Conception And Development And Pregnancy

Front 1

Where does fertilization normally occur?

Back 1

Ampulla (outer 3rd of the fallopian tube)

Front 2

When does implantation normally occur?

Back 2

between 7-10 days after fertilization

Front 3

What two distinct embryonic membranes develop after implantation?

Back 3

Chorion and Amnion

Front 4

What is the normal amount of amniotic fluid at 20 weeks?

Back 4

350 ml

Front 5

What is the normal amount of amniotic fluid after 20 weeks?

Back 5

700-1000 ml

Front 6

What are functions of the amniotic fluid?

Back 6

Cushions to protect against mechanical injury, controls temperture, permits symmetrical growth of the fetus, and allows the fetus freedom to move

Front 7

What are functions of the placenta?

Back 7

Fetal respiration, nutrition, and excretion of wastes

Front 8

Describe the appearance of the placenta.

Back 8

Maternal side is red and fleshlike. Fetal side is grey and shiny

Front 9

Whati s the difference between the embryonic and fetal stages of development?

Back 9

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.

Front 10

What is the chorion?

Back 10

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.

Front 11

What is amnion?

Back 11

The second membrane to originate during the early stages of embryonic development. It is a thin protective layer that contains amniotic fluid.

Front 12

Fetal development at 4 weeks

Back 12

heart begins to beat

Front 13

Fetal development at 8 weeks

Back 13

organs are formed, clearly resembles a human, long bones are beginning to form and this marks the end of the embryonic period

Front 14

When can the fetal heart rate be ascertained?

Back 14

between 8-12 weeks

Front 15

Fetal development at 12 weeks

Back 15

face is well formed, reflexive movement of the lips, tooth buds appear, fetus can curl the fingers to make a fist

Front 16

Fetal development at 16 weeks

Back 16

sex can be visualized and the fetus looks like a baby

Front 17

Fetal development at 20 weeks

Back 17

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.

Front 18

Fetal development 24 weeks

Back 18

reflex hand grip and a startle reflex. The body is covered with vernix caseosa.

Front 19

Fetal development at 28 weeks

Back 19

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)

Front 20

How many ml in 24 hours does the fetus swallow and excrete?

Back 20

400 ml/24hrs

Front 21

Differentiate signs of pregnancy

Back 21

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.

Front 22

List some subjective (presumptive) signs of pregnancy.

Back 22

Amenorrhea, N&V, urinary frequency, breast tenderness, and quickening

Front 23

List some objective (probable) signs of pregnancy.

Back 23

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.

Front 24

What are changes seen in the pelvic organs of a pregnant person?

Back 24

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.

Front 25

Human Chorionic Conadotropin (hCG)

Back 25

stiumulates progesterone and estrogen production to maintain pregnancy until the placenta is developed. Hormone detected by home pregnancy tests.

Front 26

Human Placental Lactogen (hPL)

Back 26

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.

Front 27

Estrogen

Back 27

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.

Front 28

Progesterone

Back 28

Plays the greatest role in maintaining pregnancy. It inhibits uterine contractability preventing spontaneous abotrion.

Front 29

Relaxin

Back 29

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.

Front 30

Prostaglandins

Back 30

the exact functions of PGs during pregnancy are still unknown. Decreased prostaglandin levels may contribute to hypertension and preeclampsia.

Front 31

Gestation

Back 31

the number of weeks since the first day of hte last menstrual period.

