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145 Cards in this Set
- Front
- Back
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What is considered a full term pregnancy?
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38-42 weeks
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How long is a trimester?
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13 weeks
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What is supine hypotension?
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After 20 weeks gestation, laying on back can cause enlarged uterus to press on vena cava, reducing cardiac return, output, and BP
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What happens to HGB and HCT in pregnant women?
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It lowers, encourage consumption of iron rich foods and iron supplements
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How much weight should a pregnant woman gain?
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25-35 pounds
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What is Chadwick's sign?
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A bluish tint to the labia, vagina, and cervix due to increased vascular congestion
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These are signs of what?
Generalized swelling Headache Epigastric pain Visual disturbance Proteinuria Hyper-reflexia |
Preeclampsia
(Pregnancy-induced hypertension) |
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What is the normal fetal HR?
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120-160 BPM
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What are Braxton-Hicks contractions?
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"practice contractions" that occur in the month before labor and are normal
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What is lightening?
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The baby drops and positions itself for birth 2-4 weeks before labor. Called lightening because many mothers find it easier to breath, but the baby presses harder on the bladder
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What is the zero station?
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When the babies head is even with the spines of the pelvis
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Where does fertilization of the egg occur?
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In the ampulla (outer 3rd) of the fallopian tube
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What is implantation bleeding?
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A light period experienced by many women when implantation occurs, can be confused with a normal period
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decidua
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endometrium
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When does the trophoblast implant into the endometrium?
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6-10 days after fertilization
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What is the babies most vulnerable time for the baby?
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Embryo stage, day 15-60
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What is a TORCH infection?
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group of infections capable of crossing the placenta and adversely affecting the fetus. (p.200)
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What does TORCH stand for?
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Toxoplasmosis
Other (p.1004) Rubella Cytomegalovirus Herpes |
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What is a teratogen?
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causes harm to baby (drugs, radiation, metals, infections, etc)
p.321 for list |
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Chorion
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outermost membrane...
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Amnion
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innermost membrane...
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Why is amniotic fluid important?
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thermoregulation, oral fluid, cushion, free for movement for musculoskeletal development
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What brings oxygenated blood to the baby?
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Umbilical vein
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How many arteries and veins are in the umbilical cord?
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2 arteries
1 vein |
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The placenta is responsible for increasing levels of...
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Progesterone, estrogen, hCG, hPL, hCS
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What is responsible for stimulating maternal metabolism and developing breast alveoli?
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Progesterone
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During pregnancy, you want more (Estrogen or Progesterone)?
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Progesterone
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Estrogen
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uterine growth, uteroplacental blood flow, proliferation of breast tissue, uterine contractility
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In what order does the fetus develop?
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From head to toe
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Dont memorize fetal development
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look at pgs. 321-330
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What is meconium?
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Baby's first stool, black and sticky
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Vernix
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cheesy substance formed from sloughed cells
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What is uterine souffle
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When you can auscultate a swishing sound of the placenta
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What can happen when the corpus luteum dies and the placenta takes over hormone production?
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Negative pregnancy test
miscarriages |
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The uterus grows by 2 processes
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hypertrophy and hyperplasia
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What do Braxton-Hicks contraction help with?
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Moving blood to and from the baby through the placenta
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What is Goodell's sign?
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softening of the cervix
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What happens to BP during pregnancy?
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It should go down because SVR decreases
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How much extra blood does a pregnant mother have?
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40-50% more blood volume
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Does every pregnant woman need iron supplementation?
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Yes, because she cannot get optimum amount of erythrocytes without it
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What happens to clotting during pregnancy?
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Pregnancy is a hypercoagulable state!
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What happens to the rib cage during pregnancy?
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Lower rib cage flares out
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What happens to the pH during pregnancy?
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pH increases to 7.4-7.45 (they are in a constant state of partially compensated respiratory alkalosis)
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Why are pregnant women at greater risk of UTIs?
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ureters and kidneys dilate; pH changes, increased sweatiness
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How does a pregnant woman respond to infections?
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Increased ability to fight bacterial infections.
Decreased ability to fight viral infections. Local immune suppression in the reproductive tract. |
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Ptyalism
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rare condition where saliva tastes bitter
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When should hot baths be avoided?
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First trimester
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How does weight affect fertility?
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Fat cells create estrogen, which decreases fertility and taxes progesterone producing capabilities during pregnancy
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What should you take with iron?
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Vitamin C, on an empty stomach
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What do you give to stop preterm labor?
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Magnesium
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What supplements must women take during pregnancy?
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Iron
Folic Acid |
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What is Kernicterus?
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A preventable disorder, caused by increased bilirubin, that causes permanent neurologic problems
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What are the 5 S's to calm a baby?
