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175 Cards in this Set

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Where does fertilization normally occur?
Ampulla (outer 3rd of the fallopian tube)
When does implantation normally occur?
between 7-10 days after fertilization
What two distinct embryonic membranes develop after implantation?
Chorion and Amnion
What is the normal amount of amniotic fluid at 20 weeks?
350 ml
What is the normal amount of amniotic fluid after 20 weeks?
700-1000 ml
What are functions of the amniotic fluid?
Cushions to protect against mechanical injury, controls temperture, permits symmetrical growth of the fetus, and allows the fetus freedom to move
What are functions of the placenta?
Fetal respiration, nutrition, and excretion of wastes
Describe the appearance of the placenta.
Maternal side is red and fleshlike. Fetal side is grey and shiny
Whati s the difference between the embryonic and fetal stages of development?
Embryonic stage starts on day 15 and ends at the end of the 8th week. During this time tissues differentiate into organs and the main external features develop. The developing embryo is most susceptible to tetragens during this time b/c of the development taking place.

The fetal stage begins with the 9th week and ends with birth. Development in the refining of structure and perfecting of function.
What is the chorion?
the first and outer most membrane. This thick membrane develops fromt he trophoblast and has many finger like projections called chorionic villi on its surface.
What is amnion?
The second membrane to originate during the early stages of embryonic development. It is a thin protective layer that contains amniotic fluid.
Fetal development at 4 weeks
heart begins to beat
Fetal development at 8 weeks
organs are formed, clearly resembles a human, long bones are beginning to form and this marks the end of the embryonic period
When can the fetal heart rate be ascertained?
between 8-12 weeks
Fetal development at 12 weeks
face is well formed, reflexive movement of the lips, tooth buds appear, fetus can curl the fingers to make a fist
Fetal development at 16 weeks
sex can be visualized and the fetus looks like a baby
Fetal development at 20 weeks
Lanugo covers the body; devlops a regular schedule of sleeping, sucking, and kicking; muscles are developed and the mother feels fetal movement. FHR is audible through fetoscope.
Fetal development 24 weeks
reflex hand grip and a startle reflex. The body is covered with vernix caseosa.
Fetal development at 28 weeks
the eyelids open and close under neural control, respiratory and circulatory systems have developed and surfectant is formed (stuff in the fetus's lungs to keep aveloli open)
How many ml in 24 hours does the fetus swallow and excrete?
400 ml/24hrs
Differentiate signs of pregnancy
Subjective (Presumptive): the symptoms the woman experiences and reports that may have causes other than pregnancy.

Objective (Probable): signs perceived by the examiner that also may have causes other than pregnancy

Diagnostic (Positive): signs perceived by the examiner that can be caused only by pregancy.
List some subjective (presumptive) signs of pregnancy.
Amenorrhea, N&V, urinary frequency, breast tenderness, and quickening
List some objective (probable) signs of pregnancy.
Changes in pelvic organs, enlargement of abd, braxton hick contractions, uterine souffle, changes in the pigmentation of the skin, the fetal outline on palpation, pregnancy test.
What are changes seen in the pelvic organs of a pregnant person?
Goodell's sign- softening of the cervix

Chadwicks sign- a bluish, purple, or deep red discoloration of the mucus membranes of the cervix, vagina, and vulva

Hegar's sign- softening of the isthmus of the uterus, between the cervix and body of the uterus.

