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160 Cards in this Set

  • Front
  • Back
positive pregnancy Test
measures the beta subunit of human chorionic gonadotropin (hCG) hormone in urine or serum.
hCG
hormone secreted by the trophoblast to encourage progestrone and estrogen production by the luteum to maintain the pregnancy until the placentas fully develops and takes over production
elevated hCG commonly causes
causes n&v, changes carbohydrate metabolism, triggered by hPL (human placental lactogen)
Nausea and vomiting of pregnancy (NVP)
known as “morning sickness”, but can occur at any time of day. (most common on empty stomach)
“morning sickness”,
Related to the high levels of hCG and hPL, but we are still researching other causes and contributing factors. Stress and anxiety seem to exacerbate NPV in some women, and may have a contributing factor.
NVP happens when..
Usually appears around gestational week 6 and is gone around week 12.
Fatigue in pregnancy happens when..
Common through the first trimester, and related to the high levels of progesterone secreted by the corpus luteum and then by the placenta.
fatigue improves when
Generally improves around gestational week 14
Breast tenderness
Caused by hormonally induced growth of the secretory ductal system.
Breast tenderness is common when
Common in first trimester, but may persist.
1st step in prenatal assessment
Maternal Complete health history
Key elements of Prennatal Assessment
Maternal health history (Complete health history is first step!) Laboratory assessment data (CBC, infection history), Determination of estimated due date (by preg. Wheel, Nagele’s rule), Health history of father and the maternal and paternal genetic health history, Physical assessment (e.g., pelvimetry), Use of the ACOG Antenatal Record, Demographic data for mother and father, Maternal obstetric history, Menstrual history, Past Pregnancy history, Medical history (maternal)
2 methods of ultrasound
"Transvaginal -used in 1st trimester because it is still small Transabdominal
Appropriate uses of ultrasound
detect gestational sac at 5 to 6 wks after LMP, detect fetal HR at 6 to7 wks, detect fetal breathing movement 10 to 11 wks of preg.
assessment in 1st trimester with ultrasound
Nothing can be seen before 4 weeks (before g.sac) Confirm pregnancy and viability. Determine gestational age (by crown-rump length of embryo before 12 wks) Rule out ectopic pregnancy, Detect multiple gestation, Detect maternal abnormalities
Second trimester use of ultrasound
"Confirm dates, Confirm viability (fetal heart sounds), Detect poly, Detect congential anomalies, Detect IUGR, Confirm placenta placement, Can detect the gender at this time too
Daily Fetal Movement Count
"""kick counts"" Begin in late second trimester Notify provider if no movement in 12 hours Fewer than 3 movements in one hour warrants further evaluation by non-stress testing or biophysical profile
Third trimester use of ultrasound
Confirm viability, Detect macrosomia (large birth weight), Detect congenital anomalies- that may not have shown up earlier), Detect IUGR, Determine fetal position, Detect placenta previa or abruption , Biophysical profile (BPP)= Amniotic fluid volume assessment (AFI) , Doppler flow studies, Detect placental maturity Determine gestational age (by crown-rump lentgh of embryo before 12 weeks.
California Prenatal Screening Program
Full Integrated Screening, Serum Integrated Screening, Quad Screen, Tests screen for Down syndrome (Trisomy 21), Trisomy 18 and Open Neural Tube Defect (ONTD) (e.g. spina bifida; anencephaly)
Full Integrated Screening
"First trimester blood test and u/s for nuchal translucency. Second trimester blood test
Serum Integrated Screening
"First trimester blood test Second trimester blood test Report held until after second test
Quad Screen
Second trimester blood test (15-20 wks) detects levels of AFP, hCG, UE, and inhibin-A
high AFP level
may indicate fetal neural tube defect, multiple gestation, or preg that is further along than believed.
low AFP level
risk of Down syndrome, or trisomy 18
alpha-fetoprotien (AFP
fetal protein that is excreted from the fetal yolk sac during the first 6 wks of pregnancy then production os taken over by the fetal liver.
high levels of hCG and inhibin-A and low UE
risk of down syndrome
AFI index
Measure depth of fluid volume in all four quadrants around mother’s umbilicus, and add the measurements together
Anencephaly
neural tube defect where a portion of the fetal brain is abscent
Maternal Serum Alpha-fetoprotien (MSAFP)
checks AFP, hCG, diameric inhibin-A, and estriol to screen for NTD, trisomy 21 (DS), and trisomy 18. Can be done at 15 to 22 wks gestation, ideally at 16wks.
