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69 Cards in this Set
- Front
- Back
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What describes a presumptive sign of pregnancy? are they diagnostic?
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Subjective changes felt by the woman.
-Not diagnostic |
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List the least reliable signs of pregnancy.
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1. Amenorrhea
2. Fatigue 3. N/V 4. Breast changes 5. Urinary frequency 6. Quickening |
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What is quickening?
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usually occurs in weeks 16-20 of gestation
-the feeling of fetal movements -often described as fluttering -Difficult to distinguish between fetal movements and peristalsis |
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What defines probable signs of pregnancy?
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Signs and symps and/or changes that can be observed by an examiner
-More reliable than presumptive signs but still NOT DIAGNOSTIC |
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What are examples of probable signs of pregnancy?
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-Pregnancy tests (hcg)
-Chadwick's sign -Goodell's sign -Hegar's sign -Ballottement -Enlarged abdomen (uterine) -Braxton Hicks contractions -Pigement changes |
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What is Hegar's sign?
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softening and compressibility of the lower uterine segment (isthmus) after 6 weeks gestation
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WHat is Ballottement?
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palpable fetal body parts and it "bounces back" to examiner's hand when cervix is tapped 16-18 weeks
-could also be mistaken if pt has fibroids |
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What is the only class of signs that are diagnostic for pregnancy?
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the positive signs of pregnancy
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What are the positive signs of pregnancy?
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1. Fetal Heart Tones
2. Visualization of fetus (ultrasound) 3. palpating fetal movements (by the examiner) |
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What are the 2 types of pregnancy tests? what do they measure?
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1. Serum beta hCG
(Quantitatve measurement based on gestation: + by 6-11 days after conception) 2. Urine HcG (qualitative: either + or - and can be read 17-26 days after conception) The numbers are avg and only occur if ovum is implanted |
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Why do women come in for an initial prenatal visit? What does the visit consist of?
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-They missed a period or have taken a preg test
-Do a comprehensive Hx and Physical: -BP -height and weight -urine dip (glucose and protein) -head to toe exam -pelvic exam |
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What is Nagele's Rule? How is it done?
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Way to determine the Due date
1. Take first day of last menstrual period (LMP) 2. add 7 days 3. Subtract 3 months 4. Change the YEAR!! |
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Describe G/P TPAL.
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G: gravidity: number of pregnancies (1 even if you have twins)
P: parity: number of times a woman has given birth beyond 20 weeks T: number of term births >37 weeks P: number of preterm births <37 weeks A: number of abortions (elective or sponatenous) -preg ending before 20 weeks is SAB or VTOP L: living children (currently living) |
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How many follow up visits should a woman do at 28 weeks? between 28-36 weeks? 36-birth?
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-Q 4 weeks until 28 weeks
-Q 2 weeks btw 28-36 weeks -Q week from 36 weeks to birth |
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What are the important things to check during each F/U visit?
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1. BP, height and weight
2. Urine d stick 3. Abd exam (fundus, FHT ~12 weeks, Leopolds, FM) 4. Danger SxS 5. SxS PTL 6. complaints 7. 3rd trimester discuss prep and readiness for birth |
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What is Leopold's Maneuver?
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Feeling the abdomen to determine the position of the baby
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List the possible danger signs of pregnancy.
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1. Vaginal bleeding
2. alteration in fetal movements 3. ROM 4. visual disturbances 5. swelling of face and hands 6. severe headache 7. epigastric pain 8. fever or chills 9. Ctx that increase in freq or duration prior to PTL 10. persistent vomiting |
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What is the VDRL/RPR a screen for? When is it done
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syphilis
-screen during pregnancy and then before birth |
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What is the nuchal translucency screening?
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Done in the 1st trimester and measures the thickness of the neck of the baby which has correlations with down syndrome
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The is a +PAPP-A a screen for?
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Protein/plasma protein A which is associated with down syndrome
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During weeks 15-22 what labs are taken during a F/U visit? What do they screen for?
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-MAAFP or the Triple/Quad screen
-Maternal serum alpha fetal protein -screen for down syndrome and NTD |
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what screens are done specifically during weeks 18-20 of the F/U visits?
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Ultrasound for anatomy and if MSAFP or triple/quad screen has not been done
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what lab are taken at 28 weeks?
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CBC, antibody screen, RPR, GCT, Rhogam!
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What labs are taken at the 36 week F/U
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CBC, RPR, GC/CT (gonnorhea and chlamydia), GBS vaginal culture
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According to the triple/quad screen, what is a sign of NTD?
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Elevated MSAFP, the main protein in fetal plasma
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What results of the Triple screen are a sign of trisomy 21?
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Low AFP and estriol and high hcG
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What is being measured in the triple screen?
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MSAFP, Estriol, hcG (inhibin A)
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What are the 2 ways to measure AFP?
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In maternal serum MSAFP or in amniotic fluid AFAFP
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If the quad screen comes back positive, what recommendations are made?>
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-Genetic counseling
-Ultrasound -Amniocentesis |
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What is the disadvantage of the quad screen?
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It has a HIGH false positive rate
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What % of NTDs are detected early in pregnancy?
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80-85%
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What is the name of the test that takes an aspiration of amniotic fluid to examine fetal cells?
