Chapter 6 Flashcards
What are the symptoms of pregnancy?
Missed menstrual period Breast tenderness
Morning sickness
More frequent urination
How is the delivery date calculated?
Delivery date calculated
from the first day of the last
menstrual period
-(40 weeks gestation)
When are the 1,2,3 trimesters?
Nine months of pregnancy are divided into 3 equal periods of 3 months (trimesters)
- First trimester - months 1 to 3
- Second trimester - months 4 to 6
- Third trimester - months 7 to 9
When does the the most growth take place?
• First T most growth and development is happening
What is the placenta?
an organ formed on the wall of the uterus through which the fetus receives oxygen and nutrients and gets rid of waste products
What is HcG?
Human chorionic gonadotropin (HcG) - a hormone secreted
by the placenta
How can you detect if you’re pregnant?
Test has HcG -HcG is detected in urine and blood A first morning urine sample (ideal) -hold dipstick in the urine stream or dip into a sample of urine. -Test strip changes color if hCG is present meaning you are pregnant.
What is the umbilical cord?
the tube that connects the fetus to the placenta
What is the amniotic fluid?
the watery fluid surrounding a developing fetus in the uterus
What is an ectopic pregnancy?
Conceptus implants outside of the uterus
PID
Endometriosis
Scarring of the oviducts that affects cilia
Can you save an ectopic pregnancy?
No, it is always non-viable
What are the problems related to early pregnancy?
Miscarriage
Stillbirth
What is a miss carriage?
Spontaneous abortion/ Chemical pregnancy
Natural causes
Can be emotionally challenging
-grief must be processed
When can spontaneous abortion happen?
Can happen at any time
-normally happens before 11 wks, if it happens later then can be really upsetting
What do people say if you are past the 11 weeks?
• Say that if you ge t past the 11 weeks/ first T you are safe
What is a still birth?
Fetus is delivered but not living
Delivery of a fetus after 28 weeks
What are the main pregnancy related problems?
Molar pregnancy
Pseudocyesis
GBS
What is a molar pregnancy?
Mass of abnormal
tissue (mass that isn’t chromosomal_
Not a true pregnancy
Women over 35 more at risk
Low vitamin A
What is Pseudocyesis?
False pregnancy
Symptoms may include:
- amenorrhea
- N/V
- abdominal distension
What is GBS?
Group B streptococcal
What happens if GBS goes undetected/treated?
Preterm birth/stillbirth Prenatal testing
Antibiotic prophylaxis
What happens if you are + for Strep?
• + for strep you have to have a iv antibodies, when you a deliver tp protect baby with strep (antibodies prophylaxis)
Swab around anus and sned to lab
What is the D antigen (rh) incompatibility?
D- mother carrying D+ child (gene from father)
Not usually an issue with first pregnancy
Antibody presence identifiable by Coombs blood test
Intervention required to protect subsequent pregnancies due to maternal antibodies to D antigen after birth
Who is tested for D antigen?
everyone
What is the treatment for D antigen incompatibility?
2 Rhogam (D immunoglobulin) shots given to
prevent the D- mother from producing D
antigen antibodies that can attack D+ baby
-Week 28, and within 72 hours postpartum
Non-treatment will result in hemolytic disease of the newborn, gestational death
Rhogam is also given after miscarriage, amniocentesis, gestational bleeding episodes if the mother is D-
What are pregnancy related problems in the later stages?
Pregnancy-induced hypertension Risk of preterm birth Risk of maternal stroke Risk of infant death Preterm labour (before 37 weeks) -common with multiples Born with physical issues
What is the treatment for Pregnancy-induced hypertension ?
Give birth
-induction
What are the 3 conditions of Pregnancy-induced hypertension ?
Hypertension
Preeclampsia
Eclampsia
What are the signs of preeclampsia?
Severe headaches Vomiting blood Excessive nausea Ringing or buzzing sound in ears Excessive vomitingDrowsiness Smaller amounts of urine or no urine Excessive swelling of the feet and hands Protein detected in urine Blood in your urine Rapid heartbeat Dizziness Fever Double vision Blurred vision Sudden blindness Pain in the abdomen (tummy)
What happens to the foetus in the first trimester?
Develops into a fetus with most of the major organ systems present
4th to 8th week - external body parts develop
7th week - liver, lungs, pancreas, kidneys, and intestines have formed and begun limited functioning
When is the foetus differentiated?
12 weeks
What are the physical changes in the woman int he first trimester?
Large increase in levels of hormones
Breasts swell and tingle
-development of mammary glands for future milk production/breast feeding
Need to urinate more frequently
“Morning sickness”/nausea
Vaginal discharges may increase
Feelings of fatigue and sleepiness
What are the psychological changes in the first trimester?
Psychological changes may include: -Depression -Stress; Negative emotions -Excitement; Positive feeling
What is the fetal development during the second trimester?
Quickening occurs
- women becomes aware of fetal movements
- Feels like a butterfly fluttering rather than a true kicking sensation
- Occurs around the end of the 14th week
Fetal heart beat can be detected
-Abdominal ultrasound initially Doppler
What are the physical changes on the woman in the second trimester?
