Risk Assessments and Diagnostic Testing in Pregnancy

I want to spend some time talking about the risk assessment tests they can do now to gauge whether your developing baby is healthy or not. It’s absolutely amazing the technology they have now that can be used to give you a clear assessment of your chances of carrying a baby with either a neural tube defect or a chromosomal abnormality. To be honest, going into writing this blog I didn’t want to spend any time discussing all the things that can go wrong with your baby. In my work, I come across tons of articles on a weekly basis about the horrible things that can happen to a baby and it is all very sad.  So I wanted to stay upbeat and talk about normal development in this blog.  Also as awful and sad as these abnormalities are, they are rare. So at the end of the day they don’t affect many people in the general population. And it’s really not cool to get an already emotional pregnant woman stressed out about things she has a very slight chance encountering with her baby.  But now that I’ve been through some of this testing on my own I realized there is a lot on this topic that I would like to learn, as well I’d like to give my opinions on it. And hopefully this information is useful to other women out there.

One interesting thing about advanced risk assessment and diagnostic testing is when do we hit information overload? In my personal experience with this type of testing I fell just outside the normal risk range for a 33 year old women and we opted to have some additional testing done. As a person with a science background I understand my risk was essentially that of any 33 year old women and that is to say my risk was low so although waiting to have the next test down became a little stressful as the days went on, ultimately I understood our baby was most likely as healthy as could be. But what about people who don’t deal with science terminology and statistics on a regular basis? Do these risk assessments wrongfully stress them out? That’s just one train of thought that I traveled on while going through this process.

We’ve talked about the neural tube developing early along and representing the CNS. Defects involved with it have to do with the tube not closing up the tube properly. It can either lead to open defects or closed defects, closed defects are covered and less common while open ones occur in the brain and /or spinal cord are exposed. Neural Tube Defects (NTDs) occur in 1 in every 1000 births in the US.

Chromosomal abnormalities include missing or extra copies of a chromosome, or abnormalities within a given chromosome. A healthy fetus will have 46 chromosomes, 23 from mom and 23 from dad- each set of 23 has one sex chromosome (always an X from mom and either an X or a Y from dad). The other 22 chromosomes are autosomes and are represented two-fold in the set the fetus has. There are a number of extra copy diseases where the fetus has three of a given autosome instead of the normal two. Examples include Down syndrome which is technically known as Trisomy 21, Trisomy 18 (Edwards Syndrome), and Trisomy 13 (Patau Syndrome) where the number indicates which of the autosomes is in triplicate. Deletions are known as monosomy, one example is Turner Syndrome and occurs when a female has only one copy of the X sex chromosome. About 1.4 in every 1000 births in the US have Down syndrome, as a woman’s age increases her chances of giving birth to a baby with a chromosomal abnormality increase. For example a 30 year old woman has a 1 in 385 chance of having a baby with a chromosomal abnormality while a 40 year old woman has a 1 in 65 chance. (These are stats I got from reputable sources but they are not universal, you may see/hear slightly different ones).

Back in the day the only option to evaluate these conditions was an amniocentesis. This procedure is still done today as a last measure diagnostic of chromosomal abnormalities and neural tube defects. Nowadays before a women gets to that, there are a number of less invasive tests that can be done to assess the risk that the baby isn’t healthy. Now the key phrase is to ‘assess the risk’ that’s all these early blood tests and fetal ultrasounds can do, risk assessment- they are not a diagnosis. An amniocentesis is the only test that provides a diagnosis. Women nowadays have the option of taking a blood test in the first trimester along with a detailed ultrasound, or waiting until the second trimester to take a different blood test.  Physicians will make recommendations on which (if any) time point makes more sense for a given women, strongly dependent on her age but also her family history and personal history as well. If a women is over 30 these tests are explained early on by her doctors, and suggested to do at least one of them, but if a women is over the age of 35 the first round of testing is strongly suggested. (If you are under 30 and you don’t have a family history of any of this diseases, I would assume these tests are not recommended unless you felt strongly to have them done but I’m not under 30 so I can’t speak from personal experience on this).

