Chapter 35

Front 1

amniotic sac

Back 1

the fluid filled protective sac that surrounds the fetus inside the uterus
Fluid in the sac originates from fetal secretions primarily urine the sac can contain approximately 500 to 1000 ml of fluid after 20 weeks

Front 2

bloody show

Back 2

passage of the protective blood and mucus plug from the cervix, often an early sign of labor

Front 3

choroamnionitis

Back 3

infection of the amniotic sac and its contents
Predisposes a woman to preterm labor
Risk factors include young age lower socioeconomic status
nulliparity extended duration of labor and ruptured membranes multiple vaginal examinations and pre-existing infections of genital tract

Front 4

eclampsia

Back 4

a Life threatening condition of pregnancy and the postpartum period characterized hypertension, seizures and edema
Fishers think we use the incident of listen to l a profession severe preclancia already close second me to stroke plotting are bleeding problems kidney or liver failure and death
Remember the blood pressure in pregnancy should be normal or slightly hill or the normal blood pressure of 140 /90 mm hg or an acute systolic rise more than 20 mm hg or dyastolic rise more than 10 mmhg which might be concidered normal in a non pregnant patient may indicate preeclampsia
iv magnesium sulfate by Udit in 50 to 100 ml of 5 in water is the treatment of choice for seizures cause by eclampsia
Monitor deep tendon reflexes that are lost of magnesium levels of 10 mg DL respiratory depression occurs at levels of 12mg/dl
the effects of hypermagnesemia can be reversed with calcium gluconate administered slowly iv. have ir readily available when adminestering magnesium. The ultimate treatment of eclampsia is delivery by cesarean section

Front 5

ectopic pregnancy

Back 5

pregnancy that implants outside the uterus, usually in the fallopian tube
Risk factors
Anything that may promote scaring or inflammation in the pelvis such as previous surgical adhesions PID tubal ligation and use of intrauterine device IUD to prevent pregnancy. this is because the IUD prevents pregnancy by interfering with implantation of fertilized ovum in the uterine cavity. by interfering with implantation in the uterine cavity the IUD increases the probability of implantation in the fallopian tube
Symptoms of ectopic pregnancy usually begin doing the fifth and 10 weeks of pregnancy

Front 6

Estimated date of confinement (EDC)

Back 6

The due date of the fetus
Due date assumes that conception occurred 14 days after the start of the last menstrual period the approximate date may be obtained by taking the date when the last period begin adding 7 days then counting back 3 months and adding a whole year
Example if the first date of the last menstrual. Was November 10th 2007 add 7 days and you get November 17 2007 then count back 3 months and you have august 17 add 1 year and you get the estimated due date August 17 2008

Front 7

menstruation

Back 7

cyclical shedding of endometrial lining
The menstrual cycle is divided into three phases
- proliferate face when the endometrium is stimulated by estrogen to grow thicker
- ovulation occurs at the end of the proliferat face when an ovum or egg is released from an ovarian follicle this usually occurs 14 days after the start of the previous menstrual period
After release of the egg the ovarian follicle begins to secrete progesterone marking the start of the secretory face during this time the ovary continues to secrete estrogen and the endometrium is maintained by both estrogen and progesterone.
In case of fertilization the endometrium is prepare to receive the fertilized ovum if the ovum is not fertilized menstruation ensues with this charge of the endometrial lining
- menstration last for 6 days with the blood loss of approximately 25 to 60 ml

Front 8

ovarian follicle

Back 8

the ovum and its surrounding cells.
They are formed during the proliferative phase of the menstrual cycle
These follicles typically rupture to release an ovum in the mid portion of the cycle sometimes a follicle may not rupture but rather continues to grow forming an ovarian cyst can cause pain as it grows or if it eventually ruptures

Front 9

para

Back 9

number of pregnancies carried to 20 weeks or more

Front 10

placenta abruption

Back 10

Separation of part of the placenta away from the wall of the uterus.
Usually accompanied by painful uterine contractions and vaginal bleeding that is dark in color may not be obvious because the normal increase in blood volume during pregnancy initially protects the mother from developing obvious shock if a woman has vaginal bleeding and abdominal pain in the third trimester always consider this diagnosis
Must common cause motor vehicle accidents and domestic abuse

Front 11

placenta previa

Back 11

Placement of the placenta such that it partially or completely coveres the cervix
risk factors include previous cesarean section, multi parity, increasing age and preterm births
Often associated with painless bright red bleeding

Front 12

preeclampsia

Back 12

A complication of pregnancy that includes hypertension swelling of the extremity and its most severe form seizures
Symptoms can include headaches severe swelling of hands feet and face right upper quadrant and epigastric pain nausea and vomiting and visual disturbances proteirunia usually present in patients with preeclampsia

Front 13

hyperemesis gravidarum

Back 13

Is a more severe form of morning sickness that can persist throughout pregnancy patients often with nausea vomiting weight loss Electrolyte imbalance and dehydration.
Severe cases occasionally do not respond to antiemetics and may require two feedings or IV calorie replacement

Front 14

Premature rupture of membranes (prom)

Back 14

even if baby is at term
Preterm problem occurs before 37 weeks gestation patience usually with a gush of fluid from the vagina with persistent leakage other risks to the fetus from prom include cord prolapse cesarean delivery and placental abruption prom is usually treated with antibiotics and steroids

Front 15

Diabetes

Back 15

These patients are at high risk for poor fetal outcomes including stillbirth and fetal distress more susceptible to hypertensive disease , pyelonephritis ,preterm labor ,spontaneous abortion, diabetic ketoacidosis, cerebral hemorrhage, cardiac failure and renal failure they are prone to having large babies and are at risk for shoulder dystocia at delivery

Front 16

Stages of labor

Back 16

Stage 1( dilation stage ) onset of regular uterine contractions to complete cervical dilation
Stage 2 (expulsion stage) full dilation of the cervix to the delivery of the newborn
stage 3 (placenta stage) immediately after delivery of the baby until expulsion of the placenta

Front 17

post delivery care of mother

Back 17

The average volume blood loss with a vaginal delivery is approximately 500 ml
If blood loss continues or seems excessive massage the uterus to promote uterine construction and reduce the bleeding
The mother will experience a cramping sensation this is a sign of effective massage
Also encourage the mother to breastfeed her newborn to promote uterine contraction and slow the bleeding breastfeeding stimulates the release of oxytocin a hormone that causes the uterus to contract

Front 18

Physiologic changes unique to pregnancy

Back 18

The enlarged uterus causes physiologic changes you need to pregnancy
heart rate and respiratory rate increase slightly
blood pressure decreases slightly
blood volume is significantly increase