I.

Mother and Child

Health
PROCREATIVE HEALTH
Definition of Procreation

Procreation

 It is the physical act of joining a

sperm and an egg together to
create another biological being.
With Procreation, the link between
the parent and child direct in that
the child has genetic make-up
based on both parents’ biological
contributions.
 Procreative Health

- Is the moral obligation of parents

to have the healthiest children
through all natural and artificial
means available.
Creation – is the making of all
things from nothing, by an act of
God, at the some time in the past.
God’s action could have taken a
second, or 6 days or a million
years.
Procreation Theory
 Evolution Theory
 It is the theory that all things came about by
the repeated random actions of natural
selection, whereby:

1. Life came into existence

2. Primitive life evolved into more and more
complex organisms, and eventually
producing mankind.
Estimating the EDC
Pregnant women generally want to know when
the baby is coming, which is known as the
“due date”.

The ability to detect the date of

confinement or delivery is an essential
nursing competency needed by anyone
dealing with maternity clients.
The date of delivery was formerly called the
“estimated date of confinement” (EDC).

However, because the concept if confinement is

negative, the trend now is to refer to it as
“estimated date of delivery” (EDD) or “expected
date of birth” (EDB).

Pregnant clients refer to EDB as their DUE DATE.

 Naegele’s Rule

- It is the most commonly used method for

determining the EDD, as it is most accurate.
Procedure
A. Determine the last normal menstrual period (LMP)

The date of the onset of the last normal menstrual

period is of clinical importance for determining
the EDD and fetal age.

For this reason, the LMP should be checked for

normality, regularity and character. It should not
be confused with implantation bleeding, which is
slight blood loss when the fertilized ovums onto
the wall of the uterus.
Procedure
B. Consider the first day of the LMP.

C. Consider the month in numeric terms.

Examples:
January = 1
February = 2
March = 3
July = 7
August = 8
September = 9
And so forth
 For the first three months of the year, add 12
to the numerical value.

For example:
January : 1 + 12 = 13
February: 2 + 12 = 14
March: 3 + 12 = 15
 D. Now use Naegele’s formula: Subtract three
months and add 7 days to the first day of the last
menstrual period (LMP).

Sample Problem A:

The given LMP is March 5-10, 2008. The numerical

value of March is 3.

15 5
- 3
125
+ 7
12 12= EDD: December 12
 Sample Problem B: The given LMP is June 12-
17, 2008. The numerical value of June is 6.

6 12 2008
- 3 +1
3 12 2009
+ 7
3 19 2009
= EDD: March 19, 2009
 Naegule’s Rule is just an estimate. It is said
that 4% of all babies arrive on time using this
rule, whereas 60% appear 1 to 7 days early or
late.
 To estimate the gestational age or menstrual
age

 start counting from the 1st day of the day of

last menstrual period, a time that precedes
fertilization or conception.
 This period is about two weeks before
implantation of the fertilized ovum, as
computed by obstetrician.
 At EDD, the infant is 40 weeks old or 280
days, the average of gestational or menstrual
age.

 Calculating from the date of ovulation or

fertilization, as cited by embryologist, gives
us the ovulation age or the fertilization
age, also called post-conception age.

 Ovulation age or Fertilization age is nearly

being identical and shorter by two weeks than
gestational age.
 Given the gestational age (GA), we can
estimate the ovulation (OA) or fertilization
age (FA) and vice-versa.
Example A:
Given the gestational age (GA) of 41 weeks,
what is the ovulation age or fertilization age
(OA) / FA) ?

Formula: GA – 2 = OA/FA

41 weeks – 2 weeks = 39 weeks

The ovulation (or fertilization) age is 39 weeks,

two weeks shorter.
Example B:
 Given the ovulation age (OA) of 37 weeks,
estimate the gestational age (GA)

 Formula: OA + 2 = GA

 37 weeks + 2 weeks = 39 weeks

 The gestational age is 39 weeks, two weeks

longer.
Estimating EDD: Mittendorf’s Rule
 An alternative to Naegele’s Rule in determining
the expected date of delivery (EDD) is
Mittendorf’s Rule.

