Antenatal Care & Normal Pregnancy Flashcards
Define the timeframe of the first trimester of pregnancy
first day of last menstrual period (day 0) up to and including 13 weeks & 6 days
Define the timeframe of the second trimester of pregnancy
14 weeks up to and including 27 weeks & 6 days
Define the timeframe of the third trimester of pregnancy
28 weeks to term
Define labor
onset of regular painful contractions with progressive effacement and dilation of the cervix, descent & expulsion of fetus & placenta
Describe the 4 stages of labor
Stage 1: onset of contractions to full dilation
Stage 2: full dilation to expulsion of fetus
Stage 3: after delivery of neonate until delivery of placenta
Stage 4: immediate time after birth
*latent labor moves into active labor (appx 5cm)
What are the medical goals of antenatal care
- estimation of gestational age
- ID of risks for fetal/maternal health
- constant eval of maternal/fetal health
- anticipation/prevention of issues to minimize morbidity
- health promo, education, support
Define cervical dilation
stretching of external os from a few mm to an opening large enough for birth (0-10 cm)
Define effacement
thinning/shortening of cervical canal (0-100%)
Define station in obstetrics
how far down the baby’s head is in the pelvis prior to delivery
- measured 0 when head settled into pelvis (@ ischial spine)
- -3 to -1 when above ischial spine
- +1 to +3 when below ischial spine toward cervix
Define presentation in obstetrics
orientation of fetus in womb, identified by location of presenting part of fetus relative to pelvis
List some personal goals of antenatal care
- maintain social, physical, cultural normality
- maintain health in pregnancy
- labor that is a positive experience
- positive experience mothering after birth
Define engagement in obstetrics
sensation that a pregnant person feels when fetus descends into pelvis (aka lightening)
- occurs at station 0
- typically 2 weeks prior to labor in first pregnancies
Define mucus plug
Throughout pregnancy, mucous blocks the opening of the cervix but is expelled prior to labor, sign that body is prepping for birth
Define embryo
child in utero during first 2 mos of development
Define fetus
child in utero from beginning of 3rd month until birth
Define infant
live born human from moment of birth until completion of 1 year of life
Define pre-term infant
child born between 20-37 weeks gestation
Define neonatal period
Defined as birth until 28 days of life
Define lochia
bloody discharge from vagina following delivery
Define post-term infant
child born after 42 weeks gestation
Define accelerations in obstetrics
short term rises in heart rate (one of the most important signs of well being during labor)
- increased FHR of at least 15 bpm for 15 seconds (if >32 weeks)
- increased FHR of at least 10 bpm for 10 seconds (if <32 weeks)
Define decelerations in obstetrics
temporary drops in FHR from baseline, can occur early, late, variably (late are typically the most worrisome)
Define Apgar scores
assessment of how the baby is doing at birth (1 and 5 minutes), range from 0-2 in areas of activity, pulse, grimace, appearance, respiration
List some pregnancy safe vaccines
- flu
- COVID
- Tdap
- pfizer RSV
List some vaccines that are NOT safe in pregnancy
- live virus vaccines (MMR, varicella)
- live flu vaccines (nasal)
- BCG
- oral typhoid, cholera, Japanese encephalitis, rotavirus, zoster
What are the factors impacting efficacy of prenatal care
- timing of initiation (1st tri before 10 weeks most effective)
- number/spacing of visits
- type/quality of content
- provider type/training
- ancillary services
Define gravidity
how many pregnancies someone has had
- includes miscarriages, confirmed chemical pregnancies, live births, still births, etc.
