Concept of Reproduction

Question 1

What is Negle’s Rule to determine the due date?

Answer 1

Determine the first date of the LMP

-Add 7 days and subtract 3 months

Question 2

How many days does the fertilized egg float around the uterus before it implants?

Answer 2

7-10 day

Question 3

What is the first 14 days following conception referred to as ?

Answer 3

pre-embryonic phase

Question 4

What is Cell differentation?

Answer 4

Some cell become the embryonic membrane (bag of water containing amniotic fluid, cushions and protects embryo, controls temperature)

• some will become the yolk sac and eventually the umbilical cord (yolk sac forms RBCs early on then becomes apart of the umbilical cord.)
• some will become the placenta. (provides metabolic and nutrient exchange between embryonic and maternal circulation)
• some will become the embryo itself

Question 5

What are the functions of the placenta?

Answer 5

• metabolic function (produces glycogen, cholesterol, and fatty acids for fetal use)
• transport function (O2, CO2, electrolytes, etc)
• endocrine function (produces hormones vital for fetal survival; HCG, estrogen, progesterone, relaxin, etc)
• immunologic function (progesterone and HCG prevents maternal antibodies against the embryo and placenta (preventing the pregnancy from being seen as a foreign body)

Question 6

What milestones are hallmark during the embryo stage of fetal development (3-8 weeks)

Answer 6

• highly vulnerable to teratogenesis
• 4 weeks fetal heart beat
• 6 weeks fetal circulation establishing

Question 7

What milestones are hallmark during the fetus stage of fetal development (8 weeks +) ?

Answer 7

• (8-12 weeks) can auscultate fetal heart rate with doppler. all organs are formed but require maturation
• (16 weeks) can determine gender by ultrasound
• (20 weeks) quickening, vernix and lanugo present
• (24 weeks) surfactant production begins, alveoli develops
• (28 weeks) nervous system begins regulating some functions
• (35-36 weeks) subcutaneous fat stores (plumping up)
• (38-40 weeks) term, minimal vernix and lanugo remain

Question 8

what are the presumptive signs of pregnancy ?

Answer 8

amenorrhea 
nausea/vomiting
excessive fatigue
urinary frequency
breast changes
quickening

Question 9

what are the objective (probable) signs of pregnancy?

Answer 9

pelvic organ changes
abdominal enlargement 
braxton hicks contractions
uterine souffle (uterine sound or movements)
skin pigment changes
fetal outline
positive pregnancy test

Question 10

what is considered actual confirmation of pregnancy?

Answer 10

fetal heartbeat
fetal movement palpated
visualization of fetus by ultrasound

Question 11

• Maternal O2 needs increase.
• Body alterations and weight increase necessitate an adjustment in posture. pelvic joints relax.
• Nausea and vomiting might occur as well as constipation
• Urinary frequency
• The placenta becomes an endocrine organ that produces a large amount of HCG, estrogen, prostaglandins, and progesterone
• Cardiac output increases 30% to 50% and blood volume increases 30% to 45% to term to meet greater metabolic needs

Answer 11

Physical changes associated with pregnancy

Question 12

number of pregnancies

Answer 12

Gravidity
Nulligravida: a woman who has never been pregnant
Primigravida: a woman in her first pregnancy
Multigravida: a woman who has had two or more pregnancies

Question 13

a number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy, not the number of fetuses. _____ is not effected whether the fetus is born still born or alive.

Answer 13

Parity
Nullipara: no pregnancy beyond the stage of viability
Primipara: has completed one pregnancy to stage of viability
Multipara: has completed two or more pregnancies to stage of viability

Question 14

what does TPAL stand for ?

Answer 14

T - term (born at 37 weeks +)
P - preterm (born between 20 and 36&6days)
A - Abortions/miscarriages (pregnancy ended prior to 20 weeks
L - living (living children)

Question 15

How often does one have a prenatal visit?

Answer 15

monthly until 28 weeks, every 2 weeks until 36 weeks, and then weekly

Question 16

how is a mother advised to check the fetal well-being of their baby?

Answer 16

“kick counts” - atleast 10 times in 3 hours

Question 17

Non invasive test for fetal well being. Fetus with adequate oxygenation and an intact nervous system will have accelerations in the heart beat with movement.

• a reactive result (at least 2 accelerations of 15 beats, lasting 15 seconds over a 20 minute period) fetus is mature enough to meet this requirement at 32 weeks.
• a nonreactive result (criteria described is not met)

Answer 17

Non-Stress Test

Question 18

What is the point of an ultrasound evaluation?

Answer 18

checking for :
fetal breathing movement
fetal movements of body or limbs
fetal tone (extension and flexion of extremities)
amniotic fluid volume (measure pockets of fluid)

Question 19

This test evaluates oxygenation and perfusion of fetus when exposed to the stress of contractions.

• contractions cause reduced blood flow to the placenta momentarily, resulting in decreased O2 flow to the fetus.
• a decrease in the fetal heart rate indicates a poor ability to tolerate the stress of labor.

Answer 19

Contractions Stress Test

• a negative result = no deccelerations with 3 contractions over 10 minutes
• a positive result = repetitive, persistent late deccelerations with contractions

Question 20

This test one must obtain amniotic fluid for genetic testing and/or determine fetal lung maturity (typically done around 16 weeks)
the procedure entails :
one to use a 22 g needle to withdraw 15-20 mL of fluid after applying a local anesthetic.

Answer 20

Amniocentesis

Question 21

What is important to monitor following an amniocentesis ?

Answer 21

assess maternal VS and fetal heart rate
monitor for bleeding following removal of needle
monitor of s/sx of labor, ROM, and infection

Question 22

substance lining fetal lungs that allows for lung elasticity. Produced in large quantities in the later weeks of pregnancy.

• Lecithin and sphingomyelin are components of ______.
• tests are done looking for those two components to ensure that the lungs are mature enough to safely deliver.
• The L/S ratio desired is at 2 or greater.

Answer 22

Surfactant

Question 23

another test that can be done for genetic testing at 10-12 week gestation. Can be performed trans-abdominally or trans-cervically.
-the risks associated with this test is similar to those of an amniocentesis.

Answer 23

Chorionic Villus Sampling (CVS)

Question 24

Pregnancy risk factors?

Answer 24

Diabetes Mellitus
Anemia
Substance Abuse
Psychological disorders 
HIV 
heart disease

Question 25

an abortion is only an option until ____ weeks of pregnancy.

Answer 25

prior to 20 weeks 
Three types:
medical abortion
spontaneous abortion aka miscarriage 
imminent, complete, incomplete, missed, recurrent, septic

Question 26

Why is it important for patients to report ALL miscarriages and abortions? (remember to ask privately, and be sensitive)

Answer 26

due to the risk of RH alloimmunization

Question 27

fertilized ovum implants in site other than endometrial lining of the uterus. (typically in ampulla of the fallopian tube)

• presents between 6-8 weeks but can be up to 12-16 weeks
• causes: tubal damage from PID, previous tubal surgery, tubal anomalies, endometriosis, presence of IUD, DES exposure

Answer 27

ectopic pregnancy

embryo outgrows the tube, tube ruptures, bleeding and pain (one-sided, sharp, syncope

Question 28

when to worry about RH or not ?

Answer 28

• Rh POSITIVE mom = no worry
• Rh negative mom = maybe
• Rh negative mom & Rh negative dad = no worry (body will not notice)
• Rh negative mom & Rh positive dad = WORRY (body may recognize as foreign and attack)