Excelsior Reproductive Health (Ante, Intra, And Post Partum)

Front 1

All somatic cells contain ____ chromosomes

Back 1

46

Front 2

Union of a normal egg or sperm with one that contains an extra chromosome – down syndrome is most common = 47 chromosomes

Back 2

Trisomy

Front 3

When a normal gamete unites with one that is missing a chromosome=45

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Monosomy

Front 4

Condition in which one of the 2 X chromosomes becomes inactive (female)

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Barr Body

Front 5

Genes responsible for observable expressions (brown eyes, dark skin)

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Phenotype

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Total genetic makeup

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Genotype

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Earlier diagnostic test (8-12 weeks gestation)

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Chorionic Villus Sampling (CVS)

Front 8

Allows for rapid chromosome dx, genetic studies or transfusion for Rh isoimmunization

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Percutaneous Umbilical Blood Sampling (PUBS)

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Elevated in infants w/ open neural tube defect, anencephaly, omphalocele, gastroschisis, or multiple gestation

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Alpha Fetoprotein (AFP & AFP3)

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Ashkenazi Jewish (at risk for which specific disorder)

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Tay-Sachs Disease

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African; Hispanic from Caribbean, Central/South Americas (at risk for which specific disorder)

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Sickle Cell Anemia

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Greek, Italian (at risk for which specific disorder)

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beta-thalassemia

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SE Asia - Vietnamese, Laotian, Cambodian, Philippine (at risk for which specific disorder)

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alpha-thalassemia

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Women over age 35 (at risk for which specific disorder)

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Chromosomal trisomies

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Subjective changes in pregnancy

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amenorrhea,
N/V (r/t increase hCG and change in carb metabolism) aka morning sickness
urinary frequency
excessive fatigue
breast tenderness
quickening (perception of fetal movement 18-20wks)

Front 16

Softening of the cervix

Back 16

Goodell's Sign

Front 17

Vagina, cervix, and vulva with purplish discoloration

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Chadwick's sign

Front 18

Softening of uterine isthmus (6-8 weeks)

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Heger's sign

Front 19

Soft spot anteriorly in the middle of the uterus

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Ladin's sign

Front 20

An ease in flexing the body of the uterus against the cervix

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McDonald's sign

Front 21

5th week - Irregular softening & enlargement at site of implantation

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Broun von Fernwald's sign

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Occasional almost tumor-like asymmetric enlargement

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Piskacek's sign

Front 23

Soft blowing sound at pulse rate on auscultation

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Uterine Soufflé

Front 24

Passive fetal movement by pushing up against the cervix with 2 fingers

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Ballottement

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Reproductive system changes

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uterine growth
amenorrhea
suppression of FSH
cervical & vaginal changes
color & production of colostrum

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Integumentary changes

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striae gravidarum
separation of rectus muscles
melasma or chloasma

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Respiratory changes

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SOB in late pregnancy

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Temperature changes

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increase due to progesterone secretion

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Cardiovascular changes

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increased blood volume (30%)
increased cardiac output (25-50%)
increased HR by 10

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GI Changes

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N/V
heartburn
increased saliva

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Urinary changes

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fluid retention
change in renal, ureter, & bladder function

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Hormonal Changes

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increased estrogen & progesterone cause thickening of uterine walls
cervix cells proliferates & secretes thick, tenacious mucus

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The expectant father develops physical symptoms of pregnancy: fatigue, depression, HA, backache, and nausea

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Couvade Syndrome

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Nagele's Rule

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First day of last menses, subtract 3 months, add 7 days

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Common Discomforts During 1st Trimester

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Leukorrhea (high risk for yeast infection)
Nasal stuffiness & Epistaxis
Ptyalism (excessive often bitter saliva)

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Common Discomforts During 2nd & 3rd Trimesters

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Heartburn
Ankle edema
Varicose Veins
Leg Cramps
Carpal Tunnel Syndrome

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When to administer rubella vaccine for pregnant patient?

