Care of the Pregnant Patient Flashcards
1
Q
1st Trimester
A
1-13 weeks
2
Q
2nd Trimester
A
14-26 weeks
3
Q
3rd Trimester
A
27-42 weeks
4
Q
Length of average menstrual cycle
A
28 days
5
Q
How to find day of ovulation
A
take length of cycle and subtract 14 days (If their cycle is 32 days, ovulation occurred on day 18)
**Luteal phase is ALWAYS 14 days (due to life span of the luteum)
6
Q
Follicular Phase of Menstrual Cycle
A
- Gets the follicle ready
- Rise of estrogen due to supporting cells of the follicle
- Rise in estrogen makes uterine lining thick
7
Q
Luteal Phase of Menstrual Cycle
A
- Luteinizing hormone rises during ovulation
- Early corpus luteum makes huge amounts of progesterone
- Progesterone maintains uterine environment (endometrial lining)
- Without progesterone, someone will have withdrawal bleeding
8
Q
PreEmbryonic stage
A
- Days 1-14
- Starts with conception, aka fertilization
- Formation of a zygote (egg that is fertilized with the sperm) > morula (big ball of cells) > blastocyst (hollow cell filled with fluid)
- Fertilization occurs in the arm
- Implantation into endometrium
9
Q
Embryonic Stage
A
- Day 15 – 8 weeks
- Completion of major body organs
- Where congenital defects occur
- Embryo is most susceptible to damage from external sources, including teratogens (substances that cause birth defects, such as alcohol and drugs), infections (such as rubella or cytomegalovirus), radiation, and nutritional deficiencies
10
Q
Placenta
A
- Derived from trophoblastic cells
- Interface between mother and fetus
- Develops by 12 weeks gestation
11
Q
Umbilical cord
A
- Connects mother to growing embryo
- One vein (Coming to the fetus / Oxygenated)
- Two arteries (Go away from the fetus back to the mom / Deoxygenated with CO2 waste product)
- Wharton’s jelly protects the cord from compression and prevents the cord from being kinked
12
Q
Amniotic fluid
A
- Increases throughout pregnancy
- ~1 L at term
- Low amounts can mean a dysfunction of placenta
- Fetal urine and fluid transport
13
Q
Functions of Amniotic Fluid
A
- Maintains body temperature
- Permits symmetric growth and development
- Cushions fetus from trauma
- Prevents compression of umbilical cord
- Promotes fetal movement
- Lung formation (Stretches the alveoli)
- Repository for waste
14
Q
Function of the Placenta
A
- Protects fetus from immune attack (Hides the pregnancy from the maternal immune system)
- Prevents mixing of maternal/fetal blood
- Exchange of nutrients and waste
- Hormonal function
15
Q
hCG
A
- Preserves the corpus luteum and its progesterone production so that the endometrial lining of the uterus is maintained
- This is the basis for pregnancy tests
- Once the placenta is formed, the corpus luteum is not needed
- Can cause morning sickness (causes you to be in a hypermetabolic state and your GI system doesn’t like that)
16
Q
Human placental lactogen (hPL)
A
- Modulates fetal and maternal metabolism, participates in the development of maternal breasts for lactation, and decreases maternal insulin sensitivity to increase its availability for fetal nutrition
- Causes insulin resistance (makes sure that there is always some glucose available for the fetus)
- Allows the mobilization of insulin through the placenta
- Responsible for gestational diabetes
17
Q
Estrogen (estriol)
A
- Causes enlargement of a woman’s breasts, uterus, and external genitalia
- Stimulates myometrial contractility
18
Q
Progesterone (progestin)
A
- Maintains the endometrium, decreases the contractility of the uterus, stimulates maternal metabolism and breast development, provides nourishment for the early conceptus
- Without progesterone, there can be no pregnancy
19
Q
Relaxin
A
- Acts synergistically with progesterone to maintain pregnancy, causes relaxation of the pelvic ligaments, softens the cervix in preparation for birth
- Causes the “wobble” in pregnancy
20
Q
Fetal Stage
A
- 8th week until birth
- Growth and refinement of organ systems
- Fetal circulation
21
Q
Ductus venosus
A
- Shunt because the liver doesn’t need as much blood because it has the mom’s placenta and liver
- A shunt that allows oxygenated blood in the umbilical vein to bypass the liver and is essential for normal fetal circulation. Blood becomes oxygenated in the placenta and travels to the right atrium via umbilical veins through the ductus venosus, then to the inferior vena cava
22
Q
Patent formamen ovale
A
- Shunt because fetal lungs don’t breathe
- It allows blood to go to the left side of the heart without going to the lungs
