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Cumulative > Antenatal Care & Normal Pregnancy > Flashcards

Antenatal Care & Normal Pregnancy Flashcards

1
Q

Define the timeframe of the first trimester of pregnancy

A

first day of last menstrual period (day 0) up to and including 13 weeks & 6 days

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2
Q

Define the timeframe of the second trimester of pregnancy

A

14 weeks up to and including 27 weeks & 6 days

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3
Q

Define the timeframe of the third trimester of pregnancy

A

28 weeks to term

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4
Q

Define labor

A

onset of regular painful contractions with progressive effacement and dilation of the cervix, descent & expulsion of fetus & placenta

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5
Q

Describe the 4 stages of labor

A

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)

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6
Q

What are the medical goals of antenatal care

A
  • 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
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7
Q

Define cervical dilation

A

stretching of external os from a few mm to an opening large enough for birth (0-10 cm)

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8
Q

Define effacement

A

thinning/shortening of cervical canal (0-100%)

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9
Q

Define station in obstetrics

A

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

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10
Q

Define presentation in obstetrics

A

orientation of fetus in womb, identified by location of presenting part of fetus relative to pelvis

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11
Q

List some personal goals of antenatal care

A
  • maintain social, physical, cultural normality
  • maintain health in pregnancy
  • labor that is a positive experience
  • positive experience mothering after birth
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12
Q

Define engagement in obstetrics

A

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

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13
Q

Define mucus plug

A

Throughout pregnancy, mucous blocks the opening of the cervix but is expelled prior to labor, sign that body is prepping for birth

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14
Q

Define embryo

A

child in utero during first 2 mos of development

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15
Q

Define fetus

A

child in utero from beginning of 3rd month until birth

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16
Q

Define infant

A

live born human from moment of birth until completion of 1 year of life

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17
Q

Define pre-term infant

A

child born between 20-37 weeks gestation

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18
Q

Define neonatal period

A

Defined as birth until 28 days of life

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19
Q

Define lochia

A

bloody discharge from vagina following delivery

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20
Q

Define post-term infant

A

child born after 42 weeks gestation

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21
Q

Define accelerations in obstetrics

A

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)

22
Q

Define decelerations in obstetrics

A

temporary drops in FHR from baseline, can occur early, late, variably (late are typically the most worrisome)

23
Q

Define Apgar scores

A

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

24
Q

List some pregnancy safe vaccines

A
  • flu
  • COVID
  • Tdap
  • pfizer RSV
25
Q

List some vaccines that are NOT safe in pregnancy

A
  • live virus vaccines (MMR, varicella)
  • live flu vaccines (nasal)
  • BCG
  • oral typhoid, cholera, Japanese encephalitis, rotavirus, zoster
26
Q

What are the factors impacting efficacy of prenatal care

A
  • timing of initiation (1st tri before 10 weeks most effective)
  • number/spacing of visits
  • type/quality of content
  • provider type/training
  • ancillary services
27
Q

Define gravidity

A

how many pregnancies someone has had
- includes miscarriages, confirmed chemical pregnancies, live births, still births, etc.

28
Q

Define parity

A

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

29
Q

Define ectopic pregnancy

A

pregnancy outside the uterine cavity (including cornua) (typically fallopian, ovarian, worse prognosis in abdomen d/t latching onto aorta)

30
Q

Define term in obstetrics

A

fully gestated pregnancy

31
Q

Define preterm in obstetrics

A

prematurely gestated pregnancy

32
Q

Define viability in obstetrics

A

when a fetus can survive outside the womb

33
Q

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

A
  • 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

34
Q

Define VBAC

A

vaginal birth after cesarean

35
Q

Define TOLAC

A

Trial of labor after cesarean

36
Q

What to expect in prenatal care

A
  • 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)
37
Q

List some special populations for consideration when pregnant/prenatal care

A
  • adolescents
  • advanced maternal age
  • incarcerated women
  • folks with disabilities (ADA)
  • grand multipara (5+ births)
  • obesity
  • chronic medical/psychiatric conditions
  • multiple gestations
38
Q

Define normal labor

A

full term spontaneous expulsion of the fetus, vertex position, vaginal delivery, time between 3-18 hours without complications
- 3 Ps: Power of Passenger Passage

39
Q

describe some evidence of labor

A

mucous/bloody show, rupture membranes, regular painful contractions

40
Q

Describe the evaluation of fetal status during labor

A
  • continuous or intermittent fetal heart monitoring
  • can evaluate for acidemia via cord gases
41
Q

Describe the fetal positions in normal labor

A
  • vertex
  • brow
  • face
  • compound
  • breech
  • transverse
  • unstable
  • asynclytic
42
Q

Describe the cervical exam in normal labor

A
  • 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

43
Q

What are the current expectations of labor

A
  • 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
44
Q

Describe cervical exams during labor

A
  • every 2-4 hours in the first stage
  • every 1-2 hours in the second stage to evaluate for descent

(frequency increases infection rates)

45
Q

Define cervical ripening in induction of labor

A

softening and slowly opening of the cervix
- prostaglandins (PGE1 & 2) in induction
- mechanical dilation (foley, laminaria) in induction

46
Q

Describe induction of labor

A
  • pitocin
  • membrane stripping
  • rupture of membranes
  • nipple stimulation
47
Q

Describe the monitoring used in induction of labor

A
  • monitor fetus
  • monitor mom
  • monitor excess contractions (tachysystole)
  • remove ripening agent or pitocin or give terbutaline if tachysystole
48
Q

List some indications for induction of labor

A
  • 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)
49
Q

Describe contraindications to an induction of labor

A
  • 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
50
Q

Describe augmentation of labor

A
  • 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
51
Q

Define puerperium

A
  • 6 weeks after birth
  • uterus involutes
  • massive hormonal fluctuations & ongoing vaginal bleeding
  • postpartum depression, anxiety, adjustment disorders
52
Q

What are the cardinal movements of normal labor

A
  • engagement of fetal head to zero station
  • descent
  • flexion
  • internal rotation of fetal head
  • extension of head under pubic symphisis
  • external rotation
  • expulsion

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