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Until after birth

Front 38

Reason for taking pre-natal vitamins

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Prevent neural tube defects (folic acid)

Front 39

Pre-term labor MgSO4 dose

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Loading: 4-6g over 30 minutes
Maintenance: 2-4g/hr

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Pre-eclampsia MgSO4 dose

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Loading: 6g IV over 15 minutes
Maintenance: 2g/hr

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Ritodrine

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Relaxes uterine muscle through beta-2 receptor sites

Front 42

Terbutaline sulfate

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to maintain uterine inactivity

Front 43

Betamethasone sodium phosphate (Celestone)

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corticosteroid administered to accelerate lung surfactant formation in the fetus. (Takes 24 hours to be effective)

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Recommended total weight gain for Normal BMI

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25-35 lbs

Front 45

Excessive vomiting - can progress to dehydration, electrolyte imbalance, acidosis, wt loss, ketonuria, hepatic & renal damage (rare)

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Hyperemesis gravidarum

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Tubal damage r/t PID, previous pelvic or tubal surgery, endometriosis, IUD (50% of cases referred shoulder pain

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Ectopic Pregnancy

Front 47

Hydatidiform mole - molar pregnancy - abnormal development of the placenta resulting in fluid filled grapelike clusters & trophoblastic tissue proliferates

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Gestational trophoblastic disease (GTD)

Front 48

Placenta is improperly implanted in lower uterine segment

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Placenta Previa

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Premature separation of a normally implanted placenta

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Abruptio Placentae

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Painless dilation of the cervix without contraction

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Incompetent Cervix

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Dx of chorioamnionitis in 10% of cases
Responsible for 1/2 of all preterm babies

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Premature Rupture of Membranes (PROM)

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Labor that occurs between 20-37 weeks

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Preterm labor

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Most common developement of HTN, proteinuria, and edema
Define as increase in SBP of 30 mmHg or DBP of 15mmHg

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Pre-eclampsia

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Convulsion - high risk for seizure or coma

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Eclampsia

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When BP is 140/90 or higher before pregnancy or before 20th week

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Chronic Hypertensive Disease

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When transient elevation of BP occurs during labor or in early post-partal period, returning to normal within 10 days postpartum

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Later or Transient HTN

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An antigen-antibody immunologic reaction within the body

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Rh Sensitization

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TORCH

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Toxoplasmosis
Rubella
Cytomegalovirus
Herpes simplex virus

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Indicator of fetal well-being (AFV and AFI)

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Amniotic Fluid Assessment

Front 60

*****: Breathing movement, body movement, tone, AFV, and FHR

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Biophysical Profile

Front 61

Study of non-invasive blood flow changes

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Doppler Velocimetry

Front 62

Spontaneous or induced by Oxytocin, test evaluates placental function & fetal health

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Contraction Stress Test

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Assesses FHR related to fetal movement

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Non-Stress Test

Front 64

Can make chromosomal & biochemical determinations as early as 1-18 weeks

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Amniocentesis

Front 65

Test that allows for rapid chromosome dx

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Percutaneous Umbilical Blood Sampling

Front 66

Refers to relation of the fetal parts to one another

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Fetal Attitude

Front 67

Relationship of the cephalocaudal axis of fetus to that of mother

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Fetal Lie

Front 68

Most common fetal position

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LOA (Left, occipito-anterior)

Front 69

Second most common fetal position

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ROA (Right, occipito-anterior)

Front 70

When the largest diameter of the presenting part reaches or passes through the pelvic inlet

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Engagement

Front 71

Relationship of the presenting part of the imaginary line between the ischial spines of the maternal pelvis

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Station

Front 72

Landmark on the presenting fetal part to the front, back, or sides of the maternal pelvis

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Fetal Position

Front 73

Uterine muscular contractions which cause the changes in the 1st stage of labor - complete effacement & dilation of the cervix

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Primary Force

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Use of abdominal muscles to push during the 2nd stage of labor

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Secondary Force

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3 Phases of Contractions

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Increment
Acme (peak)
Decrement (letting up)

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Time between beginning of one to the beginning of next contraction

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Frequency of contractions

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Measured from the beginning of the contraction to the end of said contraction

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Duration

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Strength of the contraction

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Intensity

Front 79

Labor that produces progressive dilation & effacement of the cervix
Contraction intervals are regular & gradually shorten

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True Labor

Front 80

Irregular, intermittent contractions, may be uncomfortable & exhausting

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Braxton Hicks

Front 81

Fetus settles into pelvic inlet - mother can breathe more easily

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Lightening

Front 82

Softening of the cervix

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Ripening

Front 83

Begins with contractions & ends with fully dilated cervix (10cm)

