Embryology & Fetal Development

Study Group Module

Embryology and Fetal Development National Midwifery Institute, Inc. Study Group Coursework Syllabus

Description: This module explores the anatomy and physiology of early embryonic development and fetal growth and milestones. It also explores teratogens, and the impact of preterm birth. It includes recommended reading materials in print and online, and asks students to complete short answer questions for assessment, long answer questions for deeper reflection, and learning activities/projects to deepen your hands-on direct application of key concepts.

Learning Objectives: ● Identify the difference between gestational age and dating from LMP. ● Discuss the real-life considerations regarding habit, nutrition, and lifestyle that can impact a developing embryo. ● Identify the rapidly changing occurrences in cell division and development from conception to the beginning of the embryonic period. ● Identify the embryonic and fetal periods. ● Identify the major changes during the fetal development period, including major organ systems growth and development. ● Identify the role of the SRY gene. ● Identify the approximate size of the developing fetus during the passing weeks of gestation. ● Review the maturation of fetal lungs. ● Identify the fetal brain development that occurs between 35 and 40 weeks. ● Understand the timing of exposure to teratogens and the potential effects on a developing embryo and fetus. ● Identify the rate of birth defects in the US. ● Identify the role of folate, a water-soluble B vitamin, and its relationship to folic acid, in reducing congenital defects. ● Identify various teratogens and the harm they are known to cause. ● Consider how and when to present information about embryology and fetal development to your clients.

Learning Activities: ● Research and read appropriate study sources, seeking out additional study sources where needed ● Complete short answer questions in attached module document for assessment © National Midwifery Institute, Inc. Revised 2018

Study Group Module: Embryology & Fetal Development

● Complete long answer questions for deeper reflection in attached module document for assessment ● Complete learning activities listed in attached module document for assessment ○ Identify the actual sizes of various embryonic stages and demonstrate this understanding creatively. ● Submit work to Study Group Course Coordinator ● Reflect on feedback from Study Group Course Coordinator and re-submit work as needed

Study Sources (print): The following texts are recommended for completion of this module. Use them to cross reference and build a more comprehensive understanding. Using keywords from the Learning Objectives, search the index. Read those pages listed, and read the chapter in which they are found. Establish a context for the information so that you understand how other topics are related. In addition, read the chapter headings in the Table of Contents, and flip through each text to familiarize yourself with the content of chapters. As you work through Study Group modules, you will eventually read each text in its entirety. ● Human Anatomy and Physiology, Marieb ● Holistic Midwifery, Vol. I, Frye ● Varney’s Midwifery ● Myles Textbook for Midwives ● The Natural Pregnancy Book, Romm

Study Sources (online): See NMI website Embryology and Fetal Development module web resources section for current online study sources for this module.

Related Modules: ● Fertility and Conception ● Fetal/Newborn circulation ● Prenatal Genetic Screening ● Meconium ● Placenta ● Ectopic Pregnancy ● Labwork and Other Clinical Assessments ● Pregnancy Loss: Abortion, Miscarriage, and Stillbirth ● Substance Use and Abuse

Submitting Module for Assessment: Study Group modules are accepted electronically in PDF format only. We encourage you to submit modules as you complete them throughout each quarter of enrollment.

Study Group Module: Embryology & Fetal Development

Please e-mail your completed Study Group module to: Study Group Course Work Instructor [email protected]

Once your module has been e-mailed to us, you will receive an e-mail confirmation that we have received it. Study Group modules are reviewed and returned in digital format as PDF documents. Modules can take up to 1 month from submission to be reviewed and returned to you. We will return your module as an e-mail attachment. Each module includes an Evaluation Sheet at the end of the pdf. The module’s page on the student portal also includes a link to a fillable online module evaluation sheet. Please take the time to fill out the module evaluation sheet and return it to us for each module, it helps us to improve our course work.

