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OB > antepartum (unit 1) > Flashcards

antepartum (unit 1) Flashcards

1
Q

presumptive signs of pregnancy

A
  • subjective
  • breast/abdominal enlargement
  • skin changes
  • amenorrhea
  • N/V
  • fatigue
  • urinary freq.
  • quickening
  • breast tenderness
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2
Q

probable signs of pregnancy

A 
•objective (examiner)
•uterine enlargement
•cervical changes
•braxton hicks
•ballottement- push down and bounce back 
*positive preggo-test
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3
Q

false negative preggo test

A
  • too soon
  • urine dilute
  • ectopic PG
  • improper technique
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4
Q

fasle positive preggo test

A
  • UTI (protein/blood in urine)
  • recent pregnancy
  • drugs
  • tumor
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5
Q

positive signs of pregnancy

A
  • confirms presence of fetus
  • fetal HT 10-12 weeks
  • visual in abd. 5-6 wks
  • visual in vag. 16 days
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6
Q

LMP

A

•last menstrual period

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7
Q

CD

A

•conception date

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8
Q

EDD

A

•estimated date of delivery

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9
Q

EDC

A

•estimated date of confinement

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10
Q

EDB

A

•estimated date of birth

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11
Q

length of pregnancy

A 
•280 days (40 wks)
•3 trimesters
1. 1-13.9 wks
2. 14-26.9 wks
3. 27-40 wks
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12
Q

Nagele’s Rule for EDD

A
  • subtract 3 from the month # of LMP

* add 7 to the day # of LMP

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13
Q

gravida

A

•# of pregnancies

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14
Q

para

A

•# of pregnancies reaching 20 wks GA

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15
Q

term

A

•deliveries at 38-42 wks

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16
Q

preterm

A

•deliveries prior to 37 wks and after 20 wks

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17
Q

post-term/postdates

A

• > 42 wks GA

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18
Q

abortion (Ab)

A

•ETOP- elective termination of pregnancy
•SAB- spontaneous abortion
•TAB- therapeutic abortion (medical reasons)
*abortion at less than 20 wks

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19
Q

GTPAL system

A
  • gravida
  • term
  • preterm
  • abortion
  • living
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20
Q

pregnancy after twins

A
  • G2
  • T1
  • P0
  • A0
  • L2
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21
Q

safe category drugs

A
  • A

* B

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22
Q

questionable category drugs

A
  • C
  • weigh risks w/ benefits
  • Ex: Zoloft
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23
Q

contraindicated category drugs

A
  • D (seizure drugs)
  • X (NEVER give)
  • proven fetal harm
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24
Q

pancreas changes during pregnancy

A
  • 1st trimester: dec. insulin (fetus takes glucose)

* ⅔ trimester: mom inc. resistance to insulin (more supply glucose for fetus)

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25
Q

progesterone

A 
•"hormone of pregnancy"
•secreted from ovary/placenta
•effects
-maintains uterine lining 
-relaxes uterine smooth muscle
-prepares breasts for lactation
-maternal fat stores (w/ estrogen)
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26
Q

estrogen

A 
•secreted from ovary/pl
•effects
-uterine, genital, breast growth
-ducts for lactation
-skin changes
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27
Q

human chorionic gonadotropin (hCG)

A 
•first produced by fetus
•effects
-positive preg. test
•prevents involution corpus luteum
•hormone that makes people "feel" pregnant
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28
Q

hCG and progesterone

A

•work together to maintain pregnancy
•hCG maintains corpus luteum
•corpus luteum produces progesterone until placenta
*drop of either results in miscarriage

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29
Q

relaxin

A

•from ovary and placenta
•effects
-softens muscles/joints of pelvis
-inhibits uterine activity

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30
Q

oxytocin

A

•from post. pit
•effects
-uterine ctx
-milk ejection (let down) reflex

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31
Q

prolactin

A
  • from ant pit

* hormone of milk production

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32
Q

aldosterone

A
  • from adrenals

* increases during pregnancy to conserve Na+ and maintain fld balance

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33
Q

thyroxin (T4)