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First stage of labor

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Onset to rapid cervical dilatation (1-4cm), contractions every 10-30 min, 10-20 sec duration

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Latent Phase

Front 85

Cervical dilation 4-7 cm. Stronger contractions lasting 40-60 sec every 2-3 minutes

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Active Phase

Front 86

Maximum dilation 8-10 cm - Contractions reach their intensity, complete cervical effacement. Phase ends with irresistible urge to push

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Transition Phase

Front 87

Full dilation to birth of infant. Crowning to pushing the fetus out of the birth canal

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Second Stage of Labor

Front 88

Begins with expulsion of the infant & placenta

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Third Stage of Labor

Front 89

1-4 hours after expulsion of placenta

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Fourth Stage of Labor

Front 90

Viewed as normal, normally occurs late in labor when the head is fairly low, represents pressure on the fetal head during contractions

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Early decelerations

Front 91

Delayed 30-40 sec after contraction onset & continue after contraction. Suggests uteroplacental insufficiency or decreased blood flow
Interventions?

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Late decelerations
Maternal position should be lateral, slow/stop oxytocin, administer O2 and prepare for prompt delivery

Front 92

Unpredictable and indicates compression of the cord.
Interventions?

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Variable decelerations
Change position to lateral or trendelenberg, administer O2, possible amnioinfusion with NS or LR

Front 93

Sluggish contractions, dysfunctional labor

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Inertia

Front 94

Artificial rupturing of membranes with woman in dorsal recumbent position

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Amniotomy

Front 95

Surgical incision of perineum done to allow fetal head to pass, preventing a tear to the perineum

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Episiotomy

Front 96

Artificially starting laborat term.

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Induction

Front 97

Disk-shaped cup pressed against the fetal scalp to help pull fetus out
Can cause marked caput (contraindicated in pre-term)

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Vacuum

Front 98

Medication to soften cervix to prepare for labor induction

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Prostaglandins

Front 99

Synthetic form of posterior pituitary hormone used to initiate uterine contractions

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Oxytocin

Front 100

Return of reproductive organs to pre-pregnancy size & condition

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Involution

Front 101

Descends @ 1cm/day for 10 days after birth.

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Fundal Descent

Front 102

Organ that regains its shape by 18 hours after birth

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Cervix

Front 103

Lochia Rubra

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First 3 days, mostly blood with pieces of decidua and mucus

Front 104

Lochia Serosa

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4th day amount decreases and color changes to pink/pinkish brown

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Lochi Alba

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After 10th day discharge becomes yellowish white (may last for 6 weeks or more)

Front 106

Mother's need for food, fluid, & sleep. Phase of nurturing & protective care

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Taking-in phase

Front 107

Mother becomes more independent & takes responsibility for her care & shifts focus to the care of the infant (@10 days)

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Taking-hold phase

Front 108

Role change from carefree lifestyle to being on a couple. The parents move forward as a unit with a new member

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Letting-go phase

Front 109

Difficult labor - most common is dysfunctional uterine contractions that result in a prolongation of labor

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Dystocia

Front 110

Rapid labor & birth within 3 hours

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Precipitate Labor & Birth

Front 111

Pregnancy that extends more than 294 days or 42 weeks

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Post-term pregnancy

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Occiput-posterior position - causes mother severe pain

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Fetal Malposition

Front 113

Forehead becomes the presenting part, head slightly extended instead of flexed

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Brow Presentation
C-Section necessary

Front 114

Most common malpresentation

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Breech Presentation
Emergency C-Section

Front 115

Weight of more than 4000 g (8lb 14oz)

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Macrosomia

Front 116

One or more accessory lobes of fetal villi will develop on the placenta

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Succenturiate Placenta

Front 117

Double fold of chorion & amnion form a ring around cord on fetal side

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Cicumvallate placenta

Front 118

Umbilical cord is inserted at or near the placental margin

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Battledore placenta

Front 119

Vessels of the cord divide some distance from the placenta

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Velamentous insertion of the umbilical cord

Front 120

Bolus of amniotic fluid enters the maternal circulation & cord is compressed

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Amniotic Fluid Embolism/Anaphalactoid Syndrome of Pregnancy

Front 121

Occurs when there is > 2000ml of amniotic fluid during 2nd half of pregnancy

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Hydramnios

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Turning the fetus

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Version

Front 123

Presentation is changed from breech to cephalic by externa manipulation of the abdomen

