Ob Final-1

Front 1

What is Nagele’s rule

Back 1

A way to estimate date of birth using the first day of the last menstrual period

Front 2

How to calculate EDD using Nagele's rule?

Back 2

Beginning with the first day of the last menstrual period, SUBTRACT 3 months
ADD 7 days

Front 3

Calculate EDD using Nagele's rule if fist day of last menstrual period is Sept 15th:

Back 3

Sept 15th – 3 months = June 15th plus 7 days = June 22

Front 4

Gravida

Back 4

indicates the number of times the mother has been pregnant, regardless of whether these pregnancies were carried to term. A current pregnancy, if any, is included in this count.

Front 5

TPAL

Back 5

# Term
# Preterm
# Abortion
# Living

Front 6

Term

Back 6

the number of infants born at the completion of 37wks or beyond

Front 7

Preterm

Back 7

the number of infants born after 20wks but before the completion of 37wks gestation, whether living or stillborn

Front 8

Abortion

Back 8

Number of pregnancies ending in either spontaneous or therapeutic abortion

Front 9

Living

Back 9

Number of currently living children to whom the woman has given birth

Front 10

Leopold’s Maneuvers (LM):

Back 10

a systematic way to evaluate the maternal abdomen. These maneuvers determine fetal position by palpation.

Front 11

When may LM be difficult to perform?

Back 11

may be difficult to perform on an obese woman or on a woman who has excessive amniotic fluid (hydramnios).

Front 12

What should we have mom do before performing LM?

Back 12

Have mom empty her bladder- this provides improved comfort

Front 13

Should LM be performed during or between contractions?

Back 13

between contractions

Front 14

How to position mom for LM?

Back 14

She should lie on her back with abdomen uncovered; shoulders should be raised slightly on a pillow and knees drawn up a little

Front 15

Leopold’s Maneuvers- First Maneuver:

Back 15

While facing the woman, the nurse palpates the upper abdomen with both hands

Front 16

What information do we receive from first LM?

Back 16

To determine if the head or the buttocks occupies the top of the fundus

Front 17

If the fetal head occupies the top of the fundus, what will it feel like?

Back 17

Fetal head is firm, hard, and round, and moves independently from trunk

Front 18

If the fetal buttocks occupies the top of the fundus, what will it feel like?

Back 18

Breech feels softer and symmetric and has small bony prominences; it moves with the trunk

Front 19

Leopold’s Maneuvers- Second Maneuver:

Back 19

Still facing the woman, palpate the abd. With deep but gentle pressure, using the palms – 1 hand should be steady while the other explores one side of the uterus (then repeat on other side)

Front 20

What information are we gathering form LM second maneuver?

Back 20

Location of fetal back and extremities- wether the fetus is facing the right or left side

Front 21

Leopold’s Maneuvers- Third Maneuver:

Back 21

gently grasp the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand.

Front 22

What information are we gathering during LM third maneuver?

Back 22

Determining what fetal part is lying above the inlet and confirming wether the baby is cephalic or breech

Front 23

Using LM This maneuver, how can we determine wether the fetus is engaged or not?

Back 23

If the head is presenting and not engaged, it may be gently pushed back and forth.

Front 24

Leopold’s Maneuvers- Fourth Maneuver:

Back 24

The nurse faces the woman’s feet and attempts to locate the cephalic prominence or brow- the fingers of both hands are moved gently down the side of the uterus toward the pubis

Front 25

What information do we gain from performing LM Fourth Maneuver?

Back 25

We are determining the descent of the presenting part into the pelvis

Front 26

Using LM fourth maneuver, what will we feel if the head is not flexed?

Back 26

The first cephalic prominence palpated will be on the same side as the back

Front 27

Using LM fourth maneuver, what will we feel if the head is well flexed?

Back 27

The first prominence found will be opposite the back

Front 28

Version

Back 28

(turning the fetus) is a procedure used to change the fetal presentation by abdominal or intrauterine manipulation

Front 29

external cephalic version (ECV)

Back 29

Most common type of version- the fetus is changed from a breech, transverse, or oblique lie to a cephalic presentation by external manipulation of the maternal abdomen

Front 30

Ballottement

Back 30

the passive fetal movement elicited by pushing up against the cervix with two fingers. This pushes the fetal body up and, as it falls back, the examiner feels a rebound.

Front 31

Ballottement of a fetus within a uterus is a probable objective sign of...

Back 31

pregnancy

Front 32

SGA

Back 32

Small for Gestational Age- birthweight below the 10th percentile for babies of the same gestational age.