McDonald's sign- an ease in flexing the body of the uterus against the cervix.
Human Chorionic Conadotropin (hCG)
stiumulates progesterone and estrogen production to maintain pregnancy until the placenta is developed. Hormone detected by home pregnancy tests.
Human Placental Lactogen (hPL)
an antagonist of insulin; it increases the amount of circulating free fatty acids for maternal metaboic needs and decreased maternal metabolism of glucose to favor fetal growth.
Estrogen
secreted by the corpus luteum, it is primarily produced by the placenta as early as the 7th week. It stimulates uterine development to provide a suitable environment for the fetus. It aslo helps develop the ductal system of the breasts in preparation for lactation.
Progesterone
Plays the greatest role in maintaining pregnancy. It inhibits uterine contractability preventing spontaneous abotrion.
Relaxin
Inhibits uterine activity, diminishes the strength of the uterine contractions, aids in the softening of the cervix , and has the long term effect of remodeling collagen.
Prostaglandins
the exact functions of PGs during pregnancy are still unknown. Decreased prostaglandin levels may contribute to hypertension and preeclampsia.
Gestation
the number of weeks since the first day of hte last menstrual period.
Abortion
birth that occurs before the end of 20 weeks' gestation
Term
the normal duration of pregnancy (38-42 weeks)
Antepartum
time between conception and the onset of labor; often used to describe the period during which a woman is pregnant
Intrapartum
time from the onset of true labor until the birth of the infant and placenta
Postpartum
time from birth until the woman's body returns to an essentially prepregnant condition
Preterm or premature labor
labor that occurs after 20 weeks but before the completion of 37 weeks
Postterm labor
labor that occurs after 42 weeks gestation
Gravida
any pregnancy, regardless of duration, including present pregnancy
Nulligravida
a woman who had never been pregnant before
Primigravida
a woman who is pregnant for the first time
Multigravida
a woman who is in her second or subsequent pregnancy
Para
birth after 20 weeks gestation regardless of whether the infant is born alive or dead
Nullipara
a woman who has no births ant more than 20 weeks gestation
Primipara
a woman who has had one birth at more than 20 weeks gestation, regardless of whether the infant was born alive or dead
Multipara
a woman who has had two or more births at more than 20 weeks gestation
Stillbirth
an infant born dead after 20 weeks gestation
What is the GTPAL system?
G- number of times the woman has been pregnant

T- the number of TERM infants

P- the number of PRETERM infants

A- number of pregnancies that ending in abortion

L-number of currently living children.
On prenatal assessment, what are normal VS ranges of the mother?
BP= less than or equal to 135/85 mm Hg

P= 60-90 beats/minute; may increase 10 beats/min during pregnancy

Res= 16-24 breaths/min

Temp= 97-99.6
Normal Hemoglobin ranges
12-16 g/dl

<12 g/dl requires nutritional counseling; <11 g/dl requires iron supplementation
Normal Hematocrit ranges
38%-47%
Normal RBC ranges
4.2-5.4 million/ul
Normal WBC ranges
5,000-12,000/ul
Normal ranges for USG
pH 4.6-8.0

Abnormal color may indicate porphyria, hemoglobinuria, or bilirubinemia. Alkaline urine may indicate metabolic alkalemia, Proteus infection, or an old specimen.
Normal ranges for Rubella titer (HAI)
1:10 indicates a woman is immune

if HAI is <1:10 immunization will be given on postpartum or within 6 weeks after childbirth; Instruct women whose titers are >1:10 to avoid child who have rubella
What is the most common method of determining the EDB? Explain how to apply it.
Nagele's rule

To use this method, one begins with the first day of the last menstrual period, subtracts 3 months,and adds 7 days
What is McDonald's method?
a centimeter tape is used to measure the distance abdominally from the top of the symphysis pubis to the top of the uterine fundus.

Fundal ht in cm correlates will with weeks of gestation between 22 to 24 -34 weeks.
What may indicate intrauterine growth restriction (IUGR)?
a lag in progression of measurements of fundal ht from month to month and week to week. A sudden increase in fundal ht may indicate twins or hydramnios.
Methods used to assess fetal development.
Quickening, doppler devices to assess fetal heartbeat, ultrasound is used to detect a gestational sac, fetal heart activity, and fetal breathing movement. US can also be used to make crown to rump (c-r) measurements to assess fetal age.
What is Biparietal diameter?
measurements of the fetal head can be made by approximately 12-13 weeks are are most accurate between 20-30 weeks.
How often should subsequant antepartal visits be made?
Every 4 weeks for the first 28 weeks

Every 2 weeks until 36 weeks

Every week after 36 weeks until childbirth
What are danger signs in pregnancy and the possible causes of these signs?
Sudden gush of fluid- premature rupture of mebranes

Vaginal bleeding- abruptio placentae, placenta previa, lesions of cervix or vagina "Bloody show"

ABD pain- premature labor, abruptio placentae

Temp above 101 and chills- Infection

Dizziness, blurring of vision, double vision, spots before eyes- hypertension, preeclampsia

