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76 Cards in this Set
- Front
- Back
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Nagele's Rule |
Calculate due date (first day of LMP) - 3 months +7 days + 1 year |
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GTPAL format |
Gravidity, para: Term, Preterm, Abortions, Living children |
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Full term |
38+ weeks |
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Preterm |
20-37 weeks |
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Abortion |
pregnancy ended before 20 weeks |
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Presumptive Signs of Pregnancy |
breast changes amenorrhea n/v urinary frequency fatigue quickening |
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Probable Signs of Pregnancy |
1st trimester: -goodell sign -chadwich sign -hegar sign -+preg test 2nd trimester: -braxton hicks contractions (16+ weeks) -ballottlement: 16-28 wks |
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Positive signs of pregnancy |
Diagnostic 5-6 weeks: ultrasound visualization 6wks: HR by ultrasound 10-12 wks: hr doppler 17-19wks: hr stethoscope 19-22 weeks: movement palpated |
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Chadwick's Sign |
Blue purple color of vaginal mucous 4th week increased vascularity |
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Hegar's Sign |
Softening of lower uterine segment Results in uterine antiflexion |
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Goodell's Sign |
softening of cervix in second month |
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Human Chorionic Gonadotropic (hCG) |
Hormone produced by chorionic villi; biologic marker in pregnancy tests elevated= downs low= trisomy 18 |
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Chloasma |
increased pigmentation over nose and cheeks of pregnant women "mask pregnancy" |
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linea nigra |
line of darker pigmentation n middle of abdomen from symphysis pubis to umbilicus |
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Striea Gravidarum |
stretch marks |
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Caloric intake 2nd trimester |
increases of 340 cal/day |
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caloric intake 3rd trimester |
incase of 452 cal/day |
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recommended weight gain 1st trimester |
2.2-2.4 lbs |
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2nd and 3rd trimester weight gain |
1lb/wk |
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H&H during Pregnancy |
expect a decrease --> looking for anemia Hgb >11; lower = iron deficiency anemia |
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Alpha-fetoprotein test |
fetal antigen: elevated levels in amniotic fluid and maternal blood associated with neural tube defects screening recommended for all pregnant women 15-22wk low=downs elevated= NTD |
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Ectopic Pregnancy |
implantation of fertilized ovum in a site other than the endometrial lining of the uterus lower abdominal pain, vaginal bleeding referred shoulder pain faintness, dizziness signs of hemorrhage and shock: hypotension, tachycardia, pallor if progesterone and hCG elevated= not ectopic |
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Hydatiform Mole |
Abnormal development of placenta resulting in fluid filled grape clusters Trophoblastic tissue proliferates usually pregnancy loss or choriocarcinoma vaginal bleeding, dark brown/bright red discharger, anemia, n/v, abdominal cramps, passing of vesicles, preeclampsia transvaginal ultrasound and serum hCG: diffuse snowstorm pattern |
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Threaten Abortion |
vaginal bleeding before 20 weeks + FHR closed cervix painless or possible cramping spotting |
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Inevitable abortion |
all the signs of miscarriage but hasn't finished yet moderate to heavy bleeding cervical dilation tissue passage amniotic membranes broken |
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incomplete abortion |
fetus passes, placenta still in uterus |
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missed abortion |
no symptoms no bleeding or cramping closed cervical os no fetal cardiac activity or empty sac |
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Hyperemesis Gravidarum |
severe n/v resulting in dehydration and malnutrition occurs in <2% of pregnancies dehydration, electrolyte imbalance, acidosis, weight loss, ketonuria, hepatic and renal damage |
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Quickening |
maternal perception of fetal movement that usually occurs between 16-20 weeks first time u feel the baby move |
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Fundal height measurement |
measurement from symphysis pubis to top of uterine funds 18-32 weeks gestation approximates gestational age |
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kick count |
normal: 10 kicks in 1-2 hours |
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Braxton-Hicks contraction
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mild/intermittent painless uterine contractions that occur more frequently as pregnancy advances but not representing true labor usually relieved by walking |
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Hemorrhoids |
increased pressure on intestines from growing uterus decreased intestinal motility due to progesterone and constipation |
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Vena Cava Syndrome |
Low BP from weight and pressure of uterus on vena caba--> decreases beanies blood flow to heart when supine hypotension, fetal hypoxia dizziness, pale and clammy 4th month or later position on left side, semi-fowlers, wedge under hip |
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Gestational Diabetes |
hypoglycemia: nervousness, HA, weakness, irritability, hunger, blurred vision, tingling hyperglycemia: thirst, nausa, abdominal pain, frequent urination, flushed dry skin, fruity breath, shallow respirations, rapid pulse, vomiting, excess wt gain ideal glucose: 70-110 |
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50g, 1hr glucose screening |
>130-140mg/dl glucose = at risk --> further testing |
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100g, 3hr glucose tolerance test |
fasting 2 or more= abnormal=gestational diabetes |
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Preeclampsia |
hypertensive disease usually seen in last 1-12 weeks of pregnancy, during labor, or 48 hr postpartum increase in systolic BP or 20 or diastolic of 15 per baseline twice for 6 hrs BP 140/90 protein urine +2 edema in hands and face hyperreflexia, HA, conulsions, epigastric pain, visual disturbances magnesium sulfate: CNS depressant, anticonvulsant, lowers BP antidote= calcium gluconate |
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Magnesium Sulfate for Preeclampsia
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toxicity: absent deep tendon reflexes, urine output <30mL/hr, respirations <12/min, decreased LOC, dysrhythmias |
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Eclampsia |
conclusions HA, epigastric pain, hyperrelexia, hemoconcentrations |
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Cervical insufficiency |
