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91 Cards in this Set
- Front
- Back
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mean corpuscular volum (MCV): what does it indicate
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The average size of a red blood cell.
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mean corpuscular hemoglobin (MCH) define.
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the average amount of hemoglobin per cell
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In iron deficiency anemia, what do the lab tests for MCV and MCH show?
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MCV will be normal and MCHH is low
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What is another name for iron deficiency anemia?
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Microcytic anemia
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What are macrocytic or megaloblastic anemias? And what do the lab test reveal?
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B 12 and folic acid anemia are large cell anemias. MCV s elevated, but MCH is normal.
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Name two types of hereditary anemias.
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Sickle cell anemia and thalassemia.
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If a mother is gaining weight more rapidly than usual, you might consider a __________.
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Fetal growth spurt.
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Discuss issues that may come up in pregnancy for women with a history of eating disorders.
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Anorexia: troubl getting pregnant and styaing pregnant. Activation of disordered eating from body changes, at risk for malnutrition. Bulimia: at risk for hyperemeis
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Define spontaneous abortion.
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miscarriage before 20 weeks
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Define fetal demise.
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Miscarriage after 20 weeks.
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Define threatened abortion.
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Vaginal bleeding in the first half of pregnancy, particularly if combined with cramping or persistent backache, 1 in 4 women bleedin in the first trimester and only half of these actually miscarry.
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Define inevitable abortion
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when the membranes ruptureor the cervix dilates.
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Define missed abortion.
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The fetus has died but is retained in uterus. Symptoms: light brown bleeding that doesn't get worse, breasts return to normal size, weight loss of several lbs.
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What is a possible risk of missed abortion?
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DIC disseminated intravascular coagulation, a coagulation disorder, occuring in reastion to fetal breakdown and resulting in catastrophic bleeding.
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What are the signs, symptoms and risks of ectopic/tubal pregnancy?
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symptoms: pelvic pain, spotting, severe g.i. upset, may be misdiagnosed as appendicitis or PID, pain referreed to the shoulder area Risks of tubal rupture are severe internal hemorrhage, shock and death.
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What is the primary cause of tubal pregnancy and why?
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Pelvic inflammatory disease (PID); it leaves scar tissue that may partially occlue the tube
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Define complete mole.
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In 95% of cases of hydatidiform mole, an abnormal spermj inactivites the chromosomes of the ovum and there is no fetus.
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Define partial mole.
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In 5% of hydatidiform mole there is fetal tissue present.
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What changes in the pregnant cervix predispose women to mild vaginal bleeding after intercourse?
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increased vascularity and increased friability.
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Besides light bleeding after sex or vaginal exam, what is anothere benign cause of bleeding during pregnancy?
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Ruptured cervical polyp.
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Define placental abruption and list causes.
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"refers to premature seperation of the placenta..may be caused by cord entanglement, physical trauma, hypertension, but often the cause is unknown."
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List the three types of placental abruptions.
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marginal, concealed and complete
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List the symptoms of the 3 types of abruption.
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complete: profuse bleeding and rapid shock. concealed: no bleeding but acutre consistent abdominal pain, woody hard uterus that is tender to the touch, marginal: bright red bleeding but abdominal pain may be less intense.
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What are the signs of placenta previa?
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episodes of light bleeding with no abdominal pain.
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What gynecological and obstetric history predisposes a woman for placenta previa?
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previous uterine surgeries including d and c, PID, endometritis, multiparity, short intervals between pregnancy.
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List and describe theh 3 degrees of placenta previa.
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total: placenta completely covers the os, partial: os is partially covered, marginal: edge of the placenta is at the edge of the os
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What is macrosomia?
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increase in growth of the baby, "particularly in the chest region"
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Macrosomia is a result of what condition? What are the risks?
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Marcrosomia is a result of getational diabetes. Complications: prolonged labor, shoulder dystocia, RDS (excess insulin can interrup surfactant production.
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A newborn born to a mom with gestational diabetes may experience_________.
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Hypoglycemia and hypocalcemia.
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Describe the glucose challenge test (GCT). What result may indicate the need for further screening?
