NURSING 2202 Pam Mammano B 220 Phone 224

NURSING 2202 Pam Mammano B 220 Phone 224 - 0322 Home 434 - 5061 Kim Abel B 302 A Phone 224 - 0330

Time management is essential. Have back up alternatives !

In Nursing 2202 we are going to discuss how we go from Sperm & ovum 30 HRS fertilized egg TO

And the implications for us as nurses! This is not a A & P class But we will do some review.

U. S. Infant Mortality Rates have decreased over time due to: regional transport for high risk deliveries improved screening for fetal abnormalities improvements in case management increases in early prenatal care. use of surfactants protective health behaviors - e. g. , breastfeeding, not smoking, back to sleep - also contributed to this decrease. Mortality rate for black infants remains more than twice the rate for white infants. Low birth weight rates have increased from 6. 7% in 1984 to 8% in 1999. During this same decade, infant deaths due to prematurity/low birth weight increased. Deaths due to birth defects remained stable at 22%, respiratory distress syndrome and SIDS decreased. (National Center for Health Statistics)

Morbidity vs Mortality Morbidity & New Morbidity : the prevalence of illness & disease over a period of time Denotes 3 things: 1. Acute illness 2. Chronic Disease 3. Disability New Morbidity : Problems besides disease or injury which affect individual’s health. Examples include behavioral, social (family), educational problems.

Mortality - death. Fetal Death: intrauterine death of a fetus of at least 20 weeks gestation with absence of any signs of life after birth. Neonatal death: death of an infant born with signs of life up to 28 days after birth. Perinatal death : sum of fetal & neonatal deaths per 1000 live births. ** BEST indicator of perinatal care INFANT MORTALITY: the number of deaths per 1000 that occur in the first year of life. *** This the statistic used by most countries. This is what is most seen in the Literature ALTHOUGH is not the best indicator of Perinatal care. Maternal Death: death of mothers per 100, 000 due to complications of pregnancy, labor , delivery or postpartum.

United States Infant Mortality 1900 ……………… 200 per 1000 1940 ……………… 47. . 1960 ……………… 26. . 1982 ……………… 11. 2. . (Black infants - 25. 7 per 1000) 1998 ……………… 7. 2. . 1999 (Illinois)……. . 8. 3. . Blacks in IL…. . 17. 4. . Whites in IL…. 6. 2 Leading Causes Infant Mortality: #1 Congenital Anomalies #2 R/T Prematurity and LBW #3 SIDS 1992 AAP recommends babies sleep on back 1989: 5634 SIDS deaths, 1993: 4669 SIDS deaths, 1996: 2908 SIDS deaths

UNITED STATES Maternal Mortality (per 100, 000 births) 1915 1940 1950 1960 All Women 608 376 83. 3 37 White Women 61 26 Nonwhite Women 221. 6 97. 9 Adequate prenatal care Poor prenatal care No Prenatal Care 1983 1997 8 7. 2 5. 9 5. 5 18. 3 18 -20 3 5 23 All Women 1999= 7. 4; 2000 = 7. 3 Leading Causes Pregnancy Related Death: hemorrhage, embolism, hypertension, infection, anesthesia related complications

Maternal Mortality Rate : approximately 7. 5 per 100, 000 in 1998 When compared to white women ; Black women have 4 times the risk for dying from complications of pregnancy and childbirth. One half of all deaths could be prevented with early detection. No significant changes since 1982 - fluctuated between 7 & 8 %. Hemorrhage, PIH, infection, and ectopic pregnancies account for most of the deaths. Fetal mortality rate in 1998 was 6. 7% improved from 6. 8% White = 5. 7% Black = 12. 3% Perinatal Mortality = 7. 2% ; Whites = 6. 2% , Blacks = 12. 9% Neonatal mortality = 4. 8% ; Whites = 4. 0% , Blacks = 9. 4%. | In 1990 was 5. 7% | Postneonatal Mortality = 2. 4% ; Whites = 2. 0% , Blacks = 4. 4 % Taken from the last CDC statistics 1998

Cesarean section rate: 1980………. 17% 1986………. 24% 1998………. 22% 1999………. 23. 8% 2000………. 22. 9% 2001……… 24. 4% Highest in the World Factors:

In 1998 1 out of every 8 Live births was to teens. Most were 15 -17 yrs. 2001 = 4, 040, 121 2001 = 455, 158

2000 – Illinois Teen birth rate = 11. 4 % (21, 108) down from 12% in 1999 National teen birth rate = 11. 28% Births to: teen moms single moms receiving late or no prenatal care moms who smoked in pregnancy low birth weight preterm birth mom less than 12 th grade education teens already mother source: “The Right Start” Report 1990 13% 28% 6% 18% 7% 11% 24% 1998 12. 5% 33% 4% 13% 8% 12% 22%

1999 -2000 Teen Birth rate decreased by 22% 1990 -2000 Black Teen Birth Rate decreased by 31% 1990 -2000 Hispanic Teen Birth Rate decreased by 12%

The United States infant mortality rate ranked 26 th among selected countries in 1996. The 1996 US infant mortality rate of 7. 3 per 1, 000 live births was more than twice as high as the number 1 ranked country Singapore, with a rate of 3. 8. The 1998 preliminary US infant mortality rate was 7. 2 per 1, 000 live births Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Country Rate Singapore 3. 8 Japan 3. 8 Sweden 4. 0 Finland 4. 0 Norway 4. 0 Hong Kong 4. 1 Spain 4. 7 Switzerland 4. 7 France 4. 9 Germany 5. 0 Austria 5. 1 Ireland 5. 5 Belgium 5. 6 Netherlands 5. 7 Denmark 5. 7 Australia 5. 8 17 Northern Ireland 5. 8 18 Italy 6. 0 19 Czech Republic 6. 0 20 England Wales 6. 1 21 Canada 6. 1 22 Scotland 6. 2 23 Israel 6. 3 24 New Zealand 6. 7 25 Portugal 6. 9 *** 26 UNITED STATES 7. 3 **** 27 Cuba 8. 0 28 Greece 8. 1 29 Slovakia 9. 9 30 Puerto Rico 10. 4 37 Russia 18. 2 38 Romania 22. 3

In 1998 7. 2 % For whites 6. 0% For blacks 13. 8% For native Americans 9. 3 %

In 1995 Illinois ranked 13 th in US for Infant Mortality rate, 8. 4. Columba = #1 ; 12. 5

2000 preterm/LBW = 19. 2 %; preterm = 11. 6%; LBW = 7. 6 % Goal for 2010 = 7. 0% LBW Preterm = 7. 5 %

Born before 37 wks.

2000 11. 6 % were born too early 7. 6 % weighed less than 5. 5 lbs.

Illinois ranks 21 in the states for women without health insurance !!

QUICK STATS FOR THE UNITED STATES: - every 8 seconds a baby is born in the US - every hour 3 babies die - African American infants are more than twice likely to die before their first birthday as white infants -birth defects are leading cause of infant mortality - every 3. 5 minutes a baby is born with a birth defect - each year 2, 500 infants are born with defects of the brain & spinal cord - every 2 minutes a lowbirth weight baby is born - every year more than 4, 200 babies are born weighing less than 1 pound - every minute a baby is born to a teen mother - each day 410 babies are born to mothers who started prenatal care in the 3 rd trimester or received no prenatal care at all -more than 1 in 9 infants is born preterm - less than 37 weeks gestation - the US infant mortality is higher than 25 other nations

Not an anatomy class, but review

Ovum through release, fertilization, implantation

CERVICAL MUCUS

Ovum in Fallopian Tube

Fertilization: Ovum Sperm

30 Hours after 31 fertilization Preembryonic period= First 2 weeks after Contraception. Zygote

Down’s Syndrome note low set ears Simian Crease of palm

Morula = ball like cluster Of cells Blastocyte = Cavity forms Within dividing cells

Early implantation

Blastocyst implantation

Early Pregnancy

From ovulation to implantation. Names & cell Division shown

Bag of water at term between 800 to 1200 cc of fluid Amnion = inner layer secretes fluid Chorion = outer layer Functions of amniotic fluid: cushions fetus from injury Separates fetus from membranes Allows freedom of movement; thus allows musculosketetal develop. Maintains constant fetal body temperature Provides oral fluids - acts as excretion collection system

Placenta functions as Organ of excretion; Respiration; Elimination Digestion Endocrine Does act as barrier to large molecules & blood cells Organ shared by mom & baby

4 Week embryo : Embryonic period = from 3 rd wk through end of 8 th wk

5 weeks

5 th week

8 weeks Note Chorionic Villi

6 weeks spine view

Myelomeningocele Most CNS defects between 3 -6 weeks

9 weeks Fetal period or fetus = 9 wks until birth

Omphalocele herniation through umbilical ring (5 -10 weeks) 1 in 5000 births Gastroschisis 2 in 10, 000 births herniation of bowel through abdominal wall