- A hole between the left and right atria (upper chambers) of the heart
23
Q
Fetal hemoglobin & hematocrit
A
Higher
24
Q
Normal Fetal Heart Rate
A
110-160 bpm
25
Prenatal Care
- Assess maternal and fetal health
- Identify social, behavioral, environmental, and biomedical risks
- Reduce risks through identification, educations, and intervention
- Health promotion
26
Antenatal Care Visit Schedule
Monthly until 28 weeks
Every other week from 28 weeks
Weekly from 36 weeks
27
Initial OB Visit
- Reason for seeking care
- Confirmation of Pregnancy
- Identification of risk factors
- Get a full health history (medical, surgical, GYN, career information, social history)
- Education/Anticipatory guidance
28
Presumptive Indicators of Pregnancy
What the patient reports (i.e., late period and tiredness
29
Probable Indicators of Pregnancy
What the examiner can appreciate (i.e., pelvic exam shows some physical changes)
Maybe you’re pregnant, maybe you’re not
30
Positive Indicators of Pregnancy
Fetal only (i.e., ultrasound shows a fetus)
31
Nägele’s Rule
- Used to estimate date of delivery
- Add 7 days to 1st day of last menstrual period
- Subtract 3 months or add 9 months
- Use actual # of days in month when crossing over to another month
32
Gravidity
- How many times have you been pregnant (including this one)
- First = G1
- Tenth = G10
33
Parity - Term
37 weeks 0 days and above (37 0/7 and above)
34
Parity - Preterm
20 weeks 0 days to 36 weeks 6 days (20 0/7 – 36 6/7)
35
Parity - Abortion
- Any pregnancy that ends before 20 weeks regardless of how it ended
- SAB = spontaneous abortion (miscarriage)
- EAB = elective abortion
- TAB = therapeutic abortion
- Also includes ectopic pregnancy (occurs outside the uterine cavity)
36
Parity - Living
All the live births
37
A client presents for care. This is their first pregnancy. G__P__
G1 P0
Prima gravida
38
The client delivers a male newborn at 41 weeks gestation. G__P__
G1 P1001
39
Client presents for care in the next pregnancy at 10 weeks gestation. G__P__
G2 P1001
40
Client delivers a male newborn at 38 weeks gestation. G__P__
G2 P2002
41
Client delivers a male newborn at 38 weeks gestation. Next pregnancy, client presents for care at 9 weeks with cramping and vaginal bleeding, and subsequent pregnancy loss at 10 weeks. G__P__
G3 P2012
42
Client delivers a male newborn at 38 weeks gestation. Next pregnancy, client presents for care at 9 weeks with cramping and vaginal bleeding, and subsequent pregnancy loss at 10 weeks. The client is now pregnant again with twins. G__P__
G4 P2012
43
Client delivers a male newborn at 38 weeks gestation. Next pregnancy, client presents for care at 9 weeks with cramping and vaginal bleeding, and subsequent pregnancy loss at 10 weeks. The client is now pregnant again with twins. The twins are delivered by cesarean section at 34 weeks. G__P__
G4 P2114
If one came out, had a severe heart defect and died: G4 P2113
44
Nutrition in Pregnancy: Calories
Additional 300 calories per day in the second and third trimester
45
Nutrition in Pregnancy: Folic Acid
400 to 800 mcg/day
Should be given pre-conception
Important for the neural tube
46
Nutrition in Pregnancy: Iron
27 g/d
47
Nutrition in Pregnancy: Protein
80g/d
48
Total Weight Gain Range (lbs) in Normal pregnancy BMI
25-35
49
Rates of Weight Gain in 2nd and 3rd Trimester (Mean range in lbs/week)
1 (0.8-1)
50
Food concerns in pregnancy
- Artificial Sweetener (can have in moderation)
- Seafood (can have in moderation because it has Mercury but it also has healthy fats)
- Listeriosis
51
First Trimester Prenatal Labs
- ABO/Rh, RBC antibody screen
- CBC
- Syphilis (RPR/VDRL)
- Hepatitis B/C
- Rubella
- Varicella
- HIV
- STIs
- Urine (Culture, UA)
- Aneuploidy
52
Second Trimester Prenatal Labs
- Maternal Serum AFP
- Gestational diabetes screen
- Repeat CBC, Ab Screen, HIV/RPR
- STIs
53
Third Trimester Prenatal Labs
- Group beta strep
- STIs
- HIV/RPR
54
Optional Prenatal Labs
- Pap smear
- Hg Electrophoresis, CF, SMA, Fragile X
- Carrier screen
- Thyroid
- A1C
- Lead
55
Aneuploidy screening
- Abnormal number of (entire) chromosomes
- Screen ALL pregnant persons to identify those at high risk every pregnancy
- Down syndrome (1/800)
- Trisomy 18 (1/3-5000)
- Trisomy 13 (1/8000)
56
Rh D Immunoglobulin
Administered at 24-28 weeks antepartum to any patient Rh negative, within 72 hours postpartum if neonate is Rh positive, or if antenatal vaginal bleeding (trauma) to non-sensitized Rh-negative clients