A

•inc. when estrogen inc.
•causes bigger thyroid
•inc. BMR for 1st trimester
*hyperactive thyroid during pregnancy (hard to regulate in 1st trimester if had previous issue and are on meds)

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34
Q

human chorionic somatommotropin (hCS)

A
  • from placenta

* growth hormone affecting breast development and decreasing maternal metabolism

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35
Q

uterus growth during pregnancy

A

•12 wks: rise out of pelvis
•16 wks: midway b/t symphysis and umbilicus
•20 wks: umbilicus
•38-40 wks: FSH dec -> lightening (feel better)
*grows 1 cm/wk

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36
Q

funic souffle

A
  • blood rushing through umbilical vessels

* sync w/ fetal heart beat

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37
Q

uterine souffle

A
  • blood in uterine arteries

* sync w/ maternal pulse

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38
Q

Hegar’s sign

A
  • softening of lower uterine segment

* 6-8 wks

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39
Q

Goodell’s sign

A
  • cervical softening r/t congestion of blood

* 6 wks

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40
Q

Chadwick’s sign

A
  • bluish color of cervix r/t inc. vascularity

* 8-12 wks

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41
Q

mucus plug (operculum)

A
  • barrier in cervix
  • protects baby from bacteria
  • sloughing of vaginal cells caused by progesterone
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42
Q

leukorrhea

A
  • changes in vaginal acidity to protect against infection

* due to increased lactic acid production making mom more vulnerable to yeast infection

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43
Q

cardiovascular changes during pregnancy

A 
•inc. clotting factors
•dec. fibrinolytic (prevent clots from sticking) activity 
•inc. WBC and RBC
•inc. blood vol. -> inc. CO
•inc. pulse 
•inc. respirations
•dec. BP during 2nd trimester 
*extremely high risk for blood clots
44
Q

pseudo (physiological) anemia

A

•inc. in RBC, but diluted by expanded blood vol., so looks like anemia
•Hct < 35%
•Hgb < 10%
*lower than normal H&H okay as long as they are tolerating it

45
Q

why does BP decrease 5-10mmHg during 2nd trimester

A

•b/c have extra volume and body responds by signaling vasodilation to relax vessels and lower BP

46
Q

dependent (physiologic) edema

A
  • poor venous return d/t pressure of uterus
  • creates pooling/varicose veins in LE
  • pt should avoid tight clothing/shoes
47
Q

urinary changes during pregnancy

A
  • bladder capacity doubles
  • filtration rate inc.
  • inc. risk for infection
  • ketones/protein in urine bad
48
Q

protienuria during pregnancy

A

•not good b/c can lead to irreversible kidney damage (too big to filter)
•if in combo w/ HTN risk for preeclampsia
*check at every appt.

49
Q

integumentary changes during pregnancy

A
  • chloasma (face pigment)
  • linea nigra
  • vascular spiders
  • palmar erythema (r/t estrogen)
  • striae gravidarum (collagen stretch)
  • epulis (gum hypertrophy)
  • acne
50
Q

causes of leg cramps during pregnancy

A
  • impaired circulation
  • low K+
  • high P
  • low Ca++
  • low Mg++
51
Q

round ligament pain

A
  • sharp pain in abd. extending to pelvis/vag
  • caused by stretching of ligaments as uterus grows
  • tx w/ Tylenol, NOT NSAIDs
52
Q

causes of fatigue during pregnancy

A
  • hypoglycemia
  • initial fall in BMR (1st tri)
  • progesterone
53
Q

neurologic system changes during pregnancy

A 
•sciatic nerve pain
•sensory changes in legs
•tension HA
•carpal tunnel (r/t edema compression)
•acrothesias (numb hands)
•hypocalcemia (cramps)
*nerve/sensory s/sx
54
Q

ptyalism

A

•excessive secretion of saliva

55
Q

morning sickness causes

A
  • inc. hCG, estrogen, progesterone
  • hypoglycemia
  • altered carb metabolism
  • tx w/ gum, hard candy, oral care, etc
56
Q

hyperemesis

A

•severe morning sickness
•requires frequent monitoring of weight/electrolytes
•may need hospitalization and IV tx
*r/o appendicitis

