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166 Cards in this Set
- Front
- Back
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What is Gametogenesis?
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Production of gametes- Sperm and Ovum
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What is the zona pellucida?
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The ovum after it has been fertilized, the ovum chemical composition changes so multiple sperm can no enter
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What is the fertilized ovum called?
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Zygote
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When the zygote begins mitosis, it forms a what?
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Morula- a solid ball of cells
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The outer shell of the morula and the attatched inner group of cells forms, changing the morula into a....
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Blastocyst
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The outer group of cells in the blastocyst do what?
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nourish and protect the embryo
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What are the 3 major layers of the inside of the blastocyst?
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ectoderm, mesoderm, and endoderm
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What do the inner cells of the blastocyst become?
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The inner cells develop into the fetus
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the outer wall of the blastocyst is called the....
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trophoblast
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When will the trophoblast ( outer wall of the blastocyst) attach to the endometrium ( implantation)
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7- 9 days after fertilization occurs
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When is the embryo fully implanted by?
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Day 10
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at 2-4 days after fertilization what is the embryo doing?
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entering the uterus
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referring to the embryo...When does cell differentiation occur?
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the time between implantation and the 8th week
( blood cells, kidney cells, nerve cells etc) |
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From the 8th week until birth the embryo is now termed what?
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fetus
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Where should implantation occur?
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At the fundus of the uterus
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Attached to the embryo, the ______ nourishes the embryo via blood vessels until around week 12
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Yolk Sac
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If the embryo implants lower than the fundus, this is known as
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Placenta previa
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When does placenta formation begin?
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immediately after implantation
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What are the three parts of the placenta?
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basalis, capsularis and vera
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what part of the placenta unties with chorion to form the maternal side of the placenta?
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the basalis
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The capsularis surrounds what?
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the chorionic sac
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the decidua vera is what?
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mucous membrane lining the main cavity of the pregnant uterus other than at the side of implantation
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the developing embryo secretes what hormone
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hCG- human chorionic gonadotropin
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hCG enabled the corpus luteum to continue to secrete what hormone(s)
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progesterone and estrogen
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the placenta begins to produce hormones around what week
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by the 7th production begins, and entirely by week 12
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The outer fetal membrane closest to the uterine wall is called the ....
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chorion
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finger like projections known as ______ form and invade the endometrium and become the fetal part of future placenta around 2-3 weeks after fertilization
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chorionic villi
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the space between the chorionic villi where maternal blood circulated with in the placenta is know as the
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Intervillous Space
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The amnion is
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the inner fetal membrane
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The chorion and amnion fuse to become what
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amniotic sac
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How long should the umbilical cord approximately be
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50-55 cm and 2 cm in diameter
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There are how many veins and arteries in the umbilical cord?
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two arteries, one vein
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The umbilical vein carries what type of blood
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oxygenated
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the umbilical arteries carry what type of blood
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de-oxygenated
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The umbilical cord develops at what week in gestation
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5 weeks
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What substance protects the vessels within the umbilical cord
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Wharton s Jelly
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Blood flows through the umbilical cord at what rate
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400 ml /min
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Describe placental structure
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15-20 subdivisions called cotyledons
the fetal side of the placenta is smooth and shiny covered by amnion, known as shiny Schultz the maternal side of the placenta is red and flesh like with the 15-20 subdivisions known as dirty Duncan |
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The placenta functions as a
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transport mechanism between mom and fetus
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A shorter umbilical cord can lead to
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abruption
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Pre-eclampsia is?
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pregnancy induced hypertension
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The placenta produces what hormone
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Human placental lactogen
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The placenta transfers IGG antibodies at the end of the third trimester this is known as
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passive immunity
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after delivery when examining the placenta, there is a dark area noticed, what would this mean?
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a clot or small abrubtion
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How much amniotic fluid should be present and what color should it be, should it have an odor?
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800-1200 ml of clear to yellow fluid
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What is contained in amniotic fluid
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lanugo, albumin, urea
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How often is amniotic fluid replaced and how?
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every three hours from maternal circulation
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What are some functions of amniotic fluid?
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Preserve fetal body temperature, cushions fetus, acts as an excretion collection system, facilitated fetal growth and development
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Which trimester is the fetus most susceptible to damage from external sources
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the first trimester
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Name 5 things that can cause damage to the fetus
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alcohol
some prescription drugs/recreational drugs infections radiation nutritional deficiencies |
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What week does the fetal heart start to beat
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4 weeks
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All the organs of the fetus are formed, fetus weighs less than a grape, arms and legs are tiny buds, what week would this be?
