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325 Cards in this Set
- Front
- Back
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which hormone is responsible for maintaining pregnancy (i.e. keeping the uterine lining thick)?
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Progesterone
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what are the 4 classic pelvic shapes?
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gynecoid
anthropoid android platyelloid |
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Which pelvic shape is characterized by A-P ellipse and has it's biggest dimension in the A-P plane?
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anthropoid
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which pelvic shape is considered the classic shape of the pelvic outlet, the classic female shape, "a big circle", biggest in the A-P and M-L dimensions?
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gynecoid
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which pelvic shape is flat or kidney shaped and has it's biggest dimension M-L?
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platypelloid
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which pelvic shape is triangular, base is the sacrum and the classic male shaped pelvis?
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android
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what is the deepest layer of the pelvic floor?
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pelvic peritoneum
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what is the most superficial layer of the pelvic floor?
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deep muscle layer
the muscle that forms a figure 8 - levator ani mm group and the pubo-coccygeaus mm |
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what are the 4 layers of the pelvic floor from deepest to most superficial
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pelvic peritoneum
pelvic fascia ligamentous support deep muscle layer |
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what are the components of the pelvic ligamentous support?
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transverse cervical ligament
uterosacral ligament pubocervical ligament round ligament |
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which layer of the pelvic floor is a double layer that folds to form the broad ligament?
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the deepest, the pelvic peritoneum
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which layer of the pelvic floor is in between organs to keep them from rubbing?
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pelvic fascia
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which ligament attaches from the lateral edge of the cervix to the pelvic wall?
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transverse cervical
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which ligament attaches from the posterior cervix and splits to go around the rectum & attaches to the sacrum?
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Uterosacral ligament
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which ligament attaches from the anterior cervix to the pubic arch?
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Pubocervical
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This ligament bisects the broad ligament & attaches to the top of the uterus (the fundus) - it bisects the broad lig and goes posterior in the inguinal canal & has fibers which end up in the labia minora/majora
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the round ligament
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which muscles are the deep muscle layer of the floor of the pelvis and form a figure 8?
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levator ani and pubococcygeus mm's
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what is an egg called when it's in the period from fertilization until villi appear? Approx 12-14 days gestation?
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ovum
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what is it called when it is in the period from ovum until the embryo measures approx 3 cm from crown to rump - about 54-56 days?
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embryo
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what is a fetus?
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from embryo stage until the pregnancy is completed - birth
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how do we measure birth rate?
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# births/1000 population
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how do we measure infant mortality rate?
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# death/1000 live births
death before age 1 |
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How is Maternal mortality rate measured?
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# deaths/100,000 live births
any cause of death during pregnancy or within 42 days |
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what is the hormone that produces ligamentous laxity.
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relaxin
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T/F Relaxin can lead to unstable SI joints, progressive lumbar lordosis and displacement of center of gravity
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True
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T/F Relaxin makes it easier to adjust pregnant women but makes it more difficult for them to hold their adjustments
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True
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When do pregnant women begin producing relaxin and for how long?
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it can be produced at 6-8 weeks of pregnancy but it can continue to be produced 6 months afterwards.
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what is the first recognition of fetal movements by the mother called?
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quickening
(like bubbly yeast |
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when is quickening usually first felt?
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16-18 weeks
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what is the decent of fetus partially into the pelvis known as? when would you expect this?
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lightening
usually 2-3 weeks prior to birth in the first pregnancy |
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this is a softening of the cervix and lower 1/3 of the uterus that is found on palpation
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Hegar's sign
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this is a bluing of the cervix and the upper 1/3 of the vagina and is observed upon inspection with the speculum
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Chadwick's sign
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T/F Hegar and Chadwicks signs can happen in some women simply upon the cycle of menstration
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true
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softening of the cervix is known as
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effacement
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opening of the cervix is known as
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dilation
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how is the interval of contractions defined?
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the time from the start of one contraction to the start of another
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at what interval do we consider contractions to be active labor?
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5 minutes
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at what interval is it usually time to push?
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3 minutes
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define the duration of uterine contractions?
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the time elapse during the entire contraction
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at what duration do we consider labor to be active?
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60-90 seconds
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at what duration do we push?
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60 seconds at push
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the amplitude of contractions is known as
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intensity
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the initial presentation of the fetus's presenting part is known as
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crowning
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aka for the first pregnancy is
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primagravada
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what is it called if a women over 35 is pregnant for the first time?
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elderly primagravada
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a women who has had more than one but less than 5 pregnancies is known as
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multigravada
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a woman who has had more than 5 pregnancies is said to be
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Grand-multigravada
record is 69 |
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what are 5 systems that have maternal adaptations to pregnancy?
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Circulatory
Respiratory GI GU Metabolic/endocrine |
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what are the maternal adaptations of the circulatory system?
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1. blood volume is increased 45% (RBC's and plasma)
2. which leads to a dilution of the blood which may predispose her to anemia and cause her to be low in clotting factors - takes a couple weeks to catch up 3. 25-50% increase in cardiac output-heart has to work harder 4. Presence of heart murmurs in 3rd trimester 5. cutaneous vascular changes - red palms and soles and vascular spiders |
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what might a pregnant women experience in the 1st trimester as a result of her circulatory system adapting to pregnancy?
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nose bleeds and bleeding gums
and varicose veins |
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why would you see heart murmurs in the 3rd trimester of pregnancy?
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because of the enlarged uterus pushing on the diaphragm which changes the configuration of the heart and causes the murmurs
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what hormone is responsible for circulatory adaptaions during pregnancy?
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Estrogen
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what changes/adaptations will you see in the respiratory system during pregnancy?
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increased rate of respiration and an increase in the A-P diameter of the chest.
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what hormone causes the increased A-P diameter in the chest during pregnancy?
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relaxin
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what are pulmonary function studies? what did they tell us?
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an umbrella for: tidal volumes, residual volumes etc.
they showed that pregnant women experience shortness of breath during their 3rd trimester due to the pressure of the uterus on the diaphragm. |
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which hormone is responsible for the changes and adaptations in respiratory system during pregnancy?
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progesterone
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what are the GI adaptations during pregnancy?
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decrease in smooth mm tone, decreased motility, decreased glandular and mucosal secretions.
heartburn and indigestion are common Constipation and hemmoroids |
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why do pregnant women commonly get hemmoroids?
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because of the increased blood pressure and increase in constant pressure of the fetus on the blood vessels causing the irritation.