The first test is most likely some variation depending on which genetic company your doctor’s office used. My OBGYN uses Integrated Genetics’ First Screen, a maternal blood test where they protein looked at is PAPP-A, commonly known as the Pregnancy Associated Plasma Protein A (it is more scientifically known as pappalysin 1). PAPP-A is an enzyme that cleaves a growth factor binding protein, it is thought to have a role in wound healing and bone remodeling.  This test only gauges risk of a chromosomal abnormality not of NTDs and it is done in conjugation with a detailed ultrasound of the fetus where the technician looks at the fluid filled space at the back of the neck. Extra fluid is an indicator for increased risk for chromosomal abnormalities. This measurement is known as nuchal translucency and it is used in combination with the PAPP-A blood test result to given an assessment of how likely it is the baby has trisomy 21 or 18. This combination of tests can be done between week 10 to 14.

The next option is a test done in the beginning of the second trimester, another maternal blood test this one looking at AFP- alpha fetoprotein. Again my doctor’s office uses Integrated Genetics and their Afp4 test, this test looks at risk for not just chromosomal abnormalities but also neural tube defects. This test compares this fetal protein to three maternal proteins, hCG (human chorionic gonadotropin, a hormone produced in early pregnancy that aids in setting up shop for embryo to grow. This hormone is known to most as the hormone detected in home pregnancy tests, it is also evaluated in the aforementioned First Screen test along with PAPP-A), along with two other proteins. The levels of all four are measured and a risk is calculated separately for chromosomal abnormalities and neural tube defects.

Now hopefully whichever test you decide on comes back putting you within the normal range of risk for a woman your age. It’s important to remember that this is only a risk assessment it’s not a definite yes or no that your baby is healthy or unhealthy. If your risk assessment comes back negative it means you fall within the normal risk range of having an unhealthy baby and that risk is small.  If your risk assessment comes back positive there are additional tests that can be done to either add to the risk assessment or go directly to the diagnosis phase. There is an additional risk assessment blood test for high risk women, that is women over the age of 35 or women under 35 that have tested positive on one of the maternal blood tests. This test looks at fetal chromosome fragments in maternal blood to give a clearer assessment of chromosomal abnormality in the fetus. The final option is amniocentesis, where amnion fluid is draw up through a long, thin needle with an ultrasound done before and after the insertion of the needle. This fluid can be evaluated for chromosomal abnormalities, neural tube defects, and certain genetic diseases. There is a slight risk of miscarriage and other complications from this procedure, such as bleeding and infection.

All-in-all this whole process can be scary and sometimes, as I mentioned above, give you case to freak out when really your baby is fine. Ultimately the silver lining to going through this nerve-wracking process is you come out knowing pretty definitely (depending on how far you go in the assessment) that your baby is healthy, which is more information than a women not opting to have these tests done would be armed with going into delivery.

Training for Baby

Jan 4^th- Well at this point most of our close friends know the news, it’s nice to have it out there now and it was of course nice to tell people. I’m still waiting to tell work, with all the doctor’s appointments so far neither my boss nor manager has asked what’s up so I figure I am good to go for a few more weeks. I am definitely starting to show in certain outfits, and by that I mean anything that isn’t my baggy sweatshirt/yoga pants attire that doubles as my work clothes and home clothes since those are one in the same. I wore a short summery dress over leggings and a long sweater (and a shirt underneath, the dress winterized quite nicely actually) for New Years and I was bumping! Funny- I tried on the short dress I wore out on my Bachelorette and I think it looked pretty cute with my baby bump. Crazy to think how different things are since early August when that was, and how much more different things will continue to get.

Jan 7^th- I’ve been getting back into my shoulder physical therapy, from a work-related injury from my previous job a few years ago. Once I finally left the job I continued to do the physical therapy for probably a solid 8 months but since then I stopped. The injury isn’t really better I just don’t do things that aggravate it and unfortunately one thing that aggravates it is holding babies. I feel like I am training for the most physically demanding job I’ll ever have. So I started the PT back up slowly in December and have now added about half of the exercises to the routine, and I’ve been doing them every couple of days. Also it is freezing out and I mean that almost without exaggeration, today it was maybe 10 degrees while the sun was out. So I have not been able to go out and walk and I don’t like to do the same cardio every day because it’s better for my body to cross-train. I started last week doing some of the cardio dance moves from memory from the various cardio dance workout videos I have, as well as some squats (which is from another cardio video). I’ve been hesitant to actually do a full video workout because it’s a lot of up and down and I huff and puff by the end. But I’ve slowly started to work some of the steps in and yesterday I did about half (20 minutes) of one of The Firm videos but I don’t use the weights (I never use the weights even if I wasn’t pregnant) but I like it because it incorporates some cardio dance moves, squats, and corresponding arm movements (that’s what the light weights are for that I disregard). I thought I’d wake up really sore but I was ok, so I think I’ll ride the bike today and then tomorrow do the second 20 minutes of the video.  In other news I am having trouble sleeping on my left side, I have tried to prop myself with a pillow on my back so that at least if it opt out of the side sleeping I’m at least on the pillow somewhat.

