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301 Cards in this Set
- Front
- Back
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Any pregnancy, regardless of duration, including present pregnancy
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Gravida
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Birth after 20 weeks gestation regardless of whether the infant is born alive or dead
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Para
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The number of weeks since the first day of the last menstrual period
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Gestation
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The normal duration of pregnancy
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Term
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Second or any subsequent pregnancy
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Multigravida
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Period during which a woman is pregant
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Antepartum
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From the onset of labor until birth of the baby and placenta
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Intrapartum
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From birth until the woman's body return to a prepregnant condition. Approx. 6 weeks
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Postpartum
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G, T, P, A, L
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Gravada
Number of term Number or pre-term Abortions Living |
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What must you consider for gestational age
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1)last menstrual period
2)menstrual history (interval and duration) 3)contraceptive use |
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What is Nagele's Rule
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LMP + 7 -3 months = EDC
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What are ancillary dating methods used for pregnancy testing
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Detects presence of Beta hCG
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When can Beta hCG be detected in normal pregnancy
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as early as 6-9 days following ovulation
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When does the level of Beta hCG rise after conception
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During the first 3-4 weeks and then levels off eventually to decline
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What do low levels of hCG indicate
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Ectopic, or impending SAB
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What can higher levels of hCG indicate
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Twins
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When are heart tones first audible?
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Doppler 10-12 weeks
Fetoscope 17-20 weeks |
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The fundus reaches the umbilicus at approximately how many weeks
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20
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Between how many weeks gestation is the fundal hight in cms equal to the G.A in weeks
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20-31
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When measuring fundal height, where do you measure the top
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Fetal pole in fundus
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When does quickening usually occur
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between 17-20 weeks
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What is the general rule regarding ultasound dating
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the earlier teh estimate of the age, the more accurate it is
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What is the new cornerstone of dating
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Ultrasound
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What is the most common used method for figuring out the gestational age with an unknown LMP, irregular menses, and contraceptive use
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Ultrasound
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Good dates
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-reliable LMP
-Documented positive pregnancy test by 6 weeks -1st exam before 12 weeks, S=D -FHT's by doptone @10 weeks |
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Poor Dates
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-unknown LMP
-1st exam after 30 weeks -U/S after 30 weeks -size < or > dates |
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What signs are these:
nauseated breastes are tender tiredness -Cessation of menses -increased urination -Elevated BBT -Quickening -Skin changes |
Presumptive signs
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What signs are these:
-Enlargement of the abdomen -Enlargement and change in shape of uterus -Palpation of fetal outline -Palpation of UC's -Positive pregnancy test |
Probable Signs
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What signs are these
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-Fetal Movement
-FHT's -Ultrasound |
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When can the gestational sac be seen with an ultrasound
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4-6 weeks
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What are dark brown splotchy areas over the face
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Chloasma
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What is Palmar Erythremia
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Redness of the palms of the hands due to high estrogen levels
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What are stretch marks called
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Striae Gravidarum
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What are breast changes during pregnancy
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-Breast enlargement and fullness
-Tingling and tenderness -Areola darkening -Montgomery tubercles become prominent -Colostrum |
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When pregnant stomach tone and motility ___
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Decrease
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When pregant small intestine motility ____
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Decrease
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When pregnant Colon motility _____
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Decrease
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When pregnant what happens to the bladders tone
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Decrease
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When pregnant what happens to retention capacity
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It's reduced
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When pregnant what happens to the kidneys and ureter
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Dilation
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What happens to the Tubules during pregnancy
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unable to reabsrob all filtered substances causing spillage of glucose
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What are women at risk for
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UTI's
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What respiratory change occur in pregnancy is not normal
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Breathing from the diaphragm
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When pregnantion what occurs as the tidal volume increases to blow off excessive CO2 coming from fetus
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hyperventilation
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What happens to oxygen consumption when pregnant
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It increases
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Breathing is what during pregnancy
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Thoracic, rib cage flares
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When is the diaphragm displaced when pregnant
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upward, SOB
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How much does Blood volume increase during pregnancy
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45%
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How much increase in plasma volume during pregnancy?