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amniocentesis
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Is an amniocentesis diagnostic or a screen?
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Diagnostic
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When is an amniocentesis usually done?
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After 14 weeks or in the 3rd trimester
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What can an amniocentesis detect?
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-Genetic disorders or anomalies
-Pulmonary maturity (3rd trimester) -Fetal hemolytic disease |
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When is an amniocentesis indicated?
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-Maternal age > 35
-H/O child with chromosomal abnormality -Family hx of chromosomal abnormality -inherited disorders of metabolism -abnormal triple screen |
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Describe the complications of amniocentesis.
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-They occur in fewer than 1% of the cases
-Maternal/fetal hemorrhage -Fetal DEATH! -hemorrhage -infection -direct injury from needle -miscarriage -PTL -Leakage of fluid |
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What is the purpose of Chorionic Villus Sampling?
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Used to diagnose fetal chromosome or metabolic abnormalities
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When can Chorionic Villus Sampling not be used?
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Cannot be used for abnormalities that require amniotic fluid, such as NTD which requires AFP
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What option does CVS give to couples
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If there is abnormal result, it gives the couple the option to terminate
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When is a CVS performed?
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10-12 weeks
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What is removed during a CVS? WHat methods is it performed?
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Small tissue specimen from fetal portion of the placenta
-can be performed transcervically or transabdonminally |
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What are the complications associated with CVS?
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1. Vaginal spotting or bleeding
2. Miscarraige -.3% 3. ROM -0.1% 4. Chorioamnionitis 0.5% 5. Maternal-fetal hemorrhage 6. Limb deformities 7. Must administer rhogman if mom is Rh - |
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When should the nurse instruct the woman to begin documenting "kick counts?"
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Begin at 28 weeks
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what are the advantages to Fetal movement counts?
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1. inexpensive
2. noninvasive 3. convenient for the client and encourages her participation in care |
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what are the disadvantages to using kick counts?
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1. fetal resting state normally drops counts
2. maternal perception of fetal movement varies 3. time of day may affect fetal movement (less in morning, more at night) 4. Maternal use of drugs (sedatives decrease movement) |
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What is considered a reactive Non stress test?
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two accelerations in 20 mins
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A nonreactive non stress test would have what characteristics?
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less than 2 accelerations in FHR in 20 mins
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What is an unsatisfactory non-stress test?
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Cannot identify baseline (marked variablilty) or technical problems/poor tracing
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What does the Contraction stress test identify?
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The fetus who is compromised under stress
-the jeapordized fetus that was stable at rest but showed evidence of compromise under stress |
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When does a deceleration in fetal HR result during a Contraction stress test?
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when the contraction causes decrease in uterine blood flow and placental perfusion to the point of hypoxia
the decel will begin at the peak of Ctx |
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How are the uterine ctx stimulated for a contraction stress test?
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1. nipple stimulation
2. oxytocin |
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What are the interpreting results for a contraction stress test?
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Negative CST: no decelerations with Ctx
POSITIVE CST: repetitive, late decels with Ctx |
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How many ctx must occur in 10 mins to be considered adequate for a CST?
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3 in 10 mins
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Which test is a very accurate indicator of impending fetal death?
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Biophysical Profile BPP
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What does the biophysical profile test for?
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Assesses physiological characteristics of fetus and biophysical responses
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The are the two components of the biophysical profile?
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1. ultrasound
2. external fetal monitoring |
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What fetal complication can be diagnosed early using the BPP?
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fetal acidosis
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What are the 5 components of the BPP?
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1. Fetal breathing movements
2. Gross body movements 3. Fetal tone 4. Fetal HR 5. Amniotic fluid volume |
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What are the results of a BPP?
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-Normal: 8-10 if Amniotic fluid volume is within normal limits
(indicates CNS is functional and fetus is not hypoxemic) -Equivocal: 6 -Abnormal <4 with abnormal AFV (induction!) |
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What must occur if an abnormal result is seen in a BPP?
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Induction
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What is the normal range for the amniotic fluid index?
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5-20cm
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How do you assess the amniotic fluid index AFI?
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with an ultrasound
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according to the AFI, what is considered olgiohydramnios? polyhydramnios
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-oligo: < 5cm
-poly: > 20cm |
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What anomaly can result from polyhydramnios?
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Neural tube defects
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Which ultrasound can only be done with a FULL bladder? when is it usually done?
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Abdominal
-Most effective after the 1st trimester |
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When is a transvaginal ultrasound used? what must the pt be instructed of prior to the procedure?
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Optimal for the FIRST trimester
Pt must empty their bladder! |
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What is the first trimester sonogram looking for?
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1. number, size, location of gestational sacs
2. presence or absence of fetal cardiac and body movements 3. utuerine abnormalities or adnexal masses 4. Estimation of gestational age 5. presence and location of IUD |
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The 2nd and 3rd trimester sonograms are looking for what aspects of the pregnancy?
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1. Fetal viability
2. number of fetuses 3. gestational age, growth pattern 4. fetal anomalies 5. Amniotic fluid volume 6. placenta location and maturity 7. fetal position 8. uterine fibroids and anomalies 9. adnexal masses 10. cervical length (short?) |
