Antepartum Flashcards
Polysystic ovary syndrome
Treatment
Varies + depends on the degree of infertility and desire for conception
Pcos in obese women has been treated with weight loss programs alone
Hormonal contraceptives to initiate normal orulatory function and suppress the continued physical enlargement
Poly cystic ovary syndrome
S/s
Cause
V406
Affects5% of women. Most common diagnosis implicated in ovarian dysfunction related to infertility
Hyperandrogenism
Menstrual irregularities amenorrhea, oligomen
Physical characteristics: obesity, acne, alopecia, hirsuitism
Often insulin resistant
Cause is unknown
What conditions are associated with the development of oligohydramnios?
Congenital anomalies
IUGR
Postmature syndrome
What is the shortest anteroposterior diameter of the pelvis?
The obstetrical conjugate
Congenital heart disease
Grades 2-4
Why a high risk factor
Increased blood volume and weight puts strain on the heart
Condition requires clinical, radiological surveillance
B/P
Systolic reading
Indicates the pressure in the arteries when the heart is actively pumping
Systolic pressure indicates cardiovascular tolerance for exertion
B/P
Diastolic reading
Indicates the pressure in the arteries when the heart is at rest
Diastolic pressure assesses baseline intravascular tension
MSAFP should be performed between what weeks?
What 3 anomalies could cause a level above normal?
15-20
Neural tube defects
Multiple gestation
Fetal demise
Fetal alcohol syndrome
S/S
Growth problems
Heart defects
Mental retardation
Facial abnormalities
Problems with muscle and nerve development
Less agile/athletic
Trouble with organization, concentration and impulse control
History of PID and effects
Can cause scarring of the uterine lining Predisposes to Ectopic prey Irregular placental implantation 3 rd stage hemorrhage Scar tissue may form at the cervical os
LEEP
Consideration
A laser procedure similar in effect to cone biopsy
Correlated to incomplete cervix and premature labor
Macrocyclic anemias
V 684
Increased red cell size
Vitamin b12 deficiency Folic acid deficiency Hypothyroidism Alcoholism Chronic liver or renal disease
Micro cystic anemias
V684
Decreased Rbc and size
Iron deficiency anemia Thalalsemias Hemoglobin E disorders Lead toxicity Chronic disease infection neoplasm
Hemolytic anemia
V684
This is a normocytic anemia,where rbc’s are abnormal size
Hemolytic disorders
Sickle cell disease
Hemoglobin c disorders
Acquired medication side effect
Autoimmune
FetL heart rate reactivity is usually reached at what gestational age?
28-32 weeks
What are 3 changes in the cardiac system during pregnancy?
Increase in cardiac volume
Heart displacement to the left
Increase of 10 beats /min in resting heart rate
Complications with polyhydfamnios
Cord prolapse
Placental abruption
Pp hemorrhage
For how long does rho gam provide protection against developing antibodies?
12 weeks
Untreated a symptomatic bacteriuria can cause
Low. Orthodox weight infant
Pyclonephritis
Preterm labor
Which result of a uc bacterial count indicates the presence of a uti?
50,000 bacteria of same species per milliliter of urine
What is the physiological reason for increased chance of uti in pregnancy?
Hydronephrosis which causes urinary stasis
Frequency of SAB after the preg has been clinically diagnosed
1 in 20
Blood volume increases by approximately _____ during pregnancy?
40-45%
Exercise increases all of the following in the preg body?
3 answers
Blood volume
Vascular urge
Cardiac input
Two hormones the placenta produces are
Estrogen and progesterone
Three risk factors for an incompetent cervix?
Previous cervical cone biopsy
History of cervical laceration during a previous childbirth
History of 3 or more abortions using suction
Diabetes
Why is it a high risk factor
Fetal demise after 36 weeks
5x the normal incidences of fetal abnormalities
Increased polyhydramnios
30-50% higher incidence of pre eclampsia
Increased incidence of prematurity and nb respiratory difficulties
Thyroid disease
Why is it a high risk factor
Particularly hyperthyroidism
Dangers
Thyroid medication has potential for causing severe fetal complications
Miscarriage, premature labor, fetal anomalies
Untreated hypothyroidism can lead to cretinism in the newborn
Acute tuberculosis
Why a high risk factor
If under treatment prognosis is god
Baby must be imm. Separated from the mom if she is infectious
Dangers
Slightly higher risk of miscarriage or premature labor
TORCH illnesses
T-toxoplasmosis o- other syphillis, hep b, parvovirus, Epstein Barr and varicella R-rubella C-cytomegalovirus H-herpes simplex virus
Hepatitis A Definition S/S Transmission Treatment Effects on baby
Infectious flu like symptoms
Fecal loran route contaminated water and food
99% require no treatment
No adverse fetal effects of active maternal infection have been identified
Breast feeding is okay
Hepatitis B Def Transmission Screening Effect on baby
Serum hep chronic or carrier state
Transmitted through blood, dirty needle, saliva, vag secretions, semen
Screening blod sample for hbsag
High risk of transmission to NB, who if infected have a high risk of becoming carriers. Should be immunized 12 hrs after birth
Hepatitis B
S/s
Treatment
Abdominal pain, chills, fever
Should be hospitalized and have all family members screened
Not responsive to any treatment and must run its natural course
A person with chronic hep b should be screened for liver disease
Hep b is present in all bodily fluids except
Breast milk
What is the best management of a NB of a hep b infected mother?