Front 33

Intrauterine growth restriction (IUGR) causes:

Back 33

Maternal factors (primiparity, gram multiparity, multiple gestation, inadequate health care)
Maternal disease, (smoking, drugs, alcohol, PIH, advance DM)
Environmental factors (high altitude, x-ray exposure, excessive exercise, work-related toxins teratogenic drugs)
Placental factors (small, abnormal cord infarated areas, Fetal factors (congenital infections, chromosomal disorders)

Front 34

Intrauterine growth restriction (IUGR) Common complications:

Back 34

asphyxia,
aspiration syndrome,
temperature instability,
hypoglycemia,
polycythemia

Front 35

Asymmetric disproportional IUGR

Back 35

head and length proportional but wt below 10%

Front 36

LGA

Back 36

Large for Gestational Age- birth weight is at or above the 90th percentile on the intrauterine growth curve (at any wk of gestation)

Front 37

Some causes for LGA

Back 37

genetic predisposition,
multiparous women,
male infants

Front 38

Problems that LGA babies present with?

Back 38

more breech and shoulder presentations due to size, have more brome clavicles, brachial palsy, and facial palsy.

Front 39

Common complications of LGA

Back 39

birth trauma,
increased incidence of C-sections,
Hypoglycemia,
polycythemia,
hyperviscosity

Front 40

AGA

Back 40

Appropriate for Gestational Age- infants are those between the 10th percentile and 90th percentile growth curve.

Front 41

Nulligravida

Back 41

a woman who has never been pregnant

Front 42

Primigravida

Back 42

a woman who is pregnant for the first time

Front 43

Intrapartum

Back 43

time from onset of labor until the birth of the infant and placenta

Front 44

Antepartum

Back 44

Time between conception and onset of labor, usually used to describe the period during which a woman is pregnant; used interchangeably with prenatal

Front 45

Gestation

Back 45

number of weeks since the first day of the alt menstrual period(LMP)

Front 46

Abortion

Back 46

birth that occurs before the end of 20 weeks gestation

Front 47

Term

Back 47

normal duration of pregnancy 38-42 weeks gestation

Front 48

Preterm or premature labor

Back 48

labor that occurs after 20 weeks but before 37 weeks

Front 49

Postterm labor

Back 49

after 42 weeks

Front 50

Para

Back 50

birth after 20 weeks, regardless of born alive or dead

Front 51

Nullipara

Back 51

woman who has not given birth at more than 20 weeks gestation

Front 52

Primipara

Back 52

one birth >20 weeks regardless of alive or dead

Front 53

Multipara

Back 53

two or more births >20 wks

Front 54

Stillbirth

Back 54

fetus born dead after 20 wks gestation

Front 55

Mc Donald’s Method

Back 55

used as an indicator of uterine size. The fundal height in cm is equal to wks of gestation; it occurs between 22-34wks gestation.

Front 56

Fundal height, or McDonald's rule, is a measure of.... and is used to assess...

Back 56

measure of the size of the uterus used to assess fetal growth and development.

Front 57

How to measure fundal height

Back 57

measured from the top of the mother's uterus to the top of the mother's pubic bone in centimeters.

Front 58

Measuring the fundal height can be an indicator of...

Back 58

proper fetal growth and amniotic fluid development

Front 59

When is fundal height no longer accurate as a measure of gestational age?

Back 59

Inaccurate during 3rd trimester because the fetus is growing more in wt than in height.

Front 60

What happens to the intraocular pressure in mom during pregnancy?

Back 60

Intraocular pressure DECREASES due to increased vitreous outflow.

Front 61

What happens to moms corneas during pregnancy?

Back 61

Slight thickening of the cornea occurs due to fluid retention. If the woman wears contact lenses she may notice that her normally comfortable lens now are bothersome

Front 62

Do the cornea changes ever disappear for mom after pregnancy?

Back 62

Yes- Cornea changes disappear by 6 wks postpartum

Front 63

How much growth does the uterus go through during pregnancy (in grams)?

Back 63

Before pregnancy- 60 g
End of pregnancy- 1000 g

Front 64

How much change in capacity does the uterus go through during pregnancy (in mLs)?

Back 64

Capacity increases from 10 ml to 5000 ml

Front 65

What happens to the fibrous connective tissue in the uterus during pregnancy?

Back 65

Amount of fibrous tissue between the muscle bands increases markedly

Front 66

What happens to myometrial cells during pregnancy?

Back 66

Increase in size by hypertrophy

Front 67

What causes the uterine walls to thicken during pregnancy?

Back 67

estrogen and progesterone initially and after 3 months the fetus and contents begin to exert pressure on the uterus.

