4Developmental stages 3 stages Preembryonic stage-stage of ovum 3wk after fertilization: tissue grow and differentiate****Embryonic stage- 4-8wks:organogenesis****Fetal stage- growth and further development of organ and system
5Role of nurse Assess clients for environmental and behavioral risks. Design individualized plans of care that support women in reducing risks in their lifestyles.
6Role of nurseIntervene using teaching, support, observations, and referrals to minimize environmental risks in pregnancy.
7Role of nurseProvide ongoing evaluation of maternal and fetal well-being so that care can be tailored to each client’s changing needs.
12Ionizing radiation Energy in wave or particle form,such as X-rays. The fetal CNS is vulnerable to high-dose radiation, particularly between 7 and 15 weeks gestation.1920- microcephaly and CNS disturbance.1945- Hiroshima and Nagasaki(atomic bombs) also.
131980- nuclear power plant accident in Chernobyl,(radioactive cesium) – NTD and other malformations, spontaneous abortions and fetal growth retardation.
18SolventsFOUND IN DRY-CLEANING PRODUCTS, SPRAY ADHESIVES, PAINTS, NAIL POLISH REMOVERS, FELT-TIPPED PEN ETC.Toluene – cardiovascular malformations, miscarriage and anencephaly.
19Carbon MonoxideCarbon Monoxide is a colorless ,odorless and extremely toxic gas.In animal model – fetal death, neurologic abnormalities, and LBW.
20Heat and Radiation Radiation Less than 0.05 Gy –safe. Complete avoidance of X-ray exposure during the first 15 weeks is recommended.More than 0.2 Gy-birth defects.Pregnancy should be limited to no more than Gy( Office of technology Assessment,1985 ).
22Fatigue and Physical Risks Jobs: stand for long period,lift heavy objects,climb stair, sitting for 8-hour workday fatigue preterm birth,low birth weight,(Simpson,1993).: standing at work more than 7 hours a day increased spontaneous abortion(Fenster et al., 1997).
23Food Additives and Contaminants FDAArtificial additiveCaffeineSmokingFood contaminant
24VitaminsCalciumIronFolic acidVit A not more than 18,000 IU/d
26ปัจจัยที่มีผลต่อการเจริญ 4. ยาที่ใช้ระหว่างตั้งครรภ์antihistamine- anomalieserythromycin- liver damagemetronidazole- anomaliesPhenobarb- infant hemorrhagePhenytoin( Dilantin)- growth retardationThalidomide- malformationTetracyclin- brown coloration of teeth
27Teratogenic Risks of Drugs FDA Categories Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester or later trimesters. Possibility of fetal harm appears remote
28Teratogenic Risks of Drugs FDA Categories BAnimal reproduction studies have not demonstrateed a fetal risk, but there are no controlled studies in pregnant women. Or animal studies have shown an adverse effect but the risk is not confiemed in human studies in the first trimester ( there is no evidence of risk in later trimesters).
29Teratogenic Risks of Drugs FDA Categories Studies in animals have revealed adverse effects on the fetus, and there are no controlled studies in pregnant women. Or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potentil risk to the fetus.
30Teratogenic Risks of Drugs FDA Categories XThere is positive evidence of human fetal risk, but the benefits from use may be acceptable despite the risk.Studies in animals or humans have demonstrated fetal abnormalities.
32referenceเอกสารประกอบคำสอนรวมเล่ม วิชา การพยาบาลครอบครัวที่มีการเจริญพันธุ์ เล่ม 1 มหาวิทยาลัยคริสเตียน 2547.2. จันทิมา รุ่งเรืองชัย The developing human บริษัทบุ๊คเน็ท จำกัด 2543.3. Lynna Y. Littleton, Joan C. EngebretsonMaternal,Neonatal,and Women’s Health Nursing 2002.