Immediate birth,immunization with hep b immune globulin and immunization hep b vaccination
Hepatitis C
Definition
Transmission
Effect on baby
20% of viral hepatitis in USA
Transmission is primarily via blood and blood products but can be a std
Signs of active infection are similar to HBV, but chronic conditions develop in 85% of cases
Perinatal transmission 5% depending on the amount I’d virus in bloodstream
Breast milk not affected
No immunization for hep C
How does hep c effect pregnancy and birth?
The woman will be monitored for signs of abnormal liver disease
That may affect her nutritional status
What kind of viral hepatitis is transmitted via the fetal oral route?
Hep A
Syphilis
Def
Cause/transmission
Effect on fetus
Std
Transmitted through the placenta at any stage of infection 40%with untreated disease have fetal or neonatal loss SAB or stillborn. Another 40% have babies with congenital syphillis
Crippling lesions on internal organs and bones to death
Placenta is large, heavy and a pale yellow gray color
Syphilis
Lab test
Management
Diagnosis lab tests depend on the stage the disease is in, antibody screening,,RPR
Preg should be tested at 1st appt and at 28 weeks, or if she has chlamydia, gonorrhea or hpv
Treatment goal of preventing transmission and preventing progression of disease
Preferred drug for any stage is penicillin
Risks to fetus of treatment ptl, fetal distress, stillbirth, jarisch here helmer reaction
Syphillis
Symptoms
Primary- chancre at site of infection painless heals spontaneously AB response present
Secondary- 4 weeks to 6 months after infection
Rash on palms of hands and soles of feet, hair loss, heals spontaneously in 2-10 weeks
Latent- no manifestations.
Tertiary- 1year-3 years after infection.
High morbidity 1 mortality. 2 forms: gumma: soft tissue tumors, or cardiovascular.
Cytomegalovirus
- def
- cause
- effect on fetus
-fairly common infection- 60% pop. has antibodies
Most damaging in 1st trial
-Member of herpes virus group
- Spread thru contact with bodily fluids, within households, daycare centers, classrooms.
-Fetus at risk if primary infection for mom, usually not recognized until birth.
- 80%-90% will have complications that include hearing loss,vision impairment and varying degrees of mental retardation.
Cytomegalovirus
- SIS in pregnant women
- lab tests
- management plan
- most women have minimal if any symptoms and are unaware of the infection
- symptoms of mononucleosis
- signs of hepatis with negative test results for hepatis A,B,C
- no treatment for CMV infection in healthy persons.
- can be transmitted to the infant through genital secretions / breast milk
Toxoplasmosis
- SIS in the pregnant women
- lab tests
- management plan
- SIS vague, similar to mononucleosis
Fatigue, muscle pain, fever, sore throat,
Enlarged posterior cervical lymph nodes - serum testing for 1gM and 1gG, repeat x3 weeks
-if suspected-
imm. referral for uis to check for fetal anomalies
Amniotic fluid and fetal blood can be sampled to confirm fetal infection
-Tx: can reduce harmful fetal effects
Anti-protozoal drugs
Toxoplasmosis
- cause
- effect on fetus/child
- protozoal infection caused by toxoplasma gondii
- humans are exposed thru exposure to cat feces, infected soil, or ingestion of raw or undercooked meats -> usually pork
- can cause severe congenital malformations because it can cross the placenta. Most severe in 1st trial
- many infants have no SIS at birth, bit can develop: seizures, motor and cognitive definite and mental retardation throughout childhood.
Sickle cell trait / disease and
Implications in the AP
- primary complication is an increase in UTI and hematuria
- can be cared for by a midwife only collaboration with a physician experienced in dealing with sickle cell
How does pregnancy affect the course of sickle cell disease?
Pregnancy increases both the intensity and frequency of sickle cell crises.
Congenital rubella syndrome
Most common malformations: cataracts, cardiac defects, deafness.
May also be:
Glaucorna microcephaly, and other defects involving the eyes ears, heart, brain, and CNS.
Infants with CRS frequently exhibit intrauterine and post natal growth retardation.
In what stage of pregnancy is maternal infection with rubella most likely to cause congenital malformation
In the first month.
Explain the safety of the Rubella vaccine (for a woman 4 weeks pregnant, had vaccine 2 weeks ago)
Explain to the woman that there is a theoretical rick from the vaccine, but there is no demonstrated evidence of teratogenicity for the vaccine.
What is the best course of action when a woman has an active Varicella infection during delivery for the immediate postpartum?
Give VZIG to the infant immediately and consider isolation of infant from mother.
Rubella
-weeks gestation and risk of morbidity
-If contracted during the first trimester, there is a 52% chance the baby will be born with congenital rubella syndrome.
The risk increases to 85% if contracted during the first 8 weeks. Infection after the 20th week rarely causes defects.
Describe the rash of rubella
Pale or bright red, spreading rapidly from face to entire body, and then fading rapidly.
