Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
123 Cards in this Set
- Front
- Back
|
What are basic screening tests performed during pregnancy?
|
Pap smear
U/A- proteins, ketones, glucose, bacteria Complete blood count Rubella titer ABO and Rh typing Hepatitis B screen VDRL: Syphilis and gonorrhea screening |
|
|
Why is a pap smear performed during pregnancy?
|
To show if there are atypical cervical cells present
|
|
|
Why are urinalysis tests performed during pregnancy?
|
To screen for asymptomatic bacteria
|
|
|
What is an alpha-fetoprotein test?
|
A test to Screen for chromosomal anomolies and neural tube defects
|
|
|
Why are 1-hr 50g GTT performed at 24-28 weeks of pregnancy?
|
To detect gestational diabetes
|
|
|
What is a Group B strep test performed at 35 to 37 weeks of pegnancy?
|
Because there is a huge risk of passing it onto baby during birth and it can cause serious problems for the newborn.
|
|
|
Mom has a sudden gush of fluid from vagina during pregnancy, what can this be a dangerous sign of?
|
PROM
|
|
|
Mom has vaginal bleeding during pregnancy, what can this be a dangerous sign of?
|
Abrupto placentae, placenta previa
Lesions of cervix or vagina "bloody show" |
|
|
Mom has abdominal pain during pregnancy, what can this be a dangerous sign of?
|
Premature labor
|
|
|
Mom has a fever >101 and chills during pregnancy, what can this be a dangerous sign of?
|
infection
|
|
|
Mom has dizziness, blurry vision, double vision, or spots before eyes during pregnancy, what can this be a dangerous sign of?
|
HTN, preeclampsia
|
|
|
Mom has persistent vomiting during pregnancy, what can this be a dangerous sign of?
|
Hyperemesis gravidarum
|
|
|
Mom has severe headache during pregnancy, what can this be a dangerous sign of?
|
HTN, preeclampsia
|
|
|
Mom has edema of hands, feet, legs, and face during pregnancy, what can this be a dangerous sign of?
|
preeclampsia
|
|
|
Mom has muscular irritability and convulsions during pregnancy, what can this be a dangerous sign of?
|
preeclampsia, eclampsia
|
|
|
Mom has epigastric pain during pregnancy, what can this be a dangerous sign of?
|
Preeclampsia
ischemia in major abdominal vessel |
|
|
Mom has oliguria during pregnancy, what can this be a dangerous sign of?
|
Renal impairment
decreased fluid intake |
|
|
Mom has dysuria during pregnancy, what can this be a dangerous sign of?
|
UTI
|
|
|
Mom has absence of fetal movement during pregnancy, what can this be a dangerous sign of?
|
maternal medication
obesity fetal death |
|
|
How often does mom have prenatal visits in the first 28 weeks?
|
Q 4 weeks
|
|
|
How often does mom have prenatal visits between 28 and 36 weeks gestation?
|
Q 2 weeks
|
|
|
How often does mom have prenatal visits after 36 weeks gestation?
|
Every week until birth
|
|
|
Rh incompatability occurs when
|
When mom is Rh - and dad is Rh +
|
|
|
What is Rh sensitization?
|
If you are Rh-negative, your red blood cells do not have a marker called Rh factor on them. Rh-positive blood does have this marker. If your blood mixes with Rh-positive blood, your immune system will react to the Rh factor by making antibodies to destroy it.
|
|
|
What happens when mom is Rh - and baby is Rh + in first pregnancy?
|
First baby usually not affected, blood mixes during delivery, so antibodies are not usually made until after that point, and baby is already out.
|
|
|
What happens when mom is Rh - and baby is Rh + in second pregnancy?
|
Antibodies made from the first pregnancy will attack the second babies RBCs
|
|
|
What happens to second Rh + baby if moms antibodies attack their RBCs?
|
Causes severe hemolytic disease, anemia or death
|
|
|
What antibodies are responsible for attacking the fetal Rh+ RBCs?
|
immune globlin G (IgG) anti-D antibody
|
|
|
What does IgG do to the Rh+ RBCs?
|
It coats the fetal RH + RBCs and causes hemolysis
|
|
|
What medication is given to mom to prevent the Rh antibody-antigen reaction?
|
RhoGAM
|
|
|
How does RhoGAM work?
|
It is an immunosuppressant that stops the IGG antibody
|
|
|
What type of product is RhoGAM?