Front 68

How does the uterus primarily grow during pregnancy?

Back 68

At the funds- so it grows up. This can cause mom trouble breathing by the end of pregnancy!

Front 69

Because the uterus grows primarily at the fundus, what happens to the uterine walls?

Back 69

The upward growth causes thinning of the walls. At full trim, the wall is about 5mm thick

Front 70

What happens to the circulation to the uterus during pregnancy?

Back 70

Circulatory requirements increase- size and number of blood and lymphatic vessels increase
By the end of pregnancy 1/6th of total maternal blood volume is contained in the uterus

Front 71

What do Braxton Hicks do for circulation through the uterus?

Back 71

Stimulate the movement of blood through the intervillous spaces of the placenta. They occur intermittently during pregnancy but they increase in last 4 months and may be misidentified as contractions by client.

Front 72

At about the 8-10 week of gestation the bimanual pelvic exam will document...

Back 72

an enlarged and softened uterine body.

Front 73

Where should the fundus be at 10-12 weeks gestation?

Back 73

just above the symphysis pubis

Front 74

Where should the fundus be at 20 weeks gestation?

Back 74

at the umbilicus

Front 75

During pregnancy, the cervix softens, increases in cell number, and forms the mucus plug. What causes all this?

Back 75

Estrogen stimulating the glandular tissue of the cervix

Front 76

Goodell’s sign

Back 76

Softening of the cervix

Front 77

Chadwick’s sign

Back 77

Blue purple discoloration of the cervix- normal and expected during pregnancy- can be seen during an internal exam

Front 78

What causes increased vascularization of the cervix during pregnancy?

Back 78

hypertrophy and engorgement of the vessels below the growing uterus.

Front 79

Do the ovaries produce ovum during pregnancy?

Back 79

no

Front 80

What happens to the vagina during pregnancy?

Back 80

The vagina undergoes thickening of the mucosa and loosing of the connective tissue. Vaginal secretions increase, being acidic and this helps prevent vaginal infections. All this is In preparation for the delivery of the infant.

Front 81

What causes the increase in breast size and nodularity in women during pregnancy?

Back 81

The in crease in production of progesterone and estrogen causes glandular hyperplasia and hypertrophy. Mom is getting ready for lactation as soon she misses her first menses.

Front 82

By the end of the second month of pregnancy, what are visual changes of the breast?

Back 82

superficial veins are prominent, nipples are more erectile, and pigmentation of areola is obvious especially in dark skin women.

Front 83

During pregnancy, what maintains the suppleness of the areola?

Back 83

Hypertrophy of Montgomery’s follicles (sebaceous glands) inside the areola

Front 84

Breast/ skin changes in the pregnant woman- what are striae?

Back 84

purplish stretch marks that slowly turn silver after childbirth may develop. These are due to the increase in size of the breasts and streatching of skin

Front 85

What is colostrum?

Back 85

An antibody-rich yellow secretion that may be expressed manually by the 12th week and may leak from the breasts during the last trimester

Front 86

When does colostrum convert to mature milk?

Back 86

in the first few days following childbirth

Front 87

During pregnancy, what happens to oxygen consumption during weeks 16-40?

Back 87

Consumption increases approximately 15-20% to meet the increased needs of mom and fetus and placenta. (respiratory rate does not change significantly.)

Front 88

What happens to vital capacity in mom during pregnancy?

Back 88

30 to 40% increase in the vital capacity, which is the volume (the amount of air inspired and expired with each breath.)

Front 89

What happens to mom's diaphragm during pregnancy and what is the effect on residual lung volume?

Back 89

Diaphragm is elevated due to the enlarging uterus and Descent of the diaphragm on inspiration becomes less possible. This decreases the functional residual capacity, which is the amount of air that remains in the lungs at the end of a normal expiration. It is decreased by 20%.

Front 90

What affect does progesterone have on tidal volume and blood PCO2?

Back 90

Progesterone works by directly stimulating the central respiratory system to increase tidal volume and decrease blood PC02

Front 91

What happens to the circumference of moms chest during pregnancy?

Back 91

Circumference of the chest may increase by as much as 6 cm. Increase is in the anterior and posterior and transverse diameter. Also rib flaring

Front 92

During pregnancy, Breathing changes from abdominal to _______

Back 92

thoracic

Front 93

What causes rhinitis and epitaxis during pregnancy?

Back 93

Due to estrogen-induced edema and vascular congestion of the nasal mucosa

Front 94

What affect does pregnancy have on location of mom's diaphragm and heart?