Weeks 17-24
Mother begins to feel movement
Vernix is formed
Lungs are well formed, capillaries develop around already
Hair develops on the head, eyebrows, eyelids, eyes are structurally complete
Weeks 25-28
Subcutaneous fat is laid down Eyes down Lung physiology is sufficiently developed to enable gas exchange to begin Nervous system can control temperature Breathing movements
Week 29
The fetus is fully formed and the organs are able to function to some extent
Week 30 beyond
Organ physiology matures and the fetus continues to lay down fat and muscle
The nervous system continues myelinzation beyond term
Week 6
Liver begins to function Eyes migrate to the front of the face Rudimentary kidneys and genitalia form Cartilage begins to form the skeleton Muscle differentiation begins
Week 5
Rapid brain growth continues
Limb buds appear
Umbilical cord is formed
Heart chambers divided by septa
Week 3-4
The heart begins to pump blood
Brain begins to divide into forebrain, midbrain, hindbrain
Lungs to begin to form
Features of the gi system can be identified
So mites (future vertebrae and muscles) appear to either side of the midline
Days 18-21
The primitive nervous system begins to fold into position
The heart begins to twitch
Primitive eyes and ears begin differentiation
Red blood cells begin development
Day 15
A thick band of cells, the primitive streak appears in the midline of the dorsal surface of the embryo
Blood vessels begin to form
Cell specialization occurs
Day 13 from LMP
Chronic villi begin to secrete hcg, which stimulates the corpus luteum in the ovary to continue producing the hormones necessary to maintain the pregnancy until the placenta is mature enough to take over this role
Physiological effects of estrogen
Development of secondary sex characteristics
Myometrial thickening
Maturation of ovarian follicles
Testosterone production is stimulated by:
Lutenizing hormone
Describe oogenesis
Ongoing differentiate into primary oocytes during early fetal life
The first maturation division results in a secondary oocytes and first polar body
Final maturation of the secondary oocytes is completed at fertilization
Gametogenesis
V. 556
Halving of the chromosomes number is a result of gametogenesis , the process by which mature ova and sperm are developed
Contraction stress test
Checks to see if the fetus will withstand the decrease o2 levels with contractions and placental health EFM Done at 34+ weeks I've pitocin Indicated with abnormal BPP
Define Graafian follicle
f 176
A secondary follicle in the ovary will mature into a vestibular ovarian(Graafian) follicle which is ready for ovulation
Magnesium sulfate is administered primarily to
Decrease neuromuscular irritability
Define the fetal period
From 8 weeks gestation to birth
Parvovirus B19 (Fifth disease, erythema infection) S/s Lab tests Management plan
Flushed red face “slapped cheek pattern”
Before rash
: mild fever, malaise, myalgia a, headache, itchy rash may start on trunk and extremities
Most contagious before symptoms
Diagnosis: parvovirus B19 specific 1gm serum 1gG shows previous infection and immunity
If seroconversion occurs fetus should be checked weekly with u/s for fetal hydrops, placentomegaly, and fetal growth restriction
Parvovirus
Def
Cause
Effect on fetus
Contagious virus common in school children
Transmitted by contact with respiratory secretions or exposure to blood and vertical transmission from mother to fetus
Congenital anomalies not associated with parvovirus
For those fetuses affected some will experience apastic anemia, non immune hydrops and rarely death
Which of the following is an accurate definition of proteinuria
Protein in the urine in excess of 1 g/l
Which change, besides restoration of the diploid number of chromosomes occurs at fertilization
Start of meitotic cell division and fetal sex determination
The largest portion of the uterus is the
Myometrium
Cystic fibrosis, sickle cell anemia, and Tay-Sachs disease, which can be diagnosed by prenatal genetic studies are examples of
Autosomal recessive disorders
The physiological effects of progesterone include
Increased basal metabolism
Placental growth
Development of acini cells in the breasts
Normal values for 1 hr and 3 hr GTT
1 hr 65-139 mg/dl
3 hr fasting 65-95
1 hr 65-180
2 hr 65-155
3 hr 65-140
A rubella titer of greater than 1:64 indicates
Infection
A rubella titer of greater than 1:10 indicates
Immunity
A rubella titer of less than 1:10 indicates
Not immune
Benign ovarian cysts
Most do not require intervention
Commonly asymptomatic
Cysts of significant size cause adnexal motion tenderness or pelvic pain and may grow large enough to cause ovarian torsion
Ox best with u/s
Which of the following demarcations divides the true and false pelvis?
The linea terminalis
Chronic lung disease
Why a high risk factor
Mother at risk for pulmonary complications, baby at risk for fetal acidosis and hypoxia
Severe asthma
Why a high risk factor
Resp infections and stress may intensify attacks
Cardiopulmonary function could be reduced affecting growth and we’ll being
Certain medications used to treat asthma are contraindicated for preg
Epilepsy
Why a high risk
There is controversy over whether or not this condition is exacerbated by preg.
Dangers:
Anticonvulsant drugs may cause Folic acid deficiency which when treated with Folic acid may cause seizures
The infant may develop deficiency of coagulation factors
Renal disease
Why a high risk factor
Impaired kidney function requires close medical surveillance in preg
Signs of renal disease include:
Protein in the urine, hypertension, edema, and elevated blood urea all before the 20th week
Dangers:
Acute adrenal failure
Extreme obesity
Why a high risk factor
Pre existing with a history of medical problems
Nearly 2/3 of extremely obese women have obstetrical implications, including diabetes, hypertension, pyclonephritis, uterine dysfunction, and hemorrhage
Tobacco use
Why a high risk factor
(More than 10 cig daily, although no amount can be considered without risk)
Associated with IUGR, miscarriage, congenital heart disease mad fetal hypoxia during labor
Malnutrition
Why a high risk factor
(Extreme dietary deficiencies- May be substance abuse, debilitating illness, eating disorders)
IUGR p, preeclampsia, maternal or fetal infection, prematurity, still birth, dysfunctional labor, hemorrhage
Tubal pregnancy
S/s
Timing of rupture
Bleeding/spotting
Non rhythmic pain
10-13 weeks.
