Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
151 Cards in this Set
- Front
- Back
|
A PREGNANCY is viable at ___ wks. |
20 wks. |
|
|
A FETUS is viable at ___ wks. |
24 wks. |
|
|
During the 1-28wks gestation - how frequently will you have appointments? |
4 wks |
|
|
What do we take urine to test in early visits? |
preeclampsia, HELLP, billrubin, ketones, protein, |
|
|
What do you do at all prenatals during the 1-28 wk period? |
-vital signs (at least BP) -urine -reflexes -edema -wt -Leopolds -fundal ht -FHT -nutritional status -lifestyle factors -emotional status -preparations for birth (including emotional) - |
|
|
Do you want urine to be more acidic or basic in relation to pH? |
acidic b/c bacteria in bladder can not thrive well in acidic environments |
|
|
urobilinogen |
Can show liver malfunction along with billirubin |
|
|
What are we looking for in a urine dip? |
-specific gravity -pH -urobilinogen -blood -nitrites -luekocytes |
|
|
hemolisis |
when red blood cells breakdown |
|
|
With a urine dip how would you know if RBCs are intact or broken? |
broken down - whole square green intact - green dots on strip |
|
|
What can blood in the urine be indicative of? |
-UTI -kidney stone -kidney infection -blood could be coming from vagina instead of urethra |
|
|
What do nitrates in a urine dip tell you? |
There may be an infection |
|
|
What are luekocytes in a urine dip possibly indicative of? |
body is fighting off some sort of infection |
|
|
How do you test for edema? |
Press thumb into a shin bone
|
|
|
What are you looking for when testing for edema? |
-Does it leave an indentation -How deep does it go and how long does it take to return? |
|
|
If pitting edema doesn't get better in the morning or it presents in thighs/hands/etc. what does that tell you? |
Indicator of preeclampsia or a preeclampsia cousin |
|
|
Reflexes are important to check because |
We are seeing if the nervous system is irritated; indicative of preeclampsia |
|
|
Is it more concerning for someone to have hyperreflexes or little to no reflexes? |
Hyperreflexes |
|
|
How are reflexes "graded"? |
- 0 - +1 (little flick) - +2 (strong) - +3 (hyper) |
|
|
Why would some midwives decide not to weigh clients? |
-can estimate fetal wt via Leopolds -many women are sensitive
|
|
|
What can a midwife learn from taking wt? |
-possibly carrying extra fluid (then check for edema) -fetal development |
|
|
Common weight gain |
8lb first trimester (or none, or loss) 17ish lb second trimester 1/2lb/wk last month (some lose) 25-35lb total pg
Everyone is different so it's helpful to look for notes concerning previous pregnancies. |
|
|
You should gain no less than ____ during pregnancy. |
15lbs |
|
|
Leopolds |
Abdominal exam to asses fetal position |
|
|
Leopolds involve |
-recline -what's in fundus (head, butt, etc.) -what's in lower uterine segment -feel sides |
|
|
fundal height |
-press into belly to find top of uterus -0cm at top of pubic bone -spread over pregnant belly until top of uterus |
|
|
What does assessing fetal position help with during the exam? |
Where to place the doppler? |
|
|
As the fetus grows do you want to hear whooshing or thumpthump? |
thumpthump is more indicative of the heart; the whoosh more indicative of the umbilical cord |
|
|
What are we noting when we check FHT? |
-quality- -Is this a normal FH rate (120-160bpm) -Is this a normal rhythm -Are there times when heart rate speeds up and returns? (encouraging) -Are you hearing a deceleration? (not reassuring) |
|
|
TORCH panel |
Toxoplasmosis Other Rubella Cytomegalovirus Hepatitis |
|
|
Name two things that are standard offerings in the first trimester? |
-ultrasound -genetic screening
(It is helpful to mention these tests ahead of time to leave them time to discuss it.) |
|
|
What other tests may you offer during the first trimester? |
