Antepartum/Maternal Flashcards
1
Q
DEFINE:
- Fusion of ovum and sperm
- In fallopian tubes.
A
FERTILIZATION
2
Q
When does FERTILIZATION occur.
A
Occurs around 2 wks. after last normal menstrual period in a 28-day cycle.
3
Q
DEFINE:
Occur about 7-10 Days after conception.
A
IMPLANTATION
4
Q
What happens during IMPLANTATION?
A
Fertilized egg attaches to endometrium.
5
Q
DEFINE:
- When fertilized egg cell divides MANY TIMES to produce specialized cells.
A
CELL DIFFERENTIATION
6
Q
Pregnant period time.
A
- 40 weeks
- 90 months
- 266-280 days
7
Q
Name the THREE stages of FETAL DEVELOPMENT.
A
- Pre-embryonic stage
- Embryonic stage
- Fetal Stage
8
Q
Pre-embryonic stage INCLUDES 2 stages of the human development.
1.
2.
A
- Zygotic stage
- Blastocyst stage
9
Q
define:
fertilization of sperm & egg through second week.
A
Zygote stage
10
Q
define:
Zygote divides IN ball of cells then attaches to uterus
A
Blastocyst stage
11
Q
Stage after Blastocyst.
A
Embryonic stage
12
Q
Embryonic stage lasts ____ weeks.
A
3-8 weeks.
13
Q
Stage AFTER EMBRYONIC stage
A
FETAL STAGE
14
Q
FETAL STAGE LASTS
A
9 weeks till Birth
15
Q
The babies SEX is determined by which parents dna?
A
FATHER.
16
Q
Begins day 15 post conception - week 8
A
Embryonic stage.
17
Q
The Embryonic membranes are
1.
2.
A
- Amnion-Inner layer
- Chorion-Outer layer
18
Q
What is the job of the EMBRYONIC MEMBRANES?
A
surround and protect embryo (future baby)
19
Q
Embryonic membrane that:
- contains amniotic fluid
- From ectoderm germ layer
- WIth time it expands and touches Chorion
A
Amnion-Inner Layer
20
Q
Embryonic membrane that:
1. has fingelike projections “chorionic villi”
2. From trophoblast cells and mesodermal lining.
A
Chorion-Outer Layer.
21
Q
These two fetal membranes form
A
fluid-filled amniotic sac, or bag of waters (BOW)
22
Q
What happens if the embryonic membranes has ruptured for a long time?
A
INFECTION.
Becomes chorioamnionitis
23
Q
Which of the Fetal Development Stages is MORE SUSCEPTIBLE TO TERATOGENS?
A
Embryonic Stage
24
Q
What are TERATOGENS
A
- A teratogen is a substance that **interferes with normal fetal development and causes congenital disabilities. **
- Drugs, alcohol, chemicals and toxic substances are examples of teratogens.
- Teratogens can also increase the risk for miscarriage, preterm labor or stillbirth.
25
What week of the embryonic development will show HEARTBEAT- REGULAR RHYTHM?
Week 5
26
What week of the embryonic development will begin formation of LUNGS.
week 6
27
What week of embryonic development can the fetal heartbeat be HEARD?
WEEK 7
28
What week of the embryonic develpment will the embryo resemble a human being?
Week 8
Once it becomes human looking its called a fetus.
29
Which stage is this:
* From 9th week until birth
* Longest period of dev.
FETAL STAGE
30
IN the fetal stage the embryo is now called
FETUS
31
What does the fetus have/show during the fetal stage?
* All major organ systems in BASIC form
* Dramatic growth & refinement
32
Week where Gender can be determined
Week 12
33
Weeks 9-12 the fetus has
* 20 temporary teeth
* Urine produced & excreted
34
What is happening in weeks 13-16
1. **lanugo** (hair around body
2. Fetus MOVES (**Quickening**)
3. Sucking & Swallow
4. **Nails** present
35
What is happening in weeks 17-20
1. Rapid brain growth
2. **FHR with stethoscope**
3. **Vernix caseosa**: white, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy
36
What happens in WEEKS 21-24
1. **Hand grasp & startle reflex**
2. Alveoli formation & surfactant - **LUNGS**
37
What week will show:
1. Eyelids open & close
2. Fingerprints are set
week 25-28
38
Weeks where LUNGS are NOT fully mature.
weeks 29-32
39
Weeks where:
1. Testes descend
2. transport of antibodies from MOM -> FETUS occur
* Weeks 33-38
* Considered **FULL TERM **now.