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Swaddling
Side or Stomach positioning Shushing Swinging Sucking |
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What are the top 3 leading causes of maternal mortality?
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Gestational HTN
Pulmonary embolism Hemorrhage |
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What are the top 5 leading causes of neonatal death?
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Congenital abnormalities
Disorders r/t short gestation SIDS Respiratory distress syndrome (RDS) Newborn affected by maternal complications of pregnancy |
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What does smoking do the placenta?
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ages it prematurely
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What is the leading cause of preventable mental retardation in the USA?
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Alcohol during pregnancy
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What does smoking put the baby at risk for once they are born?
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SIDS death
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What is the risk of having a baby when you have herpes?
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50% chance the baby will get herpes and 50% of those who get herpes will die
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What is the most common cause of sepsis and meningitis in newborns?
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GBS (groub B strep)
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What happens to WBC count during pregnancy?
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WBCs increase; but they are less effective in combating infections
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What happens to 50% of babies of mothers with uncontrolled diabetes?
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heart defect
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What percent of women get gestational diabetes?
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2-15%
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What is fetal macrosomia?
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big baby (usually due to being born to a mother with diabetes)
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What causes fetal macrosomia?
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When the blood sugars rise, the baby produces more insulin; it is the babies increased insulin level that causes it to be larger than normal
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What happens to the respiratory system of babies of mom's with diabetes?
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There is decreased surfactant levels
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How long do fetuses sleep?
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20-40 minutes per hour
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What is the Coomb's test?
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Done on an Rh negative woman to see if she has Rh antibodies
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What is the second leading cause of death for pregnant women?
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Battery/Violence
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What is preterm labor?
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Labor occurring before the 37th complete week
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How many births are preterm?
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1 in 10
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neonatal death is a death that occurs before...
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28 days of life
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Infants born weighing less than ____ are 200x more likely to die in the first year of life than those weighing 2500g and are 10x more likely to be neurologically impaired
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1500
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What 3 maternal behaviors are linked to increased rates of preterm deliveries?
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smoking
cocaine use poor prenatal care |
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betamethasone; dexamthasone
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helps fetal lung maturity
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Why is hydration important for preterm labor?
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Dehydration = irritable cervix = increased chance of starting labor
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current viability threshold for fetus is how many weeks?
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24 weeks; 15-20% survival rate
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What causes labor pain?
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cervical stretching
myometrial hypoxia stretching and traction on ligaments |
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Opiods are given when during labor?
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only in the beginning, do not give within 2 hours before labor d/t respiratory distress
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Narcan is
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a opioid antidote
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What are the 5 Ps of labor?
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The passenger
The passage The powers (uterus) The position The psyche |
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What is fetal lie?
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relationship of the fetal spine to the maternal spine:
Can be: vertical (cephalic or breech) horizontal or transverse oblique |
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What is fetal attitude?
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Relationship of fetal parts to each other
Can be: Vertex (flexed) Military (extended) Brow or Face (extended) |
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What is fetal presentation?
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Part that enters the pelvis first
Can be: cephalic (96%) breech (3%) shoulder (1%) |
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What is fetal position?
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Relationship of the presenting fetal part to the maternal pelvis
Right/Left Occiput Anterior (ROA, LOA) Right/Left Occiput Posterior "back labor" Occiput Transverse - won't be able to deliver |
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What could be a cause of excessive back pain during labor?
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Could be a posterior presentation rather than anterior
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If the baby is at 0 station, where are they?
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Their head is at the ischial spines
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If the baby is at -5 station, where is the baby's head?
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Above the ischial spines
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Transition phase
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8-10 cm; when the pain is the worst
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2nd stage lasts how long?
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About 2 hours
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1st stage of labor is?
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2-10 cm dilation
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3rd stage lasts how long?
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The placenta should be delivered within 1 hour
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What are the signs of placental detachment?
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Uterus become more globular
Umbilical cord lengthens There is a "separation gush" of blood |
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The latent phase of 1st stage labor
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0-4 cm dilated
can take hours or days |
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The active phase of 1st stage labor
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4-8 cm dilated
approximately 1 hr per cm |
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The transition phase of 1st stage labor
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8-10 cm dilated
most rapid and most uncomfortable stage |
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What are the signs preceding labor (important!!)
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Lightening
Urinary frequency Backache Stronger Barxton Hicks Contractions Flu-like symptoms or fatigue Surge of energy (nesting) Slight weight loss the week of labor Bloody show Cervical ripening Loss of mucous plug |
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What happens to BP during labor?
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Stays the same, except increases during contractions
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What is the difference between true and false labor
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Main difference:
Contractions get stronger and more regular with true labor Contractions slow or stop with activity changes with false labor |
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What do we give to greatly increase lung maturity in premature neonates?