Back 94

Pressure of the diaphragm, due to the inability of the diaphragm to fully expand and the increasing intra-abdominal pressure, pushes the heart upward and to the left and rotating it forward- making it appear enlarged on x-ray

Front 95

Does pregnancy cause any EKG changes or heart murmers?

Back 95

No significant changes in EKG.
90% of pregnant women have a systolic heart murmur, which can be heard at 20 wks gestation and disappears shortly after delivery.

Front 96

What happens to blood volume during pregnancy?

Back 96

Blood volume progressively increases

Front 97

By the middle of the 3rd trimester, how much has blood volume increased?

Back 97

about 45% above non-pregnant levels.

Front 98

At term, cardiac output has increased, how much of the blood volume is gong to the uterus?

Back 98

about 20%

Front 99

Is there an increase in pulse for a pregnant mom?

Back 99

no increase or if any increase only 10-15 bpm

Front 100

What causes the decrease in systemic vascular resistance in pregnant women?

Back 100

increased hormonal activity relaxes smooth muscle, causing vessels to dilate and thus allowing the body to accommodate increased blood volume without pressure changes.

Front 101

Why is a decrease in systemic vascular resistance in pregnant women important?

Back 101

Because mom has a higher blood volume but still needs to maintain normal vessels pressures.

Front 102

What happens to blood pressure during pregnancy?

Back 102

Both systolic and diastolic BP decrease in first trimester by 5 to 10mm HG and begin to rise at 22-24 weeks returning to normal non-pregnant readings at term.

Front 103

What organs start to receive more blood flow during pregnancy?

Back 103

uterus and kidneys

Front 104

What are pregnant women at risk for postural hypotension?

Back 104

because of increased blood volume in the lower extremities and pressure on vena cava when the women are lying down. This pressure interferes with the returning blood flow and produces marked decrease in BP with dizziness, pallor and clamminess. Have women lay on left side.

Front 105

Why do pregnant women have an increase in erythrocyte levels?

Back 105

There is an increased need for iron. Increase in red cell mass up to 33% with iron supplements (those who don’t take supps only increase to 18%) The increase is necessary for oxygen transport.

Front 106

Why are pregnant women at risk for DVT?

Back 106

Fibrin level is increased by 40%,
Blood factors are increased,
Hypercoagulable state

Front 107

Why does anemia occur during pregnancy?

Back 107

the total plasma volume increases more than the total number of erythrocytes. This produces a drop in the hematocrit.

Front 108

What causes N/V during first trimester?

Back 108

Increase in hCG secreted by implanted blastocyst

Front 109

Why, during pregnancy, is gum tissue softened, leading to bleeding gums?

Back 109

Due to estrogen causing proliferation of blood vessels and connective tissue in the gums. They become soft and edematous. The tissue is friable and may bleed easily.

Front 110

Why are GI issues present during second half of pregnancy?

Back 110

Numerous GI problems due to pressure of growing uterus and smooth muscle relaxation due to elevated progesterone levels
Intestines are displaced laterally and posterior and the stomach superiorly

Front 111

Why does pregnancy cause heartburn?

Back 111

reflux of acidic secretions due to relaxation of the cardiac sphincter. Also the peristalsis of the esophagus decrease. Stomach is now higher due to growing fetus.

Front 112

What causes hemorrhoids during pregnancy?

Back 112

Pressure on vessels

Front 113

What causes urinary frequency and/or incontinence during pregnancy?

Back 113

The growing uterus puts pressure on the bladder
Tone of bladder is relaxed
Bladder normally convex becomes concave from the external pressure and retention capacity is reduced
Glomerular filtration rate and renal plasma flow increase

Front 114

Why are pregnant women more at risk for UTI?

Back 114

Dilatation of the kidneys and ureters may occur due to the lie of uterus- risk of UTI- more prominent on the right side due to lie of uterus.

Front 115

What causes increased urine flow and volume ,decreased serum BUN, creatinine, and uric acid levels during pregnancy?

Back 115

Glomerular filtration rate and renal plasma flow increase

Front 116

What can cause glucosuria during pregnancy?

Back 116

Due to GFR increase during pregnancy. The body’s inability to reabsorb all the glucose filtered by the glomeruli.

Front 117

Chloasma

Back 117

"Pregnancy mask"-cheeks, forehead, and nose accentuated by sun exposure, more prominent in dark haired women, fades or least regresses after birth.

Front 118

Linea nigra

Back 118

dark line in the middle of the abdomen caused by hyper pigmentation

Front 119

What happens to the color of Areolae and nipples during pregnancy?

Back 119

darkened pigmentation that’s seen more pronounced in dark skinned women.