Front 32

Abortion

Back 32

birth that occurs before the end of 20 weeks' gestation

Front 33

Term

Back 33

the normal duration of pregnancy (38-42 weeks)

Front 34

Antepartum

Back 34

time between conception and the onset of labor; often used to describe the period during which a woman is pregnant

Front 35

Intrapartum

Back 35

time from the onset of true labor until the birth of the infant and placenta

Front 36

Postpartum

Back 36

time from birth until the woman's body returns to an essentially prepregnant condition

Front 37

Preterm or premature labor

Back 37

labor that occurs after 20 weeks but before the completion of 37 weeks

Front 38

Postterm labor

Back 38

labor that occurs after 42 weeks gestation

Front 39

Gravida

Back 39

any pregnancy, regardless of duration, including present pregnancy

Front 40

Nulligravida

Back 40

a woman who had never been pregnant before

Front 41

Primigravida

Back 41

a woman who is pregnant for the first time

Front 42

Multigravida

Back 42

a woman who is in her second or subsequent pregnancy

Front 43

Para

Back 43

birth after 20 weeks gestation regardless of whether the infant is born alive or dead

Front 44

Nullipara

Back 44

a woman who has no births ant more than 20 weeks gestation

Front 45

Primipara

Back 45

a woman who has had one birth at more than 20 weeks gestation, regardless of whether the infant was born alive or dead

Front 46

Multipara

Back 46

a woman who has had two or more births at more than 20 weeks gestation

Front 47

Stillbirth

Back 47

an infant born dead after 20 weeks gestation

Front 48

What is the GTPAL system?

Back 48

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.

Front 49

On prenatal assessment, what are normal VS ranges of the mother?

Back 49

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

Front 50

Normal Hemoglobin ranges

Back 50

12-16 g/dl

<12 g/dl requires nutritional counseling; <11 g/dl requires iron supplementation

Front 51

Normal Hematocrit ranges

Back 51

38%-47%

Front 52

Normal RBC ranges

Back 52

4.2-5.4 million/ul

Front 53

Normal WBC ranges

Back 53

5,000-12,000/ul

Front 54

Normal ranges for USG

Back 54

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.

Front 55

Normal ranges for Rubella titer (HAI)

Back 55

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

Front 56

What is the most common method of determining the EDB? Explain how to apply it.

Back 56

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

Front 57

What is McDonald's method?

Back 57

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.

Front 58

What may indicate intrauterine growth restriction (IUGR)?

Back 58

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.

Front 59

Methods used to assess fetal development.

Back 59

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.

Front 60

What is Biparietal diameter?

Back 60

measurements of the fetal head can be made by approximately 12-13 weeks are are most accurate between 20-30 weeks.

Front 61

How often should subsequant antepartal visits be made?

Back 61

Every 4 weeks for the first 28 weeks

Every 2 weeks until 36 weeks

Every week after 36 weeks until childbirth

Front 62

What are danger signs in pregnancy and the possible causes of these signs?

Back 62

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

Front 63

What is the normal wt gain pattern?

Back 63

First trimester= 3.5-5 lbs
Second trimester= 12-15 lbs
Third trimester= 12-15 lbs

Front 64

What are some discomforts of the first trimester?

Back 64

N&V, Urinary frequency, Fatiuge, Breast Tenderness, Increased vaginal discharge, Nasal stuffiness and Epistaxis, and Ptyalism

Front 65

Factors influencing N & V and self care measures

Back 65

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.

Front 66

Factors influencing urinary frequency and self care measures

Back 66

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.

Front 67

Factors influencing fatigue and self care measures

Back 67

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.

Front 68

Factors influencing breast tenderness and self care measures

Back 68

Increased levels of estrogen and progesterone.

Wear well fitting, suppotive bra

Front 69

Factors influencing increased vaginal d/c and self care measures

Back 69

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.

Front 70

Factors influencing nasal stuffiness and epistaxis (nosebleed) and self care measures

Back 70

elevated estrogen levels

May be unresponsive, but cool-air vaporizor may help, avoid use of nasal sprays

Front 71

Factors influencing ptyalism (excessive, often bitter salvation) and self care measures

Back 71

specific causitve factors unknown.

Use astringent mouthwashes, chew gum, or suck hard candy.

Front 72

What are discomforts associated with the second and third trimesters?

Back 72

Heartburn (pyrosis), ankle edema, varicose veins, hemorrhoids, constipation, backache, leg cramps,faintness, dyspnea, flatulence, carpel tunnel syndrone.

