1. Genitourinary & Gastrointestinal Systems Maternal Alterations in Pregnancy & Fetal Development www.pregnancy-leads-to-new-babies.com/images/...

4. Maternal Adaptation to Pregnancy

16. Heartburn is a retrosternal burning sensation that is felt by 30-70% of pregnant women that is increased by: 1. Multiple pregnancies 2. Polyhydramnios 3. Obesity 4. Spicy foods, alcohol and chocolate Clinical Implications: Heartburn can be limited by advising the client to take smaller meals, avoid spicy food, and limit movements such as excessive bending over Alterations in the GI System Related to Pregnancy: Heartburn

37. Clinical implications involve education about position and encouraging the lateral recumbent position www.fotosearch.com Maternal Genitourinary Pathology (Blackburn, 2007)

55. Effects on Increased GFR Levels on BUN BUN/Cr levels are ↓ so a woman who presents with normal BUN/Cr levels may actually have underlying renal disease. Maternal GFR/Kidney/Blood Flow/Electrolytes

59. Normal Fetal Development Genitourinary & Gastrointestinal Systems

62. Normal Fetal Development: Urinary System Tucker Blackburn, 2007, p. 392 Stages of fetal kidney development

63. Urinary System: Amount of Urine Formed In Relation to Gestational Age 2ml @ 10 weeks gestation 5ml @ 20 weeks gestation 10ml @ 30 weeks gestation 30ml @ 40 weeks gestation

68. Normal Fetal Development: Gastrointestinal System Blackburn, S. Maternal, Fetal, & Neonatal Physiology (3rd edition) pg 433

73. Normal Neonate Development Gastrointestinal System Liver (Tucker Blackburn, 2007, p. 447) Liver portal blood flow is lower in the fetus, with shunting of a portion of the blood away from the portal sinuses and liver parenchyma and into the inferior vena cave via the ductus venosus The newborn liver accounts for about 5% of the infants weight Infants have a unique pathologic response to liver dysfunction, with active fibroblastic proliferation and early bile stasis that can alter the presentation of liver disorders Decreased bile flow (cholestasis) – often in association with a direct (conjugated) hyperbilirubinemia- is seen with many liver disorders

86. Normal Neonate Development Gastrointestinal System Digestion and Absorption of Proteins and Carbs (Tucker Blackburn, 2007, p. 447) In spite of limitations, term infants and many preterm infants ingest absorb proteins relatively well Gastric acid secretion increases within 24 hours of birth and doubles by 2 months Salivary amylase activity at birth is 1/3 of that of adults Levels increase after 3-6 months of age and may be related to the addition of solid food in the infants diet

87. Normal Neonate Development Gastrointestinal System Digestion and Absorption of Proteins and Carbs (Tucker Blackburn, 2007, p. 447) Pancreatic amylase levels increase after 4-6 months Digestion of glucose polymers depends on salivary amylase, glucoamylase, and human milk amylase Lactase activity increases rapidly in late gestation and is adequate after 36 weeks gestation

88. (Tucker Blackburn, 2007, p. 452) Food and warmth are two of the most important controllable factors in determining survival and normal development Limitations of GI function in term and preterm neonates have major implications for the infant’s nutritional needs and the composition and method of feeding .

89. Genitourinary & Gastrointestinal Systems Congenital Defects Of the Anterior Abdominal Wall i.ehow.com/.../InfantSleepings-main_Full.jpg

92. Congenital Abnormalities of the Fetal Anterior Abdominal Wall: Three Common Defects Omphalocele: herniation of the abdominal contents occurs as a midline wall defect; either central or epigastric Gastroschisis: herniation of small bowel occurs through a lateral wall defect, usually located to the right side of the midline Bladder Exstrophy: Failure of the fusion of the caudal fold with protrusion of the urinary bladder Multiple defects often occur simultaneously

96. Omphalocele: The Omphalocele Sac The omphalocele is covered by a thin, avascular membrane (peritoneal membrane) ( Blackburn, 2007) The membrane may be intact or ruptured (Blackburn, 2007) An intact membrane protects the fetus from infection (Glassner,2009) http://bms.brown.edu/pedisurg/images/ImageBank/AbdWallDefects/omphalocele2.jpg