Jan 8^th- I will feel a lot better when all the sweets (from New Years and Christmas) and leftover dips from New Years are gone. I hate to waste any food so I will rarely throw things out but we might get to that point soon. Chris brought some goodies to work and anything chocolate-based I put in the fridge and snack on here and there for months. I am getting back to my veggies so that’s good. I’ve been making veggie quesadillas for lunch here and there, granted they are bread, a little cheese, and a little sour cream on top, but I pack them with spinach and/or arugula, mushrooms, and sometimes tomatoes as well so I feel like the positives outweigh the negatives. Tried a new recipe the other night from one of my annual Christmas cookbooks. Every year I get the Better Homes and Garden’s Annual cookbook from Chris’s stepmom but this year I got two of them, because I asked my Secret Santa for a previous year I was missing, and my Santa delivered. So now I have two to go through and make lists of the recipes I want to make and start trying them out! It's one of my favorite January traditions.

Nervous System Development

Week 8- The change from embryo to fetus occurs, now all major organs have at least begun to development

I’m throwing the nervous system in here, it along with the other major systems are continuing to develop in week eight and I’ve yet to talk about it in detail so here we go. We’ve already discussed the very beginning of the nervous system, the neural tube gives rise to the Central Nervous System- the brain and spinal cord while the neural crest cells gives rise to the Peripheral Nervous System- the sensory neurons, nerves, and ganglia. To be honest this system is the system of the body I need to most review for because I get confused by all the terminology and classification. The CNS and PNS are the two major subdivisions of the nervous system, with the PNS acting as the network throughout the body that allows for information to be relayed to the CNS. The PNS includes the Autonomic Nervous System, which in turn includes both the Parasympathetic and Sympathetic components. As well there is the Enteric Nervous System, which is either its own separate entity or part of the ANS depending where you fall on that debate. Regardless, it functions to innervate the gastrointestinal system. 

People commonly call the major functional unit of the nervous system nerves. Nerves technically speaking are neurons where each individual neuron contains a dendrite, which receives information and sends it to the soma or cell body, the main component of the neuron; and an axon which relays information from the soma. The major two types of neurons are afferent/sensory neurons which transmit information from the body to the CNS via the spinal cord, and efferent/motor neurons which transmit information from the CNS via the spinal cord to the body. Ganglion (singular, ganglia is plural) is a mass of nervous tissue located in the PNS.  Glia is the collective term for supporting cells in the nervous system. Now see why this system gets me all confused?

Source:

http://damiane.wikispaces.com/file/view/wyDiagramNervousSystem.jpg/220681914/wyDiagramNervousSystem.jpg

Now to go back to the start we’ve briefly discussed the origin of the neural tube and the neural crest cells giving rise to the Central and Peripheral Nervous Systems.  The neural tube will give rise to the brain and eventually all of its regions which are broken down to five areas. The front end of the neural tube will first make three major areas- the forebrain, midbrain, and hindbrain known at this stage in development as the prosencephalon, mesencephalon, and rhombencephalon. At around seven weeks, the forebrain and hindbrain area divided again giving rise to the telencephalon and diencephalon in the forebrain region and the metencephalon and myelencephalon in the hindbrain area. The mesencephalon does not further divide and thus continues to be known by this name, it gives house the tectum and the cerebral aqueduct. The telencephalon area becomes the largest part of the brain, the cerebrum which contains the cerebral cortex, hippocampus, basal ganglia, and the olfactory bulb. The diencephalon makes up the optic vessel and the hypothalamus. The hindbrain houses the pons and the cerebellum, and the myelencephalon eventually becomes the medulla oblongata at 20 weeks.  As well the neural tube will give rise to the spinal cord at the tail end of the tube.  When the spinal cord is complete, again I’ll use the term adult as in the adult spinal cord, it will run from the occipital bone down to the lumbar vertebra.  In order to fully understand the development of the spinal cord, a cross section of the adult spinal cord is a good place to start.