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8 weeks
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Heart sounds can be heard by Doppler, baby can kick, sex organs are formed, fingers and toes developed, eyelids are fused, what week is this
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12 weeks
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The baby's sex can be seen, uterus is the size of a grapefruit, fetus as big as an orange, fetus beginning to suck and swallow, nails on fingers and toes, actively swallowing amniotic fluid, lanugo forms, what week is this
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16 weeks
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heartbeat is heard with fetoscope, baby begins to develope regular schedule, sleeping , sucks thumb,kicking, hands can grasp, vernix caseosa forms, can assume favorite position in utero, fetal movement ( quickening felt) what week is this
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20 weeks
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fetus weighs about 1.3 lbs, increased activity, respiratory movement begins, regular sleep time what week is this
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24 weeks
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eyes can open and close, baby makes breathing movements, surfactant begins forming testes descend, can hiccup, can cry , can hear moms voice, about 2.2 lbs
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28 weeks
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brain growing, lungs still immature, skin pink covered in vernix and lanugo begins to disappear , braxton hicks are felt, approx 4 lbs .what week is this?
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32 weeks
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A baby is considered to be full term at what week?
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37
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A preemie is a baby born between what weeks of gestation
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20 -36 weeks
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a baby born less than 20 weeks and is not viable is considered a _____
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miscarriage
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A baby born after 20 weeks is considered
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A stillborn
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Breastfeeding provides the baby with what antibodies
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IGA
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Fetal circulation---________blood comes form the placenta (maternal circulation) and enters the umbilical _________, from the umbilical _________, 2/3 gets shunted by the ______ _______ away from the liver into the ______ ,______ ______ but a small amount still goes to the ______ vein, from the _______ _______ ______, 30-35 % enters the _____ _______ and passes through the _______ _______ which is a shunt in the fetal heart into the ______ ______ then to the ______ _______ which then goes into the ______ ______ to bring oxygen to the head
65-70% of the blood in the right atrium mixes with the poor blood returning from the ___ _____ __ and enters the _____ _______ into the _____ ______ to be shunted away from the ________ all o2 poor blood leaves through aorta to _______ ______ to the placenta |
oxygen rich
vein vein ductus venosus inferior vena cava hepatic inferior vena cava right atrium foramen ovale left atrium left ventricle ascending aorta right ventricle superior vena cava right ventricle ductus arteriosis lungs umbilical arteries |
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On either side of the vagina there are glands that secrete mucous during intercourse they become visible with infection what are they called?
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bartholin's glands
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Why do they catheterize right after delivery ?
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Urinary retention
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endometrium myometrium and perimetrium are layers of the what
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uterus
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The ovaries influenced by FSH ( follicle stimulating hormone) and LH
cause what to happen? |
Ovum to grow and mature monthly
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Ovaries produce what 3 hormones
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estrogen, progesterone and small amounts of testosterone
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during puberty the anterior pituitary releases FSH, LH, androgen and estrogen that leads to the development of
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secondary sex characteristics
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Breast are divided in to 4 quadrants , what quadrants are most prevalent for breast cancer
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upper outer
2nd is nipper |
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The best time for a breast exam is
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7 days after period
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Nursing mothers do not need to wash their nipples with soaps, why?
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the raised nodules around the nipple on the areola called Montgomery tubercles produce an oily substance that cleans the nipple
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During pregnancy the areola enlarges and darkens, does this return back to normal after pregnancy
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no
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The breasts have 3 types of tissue what are they
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Glandular- breast milk production, each breast has 15-20 lobes, each lobe contain alveoli that secrete milk into lactiferous ducts where it passes into lactiferous sinuses which are milk reservoirs and release through excretory ducts into the nipple
other tissues are fat and muscle |
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Colostrum contains which antibody and is known as what
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IGA.... Liquid gold
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A mother who is planning on breast feeding, something you may tell her that may help her produce milk would be
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take a warm shower, or use a warm compress
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A mother who does not want to breast feed and plans to use a bottle , something you may want to tell her to stop milk production
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wear a tight bra, and use cold compress
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The menstrual cycle has 2 phases uterine and ovulatory phase, what happens briefly during these phases
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Uterine -menses 5 days, and proliferation( thickening of endometrium)5-14 days and secretory ( progesterone makes lining rich in nutrients, )14-28 days, no fertilization menses 2-3 days later
Ovulatory phase 1) follicular- ovum grows and surrounded by follicle, mature graafian follicle moves to edge of ovary to release egg 2) Ovulation, LH surge. follicle ruptures, and ovum in release, waits to be fertilized in fallopian tube 3)Luteal if not fertilized , ovum and corpus luteum shrink, if fertilized corpus luteum stays 10-12 weeks to produce progesterone to sustain pregnancy until placenta develops |
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how much folic acid pre-pregnancy is recommended
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400 mcg
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During pregnancy how much folic acid should the mom be taking and how much should she not exceed
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1 mg, should not exceed 1 mg
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Pre-conception counseling should include...