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50%
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How much is cardiac output increased?
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30-50%
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Pulse rate increase by
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10-15 BPM
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What are some iron rich foods
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Lean Beef
Spinach Baked Beans |
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Pregnant Hemoglobin
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> 11
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Pregnant Hematocrit
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>33 (Normal 37-47)
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Pregnant Anemia
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Hgb <10
Hct<35% |
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Anemia in non-pregnant
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<12
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What are changes in the uterus
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size increases by stretching
thinner and softer increase in muscle fibers increase in contractility |
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What is the Chadwick's sign
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Bluish Hue of the cervix when a woman is pregnant
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What are changes in the cervix
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more vascular and edematous
Chadwick's sign Goodell's sign Increase in mucus production |
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What is the Goodell's sign
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Softening of the uterus
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What changes happen in the vagina during pregnancy
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Hypertrophy and hyperplasia
-thickened vaginal mucosa -Increase in lenght of vault -Increase in white vaginal discharge |
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when do food cravings common
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Second trimester
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When is constipation common
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Second trimester
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When are pigmentation change common
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Second trimester
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When are varicose veins common
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Second trimester
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When are round ligament pain common
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Second trimester
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When is supine hypotension common
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Second trimester
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When are Braxton Hicks UC's common
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Third
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When is Dependent Edema common
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Third Trimester
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When is Insomnia common
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Thrid Trimester
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When is Urinary Frequency common
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Thrid trimester
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What are signs of pregnancy induced hypertension
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headache, blurry vision
seeing spots before eyes |
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When is absence of fetal movement a danger sign
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After 20 weeks
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What are some danger signs
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Sudden gush in fluid
-Vaginal bleeding -Abdominal pain -Temp and chills -Sever H/A, blurred vision, spots -Dysuria |
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when should someone be referred for genetic consultation
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Hx of 2 or more miscarriages
Mother 35> Hx of family member with defect -Exposure -Mother's health condition -Couple is first cousin or other close blood relative |
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What test is removal of a small tissue specimen from the fetal portion of the placental
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Chorionic Villus Sampling
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When is Chorionic Villus Sample taken
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10-12 weeks
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When should chorionic Villus not be done
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Before 10 weeks
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What does MSAFP stand for
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Maternal Serum Alpha-fetoprotein
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This test is recommended for all pregnant women
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MSAFP
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What does MSAFP detect
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Neural Tube defects and open abdominal wall defects
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Where is AFP produced
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by the fetal liver
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WHen is AFP detected in the serum
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From 14-34 weeks
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What do lower levels of AFP possibly mean
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Down Syndrome and other autosomal trisomies
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When is the triple-marker test performed
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16-18 weeks
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What does the triple-marker test test?
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Three maternal serum markers:
MSAFP unconjugated estriol Human chorionic gonadotropin |
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Using a triple-marker test, what will a baby with down syndrome test
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MSAFP and unconjugated estriol levels are low, and hCG level is elevated
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MSAFP is what?
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Only a screening test, not diagnostic
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What happens if the MSAFP is positive
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An U/S is ordered, Refered to genetics who will order amniocentesis
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What is one example of a Genetic Diagnostic test
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Chorionic Villi Sampling
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What is CVS?