Source: http://www.mybrainnotes.com/telencephalon-diencephalon.gif

Source: http://www.apa.org/Images/brain-braingrowth_tcm7-96744.gif

 

 

Ok so there is a lot going on in the spinal cord and I’m really not going to get into it in a lot of detail because like I said earlier this system is one I am not really familiar with and I’d rather be vague then wrong! Going back to the neural tube, the end of it will become the spinal cord so a cross-section of the neural tube and its different regions will begin to tell the tale of how the adult spinal cord gets the way it is in the above picture. The cell type that gets this party started is neuroepithelial cell, located in the wall of the neural tube, and it gives rise to a lot of the various nervous system cells, including the neuroblasts which are precursors to all neurons, as well as macroglia and accessory cells like astrocytes and oligodendrocytes.  

Source: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0eti9fSrYME7TxbYZZ6qwsoaeHcC-mw-aCS4qp6x8-v22K8muIGPMp4YIRoIHaGLacmH5_HW_YMQRVDFjbkGWZM4LNlAxUXbszlzTBLlNd09ckTDoeJwiLmBDvIbt_MIZgW16EMJB9ZA/?imgmax=800

 

 

A distinction is made in the tube that gives a dorsal portion known as the alar plate from the ventral portion, the basal plate. The alar plate will give rise to the afferent, or sensory, neurons while the basal plate will give rise to the efferent, or motor, neurons. Collectively these two areas will become the interior of the spinal cord, known as the grey matter. The interior of the spinal cord is known as the grey matter due to its appearance directly related to the relatively few myelinated axons it has, this is in contrast to the surrounding area in the spinal cord, known as the white matter which has a lot of myelinated axons. As you can probably guess it is the myelin, a protective sheath that provides insulation for axons, that gives this white color.  The grey matter contains a large amount of cell bodies, along with dendrites, some unmyelinated axons and glial cells. Conversely the white matter contains few cell bodies. The grey matter is made up of the dorsal and ventral horn which are the top and bottom of the grey matter, respectively with the lateral horn in the middle of the two. The dorsal horn consists of sensory neurons, it leads into the dorsal root and ultimately the dorsal root ganglion.  The dorsal root ganglion, found on either side of neural tube, is formed from the neural crest cells. This group of nervous tissue is also referred to as the Spinal Ganglion and it carries signals from the sensory organs to the integration center.  The ventral horn, made up of motor neurons, which will makes its way into the ventral root. The lateral horn deals with the sympathetic nervous system as well, its neurons travel along the ventral horn root along with the motor neurons. The last piece to this puzzle that I’ll mention is the spinal nerves, where both the ventral and dorsal roots go on to. Spinal nerves carry sensory, motor, and autonomic information from the intertwined fibers that came from both the ventral and dorsal root. Theses nerves continue on their path depending on where in the body they are located. There are 31 pairs of spinal nerves (that for the most part correspond with the vertebra) cervical (8), thoracic (12), lumbar (5), sacral (5) and 1 pair of spinal nerves in the coccygeal area.

Source: http://tgesbiology.weebly.com/uploads/9/0/8/0/9080078/____915540999.jpg

All the previous discussion was about the neural cord giving rise to the brain and spinal cord. The other major contributor to the nervous system development is the neural crest cells. The neural plate border is a distinct region at the end of the neural plate (go figure), this border will give rise to the neural crest cells. During neurulation these cells will undergo a transition in type (epithelial to mesenchyme) that will allow them to migrate and differentiation into a lot of different cell types.  These cells position themselves along the anterior-posterior axis and develop into four functional regions- cranial, trunk, vagal & sacral, and cardiac region. Each give rise to different nervous system anatomy but also cartilage, bone, and connective tissue. Of note the vagal & sacral region of neural crest cells gives rise to the Enteric Nervous System and the Parasympathetic ganglia, while the trunk region gives rise to the other major component of the ANS- the sympathetic ganglia.  

 Fast fact- The adult brain has over 100 billion neurons.

 

Christmas and New Year's Eve

Dec. 23^rd- Well I am happy to report that my pregnant status did not prevent me from doing all the baking I normally do for Christmas so that was really great. Today I probably overdid it but this is the home stretch so I went big. Usually making all these sweets isn’t that much of a temptation for me but this year I definitely want to be a Grinch and keep everything for myself. My sweet tooth is raging! I can’t even imagine what kind of baking I’ll be able to get down next year, but that’s ok. I’ll just have to see where we are at!