Normal rate of weight gain
She should gain at least 10lbs by 20 weeks and about 1 lb a week afterwards
Sequential screen
Part 1: 10-12th week blood draw and u/s for unchallenged trans.
Part 2: btw 16-18th week 2nd blood test
Provides risk of having a baby with Down syndrome, trisomy, or neural tube defects
Hugh rate of false positives
Why are yeast infections more common in pregnancy
Yeast tends to overgrow in preg because of increased vaginal alkalinity, which in turn is caused by elevated progesterone levels
Vagina yeast infection
Management
Physiology
Increase of acidity of vaginal canal and extra discharge
-7 day monistat Diflucan No sugar or simple carbs Garlic Tea tree oil
How many days after fertilization is implantation
6 days
When diagnosing preeclampsia what is an accurate definition of hypertension
140/90 + either#
What predisposes a woman to develop preeclampsia
Trophoblastic disease
Maternal age greater than 35
Multiple pregnancy
S/s of preeclampsia
Persistent headaches Visual disturbances Edema Protein urea Increased blood pressure Epigastric pain
Hypermesis gravidarium
Chronic and self perpetuating N+V
So disrupts the electrolyte balance that the woman cannot retain food/ liquid must be restabilized with IV fluids
Emotional underpinnings
Psychological conflicts regarding preg.
History of eating disorders/ body image issues
The heart begins beating in the embryo at (from conception)
___ weeks
3 weeks
5 weeks from LMP
B12
The vegan mother must be careful to ingest adequate ___, without which a serious for of anemia may develop and cause neurological damage to her and her baby
Of the babies whose mothers drank heavily while pregnant, ____% develop FAS
4%
Caffeines effect on the fetus
Elevate fhr
Reduce the amount of fluid and calcium available for baby’s optimal growth
To help prevent leg cramps from disturbing her sleep recommend:
Elevate and support her legs on pillows while sleeping
LAM
Baby must be 6 months or less
After 6 months the woman must find another form of contraception
On demand nursing, at least every 4 hrs during the day and. 6 hrs at night
With a history of gestational diabetes what is a woman’s chance of developing diabetes mellitus in the future
25%
PUPPP
Pruritic urticarial papules and plaques of pregnancy
Rare- late in pregnancy and resolves with birth
Comfort measures- oatmeal bath, vegetable based salve or lotion
Placenta functions
Provide fetus with a o2 co2 exchange Passage of essential nutrients Excretion of metabolic waste products Transfers maternal antibodies 3 main functions 1. Organ of metabolism 2. Organ of transfer 3. Endocrine organ in synthesis, production and secretion of protein hormones and steroid hormones
What causes shortness of breath in early pregnancy?
It is thought that an increased amount of progesterone acts directly on the respiratory center to lower the carbon dioxide levels and increase the o2 levels.
Increase o2 benefits the fetus
The increase of metabolic activity that occurs during pregnancy causes an increase in co2 levels; hyperventilation decrease in co2 levels
Women may experience this early in the 2nd trimester
FHT minimal/absent variability
Causes: fetal sleep , drugs, hypoxia, anemia, prematurity less than 28 weeks, congenital neurological anomalies
Def: steady baseline even with contractions or movement. No reaction to stimuli
Bradycardia
Mild
Marked
Mild 100-119
Marked 99 or less
Late FHT decelerations
Type 2
Cause uteroplCental insufficiency: IUGR, PIH, hypertonic contractions, post dates, abnormal placenta, fetal anemia
The severity of the hypoxia cannot be measured by the depth of the deceleration
Treatment- position, IV fluids, o2, then re-check
Very serious, needs intervention
FHT’s decrease after peak. Contraction
_____ is the relation of the fetal head to its trunk
Attitude
What does the indirect Coomb’s testing show
It tests maternal blood for RH antibodies
The uterine endometrium during pregnancy is called the
Decidua
In clinical pelvimetry, if the pelvis is adequate, the angle of the pubic arch should be at least:
90 degrees
2 finger breadths
The basic shape of the android pelvis is:
Heart shaped
The pubic arch of the platypelloid pelvis is
Greater than 90 degrees
The basic shape of the anthropoid pelvis is
Anterior posterior oval
Two features of the android pelvis
Heart shaped inlet
Narrow pubic arch
Missed abortion
Fetus dies but the products are retained for a prolonged period (2+weeks) S/s Vaginal spotting at the time of death Fundal height stops or decreases Regression of mammory symptoms Loss of weight Persistent amenorrhea No FHT's
What term is used to describe an increase in the size of existing cells?
Hypertrophy
What term is used to describe an increase in the number of cell ny cell division
Hyperplasia
What is the shortest anteroposterior diameter of the pelvis
Obstetrical conjugate
MSAFP should be performed between ___ to ___ weeks.