40
What organ provides FETAL oxygenation?
placentA
41
in FETAL CIRCULATION are the lungs involved?
No- fetus lungs are NOT FUNCTIONAL.
42
Explain fetal circulation in basic terms
PLACENTA ---> FETUS ---> PLACENTA
43
Does the fetus perform any metabolic functions?
NO.
Mothers body performs these functions.
44
In fetal circulation there are **small passages** that direct blood that needs to be OXYGENATED.
what are these passages called?
Shunts.
45
WHat are the 3 SHUNTS in fetal circulation?
1. Ductus Venosus
2. Ductus Arteriosus BYPASSES L. Lungs
3. Foramen Ovale BYPASSES L. Ventricle & Lungs
46
Which sHUNT bypasses LIVER
DUCTUS VENOSUS
**THINK: VENOUS DELIVERY FROM PLACENTA**
47
WHICH SUNT bypass L. LUNGS
DUCTUS ARTERIOSUS
**THINK: DEOXYGENATED BLOOD CARRIED AWAY**
48
WHICH SHUNT BYPASSES Right VENTRICLE AND LUNGS.
FORAMEN OVALE
** THINK OPENING (OVALE)**
49
MAIN function of fetal shunts
Ensures oxygenated blood is received in heart and brain.
50
So, during fetal stage oxygen is received via ______.
After birth, oxygen is received via _______.
1. placenta
2. lungs.
51
Circulatory Changes AT BIRTH
1. shunts no longer needed
2. Newborn takes 1st breath
3. Clamping of cord changes circulation.
4. circulation and blood flow functions like an adult.
52
What is FUNCTIONAL MURMUR
Delay shunt closure can be benign or innocent (no damages)
53
Define:
1. Surrounds EMBRYO for protection.
2. **embryo swallows and voids** in this fluid.
3. **Includes Maternal BLOOD also.**
3. Formed by the amnion (inner layer) and chorion (outer layer) membranes
Amniotic fluid
54
How much amnioitic fluid is accumulated in a FULL TERM?
1 Liter
55
Whats in the amniotic fluid?
98% water
2% organic matter
56
Functions of the Amniotic fluid include:
* **Thermoregulation** for fetus
* Permit **symmetric growth & development**
* **Cushion** fetus from trauma
* **prevents umbilical cord from compression**
* Promote **fetal movement**
57
too little amniotic fluid
<500 mL at TERM is called
oligohydramnios
58
oligohydramnios is associated with
* Renal abnormalities
* Risk of surgical births
* Low-birth-weight infants
59
Too much amniotic fluid
<2000 mL at term.
Hydramnios
60
Hydramnios is associated with
* Maternal DM
* Neural tube defects
* Chromosomal deviations
* Malformations of CNS &/or GI tract
* May CAUSE premature rupture of membrans related to over distention
61
AMniotic fluid that is
Colorless with slight to moderate turbidity
normal
62
amniotic fluid that is bLOOD-STREAKED
trauma tap, abdominal trauma, intra-amniotic hemorrage
63
amniotic fluid that is DARK GREEN
MECONIUM:
Babies poop- indicates fetal hypotension or distress.
64
amniotic fluid that is YELLOW
HDN
(hemolytic disease of the newborn)
65
AMniotic fluid with dare red-brown appearance
fetal death.
66
What forms the umbilical cord?
AMnion membrane
67
Describe Umbilidcal cord
1. ONE large blue vein
2. TWO small red arteries
3. surounded by WHARTON JELLY
4. length at birth: 22 in and 1 in Wide
68
Whos job is this?
Vital passage for nutrients, oxygen & waste products to and from the fetus
UMBILICAL CORD
69
PLACENTAs function depends on
Moms BP!
70
Functions of the PLACENTA
* Serves as interface between mother & fetus (barrier)
* Protects fetus from immune attack by mother
* Removal of fetal waste products
* Induces mother to bring more food to placenta
71
HORMONES produced by **PLACENTA** necessary for normal pregnancy
1. **hCG: human Chorionic Gonadotropin**-progesterone release
2. **Prolactin**- contractions
3. **Human placental lactogen (hPL)**
4. **Estrogen (estriol)**
5. **Progesterone (progestin)**
6. **Relaxin**
7. **Adrenal hormones**
8. **thyroid hormones **
**Prepare fetus for life OUTSIDE uterus and builds moms energy reserves**
72
does the maternal blood and fetal blood mix?