Dec. 24^th- Christmas Eve! I’m working and not very focused but I’m still in my Christmas pjs (it’s 12pm) and I’m cranking my Christmas music. Actually had a listen morning sickness this morning which was not helped by the fact that I had a dental journal to work on first thing and it had some lovely surgical pictures. Usually dental surgery is the least offensive pictures I get but they made my stomach drop today.  Anyway anytime there is a particular occasion, like a holiday I always tend to think about how things were the year before and how they may be the following year. It’s crazy to think how much things are going to change for next year! And it’s funny to look back on Christmas last year, it was just a normal Christmas, Chris and I were engaged, no clue we’d be pregnant this year. Chris got an absolutely adorable Tom Brady jersey onesie from his Secret Santa at work yesterday which was very thoughtful since his coworkers know how much he loves his football jerseys (he gets the chance to wear them on casual Fridays). It’s so cute because it is not cotton, it really is jersey material tucked into an onesie. So cute.

Dec. 28^th- I’ve been over-wearing my thin, black, maxi skirt that is made out of yoga material. I got it over the summer and I’m obsessed with it because you can wear a tank or t-shirt with it and flip-flops or dress it up a bit. And now come winter I have found that I can winterize it with thick tights and boots and a sweater. I’ve worn it to every get-together in November and December thus far. So I’m at Marshalls today doing my signature between Christmas-Birthday (the 31^st) clothing shopping, which works a little different when you are pregnant but I was looking for leggings to wear with skirts and cardigan style sweaters. Found one of each and then I stumbled upon a maxi skirt in the Juniors section, very similar to mine but it was dark blue and black striped, however the fabric was cut and sown in a way on the front that the stripes were diagonal so it was really cute. All they had was a medium which didn’t quite cut it so I went to another Marshalls even though I know the stores don’t typically get the same exact merchandise, no dice. Then I remember there is a new one near my supermarket and I was headed there tonight, stopped at the new one too and also no dice. Then I came home and looked at Gap (where I got the black one), Old Navy, Delia’s and Alloy and found several of them at Alloy. So I ordered a large olive one with subtle black tie-dye and an extra-large coral colored one for later in the pregnancy! I’m hoping between my lack of work apparel and the fact that non-maternity trends right now are very pregnancy amendable (big sweaters, leggings with oversized tops) that I won’t have to actually buy much maternity clothes.

Dec. 30^th- The sleeping position thing has become an issue, I knew it would. I was just hoping it’d be later in the pregnancy but I’m at the point where it is recommended that I sleep on my left side and it’s tricky for me. I read something today that made me feel a little better because, of course, my worry in the middle of the night when I’m tossing and turning is that my actions are hurting the baby somehow. I knew, vaguely, it has to do with better circulation for the baby. I looked into it a bit more and found out that although sleeping on your back isn’t great for the baby, it’s more of a detriment to you and the negative effects will kick in on your system and you’ll want to switch positions before it would be a negative for the little one . Ultimately sleeping on your back is bad for you, as a pregnant lady with new infrastructure (and occupant) in your belly. All of the weighing down on your back while your sleeping can lead to pressing on your vena cava which can lead to low blood pressure along with some other problems too. Here’s the info I found from Parenting.com. My body is high maintenance and in addition to my ear drum damage on the left side, I also have this weird muscle injury that will not go away and it is on my left, lower back.

Dec. 31^st- Today is a special day, to me I consider today a holiday more so than Jan. 1^st. Although I do love having Jan. 1^st off and I plan on being lazy for it. But today is my birthday and we host a party to ring in the New Year with friends and family. Again I am really happy with my energy level, especially since Chris was sick this weekend and all food prep (and food shopping) was on me. Plus the cleaning because I’m really the one who does the major cleaning, as I am the neat freak. I did a complete top to bottom kitchen clean on Saturday which was partially to do with having people over for tonight but also to do with the end of my baking marathon that is December. I really only clean what is needed during December none of the extra stuff. So I find that the weekend in between Christmas and New Year’s is a good time to do a major clean. I took today as a vacation day to party prep but also just so I’m not so crazy busy. I am chilling this morning then I’m going to work out and shower and then do the stuff that can’t be done until closer to the party. For the most part Chris and I have gotten all the stuff that can be done ahead of time accomplish over the weekend and yesterday. It’s so weird to think we are going to have a six month old next year at this time! I hope we will still do this party. Funny since Chris was sick and I did all the prep I feel like that was good practice for when there is a six month old around here next year.