|
A blood product
|
|
|
How much RhoGAM is given and when is it admin?
|
300 mcg within 72 hours of baby being delivered
Also given at 28 weeks gestation if mom has a positive coombs test, blunt trauma to the abdomen, or any other situation in which blood from the fetus and mother might have been exchanged. |
|
|
What is the Indirect coombs test?
|
Blood test taken on mother after delivery to determine the number of Rh + antibodies created
|
|
|
What is the direct coombs test?
|
Blood test taken on the infant after delivery to detect any antibody coated RH + RBCs
|
|
|
What does it mean if the infant has a positive direct coombs test?
|
The baby is at risk for hemolytic disease, must monitor
|
|
|
If baby's RBCs are coated in moms antibodies, we will see....
|
fetalhydrops and hemolysis of RBCs- so much so that the baby can die
|
|
|
What is done if baby has fetalhydrops and RBC hemolysis due to antibody-antigen reaction from Rh_-mom?
|
Perform a blood exchange transfusion
|
|
|
What is ABO incompatability?
|
when the mother is type O and the fetus is type A, B, or AB. The antibodies attack the fetus just as in Rh alloimmunization. It typically affects the first infant and does not affect subsequent births.
|
|
|
What is the treatment for ABO incompatablity in the newborn?
|
assess the newborn for signs of hyperbilirubinemia.
|
|
|
What is TORCH?
|
an acronym standing for
Toxoplasmosis Rubella Cytomegalovirus Herpes- all of which pose a grave threat to the fetus. |
|
|
What is Toxoplasmosis?
|
An infectious disease Caused by the protozoan Toxoplasma gondii
|
|
|
How is Toxoplasmosis contracted?
|
contracted and transmitted to the fetus by eating raw or undercooked meat, by drinking unpasteurized goat’s milk, or by contact with the feces of infected cats, either through the cat litter box or by gardening in areas frequented by cats
|
|
|
What are the S/S of Toxoplasmosis?
|
myalgia
malaise rash splenomegaly enlarged posterior cervical lymph nodes |
|
|
What are the mild side effects of Toxoplasmosis?
|
retinochoroiditis (inflammation of the retina and choroid)
may be the only recognizable danger, and it may not appear until adolescence or young adulthood |
|
|
What are severe side effects of Toxoplasmosis?
|
Severe neonatal disorders include convulsions, coma, microcephaly and hydrocephalus.
May die soon after birth- Survivors often blind, deaf, and severely retarded. |
|
|
Other Infections - Group B Streptococcus (GBS)
|
Bacterial infection found in the lower GI or urogenital tracts of pregnant women
|
|
|
How is GBS transmitted to the fetus?
|
in utero or during childbirth
|
|
|
Who is screened for GBS?
|
All women are screened at 35-37 weeks
|
|
|
How is GBS treated?
|
For vaginal births, if GBS positive, will receive IV antibiotic prior at the onset of birth.
|
|
|
S/E of GBS for infant?
|
pneumonia and overwhelming septicemia, long-term neurologic complications, meningitis
|
|
|
What is Rubella?
|
Infection of mother during pregnancy may be serious especially within first 20 weeks of pregnancy
|
|
|
Rubella AKA
|
German Measles
|
|
|
How is Rubella transferred to the fetus?
|
from mother through the bloodstream
|
|
|
When are the Greatest teratogenic effects of rubella on the fetus?
|
during the first trimester
|
|
|
What are the effects of Rubella if it occurs in the first trimester?
|
spontaneous abortion or serious abnormalities, such as heart damage, cataracts, and mental retardation
|
|
|
If Rubella infections occurs in the early second trimester what will the results be?
|
most often permanent hearing impairment, microcephaly which comes with mental retardation, or psychomotor retardation
|
|
|
Expanded Rubella Syndrome
|
may develop years after infection (Type 1 DM, sudden hearing loss, glaucoma, slow progressive encephalitis)
|
|
|
Cytomegalovirus (CMV) belongs to what virus group??
|
Herpes simplex virus group
|
|
|
What does CMV cause?
|
both congenital and acquired disorders
|
|
|
What is the Most frequent agent of viral infection in the human fetus?
|
Cytomegalovirus (CMV)
|
|
|
How is CMV transmitted to the fetus?
|
transmitted by asymptomatic women across the placenta to the fetus or by cervical route during birth
|
|
|
What is the result of CMV?
|
Can result in extensive intrauterine tissue damage that leads to FETAL DEATH
|
|
|
If fetus survives CMV what can the effects be?