No- thanks to placental barrier.
73
What am I?
allows for close enough contact for exchange but AVOIDS mixing of fetal & maternal blood
Chorionic villi.
74
Cause harm, defects, or death in fetus
Teratogens
75
When are TERATOGENS MOST HARMFUL?
During EMBRYONIC STAGE
(DAY 15 of conception to WEEK 8)
76
Genetic Disorder:
* **Increased levels** -neural tube, Turner Syndrome, omphalocele
* **Decreased levels**- Down Syndrome
Alpha-Fetoprotein (AFP)
**tests maternal blood**
77
Alpha-Fetoprotein is tested during what weeks?
15-18 weeks
-blood test
78
transabdominal puncture of the amniotic sact to **obtain a sample of amniotic fluid** for analysis.
Amniocentesis
79
Safety concerns for Amniocentesis
* Infection
* pregnancy loss
* fetal injuries
80
Amniocentesis is tested during what weeks of pregnancy?
15-20 weeks.
81
What is tested in Amniocentesis
* Chromosome analysis
* DNA markers
* Viral studies
* Metabolism errors
82
* Invasive procedure involving 18 gauge needlestick through abdomen through the vervix under ultrasound guidanc.
* obtains sample of chorionic villi from placenta for prenatal eval.
Chorionic villus sampling
83
Safety concerns for Chorionic villus sampling
* Severe limb defects
* Pregnancy loss
84
Chorionic villus sampling tests for
* Sickle cell anemia
* Phenylketonuria
* Down Syndrome
85
when is Chorionic villus sampling tested?
10-12 weeks.
86
insertion of a needle directly into a **FETAL** **umbilical vessel** under ultrasound guidance.
Percutaneous umbilical blood sampling.
87
safety concerns with Percutaneous umbilical blood sampling.
1. Infection
2. Fetal Hemorrhage
88
safety concerns with Percutaneous umbilical blood sampling tests for
* Inherited blood disorders
* Fetal infection
* Acid-base status
* Isoimmunization
89
safety concerns with Percutaneous umbilical blood sampling tests for tested during which week?
16 weeks.
90
Sign and symptoms of pregnancy are grouped into 3 categories.
1. presumptive signs
2. probable signs
3. positive signs
91
Signs a mother can PERceive such as :
* absence of menstruation.
* N/V, FATIGUE, URINARY FREQ., BREAST CHANGES
* least reliable indicator of pregnancy- can be caused by other factors (amenorrhea)
Presumptive signs
92
* Signs of pregnancy detected on physical examination by HCP
* Vaginal mucousa and cervix changes.
* Changes in uterus.
PROBABLE signs
**(bc other conditions can elevate pregnancy levels (hCG) levels**
93
* enough subjective symptoms are present so that a woman can be reasonably sure she is pregnant.
* Confirm fetus is growing in uterus.
* POS Ultrasounds, fetal heartbeat
* Hear & See baby
POSITIVE signs.
94
Pregnancy test:
* 99%
* blood serum or urine
* over the counter purchase
* 4 days AFTER implantation
Elisa
95
Pregnancy Test:
Return of fetus when cervix is tapped
"BOUNCE"
ballottement
96
Pregnancy Test:
* A softening of the cervix
* 6-8 weeks
* due to Estrogen
Goodells sign
97
Pregnancy TEst:
* Bluish color to the CERVIX (increased vascularity)
CHADWICKS sign
98
Prego test:
* Lower uterine segment softens (isthmus)
* 6-8 weeks
hegar's sign
**hegars test is done same way as Goodell's**
99
Fetal movements
20 weeks
**detected by HCP**
100
Visualization of embryo or fetus
4-6 weeks
101
What hormone stimulates UTERUS groth
estrogen
102
* Uterine contractility is enhanaced
* Starts 1st trimester - throughout pregnancy.
* False labor pain
Braxton Hicks Contractions
103
Explain Fundal Height measurement
* Height of top of uterus in cm
* corresponds to # of gestational wks.
* +/- 2
104
* HIGHEST fundal height
* Mom shortness of breath
36 weeks.