Kidney Development

Week 7- Highlights- Kidney, lung and other organs began development, external genitals start to develop, eyelids form, bone development begins.

Source: http://kidneyadvice.net/kidney%20disorders.html

Ok let’s talk kidney development, to be honest and geeky, the kidney is one of my favorite organs in terms of anatomy and physiology. Let’s do things in reverse for the kidney, the basic anatomy and physiology of the adult kidney is a series of tubules that allow for the filtration of blood and the ultimate formation of waste (in the form of urine) to be sent to the bladder. The kidney also functions in maintaining proper homeostasis in the body, maintaining balance of water content and electrolyte composition, as well as blood pressure and volume. Since the kidneys work with blood and urine, it is safe to say there is co-mingling of the kidneys with components of both the circulatory system and the urinary system. The major functional unit of the kidney is the nephron which houses both the filtration device, called the glomerulus- a network of capillaries, and the collecting tubes, shown in the picture above with the various parts and their respective names. The tubules and ducts take in and transport any materials (urea, waste, extra water) to the bladder via the ureters.  

Recall that everyone has a pair of kidneys, and thus at the earliest stage of kidney development we start with an embryonic pair of kidneys. Even though week seven was referenced on one particular website as being when the kidney forms there is behind the scenes work being done as earlier as 22 days. The earliest form of kidneys represent another transient/embryonic structure like some others we have encountered and are called the pronephros. (Kidney terminology has a lot of ‘nephro’ (Greek) in it as the nephron is the functionally unit found in this organ. Also renal (Latin) is used a lot). The pronephros grows out from the intermediate mesoderm when epithelial cells are arranged into, you guessed it, tubules. This makes sense with our ongoing theme of organogenesis starting with a bunch of tubes but it also makes perfect sense when we think ahead to the adult kidney being a series of tubules and ducts. To me the development of the series of tubes and tubules of the kidney can be thought of as growing vines, spreading out in different directions, some dying off at certain points while others are thriving, and some adding on more complex anatomical structure as they mature and grow. This first pair of primitive kidneys are orientated on the head to tail axes and as they grow downward they induce more caudally located intermediate mesoderm to produce the second set of primitive tubules, these are the mesonephric tubules of the mesonephros. These are linked to the aorta which mimics the adult kidney glomerulus (the dorsal aorta gives rise to the capillaries of the glomerulus). The first part, the pronephros, are not functional but now this second pair hooked up to the aorta is functional to allow for filtrate to flow in and be drained. By the time the mesonephros comes about the first pair of embryonic kidneys, the pronephros, start to degenerate. Like the pronephros, the mesonephros grows downward toward the tail end of the organism. In the fifth week the mesonephros develops the ureteric bud, the stalk of this bud will eventually become the ureter as well this bud grows into several key components of the kidney’s overall anatomy. This ureteric bud starts growing at the most caudal point and develops upwards, which is why the overgrowth of vines is an appropriate analogy.   Once the ureteric bud is made, it then interacts with the final precursor cells, the metanephric mesoderm to form the final pair of kidneys, which as you can probably guess go by the name of metanephros. This interaction of the ureteric bud and mesoderm will give rise to the kidney glomeruli and renal tubules while the ureteric bud gives rise to collecting ducts and ureters (the ureters transport urine to the bladder).  As the organism grows, the kidneys will eventually rotate and migrate and this will force the ureters to increase in length as well.  Urine production begins late in the first trimester. It is passed to the amnion where it will make up most of the amniotic fluid.

Source: http://commons.wikimedia.org/wiki/File:Development_of_embryonic_nephrons.png

 

No meatball zone

Dec.4^th-You know you are pregnant when….you cry reading birthday cards for your husband at CVS. I don’t know though I guess I should be a bit more fair on this, seeing as it is the first birthday of Chris’s I am able to buy the ‘husband’ cards and it didn’t occur to me until I got into the card aisle. Plus I got him the most perfect one, it is like I wrote it. So maybe the tears were warranted.

Dec. 5^th- We got to hear the baby’s heartbeat today! It was really cool. The more I go for appointments at my OBGYN the more I am happy with my decision, all the staff is really nice. Today we met our first doctor- they have five on staff and you rotate between them during your pregnancy and then whoever is on call when you go into labor delivers for you. Also the office has 7:30am appointments which is awesome, Chris was able to come with me and he was still on time for work. I start work at 7:30 so I was behind schedule but since I work an early shift having the option for early morning appointments is great because it messes with my schedule the least.

