominis muscle is divided down the middle by the tendinous line called the linea alba.^[3] It is kept in line by your transverse abdominal and your oblique abdominal muscles. During pregnancy, the growth of the fetus exerts pressure on abdominal cavity muscles, in particular the rectus abdominis. In pregnancies that experience rapid fetus growth or women with particularly weak abdominal muscles, this pressure can sometimes causes the rectus abdominis muscle to separate along the linea alba, creating a split between the left and right sides of the rectus abdominis.

About one-third of all pregnant women experience diastasis recti at some point in their pregnancy, however it is much more likely to occur during the second trimester or third trimester of pregnancy. However, separation also frequently occurs during labor and delivery, or with women carrying more than one baby. Many cases of diastasis recti correct themselves after birth, but some do not. In cases where it persists, exercise may help improve the condition, and sometimes surgery is needed to correct the problem to prevent pain and future complications.

congenital disorder

A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life (neonatal disease), regardless of causation. Of these diseases, those characterized by structural deformities are termed "congenital anomalies"; that is a different concept  which involves defects in or damage to a developing fetus.

A congenital disorder may be the result of genetic abnormalities, the intrauterine (uterus) environment, errors of morphogenesis,infection, or a chromosomal abnormality. The outcome of the disorder will depend on complex interactions between the pre-natal deficit and the post-natal environment Animal studies indicate that the mother's (and possibly the father's) diet, vitamin intake, and glucose levels prior to ovulation and conception have long-term effects on fetal growth and adolescent and adult disease Congenital disorders vary widely in causation and abnormalities. Any substance that causes birth defects is known as a teratogen.

The older term congenital disorder does not necessarily refer to a genetic disorder despite the similarity of the words. Some disorders can be detected before birth through prenatal diagnosis (screening).

Neonatal Care

A neonatal intensive care unit (NICU) is an intensive care unit specializing in the care of ill or premature newborn infants. The first official ICU for neonates was founded in 1961 at Vanderbilt University by Dr. Mildred Stahlman, officially termed a NICU when Dr. Stahlman used a ventilator off-label for a baby with breathing difficulties, for the first time ever in the world.

A NICU is typically directed by one or more neonatologists and staffed by nurses, nurse practitioners, pharmacists, physician assistants, resident physicians, and respiratory therapists. Many other ancillary disciplines and specialists are available at larger units. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin".