Maternal, Fetal, & Neonatal Physiology - E-Book: A Clinical Perspective (Maternal Fetal and Neonatal Physiology)

Awarded first place in the 2018 AJN Book of the Year Awards in the Maternal-Child Health/Prenatal Nursing/ Childbirth category! Learn to provide the best prenatal, intrapartum, postpartum, and neonatal care possible. Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective, 5th Edition includes expert insight and clinically relevant coverage of the physiologic changes that occur throughout all major periods of the perinatal experience. This classic reference gives you a solid foundation for assessment and therapeutic interventions, featuring an emphasis on the evolving interrelationships between mother, fetus, and neonate and adaptations of preterm and term infants to the extrauterine environment. Key Features Solid coverage of the physiologic bases for assessment and therapeutic interventions make this an ideal resource for maternity, neonatal, women’s health, or midwifery programs. Synthesis of the latest research studies and evidence-based practice provides vital data on normal physiologic changes during the antepartum, intrapartum and postpartum periods; anatomic and functional development of the fetus; and developmental physiology of preterm and term neonates. Coverage of pathophysiology and interventions for the pregnant woman, fetus, and newborn for selected abnormal events gives you a solid understanding of physiologic adaptations and developmental physiology relating to major body systems and metabolic processes. Pharmacology tables offer quick access to key pharmacology information and drug effects with clinical examples. Front Cover......Page 1 Maternal, fetal, & neonatal physiology......Page 4 Copyright......Page 5 Reviewers......Page 6 Acknowledgments......Page 8 Contents......Page 9 Chromosomes......Page 16 Genes......Page 17 DNA and RNA......Page 19 Genomics and epigenetics......Page 20 Mitosis......Page 21 Meiosis......Page 22 Oogenesis......Page 23 Abnormal gamete development......Page 25 Alterations in chromosome number......Page 26 Alterations in chromosome structure......Page 28 Gene disorders......Page 29 Modes of inheritance......Page 30 Autosomal dominant inheritance......Page 31 Multifactorial inheritance......Page 32 Nontraditional modes of inheritance......Page 33 Embryonic and fetal development of the reproductive system......Page 34 Indifferent stage......Page 35 Development of the male genital ducts......Page 36 Development of the male external genitalia......Page 37 Disorders of sex development......Page 39 Genetic screening......Page 40 Summary......Page 41 References......Page 42 Hormone activators, receptors, and messenger systems......Page 44 Hormone storage......Page 45 Hypothalamic and pituitary glands......Page 46 Reproductive hormones in females and males......Page 48 Activin......Page 50 Steroid hormones......Page 52 Estrogens......Page 53 Testosterone......Page 57 Feedback systems......Page 58 Oogenesis......Page 59 Puberty......Page 60 Male puberty......Page 61 Ovarian cycle......Page 63 Luteal phase......Page 67 Endometrial cycle......Page 68 Menstrual phase......Page 69 Secretory phase......Page 70 Male reproductive endocrinology......Page 71 Climacteric......Page 72 Aging male......Page 73 References......Page 74 First trimester......Page 76 Second trimester......Page 77 Ovulation......Page 78 Sperm transport......Page 80 Fertilization......Page 81 Cleavage and zygote transport......Page 83 Regulation of development......Page 84 Cell differentiation......Page 86 Cell migration......Page 87 Overview of embryonic development......Page 88 Overview of fetal development......Page 93 Implantation......Page 94 Endometrium and decidua......Page 96 Placentation......Page 97 Development of the villi......Page 98 Placental growth......Page 99 Placental circulation......Page 100 Maternal uteroplacental circulation......Page 101 Placental endocrinology......Page 104 Human chorionic gonadotropin. ......Page 105 Progesterone. ......Page 106 Simple (passive) diffusion. ......Page 107 Active transport. ......Page 108 Transfer of substances across the placenta......Page 109 Umbilical cord......Page 110 Amniotic fluid volume and turnover......Page 111 Assisted reproductive technology......Page 112 First trimester screening. ......Page 114 Prenatal diagnosis......Page 115 Preimplantation genetic diagnosis. ......Page 116 Alterations in placenta, umbilical cord, and amniotic fluid......Page 117 Polyhydramnios. ......Page 118 Oligohydramnios. ......Page 119 Abnormalities of placentation. ......Page 120 Multiple gestation......Page 121 Monozygotic twins......Page 123 Placental abnormalities in multiple gestations......Page 124 Summary......Page 125 References......Page 126 Uterine structure......Page 130 Myometrial cell structure......Page 131 Cervix......Page 133 Cervical ripening and dilation......Page 134 Parturition......Page 136 Initiation of labor......Page 137 Progesterone......Page 139 Prostaglandins......Page 141 Nitric oxide......Page 142 Myometrial contraction......Page 143 Coordination of uterine contractions......Page 144 Gap junction formation......Page 145 Maternal position during labor......Page 146 Maternal pushing efforts during the second stage......Page 147 Preterm labor and birth......Page 148 Induction and augmentation of uterine activity......Page 150 Inhibition of labor......Page 151 Summary......Page 152 References......Page 153 Uterus......Page 157 Cervix, vagina, and perineum......Page 158 Estrogen and progesterone......Page 159 Resumption of menstruation and ovulation......Page 160 Anatomy of the mammary glands......Page 161 Embryogenesis......Page 162 Lactogenesis......Page 163 Prolactin patterns during lactation......Page 164 Oxytocin release during lactation......Page 165 Milk production and composition......Page 166 Carbohydrate synthesis and release......Page 168 Fat synthesis and release......Page 169 Human milk for the preterm infant......Page 170 Common breastfeeding problems......Page 172 Social and cultural barriers to breastfeeding......Page 173 Summary......Page 174 References......Page 175 Baroreceptors and chemoreceptors......Page 177 Uteroplacental circulation and gas exchange......Page 178 Uterine blood flow in the intervillous space......Page 179 Summary of fetal respiration......Page 180 Chronic fetal hypoxemia......Page 181 Severe asphyxia: Hypoxic-ischemic encephalopathy and neonatal encephalopathy......Page 182 Respiratory acidemia......Page 183 Beat-to-beat variability......Page 184 Alterations in fetal heart rate......Page 185 Late decelerations......Page 186 Fetal heart rate pattern evolution......Page 187 Third trimester fetal assessment techniques......Page 188 Nonstress test......Page 189 Biophysical profile......Page 190 Electronic fetal monitoring......Page 191 Summary......Page 192 References......Page 193 Pharmacokinetics......Page 195 Pharmacogenetics and pharmacogenomics......Page 196 Drug use during pregnancy......Page 197 Alterations in drug absorption, distribution, metabolism, and excretion during pregnancy......Page 198 Drug absorption......Page 199 Drug distribution......Page 200 Hepatic drug metabolism......Page 201 Transfer of drugs across the placenta......Page 202 Factors influencing placental transfer......Page 203 Physiochemical characteristics and concentration gradients. ......Page 204 Protein binding. ......Page 205 Placental influx and efflux transporters......Page 206 Summary......Page 208 Fetal hepatic metabolism. ......Page 209 Fetal drug therapy......Page 210 Neonatal pharmacokinetics......Page 211 Oral agents......Page 212 Drug distribution......Page 213 Hepatic drug metabolism......Page 214 Summary......Page 216 Teratogenesis......Page 217 Principles of teratogenesis......Page 218 Cigarette smoking......Page 220 Opioids......Page 221 Cocaine and amphetamines......Page 222 Drugs and lactation......Page 223 Minimizing infant drug exposure......Page 225 Summary......Page 226 References......Page 227 Changes in blood and plasma volume......Page 230 Changes in red blood cells. ......Page 231 Changes in white blood cells and platelets. ......Page 232 Changes in plasma components......Page 234 Changes in coagulation factors and hemostasis......Page 235 Changes in hemostasis......Page 237 Changes in hemostasis......Page 238 Iron requirements during pregnancy......Page 239 Iron-deficiency anemia......Page 240 Thalassemias......Page 241 Platelet and coagulation disorders during pregnancy......Page 242 Summary......Page 243 Formation of blood cells......Page 244 Development of red blood cells......Page 245 Formation of hemoglobin......Page 246 Fetal iron requirements......Page 247 Transitional events......Page 248 Hemoglobin and hematocrit......Page 249 Iron and serum ferritin......Page 250 Coagulation......Page 251 Site of sampling......Page 253 Vitamin k deficiency bleeding......Page 254 Physiologic anemia of infancy......Page 255 Anemia of prematurity......Page 257 Infants with a hemoglobinopathy......Page 258 Infants at risk for altered platelets and hemostasis......Page 259 Changes in hematologic parameters......Page 260 Summary......Page 261 References......Page 262 Total blood volume. ......Page 266 Cardiac output and stroke volume. ......Page 267 Heart rate. ......Page 268 Systemic vascular resistance. ......Page 269 Pulmonary blood flow. ......Page 270 Physical changes......Page 271 Heart sounds. ......Page 272 Postpartum period......Page 273 Supine hypotension......Page 274 Physiologic responses to exercise during pregnancy......Page 275 Benefits and recommendations......Page 276 Cardiac disease and pregnancy......Page 277 Mitral valve prolapse. ......Page 278 Eisenmenger syndrome. ......Page 279 Preeclampsia......Page 280 Development of the cardiovascular system in the fetus......Page 283 Anatomic development......Page 284 Development of the primitive heart......Page 285 Atrioventricular canal. ......Page 286 Bulbus cordis and truncus arteriosus. ......Page 287 Vasculature......Page 288 Veins. ......Page 289 Developmental basis for common anomalies......Page 290 Myocardial performance......Page 291 Fetal circulation......Page 293 Oxygen content......Page 294 Transitional events......Page 295 Closure of the ductus venosus......Page 296 Closure of the ductus arteriosus......Page 297 Metabolic rate and oxygen transport......Page 298 Preload......Page 299 Afterload......Page 300 Regulation of fetal and neonatal circulation......Page 301 Cyanosis......Page 302 Congenital heart defects......Page 303 Truncus arteriosus......Page 304 Coarctation of the aorta......Page 305 Maturational changes during infancy and childhood......Page 306 Summary......Page 307 References......Page 308 Hormonal and biochemical factors. ......Page 312 Lung volume......Page 313 Airflow. ......Page 314 Oxygen-hemoglobin dissociation curve. ......Page 315 Intrapartum period......Page 316 Upper respiratory tract capillary engorgement......Page 318 Effects of altitude and air travel......Page 319 Asthma......Page 320 Smoking......Page 321 Summary......Page 322 Anatomic development......Page 323 Pulmonary vasculature......Page 326 Surfactant......Page 327 Influences on fetal lung maturation......Page 330 Factors enhancing and delaying lung maturation. ......Page 331 Lung liquid......Page 332 Neonatal physiology......Page 333 Establishment of extrauterine respiration......Page 334 Control of respiration......Page 337 Chemoreceptors......Page 338 Laryngeal and pulmonary reflexes......Page 339 Diaphragm......Page 340 Chest wall compliance......Page 341 Lung compliance......Page 343 Closing capacity......Page 344 Ventilation-perfusion relationships......Page 345 Developmental differences in v./q. matching......Page 347 Oxygen-hemoglobin dissociation curve......Page 348 Clinical implications for neonatal care......Page 349 Physiologic basis for clinical findings......Page 350 Periodic breathing and apnea of prematurity......Page 351 Hypoxia and hyperoxia......Page 352 Respiratory distress syndrome......Page 354 Clinical manifestations......Page 355 Treatment......Page 356 Bronchopulmonary dysplasia......Page 357 Meconium aspiration syndrome......Page 358 Persistent pulmonary hypertension of the newborn......Page 359 Maturational changes during infancy and childhood......Page 360 Summary......Page 361 References......Page 362 Structural changes......Page 366 Urodynamic changes......Page 367 Changes in renal hemodynamics......Page 368 Alterations in tubular function......Page 369 Sodium homeostasis. ......Page 370 Renin-angiotensin-aldosterone system......Page 371 Volume homeostasis and regulation of osmolarity......Page 372 Arginine vasopressin. ......Page 373 Postpartum period......Page 374 Urinary frequency, incontinence, and nocturia......Page 375 Risk of urinary tract infection......Page 376 Maternal-fetal fluid and electrolyte homeostasis......Page 377 Glycosuria......Page 378 Summary......Page 379 Development of the renal system in the fetus......Page 380 Development of the kidneys......Page 381 Developmental basis for common anomalies......Page 382 Functional development......Page 383 Neonatal physiology......Page 384 Body composition......Page 385 Renal blood flow and glomerular filtration......Page 386 Sodium......Page 388 Renal handling of other solutes......Page 389 Water balance......Page 390 Renin-angiotensin-aldosterone system......Page 391 Fluid and electrolyte balance......Page 392 Urine water loss......Page 393 Sodium requirements of preterm infants......Page 394 Hyperkalemia in preterm infants......Page 395 Renal function during neonatal illness......Page 396 Maturational changes during infancy and childhood......Page 397 Summary......Page 398 References......Page 399 Mouth and pharynx......Page 402 Small and large intestines......Page 404 Liver......Page 405 Weight gain during pregnancy......Page 407 Postpartum period......Page 408 Nutritional requirements of pregnancy......Page 409 Heartburn and gastroesophageal reflux......Page 410 Nausea and vomiting......Page 412 Effects of altered maternal nutrition......Page 413 Pregnancy and gastrointestinal disorders......Page 414 Cholelithiasis and pregnancy......Page 415 Summary......Page 416 Anatomic development......Page 417 Esophagus. ......Page 418 Stomach, duodenum, and pancreas. ......Page 419 Development of the midgut and common anomalies......Page 420 Development of the hindgut and common anomalies......Page 422 Functional development......Page 423 Fetal growth......Page 424 Neonatal physiology......Page 425 Initiation of enteral feeding......Page 426 Minimal enteral feedings......Page 427 Sucking and swallowing......Page 428 Gastric emptying......Page 429 Physiologic limitations......Page 430 Digestion and absorption of proteins......Page 431 Digestion and absorption of carbohydrates......Page 432 Absorption of other substances......Page 433 Infant growth......Page 434 Nutritional requirements of term and preterm infants......Page 435 Fat......Page 436 Iron. ......Page 437 Human milk......Page 438 Issues in infants with various health problems......Page 439 Considerations related to feeding method......Page 440 Regurgitation and reflux......Page 441 Necrotizing enterocolitis......Page 442 Summary......Page 443 References......Page 444 Antepartum period......Page 450 Alterations in innate immunity......Page 452 Alterations in adaptive immunity......Page 453 Immune function at the fetal-maternal interface......Page 455 T cells. ......Page 457 Protection of the fetus from infection......Page 458 Immunologic properties of human milk......Page 459 Spontaneous abortion......Page 460 Inflammation, infection, and preterm labor......Page 461 Immunization and the pregnant woman......Page 462 Fetal and neonatal complications associated with transplacental passage of maternal antibodies......Page 463 Rho(D) alloimmunization and ABO incompatibility......Page 464 Abo incompatibility......Page 465 Summary......Page 466 Development of host defense mechanisms in the fetus......Page 467 Transitional events......Page 468 Intestinal colonization. ......Page 469 Alterations in innate immunity......Page 470 Alterations in cell-mediated immunity......Page 473 Alterations in antibody-mediated (humoral) immunity......Page 474 Gut host defense mechanisms......Page 475 Limitations in immune responses to bacterial infections......Page 476 Immune responses to viral infections......Page 477 Diagnosis of neonatal infection......Page 478 Maturation of host defense factors......Page 479 Immunizations......Page 480 Summary......Page 481 References......Page 482 Hyperpigmentation. ......Page 486 Changes in connective tissue......Page 487 Spider angioma. ......Page 488 Alterations in secretory glands......Page 489 Hair loss......Page 490 Summary......Page 493 Epidermis......Page 494 Dermis......Page 496 Arrector pili muscle. ......Page 497 Vernix caseosa......Page 498 Transitional events......Page 499 Acid mantle and other protective mechanisms......Page 502 Thermal environment......Page 503 Clinical implications for neonatal care......Page 504 Bathing......Page 505 Transepidermal absorption......Page 506 Extremely immature infants......Page 507 Summary......Page 508 References......Page 509 Ocular changes......Page 512 Musculoskeletal changes......Page 513 Sleep......Page 514 Pain and discomfort during labor......Page 515 Sleep during the postpartum period......Page 517 Ocular adaptations......Page 518 Musculoskeletal discomforts......Page 519 Migraine headaches......Page 520 The pregnant woman with epilepsy......Page 521 The woman with a spinal cord injury......Page 522 Preeclampsia and eclampsia......Page 523 Summary......Page 524 Embryonic development of the central nervous system......Page 525 Anomalies arising in the embryonic period......Page 529 Migration......Page 530 Organization......Page 531 Myelination......Page 532 Sensory abilities......Page 533 Motor abilities......Page 535 Fetal state patterns......Page 536 Sensory functions......Page 537 Cerebral autoregulation......Page 538 Neonatal sensory function......Page 539 Sensory modalities......Page 540 Neonatal motor function......Page 541 Neonatal reflexes......Page 542 Sleep-wake states related to brain maturation......Page 543 Neurobehavioral organization......Page 544 Vulnerability to brain injury in preterm and term infants......Page 545 Germinal matrix and intraventricular hemorrhage......Page 546 White matter injury (periventricular leukomalacia)......Page 547 Hypoxic-ischemic encephalopathy......Page 548 Neonatal seizures......Page 549 Neonatal pain......Page 550 Consequences of pain in the neonate......Page 551 Summary......Page 552 References......Page 553 Antepartum period......Page 558 Carbohydrate metabolism......Page 559 Lipid metabolism......Page 560 Insulin......Page 561 Postabsorptive and fasting state. ......Page 563 Effects of placental hormones and other substances......Page 565 Effects of metabolic changes on glucose tolerance tests......Page 566 Maternal-fetal relationships......Page 567 The pregnant diabetic woman......Page 568 Fetus of a diabetic mother......Page 569 Development of carbohydrate, fat, and protein metabolism in the fetus......Page 570 Carbohydrate metabolism......Page 571 Lipid metabolism......Page 574 Transitional events......Page 575 Carbohydrate metabolism......Page 576 Lipid metabolism......Page 577 Neonatal hypoglycemia......Page 578 The infant of a diabetic mother......Page 580 Neonatal hyperglycemia......Page 581 References......Page 582 Calcium......Page 586 Vitamin D......Page 588 Changes in bone formation and density......Page 589 Maternal nutritional needs......Page 590 Maternal calcium metabolism and pregnancy complications......Page 591 Maternal-fetal interactions......Page 592 Parathyroid glands......Page 593 Functional development......Page 594 Calcium......Page 595 Magnesium......Page 596 Neonatal hypocalcemia......Page 597 Late neonatal hypocalcemia. ......Page 599 Neonatal osteopenia and rickets......Page 600 Summary......Page 601 References......Page 602 Maternal hyperbilirubinemia......Page 604 Development of bilirubin metabolism in the fetus......Page 606 Benefits of bilirubin......Page 607 Patterns of physiologic jaundice......Page 608 Causes of physiologic jaundice......Page 609 Neonatal hyperbilirubinemia......Page 611 Breastfeeding and neonatal jaundice......Page 612 Management of hyperbilirubinemia in breastfed infants......Page 613 Pharmacologic agents......Page 614 Physics of phototherapy. ......Page 615 Side effects of phototherapy. ......Page 616 Methods of providing phototherapy. ......Page 617 Competition for albumin binding......Page 618 Acute bilirubin encephalopathy and kernicterus......Page 619 Summary......Page 620 References......Page 621 Anterior pituitary function. ......Page 624 Adrenal function. ......Page 626 Hypothalamic-pituitary-thyroid axis......Page 627 Postpartum period......Page 630 Thyroid function tests during pregnancy......Page 631 The pregnant woman with hyperthyroidism......Page 632 The pregnant woman with hypothyroidism......Page 633 Breastfeeding in women with thyroid disorders......Page 634 Maternal-fetal endocrine relationships......Page 635 Maternal stress responses and fetal endocrine programming......Page 636 Summary......Page 637 Hypothalamic and pituitary function......Page 638 Adrenal function......Page 639 Thyroid function......Page 641 Role of maternal thyroid hormones......Page 642 Hypothalamic-pituitary-thyroid axis......Page 643 Clinical implications for neonatal care......Page 644 Adrenal cortex insufficiency......Page 645 Transient alterations in thyroid function in preterm infants......Page 646 Neonatal hyperthyroidism......Page 647 Congenital adrenal hyperplasia......Page 648 Summary......Page 649 References......Page 650 Intrapartum period......Page 654 Postpartum period......Page 655 Maternal exercise and temperature elevations......Page 656 Development of thermoregulation in the fetus......Page 657 Transitional events......Page 658 Heat production and conservation......Page 660 Brown adipose tissue metabolism......Page 661 Neutral thermal environment......Page 663 Conduction......Page 664 Evaporation......Page 665 Monitoring temperature......Page 666 Methods of promoting thermal stability......Page 667 Skin-to-skin care......Page 668 Use of hypothermia for neuroprotection......Page 669 Hyperthermia and fever in the neonate......Page 671 Summary......Page 672 References......Page 673 List of abbreviations......Page 676 A......Page 682 C......Page 684 D......Page 688 E......Page 690 F......Page 691 G......Page 694 H......Page 695 I......Page 699 K......Page 700 L......Page 701 M......Page 702 N......Page 704 O......Page 706 P......Page 707 R......Page 713 S......Page 714 T......Page 716 U......Page 718 V......Page 719 Z......Page 720 Awarded first place in the 2018 AJN Book of the Year Awards in the Maternal-Child Health/Prenatal Nursing/ Childbirth category! Learn to provide the best prenatal, intrapartum, postpartum, and neonatal care possible. Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective, 5th Edition includes expert insight and clinically relevant coverage of the physiologic changes that occur throughout all major periods of the perinatal experience. This classic reference gives you a solid foundation for assessment and therapeutic interventions, featuring an emphasis on the evolving interrelationships between mother, fetus, and neonate and adaptations of preterm and term infants to the extrauterine environment. Solid coverage of the physiologic bases for assessment and therapeutic interventions make this an ideal resource for maternity, neonatal, women's health, or midwifery programs. Synthesis of the latest research studies and evidence-based practice provides vital data on normal physiologic changes during the antepartum, intrapartum and postpartum periods; anatomic and functional development of the fetus; and developmental physiology of preterm and term neonates. Coverage of pathophysiology and interventions for the pregnant woman, fetus, and newborn for selected abnormal events gives you a solid understanding of physiologic adaptations and developmental physiology relating to major body systems and metabolic processes. Pharmacology tables offer quick access to key pharmacology information and drug effects with clinical examples. NEW! Thoroughly updated content addresses the very latest practice issues and provides the basis for understanding physiologic adaptations in pregnant women, infants, and children. NEW! Expanded coverage of maternal, fetal, neonatal, and pediatric physiology . NEW! Soft cover and added color provide a contemporary look and feel. "Awarded first place in the 2018 AJN Book of the Year Awards in the Maternal-Child Health/Prenatal Nursing/ Childbirth category! Learn to provide the best prenatal, intrapartum, postpartum, and neonatal care possible. Maternal, Fetal, & Neonatal Physiology: A Clinical Perspective, 5th Edition includes expert insight and clinically relevant coverage of the physiologic changes that occur throughout all major periods of the perinatal experience. This classic reference gives you a solid foundation for assessment and therapeutic interventions, featuring an emphasis on the evolving interrelationships between mother, fetus, and neonate and adaptations of preterm and term infants to the extrauterine environment" -- Amazon.com