 Procedure:
A. Determine the first day of the last menstrual
period (LMP)
B. Categorize the woman as Caucasian or Non-
caucasian race
C. Identify her gravidity: Primigravida (G1) or
multigravida (G2 or above)
For Primigravid Caucasian Women:
 Formula: LMP + 15 days (constant) – 3
months = EDD

Example A: What is the EDD of Mrs. Smith, a G1

(first time pregnant) Caucasian with last
menstrual period (LMP) of May 14?
M D
5 14
-3 +15 2 29 =
EDD: February 29
For Multigravid non-Caucasian
Women:
Formula: LMP + 10 Days (constant) – 3 months
= EDD

Example B: What is the EDD of Mrs. Peralta, G2

(multigravida) Filipino woman (non-
caucasian) with LMP of August 10?
M D
8 10
-3 +10 5 20 =
EDD: May 20
Common Teratogens and their
effects
Teratogen
- It is defined as any agent that results in
structural or functional abnormalities
(malformation) in the fetus, or in the child after
birth, as a consequence of maternal exposure
during pregnancy.

-Birth defects are known to occur in

3-5% of all newborns.

-They can do direct damage to the fetus, causing

abnormal development.
 Teratogens are substances that may produce
physical or functional defects in human
embryo or fetus after the pregnant woman is
exposed to the substance.

 Alcohol and cocaine are examples of such

substances. Exposure to the teratogen affects
the fetus or embryo in a variety of ways, such
as the duration of exposure, the amount of
teratogenic substance and the stage of
development the embryo or fetus is in during
the exposure.
 They affect the embryo or fetus in a number
of ways, causing:

1. Physical malformations
2. Problems in the behavioral or emotional
development of the child
3. Decreased intellectual quotient (IQ) in the
child.
History
 The word teratogens originates from the Greek word
for monster, teratos Isidore Geoffroy Saint-Hilaire, a
physician from Paris, France, defined it in 1932.

 People had sought explanations for abnormal

human and animal development, however, for
centuries, and they had developed different theories
about the causes for the abnormalities.

 The study of teratology has interested both

developmental biologists and physicians alike.
Microbial Teratogens
 This class of teratogens include infectious
microorganisms.
 These microbes affect 1-5% of all live births and

are among the leading causes of neonatal

morbidity and mortality.
 General symptoms include:

1. Premature birth

2. Growth retardation

3. Neurological Abnormalities

4. Damage of the eye, liver, heart and ear along

with bone lesions.
Rubella
 Abnormal babies are born to women suffering from
Rubella (German Measles) during the first five weeks
of pregnancy.

 The abnormalities include:

1. Microphthalmia

2. Cataracts

3. Glaucoma

4. Cardiac malformations

5. Hearing loss

6. Mental retardation

The mode of action of the pathogen can be direct viral

effects or damage to immune response.
 Cytomegalovirus (CMV)
& Herpes Simplex
 Cytomegalovirus infection early in gestation
is fatal while infection of later embryos might
lead to:
1. Blindness
2. Deafness
3. Cerebral Palsy
4. Mental Retardation
 CMV damage including:
1. Hepatitis
2. Gestational Prematurity
3. Anemia

Mode of Action of CMV is similar to that of

rubella virus. i.e. Cell lysis and immune
response
Toxoplasma
Toxoplasma goondii
It is a protozoan parasite carried by rabbits

and cats. It can cross the placenta causing:

1. Hydrocephaly
2. Microphthalmia
3. Brain lesions
4. Multiple organ damage
 Fetal infection occurs approximately one in
four thousand pregnancies.

 The fetal damage caused by the teratogen is

maximum if the mother is infected in third
trimester resulting in 60% of the infected new
born.
SYPHILIS
 Treponema pallidum
 It is the cause of syphilis.

 Several hundred most often results in spontaneous

abortion.

 Newbrn which survuve are anemic having spleen and

liver malformations.

 Infection during late pregnancy results in deafness,

dental and bony abnormalities, cardiovascular defects
and skin lesions.
“You may not feel a few drinks,
but your baby could feel them
forever”
Fetal Alcohol Syndrome (FAS)

 It
is a physical and mental damage
in a child due to alcohol exposure
while in the womb
 Physical
Symtoms of Fetal Alcohol
Syndrome

1. Thin upper lip

2. Wide-set eyes
3. Small head circumference as well as
brain size
4. deformed joints, fingers, and limbs

Babies can have the symptoms shown

above as well as short noses and low
nasal bridges.
Nervous system symptoms of Fetal
Alcohol Sydrome

1. Poor coordination or balance

2. Brain Damage
3. Hyperactivity
 Babies who are born with Fetal Alchol
Syndrome can suffer from learning and
intellectual disabilities as well as
delayed development.