Front 73

Factors influencing hearburn (pyrosis)and self care measures

Back 73

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

Front 74

Factors influencing ankle edema and self care measures

Back 74

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.

Front 75

Factors influencing varicose veins and self care measures

Back 75

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

Front 76

Factors influencing hemorrhoids and self care measures

Back 76

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

Front 77

Factors influencing constipation and self care measures

Back 77

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

Front 78

Factors influencing backache and self care measures

Back 78

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.

Front 79

On prenatal assessment, what are normal VS ranges of the mother?

Back 79

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

Front 80

Normal Hemoglobin ranges

Back 80

12-16 g/dl

<12 g/dl requires nutritional counseling; <11 g/dl requires iron supplementation

Front 81

Normal Hematocrit ranges

Back 81

38%-47%

Front 82

Normal RBC ranges

Back 82

4.2-5.4 million/ul

Front 83

Normal WBC ranges

Back 83

5,000-12,000/ul

Front 84

Normal ranges for USG

Back 84

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.

Front 85

Normal ranges for Rubella titer (HAI)

Back 85

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

Front 86

What is the most common method of determining the EDB? Explain how to apply it.

Back 86

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

Front 87

What is McDonald's method?

Back 87

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.

Front 88

What may indicate intrauterine growth restriction (IUGR)?

Back 88

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.

Front 89

Methods used to assess fetal development.

Back 89

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.

Front 90

What is Biparietal diameter?

Back 90

measurements of the fetal head can be made by approximately 12-13 weeks are are most accurate between 20-30 weeks.

Front 91

How often should subsequant antepartal visits be made?

Back 91

Every 4 weeks for the first 28 weeks

Every 2 weeks until 36 weeks

Every week after 36 weeks until childbirth

Front 92

What are danger signs in pregnancy and the possible causes of these signs?

Back 92

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

Front 93

What is the normal wt gain pattern?

Back 93

First trimester= 3.5-5 lbs
Second trimester= 12-15 lbs
Third trimester= 12-15 lbs

Front 94

Factors influencing leg cramps and self care measures

Back 94

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.

Front 95

Factors influencing faintness and self care measures

Back 95

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.

Front 96

Factors influencing dyspnea and self care measures

Back 96

decreased vital capacity from pressure of enlarging uterus on the diaphragm.

Use proper posture when sitting or standing, sleep propped up with pillows.

Front 97

Factors influencing flatulence and self care measures

Back 97

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

Front 98

Factors influencing capral tunnel syndrome and self care measures

Back 98

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

Front 99

What are the different classes of medication ?

Back 99

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)

Front 100

What effects do sulfonamides have if taken in the last few weeks of pregnancy?

Back 100

Sulfonamides are known to compete with bilirubin attachment of protein-binding sites, increasing the risk of jaundice in the newborn.

Front 101

What is the Quad marker screen?

Back 101

blood test performed ar 15-20 weeks gestation. Evaluates four factors- maternal-serum alpha-fetoprotein (MSAFP), unconjugated estriol (UE), hCG, and inhibin -A

Front 102

What does an elevated MSAFP suggest?

Back 102

neural tube defect, underestimated gestational age, multiple gestation.

Front 103

What does a lower than normal MSAFP suggest?

Back 103

Down syndrome, trisomy 18

Front 104

What does a lower than normal UE suggest?

Back 104

Downs

Front 105

What does a higher than normal hCG and inhibin -A suggest?

Back 105

Downs

Front 106

What is a triple screen?

Back 106

Same as a Quad but does not test inhibin-A

Front 107

When is an indirect Coombs test done?

Back 107

28 weeks gestation on an Rh negitive woman. If she is not sensitized, she is given RhoGAM.

Front 108

Glucose Tolerance Test

Back 108

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.

Front 109

3 hour GTT

Back 109

high carb diet for 3 days, then NPO p MN, then 100 g oral glucose with blood draws at 1, 2, and 3 hours.

Front 110

Screening for Group B streptococcus (GBS)

Back 110

rectal and vaginal swabs obtained at 35-37 weeks.