Front 120

Striae

Back 120

"Stretch marks" occur in about 50% of women and tend to be pinkish to purple lines that occur in the connective tissue due to elevated adrenal steroids. Tend to be a genetic disposition for this. Never completely disappear but become silver-whitish marks.

Front 121

Vascular spider nevi

Back 121

on chest, neck, face, arms, and legs small bright red elevations of the skin radiating from the central body, due to subcutaneous blood flow in response to estrogen occur about 8 to 20 weeks of gestation

Front 122

What happens to rate of hair growth during pregnancy?

Back 122

Rate of hair growth may decrease follicles go into resting phase. After birth increases but moms may notice hair loss

Front 123

What happens to pregnant mom's gait and whta causes the change?

Back 123

Waddling gait- due to the hormone relaxing the ligaments in the pubic symphysis and sacroiliac joints soften.

Front 124

What may show on X-ray of pubic symphysis during pregnancy?

Back 124

Slight separation

Front 125

What happens to center of gravity during pregnancy?

Back 125

Center of gravity changes the lumbodorsal spinal curve is accentuated, posture changes to compensate for the uterus- (lordosis) gives low backache parasthesias in late pregnancy due to pressure on peripheral nerves. Falls are common. Need to wear supportive shoes.

Front 126

What happens to mom's metabolic rate during pregnancy?

Back 126

Metabolic functions accelerate during pregnancy to support fetus mother must meet own tissue needs and those of the fetus.

Front 127

What is normal wt gain during pregnancy?

Back 127

25-35 lb for those of normal wt.

Front 128

What is recommended wt gain for overweight moms?

Back 128

15-25lbs

Front 129

What is recommended wt gain for underweight moms?

Back 129

28-40lbs

Front 130

How much weight gain during 1st trimester?

Back 130

3.5 to 5 lbs

Front 131

How much weight gain during 2nd and 3rd trimester?

Back 131

12 to 15lbs

Front 132

During pregnancy, mom undergoes 4 major psychologic tasks:

Back 132

1.Ensuring safe passage through pregnancy, labor and birth
2.Seeking acceptance of child by others
3.Seeking commitment and acceptance of herself as mother to the infant
4.Learning to give of oneself on behalf of one’s child

Front 133

What happens to thyroid during pregnancy?

Back 133

increases in size and activity- some think this is in response to high estrogen levels. These complex interactions effect the BMR increases by as much as 20-25%

Front 134

What happens to Pituitary during pregnancy?

Back 134

enlarges especially the anterior, which suppresses the hormones for ovulation and stimulates the production of prolactin, which increases breast development. It also stimulates the hypothamus to produce oxytocin but it is stored & released in the pituitary later for uterine contractions. Also releases vasopressin to cause vasoconstriction, which helps with water balance.

Front 135

What happens to Parathyroid during pregnancy?

Back 135

enlarges paralleling the fetal calcium & phosphorus requirements. Reaches highest concentrations 15-35 weeks returns to normal after birth

Front 136

What happens to Adrenals during pregnancy?

Back 136

little structural change- increased cortisol levels which effect renal excretion and carbohydrate and protein metabolism. Aldostrone is also increased and thought to protect the pregnant mom from excessive sodium losses.

Front 137

What happens to Pancreas during pregnancy?

Back 137

increased insulin needs- increase in number and size of beta cells.

Front 138

What happens with hCG (human chorionic Gonadatropin) during pregnancy?

Back 138

tissue surrounding the embryo secretes in early pregnancy, this hormone is responsible for the secretion of progesterone and estrogen to maintain the pregnancy until the placenta can take over.

Front 139

What happens with hPL (human chorionic Gonadatropin) during pregnancy?

Back 139

antagonist of insulin- increase amount of circulating free fatty acids for maternal metabolic needs and decreases maternal metabolism of glucose to favor fetal growth

Front 140

What does Estrogen do during pregnancy?

Back 140

Estrogen stimulates uterine development, develops the ductal system of the breasts increases blood flow to the uterus by promoting vasodilatation. Changes the sensitivity of the respiratory system to C02, softening of the cervix, estrogen increases rapidly during early pregnancy and starts to slow between 24-32 weeks.

Front 141

What does Progesterone do during pregnancy?

Back 141

maintains the endometrium inhibits spontaneous uterine contractility preventing abortion, develops the acne and lobules of breast for lactation.it is responsible for getting uterus ready for implantation. it is responsible for getting uterus ready for implantation. Relaxing inhibits uterine activity, diminishes the strength of uterine contractions, aid in the softening of the cervix,