Assignment task:
Tara is a 16-year-old high school girl who has been sexually involved with her boyfriend Ted for several months. She has kept this a secret so far, but because of her secrecy, she hasn't been able to get birth control pills or be fitted for an IUD. Ted rarely uses a condom and says he'll "pull out in time." Now, however, Tara has missed two menstrual periods and occasionally feels nauseated in the morning. She buys a home pregnancy testing kit, and the result indicates that she is indeed pregnant. When he gets the news, Ted accuses Tara of getting pregnant by someone else and breaks off their relationship. In desperation, Tara finally decides to confide in her mother.
Tara's mother, Ann, takes her to a gynecologist. A physical examination, urine hCG test, and sonogram all confirm that Tara is pregnant. From the hCG level and the crown-to-rump length of the fetus measured by sonography, the pregnancy is estimated to be 10 weeks along. The fetus and placenta look normal and healthy.
Tara and Ann decide to continue the pregnancy and to do what they can to ensure a healthy baby. Ann, a nurse and a smoker, stops smoking indoors when Tara is at home, and knowing that Tara has sometimes had a few beers at parties with older friends, she cautions her not to drink during the pregnancy for the sake of the baby. Tara has been using Accutane for her complexion, and Ann tells her she'll make an appointment for Tara to see a dermatologist about a safer acne medication. She also tells Tara to lay off the Mountain Dew, iced tea, and other caffeine-containing drinks that she likes so much.
The pregnancy progresses normally. At 20 weeks, Tara has another sonogram and everything appears normal. The heartbeat is clearly visible, and even the sex of the fetus is identifiable-Tara is going to have a baby boy.
Two months later, however, signs of problems begin to appear. Tara has trouble getting her rings off, and she notices that her fingers seem puffy. A few days later, looking in the mirror, she thinks her face is starting to look fat too. She doesn't attach very much importance to this, assuming it to be normal in pregnancy. But not long after that, she notices that her urine is oddly foamy, and she begins missing school because of headaches. When Ann asks how she's feeling, Tara mentions the foamy urine. Ann has seen this in some of her patients in the O.B. ward. Knowing that it might be a sign of preeclampsia, she takes Tara to the gynecologist immediately.
Tara's physical examination and laboratory tests show that her blood pressure is 146/92 and she has proteinuria (a +1 level of albumin in the urine). The doctor advises Tara to stay out of school for a few days, get plenty of bed rest, drink extra water, and come back every 2 days for a checkup. On her second return visit 4 days later, Tara's proteinuria is up to +3, her blood pressure is 154/112, and she has hyperreflexia (slightly exaggerated reflexes). The doctor admits Tara to the hospital immediately, where she is given I.V. saline and then, to prevent convulsions, 4 g of MgSO4 over 15 minutes followed by 2 g of MgSO4 per hour for the next 6 hours. This treatment reduces Tara's hyperreflexia and lowers her blood pressure. She is taken to surgery, and her baby is delivered by cesarian section at a gestational age of 30 weeks and a birth weight of 2.3 kg (5 lb., 2 oz). The baby is treated in the neonatal I.C.U. for respiratory distress syndrome. Tara remains in the hospital for 7 days postpartum for observation and stabilization, and the baby is released after 2 weeks. Both eventually go home healthy, but Tara is scheduled for weekly follow-up physicals and urinalysis for the next 6 weeks.
Based on this case study and other information in Chapter 29, answer the following questions.
Q1. Why does Tara's mother take her off Accutane? What problems does Accutane cause in pregnancy? Want Online Tutoring?
Q2. What do you think might have happened to Tara if the doctor had not admitted her to the hospital, but had released her and told her to come back in another week?
Q3. Aside from respiratory distress syndrome, suggest some other conditions that Tara's premature baby might exhibit that most neonates do not.
Q4. When Tara has her first sonogram, do you think a fetal heartbeat is detectable? By the time of her second sonogram, is Tara feeling any fetal movement?
Q5. Why do you think Tara's baby is not delivered vaginally?
Q6. Why do you think teratogenic drugs have more severe effects on a conceptus prior to 8 weeks of gestation than after 8 weeks?