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Perinatal and Fetal Development - Vocabulary Flashcards

SEXUAL RESPONSE CYCLE (as per Page 14)

  • EXCITEMENT/PLATEAU PHASE (implied by initial descriptions):

    • Vagina swells from increased blood flow; vaginal walls darken to purple; clitoris becomes highly sensitive and retracts under the clitoral hood

    • To avoid direct stimulation from the penis, the man's testicles are withdrawn up into the scrotum; the man's testicles swell; his scrotum tightens and he begins producing a lubricating liquid

  • 3. ORGASM PHASE (CLIMAX)

    • General characteristics: climax of the sexual response cycle; shortest phase, generally lasting only a few seconds; involuntary muscle contractions

    • BP, heart rate, and breathing at their highest; rapid intake of oxygen; feet muscles spasm; sudden forceful release of sexual tension

    • WOMEN: vaginal muscles contract; uterus undergoes rhythmic contractions

    • MEN: rhythmic contractions at the base of the penis lead to ejaculation; a rash or sex flush may appear over the body

  • 4. RESOLUTION PHASE

    • General characteristics: body slowly returns to normal functioning; swollen/erect parts return to previous size/color; sense of well-being; often fatigue

    • WOMEN/MEN: some may rapidly return to orgasm with additional stimulation and may experience multiple orgasms

  • REFRACTORY PERIOD

    • Recovery time after orgasm during which orgasm cannot be reached again

    • Duration varies among men and changes with age

PERINATAL PERIOD (Overview from Page 14-16)

  • COMMENCEMENT AND ENDS

    • Commences at 22 weeks or 154 days of gestation

    • Ends at 7 completed days after birth

  • THREE TRANSITION PERIODS

    • PRENATAL: during pregnancy/before birth

    • INTRAPARTAL: labor/delivery

    • POSTPARTUM: period after delivery

  • PRENATAL CARE (CARE OF THE FETUS)

    • FETAL FORMATION AND FERTILIZATION (CONCEPTION)

    • Sperm lives for ext{lives for }72 ext{ hrs} (roughly 48 hrs before ovulation and 24 hrs after); average travel time ~46 ext{ hours}

    • Sperm must be in the genital tract 4-6 ext{ hours} before fertilizing an egg

    • Hyaluronidase enzyme dissolves hyaluronic acid that holds ovum together; enables fertilization

    • Ova survive 24-48 ext{ hrs} only

    • HYALURONIDASE: enzyme that dissolves hyaluronic acid covering the ovum

  • FERTILIZATION PROCESSES (Factors Affected)

    • Equal maturation of sperm and ovum

    • Two key processes: ext{sperm capacitation} and ext{acrosomal reaction}

    • Sperm capacitation: sperm hypermobility, plasma membrane breakdown exposing acrosomal membrane, enabling binding to zona pellucida

    • Acrosomal reaction: hyaluronidase released from acrosomal cap allows penetration of corona radiata and zona pellucida

    • Upon fertilization, sperm contacts vitelline (zona pellucida) membrane; cortical granule release prevents multiple sperm penetration

  • ZYGOTE TO EMBRYO (Chromosomal):

    • When fertilization occurs, the male pronucleus unites with the female pronucleus, restoring chromosome number to 46

    • The zygote forms a new combination of genetic material (unique individual)

    • Ovum and sperm each contribute 23 chromosomes; total 46

    • 22 pairs are autosomes; the last pair are sex chromosomes (determine sex)

    • Ovum contributes X; sperm contributes X → FEMALE; Ovum contributes X; sperm contributes Y → MALE

EMBRYONIC DEVELOPMENT (Embryogenesis) & IMPLANTATION (Pages 15-16)

  • EMBRYONIC DEVELOPMENT OVERVIEW

    • Fertilization occurs in the fallopian tubes (uterine tube)

    • After fertilization, cleavage divisions progress: 2 cells → 4 → 8 → …

    • Morula: when cell number reaches 16

    • Blastula (blastocyst): hollow ball of cells with a fluid-filled cavity; differentiation starts

    • Blastocyst differentiation includes an inner cell mass and an outer trophoblast

    • Trophoblast attaches to the endometrium; inner cell mass differentiates to form embryo proper