Dec. 8^th- Chris had the super cute moment with the ‘we are having a baby’ written in the sand for his mom and stepdad. We probably should have just went with that for the duration. I feel like I’ve gone over the moment of telling friends and family in my head so many times that now that we are actually at that stage we both are guilty of just blurting it out like hey I’m going to get the pancakes and btw we are having a baby. (That’s pretty much how it went last night out with some friends (just sub in a dinner appropriate option instead of pancakes, not that there is anything wrong with pancakes for dinner) and how it went this morning at Chris’s birthday breakfast with the rest of his immediate family. They were all so shocked it took them a while to react to the exciting news.

Dec.9^th- Just when you think you are out of the woods, I made meatballs tonight and a broccoli cheesy casserole side dish and I wanted nothing to do with either of them! So annoying, I can’t even pin-point what kind of food is off limits so cooking is really just a gamble at this point. Tonight’s menu included recipes I have made before and really like so it was really weird, frustrating, and disappointing. I’m thankful it’s cold weather season because we can use our outdoor fridge (the balcony) and they are both out of sight, out of mind.

Dec.10^th- I signed up for this great supplementary program my insurance company offers cleverly called Baby Yourself. I registered online the other day (they figure out that you are pregnancy based on your insurance claims and then send you something in the mail about it) and spoke to an RN today on the phone for about 15 minutes. She was really nice- went over some stuff with me, some stuff I didn’t know-like when to start sleeping on your side (to be honest I didn’t completely catch what she said but I looked it up and I think she must have said 16 to 18 weeks based on seeing 20 weeks online). Overall she is an additional resource and is going to check in on me from time to time, as well I can call her if I ever had any questions. Also I got a free large water bottle and a great book about pregnancy (and labor although I haven’t gotten anywhere near that far in it) which are both really cool. The sleeping on my side thing is going to be an issue. They recommend specifically that you sleep on your left side- which for me is better than my right. But my high maintenance body is tricky on either side, normally I sleep on my back. Due to  my right hip pain, sleeping on my right is pretty much 100% off limits and on the left I have ear drum damage that if I find myself sleeping on my left- really bearing down on that ear I will be woken up by horrible ear pain. I am ridiculous I know. So I need to scrap sleeping on my back for the most part and go with the left. It is the better side to sleep on for increased blood flow to the baby and looking online it said the sleeping on your back can actually be bad for your back muscles and I don’t need any help in that department. So I should really try to focus on left side sleeping.

Dec. 12^th- I tried Monday’s meatball and broccoli side dinner again tonight, I was a little more successful with the meatballs but no dice with the broccoli. So weird, I am normally broccoli’s biggest fan. Also I went food shopping tonight and its funny because they always say don’t go to the grocery store when you are hungry, well you definitely shouldn’t go when you are hungry and pregnant. I feel like it’s a little early in the pregnancy to have Chris go all the time from here on out but man would it save money. Of course it’s December and I do the majority of my Christmas shopping at the supermarket since most of my gifts are cooked/baked goodies but still I just want to buy everything in the store. But of course who knows what I would actually really want to eat seeing as there is still no way to predict that.

Dec. 14^th- We are learning that we are pretty much just shocking people with our pregnancy news and so if they don’t seem super-excited it’s just because it hasn’t sunk in yet. We saw some close friends who are essentially family today and it was passed along to some of them by Chris’s dad (we asked people to keep it to themselves so we could spread the word through December but apparently the rules don’t apply to him!) and he was so excited. So although he didn’t listen to our request at listen he did so in an enthusiastic way.

Dec. 17th- This is pretty much how I feel all the time http://youtu.be/bETsltSTrhA (This clip is the only one I could find and for some reason it's in English but has French subtitles.
 

Lung Development

Week 6-Highlights: Lungs and digestive system are beginning to take shape, the heart begins to beat, facial components-eyes, nose, mouth and ears begin to form. The whole body is about 1/2 an inch long.