Persistent vomiting- hyperemesis gravidarum

Severe HA- hypertension, preeclampsia

Edema of hands, face, feet, legs- preeclampsia

Muscular irritability- preeclampsia, eclampsia

Epigastric pain- preeclampsia, ischemia is major abd vessel

Oliguria- renal impairment, decreased fluid intake

Dysuria- UTI

Absence of fetal movement- maternal medication, obesity, fetal death
What is the normal wt gain pattern?
First trimester= 3.5-5 lbs
Second trimester= 12-15 lbs
Third trimester= 12-15 lbs
What are some discomforts of the first trimester?
N&V, Urinary frequency, Fatiuge, Breast Tenderness, Increased vaginal discharge, Nasal stuffiness and Epistaxis, and Ptyalism
Factors influencing N & V and self care measures
Increased levels of human Chorionic gonadotropin, changes in carbohydrate metabolism, emotional factors, fatigue

Avoid odors or causative factors, Eat dry crackers or toast before arising in the morning, have small frequent meals, avoid greasy or highly seasoned foods, drink carbonated beverages.
Factors influencing urinary frequency and self care measures
Pressure of uterus on bladder in both first and third trimesters.

Void when urge is felt, increase fluid intake during the day, decrease fluid intake only in the evening to decrease nocturia.
Factors influencing fatigue and self care measures
specific causative factors are unknown, may be aggravated by nocturia due to urinary frequency

Plan time for a nap or rest period daily, go to bed earlier.
Factors influencing breast tenderness and self care measures
Increased levels of estrogen and progesterone.

Wear well fitting, suppotive bra
Factors influencing increased vaginal d/c and self care measures
hyperplasia of vaginal mucosa and increased production of mucus by the endocervical glands due to the increase in estrogen levels.

Promote cleanliness by daily bathing, avoid douching, nylon underpants, and pantyhose.
Factors influencing nasal stuffiness and epistaxis (nosebleed) and self care measures
elevated estrogen levels

May be unresponsive, but cool-air vaporizor may help, avoid use of nasal sprays
Factors influencing ptyalism (excessive, often bitter salvation) and self care measures
specific causitve factors unknown.

Use astringent mouthwashes, chew gum, or suck hard candy.
What are discomforts associated with the second and third trimesters?
Heartburn (pyrosis), ankle edema, varicose veins, hemorrhoids, constipation, backache, leg cramps,faintness, dyspnea, flatulence, carpel tunnel syndrone.
Factors influencing hearburn (pyrosis)and self care measures
Increased production of progesterone, decreasing GI motility, and increasing relaxation of cardiac cphincter, displacement of stomach by enlarging uterus, thus regurgitation of acidic gastric contents into the esophagus

Eat small frequent meals, use low sodium antacids, avoid overeating, lying down after eating, and soidum bicarbonate
Factors influencing ankle edema and self care measures
prolonged standing or sitting, increased levels of sodium due to hormonal influences, circulatory congestion of lower extermities, increased capillary permeability, varicose veins.

practice frequent dorsiflexion of feet when prolonged sitting or standing is necessary, Elevate legs when sitting or resting, avoid tight garters or restrictive bands around legs.
Factors influencing varicose veins and self care measures
venous congestion in the lower veins that increases with pregnancy, hereditary factors, increased age and wt gain.

Elevate legs frequently, wear supportive hose, avoid crossing legs at the knees or standing for long periods, and hosiery with constrictive bands
Factors influencing hemorrhoids and self care measures
constipation, increased pressure from gravid uterus.

Avoid constipation, apply ice packs, topical ointment, anesthetic agents, warm soaks, or sitz baths, gently reinsert into rectum as necessary
Factors influencing constipation and self care measures
increased levels of progesterone, which cause general bowel sluggishness, pressure of enlarging uterus on intestine, iron supplements, diet, lack of exercise, and decreased fluids.

Increase fluid intake, fiber in diet, and exercise, develop regular bowel habits, use stool softener as recommended
Factors influencing backache and self care measures
increaswed cuvature of the lumbosacral vertebrae as the uterus enlarges, increased levels of hormones, which cause softening of cartilage in body joints, fatigue, poor body mechanics.