Amniocentesis
used for genetic dx, done btwn 15 and 20 wks for NTD, AFP levels, blood type, DNA. Later done btwn 30 to 35 wks dor lung maturity tests
Oligohydramnios
If less than 5 cm AFI
Polyhydramnios
If greater than 20 cm AFI
Electronic Fetal Monitoring used when..
Used to assess women at risk for uteroplacental insufficiency
Non-stress test (NST) reactive
"2 or more accels of 15 bpm lasting over 15 sec in a 20 minute period. Long-term variability of 10 or more bpm
Non-reactive NST
if doesn’t meet NST criteria after 40 minutes
Contraction Stress test (CST)
Fetal monitoring in conjunction with nipple stimulation or oxytocin administration
Recommended weight gain in pregnancy, based on maternal BMI:
"Low (<19.8) 28-40 lbs.--Normal (19.8-26) 25-35 lbs.--High (27-29) 15-25 lbs.--Obese (>29) 15-20 lbs.--4 to 6 lbs a month to gain in weight during pregnancy.
How many lbs a month to gain in weight during pregnancy?
4 to 6 lbs a month (the text states 3.5 to 5lbs during 1st trimester then 1lb per week in 2nd and 3rd trimester)
weight of fetus, placenta, amniotic fluid
11 lbs. (5kg)
weight of uterus
2 lbs. (0.9kg)
weight of increased blood volume
4 lbs. (1.8kg)
weight of breast tissue
3 lbs. (1.4kg)
weight of maternal stores
5-10lbs. (2.3 to 4.5kg)
Daily servings of dairy?
4, 8oz servings
Dai;ly servings of meat?
3, 2oz
Daily servings of grains?
6-11, (one slice of bread, 1oz dry cereal or 1/2cup rice)
Daily servings of fruit/juices?
2-4, 1cup or 4oz juice
Daily servings of vegetables?
3-5, 1cup raw vegetable or 1/2 cup cooked veg.
Daily servings of fats?
as desired 1 serving= 1tbsp
Dail servings of sugars?
occasionally
Obesity complication in preg.
"Prematurity, Neural tube defect, Stillbirth, Macrosomia, Wound infection/dehiscence if c-section
Nutritional servings in preg.
"Dairy – 4 8-oz servings, Meat or alternatives – 3 servings, Grain products – 6-11 servings, Fruit/juices – 2-4 servings, Vegetables – 3-5 servings, Fats – as desired, in moderation, Sugar/sweets/desserts – occasionally, if desired
Prenatal vitamins (PNV)
Higher in iron, calcium and folic acid, Lower in Vitamin A,
Antepartum
time btwn conception and onset of labor, used interchangeably with prenatal
Intrapartum
time from onset of labor to birth of infant and placenta
Postpartum
Time from birth until women's body returns to prepregnancy state
Nagele's rule
1st day of LMP, subtract 3 months, and add 7 days
Fundal height
measures the distance from the top of the symphysis pubis over the curve of the abdomen to the top of the uterine fundus. Correlates with weeks gestation. Ex 26cm=26 weeks gestation
Quickening
fetal movement felt by the mother indicates 20 weeks gestation or some btwn 16-22.
Vibroacoustic Simulation (VAS)
application of sound 90db for 1 to 3 secounds to stimulate fetal movement
Biophysical Profile (BPP)
FHR accleration(done with NST), (rest doen with ultrasound) fetal breathing, fetal movements, fetal tone, amniotic fluid volume. Also, (doppler flow studies and detect placental maturity= placental grading).
2 most important parts of the BPP are…
NST (reflect intactness of nervous system and AFI (reflects kidney perfusion)
Normal fetal breathing movements
greater than or equal to 30 sec of normal breathing rhythm within 30 minutes
Normal fetal movements
greater than or equal a discrete body or limb movement within 30 minutes ????