    • Embryogenesis requires nutrition; implantation is essential for nourishment

  • DIFFERENTIATION AND PLACENTA

    • Differentiation: cells become specialized

    • Blastocyst contains differentiated cells; once embedded, nourishment is established via the placenta

  • IMPLANTATION (nidation)

    • Occurs ~8-10 days after fertilization at the fundal portion of the uterus (upper 1/3 of uterus; can be anterior or posterior)

    • Ectopic pregnancy occurs when implantation is outside the uterus (e.g., fallopian tube); dangerous if rupture occurs

    • Blastocyst buries itself entirely in endometrium; placentation begins

    • Amniotic sac forms around the embryo with amniotic fluid; membranes include Amnion and Chorion

    • Langerhans layer of placenta protects against some viruses in early pregnancy

    • Trophoblast forms chorionic villi that attach to endometrium; placenta forms from chorionic villi and decidua basalis

    • Low-lying implantation (placenta previa) can obstruct the cervix and complicate delivery

    • Placenta functions: oxygen/nutrient transfer, waste removal, gas exchange, endocrine secretion

  • PLACENTA: STRUCTURE AND FUNCTIONS

    • Placenta: organ that develops in the uterus; provides oxygen and nutrients to the fetus; removes fetal wastes

    • Umbilical cord arises from placenta and attaches to the fetus; AVA (artery-vein-artery) arrangement: 2 arteries, 1 vein

    • Normal cord: 3 vessels (2 arteries, 1 vein)

    • Wharton’s jelly surrounds the vessels to prevent compression

    • Nuchal cord: cord wrapping around the neck is common and may occur during pregnancy, labor, or delivery

    • Placental sides: Maternal side = Duncan (dirty, ragged, beefy appearance); Fetal side = Schultz (shiny, smooth); cotyledons observed at delivery; missing cotyledons may indicate placental fragments requiring attention

  • PLACENTAL HORMONES (and their roles)

    • HCG (Human Chorionic Gonadotropin): secreted as early as 8-10 days after fertilization; detected in serum at implantation; present in urine and blood after first missed period up to 1-2 weeks postpartum; suppresses maternal immune rejection of the placenta; typical quantity ~ N = 4 imes 10^5 ext{ IU}/24 ext{ h}

    • HCG and hydatidiform mole: hydatidiform mole is a trophoblastic disease with trophoblast proliferation that can mimic pregnancy; not all high HCG indicates pregnancy

    • Progesterone: maintains pregnancy and prevents uterine contractions

    • Estrogen: mammary development and uterine development

    • HCS/Human Placental Lactogen (also called human placental lactogen, or HPL): secreted by the placenta beginning in the third week after ovulation; resembles growth hormone; acts as insulin antagonist (glucose-sparing effect); prepares breast for lactation

  • AMNIOTIC FLUID (Page 18-19)

    • Clear, straw-colored fluid surrounding the fetus; originates from fetus and mother; fetal urine contributes after week 10; pH around 7.2 (slightly alkaline)

    • Typical volume: 800 ext{ mL} - 1200 ext{ mL}

    • Abnormal volumes:

    • Oligohydramnios: < 500 ext{ mL}; suggests kidney issues

    • Polyhydramnios: > 2000 ext{ mL}; may indicate esophageal atresia or excessive amniotic fluid

    • Meconium-stained amniotic fluid: green discoloration; indicates fetal stool expelled intrauterine, especially later gestation

    • Golden amniotic fluid: suggests hemolytic disease and bilirubin overload

  • AMNIOTIC FLUID FUNCTIONS

    • Shock absorber; protects fetus; allows symmetrical growth and movement

    • Medium for excretion; specimen for diagnostic exams; fetal temperature regulation; maintains amniotic pressure and placental perfusion during labor

  • UMBILICAL CORD (Page 20)

    • Conduit between fetus and placenta; length ≈ 55 ext{ cm} at term; contains 1 ext{ vein} + 2 ext{ arteries}

    • Blood vessels enclosed by Wharton’s jelly

    • Function: transport oxygen and nutrients to fetus; remove wastes back to placenta

    • AVA arrangement: arteries (2) carry deoxygenated blood; vein (1) carries oxygenated blood to fetus

    • Nuchal cord: can wrap around fetal neck

FETAL CIRCULATION AND TRANSITIONS (Pages 20-22)

  • FETAL CIRCULATION SHUNTS (to bypass immature lungs and liver)

