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Mama Baby, How to care health
每週更新 ⋅ 2022年12月27日
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Monitoring Editor: Marike Lemmers, Marianne AC Verschoor, Bobae Veronica Kim, Martha Hickey, Juan C Vazquez, Ben Willem J Mol, James P Neilson, and Cochrane Pregnancy and Childbirth Group
Academic Medical Center, Department of Obstetrics and Gynaecology, Meibergdreef 9, AmsterdamNetherlands, 1105 AZ
School of Medicine, The University of Adelaide, Robinson Research Institute, AdelaideSAAustralia, 5006
The Royal Women's Hospital, The University of Melbourne, Level 7, Research Precinct, MelbourneVictoriaAustralia, Parkville 3052
Instituto Nacional de Endocrinologia (INEN), Departamento de Salud Reproductiva, Zapata y D, Vedado, HabanaCuba, 10 400
Monash University, Department of Obstetrics and Gynaecology, 246 Clayton Road, ClaytonVictoriaAustralia, 3168
The University of Liverpool, LiverpoolUK
James P Neilson, Email: ku.ca.looprevil@noslienj.
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This article is an update of "Medical treatment for early fetal death (less than 24 weeks)" in volume 2006, CD002253.
Abstract
Abstract
Background
Background
In most pregnancies that miscarry, arrest of embryonic or fetal development occurs some time (often weeks) before the miscarriage occurs. Ultrasound examination can reveal abnormal findings during this phase by demonstrating anembryonic pregnancies or embryonic or fetal death. Treatment has traditionally been surgical but medical treatments may be effective, safe, and acceptable, as may be waiting for spontaneous miscarriage. This is an update of a review first published in 2006.
Objectives
Objectives
To assess, from clinical trials, the effectiveness and safety of different medical treatments for the termination of non‐viable pregnancies.
Pina Bozzo, Angela Chua-Gocheco, MD, and Adrienne Einarson, RN
Copyright and License information Disclaimer
Abstract
Abstract
Question Many of my female patients complain about acne, unwanted hair growth, and other skin problems that have only developed since they became pregnant. Are products used for these types of benign skin conditions safe to use in pregnancy, as it is understandable that women want to look their best at this important time in their lives?
Answer With the exception of hydroquinone, which has a relatively high systemic absorption rate, and tretinoin, for which the evidence is controversial, these products act locally and therefore produce minimal systemic levels. Consequently, in most cases women can deal with these cosmetically unappealing skin conditions without compromising the safety of their unborn children.
Women experience many physiologic changes during pregnancy, including increases in androgen levels.1 This might lead to development or worsening of acne vulgaris and an increase in hair growth on various parts of the body.
Topical treatment options for acne often include retinoids, antibacterials, and agents such as benzoyl peroxide and salicylic acid. Other agents used to improve the appearance of skin, or used in skin maintenance, include the following: hydroquinone found in skin-lightening agents; avobenzone, octinoxate, and oxybenxone found in sunscreens; and dihydroxyacetone found in self-tanning agents. Common topical agents used for removing hair or reducing its appearance include salts of thioglycolic acid and sodium, calcium, and potassium hydroxide found in depilatory creams, or hydrogen peroxide found in hair-bleaching creams. Table 12–14 presents absorption of topical agents.
How does the fetal circulatory system work?
How does the fetal circulatory system work?
During pregnancy, the fetal circulatory system works differently than after birth:
The fetus is connected by the umbilical cord to the placenta. This is the organ that develops and implants in the mother's uterus during pregnancy.
Through the blood vessels in the umbilical cord, the fetus gets all needed nutrition and oxygen. The fetus gets life support from the mother through the placenta.
Waste products and carbon dioxide from the fetus are sent back through the umbilical cord and placenta to the mother's circulation to be removed.
The fetal circulatory system uses 3 shunts. These are small passages that direct blood that needs to be oxygenated. The purpose of these shunts is to bypass the lungs and liver. That's because these organs will not work fully until after birth. The shunt that bypasses the lungs is called the foramen ovale. This shunt moves blood from the right atrium of the heart to the left atrium. The ductus arteriosus moves blood from the pulmonary artery to the aorta.
Oxygen and nutrients from the mother's blood are sent across the placenta to the fetus. The enriched blood flows through the umbilical cord to the liver and splits into 3 branches. The blood then reaches the inferior vena cava. This is a major vein connected to the heart. Most of this blood is sent through the ductus venosus. This is also a shunt that lets highly oxygenated blood bypass the liver to the inferior vena cava and then to the right atrium of the heart. A small amount of this blood goes straight to the liver to give it the oxygen and nutrients it needs.
Waste products from the fetal blood are transferred back across the placenta to the mother's blood.
Inside the fetal heart
Inside the fetal heart
Blood enters the right atrium. This is the chamber on the upper right side of the heart. When the blood enters the right atrium, most of it flows through the foramen ovale into the left atrium.
Blood then passes into the left ventricle. This is the lower chamber of the heart. Blood then passes to the aorta. This is the large artery coming from the heart.
From the aorta, blood is sent to the heart muscle itself and to the brain and arms. After circulating there, the blood returns to the right atrium of the heart through the superior vena cava. Very little of this less oxygenated blood mixes with the oxygenated blood. Instead of going back through the foramen ovale, it goes into the right ventricle.
This less oxygenated blood is pumped from the right ventricle into the pulmonary artery. A small amount of the blood continues on to the lungs. Most of this blood is shunted through the ductus arteriosus to the descending aorta. This blood then enters the umbilical arteries and flows into the placenta. In the placenta, carbon dioxide and waste products are released into the mother's circulatory system. Oxygen and nutrients from the mother's blood are released into the fetus' blood.
At birth, the umbilical cord is clamped and the baby no longer gets oxygen and nutrients from the mother. With the first breaths of life, the lungs start to expand. As the lungs expand, the alveoli in the lungs are cleared of fluid. An increase in the baby's blood pressure and a major reduction in the pulmonary pressures reduce the need for the ductus arteriosus to shunt blood. These changes help the shunt close. These changes raise the pressure in the left atrium of the heart. They also lower the pressure in the right atrium. The shift in pressure stimulates the foramen ovale to close.
Blood circulation after birth
Blood circulation after birth
The closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change of fetal circulation to newborn circulation.
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