What 3 anomalies could cause a level above normal
15 to 20
Neural tube defect, multiple gestation, fetal demise
Hemolytic anemia
This is a normocytic anemia, where RBC’s are a normal size
Disorders: Sickle cell disease Hemoglobin C disorders acquired (medication side effect) Autoimmune
Fetal heart rate reactivity is usually reached at what gestational age
28-32 weeks
Ectoderm
Layer of the germ cell Surface ectoderm: Epidermis, hIr, nails, breast, enamel of the teeth, internal ear, lens of eye, anterior pituitary Neural crest- Cranial nerves Pigment cells Sensory ganglia
Neural tube-
CNS
Retina
Post pituitary
Endoderm
Middle of the three germ layers
Endoderm forms the epithelial lining of the gi tract, pharynx, tonsils, thyroid, trachea, bronchi, lungs, liver, pancreas, bladder
Zygote definition
The fusion of the pro nuclei of the sperm and ovum
Two hormones the placenta produces are
Estrogen and progesterone
Three risk factors for am incompetent cervix
Previous cervical cone biopsy
History of cervical laceration during previous childbirth
History if 3 or more abortions using suction
Inflammation of sciatic nerve
Cause
Management
Largest nerve in the body
Cause irritation as pelvic joints move, hormonal influences, as weight of uterus increase
Chiropractic
Massage
Yoga/stretching
Skin darkening
Cause
Management
Cause increase in production of estrogen and melanocytes stimulating hormone
No treatment p, disappears after birth
Oily skin/acne
Cause
Management
Cause is increase in estrogen
Wash frequently with oil free products
Normal FHT during a contraction
A slight rise at the peak, with a return to baseline by the end
Sinusoidal pattern
Undulating, repetitive, uniform FHR equally distributed 5-15 boom above and below the baseline. No relationship to contraction pattern of fetal movement. 2-6 cycles/min
Rare
Cause: fetal anemia or hypoxia abruptio placentae
Treatment: immediate intervention to prevent fetal death
Early decals are thought to be caused by
Head compression
What FHR IS considered the cut off for marked tachycardia
180 bpm
Poor recovery
Def
When to transport
The period of deceleration. Will extend past the end of the contraction
If detected during first stage, give the mother o2 and transport
Wandering baseline
Def: a very late development in the progression of fetal deterioration. Usually within the normal range of 120-160 , but no short term variability, no consistency. Rare. Serious. Often prior to death
Treatment: immediate c section
Prolonged deceleration pattern
Def: decels lasting longer than 60-90 secs usually occurring as an isolated event
Cause: cord compression, placental insufficiency, hypotension, maternal valsalva, pelvic exam, AROM, rapid rapid descent of fetal head
Treatment- if recurring then section
Variable decelerations
Cause: umbilical cord compression/ entanglement or knots
Treatment: have the mother try a new position
A wide range of ht, with no relation to contraction, can be mild to severe, repetitive or random
Accelerations
Def: transient increase above baseline, associated with fetal movement
Normal
Causes: movement, fetal scalp stimulation
Early decelerations
Type 1
Def: lowest FHR at peak of contraction, quick recovery, no treatment needed
Cause: head compression, from 4-7 cm, and second stage
Initiated by pressure of dilating cervix on posterior fontanel
Frye: decel begins as ctx starts, lowest at peak, promptly returns to baseline as ctx tapers off
The heart begins beating in the embryo at ____ weeks
4
Weeks 13-16
Fetus grows rapidly, almost doubling in length
Facial features migrate to the correct place
Muscle and bone develop rapidly, enabling plenty of fetal movement to occur
Meconium begins to form in the gut
Weeks 8-12
The head is 1/2 the fetal length
Teeth form in the gums and fingernails can be seen
Intestines become established
Fetus begins to swallow amniotic fluid and pass urine
Blood begins to form
When is the embryo susceptible to teratogens
For the first 14 days after conception, the embryo is protected from harm by the zone pellucida
It is not until after implantation that the embryo is exposed to teratogens
Week 8
Hands and feet are well formed
Heart has 4 chambers and beats at 40-60 bpm
Major blood vessels form, circulation begins through the umbilical cord
Male or female genitalia can be distinguished
All body systems and organs are formed
Week 7
Eyelids, gall bladder, palate, and tongue form
Neck becomes visible
Bone cells begin to replace cartilage
Arms and legs begin movement
Amniocentesis
Weeks gestation
Indications
Usually performed at 15-16 weeks, when indicated
Women at risk for open neural tube defects, genetic disorders, aneuploidies
Chorionic villus sampling Indications Timing Risks Methods
To rule out a genetic/chromosomal disorder
( Tay/Sachs, sickle cell, cystic fibrosis)
Btw 10-12 weeks
Collected by either
Catheter thru cervix to placenta
With needle through belly with ultrasound
Villus cells taken for biopsy
Chorionic villus sampling
When
Indications
Risks
10 weeks gestation
Testing for common genetic disorders
Done early for parents that may want to terminate
More risk of pregnancy loss than amniocentesis
Maternal serum alpha fetoprotein should be done when
15-20 weeks
Alpha fetoprotein testing
When
Why
What results
A blood draw done btw 14-22nd wk best at 16-18
High levels neural tube defects, anencephaly, esophageal defect, failure abdomen to close
Inaccurate dating of preg
Low levels trisomy 21 or 18
Sign of the cervix is a sign of pregnancy called
Goodell’s sign
When to start measuring fundal height
18
Decidua basalis
Decidua capsularis
Decidua Vera
Beneath the site of implantation of the embryo, becomes maternal contribution to the placenta
Surrounds the remainder of the embryo with fetal growth, it bulges into the uterine cavity and fuses with the Decidua Vera
The Decidua lining of the rest of the uterus
Generally maternal ingestion of over the counter drugs and prescribed drugs _______ increase fetal risk
Does
A typical human gestation is _____ days (from LMP)
280
Immediately following fertilization the product of conception is called a
Zygote
At 28-30 weeks the cut off level for anemia
Measured by hemoglobin
11
During the second trimester, the midwife can expect the woman to feel _____ about her baby and pregnancy
Identify the fetus as a separate human being
What normal physiological change is responsible for intermittent nosebleeds.