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At 24 to 28 weeks pregnant, a mom ingests 50mg of glucose (glucose, soda, apple juice or 18 jelly beans). One hr later her blood is tested for the glucose level. >140 indicates the need for more screening.
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Describe the oral glucose tolerance test (OGTT).
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A woman fasts overnight. Her blood is drawn for a fasting glucose level. Then she ingests 75mg of glucose. Her blood is drawn again at 1 hr and 2 hrs after the test.
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What level of blood glucose is considered acceptable for fasting blood glucose and 1 hour and 2 hour blood glucose levels after the OGTT?
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fasting: 90
one hour 180 two hours 155 |
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What are two problems with the OGTT?
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1. extremely high false positive rate. 75% of asymptomatic women with positive results never develop diabetes.
2. women may feel ill from the 75 mg of glucose ingested on after fasting. |
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Midwives may prefer not to do the OGTT. Describe the alternative protocol.
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1. Take a fasting blood glucose (upon rising, no food for 8 hours overnight). 2. Two hour post prandial whole blood test. Woman eats a large high carb breakfast. Blood glucose level is tested 2 hours after eating. Should not exceed 140.
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What is essential hypertension?
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" A preexisting condition indicated by initial and subsequent readings of 140/90 or more."
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What is gestational hypertension?
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"when [blood pressure] readings increase to this level [140/90] after a normal baseline was established earlier in pregnancy."
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According to Heart and Hands what bp reading indicated severe gestational hypertension and is a contraindication for homebirth?
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160/110 or more.
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Severe gestational hypertension is linked to what problems? (3)
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1. placental abruption
2. IUGR 3. vasocnstriction affects flow of O2 to the baby--fetal distress |
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Any woman showing a consistent rise in blood pressure during pregnancy should have what 3 lab tests as a screening for preeclampsia?
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1. liver enzymes
2.blood urea nitrogen 3.uric acid |
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Heart and Hands lists 5 general guidelines that the midwife should be suggesting to her client with elevated blood pressure. List.
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1. exercise
2. deep relaxation 3. no stimulants 4. good diet and healing herbs 5. counseling |
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How does exercise help with hypertension?
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"Exercise increases circulation and forces the blood vessels to stretch and dilate, which reduces the pressure inside them."
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List 5 foods named in Heart and Hands to specifically reduce blood pressure.
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watermelon, cucumber, parsley, onion and garlic
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List 5 herbs that may be used to induce relaxation and may reduce blood pressure.
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hops, skullcap, passionflower, hawthorn and chamomile
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What nutrient may reduce blood pressure?
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Calcium
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What are microthrombi and what role do microthrombi play in preeclampsia?
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Microthrombi are tiny clots. "If hypertension becomes severe, vasospasm and irritation of the blood clel walls cause microthrombi to form. The microthrombi stretch the filtering slits in the kidneys so that large protein molecules begin to slip through, leading to proteinuria....and impairing circulation to the liver (caujsing epigastric pain).
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What does HELLP stand for and what is one of the risks to the mother from HELLP syndrome?
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Hemolysis, Elevated Liver Enzymes and Low Platelet count--increases the risk of DIC as the body exhausts its clotting factors.
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Define hemoconcentration.
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Hemoconcentration is an early sign of preeclampsia, revealed by an abnormally high hematocrit or one that does not dip as is normal in the latter part of pregnancy.
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List 8 signs and symptoms of preeclampsia listed in Heart and Hands.
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hemoconcentration, hypertension, protein in the urine, elevated liver enzymes, BUN, uric acid, generalized edema and hyperreflexia.
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What are two signs/symptoms of preeclampsia that may or may not manifest?
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Generalized edema and protein in the urine.
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Pitting edema: how to check ofr it and measurements.
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Press a fingertip into the skin and see whether or not a depression remains. 2 mm=+1, 4 mm=+2, 6 mm = + 3, 8 mm = +4.
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You determine hyperreflexia by checking for clonus. Describe.
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Mother sits in a straight backed chair, lift and support her calf with one hand, then dorsiflex her foot. Maintain this hold for a moment and then release. Ordinarily, the foot will fall back to its natural position with no extra movement; jerfking or oscillation is a positive result for clonus.