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what hormone is primarily responsible for the GI adaptations during pregnancy?
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progesterone
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What are the GU adaptations during pregnancy?
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Increased GFR by 50 % ** Most important
INcreased vaginal discharge which becomes acidic |
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what is the significance of an increased GFR during pregnancy?
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this means the kidneys are working harder
it would not be unusual to have some glucose spill out into the urine during pregnancy as a result of this glucose in the urine predisposes women to bladder and kidney infections which can cause premature labor |
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what is the hormone responsible for the GU adaptations during pregnancy?
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progesterone
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what are the primary glands affected by the metabolic/endocrine adaptations during pregnancy?
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increase in thyroid, adrenal and pituitary gland
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what hormone is responsible for the metabolic changes during pregnancy?
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estrogen
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what is "the mask of pregnancy" and what causes it?
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a rash in a malar pattern (butterfly) on the face known as Chloasma
caused by an increase in melanocyte stimulation hormone |
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what is the dark line that sometimes appears from the umbilicus to the pubic arch called and what causes this?
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Linea nigra
melanocyte stimulating hormone |
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what happens to the anterior pituitary during pregnancy?
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it increases 2-3 times it's normal size
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what is anterior to the anterior pituitary gland?
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optic chiasm
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what happens to the optic chiasm during pregnancy?
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since it is anterior to the anterior pit, and the anterior pit increases to 2-3 times it's normal size it puts pressure on the optic chiasm. This results in visual changes during pregnancy
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what type of vision changes are typical during pregnancy?
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Tunnel vision
she said something about this not being typical in a certain trimester but i didn't get all of it... |
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what is the minimal weight gain during pregnancy for an average normal woman
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20 pounds
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what is the average weight gain during pregnancy?
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25-30 pounds
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what is the majority of the weight gain in pregnancy?
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fetus - 7.75 pounds
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what is second largest contributor to pregnancy weight gain?
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increased blood volume = 4 pounds
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interstitial body fluid is how many pounds to pregnancy weight?
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3 pounds
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maternal fat is waht portion of pregnancy weight?
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3.5 pounds
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what is the rule that is used to calculate/determine the due date?
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Nagel's rule
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what are the primary glands affected by the metabolic/endocrine adaptations during pregnancy?
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increase in thyroid, adrenal and pituitary gland
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what hormone is responsible for the metabolic changes during pregnancy?
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estrogen
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what is "the mask of pregnancy" and what causes it?
|
a rash in a malar pattern (butterfly) on the face known as Chloasma
caused by an increase in melanocyte stimulation hormone |
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what is the dark line that sometimes appears from the umbilicus to the pubic arch called and what causes this?
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Linea nigra
melanocyte stimulating hormone |
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what happens to the anterior pituitary during pregnancy?
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it increases 2-3 times it's normal size
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what is anterior to the anterior pituitary gland?
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optic chiasm
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what happens to the optic chiasm during pregnancy?
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since it is anterior to the anterior pit, and the anterior pit increases to 2-3 times it's normal size it puts pressure on the optic chiasm. This results in visual changes during pregnancy
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|
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what type of vision changes are typical during pregnancy?
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Tunnel vision
she said something about this not being typical in a certain trimester but i didn't get all of it... |
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what is the minimal weight gain during pregnancy for an average normal woman
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20 pounds
|
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what is the average weight gain during pregnancy?
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25-30 pounds
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what is the majority of the weight gain in pregnancy?
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fetus - 7.75 pounds
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what is second largest contributor to pregnancy weight gain?
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increased blood volume = 4 pounds
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interstitial body fluid is how many pounds to pregnancy weight?
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3 pounds
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maternal fat is what portion of pregnancy weight?
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3.5 pounds
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what is the rule that is used to calculate/determine the due date?
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Nagel's rule
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how is the pregnancy due date calculated using Nagel's rule?
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date of last menstrual period plus 7 days and subtract 3 months
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what is EDC?
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Expected date of confinement
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T/F darkening of the areola nipple and elevation of tine glands around nipple that occur in the first trimester are a PROBABLE sign that you are pregnant
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False - POSSIBLE sign
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POSSIBLE signs of pregnancy
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amenorrhea (entire preg)
morning sickness (2-7 wks) frequent urination (6-12 wks) tingling, tender, swollen breasts (few days after) changes in color of vagina and cervical tissue (1st tri) darkening of areola around nipple and elevation of tine glands aroung nipple (1st tri) blue and pink lines under skin on the breast and later on the abdomen/thighs (lst tri) food cravings (1st tri) darkening line from navel to pubis (4th or 5th month) |
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POSSIBLE signs of pregnancy
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Frequent urination
b. tingling, tender swollen breasts c. changes in color of vaginal/cervix tissue d. food cravings |
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T/F Blue and pink lines under skin on the breast and later on the abdomen/thighs that occur in the 1st trimester are possible signs of pregnancy
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True
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T/F a darkening line from the navel to the pubis is a probable sign of pregnancy
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False - possible
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PROBABLE sign of pregnancy
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a. softening of the uterus and cervix
b. enlarging uterus and abdomen c. intermittent painless contractions d. fetal movements |
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softening of the uterus usually occurs at
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2-8 weeks after conception
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enlarging of the uterus usually occurs at
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8-12 weeks
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when do intermittent painless contractions usually occur?
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early in pregnancy and increase in frequency
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fetal movements are first noted at how many weeks?
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14-20
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what else besides pregnancy can elevate a HCG level?
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teratoma
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T/F an elevated HCG level is a possible sign of pregnancy
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false PROBABLE
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there are only 3 POSITIVE signs of pregnancy, what are they and when do they occur?
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1. auscultation of the fetal heart beat - 10-20 weeks
2. palpation of fetal movement BY EXAMINER - 16 weeks 3. visualization of the fetus using ultrasound - 4-6 weeks after conception |
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what are the 3 conditions of the placenta?
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1. placenta previa
2. placenta abruptio 3. placenta acreta |
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which condition of the placenta relates to a placement issue?
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placenta previa
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where does the placenta implant in a normal pregnancy?
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upper 2/3 of the uterus
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where does the placenta implant in placenta previa?
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lower 1/3
and it can be a cause for a C-section if it covers the os |
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what is it called when there is a premature separation of the placenta?
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Placenta abruptio
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what are some probable causes of placenta abruptio? What is the mechanism of injury?
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MVA
tears begin between the placenta and the uterus |
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what is the modality of choice for confirmation of suspected placenta abruptio?
