2nd and 3rd Trimester Flashcards
2nd trimester
13-28 weeks
3rd trimester
29-40 weeks
Body changes as you move into 2nd and 3rd trimester
Larger breasts and belly Braxton Hicks contractions Skin changes Nasal and gum problems Dizziness Leg cramps Heartburn and constipation SOB Vaginal d/c Bladder and kidney infections
Venacaval syndrome
Pressure on the vena cava due to enlarging uterus that interferes with returning blood flow
Corrected by woman lying on side
What does venacaval syndrome cause?
Decreased BP
Dizziness
Pallor
Clamminess
Calorie requirement for 2nd and 3rd trimester:
2300-2400 cals/day
300 calories above pre-pregnancy
Gain 1 lb/week
Subsequent routine prenatal exam
VS Weight gain Uterine size & fetal position Urinalysis CBC and other blood work Fetal heartbeat and movement Psychological status Complaints
Fetal Well Being Tests
Kick counts Ultrasound Amniocentesis CVS Non-stress test Contraction stress test
Start monitoring kick counts when?
28 weeks and after
Should have 3 movements/hour
AFP screening tool
15-22 weeks gestation
Elevated AFP levels indicate:
Open NTD Congenital nephrosis/anomalies Multiple gestation Maternal diabetes Rh incompatibility
Low AFP levels indicate:
Down’s Syndrome (Trisomy 21)
Amniocentesis (when and what is it?)
15-18 weeks
Transabdominal removal of a sample of amniotic fluid
Non-Stress Test (NST)
Shows if the baby is not receiving enough oxygen because of placenta or umbilical problems
Detects fetal heart rate acceleration in response to fetal movement to determine adequacy of fetal oxygenation and autonomic function
External fetal monitoring for 20 - 40 mins
Interpretation 2 movements/20 minutes
- Reactive - FHR accelerations (repeat q wk)
- Non-reactive - insufficient HR accels x 40 min (repeat in 12-24 hrs or refer for wk up)
Reason for Non-Stress Test (NST)
If mother reports baby not moving as frequently as usual
Mom is overdue
Any reason to suspect the placenta is not functioning properly
High risks
Why is a Contraction Stress Test (CST) done?
To see if the baby will stay healthy during the reduced O2 levels that normally occur during contractions during labor
If the placenta is healthy and can support the baby
When is a CST done?
34 weeks+
When results from a non-stress test or a biophysical profile are not in normal range
Normal (-) CST results:
Baby’s heart rate does not slow and stay low after contraction
If 3 contractions occur in10 minutes lasting > 45 seconds with no decelerations, baby can tolerate labor
Abnormal (+) CST results:
Late decelerations that stay low after the contraction
Contractions that last longer than 90 seconds and occur every few minutes are present
How to prepare a patient for a CST:
NPO 4-8 hours before
Empty bladder
No smoking for 2 hours prior
Consent
Test may take 2 hours
Observed until contractions go away
Risks of CST
Labor may start earlier than expected
Prolonged contractions - may cause issue for baby
Contractions usually stop when oxytocin is stopped
If contractions don’t stop, then Dr. may recommend delivery
Contraction Stress Test (CST)
Placental insufficiency
Induce contraction with nipple stimulation or Pitocin
3 contractions of 40 second duration in 10 minutes
Indications for NST and CST
Maternal diabetes Chronic HTN IUGR Sickle cell disease Maternal cyanotic heart disease Post-maturity History of stillbirth Decreased fetal movement
Biophysical Profile
Fetal breathing and movements Gross body movements Fetal tone Reactive FHR Amniotic fluid volume
3 signs of labor
Bloody show
Contractions
Rupture of amniotic sac membranes
Early amniotic fluid contents:
Water
Electrolytes
Late amniotic fluid contents:
Lipids Proteins Carbs Phospholipids Urea
pH of amniotic fluid
7.0-7.5
Does the baby breath in and out in the amniotic fluid?
Yes
Breathes in the fluid bathing the lungs