    • FORAMEN OVALE: right atrium to left atrium shunt; bypasses lungs; normal in fetus, normally closes after birth

    • DUCTUS ARTERIOSUS: connects pulmonary artery to aorta; blood can bypass lungs via the ductus arteriosus

    • DUCTUS VENOSUS: shunt from placenta via the umbilical vein to the inferior vena cava; allows highly oxygenated blood to bypass the liver; most blood bypasses liver; remainder perfuses liver

  • FETAL CIRCULATION (Video summary) – Key flow

    • Blood from placenta via umbilical vein → ductus venosus → inferior vena cava → right atrium

    • From right atrium, some goes to right ventricle to pulmonary artery; most crosses via foramen ovale to left atrium → left ventricle → aorta → body

    • Blood that goes to right ventricle mainly goes to the pulmonary artery and then via ductus arteriosus to the aorta

    • Lungs are fluid-filled; high pulmonary vascular resistance directs more blood through the ductus arteriosus

    • Pressure in right atrium is higher than left, promoting foramen ovale flow

    • Only ~8% of right ventricular output goes to lungs; most goes through ductus arteriosus to the body

    • Umbilical arteries: carry blood from the body back to the placenta for oxygen/nutrients exchange

  • TRANSITION TO POSTNATAL CIRCULATION AFTER BIRTH

    • At birth, cord clamped; placenta removed; systemic vascular resistance increases; lungs inflate; alveolar vessels dilate with oxygen

    • Pulmonary pressures decrease; at ~6-8 weeks postnatally, pulmonary vascular resistance normalizes

    • Foramen ovale closes due to increased left atrial pressure; functional closure within weeks; permanent closure by about 3 months; Patent Foramen Ovale (PFO) may persist in 15-25% of adults

    • Ductus arteriosus: typically closes within 4-10 days after birth; functional closure occurs earlier with breathing at birth

    • Ductus venosus: closes within 3-7 days; remnant becomes ligamentum venosum; umbilical vessels become ligaments

RESPIRATORY SYSTEM (Endoderm) & NEURAL DEVELOPMENT (Pages 23-24)

  • RESPIRATORY SYSTEM

    • Not functional until birth; develops from a single tube that separates into esophagus and trachea by the 4th week of gestation

    • Lecithin/Sphingomyelin (L/S) ratio used to assess fetal lung maturity; surfactant production begins around 24 ext{ weeks}; prevents alveolar collapse at expiration

    • Betamethasone (steroid) can be given to the mother to accelerate surfactant synthesis if preterm birth is anticipated

    • If preterm birth occurs, neonatal care may include endotracheal intubation and artificial surfactants

  • NERVOUS SYSTEM

    • Develops from ectoderm; neural plate forms by ~3 weeks AOG; neural tube forms CNS (brain and spinal cord); neural crest forms PNS

    • Brain development occurs in utero; full maturity occurs after birth; rapid brain growth continues into early childhood

    • Folic acid deficiency linked to neural tube defects (e.g., spina bifida); prenatal vitamins include folic acid to reduce risk

DIGESTIVE & REPRODUCTIVE SYSTEMS (Pages 24-25)

  • DIGESTIVE SYSTEM

    • Develops from endoderm

    • Sterile gut at birth; newborn gut lacks normal flora; vitamin K synthesis depends on intestinal bacteria; low vitamin K in newborns

    • Atresia and stenosis are common congenital GI defects; esophageal atresia may occur from failure of trachea and esophagus to separate properly

    • Omphalocele: abdominal contents herniate through umbilical ring due to abdominal wall closure failure

    • Meconium: first stool of the newborn; composed of intestinal cells, lanugo, mucus, amniotic fluid, bile; viscous and dark olive green; important nursing task to document passage

    • Fetal liver remains active; immature at birth; risk of hypoglycemia and hyperbilirubinemia in first 24 hours; mother’s substances cross the placenta

  • REPRODUCTIVE SYSTEM

    • Develops from mesoderm

    • Gonads develop around ~6 weeks AOG; sex determined at conception by sperm carrying X or Y

    • Testosterone influences male duct development; absence leads to female organs

    • Testes form in abdomen and descend into scrotum around weeks 34-38; preterm infants may have undescended testes; follow-up necessary for descent

