antepartum normal Flashcards
Two parts of cell division
mitosis- replicate DNA then divide
Meiosis- divide and decrease chromosome # by half (egg and sperm)
Gametogenesis
spermatogenesis- beings at puberty
oogenesis- begins in fetal life; present at birth
conception- union of egg and sperm
ovum- fertile for approx 24 hours after ovulation
sperm- remain viable in female reproductive system 2-3 days
fertilization
zygote- 2 cel organism of united egg/sperm
morula- 16 cells; solid ball produced within 3 days
blastocyst- 58 cells, 4 days, fluid enters and separates into 2 parts (trophoblast and embryoblast); drops into uterus
implantation
chorionic villi- finger-like projections develop out of trophoblast; grow into endometrium
decidua basalis- portion under blastocyst where chorionic villi have implanted
primary germ lays
during 3rd week
ectoderm
mesoderm
endoderm
embryo development
most crucial time in dev of organ systems and main external features- day 15 to 8 weeks after conception
most vulnerable time to malformations from teratogens
membranes (formed from trophoblast
chorion- where HCG comes from (6-10d after conception)- becomes covering of fetal side of placenta containing major blood vessels
amnion and amniotic cavity- bag of water- around baby (maternal serum, then fetal lung liquid and urine
actions of amnion
protects fetus and maintains temp
volume important
fluid neutral to alkaline
umbilical cord
supplies the embryo with maternal nutrients and oxygen
placenta structure
maternal-placental-embryonic circulation; by day 17 embryonic heart starts beating
placenta function
- endocrine gland: 4 hormones to support pregnancy and embryo/fetus (HCG {in serum by 8-10 days after conception} HPL, estrogen, progesterone)
- metabolic function and waste
- nutrient storage
- immunologic function
newborn cord
3 vessels- 2 arteries (unoxygenated) 1 vein (oxygenated)
fetal maturation time
9 weeks to end of pregnancy
viability
-capability of fetus to survive outside uterus (wt and gestation)
- limitations based on central nervous system function and oxygenation capability of lungs
Fetal circulatory system
FHR 110 to 160 beats/min
teratogens
drugs
chemicals
infection
exposure to radiation
maternal conditions:
-alcoholism
-diabetetes
-endocrinopathies
-PKU
-smoking
-nutritional problems
maternal nutrition
malnutrition=
LBW
decreased brain development
neural tube defects
gravida
woman who is pregnant
gravidity
pregnancy
multigravida
woman who has had two or more pregnancies
multipara
woman who has completed two or more pregnancies to stage of fetal viability
nulligravida
woman who has never been pregnant
nullipara
woman who has not completed a pregnancy with fetus or fetuses who have reached stage of fetal viability
parity
number of pregnancies in which fetus or fetuses have reached viability
postdate
pregnancy that goes beyond 42 weeks of gestation
preterm
pregnancy that has reached 20 weeks of gestation but ends before 37 weeks 0 days of gestation
primigravida
woman pregnant for first time
primipara
woman who has completed one pregnancy with fetus or fetases who have reached stage of fetal viability
term
pregnancy from beginning of week 37 of gestation to end of week 42 gestation
viability
capacity to live outside uterus; state to state defined; about 22 to 25 weeks gestation are on the threshold of viability (premature infants are vulnerable to brain injury)
OB history
2 digit (gravida, para)
5 digit (gravidty, term, preterm, abortions, living)
presumptive s/s
amenorrhea
n/v
breast tenderness, ^size
urinary frequency
fatigue
quickening
probable s/s
change in abd size
positive pregnancy test
braxton hicks contraction
ballottement (16-18wks)
goodell’s sign (6th wk)
positive s/s
fetal heart rate
ultrasound visualization
fetal movement
HCG
-biological marker for all pregnancy tests
- produced by chorionic villi on day of implantation
- present in blood (8-10 days after conception), urine (26 days after conception)
types of tests
ELISA- home preg test, urine
RIA- tests beta subunit HCG, maternal serum test
uterus
-uteroplacental blood flow established
- change in size, shape and position
- palpable by 12-14 weeks
- @ U by 20-22wks
- increase tension on broad and round ligaments
- change in contractility
- ballotterment
-quickiningc
cervix
-goodell’s sign- softening of cervical tip
- endocervical mucous plug forms
vagina
chadwick’s sign- violet blue color of vaginal and cervical mucosa (vascular, 6-8 wks)
breasts
- full, heavy, increase sensitivity
- areola pigmented
- montgomery tubercles
- colostrum
heart
-hypertrophies
- sinus arrhythmias, may have pulmonic/apical murmur
- increased blood volume and flow (40-45%)
- decreased viscosity
BP
- 2nd trimester decreased
- 3rd trimester back up to baseline
- <140/90 goal
- supine hypotension
labs
- decreased H&H (physiologic anemia)
- increase WBCs to 15000
hypercoagulable state
platelets (sign of pre eclampsia if low)
pulmonary function
- change in circumference of thorax r/t estrogen
- proliferation of nasal tissues from estrogen lead to nasal stuffiness and increased blood flow/nose bleeds
- ear fullness and change in voice
- chronic mild hyperventilation, increase sensitivity to CO2; SOB easily (physiologic dyspnea)
renal anatomic changes
