CH 21 Woman during pregnancy Flashcards
WHAT should you screen for in pregnancy when adding a new member to the family?
physical, emotional, and/or financial abuse during preg and postpartum period
zygote and blastocyst
at fertilization it’s a zygote
then blastocyte up to 2 weeks (ball of cells)
embryo weeks
embryo is 2-8 weeks
fetus in weeks
8 weeks to term
early term in weeks
37 weeks (lungs are now mature) through 38 weeks plus 6 days
full term in weeks
39 weeks through 40 weeks plus 6 days (Estimated date of delivery (EDD)) = 40 weeks)
-most women give birth at 40 weeks
Late-term in weeks
41 weeks through 41 weeks plus 6 days
-more awake and hungry; more neurological development
Post-term in weeks
42 weeks and beyond
-do not encourage beyond 42 weeks, placenta deterioriates
at what stage of development is baby not susceptible to teratogens?
first 2 weeks; blastocyst stage
no organ system for teratogen to damage
implantation bleeding
~2 week after conception, when fertilized egg implants to uterus = light bleeding
Ask how many days lasted? timing normal? duration of menses?
“last period came 1 week early and lasted 1 day and was very light”
when is fetus most susceptible to teratogenic drugs?
week 3-8 is most intense organogensis (organs developing)
stages of human development
brain develops throughout pregnancy
naegele’s rule
expected date of delivery EDD by last menstrual period
- substract 3 months from 1st day of LMP, add 7 days = 40 weeks from LMP or 38 weeks from date of conception
can be inaccurate if have irregular menses or unclear LMP
when is the MOST accurate source for EDD?
1st trimester ultrasound
-using crown-rump measurement
-accurate with potential of 7 day error mragin
what is another way to estimate EDD by ultrasound that is not accurate?
2nd trimster ultrasound (up to 22 weeks)
using multiple fetal measurements BUT 14 day error
why evaluate uterine size?
provides info during antepartum period about fetal growth and maternal well being
size of non gravid and at 8 weeks old?
non gravid - lemon
8 weeks - tennis ball/orange
when can you hear fetal heart sounds?
starting at 10 weeks and fersure at 12 weeks via doppler
-baseball size
what week is when the fetus is rising above symphysis pubis?
- at 12 weeks (can also reliably hear FHT)
- softball/grapefruit
at what week is fundal height halfway between symphysis pubis and umbilicus?
16 weeks
at what week is fundal height at umbilicus?
20 weeks
from 20 weeks to 36 weeks, how high does fundal height grow per week?
1 cm per week *correlates to gestational age plus or minus 1 cm
-ex: 28 week gestion, u anticipate fundal heigh t is 28 cm above umbilicus + or - 1 cm
when does fundal height drops?
-at term. uterus dips into pelvis with fetal head engagement
-vertex (cephalic) position by 36 weeks
how much calories does she need during pregnancy?
-additional 300 calories/day over baseline
-need more calories if 1-2 years from menarche (mom is still growing) and w/ mult gestation
how much calories does she need during lactation?
additional 500 cal/day above baseline
how much calcium in pregnancy needed per day?
1,000-1,500 mg/day
age 14-18 need minimum 1,300 mg /day
age 19-50 need minimum 1,000mg/day
how much folic acid needed during pregnancy?
0.4 -1 mg/day if without history of neural tube defect
if have history of neural tube defect or family hx of NTD (anencephaly, myelomeningocele, spinal bifida), how much folic acid?
4 mg/day for 1 month BEFORE pregnancy and DURING first 3 months gestation, then resume 0.4-1 mg per day to promote placental/fetal growth
iron supplements in pregnancy
-if not anemic in preg, little evidence it’s needed unless in prenatal vitamin (NO excess supp needed = free radical damage)
-if Hgb < 11 in 2nd trimester or < 10.5 mg in 3rd trimester = need 30 mg elemental iron PO per day
-recheck 1 month after therapy, if still low check ferritin to confirm iron def and adjust iron dose
-divide dose if >30 mg daily for better absorption; add zinc or copper (prenatal vitamins)
recommended total weight gain for underweight (BMI < 18.5) mom?
28 - 40 lbs (12.7-18.14 kg)
for 2nd & 3rd trimester: gain 1lb / week
**recommended total weight gain for healthy BMI (18.5-24.9)?
25 - 35 lbs (11.34 -15.88 kg)
for 2nd & 3rd trimester: gain 1lb / week
recommended total weight gain for overweight (25-29.9) mom?