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ultrasound
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this condition of the placenta occurs after birth of the baby?
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Placenta acreta
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when does the placenta normally detach from the uterus?
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within 10-20 minutes after the birth of the baby
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what if the placenta stays embedded?
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the mother may hemorrhage and this can cause DIC = disseminating intravascular coagulation
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what should be done for placenta acreta?
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Doctor should gently scrape the placenta away from the uterus...
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What are the 4 functions of the placenta?
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1. nutritional through active transport
2. excretory 3. respiratory 4. endocrine |
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T/F placenta secretes hormones
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true
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waht is the difference between fetal hemoglobin and normal hemoglobin?
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fetal hemoglobin has 2x the affinity for oxygen
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what are the 4 terms that define the layers of the placenta?
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Amnion
Chorion Umbilical cord Wharton's jelly |
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which layer of the placenta is closest to the fetus?
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amnion
(A-B= Amnion is closer to Baby) |
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which layer of the placenta is closest to the mother?
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chorion
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what structure provides the sustenance to the fetus?
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umbilical cord
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how many veins/arteries compose the umbilical cord?
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2 umbilical arteries and 1 umbilical vein
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T/F it is uncommon to have altered variations in the arteries and veins of the umbilical cord
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False - a common variation is the absence of 1 umbilical artery
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absence of one of the umbilical artery predisposes the fetus to what other abnormalities? Why?
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increases the likelyhood of other GI abnormalities such as polycystic kidneys
because congenital abnormalities tend to run in clusters - so look for them |
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what substance keeps the umbilical cord distended?
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wharton's jelly
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what is the normal color of wharton's jelly
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clear
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This is replaced every 3 hours, is directly from maternal circulation and is diffused through the umbilical cord.
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amniotic fluid
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where is anmiotic fluid secreted?
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by the amnion
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how much amnionic fluid is normally present?
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800 cc (3.2 cups)
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T/F Once Anmiotic fluid is secreted by the amnion it is not replaced the entire pregnancy, until the water breaks
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False - it is replaced every 3 hours
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what is amniotic fluid composed of?
|
protein
creatinine urea uric acid glucose total lipids cholesterol phospholipids electrolytes hormones enzymes |
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what are the 7 functions of the amniotic fluid?
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1. protection from trauma
2. separates fetus from fetal membranes 3. allows freedom of movement and aids in muskuloskeletal development 4. facilitates symmetrical growth and development 5. protects from loss of heat and maintains constant temperature 6. source of oral fluid 7. excretion collection system |
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what are the components of the history that will be done on the first prenatal visit?
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Complete medical history
signs and symptoms social habits/life style exposure to teratogens |
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What exams will be done on the first prenatal visit?
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complete exam including vital signs
chest and abdomen exam leopold maneuver |
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what is the leopold maneuver?
|
an exam procedure involved in palpating the uterus and fetus
one hand stabilizes (@ the PS) & the other hand palpates @ the top of the uterus to determine the position of the fetus |
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what labs are done at the first prenatal visit?
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HCG
CBC UA Chemistry panel ABO typing Rubella titer VDRL (RPR) TB skin test PAP smear |
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why is a CBC done?
|
to rule out anemia and infections
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what is the VDRL? the RPR?
|
a blood test for screening of venereal diseases
RPR=reactive protein reagent for syphillis - syphillis can cross the placenta |
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what are 10 components of a urinalysis?
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color/odor
pH blood protein glucose ketones nitrite/bacteria bilirubin urobilinogen CASTS |
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|
this is caused by the german measles and if the mother is exposed to it in the first 10 weeks of pregnancy can cause major defects in cardiac, respiratory, GI and sensory functions of fetal development
|
Rubella syndrome
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What is ABO typing? what is done for this?
|
Rh- mom with a Rh+ baby will make antibodies to the Rh+ which will cause damage to the second fetus this is called erythroblastosis fetalis
|
|
|
Rhogam
|
is a drug that can be given to the mother after the first baby which will prevent her form making the antibodies against the next pregnancy
|
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what are the components of the CBC
|
RBC --> HgB/HCT which are "indices" = MCH/MCHC/MCV
WBC --> differential comes from this Platelets |
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what additional lab tests may be done at the first prenatal visit based on the history and exam findings?
|
HIV
Hepatitis Herpes Chlamydia Gonorrhea GTT=glucose tolerance test CXR=chest xray (a follow up to TB) |
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T/F most pediatric AIDS are caused by maternal transmission
|
true
|
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T/F Chlamydia and Gonorrhea can cause blindness in the new born infant
|
true
|
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what are 6 indications for a C-Section?
|
1. placenta previa
2. placenta abruptio 3. active herpes infection 4. breech 5. Cephalopelvic disproportion=CPD 6. multiple gestations |
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what are 5 things that may cause a false positive on the Alpha feto-protein screening test?
|
1. multiple gestations
2. miscalculated due date 3. fetal death 4. herpes infection 5. hepatitis |
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what are 6 indications for an amniocentesis?
|
1. maternal age over 35
2. already had a child with a chromosome abnormality 3. hx of neural tube defects 4. mother is a carrier of X linked disorder 5. both parents are carriers of autosomal recessive inherited disease 6. assess fetal lung maturity |
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The first time the mother can see the baby's "presenting part" is called
|
crowning
|
|
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the hormone responsible for ligamentous laxity during pregnancy is:
|
relaxin
|
|
|
which of the following is a reason for a cesearean section?
|
active herpes
|
|
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which of the following is not a positive sign of pregnancy?
|
positive HCG test
|
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the method of fetal karyotyping that requires the longest time for processing is
|
b. amniocentesis
2-3 weeks |
|
|
maternal physiology during pregnancy
|
b. intestinal motility is decreased
c. glomerular filtration rate is increased d. cardiac output is increased |
|
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function of the amniotic fluid
|
protects from direct trauma
|
|
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rectus diastasis is a contraindication for which of the following exercises?
|
abdominal crunch
|
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chloasma, the mask of pregnancy that consists of irregular brownish patches on a malar distribution, is due to an increase in which of the following substances
|
Melanocyte stimulating hormone
|
|
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it is common to find soft, blowing heart murmurs during pregnancy. This is due to
|
increased blood volume
|
|
|
maternal adaptation to pregnancy causes decreased GI motility, slows peristalsis and causes constipation. These changes are due to which of the following hormones?