  • URINARY SYSTEM

    • Kidneys not essential for fetal life; placenta handles waste clearance

    • Fetal urine forms by ~12 weeks; excreted into amniotic fluid by ~16 weeks; average fetal urine ~500 ext{ mL/day}

    • Oligohydramnios may indicate poor fetal urine production

  • INTEGUMENTARY SYSTEM

    • Fetal skin translucent until subcutaneous fat deposition (~36 weeks)

    • Lanugo: fine downy hair; appears around 16 weeks; diminishing by ~36 weeks

    • Vernix caseosa: creamy coating for lubrication and protection; forms by ~20 weeks; shed before birth

IMMUNE, ENDOCRINE, ENERGETIC SYSTEMS (Pages 25-26)

  • IMMUNE SYSTEM

    • IgG crosses placental barrier starting about week 20; provides passive immunity; peaks at birth; declines over ~8 months as infant builds its own stores

    • IgA and IgM are produced after infections and indicate fetal exposure; they do not cross the placenta

  • ENDOCRINE SYSTEM

    • Endocrine functions begin with neural system development

    • Fetal pancreas produces insulin; insulin does not cross placenta

    • Thyroid/parathyroid important for metabolism and calcium balance

    • Fetal/adrenal glands supply precursors for placental estrogen synthesis

  • MUSCULOSKELETAL SYSTEM

    • Early fetal life: cartilage templates; ossification begins around 12 ext{ weeks}; most bones ossify later; some bones (carpals, tarsals, sternum) ossify near birth

    • Fetal movement detectable by ultrasound by ~11 weeks; maternal perception of movement (quickening) typically by 16-20 weeks; more common earlier with multigravida

FETAL MILESTONES, MONTH-BY-MONTH DEVELOPMENT & TRIMESTERS (Pages 25-27)

  • MONTH-BY-MONTH OVERVIEW

    • MONTH 1: amniotic sac forms; placenta develops; primitive face; heart tube beating ~65 bpm by end of 4th week; length ~ 1/4 inch

    • MONTH 2: facial features form; ears, limbs; neural tube closed; heart beat detectable around week 6; embryo becomes fetus after week 8

    • MONTH 3: limbs fully formed; nails forming; external ears formed; reproductive organs develop but sex unclear on ultrasound; end of month: ~4 inches long, ~1 oz

    • MONTH 4: heartbeat audible via Doppler; digits defined; hair and nails form; body grows; end of month: ~6 inches, ~4 oz; sex discernible on ultrasound

    • MONTH 5: quickening occurs; lanugo covers body; vernix caseosa forms; end of month: ~10 inches, 1/2 to 1 lb

    • MONTH 6: skin reddish and veiny; prints visible; eyes open; end of month: ~12 inches, ~2 lbs; viability improves if born prematurely (≈ 23 weeks with care)

    • MONTH 7: hearing develops; fetus changes position; amniotic fluid reduces; end of month: ~14 inches, 2-4 lbs

    • MONTH 8: lungs developing; brain rapid development; ~18 inches, ~5 lbs

    • MONTH 9: lungs mature; reflexes coordinated; ready for birth; ~18-20 inches, ~7 lbs

  • TRIMESTERS

    • 1ST TRIMESTER: rapid organogenesis; high teratogen vulnerability

    • 2ND TRIMESTER: most comfortable period; fetus grows and matures

    • 3RD TRIMESTER: rapid fetal growth; fat deposition; iron and calcium demand

  • ESTIMATED DATE OF BIRTH (EDB)

    • Healthcare responsibility to determine EDB

    • Naegele’s Rule (LMP-based):

    • EDB = ext{LMP} - 3 ext{ months} + 7 ext{ days} + 1 ext{ year}

    • Month-specific adjustments (Miss Batayola’s discussion):

    • If LMP in January–March: ext{EDB} = ext{LMP} + 9 ext{ months} + 7 ext{ days}

    • If LMP in April–December: ext{EDB} = ext{LMP} - 3 ext{ months} + 7 ext{ days} + 1 ext{ year}

  • FETAL GROWTH ASSESSMENT HISTORY TAKING

    • Nutritional intake and maternal lifestyle impact fetal growth

    • Assess personal habits: smoking, drugs, alcohol; exercise

    • Ask about accidents or intimate partner abuse to assess trauma risk

  • FUNDUS AND FUNDAL HEIGHT ASSESSMENTS

    • FUNDUS: palpate from xiphoid process downward to locate uterus contraction site during labor