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Chorionic Villi Sampling, analysis of chorionic villi for chromosome analysis
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When is a CVS ordered
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(Chorionic Villi Sampling) Between 9-11 weeks
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What is an example of a genetic diagnostic test
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withdrawal of amniotic fluid
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What is both a screening and diagnostic test
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Ultrasound
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What is the most widely applied technique for antepartum evaluation of the fetus
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Nonstress test
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Describe the nonstress test:
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seated in a reclining chair
slight left or right tilt FHR is recorded with a Doppler and a codynamometer is appled to detect uterine contractions. -may take 20-30 minutes -Baby has to be awakened |
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What are accepted criteria for Non-stress tests
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Two or more accelerations of 15 beats/min lasting for 15 seconds over a 20 min period
-Normal baseline rate -Moderate variability |
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What can provide earlier warning of fetal compromise thant the NST and with fewere false-positive results
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CST (Contraction stress test)
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IS the CST Contraction stress test used often
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NO
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How does the contraction stress test work
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Two methods: nipple-stimulated contraction test and the oxytocin-stimulated contraction test
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Interpretation of CST Contraction Stress Test
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If no late deceleration are observed with the contraction the findings are considered negative
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What are three fetal well-being tests
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NST-non stress test
CST- contraction stress test BPP-biophysical profile |
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What is the Biophysical Profile
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noninvasive- Includes AFV (amniotic fluid volume)
FBMs (fetal breathing movements) Fetal movements FHR *considered a physical examination of the fetus |
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Breasts
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1-1.5
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Blood
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3-4.5
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Extra water
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4-6
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Uterus
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2.5-3
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Placenta
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1.5-2
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Amniotic fluid
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2-3.5
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Baby
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7-8
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stores of fat
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4-6.5
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When the expectant father adjusts to the reality of the pregnancy, what phase is this
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Moratorium
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stores of fat
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4-6.5
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When the expectant father adjusts to the reality of the pregnancy, what phase is this
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Moratorium
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What enzyme is present in the fetal liver in amounts less than those required after birth
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glucuronyl transferase
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How long does it take for the fetus to produce vitamin K
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several days
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What is the most critical alveolar surfactant required for postnatal lung expansion
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Lecithin
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What is used to determine the fetal lung maturity
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L/S ratio, Sphingomyelin is also produced in the lungs but is constant, Lecithin increases at 21-24 weeks.
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When are the lungs considered to be mature
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When L/S reaches 2:1
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When are the lungs usually mature by
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35 weeks
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What can retard fetal lung maturity
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gestational diabetes and chronic glomerulonephritis
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What babies have more respiratory difficulty?
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Cesarean because the fluid is not sqeezed out
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Is the GFR high or low in a term baby
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Low
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When sould newborns void
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within 24 hours of birth
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When does the neural tube form
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during the 4th week
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What can cause fetal hiccups
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cold solution placed into the amniotic fluid
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What is the name for a large fetus
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macrosomic fetus
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What is it called with infants secret fluid from engorged breasts
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Witch's Milk
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What is the cheesy material that protects the skin of the fetus
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Vernix caseosa
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What is the very fine hairs called
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Lanugo
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What is the only immunoglobulin that crosses the placenta
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IgG
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What is an immunoglobulin that is not produced by the baby
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IgA
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What does colostrum contain
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large amounts of IgA
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Two zygoes
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Dizygotic twins- two placenta that may fuse
"Fraternal" |
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Identical twins
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Monozygotic twins
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A woman who has never been pregnant
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nulligravida
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A woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 weeks
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nullipara
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A pregnancy that goes beyond 42 weeks
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Postdate or posterm
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A pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation
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preterm
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A woman who is preganant for the first time
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Primigravida
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A pregancy from the beginning of 38 weeds to the end of 42 weeks
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term
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capacity to live outside the uterus; abotu 22-25 weeks
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viability
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gravidity
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pregnancy
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What pregancy test can detect the beta subunit of hCG
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RIA radioimmunoassy; performed in the labratory
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What can cause false-positive tests
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anticonvulsants
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What causes false negatives
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diuretics and promethazine
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What does the uterus look like during the second trimester
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spherical or globular
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When does the pregnancy show?