-us -TORCH panel -genetic screening -HIV testing -STI screenings |
|
|
fetal survey ultrasound |
-how is it growing -do the structures look normal -where placenta is located -often considered "gender reveal" ultrasound -gestational diabetes screening |
|
|
When is gestational diabetes screening offered? |
28wk |
|
|
Which tests do you want ICD for? |
All of them |
|
|
pelvimetry |
-assessing shape of pelvis -identifying anything that may make birth more challenging -might be helpful during labor to work with what's there (keep in mind pelvis changes) |
|
|
When is pelvimetry done? |
Preference of midwives (Helpful the closer you are.) |
|
|
Initial Prenatal Panel |
-done as early as possible in early pg -blood group and rH factor -anti-body screening -H&H -CBC |
|
|
In relation to maternal blood types - if Mom has a positive blood type are we as Midwives concerned? |
No - We are concerned if Mom has a negative blood type. |
|
|
What is the only thing you can test to figure out blood type? |
blood testing |
|
|
H&H |
Hemoglobin & Hematocrit |
|
|
CBC |
Complete Blood Count |
|
|
hematocrit |
-a way of assessing anemia via ratio of RBC and plasma |
|
|
hemoglobin |
protein on RBC, responsible for carrying oxygen through the blood stream |
|
|
WBC |
White Blood Cell indicator of infection normal to have some, can get higher closer to term |
|
|
differential for WBC |
-are there lots of luekcoytes -monocytes -granulocytes -lymphocytes -is this viral, allergic reaction, etc. |
|
|
CBC details |
-actual RBC count -actual platelet count -actual WBC count -mean cell volume (MCV) |
|
|
MCV |
mean cell volume average size of RBCs
|
|
|
more hemoglobin on a cell the _____ oxygen a cell can carry |
more |
|
|
Mean Cell Hemoglobin Concentration |
MCHC how concentrated is each blood cell |
|
|
RBCs that are pale/teeny indicate |
crying out for iron |
|
|
RBCs that are dark/large indicate |
crying out for B12 and folate |
|
|
Ideal range for RBC |
ideal range - 3.7-4.3 |
|
|
Ideal range for hematocrit in prepregnancy-early pregnancy |
36%-48% ratio (remember hemodilution is a factor) |
|
|
Ideal range for hemoglobin |
11-13 (anything below 10 = contraindicated for homebirth) (remember hemodilution may bring it down a couple counts) |
|
|
What is one thing that can through off blood work? |
-Dehydration can make it look more concentrated than it is. -Higher altitudes may have higher numbers -Smokers have higher RBC, H&H |
|
|
Types of anemia out of our scope as midwives |
-sickle cell -thalasemia |
|
|
Antibody screening |
-Does this person have antibodies against +/- blood types -Want to test everyone at beginning of care -Usually consistent through multiple pregnancies |
|
|
Those with Rh(-) would be tested again after the initial screening when in their pregnancy to see what? |
check again at 28wks - something could have changed (bumps and bruises, amnio) |
|
|
rubella |
-basically measles -test at onset of care -via blood draw -Are they immune to rubella? (vaccination or actual illness) -equivocal response=meh (still be careful) |
|
|
MMR vaccine |
Measles, mumps, rubella |
|
|
Why is it important to find out if someone is rubella immune? |
If someone comes in contact with rubella during pregnancy it can be very dangerous for a fetus if immunities are not detected. |
|
|
RPR / VDRL |
Rapid Plasma Reagent Venereal Disease Research Lab -test to identify syphilis -positive / reactive = syphillus -negative / non-reactive = don't have syphullus |
|
|
Initial Prenatal Panel |
-Blood Group/Type -CBC -ABS -Rubella -RPR/VDRL -Hep B |
|
|
ABS |
Antibody Screen |
|
|
Hepatitis C |
-no cure -no vaccine |
|
|
How would you assess if someone has Hep C infection? |
-blood draw -Results: Positive/Reactive = abnormal :( -Can cause liver complications/failure -eventually fatal |
|
|
Can a midwife manage Hep C coverage? |