|
SGA, microcephaly, hydrocephaly, cerebral palsy, or mental retardation; or in survival with no damage at all
|
|
|
What fetal tissues and organs are affected by CMV?
|
the blood, brain, and liver
|
|
|
What is HERPES SIMPLEX VIRUS (HSV-1/HSV-2)?
|
Sexually transmitted infection that can cause painful lesions in the genital area and cervix
|
|
|
How is HSV Transmitted to the fetus?
|
almost always occurs after the membranes rupture and the virus ascends or during birth through an infected birth canal
|
|
|
Can the baby be delivered vaginally if mom has HSV but no symptomatic outbreaks?
|
Yes, however she runs the risk of infecting the baby still. There could be asymptomatic outbreak present.
|
|
|
What is the risk for baby if delivered vaginally with HSV outbreak?
|
Can cause blindness
Devastating neuroencephalitis damage- fatal |
|
|
Drug addicted neonates are at risk for :
|
• Respiratory distress
• Jaundice • Congenital anomalies & growth restriction (especially if drug was a vasoconstrictor) • Behavioral abnormalities (jittery, sleep/wake patterns altered, don’t want to be touched)(try to cluster activity to avoid multiple interventions) • SGA birth weight |
|
|
What is a high Pitched Cry a sign of?
|
Neonatal drug addiction
|
|
|
Babies born addicted to drugs get what type of medications?
|
Phenobarbital to wean from drugs- they are going through withdrawal
|
|
|
What are long term effects of babies born addicted to drugs?
|
motor, language, feeding problems
|
|
|
Babies born addicted to drugs are at high risk for what?
|
meconium aspiration
|
|
|
For mom with diabetes, what happens to the need for insulin during the first trimester?
|
Need for insulin decreases- eating less morning sickness,
|
|
|
What happens to stores of glycogen in early pregnancy?
|
Stores of glycogen increase in liver and other tissues
|
|
|
For mom with diabetes, what happens to the need for insulin during the second half of pregnancy?
|
Need for insulin quadruples
|
|
|
Why does the need for insulin increase over the second half of pregnancy?
|
There is increased resistance to insulin and decreased glucose tolerance resulting in a diminished effect of insulin
|
|
|
For pregnant moms with DM, what do we want their fasting 95 postprandial levels to be after 2 hours?
|
120
|
|
|
Why do we often see glucose in the urine of DM moms during pregnancy?
|
The renal threshold for glucose decreases
|
|
|
DM may be more difficult to control during pregnancy because...
|
N/V may cause changed access to glucose)
Increased energy needs |
|
|
What is the BS goal range for maternal glucose?
|
TIGHT CONTROL!
95-120 |
|
|
Why may mom experience hydramnios during pregnancy if she is diabetic?
|
baby is in a high glucose environment- has hyperglycemia syptoms- one is polyuria which causes hydramnios
|
|
|
What are maternal risks associated with DM?
|
Hydramnios- inc amniotic fluid (can be inc 20%)
Pregnancy-induced hypertension (PIH) Preeclampsia Ketoacidosis Dystocia- difficulty with labor monilial vaginitis - d/t high sugar environemnt attracts bacteria inc change for infections Urinary tract infections Retinopathy |
|
|
What is monilial vaginitis?
|
a fungal infection in the vagina caused by Candidia yeast
|
|
|
What may DM moms be at higher risk for monilial vaginitis during pregnancy?
|
d/t high sugar environemnt attracts bacteria increases chance for infections
|
|
|
Why do moms with DM tend to have more dystocia?
|
More painful birth due to LGA baby- difficult deliveries
|
|
|
Are babies born to diabetic mothers usually SGA, AGA, or LGA?
|
Large for gestational age (LGA)- because they had all that sugar
|
|
|
What congenital anomaly is common when baby is born to parents that both have DM?
|
sacral agenesis- lumbar spine and sacrum fail to develop
(can also have cardiac, CNS, and skeletal anomalies) |
|
|
Why is there more risk for birth trauma for DM moms?
|
The babies are very large- lots of trauma when coming out
|
|
|
Why are babies born to moms with DM at high risk for hypoglycemia after birth?
|
because they are used to a high sugar environment that has now been cut off
|
|
|
Why are babies born to moms with DM at high risk for IUGR?