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14th week
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What is it called when the fetus begins to descend and engage in the pelvis
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lightening
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When does lightening occur in the nullipara
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about 2 weeks before the onset of labor
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When does lightening occur in the multipara
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Start of labor
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at 6 weeks gestation, softening and compressibility of the lower uterine segment occur
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Hegar Sign
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When do Braxton Hicks start
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Fourth month
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What is the sound made by blood in the uterine arteries that is synchronous with the maternal pulse
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uterine souffle
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Sound made by blood rushing through the umbilical vessels and synchronous with the fetal hearth rate
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Funic souffle
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Softening of the cervical tip
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Goodell Sign
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Passive movement of the unengaged fetus
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ballottement (bouncing it gently)
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First sign
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Quickening
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Violet-bluish color of the vaginal mucosa and cervix
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Chadwick, (6-8th week)
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White or slightly gray mucoid discharge with a faint musty odor
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Leukorrhea
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formation of the mucous plug
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operculum
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Is the vaginal secretions more acidic or basic
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acid
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What is a pregnant more prone to
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yeast infections
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What are sebaceous oil glands embedded in the primary areolae
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Montgomery tubercles
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viscous secretory material can be found in the acini cells by the third month of gestation
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Precolostrum
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Creamy, white-to-yellowish-toorange premilk fluid may be expressed from the nipples as early as 16 weeks
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Colostrum
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When does the apical impulse and PMI shift
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Upward and laterally about 1-1.5 cm
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Does systolic blood pressure change
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usually remains the same
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Does diastolic blood pressur echange
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begins to decrease in the first trimester, continues to drop until 24-32 weeks, then gradually increases and retuns to prepregnancy levels by term
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Drop of more than 30mm in systolic bp. bradycardia is noted,feels faint
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Supine hypotensive syndrome
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hemodilution is referred to as
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physiologic anemia
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When does the Total white cell count increase
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second, and peaks during the 3rd
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What causes the lung expansion to relax
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Estrogen
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What does estrogen cause
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more vascularity
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What happens to BMR
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increases
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What side do the urters ususally dialate more on
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Right
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Why is their urinary frequency
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Initially from increased bladder sensitivity and later from compression
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What happens to bladder tone
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may decrease which increases the bladder capacity to 1500ml
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What happens to the GFR early in pregnancy
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increased
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Does physiologic edema or dpendent edema require treatment
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no
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Tubular reabsorption of what is impaired
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Glucose
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glucosuria occurs when maternal glucose levels are lower than
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160 (Normal 160-180)
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Does proteinuria usually occur during pregnancy
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No, except during labor or afterbirth. 1+ protein or less than 300 mg per 24 hr are acceptable
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Facial melasma is called
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chloasma
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What might cause stretchmarks
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adrenocorticoisteroids
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In multipara in addition to the striae of the present pregancy glistening silvery lines appear on...
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light skined women, purplish lines on dark skined
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Whats antoher word for vascular spiders
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Angiomas
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Where are vascular spiders normally found
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neck, thorax, face, and arms, usually disappear
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Palmar Erythema
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Pinkish-red, diffuse mottling or well-defined blotches on the palms of the hands
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What is the most common cause of pruritic rash
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Cholestasis of pregnancy
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Gingival granuloma gravidarum, red, raised nodule on the gums that bleeds easily
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Epulis
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Separation of the abdominal muscles
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diastasis recti abdominis, gradually regain tone
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When is carpal tunnel synderome common
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last trimester
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What causes carpal tunnel syndrome
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Edema involving the peripheral nerves
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Numbness and tingling of the hands
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Acroesthesia
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When does lightheadedness commonly occur
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during early pregnancy
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When does morning sickness usually appear