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If you are concerned that a client is developing preeclampsia and are in the process of initiating care with a physician, the mother should be told to report the follwoing six symptoms should they develop.
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severe headache, epigastric pain, visual distubances, decreased output of urine, extreme nervous irritability, decrease in fetal movement
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Polyhydraminos is associated with ______(4).
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multiple pregnancies 8%
rh incompatibility 11% diabetes 5-25% fetal anomalies 18-39% esp. esophageal atresia, hydrocephaly, anecephaly, spina bifida |
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chronic polyhydramnios
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"There is a slight elevation in fundal height around 28 weeks and larger than usual increments of increase in the weeks that follow....baby difficult to palpate...you may confuse a thick uterine wall with excess fluid...hjeart tones are difficult to hear."
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How do you check for fluid thrill? What does the presence of fluid thrill indicate?
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"Place a hand on each side of the uterus and if a tap from one sends a vibration to the other, the test is positive." indicats polyhydramnios.
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Overdistension of the uterus from polyhydramnios can result in what 5 complications to labor and birth?
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uterine dysfunction, placental abruption, postpartum hemorrhage, cord prolapse and fetal malpresentation
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Discuss the differences between monozygotic twins and dizygotic twins.
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Dizygotic: union of two eggs and two sperm, sperate placentas and separate amniotic sacs. Far more common.
Monozygotic: unoion of one egg and one sperms, with the fertilized ovum separating into two, share a pacenta and may share an anmiotic sac, although there are usually two spearate sacs. Far less common. |
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twin to twin transfusion syndrome (TTTS) define.
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"Rarely, with identical twins, blood is shunted from one twin to the other, putting the "donor" baby at risk for growth restriction and other complications."
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Risk of twin birth. (4 listed in heart and hands).
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cord prolapse, 2nd baby may be hypoxic after 1st baby is born due to constriction of placental vessels after loss of uterine volume, placental abruption after 1st twin, postpartum hemorrhage from overdistended and tired uterus.
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According to heart and hands the greatest risk with breech birth is __________.
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Cephalopelvic disproportion "with a vertex presentation, the head has hours to negotiate the pelvis, but with breech, it must be born quickly as exposure of the body and cord to air prompts respiration."
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List two risks of breech birth.
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Cephalopelvic disproportion and cord prolapse.
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It is common for babies to be in what position up to to twenty-six weeks?
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transverse lie
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Describe postural tilting.
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used to turn a baby to vertex. Empty bladder, lie with hips elevated 12 inches, 3x daily for twenty minutes. Suggest deep relaxation and visualization while in the tilt.
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Describe how to use a rebozo to turn a breech baby.
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mother on knees and elbows with belly sagging toward the floor. Center rebozo where buttocks meet thighs. Stand at her head with one end of rebozo in each hand and pull taut, pull firmly on one end then the other to establish a brisk rocking motion. Repeat daily.
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Describe how a midwife might do an external version.
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2 experienced practioners, one to turn baby, one to monitor FHR, drink a glass of beer or wine to relax uterus, empty bladder, position in a tilt and gently attempt to reposition going the direction the baby is facing. If resistance is felt or FHR irregularities, stop.
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The greatest risk to babies born before 37 weeks is _________________.
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Respiratory distress syndrome.
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Signs of RDS include:
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Cyanosis, tachypnea, grunting,retractions, nasal flaring.
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What is surfactant?
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A lubricant that permits the alveoli to inflate.
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Describe kangaroo care and it's benefits to premature babies.
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Skin to skin contact, baby in a diaper in between mother's breasts, reduces infant mortality, stabilizes heart rate, temp and breathing, boosts growth and brain development, more maternal confidence, better pp recover and more breastfeeding success.
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List four causes of small for gestational size
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miscalculated dates, fetus transverse or otherwise low in the pelvis, hereditary tendency to small babies, and IUGR
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Describe the difference between the prenatal growth pattern of a small baby vs. a baby with IUGR
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"IUGR is suspected when fundal height has been normal to 24 wks and then begins to fall behind. A small baby will have consistent but slightly less than normal increments of growth, wheras IUGR there will be decreasing increments of growthj--flat growth growth curve.