15-25 lb
2nd & 3rd tri: gain 0.6 lb / week
recommended total weight gain for obese (BMI 30 +)
11-20 lbs
2nd & 3rd trimester: 0.5 lb/week
maternal prepregnancy OBESITY
risk to mother:
INCREASED risk of…
- gestational DM
- hypertensive disorders
- C- section birth
- PP complications (higher rates of post surgical birth infections)
- hospital length stays
- anesthesia related problems
maternal prepregnancy OBESITY
risk to fetus/neonate:
INCREASED risk of…
- congenital anomalies
- macrosomnia
- neonatal hypoglycemia
- preterm birth, neonatal and infant mortality
- insulin resistance
lower rates of successful breastfeeding
in utero, how does the baby grow in the 2nd trimester? 3rd trimester? brain?
grows length wise in 2nd trimester, weight wise in 3rd and brain throughout pregnancy
. A 21-year-old woman with normal
BMI prior to pregnancy is now
38-weeks pregnant. Her weight gain
up to 28 weeks was 12 lbs (5.45 kg)
and she has gained 2 lbs (0.9 kg) from 29 weeks to 38 weeks. Her weight gain pattern is most likely to affect
her baby’s:
A. Birth weight.
B. Head circumference.
C. Birth length.
D. APGAR scores.
up through 2nd tri weight gain was good but poor in 3rd tri
A: birth weight
most likely to have a long, slender baby
Felicia is 18-weeks pregnant with
her first child. Which of the
following is most consistent with her gestational age?
A. Uterine fundus palpable through the abdominal wall
B. Nausea and breast tenderness
C. Report of quickening
D. Fetal heart tones detectable by
abdominal Doppler
A. Uterine fundus palpable through the abdominal wall SHOULD HAVE HAD THIS MILESTONE BY 12 WEEKS; so would have anticipated already = “gotcha” answer = poor answer
B. Nausea and breast tenderness = non specific
C. Report of quickening = feeling baby move = ANSWER!
D. Fetal heart tones detectable by
abdominal Doppler = anticipated by 10-12 weeks but NOT a new finding by 18 weeks
when is quickening reported?
- when baby moves
- by 18 weeks
- if have more gestations, can feel it sooner bc knows the feeling
nausea and vomiting during pregnancy: when? which hormones & why?
during 1st trimester!
-progesterone = delays gastric emptying = heart burn
-hCG = morning sickness; mechanism unclear; trophoblast at day 8 = sx’s worsen when hcg peaks ~ 10 weeks
interventions for nausea/v in preg
- frequent small meals
- no high fat or large meals that can further delay gastric emptying
- avoid aggravating foods (diary)
- avoid rapid intake of large amt of liquids = freq sips ok; avoid high fat liquids
-vitamin B6 supplements (25 mg 3-4x/day helps with nausea (not vomiting) for milder sx’s - ginger ale or powder capsules (1-1.5 mg/24 hrs)
- Last: antiemetics (ondansetron/Zofran, metoclopramide/Reglan, phenothiazines/Phenergan)
frequency of visits for prenatal visits?
prenatal visit every 4 weeks up to 28 weeks
28 weeks - 36 weeks = every 2 weeks
≥36 weeks = every week
genetic screening before and early pregnancy
Tay Sachs disease
Cystic fibrosis
sickle cell trait
prenatal care, 1st visit/early in pregnancy
- pap test if due gonorrhea/chlamydia
-rubella (measles), varicella, rubeola status if not previously known - syphilis, HIV, HBsAg, consider HCV testing
- CBC, blood type, antibody screen
- screen domestic violence, depression, substance abuse
-update immunization status - Tb test
- genetic screening
- 1st trimester ultrasound if unclear EDD
-UA, urine C&S (tx asx bacteremia)
when do you treat asymptomatic bacteria in the urine from a urine C&S?
one of the few times you actually need to treat!
during pregnancy, dilation of renal pelvis, more reflux into renal pelvis = higher risk of pyelonephritis
chorionic villus sampling & when is it done?
at 10-12 weeks
DIAGNOSTIC prenatal test taking a sample of placenta to test for chromosomal abnormalities
-no info on neural tube defects (need f/u blood test at 16-18 weeks)