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Assessment of medical risks and non medical risk factors
discussion of lifestyle, nutrition, meds, exercise, tobacco, alcohol , drug use, family support, unemployment, , and work related hazards, critical times for the fetus as its developing, |
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Pre-natal high risk factors
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- Low income, poor diet, multiparity greater than 3, weight less than 100 lbs, weight greater than 200 lbs, less than age 16, or older than 35, smoking, addictions,
pre-existing medical conditions, DM HTN, cardiac disease, anemia, thyroid disorder, renal disease previous stillborn, habitual abortion,cesarean delivery, Rh or blood group sensitization ( abo or rh incomp) |
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TORCH- a special group of infections that apply to pregnant women, unborn child, and new born, and children that can cause still birth and birth defects , what are these infections?
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toxoplasmosis
Hepatitis B Syphilis Varicella Rubella Rubeola cytomegalovirus herpes simplex pregnant woman may not show many symptoms but can cause damage to neurological organs during pregnancy, |
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To avoid toxoplasmosis, a pregnant woman should
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try and stay away from the cats litter box, Toxoplasmosis can also be transmitted through raw meat
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Rubella, during the 1st trimester there is a 50% rate of malformation, if mom is not immune, she should be avoiding anyone with active disease, when should she get the vaccine
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not while pregnant , at least 3 months before planning on becoming pregnant
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Can Valtrex for herpes simplex 3 be taken during pregnancy?
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Yes
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If a mother who has genital herpes has lesions present , how will they deliver the baby, vaginal or cesarean ?
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cesarean
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Cytomegalovirus is part of the herpes family and it can cause what birth defects?
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mental retardation, hydrocephaly, microcephaly, blindness, and deafness
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What are the vaccines that are safe to get during pregnancy?
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Tetanus, flu
rubella may be given after delivery |
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if mom is HIV + she will be treated with ZVD ( zidovudine) in what trimester(s)
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2nd and 3rd
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During the fist trimester what are some common discomforts?
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Nausea and Vomiting-> changes in horomonal , fatigue and carb metabolism ( ends by 2nd trimester)
Nasal Stuffiness( edema d/t estrogen) breast enlargement and tenderness ( cause by estrogen and progesterone ) very first sign of pregnancy urinary frequency increased vaginal discharge |
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Common discomforts of 2nd and 3rd trimester?
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heartburn, hemorrhoids, constipation, back ache, leg cramps, shortness of breath, ankle edema
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What is the purpose of folic acid
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protects against neural tube defects aka spina bifida
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What are good sources of folic acid
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Broccoli, collard greens, dried peas, beans, citrus, fruits, and juices
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what are some good sources of zinc
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whole grains, oats, wheat, barley, peas and beans
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What are some good sources of calcium
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milk, yogurt,cheese, tofu, sardines with bones,soy milk, OJ, legumes
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How many more calories per day should a pregnant woman be in taking
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approx 300 more calories, for a total of 2500, non pregnant around 2200
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If a client is underweight how many calories should she be taking in during pregnancy
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300 more than a pregnant woman of normal weight so approximately 2800
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What is a concern if your client who is pregnant and also a vegetarian
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that they may be anemic, and probably not consuming enough calories
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It is important to limit caffeine
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because more than 200 mg/ day doubles the risk for miscarriage
1 cup is around 100 mg and 250 ml |
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How much weight should a woman of normal weight gain during pregnancy
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25-35 lbs, but may will gain more around 50-70 lbs
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How much weight should an underweight woman gain during pregancy
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28-40 lbs
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how much weight should an overweight woman gain during pregnancy
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15-25, but they usually dont gain that much weight
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What is Pica
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eating nonfood substances or foods of low nutritional value
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How much alcohol is safe during pregnancy
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If you said anything but None, a big monster will come out of the screen and smack you :)
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Marijuana
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babies tend to be born earlier and be smaller
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Cocaine
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associated with miscarriage, abrubtion,low birth weight, premature birth, and brain damage
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Heroin
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IV- assess for hiv/aids, hepatitis
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Excersize during pregnancy
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Walking, cycling on stationary bike, yoga, swimming, no high risk excersize
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Why should pregnant women avoid the hot tub or sauna
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in early pregnancy it can interfere with normal embryonic development
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Is Tylenol safe to take during pregnancy, what pregnancy category is it in
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yes, category B
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What is a category A drug
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No risk to fetus in any trimester
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What is a Category B drug
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No adverse effects in animals , no human studies availible
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What is a category C drug
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Only prescribed after risks to fetus are considered, animal studies have shown adverse reactions, no human studies availible
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What is a category D drug
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definite fetal risk may not be given in spite of risks in life threatening situations
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What is a category X drug
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Absolute fetal abnormality, do not use anytime in pregnancy ( lithium, accutane)
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Woman over 40 have greater risks for ...