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Causes of IUGR(8)
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malnutrition, severe anemia, chronic hypertension, substance abuse, fetal malformation, infection, abnormalities of the placenta and cord and prolonged pregnancy.
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Babies with a minor degree of IUGR are at risk for what three conditions?
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hypoglycemia and hypothermia and polycythemia
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You can check a baby's blood sugar with a dextrostix(heel prick and test strip). At what level do you need to contact a pediatrician?
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below 45.
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Define and describe polycythemia.
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Excess red blood cells which predisposes a baby to severe jaundice.
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Lists causes of LGA (Large for gestational age). In the text they include any reason a mother might be measuring larger than expected, not necessarily a large baby. (10)
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miscalculated dates, hydatidiform mole, gestational diabetes, twins, polyhydramnios, maternal obesity, hereditary tendency to big babies, fetal anomalies, baby high in fundus due to previa or fibroids, postmaturity
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cepahlopelvic disproportion: describe how to check for engagement and check for ability to engage.
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Check for engagement by assessing not only the station of the head but how well it fits in the pelvis. "If the baby is still high, check for ability to engage by grasping the head externally and pressing it toward the sacral promontory, then down into the inlet. If the head feels movable and enters the pelvis readily, things are fine so far." Or use Pawlik's maneuver. Grasp head, have mom sit up completely, if head bulges into your hand instead of slipping into the pelvis, it will have difficulty clearing the inlet.
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fetal overlap
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baby's head overrides the pubic bone instead of slipping into the inlet
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natural methods of induction (6 listed in H &H).
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sexual intercourse, cervical massage with EPO, castor oil (2 TBS with orange jce, followed by another TBS 30 min later and a final TBS in another hour), acupunture techniques, blue cohosh tincture (dropperful every few hours), periodic nipple stimulation
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Define a ripe cervix
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Soft and partially effaced
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Risks of a birth where the baby is truly Large for Gestational Age. (5)
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uterus overdistended causing contx that aren't efficient, prolonged labor, arrested progress, pp hemorrhage, shoulder dystocia
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Current definition of postdatism.
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Pregnancy progressing past 42 weeks.
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Risks of postdatism.
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large baby resulting in shoulder dystocia or CPD or fetal weight loss, oligohydramnios, cord compression, fetal distress and stillbirth
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Define fetal postmaturity syndrome.
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"Maternal malnutrition and chronic dehydration can lead to reduced blood volume and oligohydramnios, which in turn can cause cord compression and fetal compromise". Note: this is not what most medical texts say about fetal postmaturity syndrome.
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How to instruct a mom to do kick counts.
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"Have the mother do this every day [in the case of postdates] for an hour after her largest meal: she should notice about 8 to 10 movement in this time period."
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Describe nonstress testing.
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"evaluates fluctuations in the baby's heart rate in response to its own movements. The desired or positive response it moderate acceleration. The NST can be performed in hospital by EFM or the midwife can simply listen with her fetascope for 20 minutes and look for FHR changes with fetal activity."
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List common assessments of fetal well being for the postdates baby. (4)
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nonstress test, amniotic fluid volume, fetal breathing movements and fetal muscle tone.
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Define elderly primigravida.
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A woman having her first baby after age 35.
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Define grand multipara. What are considered risks for the grand multipara? (2)
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A woman who has given birth five times or more. "Long considered at risk for prolonged labor and postpartum hemorrhage due to lax uterine muscle tone, research has shown no risks based on multipartiy alone."
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Define vaginismus.
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"An involuntary contraction of the vaginal muscles if any attempt is made at penetration." May be a sign of sexual abuse
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According to Heart and Hands what 9 danger signs should prompt parents to report to the midwife immediately?
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vagnial bleeeding, intial outbreak of blister in genital area during 1st trimest, severe pelvic or abdominal pain, persistent and severe midback pain (may be kidney infection), swelling of hands and face, sever headaches/blurry vision/epigastric bpain, gush of fluid from vagina, regular contractions before 37 weeks, cessation of fetal movement
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