    • TWO METHODS TO ESTIMATE AGE OF GESTATION (AOG) FROM FUNDAL HEIGHT

    • BARTHOLOMEW’S RULE OF FOURS: fundal height landmarks at 12, 16, 20 weeks, and full term

    • MCDONALD’S RULE: fundal height in cm roughly equals weeks of gestation between 20–31 weeks; limitations in later gestation due to fetal weight gain

    • JOHNSON’S RULE (FH cm): n × 155 = FW (grams) where n depends on engagement status

    • NOTE: Ensure the patient voids prior to measurement; keep hands warm; avoid causing contractions

  • ASSESSMENT OF FETAL WELL-BEING (Pages 28-30) 1) FETAL HEART RATE (FHR)

    • Normal range: roughly 110–160 bpm after 28 weeks; measured via Doppler, fetoscope or stethoscope
      2) FETAL MOVEMENT (QUICKENING)

    • 10 kicks per hour (roughly 2 per 10 minutes) is typical

    • SADOVSKY METHOD: lie on left side after meals; count movements for 1 hour; normal ~10–12 movements per hour; fewer than 10 requires rebroadcast monitoring; instruct to call clinician if movements are consistently fewer than normal
      3) RHYTHM STRIP TESTING (FHR variability)

    • Baseline FHR: average rate per minute; variability reflects autonomic regulation and oxygenation

    • Categories: Absent, Minimal, Moderate (6–25 BPM), Marked (>25 BPM)

    • Accelerations: increases in FHR with fetal movement

    • Decelerations: decreases associated with stress or contractions

    • Positioning to left lateral side reduces vena cava compression; avoid complete supine position
      4) CARDIFF COUNT-TO-TEN MOVEMENT METHOD

    • Record time to reach 10 fetal movements; typical window ~60 minutes; variability due to sleep/wake cycles; reassure; trigger after meals or other activity to stimulate movement
      5) NONSTRESS TESTING (NST)

    • Measures FHR response to fetal movements with maternal pressing call button

    • Reactive NST: two accelerations of at least 15 bpm lasting ≥15 seconds within 20 minutes (per standard pacing); non-reactive NST may indicate insufficient oxygen or sleep; duration typically 10–20 minutes; home monitoring possible

    • Interpretations: Reactive vs Non-Reactive; additional movements or low variability considered
      6) CONTRACTION STRESS TESTING (CST / OCT)

    • Uses oxytocin to induce contractions or nipple stimulation to release endogenous oxytocin

    • Negative (normal): no decelerations with 3 contractions

    • Positive (abnormal): decelerations with contractions

    • CardioTopograph can monitor FHR and contractions simultaneously
      7) VIBROACOUSTIC STIMULATION

    • Applies ~80 dB at 80 Hz to wake baby for monitoring during stress or NST
      8) ULTRASONOGRAPHY

    • Used early to confirm pregnancy and monitor placenta, amniotic fluid, fetal growth, structural anomalies

    • Assess fetal sex, presentation, maturity via biparietal diameter, etc.

    • Pre-procedure guidance: reassure patient; full bladder may help reflect better ultrasound signals; position with slight left tilt to prevent vena cava compression; warm gel

    • Doppler velocimetry provides blood flow data
      9) BIOPHYSICAL PROFILE (BPP)

    • Combines NST with ultrasound to assess fetal well-being across five components: fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume, and FHRNST reactivity

    • Scoring: normal 8–10, suspicious 6, or 4 or less indicates risk; each criterion scores 0 or 2

    • Amniotic fluid index (AFI) and oligohydramnios/polyhydramnios evaluation included
      10) MODIFIED BIOPHYSICAL PROFILE (MBPP)

    • MBPP triggers BPP if abnormal findings are observed; includes AFI and NST
      11) PLACENTAL GRADING

    • Placenta grading via ultrasound: Grade 0 to Grade 3 corresponding to gestational age and maturity
      12) MATERNAL SERUM SCREENING

    • Maternal serum AFP (alpha-fetoprotein) screening for neural tube defects; elevated AFP suggests open neural tube defects or abdominal wall defects; low AFP may indicate chromosomal anomalies