|
progesterone
|
|
|
history finding in round ligament syndrome
|
a. occurs with sudden position changes
c. sharp shooting pain d. usually unilateral |
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|
the pelvic shape that is best suited for delivering babies is the
|
gynecoid
|
|
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A pregnant patient should do kegel exercise for all the following except
|
a. prevents need for episiotomy
b. makes birth of the baby easier c. increases blood flow to the perineum |
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pregnant patients with a history of _____ should avoid strenous exercise
|
incompetent cervix
|
|
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which of the following is the most superficial layer of the pelvic floor?
|
deep muscle layer
|
|
|
for a woman of normal body weight, the recommended weight gain during pregnancy would be
|
25 to 35 pounds
|
|
|
a process where the cervix and upper 1/3 of the vagina develops a bluish color is
|
chadwick's sign
|
|
|
postural changes during pregnancy?
|
b. change in the center of gravity
c. increased lumbar lordosis d. increased foot flare |
|
|
indication for a chorionic villus biopsy
|
b. history of chromosomal disorders
c. parent with sickle cell anemia d. maternal age greater than 35 years |
|
|
T/F placenta abruptio is a reason for a cesarean section
|
True
|
|
|
T/F nausea is most common in the third trimester of pregnancy
|
false
|
|
|
T/F the minimum weight gain during pregnancy for an average built female is 20 pounds
|
true
|
|
|
T/F alpha-fetoprotein (AFP) for chromosomal analysis requires the shortest time for processing of the fetal sample
|
true
|
|
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T/F dilation is the process in which the cervix softens during labor
|
false
|
|
|
T/F progesterone is the hormone responsible for ligamentous laxity during pregnancy and post partum
|
false
|
|
|
T/F the kegel exercise increases the blood flow to the perineum
|
true
|
|
|
T/F rectus diastasis is a contraindication for pelvic tilt exercises?
|
false
|
|
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T/F pregnant patients with a history of varicose veins should avoid strenous exercise
|
false
|
|
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T/F crowning is the first time the mother can see the baby's "presenting part"
|
true
|
|
|
T/F the infectious disease that can cross the placenta to the fetus is rubella
|
true
|
|
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T/F assessing fetal lung maturity is an indication for a chorionic villus biopsy
|
false
|
|
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T/F RBC, WBC, Platelets, HCG, HGB, and indices are the components of a CBC
|
true
|
|
|
T/F the gynecoid pelvic shape is the classic female shaped pelvis
|
true
|
|
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T/F one of the functions of the amniotic fluid is to protect against direct trauma
|
true
|
|
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T/F LDH would be found on a chemistry panel
|
true
|
|
|
T/F estrogen is the hormone responsible for the maternal cardiovascular adaptations to pregnancy
|
true
|
|
|
T/F during pregnancy, the glomerular filtration rate and cardiac output is increased
|
true
|
|
|
T/F once implantation of the ovum has occurred, the placenta produces HCG during pregnancy
|
true
|
|
|
T/F a positive HCG test is a positive sign of pregnancy
|
false
|
|
|
the best differential diagnosis for a pregnant patient in her 8th month with shortness of breath is
|
rib subluxation
|
|
|
premature separation of the placenta is called placenta ______
|
abruptio
|
|
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____ is a condition of pregnancy that is due to compression of the lateral femoral cutaneous nerve that causes pain into the upper anterior/lateral thigh.
|
meralgia paresthetica
|
|
|
define lab test
|
a test used to further evaluate some type of bodily substance, i.e. blood, saliva, mucous, urine, etc
|
|
|
define special test
|
a test that involves some type of specially trained technician or specialist to perform or interpret/evaluate the test
|
|
|
give 10 examples of lab tests
|
WBC
HCT MCV MCHC Bilirubin Cholesterol urinalysis glucose CBC RBC |
|
|
list 10 examples of special tests
|
LP
ECG NCV evoked potentials tensilon test ultrasound amniocentesis TB test AFP x-ray |
|
|
define referral
|
sending a patient to another health professional or provider for further evaluation or services
|
|
|
define consultation
|
meeting with a person with the intention of providing care or service for them directly
|
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|
components of a 5 pt management plan include
|
1. adjustments
2. physical therapy 3.nutrition 4. Education/ergonomics/lifestyle changes 5. referrals/consultations |
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true pelvis
|
inside the pelvic brim
|
|
|
false pelvis
|
above the pelvic brim
|
|
|
the most useful line of mensuration for determining the adequacy of a pelvis for birth
|
diagonal conjugate
|
|
|
use of x-ray to determine the dimensions/measurements of the pelvis
|
pelvimetry
|
|
|
compare and contrast the differences in the gynecoid vs. android pelvis
|
ischial tuberosities
ischial spines sacral angle pubic arch flarring of the ilia |
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|
5 pt management plan for round ligament syndrome
|
history -> change in position OPQRST=sharp shooting pain into the vagina - typically unilateral (not bilateral) tauter on palpation
1. adjust no more than 3x/week, reeval in 3 weeks; do not over adjust 2. PT - soft tissue work - most import.; can use hot/cold & superficial modalities; no electrical modalities; exercise (specific for pregnancy) and braces/supports 3. nutrition- check clacium = 1200 during pregnancy (leg cramps? intercostal mm spasms?) prenatal vitamins 4. education- what is it? ergonomics - how to get in/out of car, body mechanics, no sudden mvmts 5. referrals - consultations - midwife; obgyn; doula |
|
|
what is the most important muscle in the deep mm layer?
|
pubo coccygeal mm
contracts during kegel |
|
|
what are some pregnancy appropriate exercises?
|
walking
yoga stretches swimming kegels tailor sit |
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|
what should calcium intake be during pregnancy?