Front 111

How is maternal wt gain distributed?

Back 111

11 lbs- fetus, placenta, amniotic fluid
2 lbs- uterus
4 lbs- increased blood volume
3 lbs-breast tissue
5-10 lbs- maternal stores

Front 112

What is the idea pattern for a normal-wt gain?

Back 112

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.

Front 113

What is the recommended increase of calories during pregnancy?

Back 113

No increase during the first trimester but an increase of 300 kcal/day during the second and third trimesters

Front 114

What is the purpose of carbohydrates during pregnancy?

Back 114

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.

Front 115

What foods are rich in carbohydrates?

Back 115

Dairy products, fruits, veges, and whole-grain cereals and breads all contain carbs

Front 116

Why is protein needed?

Back 116

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

Front 117

What is the protein requirement for the pregnant women?

Back 117

60 g/ day, and increase of 14 g over nonpregnant levels.

Front 118

Food containing protein.

Back 118

Animal produces, such as meat, fish, poultry, and eggs are sources of high quality protein.

Front 119

How many calories should a breast feeding mother increase her diet by?

Back 119

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.

Front 120

What is the protein requirement for breast feeding mothers?

Back 120

An intake of 65 g/day during the first 6 months of breastfeeding and 62 g/day during the second six months is reccommended.

Front 121

What is the calcium requirements of a breast feeding mother?

Back 121

requirements during lactation remain the sam as during pregnancy-- an increase of 1000 mg/day.

Front 122

What is the reccommended daily intake of folic acid?

Back 122

all women of childbearing age should take 0.4 mg supplement of folic acid daily.

Front 123

What are the effects on the fetus of alcohol use during pregnancy?

Back 123

Mental retardation, microcephaly, midfacial hypoplasia, cardiac anomalies, intrauterine growth retardation (IUGR), potential teratogenic effects, fetal alcohol syndrome(FAS), fetal alcohol effects (FAE).

Front 124

What are the effects of concaine use during pregnancy on the fetus?

Back 124

Ceberal infarctions, microcephaly, learning disabilities, poor state organization, decreased interactive behavior, CNS anomalies, cardiac anomalies, genitourinary anomalies, SIDS.

Front 125

What are the effects of Heroin use during pregnancy on the fetus?

Back 125

withdrawal symptoms, convulsions, IUGR, tremors, irritability, sneezing, vomiting, fever, diarrhea, and abnormal respiratory function.

Front 126

Maternal effects of alcohol

Back 126

malnutrition, bone marrow suppression, increased incidcence of infections, and liver disease.

Front 127

Maternal effects of Cocaine

Back 127

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.

Front 128

Maternal effects of Heroin

Back 128

poor nutrition, iron deficiency anemia, and preeclampsia.

Front 129

Overview of Diabetes mellitus (DM)

Back 129

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.

Front 130

Effects of normal pregnancy on carbohydrate metabolism

Back 130

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.

Front 131

What are 4 cardinal signs and symptoms of diabetes mellitus?

Back 131

polyuria, polydipsia, polyphagia, and weight loss.

Front 132

What causes polyuria in DM?

Back 132

frequent urination results because water is not reabsorbed by the renal tubules due to the osmotic activity of glucose.

Front 133

What causes polydipsia in DM?

Back 133

Excessive thirst is a result of dehydration from polyuria.

Front 134

What causes polyphagia in DM?

Back 134

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.

Front 135

What causes weight loss in DM?

Back 135

The use of fat and muscle tissue for energy.

Front 136

What is gestational diabetes mellitus (GDM)?

Back 136

any degree of glucsoe intolerance that has its onset or is first diagnosed during pregnancy.

Front 137

Who is at the most risk to have GDM?

Back 137

women who are markedly obese, have a prior history of GDM, have glycosuria, increased maternal age, or have a strong family hx of diabetes.

Front 138

Maternal risks related to DM

Back 138

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

Front 139

What are the recommend glucose ranges?