No - refer to an OB, though you may be able to do co-care. |
|
|
Can Hep C pass from Mom to Fetus? |
Yes |
|
|
Will Hep C always kill a woman during her pregnancy? |
No |
|
|
What are some possible negatives to testing for HepC? |
Anxiety b/c no cure
But may be worth the risk |
|
|
When do you test for HIV during pregnancy? |
Offered anytime based on risk |
|
|
How often do you test for HIV? |
Generally twice b/c it has a higher false-negative rate. (Later in pregnancy there may be more antibodies present, so it's more easily detected.) |
|
|
What is the HIV test looking for? |
HIV antibodies - not the virus |
|
|
Which types of HIV are basic tests looking for? |
HIV type1 HIV type 2 |
|
|
What will HIV test results looks like? |
-Reactive = in contact w/HIV, making antibodies |
|
|
What do you do if a client tests positive for HIV |
Refer to an OB |
|
|
Positive HIV pregnant clients receive what kind of standard care? |
regular antiretroviral treatments |
|
|
HIV can pass through from the Mother to the baby via what? |
-placenta -breastmilk |
|
|
Is HIV a true contraindicated for breastfeeding? |
Yes |
|
|
toxoplasmosis |
-protazoan infection - |
|
|
How is toxoplasmosis most commonly spread? |
Cat poop - esp. when it has dried b/c poo dust
Also spread through dirt/rodents/undercooked meats |
|
|
3 categories of infectious elements |
1. bacterial 2. viral 3. protazoan |
|
|
When do you offer the test for toxoplasmosis? |
Anytime |
|
|
Results for toxoplasmosis looks like: |
-Immune -Not Immune -Equivocal |
|
|
What is toxoplasmosis testing for? |
toxoplasmosis antibodies |
|
|
If a person is immune - are they ok to roll around in cat poops? |
Preferably no - keep exposure low if possible. |
|
|
IGM antibodies indicate exposure how long ago? |
-immediate exposure -recent exposure like changing litter box last week |
|
|
IGG antibodies indicates exposure how long ago? |
-long term antibodies for toxoplasmosis -exposure was a long time ago |
|
|
If you're exposed to toxoplasmosis before pregnancy - is there a danger? |
Not really |
|
|
When do you want to do a urinalysis? |
Anytime - some do it at the beginning to check for UTIs because it's harder to detect during pregnancy |
|
|
Do you need to refrigerate urine samples? Why/not? |
Yes
|
|
|
What are they looking for when they perform a urinalysis? |
-sg (specific gravity) -ketones -WBCs -nitrites -protein -blood -pH -glucose -color & clarity |
|
|
What would negative infections include |
-UTI -kidney stones -"normal skin flora present" -pyelo nephritis (kidney infection) |
|
|
What would the lab do with a test containing bacteria? |
They let it chill for a while at room temperature to see what grows. |
|
|
What can you do as a midwife if there is bacteria present? |
some herbal remedies, |
|
|
Why would you want to treat a UTI? |
Can travel to kidneys very quickly - can cause premature labor and birth |
|
|
gonnorhea & chlamydia |
-can test anytime -can cause scarring in reproductive organs -PIV pelvic inflammatory disease |
|
|
What can gonnorhea do to the fetus? |
- -pnuemonia -sepsis |
|
|
What kind of urine "catch" is best for testing for gonnorhea and chlamydia? |
First pee in the morning, "dirty catch". |
|
|
How would you treat gonnorhea or chlamydia? |
Readily treatable for antibiotics preferred over herbal treatments
Follow up after a few weeks for testing. Check partner! |
|
|
BV |
bacterial vaginosis |
|
|
How often do you see your clients in the 2nd Trimester? |
Every 2 wks |
|
|
Hemodilution is at its lowest point at ____ wks |
28 wks |
|
|
When do you want to test antibodies for Rh(-) again? |
28wks |
|
|
Do you give RhoGham before or after you receive antibody scan results? |
After |
|
|
28-36wks testing |
-CBC -gestational diabetes -? |
|
|
Testing done at 35-37 wks |
-Group B Strep test |
|
|
What can happen to a newborn that comes in contact with Group B Strep? |