|
1200mg/day
|
|
|
T/F The hormone responsible for the maternal GI adaptations is progesterone
|
true
|
|
|
T/F the ovaries produce HCG during the entire pregnancy
|
false
|
|
|
T/F the broad ligament is formed by the pelvic fascia
|
true
|
|
|
T/F approx 3.2 cups (800 cc) of amniotic fluid is replaced every 6 hours. It comes directly from maternal circulation
|
false
|
|
|
T/F one of the functions of the placenta is to protect against direct trauma
|
false
|
|
|
T/F placenta previa can cause maternal hemorrhage because of retained portions of the placenta inside the uterus
|
False - (placenta acreta)
|
|
|
T/F the hormone used in ovulation prediction kits is FSH
|
False - HCG
|
|
|
T/F as described in class, a positive HCG test is a possible sign of pregnancy
|
false - probable
|
|
|
T/F MCV and MCHC would be findings on a chemistry panel
|
false - CBC
|
|
|
T/F Lightening is the first time the mother can feel the baby move
|
false - quickening
|
|
|
T/F Stage 2 labor is characterized by contractions that last 45-60 seconds, interval is 5 minutes, moderate intensity, complete dilation/effacement and delivery of the placenta
|
False - delivery of the placenta is stage 3
|
|
|
T/F chorionic villus sampling would indicate if a fetus had a neural tube defect
|
false
|
|
|
T/F of the 4 specific exercises that we discussed in class, the pelvic tilt exercise would be the most helpful for preparing a pregnant patient for the second stage of labor
|
true
|
|
|
T/F round ligament syndrome is most common in the 2nd trimester of pregnancy
|
false
|
|
|
T/F the round ligament syndrome and intercostal lower thoracic muscle spasms are associated with low levels of dietary magnesium
|
true
|
|
|
T/F risks of a breech birth include all of the following: intracranial hemorrhage, genital edema, fractured clavicle and a higher incidence of placenta previa
|
false
|
|
|
T/F when performing the Webster in-utero constraint technique, the chiropractor must have equilization of the leg resistance after the sacral adjustment before going on to the next step
|
true
|
|
|
T/F in the hospital setting, a certified nurse midwife (CNM) can perform any procedure that a family practice MD might perform during labor and delivery
|
true
|
|
|
T/F an episiotomy would most likely be performed during transition (stage 1-3rd phase)
|
False - episiotomy would be in stage II
|
|
|
T/F Braxton hicks contractions cause the cervix to dilate
|
false
|
|
|
T/F bleeding gums/nose bleeds and caricosities are common complaints seen in pregnancy. These problems occur due to the elevated levels of progesterone
|
False - due to estrogen
|
|
|
List 4 reasons for a cesarean section.
|
Placenta previa
Placenta abruption Breech baby Active herpes lesions Previous c-section Fetal distress Cephalopelvic disproportion Prolapsed umbilical cord |
|
|
2. List and describe the physiological changes that occur with pregnancy due to the increase levels of estrogen.
|
Increase blood volume by 45%, diluting blood which may predispose to anemia
24-50% increase in cardiac output heart murmurs in third trimester cutaneous vascular changes (red palms, vascular spiders) increase in thyroid, adrenal, and pituitary glands |
|
|
Hegar sign
|
softening of the cervix and lower 1/3 of the uterus
|
|
|
Placenta previa
|
placenta implants in lower part of uterus and is close or covering cervical opening
|
|
|
Crowning
|
initial presentation of fetus’s presenting part
|
|
|
Lightening
|
descent of fetal presenting part into pelvis
|
|
|
Chorion
|
surrounds the embryo and other membranes
|
|
|
Chloasma
|
mask of pregnancy, butterfly rash
|
|
|
Quickening
|
first recognition of fetal movement (16-18 weeks)
|
|
|
Relaxin
|
causes ligamentous laxity leading to unstable SI joints, hyperlordosis, and displacement of the center of gravity
|
|
|
List 4 postural changes seen on a pregnant patient at 8 months gestation.
|
Anterior pelvic tilt with hyperextended knees
Increased lumbar lordosis Posteriorly shifting gravity line Protracted shoulders Extension of occiput on atlas Anterior angulation of c-spine |
|
|
List the components of a UA. At least 10 must be listed to receive credit.
|
Colour Specific gravity
pH RBC WBC Blood Bilirubin Urobilinogen Proteins Ketones Nitrate for bacteria Leukocyte esterase Volume |
|
|
Complete the following chart regarding the Chemistry panel.
|
Component tissue/organ
Albumin liver/kidney Globulin liver/kidney Cholesterol liver BUN kidney Rennin kidney T3 thyroid T4 thyroid Insulin pancreas Glucagons pancreas |
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|
Describe 4 common problems that the chiropractor encounters when working with pregnant patients.
|
LBP
Neck pain Shoulder pain Breech baby Pelvic instability |
|
|
Describe 4 functions of the amniotic fluid for the fetus.
|
Protects from direct trauma
Separates fetus from fetal membrane Source of oral fluid Acts as excretion collection system Facilitates symmetrical growth and development Protects from loss of heat |
|
|
Describe the history findings in a patient with round ligament syndrome.
|
Sharp shooting pain on either or both sides of lower abdomen upon moving (getting up from sitting, changing position in bed, fetal movement)
Not first pregnancy In 1st trimester Should not be associated with nausea, fever, bleeding, contractions Pain easily relieved |
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|
Using a 5 point management plan, describe the appropriate management of round ligament syndrome. Include course material as well as your own.
|
ADJUSTMENT: adjust lumbar and upper cervical region 2-3 times per week for 4-6 weeks, re-eval at that time
PT: soft tissue work longitudinally or transversely across round ligament, exercises such as kegal, pelvic tilt, and talar sit NUTRTION: eat more calcium rich foods, such as green leafy vegetables ERGONOMICS: proper posture when sitting, sleeping on side with pillow between legs, etc REFERALS: none at this time |
|
|
Which hormone is primarily responsible for maintaining a pregnancy?
|
Progesterone
|
|
|
What is the MOST definitive test for pregnancy?
|
Ultrasound (~4-6 weeks)
|
|
|
List 3 positive signs of pregnancy
|
Auscultation of fetal heart beat
Palpation of fetal movement by examiner Visualization of fetus using ultrasound |
|
|
List 2 maternal adaptations to pregnancy that is due to the elevated progesterone levels.
|
Increase respiration rate
Increase in vaginal discharge Decrease in smooth muscle tone, motility, glandular and mucosal secretion in the GI tract |
|
|
List the components of a CBC.
|
WBC count
RBC count Platelet count MCV MCH MCHC RDW Hematocrit Hemoglobin MPV |
|
|
List 3 postural changes that occur during pregnancy.