painless premature dilation of the cervix causing late miscarriage pelvic pressure, urge to push pink or red stained vaginal discharge possible contraction Cerclage: stitch to keep closed |
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Cerclage |
surgical management of cervical insufficiency-- use of sutures to keep a premature dilating cervix closed |
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preterm labor |
labor occurring between 20-36 weeks gestation Contractions AND cervical change persistent lower bacache pressure in pelvis uterine cramping mucous or small blood vaginal discharge effacement: cervical dilation and thinning regular uterine contractions fetal fibronectin cultures Nifedipie: inhibit contractions Mg sulfate Indomethacin: block prostaglandin production to prevent labor |
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Fetal Fibronectin Test |
protein found in vaginal secretions when fetal membrane is lost; strong predictor of birth in the next 2 weeks negative result: preterm unlikely |
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Premature Rupture of Membranes (PROM) |
spontaneous rupture of amniotic sac and leakage 1 hr or more before labor at any gestational age gush of fluid temp elevation increased HR/FHR foul smelling fluid abdominal tenderness prolapsed umbilical cord nitrazine paper test: turns blue from amniotic fluid Ferning test: dried amniotic fluid will have fern pattern |
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Placenta Previa |
placenta covering the cervix b/c improperly implanted in lower uterine segment painless bright red bleeding uterus soft fundal heigh greater than expected decreased urinary output NO VAGINAL EXAMS Kleihauer-Betke Test leopold maneuvers c-section required |
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Placental Abruption |
premature separation of placenta from uterine wall dark red vaginal bleeding sudden onset intese abdomen pain irritable or hard uterus hypertonicity contractions rigid, firm abdomen FHR decelerations shock Couvelair: blue uterus give corticosteroids and o2 |
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Non-stress Test |
evaluation of intact fetal CNS during 3rd trimester ruling out risk for fetal death in clients who have DM done before giving induction meds 28-32 weeks |
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Reactive Non-Stress Test |
FHR is normal baseline rate with moderate variability 32+ weeks: 2 FHR accelerations, 15 sec long, 15 beats higher than baseline over 20 min 28-31 weeks: 10 sec 10 beats 20 min fetal movement--> FHR acceleration--> adequate oxygenation--> normal autonomic NS fxing |
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Contraction Stress Test |
nipple stimulated oxytocin if nipple fails used in high risk pregnancies analysis of FHR response to contractions 3 contractions within 10 min period of 40-60 sec each positive test=bad: FHR went down with contraction bc lack of o2 |
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Biophysical profile |
NST and ultrasound assessment to visualize physical and physiological characteristics of fetus and observe for fetal response to stimuli reactive NST 30 sec fetal breathing 3 fetal movements fetal extension and flexion amniotic fluid pocket 8-10= low risk of chronic fetal asphyxia |
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Fetal HR Baseline |
110-160/min |
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Fetal Bradycardia |
FHR<110/min causes: late fetal asphyxia, maternal hypotension, prolonged umbilical cord compression assist to side lying, o2 |
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Fetal Tachycardia |
FHR>160/min causes: maternal fever, early fetal hype, drugs administer antipyretics and o2 |
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Moderate FHR Variability |
FHR baseline variability is fluctuations in FHR baseline that are irregular in frequency and amplitude FHR= 6-25/min |
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Decreased FHR Variability |
BAD decrease or loss of irregular fluctuations in baseline of FHR |
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Increased FHR variability |
GOOD caused by fetal movement positive indicator of fetal well being indicate reactive non-stress test |
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Early Decelerations in FHR |
slowing of hr with start of contraction with return to baseline at end of contraction indication of increased pressure on fetal head |
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Variable decelerations in FHR |
slowing less than 100beats/min, variable in duration, intensity, and timing sign of umbilical cord compression if persistent despite positioning --> indication of fetal hypoxia |
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Late Decelerations |
slowing of FHR after contraction has started with return to baseline after contraction has ended indication of fetal hypoxia due to uteroplacental insufficiency-- results in decreased blood flow that impedes oxygen transfer o uterus omnious sign: prompt attention place on left side |
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Tachysystole |
more than 5 uterine contractions in 10 min, averaged over 30 min a cause of late decelerations |
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Amnioinfusion |
for variable decelerations attempt to resolve variable decelerations by inserting sterile saline solution back into uterus to cushion cord and relieve umbilical cord compression used when amniotic fluid is low |
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Recommended Weight Gain |
11.2-15.9kg 25-35lbs |
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Prenatal Care |
identify existing risk factors and other deviations from normal first: within first trimester usually 6-8 weeks every 4 weeks: weeks 16-28 every 2 weeks: weeks 29-36 every week: 36 to birth |
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Danger Signs |
vaginal bleeding uterine contractions or pain swelling of fingers, face eyes PROM continuous pounding headache chills or fever painful urination |
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Call Dr if - preterm labor |
uterine contractions q10min or less for 1hr or more vaginal bleeding odorous vaginal discharge fluid leaking from vagina |
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Gravidity |
total number of pregnancies, including current one |
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parity |
number of pregnancies resulting in birth after age of viability (20 weeks) |
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nulligravida |
never been pregnant |
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primipara |
pregnant for first time |
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multigravida |
two or more pregnancies |
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nullipara |
woman who has not completed a pregnancy with fetus beyond 20 weeks gestation
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primipara |
completed one pregnancy with fetus who has reched 20 weeks gestation |
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abortion |
number of pregnancies ended before 20 weeks
wo |
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Preterm Birth |
20-37 weeks |
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term birth |
38-42 weeks |