-pneumonia -meningitis -sepsis -death |
|
|
How long is vaginal culture testing for Group B Strep deemed accurate? |
5 wks. |
|
|
When the home visit happen? |
36 wks |
|
|
What do you cover at a home visit? |
-go over logistics -know where it is -make sure family is prepared as you've asked -check birth kit -tub (check it, bring it) -test run the tub -signs of labor -when you want the alert -activity level during labor -remember the partner -birth team meet and greet -talk about holding hormonal birthy space -winter: snow clearance (us, walk, EMS) -heat? light? fire? -food and drink on hand -Placenta plan -siblings (have a discussion, Point Person) -pets (Point Person) -special desires (candles, photog, lotus) -car seat -how long will you stay after birth? -birth certificate nuances (worksheet) -birth certificate special circumstances -physical exam pieces (BP, heart tones, etc.) |
|
|
Couples Visit |
-34 wk -How are you doing getting ready for birth? -" " home visit? -What's important to you? |
|
|
What would you discuss at 37 wks on Post Dates visits? |
-BPP -ICD on past EDD stuff |
|
|
BPP |
Biophysical profile -fetal well being for 72 hours |
|
|
After 42 wks how often do you check in with the mother? |
every few days |
|
|
CBE |
-Do you provide it? -Do you require it? -Here are some options in the community |
|
|
Topics to discuss anytime - but spread out so they don't become overwhelmed: |
-CBE -cord blood banking -Braton Hicks -Warning signs of PTL -Pediatrician/Well Baby care |
|
|
Underweight (Pre-pg) |
BMI<18.5, then 25-40lb+gain |
|
|
Normal wt (Pre-pg) |
BMI 18.5-24.9, then 25-40lb |
|
|
Normal temperature |
97.6F-99.6F |
|
|
low grade fever |
100.4F |
|
|
Overweight (Pre-pg) |
BMI>25, then 15lb-gain |
|
|
What may cause an odd temp. reading? |
-eating -drinking -smoking -baths |
|
|
pulse |
? - increase by 10 points 3rd - additional 10 points term- 20 points higher than average (start of pg) |
|
|
Normal pulse early pg/pre. pg |
60-80bpm |
|
|
Weird pulse results could be b/c |
-dehydration -exercise |
|
|
normal respirations |
12 respiration/minute |
|
|
weird respiration causes |
-uterus making less room for lungs -progesterone -anemia |
|
|
Is it standard to check respirations? |
Not unless indicated |
|
|
Blood pressure |
90/160 - 140/90 -Will take a dip |
|
|
BP dips in ___ trimester, returns to normal or even a little higher in ___ trimester. |
1st 3rds |
|
|
normal edema |
+1 - slight +2 - mild |
|
|
abnormal edema |
+3 - moderate +4 edema - severe |
|
|
What can help with edema |
-diet -hydration -salt -activity -putting legs up |
|
|
Average reflexes |
+2, or their baseline |
|
|
0 edema |
no response |
|
|
+1 relexes |
low normal |
|
|
+3 reflexes |
more brisk than average
|
|
|
+4 reflexes |
VERY active |
|
|
When do you check for clonus? |
- +3 - +4 - any big jumps from their normal |
|
|
What would you consider with a lagging fundal height from visit to visit? |
-IUGR -stillbirth |
|
|
What would you consider with a rapid fundal height growth from visit to visit? |
-fluid levels -something else occupying that space |
|
|
FHT |
fetal heart tones
|
|
|
Normal FHT rate |
120-160bpms |
|
|
What could tachycardia be caused by? |
-mom dehydrated, baby responding -baby has infection -mom has fever -anemia mom or baby -mom medication? |
|
|
What could bradycardia be caused by? |
-hypoxia (baby not getting enough oxygen) -baby stress -fetal destress |
|
|
The earlier the gestational age, the ____ heart rate is. |
higher |
|
|
fetal reactivity |
respond to a stimulus in their environment |
|
|
When will you start to hear fetal reactivity? |
28 wk Reassuring sign of well being and maturation. |
|
|
Warning Signs |
-headaches -blurry/double vision -abdominal pain -vag bleeding -sudden swelling including in hands and face -size not matching dates -elevated BP -glucose in urine |