|
d/t vascular problems from DM- reduced blood flow from placental site, not enough nutrients, baby cannot grow. Also, increased amniotic fluid causes less room for growth
|
|
|
Why are babies born to moms with DM at high risk for RDS?
|
fetal insulin will interfere with fetal enzymes responsible for surfactant production
|
|
|
Why are babies born to moms with DM at high risk for Polycythemia?
|
moms RBC does not have enough affinity for O2 so baby will produce more RBS in order to get enough O2 from mom
|
|
|
Why are babies born to moms with DM at high risk for Hyperbilirubinemia?
|
It is second to Polycythemia- so many RBCs that as the RBCs die it will result in Hyperbilirubinemia. Also can occur from birth trauma and bruising
|
|
|
Babies born to DM moms are put on what type of protocol?
|
hypoglycemia protocol, ESPECIALLY 2-4 HRS AFTER BIRTH their blood sugar can drop significantly.
|
|
|
What BS level require glucose for newborns?
|
<40
|
|
|
What are the two screening tests for Gestational Diabetes?
|
Urine testing and
50 g glucose tolerance test |
|
|
We want pregnant mom's Blood sugar to be under what level for the 50 g oral glucose tolerance test?
|
Under 140
|
|
|
If moms sugar levels are not under 140 for the 50 g glucose tolerance test, what test is next?
|
3 hour glucose tolerance test
|
|
|
What is the 3 hour glucose tolerance test?
|
A test to diagnose gestational diabetes- test performed after "failing" the 50 g oral glucose tolerance test.
Mom takes high levels of carbs for 3 days, overnight fast, and takes 100g of glucose - glucose should be 140 after 3 hours |
|
|
Why is AFP screening performed for moms with diabetes?
|
Because pregnancies complicated by diabetes are at increased risk of neural tube defects
|
|
|
What happens to insulin requirements during labor for moms with diabetes?
|
During labor insulin requirements decrease will be a sliding scale to cover mom
|
|
|
What happens to insulin requirements for mom 24 hr after giving birth?
|
Little needed, mom used all of her sugar and energy stores for the birthing process. mom is on a sliding scale.
|
|
|
How is most gestational diabetes controlled?
|
diet and exercise
|
|
|
If mom with DM did not need insulin pre pregnancy, will she most likely need it post pregnancy?
|
No
|
|
|
How is BS checked on a newborn?
|
heel stick
|
|
|
What is given for a baby with Blood Sugar less than 40?
|
Formula or IV dextrose
|
|
|
What are S/S of hypoglycemia on a newborn?
|
Lethargy
Poor feeding Jitteriness, tremors, jerkiness, seizures, Vomiting Pallor Apnea Respiratory distress High pitched cry |
|
|
What is the best treatment for newborn hypoglycemia?
|
early feeding.
|
|
|
If hypoglycemia in a newborn is left untreated, what can happen?
|
permanent CNS damage or death can occur
|
|
|
Why would we also give corticorsteroids to hypoglycemic newborn?
|
to enhance gluconeogenesis from protein source
|
|
|
When do we screen newborn blood sugars?
|
within 1st 30 minutes to 2 hours after birth
|
|
|
____ intervention is critical for newborn hypoglycemia!
|
early
|
|
|
If giving newborn parenteral glucose, how should it be administered?
|
Give slowly to prevent rebound hypoglycemia.
|
|
|
What is Polyhydramnios
|
increase amount of amniotic fluid > 2000ml
|
|
|
What does polyhydramnios cause in the fetus?
|
causes fetal malformation, specifically a swallowing problem
|
|
|
What are possible causes of polyhydramnios?
|
congenital anomalies
multiples (twins, etc) gestational diabetes Rh Sensitization malformatios of fetal swallowing |
|
|
Why does gestatinoal diabetes cause polyhydramnios?
|
hyperglycemia of fetus resulting in increased urination causing an increase amount of fluid
|
|
|
What is Oligohydramnios?
|
severe decrease in amniotic fluids and concentration of that fluid, < 500ml
|
|
|
What may be some fetal causes of Oligohydramnios?
|
Renal malformation, renal UTI,uteroplacental insufficiency
|
|
|
Why would fetal renal malformation or UTI cause Oligohydramnios?
|
Fetus not urinating as they should resulting in an insufficient amount of amniotic fluid.
|
|
|
What are the causes of Oligohydramnios?
|
Dehydration of mom
uteroplacental insufficiency Post Term baby Dysfunctional labor with slow progress cord compression/ short cord |