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decreased fertility
downs syndrome htn healthy women over 40 still have same chance as younger women for healthy pregnacy |
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Teens who become pregnant are more likely to
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labor, delivery and low birth weight problems
not get prenatal care in 1st trimester not gain appropriate weight |
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AFP ( alpha-fetoprotein) screening is a screening to detect abnormalities in women younger than 35... these include
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abnormalities such as open neural tube defects ,anencephaly, downs syndrome
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AFP is made by what
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the fetal liver and yolk sac
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When can women have afp test done?
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15-18 weeks
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What is the triple marker test
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measures AFP, hCG and unconjugated estriol, has higher rate of anomaly detection but high false positive 7-9% usually due to misdated pregancy
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What is the quad test?
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it replaces the triple test
better screening for Downs syndrome, trisomy 18, 21, and neural tube defects, has a decreases falso positive rate afp, hCG, unconjugated estriol, dimeric inhibin a ( dia) dia is increases with down syndrome fetuses preformed between 15-22 weeks with 15-18 weeks optimum |
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What is chorionic villi sampling?
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allows early screening at 10 wks, chromosomal and dna analysis done on fragments ans cells from chorionic villi same genetic makeup as fetus, best done at 10-12 weeks to avoid fetal harm
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Ultrasound in 1st trimester
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confirms pregnancy
locates heartbeat verify dates and gestational age, detects twins, size, r/o eptopic pregnacy, iud, and placenta previa |
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Ultrasound 2nd trimester
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confirms location of placenta, confirm gestational age, determine fetal position,monitor fetal movements, evaluate amniotic fluid,locate fetus prior and during amnio
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Placenta previa
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placenta implanted lower in uterus, but can migrate to fundal area 10-12 weeks so early ultra sound placenta previa wait
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External Fetal monitoring
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detects uterine contractions and FHR, two components cardio and toco ( for contractions), maternal movements can cause loss of fhr
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Internal fetal monitoring
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fetal scalp electrode
IUPC -intrauterine pressuer catheter is probe along fetus to measure contractions |
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Non stress test toco- and cardio
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records fhr, accels, deccels and fetal movement, one movement every 10-20 min
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Daily fetal movement count
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done at home, 10 fetal movements within 30 minutes, if not eat a snack count again, near due date can be serious if low fetal movement, see md if low fm
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Biophysical profile to evaluate fetal well being , 5 factors
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fetal muscle tone, fetal breathing movements, fetal movements, amniotic fluid volume, fetal heart rate reactivity
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Amniocentesis
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removal of amniotic fluid from abdomen between 14-16 weeks
1-2 trimester to rule out chromosomal abnormalities, 3 trimester to check fetal lung maturity, less than 37 weeks risk of miscarriage 1/200 assess for labor, definite diagnostic, rh- mothers will get rhogam, assess for contractions for 30 minutes |
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Fetal lung maturity
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lecithin and sphingomyelin , lipoproteins found in surfactant that keep aveoli open at birth
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Steroids that increase rate of fetal lung maturity
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24-34 weeks- betamethasone 12 mg x 2 q 24 hr. dexamethasone 6 mg q 6 hr x 4 im injection, accelerated production of surfactant
full term babies lungs already make surfactant |
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Surfactant
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lubricates lining of air sacs and prevents sticking of membranes
respiratory distress is a sign of low surfactant , baby will get synthetic surfactant survanta of curasurf ( better) |
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Cesarean
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more complicated than vaginal birth, one of the safest surgeries compared to other procedures, overal all cesarean rate is 40 %
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Indications for cesarean
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Active genital herpes, overgrowth of genital warts, CPD -cephalopelvic disproportion, severe htn (toxemia), failure in progress, previous c/s with vertical incision, placenta previa, abruption, umbilical cord prolapse,macrosomia ( big baby), breech, fetal distress
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antepartum, intrapartum, postpartum
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between conception and onset of labor( 1 to about 40/41 week),
onset of true labor until delivery of infant and placenta, delivery until woman's body returns to normal after 6 weeks |
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Gravida
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ANY pregnancy regardless of duration including present pregnancy
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Para
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Birth after 20 weeks
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Primigravida