|
Increase in lumbar lordosis
Increase in sacral base angle Increase pronation Shifting plumb line posteriorly Sacrococcygeal angle changes |
|
|
Physical therapy
|
1) Hot/cold therapy
2) Electrical modalities 3) Soft tissue work 4) Exercise 5) Braces and supports |
|
|
Times HCG can be elevated is:
|
1) Pathology of the ovaries (ovarian cyst)
2) Certain types of tumors of the ovaries 3) Teratoma (hiataform mole forms in the uterus) |
|
|
life of a sperm in the human body
|
24-72 hours
|
|
|
10 day rule for x-ray
|
10 days after the onset (start) of her period is the best time to take x-rays on a
female |
|
|
Transverse cervical ligament
|
Attaches to the lateral aspects of the cervix and goes out to the pelvic wall
|
|
|
Uterosacral
|
Attaches to the posterior part of the cervix, splits and goes around the
rectum and attaches to the sacrum |
|
|
pubocervical
|
Attaches to the anterior cervix and goes to the pubic arch
|
|
|
Round ligament attachment
|
Attaches to the fundus or top of the uterus and goes on either side of the
uterus, through the inguinal canal, behind the pubic arch and terminates in the labia majora |
|
|
List 4 specific exercises that a patient should do during pregnancy. Why should each exercise be done?
|
Kegel Exercise: can prevent hemorrhoids and urinary incontinence
Pelvic Tilt: eases back pain Squat: strengthens thighs and opens pelvis Tailor or Cobblar pose: ease LBP, open pelvis and loosen hip joints |
|
|
List 3 general exercises that a patient should do during pregnancy. Why should each exercise be done?
|
Swimming: Any type of aerobic exercise helps increase the body's ability to process and use oxygen, which is important for you and your baby. So swimming also improves circulation, increases muscle tone and strength, and builds endurance. If you swim, you'll burn calories, feel less fatigued, sleep better, and cope better with pregnancy's physical and emotional challenges.
Walking: Walking is one of the best cardiovascular exercises for pregnant women because it keeps you fit without jarring your knees and ankles. It's also a safe activity to continue throughout all nine months of pregnancy Yoga: keeps you limber, tones your muscles, and improves your balance and circulation, with little, if any, impact on your joints. It is also beneficial because it helps you learn to breathe deeply and relax |
|
|
What is a Kegel exercise?
|
Kegels are exercises you can do to strengthen your pelvic floor muscles — that is, the muscles that support your urethra, bladder, uterus, and rectum. Imagine that you're trying to stop yourself from passing gas and trying to stop the flow of urine midstream at the same time. The feeling is one of "squeeze and lift" — a closing and drawing up of the front and back passages. Hold each Kegel for eight to ten seconds before releasing, and relax for a few seconds after each one.
|
|
|
Why should a pregnant woman do kegel exercises? List 3 reasons.
|
Kegels improve circulation to your rectal and vaginal area, helping to keep hemorrhoids at bay and speeding healing after an episiotomy or tear during childbirth. Finally, continuing to do Kegel exercises regularly after giving birth not only helps you maintain bladder control, but also improves muscle tone in your vagina, making postpartum sex more enjoyable.
|
|
|
Describe 3 situations where a pregnant patient should avoid strenuous exercise.
|
Heart disease
placenta previa Multiple gestations incompetent cervix Bleeding ruptured membranes Premature labor history of miscarriages |
|
|
5. Describe 4 common problems that the chiropractor encounters when working with pregnant patients.
|
Backache constipation
Fatigue hemorrhoids/varicosities Leg cramps leukorrhea Urinary frequency morning sickness Headache bleeding gums/nosebleeds Round ligament syndrome carpal tunnel syndrome Stretch marks shortness of breath |
|
|
List 4 concerns of expectant fathers as described in class.
|
Sympathy symptoms
feeling left out Anxiety over mother’s health falling apart during labour Anxiety over baby’s health bonding Impatience with mother’s mood swings exclusion during breastfeeding Fear of sex mother’s looks after having baby |
|
|
Describe the Webster Breech Turning Technique.
|
Step 1: Place the pt in a prone position and flex both legs towards the buttock, the side with the most resistance will be a sacral listing (PR or PL). The thrust will be minimal and after the legs should be equal in resistance.
Step 2: Place pt supine. One the side opposite of adjustment, draw a vector from the umbilicus 45 degrees inferior and lateral, and another vector from ASIS inferior and medial 45 degrees. Where these bisect hold an I-S contact with the thumb and rotate 15 degrees in both directions for 1-1.5 minutes until muscles relaxes. Continue for approximately 2 weeks. |
|
|
Which of conditions cross the placenta
|
Rubella, Varicella, Syphilis, Anemia, Toxoplasmosis
|
|
|
What is back labor?
|
Quoting from the first paragraph in the article, “Back-labor may be defined as: Acute, often severe, low back pain during the first and/or second stage of labor.”
Back labor is a common complication of childbirth resulting from incorrect fetal position where the back of the fetus is pressing on the nerves arising from the sacrum. Correct fetal position is the face looking in the direction of the sacrum. |
|
|
List 2 common prenatal history findings in back labor
|
The author of the article links 2 most commonly reported events to the presence of back labor. The first, and most prevalent finding is, “a history of a car accident either before or during pregnancy in which the woman wore a seat belt with a harness.” This mechanism of injury puts torsion on the muscles of the pelvis floor, complicating childbirth.
The second is “labor that was either induced or augmented with cervical gel, pitocin, or amniotomy (breaking the water).” This is most detrimental when the fetus is not in position and ready for delivery. |
|
|
Describe the 2 “solutions” that were described in the article
|
The author, a chiropractor, offers two positions to reverse the incorrect fetal rotation and reduce back labor.
