Class 1 & class 2 Flashcards
Induction
When HCP starts labour with oxytociin
Antenatal
Conception till birth
think A- ALL
Postpartum
6-8 weeks following the birth of a baby when the body starts to return to normal
Augmentation
stimulating the uterus after contractions have started
Intrapartum
Anything during labour and delivary
What is Gravidity ?
Pregnancy
What is Parity?
number of pregnancies reaching 20+ weeks (live or stillborn)
(not number of fetuses)
What is Gravita?
pregnant person
What is Nulligravita?
not preggers
never been preggers
What is Nullipara?
A person who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation
What is Primigravita
A person who is pregnant for the first time
What is Primipara?
A person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation
What is multigravida?
A person who has had two or more pregnancies
What is multipara?
A person who has completed two or more pregnancies to 20 weeks of gestation or more
What is viability?
Capacity to live outside the uterus; there are no clear limits of gestational age or weight.
22 to 25 weeks of gestation are considered to be on the threshold of viability.
What is Preterm pregnancy?
A pregnancy between 20 weeks and 36 weeks 6 days of gestation
What is late preterm pregnancy?
A pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days of gestation
What is term pregnancy?
A pregnancy from the beginning of week 37 of gestation to the end of week 40 plus 6 days of gestation
What is Post term?
A pregnancy after 42 weeks
what is hCG?
human chorionic gonadotropin
- best to check in A.M.
What is a normal non-preggers hCG level?
<5 IU/L
What period is the safe zone from teratogens ?
First two weeks
- period of dividing zygote, implantation
What period is high sensitive for teratogens?
Main embryonic period
weeks 3+
Why is the main embryonic period most sensitive to teratogens?
major organs are developing
What weeks are part of the embryonic period?
weeks 3-8
What weeks are part of the fetal period?
weeks 9-birth
why is amniotic fluid important?
- temp regulation
- protection (shock absorber)
- movement - fetus learns to move around
What are the 3 stages of fetal development and their corresponding weeks?
- Pre-embryonic - fertilization to end of week 2
- Embryonic stage - weeks 3- end of 8
- Fetal stage - week 9 until birth
how many weeks does the heart start beating?
end of week 3 - primitive heart beat
how many weeks does the yok sac fold into the digestive tract?
4th week
what week does the connecting stalk compress and turn into the umbilical cord?
week 5
What is the age of viability?
22-25 weeks
what are two non-genetic factors for congenital disorder development?
teratogens
maternal nutrition
In what fetal development period do malformations typically occur?
Embryonic stage
When does refinement of the structure and organ system occur in a fetus?
fetal stage
what are the two parts of the sack?
Amnion (inside)
Chorion (outer)
What is the purpose of the chorion?
helps with gas exchange
Outter layer - blends with placenta
What is the purpose of the Amnion?
-helps with fetus development
- contains genetic info from fetus
- can be sampled to determine lung maturity
- Temp regulation
- protection (shock absorber)
- fetus learns to move here
What is the umbilical cord made up of?
2 arteries
1 vein
wharton’s Jelly (helps hold the shape)
Is there a mixing of the blood between the pregnant person and the fetus?
No mixing.
diffusion or could need a pump
What secretes the hormones in pregnancy?
corpus luteum
What is the endocrine function of the placenta?
HCG
Estrogen
Progesterone
What is a normal amount of amniotic fluid at term?
700-1000 ml
how many weeks is the placenta complete and functional?
about 12 weeks
What is the function of the placenta?
- respiration
- nutrition (glucose & micronutrients)
- excretion and storage for the fetus (mostly diffusion)
- endocrine function
What are the placenta hormones?
- progesterone
- placental lactogen
- estrogen
- relaxin
- B-hCG
- IGFs (infant growth factors)
Does the umbilical vein bring oxygen and nutrients to the fetus or away from the fetus to the placenta?
to the fetus
(think of our veins bringing back TO our heart)
Which brings waste products to the placenta to be removed?
(CO2, metabolic waste).
The umbilical vein or umbilical arteries?