Use proper body mechanics, practive the pelvic tilt exercise, avoid uncomfortable working hts, high-heeled shoes, lifting heavy loads, and fatigue.
On prenatal assessment, what are normal VS ranges of the mother?
BP= less than or equal to 135/85 mm Hg

P= 60-90 beats/minute; may increase 10 beats/min during pregnancy

Res= 16-24 breaths/min

Temp= 97-99.6
Normal Hemoglobin ranges
12-16 g/dl

<12 g/dl requires nutritional counseling; <11 g/dl requires iron supplementation
Normal Hematocrit ranges
38%-47%
Normal RBC ranges
4.2-5.4 million/ul
Normal WBC ranges
5,000-12,000/ul
Normal ranges for USG
pH 4.6-8.0

Abnormal color may indicate porphyria, hemoglobinuria, or bilirubinemia. Alkaline urine may indicate metabolic alkalemia, Proteus infection, or an old specimen.
Normal ranges for Rubella titer (HAI)
1:10 indicates a woman is immune

if HAI is <1:10 immunization will be given on postpartum or within 6 weeks after childbirth; Instruct women whose titers are >1:10 to avoid child who have rubella
What is the most common method of determining the EDB? Explain how to apply it.
Nagele's rule

To use this method, one begins with the first day of the last menstrual period, subtracts 3 months,and adds 7 days
What is McDonald's method?
a centimeter tape is used to measure the distance abdominally from the top of the symphysis pubis to the top of the uterine fundus.

Fundal ht in cm correlates will with weeks of gestation between 22 to 24 -34 weeks.
What may indicate intrauterine growth restriction (IUGR)?
a lag in progression of measurements of fundal ht from month to month and week to week. A sudden increase in fundal ht may indicate twins or hydramnios.
Methods used to assess fetal development.
Quickening, doppler devices to assess fetal heartbeat, ultrasound is used to detect a gestational sac, fetal heart activity, and fetal breathing movement. US can also be used to make crown to rump (c-r) measurements to assess fetal age.
What is Biparietal diameter?
measurements of the fetal head can be made by approximately 12-13 weeks are are most accurate between 20-30 weeks.
How often should subsequant antepartal visits be made?
Every 4 weeks for the first 28 weeks

Every 2 weeks until 36 weeks

Every week after 36 weeks until childbirth
What are danger signs in pregnancy and the possible causes of these signs?
Sudden gush of fluid- premature rupture of mebranes

Vaginal bleeding- abruptio placentae, placenta previa, lesions of cervix or vagina "Bloody show"

ABD pain- premature labor, abruptio placentae

Temp above 101 and chills- Infection

Dizziness, blurring of vision, double vision, spots before eyes- hypertension, preeclampsia

Persistent vomiting- hyperemesis gravidarum

Severe HA- hypertension, preeclampsia

Edema of hands, face, feet, legs- preeclampsia

Muscular irritability- preeclampsia, eclampsia

Epigastric pain- preeclampsia, ischemia is major abd vessel

Oliguria- renal impairment, decreased fluid intake

Dysuria- UTI

Absence of fetal movement- maternal medication, obesity, fetal death
What is the normal wt gain pattern?
First trimester= 3.5-5 lbs
Second trimester= 12-15 lbs
Third trimester= 12-15 lbs
Factors influencing leg cramps and self care measures
imbalance of calcium / phosphorus ratio, increased pressure of uterus on nerves, fatigue, poor circulation to LE, pointing the toes.

Practice dorsiflextion of feet to stretch affected muscles, evaluate diet, apply heat to affected muscles, arise slowly from resting position.
Factors influencing faintness and self care measures
postural hypotension, sudden change of positon causing venous pooling in dependent veins, standing for long periods in warm area, anemia.

Avoid prolonged standing in warm or stuffy environments. Evaluate H & H.
Factors influencing dyspnea and self care measures
decreased vital capacity from pressure of enlarging uterus on the diaphragm.

Use proper posture when sitting or standing, sleep propped up with pillows.
Factors influencing flatulence and self care measures
decreased GI motility leading to delayed emptying time, pressure of growing uterus on large intestine, swallowing air.

avoid gas forming foods, chew foos throughly, get regular daily exercise, maintian normal bowel habits
Factors influencing capral tunnel syndrome and self care measures
compression of median nerve in carpal tunnel of wrist, aggravated by repetitive hand movements.

Avoid aggravating hand movements, use splint as prescribed, elevate affected arm
What are the different classes of medication ?
Category A- controlled studies in women demonstrate no associated fetal risk

Category B- animal studies show no risk, but there are no contolled studies in women, or animal studies indicate a risk, but controlled human studies fail to demonstrate a risk (penicillins).