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4-6 weeks
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Excessive salivation
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ptyalism
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Are peptic ulcers common
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No- estrogen decreases production of hydrochloric acid
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What causes acid indigestion or heartburn
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Increased progesterone- decreased tone and motility of smooth muscles, resulting in esophageal regurgitation, slower emptying time and reverse peristalsis
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hearburn
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pyrosis
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What causes constipation
|
increased progesterone, causes increase in water absorption from the colon and hypoperistalsis, and iron supplements
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When should bleeding be reported
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all instances
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What happens to the thyroid during pregnancy
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enlarges because of estrogen
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Does insulin cross the placenta
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No
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What causes the mother to need more insulin
|
Estrogen, progesterone, hCS and cortisol collectively decrease the mothers ability to use insulin
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|
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What is considered a LBW
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2500g or less; very big risk if less than 1500
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|
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How much folic acid should be consumed
|
400 micrograms
|
|
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What is the expected energy expenditure for the first trimester
|
the same as in the prepregnant state
|
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What is the estimated energy expenditure for the second trimester
|
340 kcal above normal amount
|
|
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What is the estimated energy expenditure during the 4th trimester
|
462 kcal abovethe normal amount
|
|
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Is theoptimal weight gain during pregnancy known
|
No
|
|
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Who are at risk for giving birth to an infant with intrauterine grwoth restriction
|
Normal-weight and underweight women
|
|
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Who is more likely to have preclampsia
|
obese women, tons of other risks
|
|
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How much weight should be gained if single fetus and with normal BMI
|
11.5-16 kg
|
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How much should women gain with single fetus and are underweight
|
12.5-18 kg
|
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How much should women gain with single fetus and are overweight
|
7-11.5 kg
|
|
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How much should women gain with twins and are underweight
|
21-28 kg
|
|
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How much should women gain with twins and are overweight
|
16.4-20.4
|
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How much should women gain with twins and are normal weight
|
17-24.5 kg
|
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How much should women gain with twins and are obese
|
12-17.7 kg
|
|
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How much should women gain with single and are obese
|
7 kg
|
|
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When are pretem births greater
|
when weight gain is during the last half of pregnancy
|
|
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Average weight gain during first trimester
|
1-2.5 kg for normal weight
|
|
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What is the recommended weight gain per week for normal weight
|
.4 kg
|
|
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What is considered excessive weight gain
|
3 kg per month
|
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How much does a a women have to gain to be especially at risk
|
18 kg or more
|
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Are high-protein supplements recommended
|
no- they have been associated with incidence of preterm births
|
|
|
How many servings of grains
|
6 ounces
|
|
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How many servings of vegetables
|
2.5
|
|
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How many servings of fruits
|
1.5
|
|
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How many servigs from milk group
|
3
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How much meat
|
5 ounce equivalents: fish, nuts, and seeds
|
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How much oil
|
6 teaspoons
|
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How much water
|
8-10 glasses or 2.3 L
|
|
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What has caffeine been associated with
|
miscarriage and giving birth to infans with IUGR
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|
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How much caffeine is "Okay"
|
no more than 150-300 mg
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What sweetner should be avoided with a woman with PKU
|
Aspartame
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|
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Who is anemia most common in
|
adolescents, AA, and lower socioeconomic
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What is the recommended amount of Iron
|
30 mg of ferrous iron daily, starting by 12 weeks gestation
|
|
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What is the recommended amount of calcium
|
There is no increase in the DRI of calcium 1000 for >19 and 1300 <19
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|
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What increase absortion of iron
|
Vitamin C
|
|
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What decreases iron absorption
|
Bran, tea, coffee, milk, oxalates,
|
|
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When should iron be taken
|
on an empty stomach and at bedtime
|
|
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What are good sources of magnesium
|
dairy products, nuts, whole grains, and green leafy vegetables
|
|
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IS moderate peripheral edema normal in pregnancy
|
yes
|
|
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What is one of the most likely vitams to be lacking in the diets of women of childbearing age
|
E
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|
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What can vitamin E help prevent
|
Preeclampsia
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|
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IF a women has borne a child with a neural tube defect they are advised to take how much folic acid
|
4 mg
|
|
|
Food can and should be the normal vehicle to meet the additional nutrient needs imposed by pregnancy except
|
Iron
|
|
|
Practice of consuming nonfood substances
|
Pica
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|
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What increases the woman's risk of obesity later in life
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adolescent pregnancy
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How much more should be consumed when breast feeding
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330 kcal for the first 6 months
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What is the average loss during lactation
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.5-1 kg per month
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What can impair milk production
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smoking
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What can accumulate in the infant
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caffeine
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Cutoff values for anemia are higher in these women
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smoke or live at high altitudes
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How many caloreis should the lactating woman get