Umbilical arteries
think AWAY from the fetus
What med boosts lungs of fetus?
Betamethadone
What is the age of viability?
22-25 weeks
What are Teratogens?
-Drugs and chemical;
- alcohol, oral isotretinoin
- Infections: rubella, varicella
-Radiation: x-rays, CT scans
-Maternal health conditions: e.g. diabetes - hyperglycemia b/c of high sugar levels
What are the 7 hormones in pregnancy?
- hCG
- Estrogen
- Progesterone
- Relaxin
- hPL
- Oxytocin
- Prolactin
What are signs of pregnancy?
Presumptive - subjective
- missed period, breast tenderness, n/V, urinary frequency
Probable - objective
- Objective sings that can be assessed by the provider
-Physical assessment findings
-Positive pregnancy test, uterine enlargement, Hegar’s sign, Goodell’s sign, Chadwick’s sign
Positive (DEF preggers)
-Signs of pregnancy that can only be positive if there is a fetus present
-FHR auscultation, fetal movement palpated by provider, U/S of fetus
What is probable pregnancy?
objective
- Objective sings that can be assessed by the provider
-Physical assessment findings
-Positive pregnancy test, uterine enlargement, Hegar’s sign, Goodell’s sign, Chadwick’s sign
What are presumptive signs of pregnancy?
subjective
- missed period, breast tenderness, n/V, urinary frequency
What are the 3 POSITIVE signs of pregnancy?
Positive (DEF preggers)
-FHR auscultation (heart beat)
- fetal movement palpated by provider
- U/S of fetus
What position is best for pregnant person when laying?
left lateral
What can cause BP to tank?
if the person is laying on their back b/c inferior vena cava gets squished and blood flow is interrupted
What is polyhydramnios?
too much amniotic fluid
what is oligohydramnios?
not enough amniotic fluid
Which is more common, polyhydramnios or oligohydraminos?
oligohydraminos
Why is polyhydramnious a bad thing?
- over stretch the uterus - can’t retract well
- hemorrhage
- detach early placental abruption
- fetal malposition (tangled)
- early preterm labour
- breech
- cord prolapse
why is cord prolapse bad?
because the baby’s head squishes it and loses it’s oxygen supply
nurse holds head up in uterus and they get wheeled down to OR for a C-section
what are preggers peeps more at risk for and why-?
UTI and infection
d/t muscle relaxation & decreased immunity
UTI can cause labour
What are 3 hematological changes ?
1.increase in plasma volume (40-50%)
2. increase in RBC
(20-30%)
3. increase in hypercoagulability
What is a risk of hypercoagulability?
stasis of blood
DVT & PE
Virchows triad for thrombus formation
What level is true anemia for a preggers person?
HBG < or = 110g/L
HCT < or = 0.32
What is a normal physiolgic anemia in pregmancy?
110-120 g/L
how much folic acid should someone take who is at low risk?
0.4 mg daily
-2-3 months prior to conception, throughout pregnancy and 4-5 weeks PP
- or continue through breast feeding
How much folic acid should someone take who is at moderate risk?
1 mg
- 3 months prior to conception
- continue x12 weeks gestation then decrease to 0.4 mg through pregnancy and 4-6 weeks PP
- or continue through breast feeding
How much folic acid should someone take who is high risk?
4-5 mg daily
-x3 months preconception
- decrease at 12 weeks
- continue through pregancy and breast feeding and at least 4-6 weeks PP
What specific risk factors make someone at low risk for folic acid deficiency?
any pregnant person with no history of neural tube defect, no diabetes, no epilepsy, no obesity, no relatives with neural tube issues
What specific risk factors are present when someone is at a moderate risk of folic acid deficiency?
- diabetes
- epilepsy
- obesity- 2nd degree relative with Neural tube defects (extended fam)
What specific risk factors are present when someone is high risk for folic acid deficiency?
Neural tube defects - self, partner, first degree relative (immediate fam) with neural tube defect
What are 3 things that adolescence face?
1.Less likely to attend prenatal care
2.More likely to smoke tobacco
3.Less likely to have adequate weight gain
what med is given to help boost baby lungs if needed?