    • Additional markers may include acetylcholinesterase, bilirubin, etc.
      13) AMNIOCENTESIS

    • Invasive procedure with ultrasound guidance to aspirate amniotic fluid for genetic testing and fetal well-being assessment; performed 18 weeks onward; risks include trauma, infection, preterm labor; mother instructed to void; positioning in left lateral tilt; sample analysis includes AFP, acetylcholinesterase, bilirubin, genetic analysis, and L/S ratio, among others
      14) PERCUTANEOUS UMBILICAL BLOOD SAMPLING (Cordocentesis)

    • Performed in 2nd–3rd trimester via ultrasound guidance to sample fetal blood for testing
      15) FETOSCOPY

    • Visual inspection of fetus via fetoscope, typically 16–17 weeks onward; used to assess fetal well-being

TERATOGENS, PATERNAL EXPOSURE & FDA PREGNANCY CATEGORIES (Pages 31-32)

  • TERATOGENS

    • Teratogen: any factor (chemical or physical) that adversely affects the fertilized ovum, embryo, or fetus; common manifestations include restricted growth or fetal death, malformations, or carcinogenesis

  • PATERNAL EXPOSURE

    • Substances affecting sperm quality, size, shape, or function may increase fetal risk

  • COMMON TERATOGENS

    • Smoking, recreational drugs, prescription drugs, alcohol, caffeine, radiation, environmental chemicals, occupational hazards, infectious agents (TORCH: Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

  • FDA PREGNANCY CATEGORIES

    • A: Controlled studies show no risk in first trimester

    • B: Animal studies show no risk or insufficient human data

    • C: Animal studies show risk; benefits may outweigh risks

    • D: Evidence of risk to human fetus; benefits may outweigh risks in serious conditions

    • X: Risks outweigh benefits; should be avoided

PRENATAL ASSESSMENT & OBSTETRIC SCORING (Pages 31-32)

  • PRENATAL ASSESSMENT

    • History: collect obstetric history; assess gravidity, parity, prior outcomes

    • Consider risk factors such as maternal health, nutrition, lifestyle, injuries, abuse

  • OBSTETRICAL HISTORY CLASSIFICATIONS (GP & GTPAL)

    • GRAVIDITY (G): total number of pregnancies (including current) regardless of outcome; multiple gestations counted as one

    • PARITY (P): number of births after 20 weeks gestation (alive or stillborn)

    • TERM: births at 37–42 weeks

    • PRETERM: births 20–36 weeks

    • ABORTION/ABORTUS: pregnancy losses before 20 weeks

    • LIVING: number of living children (including multiples counted individually)

  • 2-POINT-SYSTEM (GP)

    • Example: G3 P0 indicates currently pregnant with three prior pregnancies, no prior births beyond viability

    • G3 P1 indicates pregnant with three pregnancies and one prior birth

    • G1 P0 indicates one prior pregnancy with current pregnancy and no births above viability

  • 4-POINT SYSTEM (GTPAL)

    • Gravidity, Term, Parity, Abortion, Living

    • Twins/triplets counted as one pregnancy

  • ADDITIONAL NOTES

    • The transcript emphasizes detailed clinical techniques, exact measurements, and procedural steps for fetal assessment and obstetric scoring. It also highlights common obstetric complications (e.g., placenta previa, placental abruption risk factors) and the importance of patient education and safety (e.g., left lateral tilt during procedures, empty bladder guidelines).

Formulas and Key Numbers (LaTeX-ready):

  • Fetal dose/measurements and hormones

    • N=400{,}000\ \text{IU}/24\ \text{h} (HCG production/amount)

    • EDB = ext{LMP} - 3\ \text{months} + 7\ \text{days} + 1\ \text{year} (Naegele's Rule)

    • If LMP in Jan–Mar: EDB = ext{LMP} + 9\ \text{months} + 7\ \text{days}

    • ext{L/S ratio} = 2:1 (lung maturity marker)

    • Amniotic fluid volumes: <500\ \text{mL} (oligohydramnios); >2000\ \text{mL} (polyhydramnios)

    • Fetal movement targets: roughly 10\ \text{kicks/hour} (Sadovsky method)

    • NST: accelerations of at least +15\ \text{bpm} for +15\ \text{sec}

    • Birth weight estimates: FW = n \times 155\text{ g} where n depends on engagement status

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