Define parity
description of types of pregnancy outcomes someone has had (loosely used in those who have had a birth after 20 weeks)
- 1st number: term & post term births (37 0/7+)
- 2nd number: preterm births (20 0/7 - 36 6/7)
- 3rd number: miscarriages/abortions prior to 20 0/7 weeks EGA
- 4th number: living children
Define ectopic pregnancy
pregnancy outside the uterine cavity (including cornua) (typically fallopian, ovarian, worse prognosis in abdomen d/t latching onto aorta)
Define term in obstetrics
fully gestated pregnancy
Define preterm in obstetrics
prematurely gestated pregnancy
Define viability in obstetrics
when a fetus can survive outside the womb
What are the Gs & Ps of the following case:
Woman who has had one C-section at 37 5/7, one VBAC at 36 6/7, one miscarriage at 8 5/7, one stillbirth at 22 4/7
- G4: four total pregnancies
- P1: one full term birth
- P12: two preterm births
- P121: one miscarriage prior to 20 weeks
- P1212: two living children (after 22 wk loss)
TOTAL: G4P1212
Define VBAC
vaginal birth after cesarean
Define TOLAC
Trial of labor after cesarean
What to expect in prenatal care
- avoid tobacco, alcohol, 2nd hand smoke, teratogens, travel to endemic areas of disease
- cut out caffeine (max 150-300 mg/day)
- optimize exervise
- add folic acid & prenatal vitamins
- avoid hot tubs (denature proteins)
- avoid chemicals/cleaning products
- avoid certain meds (acne, herbal, sudafed, NSAIDs in 3rd tri, ACEi)
List some special populations for consideration when pregnant/prenatal care
- adolescents
- advanced maternal age
- incarcerated women
- folks with disabilities (ADA)
- grand multipara (5+ births)
- obesity
- chronic medical/psychiatric conditions
- multiple gestations
Define normal labor
full term spontaneous expulsion of the fetus, vertex position, vaginal delivery, time between 3-18 hours without complications
- 3 Ps: Power of Passenger Passage
describe some evidence of labor
mucous/bloody show, rupture membranes, regular painful contractions
Describe the evaluation of fetal status during labor
- continuous or intermittent fetal heart monitoring
- can evaluate for acidemia via cord gases
Describe the fetal positions in normal labor
- vertex
- brow
- face
- compound
- breech
- transverse
- unstable
- asynclytic
Describe the cervical exam in normal labor
- dilation in cm 1-10
- effacement (thinning of cervix 0-100%
- station (-4 to +4)
- consistency of cervix (firm to soft)
- position from posterior to anterior
*BISHOP score based on above criteria to determine induction or not
What are the current expectations of labor
- appx 1-2cm/hour change allowing for slower dilation prior to 6 cm
- median time for labor from 4-10 cm in nulliparous = 5-ish hours, in parous = 4-ish hours
Describe cervical exams during labor
- every 2-4 hours in the first stage
- every 1-2 hours in the second stage to evaluate for descent
(frequency increases infection rates)
Define cervical ripening in induction of labor
softening and slowly opening of the cervix
- prostaglandins (PGE1 & 2) in induction
- mechanical dilation (foley, laminaria) in induction
Describe induction of labor
- pitocin
- membrane stripping
- rupture of membranes
- nipple stimulation
Describe the monitoring used in induction of labor
- monitor fetus
- monitor mom
- monitor excess contractions (tachysystole)
- remove ripening agent or pitocin or give terbutaline if tachysystole
List some indications for induction of labor
- placental abruption
- chorioamnionitis
- fetal demise
- gestational HTN
- preeclamspia, eclampsia
- premature rupture of membranes (PROM)
- postterm pregnancy
- maternal medical conditions (DM, renal dz, chronic pulmonary dz, chronic HTN, antiphospholipid syndrome)
- fetal compromise (severe fetal growth restriction, isoimmunization, oligohydramnios)
Describe contraindications to an induction of labor
- vasa previa or complete placenta previa
- transverse fetal lie
- umbilical cord prolapse
- previous classical C-section
- active genital herpes infection
- previous myomectomy entering the endometrial cavity
Describe augmentation of labor
- when labor stalls
- give pitocin +/- intrauterine pressure catheter
- evaluate adequacy of contractions (Montevideo units of strength)
- consider in nulliparous moms 4 hrs with epidural/3 without, parous moms 3/2 hours
Define puerperium
- 6 weeks after birth
- uterus involutes
- massive hormonal fluctuations & ongoing vaginal bleeding
- postpartum depression, anxiety, adjustment disorders
What are the cardinal movements of normal labor
- engagement of fetal head to zero station
- descent
- flexion
- internal rotation of fetal head
- extension of head under pubic symphisis
- external rotation
- expulsion