In the first position the mother in on her side, hips and shoulders straight up and down, head on a pillow, with the bottom leg straight on the bed and the top leg over the side of the bed. An assistant stands perpendicular to her hips, with their thigh resting just below the baby and places their hands on top of her hip pressing downward. The position is repeated and will cause the SI joints to flare, freeing the sacrum and decreasing pelvic muscle tone. This position should be followed by an immediate change in intensity of back labor or sudden increase in frequency of labor contractions. In the second position (performed is the first position failed), the mothers gets on her knees on the side of the bed, leans forward onto a chair 2 feet from the bed resting her head on the cushion. The bed is elevated so that her hips are above her head. The result of this position is a dislodging and repositioning of the fetus. This position is helped by the mother visualizing the correct fetal position. |
|
|
Ultrasound
|
i. Why: 2 reasons – investigate a specific concern (from family history or risk indicated by another tests) or routine screen to identify potential problems
ii. When: Necessary – live fetus, early bleeding (miscarriage risk), confirm suspected ectopic pregnancy or molar pregnancy, check baby position during other procedures, check placenta position at the time of birth, levels of amniotic fluid; Unnecessary – dute date, physical abnormalities, multiple fetuses, breech position, intrauterine growth retardation iii. How: transducer producing high energy sound waves either run across belly or inserted into vagina, sound waves rebound and form an image, take a few minutes |
|
|
Amniocentesis
|
i. Why: to obtain information about the baby’s genetic makeup (potential for inherited diseases), gender, prematurity survival based on lung function
ii. When: end of 4th month, follow-up, triple screen encouraged, at doctor’s discretion iii. How: needle inserted through abdominal wall into uterus to extract ½ oz. of amniotic fluid (ultrasound used prior to needle insertion to determine position of the baby) |
|
|
Chorionic villus sampling
|
i. Why: to check for genetic, chromosomal abnormalities (not spina bifida), can be done early than amniocentesis so that a woman can choose to abort her pregnancy earlier
ii. When: week 10, elective procedure iii. How: needle inserted through abdomen (or vagina) and a sample of the chorion with villi is obtained from the embryonic sac |
|
|
Triple Screen
|
i. Why: to measure the levels of alpha-fetoprotein, estriol, and hcg for risk of Down’s syndrome, spina bifida, anencephaly or other abnormalities
ii. When: week 16, typically when woman is over 40 with 1st pregnancy, elective procedure iii. How: blood drawn, if risk indicated, test again, if second risk indicated, further testing |
|
|
What effect does GD have on the fetus/baby
|
1. Risk of fetal abnormalities/deficits
2. Macrosomia 3. Fetal death (stillbirth) 4. Diabetes in offspring |
|
|
What is the function of Pitocin during the birthing process?
|
Strengthen contractions
|
|
|
How can an epidural affect the fetal heart rate?
|
increase the heart rate
|
|
|
According to one study cited in the article, Epidural epidemic, how much did the cesarean rate increase when the epidural was given at 2 cm dilation?
|
50%
|
|
|
What is the duration of a spinal headache?
|
1-10 days
|
|
|
What is an episiotomy?
|
Cutting of perineal tissue during delivery
|
|
|
Where is the perineum?
|
Between the vagina and the anus
|
|
|
What is the lithotomy position?
|
Flat on that back with feet in stirrups
|
|
|
reason given in the article for an episiotomy?
|
a. Prevent tearing
b. Protect baby’s head c. Protection against future uterine prolapse d. Easier to repair |
|
|
Common Complaints during 1st trimester pregnancy
|
Backache,
Constipation, Fatigue, hemrrhoids/Varicosities, Leg cramps, Leukorrhea, Urinary frequency, Morning sickness, HA, Bleeding gums/nosebleeds, Round ligament syndrome |
|
|
Why Constipation during 1st trimester?
|
due to physiological changes caused by progesterone,
Responds to dietary changes, Encourage increased fluid intake and exercise, Allow time for elimination, Enemas are contraindicated during pregnancy |
|
|
Why Fatigue during 1st trimester?
|
During pregnancy there is a decreased metabolism rate that make the mother feel fatigued,
It is important to "rule out" fatigue caused by low protein levels or anemia, Encourage her to rest when possible, Resolves by the 4th month |
|
|
Why Hemorrhoids/Varicosities during 1st trimester?
|
These are due to the increased blood volume and increasing mechanical pressure - esp on the vena cava by the uterus,
Constipation will aggravate symptoms, many moms don't have problems until delivery, Raise legs to the level of the heart and use support hose (HIND tights) to promote venous return, Sitz baths, ice and witch hazel (TUCKS) will give symptomatic relief |
|
|
Why Leg cramps during 1st trimester?
|
Due to pressure of uterus on blood vessels and altered levels of CA and K, the RDA for Ca during prenancy is 1200 mg/day,
this should also be taken with Mg and Vit E to enhance absorption, these leg cramps seem more common at night - caution the mom about jumping out of bed to relieve the cramp dur to the change in her center of gravity, she may lose her balance, remember - leg cramps, round ligament syndrome and intercostal muscle spasms int he lower posterior thoracics |
|
|
Why Leukorrhea during 1st trimester?
|
there is an inc in vaginal discharge which becomes more acidic,
this keeps the bacterial count down that could possibly lead to an infection in the fetus, this discharge tends to cause irritation to the external genitalia, avoiding tight fitting clothing, cotton underwear and a 50% acetic acid soln as a rinse are helpful, It is important to avoid the development of a yeast (Candida) infection, do not douche during pregnancy |
|
|
Why urinary frequenct during 1st trimester?
|
due to the inc blood volume and the pressure of the uterus on the bladder,
there is inc risk of bladder/kidney infections, drink lots of water to keep the system "flushed" out |
|
|
Why Morning sickness during 1st trimester?
|
theories about the causes include adapting to elevated levels of HCG, estrogen/progeterone, dec/depleted levels of vit B6, hypoglycemia and the body riding itself of toxins,
certain odors can bring on symptoms, usually resolves by the 4th month, closely evaluate the thoracics and consider a hiatal hernia maneuver, many dietary suggestions, hyperemesis gravidaerium is severe dehydration due to morning sickness |
|
|
Why HA during 1st trimester?
|
there is an inc in pituitary gland size by 50%,
inc production of corticotrophin, thyrotropin, and prolactin, these 1st trimester HA's need to be ruled out from the HA's caused by gestational hypertension, pre-eclampsia, and toxemia - these HA's occur in the 2nd and 3rd trimester and are accompanied by hypertension, edema of the hands, face and feet, proteinuria, and visual disturbances "scotomas" |
|
|
Why bleeding gums/nosebleeds during 1st trimester?
|
due to inc blood volume, it takes a little while for the clotting factors to catch up,
could impact pre-existing anemia if the bleeding is excessive, salt-water mouth rinses will help prevent gum infection |
|
|
Common complaints during 2nd/3rd trimester of pregnancy
|
CTS, Stretch marks, shortness of breath
|
|
|
Why CTS during 2nd/3rd trimester/
|
in pregnancy this is usually due to edema,
those women who took birth control pills before pregnancy teend to be depleted in Vit B6 and have a greater tendency to CTS, be sure the mom has been evaluated for pre-eclampsia, inc intake of Vit B6 and lots of water will lesion the edema |
|
|
Why Stretch marks during 2nd/3rd trimester?
|
most commonly seen on the abdomen, under the breasts and outer thighs,
most significant factor for the development of strectch marks is a pos family hx, best prevention is a slow steady weight gain, topically, vit E, cocoa butter, alow vera |
|
|
Why Shortness of breath during 2nd/3rd trimester?
|
the uterus puts pressure on the diaphragm, this causes an inc in the A to P diameter of the chest and can produce cardiac murmurs which disappear after birth,
lightening will relieve SOB, be sure to rule out the possibility of a posterior rib subluxation |
|
|
Describe the process for an emergency delivery. Not an emergency C-section.
|
Stay with the woman, call for assistance
Help the woman into a comfortable position Wipe off the baby’s face, dry the rest of the body Wrap the baby in something dry, tie the cord Wait for the delivery of the placenta Make sure mother and baby are warm Wait for transportation to a medical facility |
|
|
Describe the difference between a pudendal and a paracervical nerve block.
|
Pudendal: Pudendal nerve blocks are of value in providing analgesia for the second stage when contraindications to neuraxial blockade exist and for the provision of pelvic floor relaxation when forceps delivery is required.