Betamethadone
What is GTPAL?
Gravidity (G): total number of pregnancies of any gestation (twins / multiples = 1) (includes non-viable). This includes their current pregnancy.
Term (T): # of births (≥ 37wks) (twins/triplets = 2/3)
Preterm (P): # of births (20 wks - 36 wks+6days) (twins/triplets = 2/3)
Abortions (A): # of abortions < 20 wks (induced or spontaneous)
Living children (L): # living children
how many weeks do we assess FHR (fetal heart rate?)
10-12 weeks
What does GP mean?
GP - Gravidity, Parity
Parity means the number of pregnancies that reach 20 weeks gestation and beyond regardless of outcome reached (not the number of fetuses)
When do we begin to assess SFH (fundal height)
20 weeks
When should we see fetal movement?
by 24 weeks
6 movements per 2 min
When do we start leopold’s maneuvers?
30-32 weeks
what is a normal FHR?
between 110-160 bpm and varies more than the adult heart rate
When measuring fundal height (SFH) what is important?
-empty bladder!
-supine - to the left
- top of pubic bone to top of the fundus
* stop around 36 weeks cuz baby drops
What is Leopold’s maneuver?
feeling the baby’s position (30-32 weeks)
1st palpate fetal part at the fundus (or the farthest away from the pelvic inlet)
2nd determine the location of the fetal back
3rd palpate to determine the presenting part
4th palpate for the attitude of the presenting part
When is leopold’s maneuver very helpful?
when looking for fetal heartrate.
feel for the back, that’s where you hear the HR the best
What are reasons for decrease fetal movements?
Hunger/Thirst
Sleep cycle of fetus
Amniotic fluid decreased
Death of fetus
What is Biophysical profile (BPP) ?
Assesses fetal breathing movements,
fetal movements,
fetal tone,
AFV (amniotic fluid volume)
What is Amniotic fluid volume (AFV)?
-Abnormalities in AFV are frequently associated with fetal disorders.
-Oligohydramnios & polyhydramnios
What is Doppler blood flow analysis ?
Systolic/diastolic flow ratios and resistance indices to estimate blood flow in various arteries
Which is at risk - RH negative or RH positive?
RH negative
if fetus is RH positive and the blood happens to mix, the body will try to destroy the fetus as a foreign invader
typically seen with the second pregnancy because the body builds up antibodies against RH pos
what is WinRho (made in Wpg) and why is it used?
To protect the fetus and binds to the antigens so the body won’t attack the baby if the baby is RH +.
When should preggers peeps seek help?
vaginal bleeding
leaking/abdominal cramping
fever
dysuria
headaches
What 4 main things do we assess in the pregnant person?
Assessments:
1.Vital Signs
2.Bloodwork/Labs
3.Labor Progress: Cervical change,
4. Contractions
What do we ask when doing preconception history ?
- PMHX/PSHX & chronic med. conditions
- current Meds/OTC/Supps
- GTPAL
- Gyne history
- Genetic/family history
- Mental health history
- Social history
- job- exposure to toxins/high risk jobs
- nutrition
- alcohol/drug use/smoking
- physical activity
- stress
-abuse
- IPV (intimate partner violence) - Infectious conditions
- immunizations, infections, STBBIs
- cat feces exposure
- raw or undercooked meats
What 5 things do we assess/diagnostic tests during preconception?
- Height, Weight, BMI (baseline)
- BP
- STBBI
- Pap Q 3 years after sexual contact
- other labs as required
What STI/STBBI are we testing for?
- gonorrhea
- Chlamydia
- HIV
- Hep B &C
- Syphilis
What 8 things do we discuss with patients to help with risk modification during the preconception period?
- Nutrition (diet rich in folate)
- Physical activity
- Healthy body weight (BMI > 30 kg/m2 is considered obesity)
- Safer sex practices
- Update vaccines, discuss travel
- Discuss: Alcohol use/Smoking/Drugs*/Intimate partner violence
- Oral health
- Occupation
What 2 things do we check in a fetus?