Please follow these formatting guidelines when submitting modules: ● Your first initial and last name in title of PDF, along with name of module. Example: “ERyanFirstStage.pdf” ● Title of module on the document’s front page ● Your name on the document’s front page ● Provide the text of each question, followed by a blank line and then your thoughtful answer (without the question, you have commentary without context) ● Blank line between the answer for a question and the next question: question, blank line, answer, blank line, question, blank line, answer… ● Please leave margin space for our comments! ● Don’t use script or cursive writing style text ● Font size not smaller than 12 ● Credit sources of direct quotes

Completion Requirements and Feedback: In order to complete this module for graduation purposes from National Midwifery Institute you must review all resources, complete the attached short answer questions for assessment, long answer questions for deeper reflection, and learning activities/projects, and submit them as detailed above. Upon return to you, your coursework may have feedback or ask for additional information or exploration on certain topics. Your work will be evaluated n the following Rubric (pasted below). You must achieve a minimum score of 7.5 in order to move on to your next module, though we encourage all students to strive for a 10.

Level 1 Level 2 Level 3 Level 3 Student (0 Points) (1 Point) (1.5 points) (2 points) Exceeds Score Not Developing Meets Basic Expectations Adequate Adequacy Expectations

Study Group Module: Embryology & Fetal Development

Level 1 Level 2 Level 3 Level 3 Student (0 Points) (1 Point) (1.5 points) (2 points) Exceeds Score Not Developing Meets Basic Expectations Adequate Adequacy Expectations

Completion of -Module not -Major -All aspects of -All aspects of module module completed Elements of module elements elements present and prompts and module are present, with answered completely elements missing some minor questions unanswered or missing

Demonstrates - Lack of - Responses - Responses are - Responses are clear, Comprehensi comprehensio are unclear clear and reflect well written, and n and do not basic reflect in-depth on of module reflect basic comprehension comprehension of content and comprehension of module module content and concepts of module content and concepts. Added concepts concepts subpoints and additional reflections demonstrate a deeper knowledge and curiosity. Analysis - Key terms -Inaccurate -Accurate - Accurate definitions not defined definitions of definitions of key of key items key items items -Strong connections -Limited -Connections made between connections made between evidence, subtopics made between evidence, and clinical experience evidence, subtopics and subtopics and clinical clinical experience - experience Incorporation of original ideas and incorporates some clinical experience in responses where possible

Evidence - No research -Research not -Research is -Research is abundant evidence used present but -Research is used -Research not limited compelling and clearly -Research relevant to connected to presented is communities served questions weak or not by midwives asked in relevant to module communities served by midwives

Study Group Module: Embryology & Fetal Development

Level 1 Level 2 Level 3 Level 3 Student (0 Points) (1 Point) (1.5 points) (2 points) Exceeds Score Not Developing Meets Basic Expectations Adequate Adequacy Expectations

Engagement -Evident -Evident study -Evident that -Evident that study with Learning study sources sources were study sources sources were fully were not partially utilized were fully utilized utilized and Resources utilized independent research was undertaken -Full incorporation of original ideas, personal analysis and incorporates relevant clinical experience in all areas possible

Skills Following are excerpts from the NMI forms for assessment of midwifery skills, which include all skills identified and required by NARM. Review the following skills and consider how they each relate to the content of this module. If you are currently working with a preceptor, take this opportunity to focus on these areas. During Supervised Primary Care you will formally evaluate these skills together using the NMI forms Form 52 - Assessment of Student’s Midwifery Skills and Form 53 - Student Self-Assessment of Midwifery Skills. 1. Midwifery Counseling, Education and Communication: J. Provides education, counseling and/or referral, where appropriate for: 9. Environmental risk factors 3. Maternal Health Assessment: C. Estimates due date based upon: 4. Changes in mucus condition or ovulation history 5. Date of positive pregnancy test 6. Date of implantation bleeding/cramping/pelvic congestion 7. Changes in the cervix 8. Changes in the uterus 9. Auscultation of the fetal heart 10. Date mother reported quickening 11. Measurement of fundal height 12. Palpation of body parts 113. Calendar date of conception or unprotected intercourse K. Recognizes and responds to potential prenatal complications by 11. Identifying and referring tubal (ectopic) pregnancy