Hyper mia of the nasal mucous membranes
Exercise can ease these common pregnancy discomforts
Constipation Heartburn Shortness of breath Leg cramps Fatigue Swollen ankles Insomnia
Emotional benefits of exercise during pregnancy
Reduction of mental stress and fatigue
Improve sense of well being
Stabilize hormone driven mood swings
Decreased risk of severity of depression and mood disorders with pregnancy and post partum
Asthma is associated with the following complications
Hypermesis gravidarium
Preeclampsia
Low birth weight
Causes of polyhydramnios
Multiple pregnancy IUGR diabetes mellitus Erythroblastosis Fetal malformations (Esp. Of gi tract ex TEF or CNS EX. anencephaly, meningomyclocele
Anemia in pregnancy treated with herbs
Dandelion Nettles Kelp Parsley Alfalfa
Effect of smoking on pregnancy
Greater risk of miscarriage, placental abruption, stillbirth, and infant death
The more a woman smokes, the greater the risk of placenta previa or ectopic preg
Low birth weigh, health problems, IUGR,
increased risk of SIDS
Hemorrhoids natural remedies
Red clover and nettle infusion
Grated raw potatoe as a compress directly on
Witch hazel extract
Homeopathic hamamelis 30c
Ethnicity and genetic screening
- Greek or Italian descent
- Asian or Filipino descent
- African descent
- Ashkenazi or Jewish descent
- Northern European descent
- Thalassemia
- Thalamassemia
- Sickle cell anemia
- Tay-Sachs or Canavan diseases
- Cystic fibrosis
Hemorrhoids
Management
Physiology
Cause: progesterone makes the walls of veins relax and expand, uterus presses on veins, slowing blood flow and causing expansion
Prevent constipation Warm bath Tucks pads Ice packs Avoid standing for long periods
Sleep difficulties
Cause
Management
Causes urinary frequency, anxiety, fetal movement, muscle cramps
Comfy bed Pillows Warm bath Hot tea Massage Regular exercise
Nausea/vomiting
Cause: increase hormones, stress, empty stomach
Small frequent meals Acupuncture/acupressure Avoid spicy/ greasy foods Crackers before getting out of bed Sea bands Ginger ale
Fluid retention/ swelling/edema
Physiology
Management
Cause: enlarging uterus puts pressure on pelvic veins and impairs the return of blood flow from legs. Pressure from this blood forces water into the tissue
Increase h2o intake Loose clothing Avoid prolonged siting/standing Rest with legs elevated Rest on side Support hose
Leg cramps
Management
Physiology
Cause: unknown, possibilities, added weight and pressure from uterus, circulation changes, calcium deficiency
Massage Flex foot Apply heat Regular exercise Calcium and K in diet
Varicose veins
Management
Physiology
Cause progesterone makes vein walls relax and expand, hereditary
Loose clothing Good posture no crossed legs Support hose Frequent breaks from standing Exercise regularly Elevate legs
Fatigue
Cause
Management
Cause: unknown, hormonal fluctuations
Daily exercise, healthy diet, rest and naps
Flatulence
Cause
Management
Cause: increase amounts of progesterone affect digestion
Avoid large high fat meals, no gas causing foods, chew food thoroughly
Breast tenderness
Cause
Management
Hormonal changes cause increase blood vessel and glandular development
They are growing in prep for milk production
Warm showers
Supportive bra, without underwire and sleep in bra
Constipation
Management
Physiology
Cause: increase progesterone causes intestinal muscle walls to relax, causing increase absorption of h2o, increase iron in PNV
Increase fluid intake and fiber, exercise regularly, avoid straining, go to bathroom as you feel urge
Round ligament pain
Cause
Management
Cause: ligament stretch as uterus enlarges
Flex knees into abdomen, bend toward pain, pelvic tilt, warm bath, heating pad, maternity girdle, pillow under uterus while sleeping
Headache
Cause
Physiology
Cause: pregnancy increas
Hypoglycemia, dehydration,
Also: anemia, intake of caffeine
Eating frequently
H2o intake
Rest
Skin itchiness
Cause
Management
Cause: stretching of skin and dryness
Humidify home, olive oil in a diet, avoid mineral oil skin products, oatmeal baths,massage yogurt into the skin
What is the most common use of amniocentesis in the 3rd trimester
Testing for fetal lung maturity
If the fetus suffers from malnutrition during the time of development when cells are increasing in size, the. The damage suffered by the fetus is best characterized as?
Irreversible
What is the duration of the embryonic period?
8 weeks
Measuring abdominal gain in a woman of average size is a helpful diagnostic tool when used in conjunction with Funchal,height for diagnosis of ____?