98. Omphalocele: Associated Conditions In at least 50% of the cases, omphalocele is associated with chromosomal abnormalities; Most commonly trisomy 13 and trisomy 18 ( Creasy, 2009) 80% of affected fetuses have other major structural anomalies (Creasy, 2009) Omphalocele is a component of the pentalogy of Cantrell (Creasy, 2009) Congential heart disease and urinary tract problems are also commonly associated with omphalocele (Blackburn, 2007)

99. Omphalocele: Associated Conditions Omphalocele is also associated with Beckwith-Wiedemann syndrome http://www.bwcanz.org/images/7weeks.jpg (Blackburn, 2007)

102. Clinical Implications of Omphalocele: Neonatal Followup Follow up of isolated omphalocele is based on growth and development: The neonate needs to be closely monitored for growth, weight gain and symptoms of gastroesphageal reflux (Glassner, 2009)

105. Gastroschisis: Associated Complications Malrotation of the bowel leads to vascular compromise and volvulus bowel obstruction ischemia atresia Strictures Adhesions Baby with gastroschisis and associated atresia http://members.medscape.com/article/975583-overview

106. Gastroschisis: Treatment Treatment is staged surgical repair within a few days post delivery Successful reduction of the extruded intestine and closure of the abdominal wall depends on Turgor of the intestines Amount of inflammation—surgery not possible if intestines are inflamed, matted or turgid Size of the abdominal cavity Amount of edema Prognosis is excellent with a survival rate of 97%

110. Bladder Exstrophy Epispadius: In males, the urethra may not be completely formed, is short, often split and the urethral opening is on the upper surface. Male patient with epispadias showing spadelike configuration of glans penis, incomplete foreskin, open bladder neck and dorsal urethral plate http://emedicine.medscape.com/article/1014971-overview Yerkes.

111. Bladder Exstrophy: Epispadius In females, the urethral opening is located between a split clitoris and labia minora. Female patient with epispadias showing anteriorly separated labias http://emedicine.medscape.com/article/1014971-overview Yerkes.

112. Bladder Exstrophy Associated Renal Abnormalities Dorsal Chordee: The penis lies close against the abdomen with a slight downward curve Absence of a bladder neck and sphincter Small bladder capacity Abnormally positioned ureters that allow urine reflex back into the kidneys

116. Hockenberry, M. J., & Wilson, D. (2007). Wong’s nursing care of infants and children (8th Ed.). St. Louis: Mosby-Elsevier.Louik, C., et. al. (2007, June 28). First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. The New England Journal of Medicine, 356 (26) 2675-83. Retrieved October 1, 2009, from http://vnweb.hwwilsonweb.com.proxy.libraries.uc.edu/hww/jumpstart.jhtml?recid =0bc05f7a67b1790ed703702c05f6de98b3d4e341e11d0e533531dc93a9481930233117bdfed9dd8a&fmt=C Loynd A.M.,& Rosh A. J.(2009). Pregnancy, urinary tract infections. eMedicine. Retrieved October 2,2009, from http://emedicine.medscape.com/article/797066-overview Mahendra, A. (2006). Renal disease and pregnancy . Retrieved October 4, 2009 from Medscape http:// emedicine.medscape.com /article Mann, S., Blinman, T., & Douglas Wilson, R. (2008). Prenatal and postnatal management of omphalocele . Prenatal Diagnosis, 28(7), 626-632. Retrieved, October 1, 2009, from http://search.ebscohost.com.proxy.libraries.uc.edu Nawaz Khan, A. (2008). Omphalocele . eMedicine, Retrieved October 3, 2009, from http://emedicine.medscape.com/article/404182-overview Tucker Blackburn, S. (2007). Maternal, fetal, and neonatal physiology a clinical perspective . St. Louis Missouri: Saunders Elsevier. Wang, Y., Gu Y, Lewis, D.F. (2008, November 15). Endothelial angiotensin II generation induced by placenta- derived factors from preeclampsia . Reproductive Science, 15(9), 932-938.