Category C- Either no adequate animal or human testings are avaliable or animal studies show teratogenic effects, but no controlled studies in women are avaliable. (Epinephrine, betablockers, and zidovudine{drug used to decrease perinatal transmission of HIV}).

Category D- evidence of human fetal risk exists, bu the benefit of the drung in certain situations are thought to outweight the risks (tetracycline, vincristine, lithium, and hydrochlorothiazide.

Category X- demonstated fetal risk clearly outweigh any possible benefits. (Accutane)
What effects do sulfonamides have if taken in the last few weeks of pregnancy?
Sulfonamides are known to compete with bilirubin attachment of protein-binding sites, increasing the risk of jaundice in the newborn.
What is the Quad marker screen?
blood test performed ar 15-20 weeks gestation. Evaluates four factors- maternal-serum alpha-fetoprotein (MSAFP), unconjugated estriol (UE), hCG, and inhibin -A
What does an elevated MSAFP suggest?
neural tube defect, underestimated gestational age, multiple gestation.
What does a lower than normal MSAFP suggest?
Down syndrome, trisomy 18
What does a lower than normal UE suggest?
Downs
What does a higher than normal hCG and inhibin -A suggest?
Downs
What is a triple screen?
Same as a Quad but does not test inhibin-A
When is an indirect Coombs test done?
28 weeks gestation on an Rh negitive woman. If she is not sensitized, she is given RhoGAM.
Glucose Tolerance Test
done 24-28 weeks gestation. 50 g oral glucose ingested with blood draw 1 hour later. Normal range is < 130. If > 130 a 3 hour GTT is done.
3 hour GTT
high carb diet for 3 days, then NPO p MN, then 100 g oral glucose with blood draws at 1, 2, and 3 hours.
Screening for Group B streptococcus (GBS)
rectal and vaginal swabs obtained at 35-37 weeks.
How is maternal wt gain distributed?
11 lbs- fetus, placenta, amniotic fluid
2 lbs- uterus
4 lbs- increased blood volume
3 lbs-breast tissue
5-10 lbs- maternal stores
What is the idea pattern for a normal-wt gain?
A gain of 3.5-5 lbs during the first trimester, followed by a gain of about 1 lb per week during the second and third trimesters. A normal wt women who is expecting twins is advised to gain about 1.5 lbs per week during the second and third trimesters of her pregnancy.
What is the recommended increase of calories during pregnancy?
No increase during the first trimester but an increase of 300 kcal/day during the second and third trimesters
What is the purpose of carbohydrates during pregnancy?
Carbs provide the body’s primary source of energy as well as the fiber necessary for proper bowel functioning. Carbohydrate intake promotes wt gain and growth of the fetus, placenta, and other maternal tissues.
What foods are rich in carbohydrates?
Dairy products, fruits, veges, and whole-grain cereals and breads all contain carbs
Why is protein needed?
The amino acids required for hyperplasia and hypertrophy of maternal tissues, such as the uterus and breasts and to meet fetal needs. Protein also contributes to the body’s overall energy metabolism
What is the protein requirement for the pregnant women?
60 g/ day, and increase of 14 g over nonpregnant levels.
Food containing protein.
Animal produces, such as meat, fish, poultry, and eggs are sources of high quality protein.
How many calories should a breast feeding mother increase her diet by?
by about 200 kcal over her pragnancy requirement, or 500 kcal over her prepregnancy requirement. This results in a total of about 2500 to 2700 kcal per day.
What is the protein requirement for breast feeding mothers?
An intake of 65 g/day during the first 6 months of breastfeeding and 62 g/day during the second six months is reccommended.
What is the calcium requirements of a breast feeding mother?
requirements during lactation remain the sam as during pregnancy-- an increase of 1000 mg/day.
What is the reccommended daily intake of folic acid?
all women of childbearing age should take 0.4 mg supplement of folic acid daily.
What are the effects on the fetus of alcohol use during pregnancy?
Mental retardation, microcephaly, midfacial hypoplasia, cardiac anomalies, intrauterine growth retardation (IUGR), potential teratogenic effects, fetal alcohol syndrome(FAS), fetal alcohol effects (FAE).
What are the effects of concaine use during pregnancy on the fetus?
Ceberal infarctions, microcephaly, learning disabilities, poor state organization, decreased interactive behavior, CNS anomalies, cardiac anomalies, genitourinary anomalies, SIDS.
What are the effects of Heroin use during pregnancy on the fetus?
withdrawal symptoms, convulsions, IUGR, tremors, irritability, sneezing, vomiting, fever, diarrhea, and abnormal respiratory function.
Maternal effects of alcohol
malnutrition, bone marrow suppression, increased incidcence of infections, and liver disease.
Maternal effects of Cocaine
vasoconstriction, tachycardia, and hypertension, seizures and hallucinations, pulmonary edema, cerebral hemorrhage, respiratory failure, and heart problems.