Polyhydramnios
Funic soufflé
Synchronous whistling sound heard during normal fetal heart tones
Define vulva
Refers collectively to the labia majora and minors, the shaft and glands of the clitoris,many the opening of the urethra and yoni
The vulva extends from the pubic bone to the point in the front of the anal opening
Which genetic disorder cannot be detected by chronic villus sampling
Neural tube defects
The vas deferens is a
Conduit for spermatozoa
The almond shaped area enclosed laterally by the labia minors and extending from the clitoris to the fourchette is called the
Vestibule
In which portion of the Fallopian tube is the site of sterilization
Isthmus (narrowest)
Developing follicles and the Graafian follicle are found in the
Cortex of the ovaries
Which principal factor causes vaginal ph to be acidic
The action of the doderleins’s bacillus
In which portion of the Fallopian tubes does fertilization normally occur
The ampulla (widest portion)
Labia minora
The frenulum and prepuce of the clitoris are formed by the
The labia minora taper, extending posteriorly to form the:
Fourchette
Which term refers to the thick folds of membranous stratified epithelium of the internal vaginal wall capable of stretching during the birth process to accommodate delivery of the baby
The rugae
Which measure is essential after an rh-women undergoes cvs or amino?
Administering rho gam
The uterine isthmus is essential during pregnancy in the formation of:
The lower uterine segment
Which term refers to the upper triangular portion of the uterus
Corpus
What is the most important factor affecting amniocentesis
Needle insertion site
Which assessment during an exam would best support the diagnosis of pregnancy?
Softening of the lower uterus segment
Eclamptic seizures are usually what type
Tonic-clonic
What is the tocolytic of choice to treat PTL in multiple pregnancy?
Magnesium sulfate
When an incomplete miscarriage occurs
Some fetal and placental parts are passed and some remain inside
When would it be most appropriate to initiate suppressive therapy for asymptomatic bacteriuria?
When 2 complete courses of treatment have been completed without a cure.
To reduce the risk of limb reduction defects related to cvs the midwife should recommend
Procedure should be performed at 10 weeks gestation
During an abdominal exam of. Woman at term you feel the cephalic prominence on the same side of the fetal parts. This indicates what presentation?
Vertex occipital presentation
Loa lot etc.
Threatened abortion
Vaginal bleeding in the first 1/2 of pregnancy
May have cramping
Fetal kick counting
For late pregnancy (at least after 28 weeks)
At same time each day, time how long t takes your baby to make 10 movements
Clonus
Definition- involuntary rapid, repetitive contractions and relaxation a of a muscle when it is simply stretched
Indicative of upper motor neuron disease and is never present except when there is a disease of the CNS
If conception fails to occur, menstruation takes place about 2 weeks after ovulation as a result of
Degeneration of the corpus luteum
Cytomegalovirus
Def-
Cause-
Effect on fetus-
Fairly common infection 60% of population has antibodies, most damaging in the first trimester
Member of the herpes virus group
Spread through contact with bodily fluids, within households, day care centers, classrooms
Fetus is at risk if primary infection for mom, usually not recognized until birth
80-90% will have complications that include hearing loss, vision impairment, varying degrees of mental retardation
Cytomegalovirus
S/s
Lab tests
Management plan
Most women have minimal if any symptoms and are unaware of the infection
Symptoms of mononucleosis
Signs of hepatitis with negative test results for a,b,c
No treatment for CMV infection in healthy persons
Can be transmitted to the infant through genital secretions/breast milk
Hepatitis A definition signs and symptoms transmission treatment effects on baby
Definition infectious with flu like symptoms
fecal oral route, contaminated water/food
99% required no treatment
no adverse fetal effects of active maternal infection have been identified
breast-feeding is okay
Hepatitis B definition transmission screening effect on baby
Serum hep chronic or carrier state transmitted through blood, dirty needles, saliva, vaginal secretions, and semen
Screening blood sample for hbs AG
High risk of transmission to newborn who if infected have high risk of becoming carriers. Should be immunized within 12 hours of birth
Hepatitis B is present in all bodily fluids except;
Breast milk
Hepatitis B
signs/symptoms
treatment
Nausea and vomiting, abdominal pain, chills, fever
Should be hospitalized and have all family members screened
Not responsive to any treatment and must run its natural course
A person with chronic hepatitis B should be screened for liver disease
Frequency of SAB after the pregnancy has been clinically diagnosed
One in 20
What is the best management of a newborn of a hepatitis B infected mother?
Immediate birth, immunization with hep B be immune globulin and immunization for hepatitis B vaccine
How does Hepatitis B effect pregnancy and birth?
The woman will be monitored for signs of abnormal liver disease that may affect her nutritional status
Hepatitis C
definition
transmission
effect on baby
20% of viral hepatitis in USA
transmission is primarily via blood and blood byproducts but can be an STD
Signs of active infection are similar to HBV but chronic conditions develop in 85% of cases.
Perinatal transmission 5%, depending on the amount of virus in the bloodstream
Breastmilk not affected
no immunization for hepatitis C
What kind of viral hepatitis is transmitted via the fecal oral route
Hepatitis A
Inevitable abortion
When a spontaneous abortion is almost certain and cannot be stopped
cervical dilation and/or rupture membranes in addition to bleeding and cramping
What is the reason for the use of Cordocentesis
It can be used to do fetal blood transfusions or to medicate the fetus
What are three tests for fetal lung maturity
- Lecithin/ sphingomyelin ratios l/s should be twice
- Phosphatidylglycerol (pg test )
- The shake and tap tests
Corticotropin releasing hormone CRH
Comes from the baby, placenta, and tissues within the uterus
Increased levels of CRH in late pregnancy change the ratio of estrogen to progesterone
The male hormone testosterone, which maintains spermatogenesis is synthesized and released by;
Leydig’s cells
In response to anterior pituitary stimulation, the graafian follicle secretes;
Estrogen
Increased levels of GN/RH stimulates the anterior pituitary to secrete;
FSH
What is the normal range of respirations for an adult?