- smooth muscle in ureters and kidneys dilate-urine stagnates in renal pelvis
decrease bladder tone/ increase capacity
renal physiologic changes/ fluids and electrolytes
- increase GFR by 50%
- increased reabsorption of Na+
- decreased threshold for glucose- spills into urine
- protein in urine ABNORMAL (trace to +1 acceptable, anything more warning sign of preE)
- most efficient kidney perfusion/function and least edema with lateral recumbent position, worst with supine position
Integumentary
- chloasma
melasma
linea nigra
striiae gravidarum
Musculoskeletal
posture/gain= wide stance; lordosis
- rectus abdominus- split
neurologic
-hormonal headaches
- sleep alterations
-carpal tunnel
GI
basal metabolic rate- increase by 15-20%
Appetite- changes, n/v good sign; decreased 1st tri, pica
mouth- epulis, ptyalism
esophagus, stomach, intestines- pyrosis, constipation
gallbladder and liver- cholecystitis, cholelithiasis, pruritis gravidarum
abd discomfort
stomache measurments
- measurements used to trend growth
- 12-14 wks above symphysis pubis
- 20-22 wks at umbilicus
- correlates within 2wks of gestation
pregancy calendar
- 9 months
first tri - wks 1-13
- organogenesis
- presumptive s/s
second tri - wks 14- 26
- increase uterine/fetal size
- feels movement 20 wks
third tri - wks 27-40
- increase uterus furth displaces structures
estimated date of birth
Naegele rule
- determine first day of last menstrual period
- subtract 3 months
- add 7 days
- plus 1 year
Maternal adaptation
-accepting the pregnancy
- identifying with the mother role
-reordering personal relationships (feeling loved and valued, partner accepting preg)
establishing a relationship with fetus
- preparing for childbirth
partner adaption
- accepting the pregnancy(announcement, moratorium, focusing)
- identifying with parent role
- reordering personal relationships
- establishing relationship with fetus
- preparing for childbirth; consider individual needs
prenatal care goal
to promote the health and well-being fo the pregnant woman the fetus, the newborn, and family
prenatal care emphasis
preventive care and optimal self care
prenatal care population
- sough routinely by middle or high socioeconomic status
- povertery of lacking insurance decrease access
barrieres to obtaining prenatal care
lack of motivation to seek care
- inadequate finances
- lack of transportation
- unpleasant clinic peronnel
- unpleasant facilities or procedures
- inconvenient clinic hours
- problems with child care
- personal and cultural attitudes
prenatal testing
-assessments of fetal well-being
-indications:
materanl at >/=35
older paternal age (40-50)
parents affected by or carriers of genetic disorder
women with prior child with structural birth defect of one identified by ultrasound with current pregancncy
women with prior child with chromosomal abnormality
maternal serum-alpha-fetoprotein
- screening for neural tube defects
- detects 85-92% of open NTDs and almost all anencephaly
- recommended for all pregnant women
- performed between 14-20wks gestation
chorionic villus sampling
- sampling of chorionic villi by aspiration for genetic disorders or congenital anomalies
- earlier diagnosis and rapid results of genetic testing
performed between 10-13 wks
amniocentesis early
-for prenatal screening for genetic disorders or congenital anomalies
- amniotic fluid aspiration under ultrasound guidance
performed at or after 14 wks
amniocentesis late
- for fetal lung maturity diagnostic
-performed after 24 wks gest - LBC
- L/S ratio
- PG
amniotic fluid index
- evaluate total amniotic fluid volume by measuring largest pckets in al 4 quadrants and totaling
- 8-18 normal
- <5cm- oligohydramnios
- > 35- polyhydramnios
Biophysical Profile: NST + 4 ultrasound criteria
- criteria: fetal breathing movements, fetal movement, tone, AFI
- 8-10 normal
- 4-6- suspect; deliver or repeat based on situation
- <4- strongly suspect, likely deliver
Non-stress test
Basis: normal fetus produces heart rate accelerations in response to fetal movement, uterine contractions, stimulation. If they don’t, most often indicates compromise in well-being.
Reactive (positive): 2 or more accelerations in 20 mins of testing with normal baseline heart rate & variability.–REASSURING
contraction stress test
To identify fetus stable at rest but compromised with stress.
Contractions decrease uterine blood flow/placental perfusion. If creates fetal hypoxia→decreased FHR
Negative: no late decelerations–REASSURING
Positive: repetitive late decelerations–unsatisfactory/suspicious
Daily fetal movement Counts
Mother’s generally recognize 80-90% of movements; movement is correlated with fetal well-being
Fetal movement decreases with hypoxemia
Methods:
Once a day for 60 mins
Two or three times daily for 2 hours or until 10 movements
All movements in 12-hour period until 10 movements
Concerning:
Decreased movement
No movement for 12 hours (“fetal alarm signal”)
collaborative care
Collaborative care
Education for self-management
Procedures/testing
Medications and herbal preparations
Immunizations
Alcohol, smoke, caffeine, and drugs
Normal discomforts (see Perry Table): what to report?
Recognizing potential complications
1st trimester: bleeding
2nd trimester: bleeding, preeclampsia, preterm labor (PTL)
3rd trimester: preeclampsia, infections (UTI)
