antepartum Flashcards
What is conception?
fertilization (joining of sperm and ovum)
Where does fertilization occur?
fallopian tube
What is a fertilized ovum called?
zygote
What is a blastocyst?
Zygote that repeatedly as it moves down the fallopian tube towards the uterus
What is the preembryonic period?
First 2 weeks after conception
What are stages of development after conception?
fertilized ovum (zygote), blastocyst, embryo, fetus
What vitamin is important for pregnant women and those attempting pregnancy?
folic acid
What is folic acid?
water-soluble B-complex vitamin
What is folate for?
red blood cell production
What is the minimum amount of folic acid needed per day for pregnant women and those attempting pregnancy?
400 mcg/day
Why is it necessary to increase folic acid before and during pregnancy?
to decrease risk of neural tube defects (eg spina bifida, anecephaly)
What are ways to increase folic acid?
dietary sources of folic acid and supplementation (contains 400-800mcg)
What are best dietary sources of folic acid?
leafy green vegetables (asparagus, broccoli, spinach, green peas)
What are appropriate food choices to increase folic acid?
cooked beans, rice, spaghetti, fortified cereals, peanut butter, enriched breads
Where is amniotic fluid produced?
fetal kidney
What are 2 major purposes of amniotic fluid?
prevent cord compression and promote lung development
What is oligohydramnios?
condition characterized by low amniotic fluid volume
What causes oligohydramnios?
fetal kidney anomalies (renal agenesis or urine flow obstruction) or fluid leaking through the vagina (undiagnosed ruptured membranes)
What is the risk with a 41 weeks gestation?
fluid volume declines
What are signs of oligohydramnios?
small uterine size for gestational age or fetal outline that is easily palpated through maternal abdomen
Which test confirms diagnosis of oligohydramnios?
ultrasound
What are major complications of oligohydramnios?
1) pulmonary hypopolasia 2) umbilical cord compression
What causes pulmonary hypoplasia?
lack of alveolar distention by aspirated amniotic fluid
What are interventions for the complications of oligohydramnios?
1) Additional neonatal personnel should attend birth. 2) continuous fetal monitoring of variable decelerations
Why should more personnel be present during oligohydramnios intervention?
possible resuscitation or evaluation of newborn
What is induction of labor?
deliberate initiation of uterine contractions that stimulates labor
What increases operative vaginal birth (use of forceps or vacuum)?
prolonged second-stage labor or fetal distress
What is polyhydramnios?
excessive amniotic fluid volume
When is polyhydramnios a risk?
postpartum hemorrhage
Why is polyhydramnios a risk factor?
overdistension of the uterus
What is the type of drug needed for polyhydramnios?
uterotonic durgs
What is pyrosis?
Heartburn
Why is pyrosis common during pregnancy?
increase of progesterone hormone and uterine enlargement displaces the stomach
How does progesterone cause heartburn?
Relaxes smooth muscle, resulting in esophageal sphincter relaxation. Gastric contents are regurgitated, usually causing burning sensation behind sternum
What can reduce heartburn during pregnancy?
lifestyle changes (keep HOB elevated, sit upright, eat small frequent meals, avoid tight-fitting clothing, eliminate dietary triggers (fried/fatty foods, caffeine, citrus, chocolate, spicy foods, tomatoes, carbonated drinks, peppermint)
What is a liver disorder exclusive to pregnancy?
Intrahepatic cholestasis of pregnancy
What are the manifestations of intrahepatic cholestasis?
Intense, generalized itching but no rash
Where do the manifestations of intrahepatic cholestasis occur?
hands and feet
What is the risk of intrahepatic cholestasis?
intrauterine fetal demise
What is the assessment of intrauterine fetal demise?
loss of fetal movement, absent fetal heart tones, diseeminated intravasular coagulation, bleeding, low hemoglobin and hematocrit levels
What is a immediate intervention of intrahepatic cholestasis?
assessment by the HCP
What are interventions for intrahepatic cholestasis of pregnancy?
laboratory testing (elevated bile acids), fetal surveillance (biophysical profile, nonstress test), medication (ursodeoxycholic acid), and labor induction around 37 weeks gestation
What is the nonstress test?
evaluates fetal heart rate and response to fetal movement, placental function and oxygenation, fetal well-being
What is a biophysical profile?