Normal (meaning a score of 2 )Fetal tone
greater than or equal to an episode of exention followed by flexion of hand or leg etc.
normal FHR
two or more accelerations of at least 15 beats per minute that last at least 15 seconds each during a 20-40-minute period
Normal AFI
Single vertical pocket less then 2 cm, total greater than 5 cm and less than 20cm
Placental maturity grade
I - III , III being the most mature can be due to GD, postterm, preclampsia, etc.
Intrauterine Growth Restriction (IUGR)
any fetus that falls below the 10th percentile in ultrasonic estimation of weight at a given gestational age.
Macrosomia
fetal weight greater than 4000 to 4500 g (8lb 13oz to 9lb 4oz). Greatest risk factor for ___ is shoulder dystocia.
Chroionic Villus Sampling (CVS)
used to detect genetic, metabolic, and DNA abnormalities. Can not detect NTDs can be done btwn 10 to 12 wks
Percutaneous umbilical blood sampling (PUBS) or Cordocentesis
gets pure fetal blood to dx blood disorders, anemia, infection, blood grouping,
Fetal fibronectin (fFN)
prescence of this in the cervicovaginal btwn 20 to 34 weeks is a strong predictor of spontaneous preterm labor or premature rupture of membranes
lecithin/sphingomyelin (L/S) ratio
at 30 to 32 wks the two substances become equal than at 35 wks (?) exceeds (?) at 2:1, which indicates that RDS is very unlikely
Phosphatidylglycerol (PG)
2nd most abundant phosopholid in surfactant. Appears at 36 wks and increases till term. Mere presence of substance reflects low risk of RDS (and vise versa)
Coombs Test
Antibody test to find antibodies that attack red blood cells. Example= Rh antigen Two types 1. Direct (test are in system) 2. Indirect (tests mixing risks)
Rhesus factor sensitization
Mom= Rh negative, Baby= Rh-postive (father Rh=positive), leading to mom's antibodies attacking the baby.
Calcium in pregnancy
additional 1000mg on top of the PNV. (; there are 300 mg of calcium in 8 oz of milk, yogurt, calcium-fortified orange juice or soy milk)
Omega-3, DHA – essential fatty acids
"Good neurological development for fetus, Fish oil capsules or flaxseed oil capsules – 1000 mg a day, Expecta – OTC formula of DHA/EFA, Some PNV include these as part of the packaging (e.g. One-A-Day Prenatal Formula)
Iodine
220 mcg a day for normal thyroid function and prevention of impaired brain development
Sodium
2 to 3 g a day for proper metabolism and fluid balance
Zinc
11mg per day to 12 mg per day during lactation. Used for metabolism and synthesis od DNA and RNA, aids fetal growth and milk production during lactation.
Magnesium
320 mg day for cellular metabolism and growth
Iron
15 to 18 mg a day during pregnancy it is 27mg a day therefore a supplement is needed.
physiologic anemia of pregnancy
nonpregnant women hmcrit is 38to 47%. When pregnant hematocrit can drop to 34%.
Vit A
Fat soluble V, aids in metabolism of carbs and fats, aids in growth os epithelial cells (skin and GI tract) and develops healthy eyes in fetus. 770mcg a day for preg. High amounts of this V cause birth defects.
Vit D
5 mcg a day. Aids in absorption of calcium and phosphorus
Vit E
15 mg per day. It is an antioxidant.
Vit K
is an essential factor for synthesis of prothrombin= related to normal blood clotting. 90 mcg per day (it does not increase during pregnancy)
Vit C
increases in pregnancy from 75 to 85 mg a day. Essential to the formation of collagen, overall aids in the development of connective tissue and the vascualr system,
B vitamins
Need 800 mcg of folic acid daily during pregnancy. Pre-pregnancy, all women of reproductive age should be on daily 400 mcg, in case of accidental pregnancy.
Fluids
8 to 10 (8oz) glasses a day which 4 to 6 should be water
Caffeine
"Eliminate if possible, Vasoconstrictor, increase risk for miscarriage because limits blood flow to developing fetus, Limit to 300 mg daily if desired (one cup of coffee or one can of soda a day).
Mercury
"Limit fish intake to no more than 12 oz a week. Avoid swordfish, tile fish, king mackerel, large tuna steaks, shark. Fish oil capsules okay. Generally, salmon, shrimp okay; one 6 oz can of chunk light tuna (not albacore or white tuna) a week.
