Unit 10 - 5 Scheme

Front 1

headaches + epigastric pn in pregnancy

Back 1

preeclampsia

Front 2

blue discoloration of cervix/vagina

Back 2

chadwicks sign of pregnancy

Front 3

softening of the cervix (multiplied cells) - goodell's sign

Back 3

softening of the uterus (ladins sign and hegars sign) of pregnancy

Front 4

darkening of the nipples

Back 4

sign of pregnancy

Front 5

naegele's rule (calculate due date)

Back 5

LMP + 7 days - 3 months

Front 6

complications of gestational diabetes

Back 6

macrosomic babies

Front 7

first prenatal visit

Back 7

wt, ht, bmi, bp, assess uterine size and auscultation of fetal herat if >12 wks

also heart/lung/breast/pelvic exam are parts of initial prenatal visit

20 wks = level of umbilicus

pap smear if not performed in past year, test for clap/gonorrhae

urinarlysis and culture (proteinuria, glycosuria, hematuria)

cbc (detect/tx anemia)
screen for hemoglobinopathy if pt AA or mediterranean origin (sickle cell/thalassemia)

blood type, ab screen (rubella, syphillis, hepatitis, HIV)

Front 8

education at initial visit regarding setabelts

Back 8

pts need a 3 point seatbelt, should not put waistband over belly

Front 9

old striae vs new striae

Back 9

itching/pinkish vs silvery color (old)

Front 10

breast changes in pregnancy

Back 10

nipple darkens as pregnancy progresses

Front 11

uterine size w pregnancy

Back 11

full term; xyphoid
20 wks; umbilicus
16 wks; pubis symphiss
12 wks; mons pubis

Front 12

when can you first detect fetal heart tones

Back 12

6 wks gestation; (4 weeks post conception)

always calculate gestational age from LMP; while in embryo the gestational age will always be after conception (2 wk difference bc 2 weeks for ovulation)

Front 13

nuchal translucency scan

Back 13

should not perform after 14 wks

asessing fetus in midsaggital plane; if nuchal area is > 3 mm risk of chromosomal anomalies is estimated; if > 6 mm than 90% of fetuses will be detected with chromosomal anomalies (2nd to lymphedema ->

Front 14

AFP

Back 14

produced by fetal liver (baby albumin); always elevated in neural tube and frontal abdominal defects

Front 15

bHCG

Back 15

produced by palcenta

Front 16

low afp, low estriol, high hcg

Back 16

down syndrome

Front 17

low afp, low estriol, low hcg

Back 17

trisomy 18

Front 18

high afp

Back 18

neural tube defects

Front 19

inhibin A

Back 19

produced by placenta/ovary, ELEVATED in DS, normal in trisomies 13 and 18

Front 20

how to diagnose chromosomal defect (prenatal diagnosis)

Back 20

karyotyping based on amniocentesis, chorionic villus sampling, percutaneous sampling

Front 21

2nd trimester visit (24-28 weeks)

Back 21

perform glucose tolerance test;

Front 22

3rd trimester labs

Back 22

repeat hg/hct

Rh screening

syphillis if high rsik

STD

screen for group B beta-hemolytic streptococcus (prevent meningitis/pneumoniae of newborn)

Front 23

fetal lie

Back 23

transverse lie can be an indication for c section

Front 24

fetal engagement

Back 24

fetal head is engaged if 3/5 of fetal head are below the pelvic brim; happens late in 3rd trimester

Front 25

fetal positioning; if fetal back lies on left side
on the right side

Back 25

the babies occiput will be transverse

occiput will be right transverse

Front 26

outlet diameter

Back 26

> 8 cm; baby should have no problem

Front 27

leopold maneuvers

Back 27

sued to determine orientation of fetus;

1st; what are the fetal parts that line the fundus
2. hands parallel to fetus and see which side is fetal back
4. which fetal pole is headed toward the pelvis? palpate angle between fetal head and symphisis

Front 28

mother vitals

Back 28

bp > 140 = preeclampsia
inc temp = infection (chorioamnionitis)
pulse > 100 bpm - hypovolemia

Front 29

nitrazine test

Back 29

yellow = vaginal secretions
blue = amniotic fluid

Front 30

nitrazine test

Back 30

yellow = vaginal secretions
blue = amniotic fluid

Front 31

fetal heart rate monitoring

Back 31

when contracations start there is reduced flow into uterus and at maximum contraction there is no flow into uterus; so if the baby is compromised there will be manifestations in the heart rate