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betamethasone
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If a baby is having late decelerations, what is one thing you can try
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Make sure the woman isn't lying on her back
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Read ch. 36!
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very important chapter
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Bishop score:
Which is better, lower or higher? |
Higher; higher means more ready for labor
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Side effects of pitocin (oxytocin)
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Contractions too strong
Late decels d/t long, hard contractions Water intoxication - d/t increased ADH (the other posterior pituitary hormone) tetanic contractions placental abruption uterine rupture cervical lacerations postpartum hemorrhage |
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What position do you put the mother in if they have shoulder dystocia?
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McRoberts position (knees to chest - out to the side of the pregnant tummy)
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Where can you push if the baby is coming out shoulder first?
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suprapubic pressure
NO fundal pressure |
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What do you do if the cord comes out first?
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This is cord prolapse.
You use your fingers to try and keep the baby's head off the cord and call for an emergency c-section |
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Know how to manage amniotic fluid embolism!
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on test definitely!
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In a FHR monitoring strip, what type of variability is reassuring?
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Moderate variability
Variability can be described as: Absent Minimum Moderate Marked |
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FHR tachycardia is ?
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greater than 160 bpm average in a 10 min period (excluding accelerations)
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FHR bradycardia is?
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less than 110 bpm average in a 10 min period
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This is a FHR decrease of at least 15 bpm that lasts less than 2 minutes
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deceleration
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This is a FHR decrease of at least 15 bpm that lasts 2-10 minutes
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prolonged deceleration
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How do you measure uterine contractions?
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The number of contractions in a 10 minute period as an average over 30 mins (contractions in 30mins / 3)
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What is the normal number of uterine contractions in a 10 min period?
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5 or less
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What is tachysystole?
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More than 6 contractions in a 10 minute period
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IUPC
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Intrauterine pressure catheter
Placed in amniotic cavity and monitors uterine contraction strength |
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What is the difference between an early deceleration and a late deceleration?
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Early is at the same time as a u uterine contraction
Late is after the uterine contraction |
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What is the cause of late decelerations?
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Fetal hypoxemia
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What causes a variable deceleration?
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Cord compression
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What is the first intervention for variable decelerations?
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Change position to decrease pressure on umbilical cord
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What is a category 1 FHR tracing?
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Normal; 110-160 bpm
moderate FHR variability No late decelerations May be early decelerations May be accelerations |
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What is a category 2 FHR tracing?
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Not enough evidence to be a category 1 or 3
Can have tachycardia Can have bradycardia with baseline variability |
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What is a category 3 FHR tracing?
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Abnormal; indicative of abnormal fetal acid-base status
Absent baseline FHR variability Sinusoidal pattern |
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What are some interventions for a category 3 FHR tracing?
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Interventions include:
giving mother oxygen changing maternal position discontinue labor stimulation treat maternal hypotension |
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When is the placenta developed by?
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3rd month
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Can bacteria and viruses pass through the placenta?
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Bacteria cannot
Viruses can pass through |
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When can you start doing genetic testing on a fetus?
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8 weeks
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What is Hegar's sign?
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softening and thinning of the lower uterine segment that occurs around week 6
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What is Goodell's sign?
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softening of the cervix that occurs around week 4
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What is ballottement?
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rebounding of the fetus on the examiner's fingers during palpation.
When the examiner taps the cervix, the fetus floats upwards and then falls back down, which is the rebound |
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When can the FHR be detected by doppler?
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10-12 weeks
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What is the fundal height at 16 weeks?
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halfway between sympasis pubis and the umbilicus
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What is the fundal height at 20-22 weeks?
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At the umbilicus
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What is the fundal height at 36 weeks?
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xiphoid process
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What is the fundal height at 30 weeks?
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around 30cm
During the second and third trimesters (weeks 18-30) fundal height in cm equals approx. fetal age in weeks |
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What is the definition of abortion?
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Pregnancy that ends before 20 weeks gestation
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How can you suppress uterine activity?
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Administer tocolytics (i.e. Ritodrine or magnesium sulfate)
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How do you treat preterm labor?
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Give tocolytics if less than 6 cm dilated
Give corticosteroids (betamethasone or dexamethasone) and to speed fetal lung development |
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What is an important side effect of tocolytics?
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water retention (strict I/Os; no more than 2400mL water/day)
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What is a main reason indomethacin is not given as a tocolytic?
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It can cause premature closure of the ducutus arteriosus, esp if treatment exceeds 48 hrs or fetus is 32 or more weeks
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Dystocia
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long, difficult labor
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Effacement
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How thick or thin the cervix is, expressed in percent
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What is should be given before oxytocin to induce labor?
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First give a "cervical ripening agent (prostoglandins)" which thins out the cervix.
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Amniotomy
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artificial rupture of membranes
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