57
Q

pyrosis

A
  • heartburn
  • caused by progesterone decreasing peristalsis and vasodilating smooth muscle
  • tx w/ anti-acids and diet modification
58
Q

pica

A
  • carving/eating abnormal things
  • ice is common in preggo
  • may indicate signs of anemia
59
Q

constipation during pregnancy

A 
•most common in 3rd trimester
•d/t
-dec. peristalsis
-iron supplements
-dehydration
-dec. activity level 
•tx w/ H2O, fiber diet, colace
60
Q

reason for hemorrhoids during pregnancy

A
  • increased vascularity
  • increased pressure
  • constipation
61
Q

nutrition increase requirements during pregnancy

A
  • iron- O2 demands
  • vitamin C- absorb iron
  • calcium- teeth/bone formation
  • inc. caloric intake by ~300
62
Q

nutrition during lactation

A
  • inc. by 300 kcals/day for first 6 months

* inc. by 400 kcals/day after 6 months

63
Q

adequate antepartum care

A
  • 13 visits

* begin before 20 post-conception (later is high risk)

64
Q

initial prenatal visit

A
  • health hx
  • OB hx (GTPAL)
  • GYN hx (menstrual cycle; contraception; fertility; STDs)
  • family hx (mom primarily)
  • psychosocial profile
  • physical assessment
65
Q

initial prenatal visit exam

A

•verify pregnancy and establish EDD
*U/S most accurate method
•establish baseline numbers (VS, weight, etc)

66
Q

initial prenatal visit labs

A
  • CBC- platelets; anemia
  • type Rh (redraw in L&D)
  • rubella titer
  • HBSaG
  • RPR or VDRL
  • HIV
  • gonorrhea/chlamydia cultrer
  • urinalysis/culture
67
Q

ABO incompatibility

A
  • A and B blood doesn’t mix w/ O
  • if mom is O and baby is A or B, then mom can produce antibodies that attack baby
  • can cause fetal jaundice or anemia
  • no tx
68
Q

Rh incompatibility

A
  • Rh (D) negative women who give birth to Rh (D) positive infants may develop anti-D antibodies
  • These antibodies are made when the Rh negative blood is exposed to Rh + blood (exposed to the “D” antigen)
  • These antibodies then can attack the next fetus resulting in serious illness and death due to erythroblastosis fetalis
69
Q

Rhogam

A
  • drug that reduces # of anti-Rh antibodies that are a result of Rh+ fetal blood mixing w/ Rh- maternal blood
  • given at 28 wks for Rh neg mom
  • given 72 hrs postpartum after fetal type/Rh
  • w/ tx, very little chance of antibody production
70
Q

erythroblastosis fetalis (hydrops)

A

•hemolytic anemia in fetus

71
Q

rubella titer

A
  • if non-immune and exposed to Rubella, can develop congenital rubella syndrome
  • if non-immune vaccinated postpartum
72
Q

HBSaG

A
  • hepatitis B surface ANTIGEN indicates current infection
  • surface ANTIBODIES indicate past infection/immunization
  • no tx for + during pregnancy, but can vaccinate fetus w/in 12 hrs of birth to reduce risk of infection
73
Q

RPR/VDRL

A
  • syphillis labs
  • tx w/ PCN during pregnancy
  • redrawn at L&D admit
74
Q

HIV labs

A 
•drawn at initial and on admit to L&D
•don't need pt consent 
•tx available during pregnancy
•viral count lower than \_\_\_ means can have vag. delivery
*DONT breastfeed w/ HIV
75
Q

