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96 Cards in this Set
- Front
- Back
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Three categories of pregnancy signs
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presumptive
probable positive |
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define presumptive signs
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subjective changes felt by the women
these findings are suggestive of but not diagnostic of pregnancy |
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Least reliable signs of pregnancy
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amenorrhea
fatigue NV Breast Changes (tingling, heaviness,tenderness) Urinary Frequency Quickening |
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define the probably signs of pregnancy
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probable signs of pregnancy include signs and symptoms and/or changes that can be observe by an examiner
more suggestive but not diagnostic |
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two types of pregnancy test
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Serum
Urine |
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Probably signs of pregnancy
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chadwick sign
goodell sign hegar sign ballotment enlarged abdomen braxton hicks pigment changes |
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hegar's sign
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softening and compressibility of the lower uterine segment (isthmus) after 6 weeks of gestation
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ballottement signs
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palpate fetal body part and it "bounces back" to examiner's hand when cervix "tapped" 16-18 weeks
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definition of positive signs of pregnancy
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positive signs of pregnancy cannot be contributed to anything but pregnancy
these signs are diagnostic |
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diagnostic signs of pregnancy
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FHT
Visualization of fetus Palpating fetal movement |
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Serum beta hCG pregnancy test
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quantitative (numbers are assigned based on gestation)
(+) by 6-11 days after conception |
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Urine hCG pregnancy test
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qualitative
(+) 17-26 days after conception positive only if the ovum has implanted |
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most women schedule a prenatal visit for the first time because they
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miss a period
positive pregnancy test |
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at the prenatal visit, the practitioner needs to get
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comprehensive history
BP height and weight urine dip head to toe exam pelvic exam |
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What is Nagele's Rule
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based on woman with a "normal" cycle of approx. 28 days
used to determine "due date" |
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Nagele's Rule calculation
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first day of last menstrual period
-add 7 days -subtract 3 months -dont forget to change year |
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What is gravidity
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number of pregnancies regardless of outcome
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What is parity
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number of times a woman giver birth beyond 20 weeks
includes TPAL |
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What is TPAL?
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term
preterm abortions living children |
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term births are
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number of births after 37 weeks
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preterm births are
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number of births between 20-36 weeks
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abortions are pregnancies that end
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before 20 weeks
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another sign use to represent abortion when charting
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triangle
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When are prenatal follow up visits scheduled
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Q4 weeks until 28 weeks
Q2 weeks until 28-36 weeks Q week 36 weeks to birth more often if complications |
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at 20 weeks the fundus heigh should be at the
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umbilicus
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after 20 weeks the fundus rises at a rate of
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1 cm per week
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you can hear fetal heart tones by
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10-12 weeks
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leopolds maneuver determines
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fetal positioning in the abdomen
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Possible danger signs that women should immediately cal the doctor with
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vaginal bleeding
alteration of fetal movement ROM visual disturbance swelling of face or hands severe headache epigastric pain fever or chills CTX that increase in frequency or duration before 37 weeks persistent vomiting |
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1st rimester screening
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nuchal translucent screening
PAPPA |
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nuchal translucency screening
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looking at translucency of the neck
helps identify higher risk chromosomal defects |
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What is PAPPA
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pregnancy associated plasma protein A
elevated in a fetus with down syndrome |
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what lab tests are done between 15-20 weeks
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MSAFP
Quad (triple ) Screen |
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MSAFP
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maternal serum alpha fetal protein
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quad screen
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look for chromosomal abnormalities
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tests done between 18-20 weeks
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ultrasound
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Lab tests done at 28 weeks
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CBC
antibody screen RPR GCT Rhogam |
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RPR tests for
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syphyllis
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GCT is
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glucose challenge test
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GC/CT
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clymedia and ghonarreah
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Lab Tests done at 36 weeks
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CBC, RPR, GC/CT, GBS vaginal culture
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First Trimester Screens
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noninvasive
uses maternal blood screen with an ultrasound Identify chromosomal abnormalities hCG PAPP-A Nuchal Translucency 85% accuracy |
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What are the four measurements done with a quad test
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MSAFP
Estriol hCG Inhibin A |
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Neural Tube Defect is associated with
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elevated AFP
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low AFP and low estriol with elevated hCG is associated with
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Down Syndrome
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MSAFP
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maternal screen alpha-fetoprotein
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AFP is the main protein in
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fetal plasma
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inhibin A is produced by
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placenta and ovaries
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estriol is
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a type of estrogen that is produced by the fetus and the placenta
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hCG is produced by
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placenta
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MSAFP is produced by
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fetus
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AFP diffuses
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from fetal plasma into fetal urine and is excreted into the amniotic fluid
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Some AFP rosses
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placental membrane in to maternal circulation
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AFP can be measure in both
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maternal fluid and amniotic fluid
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A triple (quad) screen results is
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NOT a a diagnosis
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if a quad screen comes back abnormal it is recommended that the future parents
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genetic counseling
ultrasound amniocentesis |
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what is an amniocentesis?