Lacto-ovovegetarians
include milk, dairy products, and eggs in diet
Lactovegetarians
include dairy but no eggs
Vegans
need to supplement with B12 vitamins
Foods to avoid in pregnancy
No raw meat, poultry, fish or eggs. No uncooked hot dogs or deli meats such as salami, prosciutto, pepperoni, smoked fish (canned smoked fish okay). No unpasteurized dairy or fruit juices. No soft cheeses that have been out of the refrigerator for longer than an hour.
Alcohol in pregnancy
Advise not to drink alcohol in pregnancy, because we have not been able to establish safety guidelines.
Cultural foods
generally not an issue, provided the foods follow the guidelines to avoid mercury and bacterial concerns.
Exercise resrtions for pregnancy
"Do not lift, push or pull more than 20-25 lbs. (harmful to mom), No excessive exertion or over-heating. No spinning classes or Bikram yoga. No hot tubs, saunas, jacuzzis or prolonged hot baths. ( Concerned about raising core body tempture that will affect fetus development). No activities requiring keen balance or coordination (e.g., skiing of any type; roller-blading, mountain biking) preg you are just clumsier!
Maximum training heart rate for pregnant mother
140 (or 160 if in good condition prior to pregnancy) because of less oxygen available to fetus.
Max altitude for pregnancy
8000 feet, Limit activities at elevations above 4000 feet no scuba diving
Flying restrictions of pregnancy
Flying is fine until 34 weeks because pressure changes can rupture amniotic sac. Move legs because of the blood clot risk due to the estrogen.
Tx for nausea and vomiting
Why heartburn in pregnancy?
happens because of displacement of the stomach by enlarging uterus and the increase of progesterone decreases GI motility and relaxes esophageal sphincter.
Tx for heartburn
Avoid overeating, ingesting fatty and fried foods, and remain upright 30 minutes after eating. Drugs: Antacids (e.g., Tums, Rolaids, Mylanta, Maalox). H-2 blockers (e.g. Zantac 75 or Pepcid AC), Simethicone (e.g. Gas-X), Don't us Tagamat= why?
Tx for constipation in pregnancy
"Increase fluids (at least 2000ml/day), exercise, fiber in diet, & Stool softeners (docusate sodium, 1-2 times a day), Glycerine suppositories, or Milk of Magnesia if laxative needed
Why constipation in pregnancy?
slowed GI due to progesterone, increased iron supplements, displaced intestines.
Tx of itching, irritation
"Lubricating skin creams (e.g., cocoa butter, Eucerin, Aquaphor), Benedryl cream for skin rashes
Tx for acne
"Facial washes containing salicylic acid (e.g. Neutrogena line), OTC Benzoyl peroxide, See Derm for topical antibiotics if needed. Can not use tetracycline's
Skin tx prevention
Wear sunscreen!!!
Back, ligament and joint pain
"Massage, heat (to the back, but not the abdomen), Chiropractic (those who are comfortable dealing with pregnancy), Carpal tunnel wrist braces, Maternity belt/girdle
Varicose veins
"Support hose, Maternity girdle
Headaches
"Pre-pregnancy migraines tend to improve in pregnancy, Acetaminophen 650 mg every 4 hours or 1000 mg every 6 hours. Add a caffeine source if needed. Massage to neck; heat or ice. NO ibuprofen or naproxen or aspirin products. NO migraine meds
The Five Factors of Labor and Birth
"Passenger (fetus and placenta), Passageway (birth canal), Powers (contractions), Position of the mother, Psychologic response
Five fetal factors as passenger
1. Size of fetal head 2. Fetal presentation 3. Fetal lie 4. Fetal attitude 5. Fetal position
Fontanels
membrane-filled spaces where the sutures of the skull bones intersect – allow for flexibility and growth of the brain
Anterior
diamond shape, 3 x 2 cm – the junction of the sagittal, coronal and frontal sutures – closes about 18 months after birth
Posterior
triangular, 1 x 2 cm – the junction of the parietal bones and the occipital bones – closes 6-8 weeks after birth
Molding
slight overlapping of the bones during labor
Fetal presentation
The part of the fetus that enters the pelvic inlet first and leads through the birth canal the presenting part is the part of the body felt by an examining finger in a vaginal exam
Cephalic presentation
head first (96% of births) – presenting part is usually the occiput (aka vertex, head completely flexed into chest) Can be sinciput, brow, or face
Breech presentation
buttocks or feet first (3%) – presenting part is the sacrum. Can be Complete, Frank, Footling
Shoulder presentation
(1%) – presenting part is the scapula
Fetal lie
The relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother
Normal fetal lie
Longitudinal (vertica). Longitudinal= fetus spine is parallel to mom's spine.