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100kcal
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What should the food plan be for women with diabetes
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four to six meals and snacks daily, carbohydrate intake distributed
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What might help nausea
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vitamin b6 or ginger
-eat dry food when nausea -avoid a lot of fluids in the morning -avoid skipping meals -avoid sudden movements -decrease fried or fatty foods -foods at cool temperature -avoid brusing teeth immediately after eating -herbal teas |
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How much fiber? (constipation)
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28g
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First trimester is weeks
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1-13
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Second trimester is weeks
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14-26
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Third trimester is weeks
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27-40
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These are detected by an examiner and related mainly to physical changes in the uterus
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Probable indicators
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When does the ultrasound examination become 100% reliable
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only at 8-9 weeks
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What is the first step in adapting to the maternal role
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accepting the idea of pregnancy and assimilating the pregnant state "I am pregnant"
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having conflicting feelings simultaneously is considered a nomal response for people preparing for a new role
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ambivalence
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When should ambivalence indicate an unresolved conflict with the motherhood role
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if persists through the 3rd trimester
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What are the two major needs expressed by the woman
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feeling loved and valued and having the child accepted by the partner
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accepts the growing fetus as disting from herself, usually accomplished by the fifth month. "I am going to have a baby"
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Phase 2
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prepares realistically for the birth and parenting of the child "I'm going to be a mother"
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Phase 3
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men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms
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couvade syndrome
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1st Phase a father goes though. last from a few hours to a few weeks. Accept the biologic fact of pregnancy
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announcement phase
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2nd phase a father goes though. adjusts to the reality of pregnancy
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Moratorium phase
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3rd phase a father goes through. last trimester. active involvement in both the pregnancy and his relationship with his child
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Focusing phase
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How will a 2 year old react to the fact of their mom being pregnant
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May exhibit more clinging behavior and revert to the dependent behaviors in toilet training or eating
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How will a 3 or 4 year old react to mom having baby
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They like to be told the story of their own beginning and accept its being compared with the present pregnancy
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How do school-age children react
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They take a more clinical interest "how did the baby get in there?". The look forward to the new baby, see themselves as mother or fathers
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How do early and middle adolescents react?
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preoccupied with the establishment of their own sexual identity
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When should dr. visits be scheduled
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Every month until 28 weeks, then every 2 weeks until 36 weeks, and then every week
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When is the height of the fundus measured
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after the first trimester
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Signs of preeclampsia
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rapidly progressive
high blood pressure protein in the urine swelling,, sudden weight gain headaches and changes in vision usually occurs after 20 weeks |
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Hypertension in pregnancy
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140 systolic
90 diastolic after 20 weeks gestation |
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When should BP be alarming
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SBP>- 125
DBP>- 75 in midpregnancy SBP>130 or DBP>- 85 later in pregnancy Any rise of 30 mmhg SBP over baseline or 15 mmhg DBP |
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excessive n/v, morning sickness
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hyperemesis gravidarum
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How many kicks within an hour after a meal indicate good fetal wellbeing
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4
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How long should the FHT be counted for
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1 minute
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What does the triple screen measue
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MSAFP, hCG and unconjugated estriol
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What test is used for syphilis
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RpR/VDRL
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When is tub bathing contraindicated
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after rupture of the membranes
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What might help prevent urinary tract and vaginal infections
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Yogurt and acidophilus milk
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How long is it recommended to breastfeed
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1 year
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When should breast shells be worn
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for 1-2 hours during the last trimester of pregnancy
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What is linked with peridontal disease
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preterm births and LBW and preeclampsia
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Can dental work be done while pregnant
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Yes, with antibacterial therapy
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How often should you take your pulse while exercising
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q 10-15min
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You pulse should not exceed what when exercising
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140
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How long should you exercise
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No more than 35 minutes
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What is the most common cause of fetal death
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Materl death, next is placental separation (abruptio placentae)
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WHat can be administered during pregnancy
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tetanus
diphtheria recombinant hepatitis B rabies |