Morning sickness tends to disappear
Constipation and nosebleeds sometimes occur
Edema - water retention and swelling
Colostrum may come out
of the nipple
-Immune components
When does the milk come in?
2 days post partum
What are the psychological changes in second semester?
Psychological well-being is greater among women who have social support
- Spouse/partner
- Family
- Friends
- Agency support
- Groups and programs
What is the fetal development during the third trimester?
Fetus opens his/her eyes
Fetus’s skin is wrinkled and covered with down- like hair
Fetus usually turns in uterus to assume a head- down position
Fetus experiences rapid growth
What are the physical changes in the third trimester?
May have low energy
Braxton-Hicks contractions
Difficulty rising out of chairs, turning over in bed, tying shoes due to the girth of the belly
What are Braxton-Hicks?
Not part of labor
“practice” contractions to tonify the uterus in preparation for labor
Usually not painful
What are the psychological changes in the third trimester?
Some discomfort as weight/pressure is put on The woman’s internal organs
Women who report higher levels of demonstrated affection with their partner also report lower levels of anxiety and insomnia
related to later pregnancy
What is couvade syndrome?
“Male” pregnancy symptoms (very rare)
May be caused by stress and hormonal changes in the partner
May include:
Indigestion, gastritis, nausea, headaches, weight gain
How can the partner help?
may choose to be actively involved
- Can alleviate feelings of helplessness, exclusion
- -Eg. Participate as birth “coach” for labor support
Is sex safe during pregnancy?
Intercourse can continue safely throughout the healthy pregnancy
During the last weeks of
pregnancy, intercourse may
encourage labor
If having intercourse what might degrade the amniotic membranes?
Prostaglandins in semen
What can intercourse help with?
Intercourse is used as a method to encourage labor in women who are post-dates (overdue)
How can we make intercourse more comfortable for women?
Positioning changes
Petting (hand-genital
stimulation)
Oral sex (oral-genital stimulation)
What must the women get in her diet?
protein, folic acid, calcium, magnesium vitamin A
Why is folate important?
Folate (B9) particularly important vitamin pre- pregnancy/early pregnancy to protect from neural tube defects (Spina bifida)
What does folate do?
Folic acid/Folate helps build healthy cells
Requirements for folate increases with pregnancy (period of rapid growth)
What are food sources of folate?
leafy green
vegetables (collards, broccoli, kale, spinach, and
fruits/fruit juices such as orange juice.
-Some foods are fortified with folate (grain breads and cereals)
What are substances that may result in birth defects?
Legal drugs (nicotine, alcohol) Illegal drugs (heroine) Prescription Meds (Steroids, accutane) Natural Health products (fit A) Foods (mercury)
What is a teratogen?
Substance that produces defects in fetus
What is FASD?
Fetal alcohol spectrum disorder
-Alcohol consumed by a woman when she is pregnant
What does FASD result in?
Prenatal and postnatal growth and developmental deficiencies
Smaller brain, smaller eye openings, joint/limb/heart malformations, mental insufficiencies
What are the characteristic facial features of FASD?
Small
! Head
! Eye openings
! Chin
Flatter face
Shorter, wider nose
Under-developed
! Outer ear
! Groove above lip
How can you detect FASD?
Electroencephalogram (EEG) test may be able to help detect sufferers of FASD
Cognitively, what are things we see with FASD?
Brains have to “work harder”
Less ability to understand the meaning of a stimulus !
Less attention paid to specific tasks
Poorer memories
Where do we see a lot of people with FASD?
Prison
What shunt pregnant women do to avoid parasitic illness?
Pregnant women should not change cat litter boxes
- Toxoplasmosis may be transmitted by fecal matter
- Mother and unborn baby can be infected
- -Multi-system effects
What are the viral infections during pregnancy?
Rubella Infection
HSV infection (herpes)
HIV
What happens if a woman is pregnant and has HIV?
Delivery by c-section
No breastfeeding
HIV positive mother receives anti-retroviral drugs throughout gestation
What are the types of procedures that can detect brith defects?
integrated prenatal screening (IPS)
first trimester screening (FTS)
maternal serum screening (MSS-quad)
obstetrical ultrasound at 18 weeks
Amniocentesis
Chorionic Villus Sampling
What is Amniocentesis?
13-18 weeks of pregnancy
Counselling accompanies procedure
-Options discussed
Gold Standard for confirming diagnoses of:
- Chromosomal anomalies
- Genetic disorders
- Gender
0.04-1.5% risk of miscarriage
What is CVS?
Chorionic Villus Sampling (CVS)
9-11 weeks of pregnancy
Transcervical or transabdominal routes
0.04-1.5% risk of miscarriage
When do we consider more advanced genetic screening?
• Will always include Genetic Counselling
• Either parent has a gene linked condition
-eg cystic fibrosis, thalassemia, sickle cell anemia
• Either parent has a genetic anomaly
• You are a pregnant after the age of 35
-vgreater risk of Trisomy
• You have delivered a child previously with a genetic “defect”