+ gonorrhea/chlamydia screened

A
  • tx during pregnancy w/ abx and TOC w/in 1 month

* infection increases risk for preterm delivery

76
Q

initial urinalysis

A
  • asymptomatic bacteria common

* tx w/ abx if count > 100,000

77
Q

HPV positive

A
  • doesn’t affect outcome of pregnancy unless invasive cancer

* doesn’t transmit to fetus

78
Q

HSV

A
  • herpes simplex virus
  • I: mouth
  • II: genitals
  • CANNOT have vag. delivery w/ active HSV lesions
  • preventative tx during pregnancy
79
Q

HGB electrophoresis

A
  • detects hemoglobinopathies (sickle cell, etc)

* only done in high risk pts

80
Q

1st trimester ultra sound

A

•done to confirm dates (may have to chafe EDC to match sono)

81
Q

smoking effects during pregnancy

A
  • vasoconstriction in placental leads to decreased blood flow
  • placenta calcifies
  • thin umbilical cord
  • fetal growth abnormalities
  • high risk of SIDS b/c CO2 crosses placenta
82
Q

2nd trimester visits

A 
•BP
•urine dip for protein, blood, ketones, glucose, bacteria
•fundal ht
•leopold's
•FHT (doppler)
•lower extremities
*every 4 wks
83
Q

2nd trimester labs

A
  • GDM screening @ 24-28 wks
  • Rh antibody screening
  • CBC (r/o anemia)
  • genetic screening
84
Q

2nd trimester ultrasound

A
  • b/t 18-22 wks
  • assess anatomical structures
  • determine sex
  • if high risk, sent for further evaluation
85
Q

3rd trimester visit

A

•same as 2nd, but add in cervical exams to assess for dilation

  • once get to 28 wks come every 2 wks
  • once get to 36 wks come every wk
86
Q

3rd trimester labs

A

•group beta strep (GBS)
-vaginal/rectal swabat 35-37 wks
•Rh screen if was - before
-admin Rhogam if still -

87
Q

3rd trimester ultrasound

A
  • not always performed

* offered for pt satisfaction of growth, size, etc

88
Q

Who is at risk for Rh incompatibility?

A

•Rh negative mother w/ Rh positive fetus

89
Q

fetal kick counts

A

•at least 3/hr
•movement peaks 9 pm and 1 am
-maternal glucose lowest
*no movement for 12 hrs is an alarm

90
Q

if pt calls about no fetal movement

A
  • tell to go eat and drink and then lie down
  • should have at least 10 movements over the next 2 hours
  • if < 10 movements need to bee seen for further testing
91
Q

pt 34 wks, what s/sx needs followup

A

•headache b/c possibly have hypertension

92
Q

immunizations during pregnancy

A
  • live virus contraindicated (MMR, polio, small pox, flu mist)
  • attenuated acceptable (flu, tetanus, dip, hep B, rabies)
93
Q

TDAP recommendations

A
  • vaccinate w/ EACH pregnancy

* given b/t 27-36 wks

94
Q

cocooning

A
  • vaccinating any child or adult that will have close contact w/ infant <12 months old
  • immunization that protects newborn
95
Q

kegel exercises

A

•deliberate ctx/rlx of pubococcygeus muscle to improve muscle tone/strength of pelvis

96
Q

couvade syndrome

A

•healthy man, whose wife is expecting, experiences pregnancy symptoms

  • loss of appetite
  • N/V
  • HA
  • fatigue
  • weight gain
97
Q

common goal of all cultures during pregnancy

A

•seek to protect mom and baby

98
Q

follicular phase

A
  • variable

* before ovulation

99
Q

“black box” layer of cells

A
  • surround uterus and prevent placenta from embedding

* improvised if had cervical scrape

100
Q

when do fundus measurements line up w/ pregnancy

A

•20 weeks

101
Q

how to rule out getting mom HB instead of fetus

A

•take radial pulse or use pulse ox

102
Q

underweight BMI

A
  • <18.4

* should gain 27-40 lbs

103
Q

normal weight BMI

A
  • 18.5-24.9

* should gain 25-35 lbs

104
Q

overweight BMI

A
  • 25-29.9

* should gain 15-25 lbs

105
Q

obese BMI

A
  • > 30

* minimal gain

OB (17 decks)

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