 They tend to have poorer memory and

trouble processing information.

 They can often have troble with

attention and poor judgment skills.
Treatment of Fetal Alcohol
Syndrome
 Speech Therapy

 Support Group, Counseling Psychology

 If caught early this is much easier to treat

(early intervention)

 Medications
 Other options for treatments can
include: having a special teacher,
early intervention to help with
walking, talking and other motor
skills and mothers can seek help
for their alcoholism.
Prenatal Radiation Exposure
 Is te exposure of an unborn baby to radiation.

 This exposure of the fetus can occur when the

mother's abdomen area is exposed to radiation
(example: X-rays).

 From the mother, radioactive debris may pass

through the umbilical cord to the baby.

 If the father has had exposure to radiation or

lead before / during conception it can lead to
birth defects as well.
 Radiation on the Fetus
 Before about 2 weeks - health effect of concern
from an exposure of 10 rads results to death of
embryo.

 If the embryo survives radiation-induced

noncancerous health effects are unlikely, no
matter what the radiation dose.

 Because the embryo is made up of only a few

cells, damage to one cell, the progenitor of many
other cells, can cause the death of the embryo,
and the blastocyst will fail to impant in the uterus.
 Embryos that survive, however, will exhibit
few congenital abnormalities.
 Smoking while Pregnant
 Smoking while pregnant significantly
increases the chances of having
complications furing pregnancy.

 Cigarettes contain chemicals such as nicotine,

carbon monoxide, and tar that are harmful to
not only adults, but definitely to growing
babies as well.

 These chemicals can prevent the development

of a healthy baby.
 Infertility
 Accordingto a recent study, both
male and female smokers are
about twice as likely to be infertile
as nonsmolers.
Birth Defects
1. Visual and/or hearing impairments

2. premature birth or low birth weight can

result in many defects or tissues

3. Mental and physical disabilities

4. Learning and behavioral problems

 Premature birth, also known as Preterm
Birth, can cause major complications for
the baby during and after birth.

 The baby can be born with visual and/or

hearing impairments, mental disabilities,
and learning and behavioral problems.

 In sever cases, these complications

eventually result in death.
 Smoking cigarettes can also cause a low birth
weight in newborns. This does not necessary
mean just giving birth to a “small” baby, it
can have severe consequences such as
development delays, cerebral palsy and just
like premature births, it can result in hearing
and vision ailments, and death as well.

 Other health issues such as cleft lips, cleft

palate, congenital heart defects, and
problems with the structure of the heart have
all been linked to smoking during pregnancy
as well.
 Teratogenic Drugs
in First Trimester of Pregnancy
 Analgesic
 Anticonvulsant
 Anticoagulant
 Antidepressant
 Antithyroid
 Vitamin A
 Metal Toxic
 Sedative / Hypnotics
 Aminoglycosides
Analgesics (Aspirin)
 A woman’s use of aspirin during the first
trimester of pregnancy appears to
significantly increase the risk of
gastroschisis.

 Gastroschisis – it a birth defect of the

abdominal (belly) wall. The baby’s intestines
are found outside of the

 During Delivery --- severe bleeding because

aspirin decrease platelet aggregation.
Gastroschisis
 Anticonvulsant
 Fetal Hydantoin Syndrome:
 Cleft Lip and palate
 Broad Nasal Bridge
 Abnormal Ears

 Congenital Heart Disease

 Limb malformation
 Mental and Growth retardation
 Anticoagulant
(Warfarin and Coumadin)
 Fetal Warfarin Syndrome
 Nasal Hypoplasia (bones appears small)
 Bone stippling
 Mental Retardation

 Respiratory distress syndrome

 Fetal and Maternal Hemorrhage

 Teratogenic Drug
 Tetracycline
 Ace Inhibitors
 Chloramphenicol
 Aminoglycosides
 Sulfamethoxazole
 Trimethoprim
 Aminoglycosides
 EG: Gentamicin, Streptomycin
 Have several potential anitibiotic mechanisms
 Disrupts the integrity of the bacterial cell

membrane.
Reminder:
 Advised the patient to be careful in taking
drugs during pregnancy.

 All Clinician including Pharmacists are

responsible to counsel patients with
complete, accurate and current information
on the risks and benefits of using
medications during pregnancy.