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aspiration of amniotic fluid which contains fetal cells
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when is an amniocentesis usually performed?
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after 14 weeks or in 3rd trimester
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an amniocentesis will detect
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genetic disorders or anomalies
pulmonary maturity (3rd trimester) fetal hemolytic disease |
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indications to due an amniocentesis
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maternal age greater then 35
H/O child with chromosomal abnormalities family hx of chromosomal abnormalities inherited disorders of metabolism abnormal triple/ quad screen |
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complications from amniocentesis
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fewer then 1% of cases
maternal-fetal hemorrhage fetal death -hemorrhage -infection -direct injury from needle -miscarriage -PTL -Leakage of fluid |
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Chorionic Villus Sampling (CVS) is used to
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diagnose fetal chromosome or metabolic abnormalities by removing a small tissue sample from the fetal portion of the placenta
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CVS cannot diagnose
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anomalies for which amniotic fluid is essential such as open neural tube defects, which require measuring AFP Levels
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when is a CVS performed
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performed between 10-12 weeks
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CVS complications
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vaginal spotting or bleeding
Miscarriage ROM Chorioamnionitis maternal-fetal hemorrhage limb deformities |
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Fetal Movement Counts
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movement by the fetus as assessed by the mother
best indication of fetal well being |
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fetal movement count begins at
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28 weeks
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fetal movement is recommended to be done
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daily
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advantages of fetal movement count
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inexpensive
noninvasive convenient |
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disadvantages of fetal movement count
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resting state decreases fetal movement
maternal perception of fetal movement time of day maternal use of drugs |
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how many kicks are normal
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6-8 per hour
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nonstress test (NST)
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assess fetal response to natural contractile uterine activity or to an increase in fetal activity
fetus will produce characteristic heart rates in response to fetal movement |
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diminishes NST response can be due to
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hypoxia
acidosis drugs fetal sleep cycle |
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NST results are classified as
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reactive
nonreactive unsatisfactory |
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reactive NST
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to accelerations in 20 minutes
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nonreactive NST
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does not meet criteria for reactive
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unsatisfactory NST
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cannot identify baseline (marked variability) or technical problems / poor tracking
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Contraction Stress Test (CST)
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used to identify a fetus under stress using electronic method
uterine contractions are stimulated when adequate contractions are present, stimulation is stopped and results assessed |
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Negative CST
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no decelerations with movement
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Positive CST
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repetitive decelerations with contractions
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Biophical Profile (BPP)
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assesses physiological characteristics of fetus and biophysical responses
accurate indicator of impending fetal death 2 components -ultrasound -external fetal monitoring |
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response to central hypoxia is
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alteration in movement
tone breathing heart rate |
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5 components of the BBP
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Fetal Breathing Movements
Gross Body Movements Fetal tone Fetal Heart Rate amniotic fluid volume 2 points for each |
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BPP uses
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real time ultrasound that allows you to monitor biophysical responses to fetal stimulation
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Normal value for AFV
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8-10
indicates CNS is functional and fetus is not hypoxemic |
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An AFV value of 6 is considered
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equivocal
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AFV value that is abnormal is
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less then 4
induction is recommended |
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Amniotic Fluid Index
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assessed with ultrasound
total AFI equals the depth in cm of the amniotic fluid in all 4 quadrants |
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normal range for Amniotic fluid is
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5-20 cm
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AFI less then 5 is indicative of
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oligohydroamnios
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AFI greater then 20 is indicative of
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polyhydroamnios
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Types of ultrasounds
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abdominal
transvaginal |
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abdominal ultrasound is more affective during the
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1st trimester
must have a full bladder |
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transvaginal ultrasound is optimal
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during 1st trimester
bladder can be empty |
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1st trimester sonogram shows
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number, size , location of gestational sacs
presence or absence of fetal cardiac and body movement uterine abnormalities or adenexal masses Estimated Gestational Age presence and location of IUD |
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2nd and 3rd trimester sonogram shows
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fetal viability
number of fetuses gestational age and growth pattern fetal anomalies AFV Placenta location and maturity fetal position uterine fibroids and anomalies adrenal masses cervical length |
