Class 1 Study Guide Flashcards
How do you figure out an EDD?
Nigels Rule: LMP- 3 months+ 7 days = EDD
exp: 1/8/15 - 3 months + 7 days = 10/15/15
Chadwicks Sign
estrogen causes hyperemia resulting in bluish purple discoloration of the cervix.
one of the earliest signs of early pregnancy
Goodels Sign
Cervix Softens
Mucus plug forms to block bacteria from entering uterus from vagina.
earliest sign of labor is when bloody show, or dislodgement of mucus plug happens
Effects of Progesterone
relaxes smooth muscle and raises sensitivity in respiratory center to CO2
Progesterone and Prostaglandins decrease airway resistance by relaxing smooth muscles
prevents spontaneous abortion, relaxing smooth muscle, prevent tissue rejection of fetus, stimulates lobules in breast for lactation
Effects of Estrogen
Increases vacularity of mucus membranes in upper airway
This may cause nosebleeds, congestion, and deepening in voice
May also cause edema of eardrums which may cause earaches
Stimulates uterine growth with increased blood supply, aids in developing ductal system in breast to prep for lactation, and associated with hyperpigmentation.
Effects of Relaxin
Inhibits uterine activity, softens connective tissues and length pubic ligaments
Human Placental Lactogen
Human Chorionic Somatomammotropin
increases availability of glucose for fetus by reducing sensitivity to insulin which leaves glucose freely available to be used by fetus.
Also promotes use of free fatty acids to provide energy to pregnant woman.
Melisma / Cholasma
Mask of pregnancy
Brown patches on face as early as 8 weeks gestation.
Caused by elevation of estrogen, progesterone, and melanocyte stimulating hormone.
Darker women have more hyper-pigmentation.
Why is weight gain important during pregnancy
After the first trimester, weight gain is important indicater of fetal growth. Insufficient weight gain has been linked to SGA, preterm labor, and failure to initiate breast feeding.
Too much weight gain has been linked to LGA, C/S, postpartum weight retention, low APGAR, and hypoglycemia.
What is the appropriate weight gain for: Normal BMI (18.5-25) Low BMI ( <25)
- 25-35lb, 1lb weekly during 2nd and 3rd trimester
- 30-40 lb””
- 15-25 lb””
How do you calculate BMI
weight (lbs) / (height {inches squared}) X 703
What is the general weight pattern during pregnancy
First trimester: 1-41/2 lbs
The rest of the pregnancy is average of 1lb weekly.
5 likely causes of decreased systemic vascular resistance (SVR)
1) vasodialation caused by progesterone and prostaglandins
2) addition of uteroplacental unit, which provides lower resistance and greater circulation
3) fetal, maternal, and placental heat production, which causes vasodialation
4) decreased vascular resistance to vascular sensitivity to angiotension II
5) endothelia: prostacyclin and endothelial derived relaxant factors such as nitric oxide
Presumptive signs of pregnancy
Amenorrhea N/V Fatigue/drowsiness increase in urination breast changes chadwicks sign fetal movement (could be gas)
*subjective, do not confirm diagnosis
Probable signs of pregnancy
abdominal enlargement goodells sign hegars sign (lower uterus can be compress to paper thin 6-8 weeks post LMP.) Ballottement (tap on cervix causes fetus to float up in uterus and back down to cervix) braxton hicks contractions uterine souffle (hearing blowing sound over uterus that corresponds to maternal pulse)
- objective, do not confirm diagnosis
Positive signs of pregnancy
funic souffle: sharp whistling sound heard over umbilical cord that corresponds to FHR
fetal movements felt by practitioner
ultrasound visualization
*objective, can diagnosis pregnancy
Alpha-Fetoprotein
can be measured in maternal serum and in amniotic fluid. Abnormal concentrations are associated with fetal abnormalities requiring additional testing. AFP increases with advancing gestational age
Should be offered between 16-18 weeks. Not to be used as diagnostic. Screening only
Advantages of AFP
Disadvantages of AFP
simple, requires only maternal blood least invasive screening test
screening test, not diagnostic. inaccurate EDD can cause benign abnormal levels which increases maternal anxiety.
Closed defects don’t produce increase AFP.
Normal levels doesn’t guarantee anything
Amniocentesis
Aspiration of amniotic fluid from amniotic sac
Amniocentesis indications
maternal age >35
chromosomal abnormality in family history
pregnancy after multiple spontaneous abortions
elevated AFP
Maternal Rh- and fetal Rh+
Amniocentesis purpose during 2nd trimester
purpose during 3rd trimester
2) identify chromosomal or biochemical abnormalities
evals fetal condition when woman is sensitized to Rh+
3) determine fetal lung maturity and evaluate hemolytic disease caused by Rh incompatibility
Amniocentesis risk factors
advantages
- relatively safe when guided by ultrasound. Risk of spontaneous abortion is less than 0.5 %, but highest during 2nd trimester
- simple, safe, almost painless done for years with few complications
- conflict maternal feelings about continuing pregnancy with negative results. Early amniocentesis poses higher risk of fetal loss and only small amounts of fluid can be withdrawn.
Nonstress Test (NST)
identify FHRP with fetal movement. Accelerations indicate adequate oxygenation.
Low risk, noninvasive, false positives can occur
NonStress Test interpretation
reactive (reassuring): at least 2 increases in FHR with movement within 20 mins peaking at least 15 bpm above baseline.
nonreactive (nonreassuring): no increases within 40 mins
Contraction stress test(CST)
same as nonstress test but with stimulated contractions to monitor FHRP with contractions. If negative, uterus can maintain life for at least another week.
negative (reassuring)
positive (nonreassuring)
Biophysical Profile (BPP)
asses NST, fetal breathing movements, gross fetal movements, fetal tone, amniotic fluid volume to predict fetal condition.
Fetal kick count
mother counts amount of fetal kicks
- count to 10: 10 fetal movements withing 12 hours
- count to 3: 3 fetal movements within 1 hour, 3 times a day