110-160 bpm = normal fetal hr; > 160 = tachy, <110 = brady - babies have severe problems and need to perform immediate delivery

short term variability; if you see no variability this is a bad sign (indicates nervous system is not responding or something)

early deceleration; fetal head compression within birth canal
late deceleration; sign of uteroplacental insufficiency (dangerous) - baby hr is slowly inc hr by end of contraction ie baby is not reacting when it should be reacting

variable deceleration; umbilical cord compression - inc fetal blood pressur e- deceleration via vagus nerve

Front 32

fetal heart rate monitoring

Back 32

when contracations start there is reduced flow into uterus and at maximum contraction there is no flow into uterus; so if the baby is compromised there will be manifestations in the heart rate

110-160 bpm = normal fetal hr; > 160 = tachy, <110 = brady - babies have severe problems and need to perform immediate delivery

short term variability; if you see no variability this is a bad sign (indicates nervous system is not responding or something)

early deceleration; fetal head compression within birth canal
late deceleration; sign of uteroplacental insufficiency (dangerous) - baby hr is slowly inc hr by end of contraction ie baby is not reacting when it should be reacting

variable deceleration; umbilical cord compression - inc fetal blood pressur e- deceleration via vagus nerve

Front 33

position baby at same level as umbilical cord

Back 33

if baby below -> too much flow -> hepatic congestion -> icterus

if baby above -> baby can be anemic

baby with 1 artery/1 vein when you examine the umbilical cord = intrauterine growth restriction

Front 34

what to do if suspect of uterine tone

Back 34

IV oxytocin, uterine massage, repair any episiotomys or lacerations

Front 35

lochia rubra

Back 35

similar to menstrual flow -> changes to serosa (pinkish) -> alba (fluid, transparent); part of post partum assessment

also have to assess uterine size/cramps, temp, bp, swelling of hands, ankles, face, breasts, bladder function, hemorrhoids

Front 36

fetal bradycardia

Back 36

It is important to remember that bradycardia is a late sign of fetal hypoxia (a
continued lack of oxygen). The heart rate slows in response to a depression of the
heart muscle activity caused by the continued decrease in needed oxyge

Front 37

FHR variability

Back 37

Absent variability indicates that the amplitude range is undetectable.
Minimal variability indicates an amplitude range that is detectable, but five beats per
minute or fewer.
Moderate, or normal variability shows an amplitude range 6 to 25 beats per minute.
Marked variability is characterized by an amplitude range greater than 25 beats per
minute.

Front 38

fetal accelerations

Back 38

Accelerations are
transient increases in the fetal heart rate caused by fetal movement. They are good
indications of fetal well-being and adequate oxygen reserve. Accelerations often
accompany contractions as a result of fetal movement in response to the pressure of
contracting uterine muscles. During an acceleration, the FHR increases by more than 15
BPM for more than 15 seconds (the 15 x15 rule). In the normal mature fetus, accelerations
can be triggered by fetal body motion, sounds, and other stimuli. They are considered
benign and are a reassuring sign that shows fetal responsiveness and the integrity of
mechanisms controlling the heart.

Front 39

early deceleration

Back 39

It appears almost as a mirror image of the
contractions; head compression during contractions

Front 40

late decelerations

Back 40

A late deceleration is a decrease is FHR from baseline that usually begins at the
middle of a contraction and remains below baseline until after the contraction is
complete (red arrows). The fetal heart rate will only improve after the contraction
has ended (in blue).

most severe, caused by HYPOXIA (uteroplacental insufficiency)

Front 41

variable decelerations

Back 41

Variable decelerations are a common type of fetal heart rate decelerations occurring with
up to 80% of fetuses.

CORD COMPRESSION

Front 42

nonreassuring FHR patterns

Back 42

fetal bradycardia, fetal tachycardia, loss of short-term
variability, late decelerations, and persistent late variable decelerations

Front 43

common cause of fetal bradycardia

Back 43

cord prolapse

Front 44

"mirrors the shape and timing of contractions, thought to be benign, and is usually caused by head compression"

Back 44

early deceleration

Front 45

nonreassuring pattern, caused by placental insufficiency

Back 45

late deceleration

Front 46

on FHR graphs what does one square on the horizontal axis represent

Back 46

10 seconds

Front 47

on FHR graphs what does one square on the vertical axis represent

Back 47

10 heart beats per minute