Back 139

70-120 mg/dL

Front 140

What can N and V during the first trimester cause for a DM pt?

Back 140

hypoglycemia as a result of decreased food

Front 141

Fetal-neonatal risk of DM

Back 141

*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.

Front 142

What is sacral agenesis?

Back 142

appears almost exclusively in infants of diabetic mothers.

The sacrum and lumbar spine fail to develop and the lower extremities develop incompletely.

Front 143

When is GDM diagnosed?

Back 143

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

Front 144

What are some ways to manage DM antepartal?

Back 144

*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.

Front 145

Symptoms of hypoglycemia

Back 145

sweating, periodic tingling, disorientation, shakiness, pallor, clammy skin, irritability, hunger, headache, and blurred vision.

Front 146

What is recommended if a womans glucose is less than 65 mg/dL

Back 146

Take 20 g of carbs, wait 20 minutes, and rest.

Front 147

What can be ingested to ensure intake of 20 g of carbs?

Back 147

1 cup of skim milk, 1/2 cup OJ or apple juice, 1/2 cup soda, 1 tablespoon of honey or brown sugar.

Front 148

Symptoms of hyperglycemia

Back 148

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.

Front 149

Fetal-Neonatal risk for HIV/AIDS.

Back 149

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.

Front 150

Medication therapy for HIV/AIDS during pregnancy.

Back 150

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.

Front 151

If diagnosed with HIV/AIDS after conception, when will the medical regimen begin?

Back 151

Because the fetus is most susceptible to teratogenic effects during the first trimester, ARV therapy may be delayed until after 12 weeks gestation.

Front 152

What can be done to reduce the risk of perinatal transmission of HIV/AIDS?

Back 152

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.

Front 153

What type of screening is done on an HIV positve pregnant woman in addition to routine screenings?

Back 153

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.

Front 154

When the CD4+ reaches a level of 200/mm3 or lower, what is more likely to develop?

Back 154

oppoutunistic infections

Front 155

When is a C-section reccommended for HIV-infected women?

Back 155

When viral load as measured by HIV RNA is greater than 1000 copies/ml.

Front 156

What is key to watch for in asymptomatic HIV postive pregnant woman?

Back 156

Wt loss, thrush, pneumonia, and enlarged lymph nodes

Front 157

What is the typical fetal active period?

Back 157

last 40 minutes and peaks between 9:00 am and 1:00 pm in response to maternal hypoglycemia.

Front 158

Advantages of Ultrasound (US)

Back 158

it is noninvasive, painless, and nonradiating to both the woman and the fetus, and it has no known harmful effects to either.

Front 159

What is US used for?

Back 159

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.

Front 160

Types of ultrasound

Back 160

Transabdominal and Transvaginal

Front 161

What is nuchal translucency?

Back 161

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

Front 162

What is amniotic fluid index?

Back 162

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.

Front 163

What is the procedure for a NST?

Back 163

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.

Front 164

How are the results of a NST interpreted?

Back 164

*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.

Front 165

What if the desired results are not acheived in NST?

Back 165

Rescheduled when the fetus is most active or after the mother has eaten. 80% - 90% of nonreactive NST are due to fetal sleep states.

Front 166

What is a biophysical profile (BPP)?

Back 166

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.

Front 167

When is the BPP indicated?

Back 167

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

Front 168

What is a contraction stress test needed for?

Back 168

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.

Front 169

When is a CST contraindicated?

Back 169

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.

Front 170

What is the procedure for a CST?

Back 170

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.

Front 171

Interpretation of CST results

Back 171

*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.

Front 172

What test determines fetal lung development?

Back 172

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.

Front 173

What should be monitored after an amniocentesis?

Back 173

contractions or uterine activity, amniotic fluid leakage, bleeding, or pain.

Front 174

What is chorionic villus sampling (CVS)?

Back 174

involves obtaining a small sample of chorionic villi from the placenta.

Front 175

Advantages and disadvantages of CVS

Back 175

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.