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31 Cards in this Set

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Abortion
termination of pregnancy before viability of the fetus (which begins between 20 and 24 weeks) – spontaneous or elective
Gravida

Gravidity

Multigravida

Nulligravida

Primigravida
a women who is pregnant

pregnancy

a women who has had 2 or more pregnancies

A women who has never been pregnant.

A women who is pregnant for the first time.
Multipara
a woman who has completed 2 or more pregnancies to the stage of fetal viability
Parity
the # of pregnancies in which the fetus/fetuses have reached viability, not the # of fetuses born. Whether the fetus is born alive or stillborn after reaching viability does not affect the parity designation.
Preterm
Born after 20 weeks gestation, but before completion of 37wks gestation
Primipara
A women who has completed on pregnancy with a fetus/ fetuses who have reached full viability.
Term
born between the 38th week of gestation and the end of the 42nd week.
Viability
capacity to live outside the uterus (22-24 weeks gestation)
• G____ T_____PT____AB____L_____ Pregnancy history: 1988 Spontaneous AB at 10 weeks, 1990 female SVD at 41 weeks, 1992 male c-section at 36 weeks, 1994 SVD at 40 weeks – stillbirth, 1996 female SVD at 39 weeks, 1999 current pregnancy

Gravita/ Term/ Preterm/ AB/ Living
o G 6 T 3 PT 1 AB 1 L 3
• G____T____PT____AB____L____ Pregnancy history: 1986 Elective AB, 1988 Spontaneous AB, 1989 Spontaneous AB, 1991 twins at 29 weeks, 1994 male at 24 weeks – died 4 days after delivery, 1999 current pregnancy

Gravita/ Term/ Preterm/ AB/ Living
o G 6 T 0 PT 2 AB 3 L 2
Cardiovascular alterations in pregnancy
-HR
stroke volume
-Blood Volume
-CO (HR x SV)
HR - inc 15-20bpm
stroke volume - inc 25% 20-24wks; 50% by term
BV - 40-45% above normal nonpreg lvls
CO - inc 1.5L/min 1st 10wks; peaks at 30wks; 6-7L/min baseline (normal is abt 4L/min)
Presumptive Evidences of pregnancy
- cessation of menses
-N/V (begins 2-6wk after conception)
- bladder irritability (enlarging uterus presses on bladder)
- breast tenderness, nipple tingling
- fatigue (inc. hormones)
Probable signs of pregnancy
• Goodell’s sign – softening of cervix - during 2nd month
• Chadwick’s sign – cervix w/ bluish color - caused by inc vascularity
• Hegar’s sign – softening lower uterine segment, palpated - 2nd -3rd month
• + serum pregnancy test
• + urine pregnancy test
• Braxton Hicks contractions
• Ballottement
Ballottement
diagnostic technique using palpation: a floating fetus when tapped or pushed moves away and then returns to touch the examiners hand
Blood Volume changes throughout gestation
single gestation ___; multiple ___
4-6 wks___
32 wks ___
2 wks postpartum ___
single inc 1600cc; multiple inc 2000cc
4-6: inc 11%
32: inc 45-50%
2wks pp: DEC. 33%
Hemodilutional Effect in pregnancy
decreased blood viscosity due to 20% increase in RBC, 45-50% increase in plasma volume.
Cardiac output increased by 50% during pregnancy - other factors that can increase CO
-Labor: inc by 40%
- Betamimetic medication: inc by 40%
- multiple gestations: inc by 18%
-Infection: inc by 8%
- Anemia: inc by 8%
If concerned about CO the best positions to increase are.

Why not supine?
knee to chest (6.9L/min)
right side (6.8L/min)
left side (6.6L/min)

sitting (6.2L/min) up is okay

Supine (6L/min) the uterus impedes venous return to the right side of the heart and dec. CO
Distribution of CO during pregnancy
- Renal 30% increase
- Uterus 50ml/min at 10wks; 500ml/min at term
- Skin -dermal capillary dialation
Systemic Vascular Resistance (SVR) and Pulmonary Vascular Resistance (PVR) changes in pregnancy? Why? Mediated by?
SVR and PVR decrease during pregnancy to optimize CO. Related to decrease in vascular resistance, uteroplacental and pulmonary circulation. Hormone mediated by estrogen and progesterone.

BP decreases in 2nd trimester could be caused by hormone which relaxes the smooth muscles
Pulmonary Alterantions in pregnancy anatomic changes
- diaphragm displaced by 4-7cm
- thoracic breathing replaces abdominal breathing
- rib cage relaxes -> inc chest expansion
-A-P & transverse diameter inc.
Pulmonary alterations in pregnancy physiologic changes
- RR 16-20
- Tidal volume inc to 500-700
- functional residual capacity dec 25%
Arterial blood gas changes during pregnancy
pH
PO2
pCO2
HCO3
pregnancy (normal values)
pH 7.4-7.45 (7.35-7.45)
pO2 104-108 mm Hg (90-100)
pCO2 27-32 mm Hg ((35-45)
(in preg O2 levels go up and CO2 levels go down this flows by diffusion)
HCO3 18-21 mEq/L (22-26)
Maternal O2 requirements increase in response to
1)
2)
- increased BMR -> the need to add tissue to the uterus and breasts
- fetus req. O2 and a way to eliminate CO2
Pregnancy is state of COMPENSATORY RESPIRATORY ALKALOSIS. How?
Mother is breathing off more CO2 (CO2 dec, O2 inc) b/c of inc RR, HCO3 (bicarbonate) is excreted to normalize the pH.
Hematologic alterations in pregnancy
-CLOT FASTER & HANG ON TO CLOTS LONGER
- clotting factors and prothrombin increase
-inc. fibrinogen
- dec fibrinolysis (breakdown of fibrin clot) -> dec antithrombin, dec plasminogen activator
Reproductive alterations in pregnancy
-uterus, vagina, cervix, vulva
-mucous plug
-breasts
-Uterus / Vagina / Cervix / Vulva – estrogen and progesterone influence
-Mucous plug (Operculum) – endocervical / acts as barrier against bacterial invasion during pregnancy
-Breasts
Fullness, sensitivity
Darkening and enlargement of areola
Venous pattern
Montgomery’s tubercles – hypertrophy of subaceous oil glands in aerola (white bumps)
Colostrum
- Chloasma
“mask of pregnancy” blotchy, brownish hyperpigmentation of the skin over the cheeks, nose and forehead.
- Linea nigra
pigmented line extending from the fundus to the symphysis pubis.
- Striae gravidarum
stretch marks, 50 – 90% of all pregnant women
Renal Alterations During Pregnancy
larger volume of urine held in the pelvis and ureters -> stagnanted urine and increased pH of urine -> higher risk for UTIs
Bladder irritability - nocturia, urinary frequency, and uregency