Paracervical: Paracervical blockade may be used as a means of reducing pain during the first stage of labour when contraindications of epidural analgesia are present. The failure rate is reported to be as high as 18%. |
|
|
Options for pain relief
|
tranquilizers (early labor), analgesics/narcotics, inhalants (nitrous oxide), regional nerve blocks (epidural, spinal - C/S, paracervical - labor, pudental - delivery), Tens, Hypnosis
|
|
|
Why specifically should caffeine, alcohol, and smoking be avoided during pregnancy?
|
They are teratogens and can cause birth defects.
|
|
|
List 2 herbs that should be avoided during pregnancy.
|
Mistletoe: uterine stimulate containing toxic chemicals that can cross the placenta
Aloe Vera: purgative leaves, should not be taken internally Basil oil: uterine stimulant, only during labour Bloodroot: uterine stimulant that can cause vomiting Wormwood: uterine stimulant that may cause birth defects |
|
|
List 4 advantages for a: Home birth
|
Statistics show that home birth is as safe as or safer than hospital birth for low-risk women with adequate prenatal care, and a qualified attendant.
At home a woman can labour and birth in privacy and comfort of the familiar surroundings surrounded by loved ones, in whatever positions and attire she finds most comfortable. Labour is allowed to progress normally, without interference and unnecessary interventions. Studies show that the risk of infection is reduced for both the mother and baby. She doesn't have to worry about when to go to the hospital since her care-providers come to her. Continuous one-on-one care is given by the midwife. |
|
|
List 4 advantages for a: Hospital birth
|
Feel safest labouring at a hospital.
It is the safest environment for the mother at risk of certain medical complications during labour. It is the only option available in the event a cesarean is necessary. Immediate pediatric attention is available should the newborn need immediate medical care. It has round the clock help for the mother and baby. |
|
|
List 7 questions that would be appropriate to ask, when interviewing a midwife/obstetrician.
|
When would you like me to come to the birth center/hospital?
What are your recommendations if water breaks before contractions begin? How long after water breaks would you recommend starting pitocin? What is your philosophy regarding episiotomies? Under what circumstances would you perform them? What percentage of the time do you and your partners perform episiotomies? Are you supportive of a delayed onset of pushing or labouring down (allowing the mother to push when she feels the urge vs. automatically pushing at 10 cm? How do you feel about natural/unmedicated birth? If I chose to use an epidural, when would you recommend I receive it? Under what circumstances would you recommend an induction of labour? How long after my due date will you wait before inducing labour? What non-medical ways of stimulating labour do you recommend? What positions for the birth/delivery are you comfortable with? Who is your back-up? |
|
|
What are the advantages of a water birth? For the mother and for the baby?
|
Mother: Immersion in warm water is an excellent form of pain relief. Some women feel the relief as soon as they lower themselves into the pool, for others it takes 10-15 minutes to get the full benefit The depth of the water gives support and makes it easier to try different positions The warm water is a natural aid to relaxation, releasing tension and anxieties, and leaving you free to go with the flow of the contractions Water birth is often accompanied by dimmed lights and aromatherapy oils, which can also aid relaxation With less anxiety, the body produces less of the stress hormones adrenaline and noradrenaline. This in turn allows more endorphins to be produced, which are the body’s own painkillers, and which also promote a feeling of wellbeing. The atmosphere of a water birth is less rushed. There is also less risk of a tear.
Baby: Apgar scores at 5 and 10 min were significantly higher after water births. Water eases the transition from the birth canal to the outside world, because the warm liquid resembles the familiar intra-uterine environment, and softens light, colors and noises. |
|
|
What initiates labor?
|
inc in circulating oxytocin,
withdrawal from progesterone, inc in fetal cortisol production, the end of 10 lunar months, pressure of the fetal head on the cervix, production of prostaglandin by fetal membranes |
|
|
Early signs of Labor
|
Lightening,
Braxton-Hicks contractions, Weight loss, Nesting urge |
|
|
Imminent signs of Labor
|
Loss of mucous plug,
Rupture of membranes |
|
|
False Labor
|
Braxton-hicks/irregular contractions, stop with walking
|
|
|
True Labor
|
regular contractions, increase with walking, full dilation, pale pink/watery discharge
|
|
|
Stages of Labor
|
4
|
|
|
Stage I
|
Labor - early, active, transition
|
|
|
Early Stage I Labor
|
Contractions 10 in apart for 30 sec with mild intensity, cervix is closed to 4 cm,
effacement goes to 100%, lasts 4-6 hours, goal is to rest |
|
|
Active Stage I Labor
|
Contractions at 3-5 min interval lasting 60 sec with moderate intensity, Cervix 5-7 cm, lasts 3-5 hours, mother concentrating, pelvic exam looking at head for sutures (posterior = triangle, anterior = diamond), labor measured in station (position of head with respect to ishial spine - abover = neg, at = 0, below = +)
|
|
|
Transition Stage I Labor
|
contractions 90 sec interval and duration, intensity strong, cervix 8-10 cm = complete, station 1+-2+, lasts 20 min - 2 hrs
|
|
|
Stage II
|
Pushing, Delivery of baby
contractions 3-5 min interval, 60 sec duration, moderate intensity, lasts 10 min - 2 hrs, crowning = 4-5+, vacuum forceps, episiotomy |
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Stage III
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Delivery of Placenta
contractions 5 min interval, 5-60 sec duration, moderate - mild intesity, lasts 10-30 min, mom may have to push |
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Stage IV
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Recovery
beginning of postpartum |