Will be present in urine for 4-7 days after use.
Maternal effects of Heroin
poor nutrition, iron deficiency anemia, and preeclampsia.
Overview of Diabetes mellitus (DM)
an endocrine d/o of carbohydrate metabolism, results from inadequate production or use of insulin. Insulin produced by the B-cells of the islets of Langerhans in the pancreas, lowers bolld glucose levels by enabling glucose to move fromt he blood into muscle and adipose tissue cells.
Effects of normal pregnancy on carbohydrate metabolism
Insulin needs often decrease during 1st trimester and increase during 2nd and 3rd trimesters.

The rise in serum levels of estrogen, progesterone, and other hormones stimulates increased insulin production by the maternal pancreas and increased tissue response to insulin. An anabolic (building up) state exists during the first half of pregnancy, with storage of glycogen in the liver and other tissues.

The second half of pregnancy causes an increased resistance to insulin and decreased glucose tolerance. This decrease effectivness of insulin results in a catabolic (destructive) state during fasting periods. Because increasing amounts of circulating maternal glucose and amino acids are diverted to the fetus, maternal fat is metabolized much more readily. As a result of this lipolysis, ketones may be present in the urine.
What are 4 cardinal signs and symptoms of diabetes mellitus?
polyuria, polydipsia, polyphagia, and weight loss.
What causes polyuria in DM?
frequent urination results because water is not reabsorbed by the renal tubules due to the osmotic activity of glucose.
What causes polydipsia in DM?
Excessive thirst is a result of dehydration from polyuria.
What causes polyphagia in DM?
Excessive hunger is caused by tissue loss and a state of starvation, which results from the inability of the cells to use the blood glucose.
What causes weight loss in DM?
The use of fat and muscle tissue for energy.
What is gestational diabetes mellitus (GDM)?
any degree of glucsoe intolerance that has its onset or is first diagnosed during pregnancy.
Who is at the most risk to have GDM?
women who are markedly obese, have a prior history of GDM, have glycosuria, increased maternal age, or have a strong family hx of diabetes.
Maternal risks related to DM
Hydramnios, or an increased volume of amniotic fluid is a result of excessive fetal urination because of fetal hyperglycemia.

Preeclampsia-eclampsia occurs more often in DM pregnancies due to vascular changes.

Hyperglycemia can lead to ketoacidosis. decreased gastric motility and the contrainsulin effect of hPL can predispose a women to ketoacidosis.

Yeast infections and UTI's
What are the recommend glucose ranges?
70-120 mg/dL
What can N and V during the first trimester cause for a DM pt?
hypoglycemia as a result of decreased food
Fetal-neonatal risk of DM
*Congential anomalies-most abnormalies occur in the heart, CNS, and skeletal system.

*Macrosomia- large for gestational age (LGA). If born vaginally, the macrosomic infant is at increased risk for shoulder dystocia and traumatic birth injuries.

*Hypoglycemia- after the umbilical cord is severed the maternal blood glucose supply is eliminated. However, continued islet cell hyperacivity leads to excessive insulin levels and depleted blood glucose in 2-4 hours.

*IUGR- infants of mother with advanced diabetes (vascular involvement) may be small due to decreased efficiency of placental perfusion.

*Respiratory distress syndrome- results from inhibition, by high levels of fetal insulin, of some fetal enzymes necessary for surfactant production.

*Polycythemia- excessive number of RBC is due to the diminished ability of glycosylated hemoglobin in the mother's blood to release o2.

*Hyperbiliruninemia- a resuld of the inability of immature liver enzymes to metabolize the increased bilirubin resulting from polycythemia.
What is sacral agenesis?
appears almost exclusively in infants of diabetic mothers.