- heart rate
- movement
What 3 things do we assess in Newborns?
- H2T – use newborn assessment tool
- Vital Signs – different for newborns than adults
- Bloodwork/Labs – all the required tests
what is 40 weeks counted from?
from the start (1st day) of the most recent (last) menstrual period
What weeks are the first trimester?
weeks 1-13
What weeks are the second trimester?
weeks 14-26
What weeks are the third trimester?
weeks 27 to term
What does oxytocin do?
labour and post-partum
can augment & induce as needed
released when breast feeding
what does Estrogen do?
vascularization
sustains pregnancy & uterus
What does Progesterone do?
smooth muscle relaxation
sustains preganacy and helps sustain uterus
what does relaxin do?
prevents contractions
What does hPL do? (human placental lactogen)
breast development
glucose production to be passed onto fetus
what are some of the social determinants of health that affect prenatal care?
1.Income and 2.Socioeconomic Status
Culture
3.Education and Literacy
4.Access to Health Services
what is one of the major health problems worldwide in infants?
LBW
low birth weight
How often does someone have prenatal visits who is <30 weeks?
Q4 weeks until 30 weeks
How often does someone have prenatal visits who is 30-36 weeks?
Q2 weeks
How often does someone have prenatal visits who is 36 weeks to delivary?
Q1 week
Which two groups of people are at increased risk for adverse outcomes in pregnancy?
Adolescent - age 15 or less (fast labour)
Advanced maternal age >35 yrs
What are concerns with adolescent pregnancy?
1.Less likely to attend prenatal care
2.More likely to smoke tobacco
3.Less likely to have adequate weight gain
what lab tests are done during the initial prenatal visit?
Confirm probably pregnancy with urine hCG
Serology for CBC, STI screening - HIV, VDRL (syphilis), Hep B
Cervical swab or urine sample for gonorrhea and chlamydia
Blood type, Rh and antibody screen
Titers for rubella and varicella
Urinalysis and urine culture
Pap (if due - routine screening q3 years)
what are common pregnancy symptoms in the first trimester?
Breast changes/tenderness
Amenorrhea
Nausea/vomiting
Urinary frequency
Fatigue
Nasal stuffiness
Bleeding gums
Leukorrhea
Mood changes
what are common pregnancy symptoms in the 2nd trimester?
Quickening
Skin changes
Pruritus
Palpitations
Supine hypotension
Orthostatic hypotension
Heartburn
Constipation
Flatulence
Varicose veins (hemorrhoids)
Headaches
Carpal tunnel syndrome
Round ligament pain
Joint pain
what are the symptoms of pregnancy in 3rd trimester?
Dyspnea
Insomnia
Mood changes
Urinary frequency & urgency
Perineal pressure
Leg cramps
Edema to lower extremities
What are potential complications in 1st trimester?
Severe vomiting / weight loss / inability to keep fluids down
Fever
Dysuria
Diarrhea
Abdominal cramping
Vaginal bleeding
what are the potential complications during 2nd and 3rd trimesters?
Persistent vomiting
Leaking of fluid or blood from vagina
Abdominal pain
Fever
Dysuria
Diarrhea
Severe backache or flank pain
Change or decrease in fetal movements
Uterine contractions (before week 37)
Visual disturbances
Headaches
Muscular irritability or convulsions
Epigastric or abdominal pain
what length of contractions are concerning in preterm labour?
continuing for an hour
When does someone call a provider regarding pre-term labour?
- contractions lasting an hour+
- regular - q10 min or less
- pelvic pressure not resolving
- vaginal bleeding or leaking
- feeling something is not right
How many weeks is FHR done?
10-12 weeks
How many weeks is SFH started?
begin 20 weeks
When are fetal movements felt regularily?
by 24 weeks
6 movements per 2 min
when do we start Leopold’s maneuvers?
30-32 weeks
What is a normal FHR?