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External cephalic version (ECV)

Front 124

Obstetrician places hand inside uterus & turns from transverse

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Internal version or podalic

Front 125

Technique where a volume of warmed, sterile NS or LR is introduced in to the uterus to increase the volume of fluid

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Amnioinfusion

Front 126

Covers the preterm newborn

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Vernix

Front 127

Flexing the baby's hand toward the ventral forearm until resistance is felt - angle is measured

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Square window sign

Front 128

Test of flexion development

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Recoil

Front 129

Degree of knee flexion

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Popliteal angle

Front 130

Placing the baby in supine & drawing an arm across the chest

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Scarf sign

Front 131

Gently drawing the foot toward the ear

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Heel to ear extention

Front 132

Infant turns head to side when corner of mouth is stroked

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Rooting

Front 133

Elicited by touching the newborn's lips

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Sucking

Front 134

Infant forces the tongue outward when the tip is depressed or touched

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Extrusion

Front 135

Fingers flex & grasp a finger placed across their palm

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Palmar grasp

Front 136

Fencing reflex - flexing & extension of limbs dependent of turning of the head

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Tonic neck

Front 137

Startle reflex - response may be asymmetrical due to injury of the clavicle, humerus, or brachial plexus

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Moro reflex

Front 138

An infant lying prone will turn shoulder & pelvis to the stimulated side when skin near spine is stroked

Back 138

Gallant reflex

Front 139

Stroking the plantar surface of an infants food upward causes great toe dorsiflexion

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Babinski's Reflex

Front 140

Bluish dsicoloration of hand & feet

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Acrocyanosis

Front 141

Lacy pattern of dilated blood vessels under the skin

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Mottling

Front 142

Color change, deep color develops over one side while other side remains pale

Back 142

Harlequin sign

Front 143

Evaluated by blanching the tip of the nose, forehead, or gum line

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Jaundice

Front 144

Firm lesion 103 cm whtie or pale yellow papule

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Erythema Toxium

Front 145

Exposed sebaceous glands - raised white spots on face

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Milia

Front 146

White cheese-like substance

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Vernix caseosa

Front 147

Blood between the periosteum of the skull bone & bone itself due to ruptured capillaries at birth

Back 147

Cephalhematoma

Front 148

Edema of scalp at the presenting part of the babies head - crosses suture line

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Caput succedaneum

Front 149

Normal neonate BP

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60/40

Front 150

Normal neonate pulse

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120-160, >180 if crying

Front 151

Normal neonate respirations

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30-60

Front 152

Vitamin K (AquaMEPHYTOIN) given why?

Back 152

To prevent hemorrhage d/t low prothrombin levels

Front 153

Why apply ophthalmic oint to neonates eye?

Back 153

Prophylaxis against Chlamydia

Front 154

S/S of Neonatal Distress

Back 154

Sternal retractions, nasal flaring, grunting excessive mucus, cyanosis, vomiting of bile, absence of meconium, and temp instability

Front 155

yellowish or creamy fluid thicker than later milk, and contains more protein, fat-soluble vitamins & minerals, high levels of antibodies

Back 155

Colostrum

Front 156

Recurrence of ovulation & menstruation?

Back 156

non-nusring mothers 7-9 weeks
90% resume in 12 weeks

Front 157

A mild, transient condition in which mother cries for no apparent reason, fatigued, anxiety, restlessness, letdown feeling

Back 157

Postpartum blues

Front 158

Serious, intense persistent feelings characterized by inability to feel loved, irritability, guild, shame, disinterest in infant, and thoughts of harming infant

Back 158

Postpartum depression

Front 159

Rhogam

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Given within 72 hours of birth to prevent sensitization of Rh negative moms who have given birth to Rh positive infants

Front 160

Uterus Compresses the aorta & vena cava when mother is supine, decreasing fetoplacental blood flow

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Venal Caval Syndrome - Change position of mother, elevate one hip in side-lying position

Front 161

What should you keep at bedside if administering Mg Sulfate?

Back 161

Calcium gluconate

Front 162

Gravida TPAL

Back 162

G: # of pregnancies regardless of duration
T: # of term infants
P: # of preterm infants
A: # of pregnancies ending in abortion
L: # of currently living children