Study Group Module: Embryology & Fetal Development

Embryology and Fetal Development National Midwifery Institute, Inc. Study Group Coursework Short Answer Questions

1. What is the difference between gestational age (or conceptual age) and dating from LMP (or menstrual age)?

2. Which “age” terminology is usually applied in discussions of embryology and fetal development?

3. What methods do we use to date pregnancies? Which are most accurate? Why might dating a pregnancy matter?

4. For each of the following embryonic stages, describe what is happening in embryonic development at this time: a. Fertilization and initial cellular division b. Morula c. Blastocyst d. Trophoblast e. Embryonic disk f. Germ Layer Specialization g. Yolk Sac formation h. Allantois

5. What is the significance of a yolk sac? What does it do for an embryo?

6. What are chorionic villi? When do they form? What are they a precursor for?

7. Where is hCG produced? How is it diagnostic of pregnancy?

8. Where does amniotic fluid come from?

9. What is the SRY gene?

10. At what gestational age (from LMP) do we transition from the term “embryo” to “fetus”?

11. At what gestational age (from LMP) do the following elements of an embryo/fetus begin to form? a. Arm and leg buds b. Nuchal Fold c. Sex differentiation d. All organ systems e. Functioning fetal kidneys

Study Group Module: Embryology & Fetal Development

f. Skeletal structure

12. What supports, supplements, diet, or lifestyle recommendations do you recommend to clients in order to support healthy embryonic and fetal development?

13. What role does methylfolate play in embryonic development? a. How does (methyl)folate differ from folic acid? b. How may the difference between folic acid and folate be especially critical for clients with the MTHFR gene mutation? c. What recommended supplementation rate is appropriate for preconception? d. What recommended supplementation rate is appropriate for pregnancy? What timing in pregnancy is important?

14. What lifestyles, substances, habits, etc. do you recommend clients abstain from in order to prevent developmental complications?

15. Define: a. Fetotoxin b. Fetotxicity c. Teratogen

16. List five viral teratogens.

17. List the conditions indicated by the CHEAP TORCHES acronym. a. Which infections on the CHEAP TORCHES list are sexually transmitted? b. Which effect do all of the infections on the CHEAP TORCHES list have in common?

18. List five environmental teratogens.

19. List five consumable substances that are teratogens. You may include drugs in this list.

20. When is the embryo/fetus most sensitive and at greatest risk to damage from teratogens?

21. How long is the central nervous system susceptible to congenital anomalies?

22. What is lanugo? What function does it serve? a. When does lanugo form?

23. What is vernix? What function does it serve? a. When does vernix begin to form?

24. Once the fetal lungs are fully formed, what must they produce before the baby can effectively breathe?

Study Group Module: Embryology & Fetal Development

26. What is the rate of birth defects in the United States? a. According to the March of Dimes, what is the global impact of serious birth defects?

27 Identify the fetal skull sutures

A. B. C. D.

Embryology and Fetal Development National Midwifery Institute, Inc. Study Group Coursework Long Answer Questions for Deeper Reflection

27. What opportunities do you have in your practice to discuss embryology and fetal development?

28. What resources do you share with clients regarding embryology and fetal development?

29. The medical trend of early elective induction of labor fluctuates in medical practice, research, and public awareness. March of Dimes created a campaign to urge parents to be patient and allow babies’ brains to finish their gestational growth. Describe the difference between a baby’s brain at 35 weeks gestation and later at 40 weeks gestation.

Study Group Module: Embryology & Fetal Development

Embryology and Fetal Development National Midwifery Institute, Inc. Study Group Coursework Projects/Learning Activities

30. Using the texts as reference, measure the actual size/length of the developing embryo and fetus week-to-week in gestation. Depict these. Label for gestational age and be sure to indicate whether length is crown to rump or something else. Find examples of embryonic and fetal sizes, use anything you like to illustrate the size progression. Indicate something about each phase of development on the examples you pull together. This does not have to be a two or three dimensional piece. If your projects is a song or performance, send us a tape or appropriate presentation.