Around week 6 lung development beings to pick up, with the necessary background work done in weeks 4 &5. A unique property of this organ is it doesn’t really have to hurry to become functional, it can take the entire gestational period and beyond (to after birth) to fully develop. This is because the lungs take care of respiration, which of course involves breathing air in and out-something our little developing organism won’t have the chance to do until it is done incubating in the womb. The other major function, but certainly tied to respiration, is gas exchange, which we learned is being covered by the placenta until further notice. Nonetheless the structure of the lungs starts to develop around the 5-6 week mark when an off-growth, the true lung primordium, of the foregut develops. And yes it starts as a tube as most other organs but the lung actually retains its tube-like structure in adult form. The lungs are series of branched tubes starting with the trachea, that branches to the two lungs- each lung is further subdivided into bronchi and these bronchi lead to bronchioles that leave to alveolar sacs and then the individual unit of gas exchange, alveoli. Alveoli complex with the pulmonary veins and arteries that deliver the blood in its two forms (deoxygenated and oxygenated- depending on which vessel it is in and thus which direction it is going) Thus the alveoli complete the pulmonary circuit we discussed in the heart development section. Because the lung has many multi-functional areas it should come as no surprise that all three of the primitive embryonic cell layers contribute different components to the lung- the endoderm gives the respiratory epithelium that lines all the divisions of the lung; the mesoderm gives the blood vessels, smooth muscle, cartilage, and other connective tissue; while the ectoderm gives the nervous system component.

 Around week 6 lung development beings to pick up, with the necessary background work done in weeks 4 &5. A unique property of this organ is it doesn’t really have to hurry to become functional, it can take the entire gestational period and beyond (to after birth) to fully develop. This is because the lungs take care of respiration, which of course involves breathing air in and out-something our little developing organism won’t have the chance to do until it is done incubating in the womb. The other major function, but certainly tied to respiration, is gas exchange, which we learned is being covered by the placenta until further notice. Nonetheless the structure of the lungs starts to develop around the 5-6 week mark when an off-growth, the true lung primordium, of the foregut develops. And yes it starts as a tube as most other organs but the lung actually retains its tube-like structure in adult form. The lungs are series of branched tubes starting with the trachea, that branches to the two lungs- each lung is further subdivided into bronchi and these bronchi lead to bronchioles that leave to alveolar sacs and then the individual unit of gas exchange, alveoli. Alveoli complex with the pulmonary veins and arteries that deliver the blood in its two forms (deoxygenated and oxygenated- depending on which vessel it is in and thus which direction it is going) Thus the alveoli complete the pulmonary circuit we discussed in the heart development section. Because the lung has many multi-functional areas it should come as no surprise that all three of the primitive embryonic cell layers contribute different components to the lung- the endoderm gives the respiratory epithelium that lines all the divisions of the lung; the mesoderm gives the blood vessels, smooth muscle, cartilage, and other connective tissue; while the ectoderm gives the nervous system component.

Source: http://discovery.lifemapsc.com/library/images/lung-anatomy-and-structure

 

Lung development is broken up into several stages-the Embryonic Stage which last up until about the 7th week, Pseudoglandular Stage (weeks 7-16), Canalicular Stage (weeks 16-25), Terminal Sac/Saccular Stage (week 26 until birth) and the Alveolar Stage (eight months until childhood). 

In the Pseudoglandular stage, the functional development of the trachea and lungs are started, with the branching of the bronchial trees and respiratory parenchyma, it also marks the development of acinus (this is another term of classification, the structure that houses the bronchi, alveolar ducts and alveoli). The differentiation of the lung cells will also begin in this stage as the cells are more specialized as we move down to the alveoli. The next stage, the Canalicular stage marks the end of the structure formation, epithelial differentiation takes place now and the air-blood barrier is formed.  The capillary network of the alveoli is set up and the lamellar bodies which will store surfactant are formed. Surfactant is a macromolecular complex of phospholipids and hydrophobic proteins present in the alveoli, the function of this complex is to decrease surface tension and prevent alveolar collapse during exhalation. Surfactant is produced by Type II cells/pneumocytes (these cells are found in the alveoli), while the type I pneumocyte is found in the airways and alveoli as well. Surfactant production begins, in modest amounts, once the type II cells are differentiated, during the Canalicular stage (16 to 25 weeks) but the real quantities are not made until week 35. After the Canalicular stage is the Terminal Sac/Saccular stage which goes from 26 weeks to birth- there is continued development of the alveoli area but even at birth this area is not fully developed, it continues to maturity after birth. The alveolar stage after birth finishes up the task of completing the alveoli for gas exchange.

Source: http://www.ehow.com/how-does_5220795_lung-development-fetus.html