15 to 20 per minute
Organogenesis
Rapid development of organ formation
takes place until the eighth week of gestation
Thyroid disease
why is it a high risk factor
Particularly hyperthyroidism dangers: thyroid medication is potential for causing severe fetal complications miscarriage premature labor fetal anomalies
Untreated hypothyroidism can lead to cretinism in the newborn
Chlamydia infection in the mother if untreated;
Can infect the urinary tract leading to premature labor
baby has a 70% chance of infection, which can result in conjunctivitis or pneumonia
Incomplete abortion
The placenta is not expelled with the fetus at the time of the abortion
the retained placenta will eventually be the cause of bleeding or infection
Epstein-Barr virus
O in Torch illnesses
One of the most common human viruses
when infection occurs during adolescence it causes infectious mononucleosis
Signs and symptoms of mono – fever, sore throat, swollen lymph glands. Almost never fatal
No known associations between active EBV and problems during pregnancy
The only hormone produced by the posterior pituitary
Oxytocin released in a pulsatile fashion
Entero virus
Small virus made of RNA and protein
second most common after the cold
Transmission; respiratory secretions or direct contact
Infection in mother; mild or no illness
A newborn/fetus; no clear evidence that maternal infection affects fetus. If ill during birth, newborn may get ill
Physical factors that increase labor pain
Hunger or thirst fatigue muscle tension full bladder discomfort from staying in the same position for too long
What best describes the normal changes in amniotic fluid volume during pregnancy?
A gradual increase through 33 to 35 weeks and then a decrease until term
Vitamin A
Eye health
helps prevent infections
sources; banana, alfalfa, dark green, yellow veggies and fruits, dairy, eggs
Vitamin E
Aids lactation, prevents blood clots, good for varicose vein’s, prevents miscarriage, aids fertility
Sources; nuts, almonds, broccoli, carrots, brown rice
Indigestion/heartburn
management
physiology
Cause:increased progesterone relaxes the valve between the stomach and the esophagus
late pregnancy the uterus is in the abdominal cavity
Avoid large/high-fat meals, dry meals, low-fat dairy to ease discomfort, chew food well, stay upright one hour after eating
Triple screen
Combines AFP and hCG and unconjugated estrogen levels, is much more accurate then MS AFP
Detects 65% of down syndrome, 80 to 85% of neural tube defects
False positive rate of only 5%
If positive amniocentesis is the next step
Gingivitis
cause
management
Cause: increased level of estrogen stimulates growth of blood vessels and body
Brush and floss regularly, at least one visit to dentist during pregnancy
Hemoglobin
definition
normal levels
The amount of hemoglobin per red blood cell
should be above 11
Hematocrit
definition
normal levels
The percent of red blood cells per total blood volume
should be 33+
Quad screen
Blood draw done between 16 and 18th week
checks for level of: AFP, hCG, estriol, inhibin-A
V for possibilities of potential genetic disorders
Lower rate of false positive
Hypericum imperforens (perforatum)
Latin name for St. John’s wort
contraindicated during pregnancy
What condition is a contraindication for the contraction stress test
A woman with placenta previa
What method of fetal assessment is the most accurate predictor of uteroplacental insufficiency
Contraction stress test
Never ever do a vaginal exam when there is ______ in late pregnancy
Vaginal bleeding
Which plane of the pelvis is known as the “plane of least dimensions?”
Mid plane
The uterus grows by _______
Hyper trophy
Where is hCG produced?
The placenta but specifically: A protein hormone produced early in the pregnancy by both the cytotrophoblast and the synchtiotrophoblast, primarily to maintain the corpus luteum and thus the endometrium and the pregnancy
Condglomata aluminata
Genital warts caused by HPV
Frequently increase in size and number during pregnancy and regress after the woman gives birth
Avoid tearing or cutting as they may bleed excessively
Extensive growth in the vagina and over the cervix may necessitate C-section because of dystocia
How does pregnancy affect the course of sickle cell disease
Pregnancy increases both the intensity and frequency of sickle cell crisis
Sickle cell trait/disease and implications in the AP
Primary complications is an increase in UTI and hematuria
Can’t be cared for by midwife only with close collaboration with the physician experienced in dealing with sickle cell
Describe the rash of rubella
Pale or bright red, spreading rapidly from face to entire body, and then fading rapidly
Drinking 1 quart of milk daily will supply the woman with large amounts of
Riboflavin and vitamin A
Congenital rubella syndrome
Most common malformations: cataracts, cardiac defects, deafness
May also be: glaucoma, microcephaly, and other defects involving the eyes, ears, heart, brain, and CNS
Infant with CRS frequently exhibit intrauterine and postnatal growth retardation
In what stage of pregnancy is maternal infection with rubella most likely to cause congenital malformation
In the first month
Explain the safety of the rubella vaccine, for a woman four weeks pregnant and had the vaccine two weeks ago
Explain to the woman that there is a theoretical risk from the vaccine, but there is no demonstrated evidence of teratogenicity for the vaccine
What is the best course of action when a woman has an active Varicella infection during delivery for the immediate postpartum
Give VZIG to the infant immediately and consider isolation of infant from mother
Rubella
weeks gestation and risk of morbidity
If contracted during the first trimester, there is a 52% chance the baby will be born with congenital rubella syndrome
The risk increases to 85% if contracted during the first eight weeks
Infection after the 20 weeks rarely causes defects