105
* fundal height drops
* Fetus descends into pelvic canal (lightening)
* Breathing easier
* increased bladder pressure
38-40 weeks
106
Recommended sleeping position for pregnant women
right lateral position
107
changes in Cervix:
* occurs 6-8 weeks
* R/T vasocongestion and estrogen
Goodell's sign
**softening of cirvix**
108
changes in Cervix:
Softening, increased elasticity & effacement
Begins about **4 wks. before birth**
Cervical ripening
109
VAginal changes
* Connective tissue loosens
* More **acidic**, thick, white
* Increase in white, vaginal discharge (leukorrhea)
* Vaginitis, candida infections
110
Overies produce hormones until
6-7 weeks gestation then placenta takes over
111
Colostrum production during
3rd trimester
- creamy, yello breast fluid
- Nourishment for breattfeeding newborn during 1st few days of life.
112
Colostrum is full of
immunoglobulins (antibodies) and proteins
113
GI SYSTEM during pregnancy
* smooth muscle relaxation
* DECREASED peristalsis (constipation)
114
MOUTH during pregnancy
* guyns- hyperemic, swollen, bleed easy
* Gingivitis, periodontitis.
115
Stomach and intestines during pregnancy
* Delayed Gastric Emptying
* Nausea & Vomiting (Ginger & antiemetics- antinausea meds)
* Bloating & Constipation
* Hemorrhoids
* GERD
* Heartburn (pyrosis)
116
Gallblader during pregnancy
* Prolonged emptying
* Hypercholesterolemia
* **Increased risk of gallstone formation**
117
When should pregnant mom call HCP
* Signs of **dehydration**
* I**nfrequent urination**
* **Dark-colored urine**
* **Dizziness with standing**
* **Vomiting repeatedly** throughout day
* Any **blood in the vomit**
* **Abdominal or pelvic pain or cramping**
* **Unable to keep food or drinks DOWN for >12 hrs**
* **Weight loss >5 pounds (2.3 kg)**
* **Fever or diarrhea WITH N/V**
118
INCREASE plasma volume during pregnancy (**dilution of RBC's**) is called
* plasma volume increases FASTER than RBCs
physiologic anemia of pregnancy .
119
Hgb and RBC levels with Physicologic anemia will show:
hgb: 10g or less
RBC: 3.5 or less
(lowerd levels)
Norms are:
* Hgb: 12-17g/dl
* RBC: 4.0-5.5 M/ul
120
Can givin IRON supplements fix the low levels of hgb and RBC in PHYSIOLOGIC ANEMIA?
No. these changes cannot be prevented by giving iron supplement.
121
Is physiologic anemia dangerous?
No, considered a normal adaptation of pregnancy. It is needed to meet other organ function for her and baby.
122
What are the VS during pregnancy?
* Incr. CO
* low BP
* incr. HR
* low systemic vascular resistance
* Incr blood /plasma volume.
**to meet demands of enlarging uterus and placenta- heart works harder and pumps more blood for both humans.**
123
If BP INCREASES during pregnancy, what should be done?
Must be investigated.
Not a norm.
124
*Blood components during pregnancy:*
What happens to RBCs?
* Increase by 20-30%
* support additional O2 & iron requirements
125
*Blood components during pregnancy:*
Hypercoagulable state DURING pregnancy shows:
* Increase in fibrin, plasma fibrinogen, & clotting factors
* Venous Stasis – pressure from uterus
* Risk for venous thrombosis
126
Respiratory Changes include:
* O2 consumption **increase** 20% to 30%
* **HYPERVENTILATION & HYPOCAPNIA**
* **Breathing DIAPHRAGMATIC than abdominal**
* **Breathes faster & more deeply**
* Congestion (Increased estrogen, sex hormones & sensitivity to allergens)
* changes tone and quality of voice
127
Renal and urinary changes include
* Increase waste & blood volume
* Increased blood flow to kidneys (50-80%)
* HYPERfiltratoin
* Drugs excreted VIA kidneys
* Require higher doses- More frequent administration
**like heart, kidneys also work harder**
128
Kidney activity is even GREATER when mom lies on
her side.
**but lying on back puts pressure on back and vena cava**
129
When mom lies on her side what happens?