The sacrum and lumbar spine fail to develop and the lower extremities develop incompletely.
When is GDM diagnosed?
After a failed 1 hour GTT and if 2 or more of the following values are equaled or exceeded in a 3 hour GTT:

Fasting 95 mg/dL
1 hour 180 mg/ dL
2 hour 155 mg/dL
3 hour 140 mg/dL
What are some ways to manage DM antepartal?
*Increase calorie intake by 300 kcal/day taken in three meals and three snacks. The bedtime snack is most important and should contain both protein and carbs.

*Self monitoring of Blood Glucose (SMBG) should be done 4-6 times a day.

*Insulin injections- oral hypoglycemics are never used in pregnancy b/c they cross the placenta, may be teratogenic, and stimulate fetal insulin production.

*Evaluation of fetus- MSAFP, US, BPP, activity, NST, CST.
Symptoms of hypoglycemia
sweating, periodic tingling, disorientation, shakiness, pallor, clammy skin, irritability, hunger, headache, and blurred vision.
What is recommended if a womans glucose is less than 65 mg/dL
Take 20 g of carbs, wait 20 minutes, and rest.
What can be ingested to ensure intake of 20 g of carbs?
1 cup of skim milk, 1/2 cup OJ or apple juice, 1/2 cup soda, 1 tablespoon of honey or brown sugar.
Symptoms of hyperglycemia
polyuria, polydipsia, dry mouth, fatigue, nausea, hot flushed skin, rapid deep breaths, ABD cramps, acetone breath, HA, drowsiness, depressed reflexes, oliguria or anuira, and stupor/coma.
Fetal-Neonatal risk for HIV/AIDS.
Following birth (first 15 months), infants often have a positive antibody titer, which reflects the transfer of maternal antibodies and does not indicate HIV infection.
Medication therapy for HIV/AIDS during pregnancy.
Combination antiretroviral (ARV) therapy supresses viral replicatoin, helps perserve immune function, and reduces the development of resistance. Zidovudine (ZDV) is the best known of the nucleoside analogs b/c it is the medication that was so effective in reducing perinatal transmission during early clinical trials, and indications are that it is relatively safe during pregnancy.
If diagnosed with HIV/AIDS after conception, when will the medical regimen begin?
Because the fetus is most susceptible to teratogenic effects during the first trimester, ARV therapy may be delayed until after 12 weeks gestation.
What can be done to reduce the risk of perinatal transmission of HIV/AIDS?
All pregnant women with HIV should be offered the three-part ZDV prophylaxis regimen after the first trimester. This regimen includes 1) oral ZDV daily, 2) IV ZDV during labor and until birth, and 3) oral ZDV for the infant starting 8-12 hours after birth and continuing for 6 weeks.
What type of screening is done on an HIV positve pregnant woman in addition to routine screenings?
The woman infected with HIV should be evaluated and treated for other sexually transmitted diseases and for conditions occuring more commonly in women with HIV, such as TB, cytomegalovirus, toxoplasmosis, and cervical dysplasia. If there is no history of Hep B , she should recevie the vaccine, as well as the pneumococcal vaccine and an annual flu shot. A platelet count and a CBC with differentials should be obtain at the first prenatal visit and repeated each trimester to edentify anemia, thrombocytopenia, leukopenia. The mouth is inspected for signs of infection such as thrush or hairy leukoplakia, the lungs are auscultated for signs of pneumonia, and the lymph nodes, liver, and spleen are palpated for signs of enlargement. Each trimester an eye exam should be done to detect complications of toxoplasmosis. She should also be checked routinely for changes indicating that HIV/AIDS is progressing. This would include the absolute CD4+ lymphocyte count. Weekly NST are started at 32 weeks.
When the CD4+ reaches a level of 200/mm3 or lower, what is more likely to develop?
oppoutunistic infections
When is a C-section reccommended for HIV-infected women?
When viral load as measured by HIV RNA is greater than 1000 copies/ml.
What is key to watch for in asymptomatic HIV postive pregnant woman?
Wt loss, thrush, pneumonia, and enlarged lymph nodes
What is the typical fetal active period?
last 40 minutes and peaks between 9:00 am and 1:00 pm in response to maternal hypoglycemia.
Advantages of Ultrasound (US)
it is noninvasive, painless, and nonradiating to both the woman and the fetus, and it has no known harmful effects to either.
What is US used for?
Soft tissue masses (such as tumors) can be differentiated, the fetus can be visualized, fetal growth can be followed, cervical length and impending cervical incompetence can be detected, and a number of other potential problems can be averted.
Types of ultrasound
Transabdominal and Transvaginal
What is nuchal translucency?
describes an area in the back of the fetal neck that is measured via US during the first trimester. Fetuses with a nuchal translucency of greater than 3 mm are at risk for certain birth defects, including trisomies 13,18, and 21
What is amniotic fluid index?
The ABD is divided into quadrants and the vertical diameter of the largest amniotic fluid pocket in each quadrant is measured. Women with and AFI of more than 20 cm are considered to have hydramnios, women with less than 5 cm at term are considered to have oligohydramnios. An AFi between 5-20 is normal.
What is the procedure for a NST?
An electronic fetal monitor is used to obtain a tracing of the FHR and fetal movement (FM). Two belts are used. One belt holds a device that detects uterine or fetal movement; the other belts holds a device that detects the FHR.
How are the results of a NST interpreted?
*Reactive test-shows at least 2 accelerations of FHR with FM of 15 beats/min, lasting 15 seconds or more, over 20 minutes. This is the desired result.