Transverse (horizontal or oblique) fetal lie:
"Fetal spine is at a right angle to mom's spine. Associated with shoulder presentations. Vaginal birth cannot occur if this lie persists
Fetal Attitude
"The relationship of the fetal parts to one another (posture). Affected by fetal growth and by conformity to the uterine cavity
Normal attitude
Back rounded, chin flexed on chest, thighs flexed on abdomen, legs flexed at knees, arms crossed over thorax, umbilical cord lies between arms and legs= General Flexion
Fetal Position
The relationship of the presenting part to the four quadrants of the mother’s pelvis: LA,RA, LP, LA. Denoted by a three-letter abbreviation. First letter is location to the right or left of pelvis (R,L). Second letter is presenting part of fetus (O,S,M,Sc). Third letter relates the presenting part to a portion of the pelvis (A,P,T)
Second letter of the presenting part of fetus O,S,M,Sc stands for what?
Occiput, Sacrum, Mentum (chin), Scapula
Ideal fetal position
occiput anterior
Station
is the relation of the presenting part to an imaginary line drawn between the mother’s ischial spines, and is a measure of the degree of descent of the presenting part through the birth canal
minus station
above the spines
zero station
at the spines
plus station
below the spines
Engagement
indicating that the largest transverse diameter of the presenting part (usually the biparietal diameter- BPD) has passed through the maternal pelvic brim or inlet into the true pelvis, and usually correlates with station 0
When does engagement occur?
"Can happen in several weeks prior to labor for a nullip. May occur before or during labor in a multip. Assessed by either abdominal or vaginal examination
Passageway is composed of…
rigid bony pelvis, and the soft tissues of the cervix, pelvic floor, vagina and introitus
What plays a greater role, since the fetus must accommodate to this relatively rigid passageway?
Bony pelvis which is made up of three sections (inlet, midpelvis (midplane), and outlet)
Estimated measurements of the pelvic inlet, midplane, and outlet are done when?
are done at the first prenatal physical exam (and may be repeated in third trimester, when increased relaxation of pelvic joints and ligaments)
4 types of pelvises
gynecoid, android, anthropoid, and platypelloid
Gynecoid
favorable for vaginal birth, inlet rounded, midpelvis adequate, oulet adequate
Android
not good for vagnal birth= descent slow, head goes in transverse or posterior
Anthropoid
good for veginal birth
platypelloid
not good for vaginal birth= head goes in transverse, difficult descent through midpelvis, delay at outlet
Role of soft tissues, lower uterine segment?
distends and allows contractions and thickening of the upper uterine segment to push the intrauterine contents down toward the cervix
Role of soft tissues, cervix?
effaces (thins) and dilates (opens) to allow the first fetal portion to descend into the vagina, drawing up and over the first fetal portion
Role of soft tissues, muscle layer of pelvic floor?
helps fetus to rotate anteriorly
Role of soft tissues, vaginal tissues
develop during pregnancy to allow dilation at term, and permitting passage of the fetus
Powers- involuntary
"uterine contractions (primary powers). Contractions move down the uterus in waves from pacemaker points – measured by: Frequency, Duration, and Intensity. The contractions also cause the effacement and dilation of the cervix
Powers- Voluntary
once the cervix has dilated, the bearing-down efforts (“pushing”) by the mother augment the force of the (?) contractions.
Ferguson reflex
Stretch receptors in the posterior vagina cause release of endogenous oxytocin, that triggers the maternal urge to bear down
Frequent changes in position do what?
relieve fatigue, increase comfort and improve circulation
Upright position
(walking, sitting, kneeling, squatting) has advantage of assistance of gravity to promote descent, more efficient contractions, and improved maternal cardiac output
“All fours” position
may relieve backache if fetus is OP and may assist in anterior rotation and in cases of shoulder dystocia
Frequency
time from beginning of one contraction to beginning of next
Duration
length of time of contraction
Intensity
strength of contraction