110-160 bmp
where do we measure the SFH (fundal height)?
top of pubic bone to top of fundus
when do we stop measuring SFH?
usually around 36 weeks when baby drops (lightening)
What are 2 concerns if someone is measuring too large for dates?
too much fluid
gestational diabetes
What are 2 concerns if measuring small for dates?
not growing
not enough fluid
what are the 4 steps of Leopold’s maneuvers?
1st palpate fetal part at the fundus (or the farthest away from the pelvic inlet)
2nd determine the location of the fetal back
3rd palpate to determine the presenting part
4th palpate for the attitude of the presenting part
what labs are done starting 4 weeks onward?
hcG - urine or serum
what labs are done 10-12 weeks?
CBC
Blood type, Rh, antibody screen
MSU C&S, urinalysis
Cervical Swab Gc & CT
Serology: HIV, HEP B, Syphilis
Titres for rubella, varicella
what are 4 possible reasons for decreased fetal movements?
Hunger/Thirst
Sleep cycle of fetus
Amniotic fluid decreased
Death of fetus
what test is done at 10-14 weeks?
U/S for Nuchal translucency
What test can be done at 15-20 +6 days ?
Maternal Serum Screening (AFP, hCG, estriol, Inhibin A)-
optional and $200 . if there are markers then you need an amniotic synthesis and cells from the placenta
what 4 tests are done at 28 weeks?
1.OGTT 50gm
2. repeat CBC
3. Repeat HIV, syphilis screening (maybe full STI panel)
4. repeat Th & antibody screen (if Rh NEG)
what test is done at 35-37 weeks?
GBS vaginal/perianal swab
- group B streptococcus b/c dangerous for baby
What is a normal level of 50g glucose challenge test ?
<7.8 mmol/L
What level indicates gestational diabetes?
7.8-11.0 mmol
What is the nursing role when someone is going for an ultrasound?
educate the person on rationale and purpose for the test
position them with a towel or wedge under rt hip to avoid supine hypotension
What are the 3 things looked at during U/S for fetal well-being?
- Biophysical profile (BPP)
- Amniotic fluid volume (AFV)
- doppler blood flow analysis
what is the purpose of additional testing for fetal wellbeing after initial U/S?
determine if the intrauterine enviornment is supportive to the fetus
what does an additional fetal test monitor?
fetal movement counting
NST
CST
BPP
AFV
doppler flow analysis
If someone is Rh NEG what is provided to them?
WINRHO Rh IgG 300mcg routinely at 28 wk & 72 hours of the birth of Rh Pos infant
Do we do interventions for Rh neg or Rh pos moms?
Rh neg
What is Chorionic Villus sampling and when it is done?
10-13 weeks
it’s an ultrasound guided biopsy of the chorion
what is the purpose of the Chorionic villus test?
diagnose genetic disorders or chromosomal abnormalities in the 1st trimester
What is an amniocentesis and when is it done?
15 weeks
ultrasound guided transabdominal extraction of amniotic fluid
What is the amniocentesis used for?
- diagnose genetic diorders or chromosomal abnormalities in 2nd trimester
- determine fetal lung maturity
- diagnose fetal hemolytic anemia
when/who do we screen people for Syphilis?
All pregnant people! & all subsequent pregnancies
- at initial prenatal visit
- at 28 weeks
- at delivery
What antibiotic do neonates receive prophylactically to prevent syphilis?
azithromycin as an eye gel
how can HIV be passed on to the fetus/new born?
breast/chest milk
in utero to fetus (placenta blood supply)
What problems can syphilis cause in a newborn?
stillbirth,
premature birth
other anomalies in newborn (issues with placenta structure, hepatomegaly, rhinitis, rash, generalized lymphadenopathy, bone abnormalities)
What vitamins should a pregnant person take?
folic acid
prenatal vitamins
When should a pregnant person seek medical help?
- bleeding
- vaginal discharge/leaking
- abdominal cramping
- fever - infection
- dysuria - dehydration
- Headaches or visual - disturbances- hypertension
- persistent vomiting - dehydration
- decreased fetal movement
What vaccines are safe during pregnancy?
Covid 19
Flu
Tdap (27-36 weeks)