*Nonreactive test-the reactive criteria are not met.

*Unsatisfactory test- the data cannot be interpreted or there was inadequate FM.
What if the desired results are not acheived in NST?
Rescheduled when the fetus is most active or after the mother has eaten. 80% - 90% of nonreactive NST are due to fetal sleep states.
What is a biophysical profile (BPP)?
A comprehensive assesment of 5 biophysical variables: fetal breathing movement, fetal movements of body or limbs, fetal tone (extension and flexion of extremities), amniotic fluid volume, and reactive FHR with active.
When is the BPP indicated?
when there is risk of placental insufficiency or fetal compromise b/c of :
*IUGR
*Maternal DM
*Maternal heart disease
*Maternal chronic HTN
*Maternal preeclampsia or eclampsia
*Maternal sickle cell anemia
*Suspected fetal postmaturity
*Hx of previous stillbirths
*Rh sensitization
*Abnormal estriol excretion
*Hyperthyroidism
*Renal disease
*Nonreactive NST
What is a contraction stress test needed for?
evaluates the respiratory function (o2 and Co2 exchange) of the placenta. It allows the healthcare team to identify the fetus at risk for intrauterine asphysxia by observing the response of the FHR to the stress of uterine contractions.
When is a CST contraindicated?
in third trimester bleeding from placenta previa or marginal abruptio placentae, previous cesarean with classical incision , PROM, incompetent cervix, anomalies of the maternal reproductive organs, hx of preterm labor, or multiple gestation.
What is the procedure for a CST?
A fetal monitor is used to provide data. After a 15 min baseline recording of uterine activity and FHR, the tracing is evaluated for evidence of spontaneous contractions. If 3 spontaneous contractions of good quality and lasting 40-60 seconds occur in a 10 min window, the results are evaluated, and the test concluded. If no contractions occur or if insufficent contractions occur, contractions are induced.
Interpretation of CST results
*Negitive- shows 3 quality contractions without evidence of late decelerations. This is the desired result. It implies the fetus can handle the hypoxic stress of uterine ctx.

*Positve-shows persistent late decelerations with more than 50% of the contractions. The hypoxic stress of uterine ctx causes a slowing of the FHR. The pattern will not improve and will most likely get worse with additional ctx.

*Equivocal or suspicious- has nonpersistent late decelerations or decelerations associated with hyperstimulation (contraction frequency of every 2 min of duration of > 90 sec). When this test result occurs, more info is needed.
What test determines fetal lung development?
The lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol (PG). A 2:1 ratio of L/S and the presence of PG indicates the risk of RDS is very low.
What should be monitored after an amniocentesis?
contractions or uterine activity, amniotic fluid leakage, bleeding, or pain.
What is chorionic villus sampling (CVS)?
involves obtaining a small sample of chorionic villi from the placenta.
Advantages and disadvantages of CVS
Advantages include early detection of certain fetal d/o with a decreased waiting time for results. Disadvantages include an increased risk to the fetus, inability to detect neural tube defects (NTD), and the potential for repeated invasive procedures.