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pregnant for the 1st time
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Primipara
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gave birth to one child past the age of viablility
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multigravida
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2 or more pregnancies
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multipara or multip
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2 or more deliveries after 20 weeks
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nulligravida
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never been pregant and not currently pregnant
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nullipara
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has not had delivery at more than 20 weeks
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stillborn
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fetal demise after 20 weeks
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TPAL
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term, preterm, abortion/miscarriage/living
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Scenario for TPAL- 20 weeks pregnant, 2 children at home twins alive born at 35 weeks, 1 top, 1 miscarriage less than 20 weeks, stillborn at 36 weeks
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Gravida 5, Para 2 TPAL 0322
once baby is delivered Gravida 5 Para 3 tpal 1323 |
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Maternal client profile
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1. Maternal age @ 1st prenatal visit
2.Current pregnancy ( 1, 2 ,3rd?) 3.last menstrual period? cramping, bleeding, planned? 4 OB HX gravida Para 5. gyn, age ant menarch physical exam, |
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Group Beta strep
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normal vaginal flora, can cause risk to fetus, 36 weeks do gbs culture if positive gbs, tx in labor w/ multi doses of antibiotics 1st dose must be complete 4 hours before delivery, untreated gbs, greatest cause of neonatal sepsis and meningitis, if moms not able to get full dose, baby gets cbc and sepsis workup, called gbs protocol vitals q 4 for 48 hrs
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Sick baby :(
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up or down temps
flacid decreased reflex decreased appetite |
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Braxton hicks
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periodic uterine tightening, not a sign of labor, practice contractions
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ballottement
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baby bounces of abd wall with ve
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positive pregnancy results
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+ hCG urine or blood test,ultrasound, fetal heartbeat heard by examiner, fetal movement felt by mom and examiner
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Physiological changes to mom during pregnancy
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blood volume doubles ( for hemmorhage prevention), cardiac hypertropy the heart enlages 1-2 cm, the heart rises and assumes a more transverse position in chest, varying resting pulse rates increase by 10 bpm
increase femoral venous pressure, increased fibrogen, increased clotting factors ( risk for dvt) hematocrit drops, hemoglobin drops, leukocyte production wbc increase |
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Changes to the gastrointestinal system during pregnancy
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swelling of gums due to estrogen
lateral/posterior displacement of intestines superior/lateral displacement of stomach deylayed intestinal motility hemorrhoids bcause increased pressure on rectal veins constipation d/t decreas gastric motility displacement of appendix decreased gallbladder emptying time-re-absorbtion of bilirubin into maternal circulation ( itching) gallstones dt plasma cholesterol levels |
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Changes to the endocrine system during pregnancy
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basal metabolic rate increases
slight hyperplasia of thyroid pituitary gland stops producing fsh and lh, posterior pituitary produces oxytoxin, increased horomones, insulin resistance preg horomones are antagonistic , excess glucos goes to fetus, maternal fat stores used for energy for mom |
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Respiratory changes during pregnancy
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increased vascularization during preg
lungs pushed upwards upwards displacement of diaghragm increased tidal air volume slight increase in respiratory rate |
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changes to metabolic system during pregnancy
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preg is hypermetabolic state
increased calories needed increased h20 retention, serum lipids, iron, carbs and lipoprotiens, |
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recommended weight gain during pregnancy
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25-35 lbs for average weight and frame
1st 3 lbs 2nd 12-13 lbs 3rd 12-13 lbs |
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Changes to integumentary system during pregnancy
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pigmentary changed r/t ^ melanocytes , estrogen, and progesterone,
hyperactive sebaceous glands and sweat glands darkening of nipples and areola, cervix , vagina and vulva chloasma- melasma-mask og pregnancy linea negra- vertical line on abdomen |
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Changed to genitourinary system during pregnancy
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kindeys enlarge to meet demands
dilation of ureters and renal pelvis Glucosuria bc glucose cant be reabsorbed fast enough, same with protein ( although protein more significant bc could be sign of preeclampsia) decreased baldder tone d/t progesterone and increased urin NA retention, maintains osmolarity dt increase fluids but K not retained |
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to determine due date
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1st day of LMP
count back 3 months add 7 days 1st trimester measurement , crown to rump, most reliable 2nd/3rd trimester fetal biparietal diameter , fetal head circumfrence, fetal abdominal circumference and fetal femur lenght fundal height in cm with tape measure Mcdonald method Fundus(cm) x8/7 |