* Relieves pressure FROM vena cava
* Venous return to heart increases
* Increased cardiac output
* Increased renal perfusion & glomerular filtration
130
Musculoskeletal system changes include:
* Changes in posture & gait
* Ligaments soften & change
* Joints widen & more moveable
* Center of gravity shifts forward
* Lumbar lordosis
* Waddle gait
131
Integumentary Changes include:
* **90% hyperpigmentation** r/t INCREASE estrogen, progesterone, melanocyte-stimulating hormone
* **Linea nigra** (pigmented line mid abdomen from umbilical to pubis)
* **Stretch marks** (stria gravidarum)
* ** Palmar erythema**
* **Malasma** : pregnancy. mask
132
Hair and nail changes
* Decline in hair growth
* Follicles undergo a resting phase
* Nails grow faster
133
vascular changes
* Varicose Veins
* Distention, Poor circulation, Uterine pressure on vessels
* Risk Reduction OR Prevention
134
Thyroid gland changes
TSH decrease 1st trimester
135
Anterior pituitary lobe activity **during** pregnancy include
Prolactin is secreted in response to baby suckling
136
What causes morning sicknes and N/V in 1st trimester
* **Decrease TSH (pituitary hormone)**
* **Elevated hCG (placenta hormone)**
137
After Birth what happens with Anteriror Pituitary lobe activities?
* AFTER placenta DELIVERY ---- **drop in progesterone **----- lactogenesis
* Prolactin IS secreted from Anterior Pituitary in response to suckling by BABY
* Melanocyte-stimulating hormone (MSH) **increases**
138
2 hormones made in the POSTERIOR PITUITARY LOBE
Oxytocin & Antidiuretic Hormone (ADH)
139
During pregnancy Oxytocin is responsible for
* Uterine contractions, before & after delivery.
* Contractions are more frequent & stronger
* Contractions lead to:
1. Cervical thinning and dilation
2. Exert pressure, & help fetus to descend in pelvis
140
After delivery, oxytocin cause
* Myometrium to contract & decrease vaginal bleeding
* Responsible for milk ejection
* Breastfeeding signals the release of oxytocin, which stimulates the uterus to contract and increases the severity of after birth pains.
141
Pancreas during pregnancy
* Insulin Resistance can occur--> gestational diabetes
* Glucose & other nutrients easily cross placenta
* Insulin does NOT cross placenta.
* Fetus must produce its own insulin
142
Adrenal glands during pregnancy
* Increased amounts of Aldosterone BY 15 wks. of pregnancy (regulates absorption of sodium)
* During pregnancy, progesterone allows salt to be wasted (or lost) in urine
* So, Aldosterone regulates -
1. Electrolyte & water homeostasis
2. Blood pressure
143
Immune System during pregnancy
Alterations help -
* Prevent mother’s immune system from rejecting fetus
* Increase her risk of developing certain infections (UTI)
144
Psychosocial Adaptations include:
Reality & acceptance occur during
(2nd trimester)
Brought on by physical changes, fetal movement, hearing heartbeat
145
an emotional roller coaster is considered
normal during pregnancy.
146
The importance of ENFACE POSITION
* eye-to-eye contact .
* promotes relationship
147
Diet recomendation during pregnancy
* **Avoid hydrogenated or partially hydrogenated fats**
* Use **reduced fat spreads & dairy products**
* Eat at least **2 servings of fish/week**
* Consume at least **2 quarts of water daily**
* Include variety from all food groups
* **Gluten-free**
148
a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes
Listeriosis
149
LISTERIOSIS causes
* miscarriages
* stillbirths
* newborn deats
**Bacteria is passed by mom to fetus. **
150
How to avoid LISTERIOSIS
* Don’t eat soft cheeses
* Don’t eat refrigerated pâté or meat spreads.
* Don’t eat refrigerated smoked seafood: "nova-style,” “lox,” “kippered,” “smoked,” or “jerky.
* Don’t eat salads made in store
* Clean refrigerator regularly
151
INTENSE craving & eating of Nonfood items FOR at least 1 M is called
PICA
152
A pregnant women who craves AMYLOPHAGIA
laundry starch
**IRON DEFICIENCY**
153
A pregnant women who craves Geophagia
dirt, sand, clay
**IRON DEFICIENCY**
154
a women who craves PAGOPHAGIA
ICE, FREEZER SOFT
**IRON DEFICIENCY**
155
WHAT FOODS WILL YOU HAVE A PREGNANT MOM FOCUS ON
* On Protein, Iron, Calcium, & Vit B12.
* Protein: Soy , beans, lentils, nuts, grains, seeds
* Iron: Meat alternate with vit. C–rich foods
* Calcium: Soy, ca.-fortified OJ, tofu.
* B12: Fortified soy foods & supplement.
156
Weight Gain During Pregnancy
* Recommended wt. gain is **dependent on
* pre-pregnancy BMI**
* **First trimester, weight gain should be 3.5-5 lbs** - DEPENDS on N/V
* **Second & third trimester: 1 lb per week**
157
Heart and blood volume changes during pregnancy
Heart works harder
And pumls More blood.