Noninvasive assessment of the fetus
What does the biophysical profile include?
fetal breathing movements, fetal movements, fetal tone, amniotic fluid index, fetal heart rate patterns, nonstress test
What does normal fetal biophysical activities indicate?
fetal central nervous system is functional and not hypoxemic
What are physiological maternal skin changes?
chloasma (mask of pregnancy)
What is chloasma?
a brownish hyperpigmentation over the bridge of the nose and cheeks
What causes chloasma?
increase in malanocyte-stimulating hormone due to increase levels of estrogen and progesterone
When does chloasma appear?
second trimester
What are the interventions with chloasma?
Benign and fades in postpartum
What is condylomata acuminata?
sexually transmitted disease caused by human papillomavirus
What are the manifestations of condylomata acuminata?
fleshy, nontender bumps on genital/anal areas
What is the treatment for condylomata acuminata?
trichloroacetic acid, or removal of warts in pregnancy
What is a dermatological complication in pregnancy?
pruritic urticarial papules and plaques of pregnancy (PUPPP)
What are the manifestations of pruritic urticarial papules of pregnancy?
pruritic, raised lesions within abdominal striae, spare the umbilicus. not harmful but can cause discomfort
Where can pruritic urticarial papules and plaques of pregnancy spread?
on the thighs, arms, legs, back
What is an ectopic pregnancy?
occurs when a fertilized egg implants and begins to grow outside the uterine cavity
Where does the fertilized egg implant most frequently in ecotopic pregnancy?
fallopian tubes
What is commonly reported with ectopic pregnancies?
positive pregnancy test, vaginal spotting/bleeding, and/or abdominal pain
What is the risk with ectopic pregnancy?
continued growth of the fertilized egg, untreated, leading to rupture
What is the result ectopic rupture?
hemorrhage (intra-abdominal bleeding) and hemodynamic compromise.
What are the manifestations of ectopic rupture?
referred shoulder pain (sign of diaphragm irritation)
What is the priority intervention with ectopic rupture?
emergency surgery and hemodynamic support (IV fluids, blood transfusion)
What are pregnancy signs?
Presumptive, probable, positive
What are presumptive signs?
subjective signs of pregnancy, self-reported by client
What is included in presumptive signs?
amenorrhea, N/V, urinary frequency, breast tenderness, quickening, excessive fatigue
What is most important to ask when presented with possible sign/symptoms of early pregnancy?
assess date of last menstrual period
What are the normal lab values during third trimester?
Hemoglobin >11 g/dL, Hematocrit >33%, RBCs 500,000-625,000 /mm3, WBCs 5,000-15,000/mm3, platelets 150,000-400,000/mm3
What is a physiological cardiovascular change during pregnancy?
physiological anemia (total blood volume increases by 40-45%)
Why does total blood volume increase in pregnancy?
To meet the increased oxygen demand and nutritional needs of the growing fetus and maternal tissues
What causes physiological anemia during pregnancy?
plasma volume increase exceeds the increase in production of red blood cells
What values are lower in physiologic anemia of pregnancy?
low hemoglobin (>11 g/dL) and hematocrit (>33%)
What is also increased during pregnancy?
white blood cell count (up to 15,000/mm3)
BMI (kg/m2)
<18.5 (underweight);
18.5-24.9 (appropriate weight); 25-29.9 (overweight); >30 (obese)
What is the weight gain during the first trimester?
1.1-4.4 lb (0.5-2.0kg)
What is the weight gain during second & third trimester?
~1 lb/wk (0.5kg/wk) for underweight and appropriate weight; ~0.6 lb/wk (0.3 kg/wk) for overweight; and ~0.5 lb/wk (0.2 kg/wk) for obese
What is the total weight gain for underweight clients in pregnancy?
28-40 lb
What is the total weight gain for appropriate weight clients in pregnancy?
25-35 lb
What is the total weight gain for overweight clients in pregnancy?
15-25 lb
What is the total weight gain for overweight clients in pregnancy?
11-20 lb
