Exam 1 Flashcards
Maternal mortality rate is
Mortality rate in US
Number of deaths related to pregnancy, delivery or postpartum / 100,000 births
19 per 100,000 live births
Factors affecting maternal mortality in US
Low SES, pre-existing conditions, hemorrhage, pregnancy related hypertensive disorders, infections
Ovarian cycle comes in 3 phases which are
Follicular phase (day 1 - 10 to 14)
Ovulation (day 14)
Luteal phase (day 15 - 28)
Follicular phase day 1-14 what happens & what hormones are involved
FSH - stimulates maturation of new follicle
As follicle increases, more estrogen is released
ESTROGEN - shuts down FSH so 1 egg is in play
ESTROGEN encourages production of LH which triggers ovulation
Ovulation phase day 14 what occurs & what hormones play a role
Surge of LH causes mature follicle to be rupture & release an ovum
Levels of estrogen drop & progesterone increases
Luteal phase (day 15-28) & hormones associated
Begins at ovulation & last until menstrual phase of next cycle
Follicle forms the corpus luteum & produces PROGESTERONE
Progesterone maintains thick uterine lining
Corpus luteum produces Estrogen that continues to thicken endometrium
FSH & LH are at lowest level
What happens if the egg is not fertilized
Corpus luteum will stop secreting hormones so the lining will begin to shed & begin menstruation
Since ESTROGEN levels drop, FSH increases & restarts the ovarian cycle
What happens if the egg is fertilized
Body will release hGh so corpus luteum is maintained & endometrium maintains thickness so egg can grow
What is menstruation
Which hormone is high & why
Lining of endometrium is being shed because egg wasn’t fertilized (day 1-5)
FSH is high to stimulate maturation of new follicle & begin ovarian cycle
Amniotic fluid is made up of
What are abnormalities & associated problems
98% water & 2% organic matter
Oligohydramnios (< 500ml, too little) : uteroplacental insufficiency & renal abnormalities
Hydramnios (> 2,000ml, too much) : maternal diabetes, neural tube defects, chromosomal deviations, CNS malformation, GI alterations
Role of amniotic fluid
Cushions the fetus from trauma
Maintains constant body temp for fetus
Promotes fetal movement
Down syndrome is an
Affects which chromosome
Characteristics of downs
Abnormality of chromosome number
Trisomy 21; extra material on chrom.
Small low set ears, wide set eyes, simian crease, open mouth with protruding tongue
Tay sachs disease is an
What does it affect & why
Autosomal recessive inheritance
Affects nervous system of the brain due to fatty substances accumulating
Antibodies that fetus has at end of pregnancy (immunoglobulins)
IgG - only one that crosses the placenta providing passive acquired immunity (most common antibody)
IgM - fetus will produce as first line of defense
IgA - produced in colostrum (breast milk) is given to baby through milk
Roles of the placenta
Placenta serves as an interface between mother and fetus (O2 & nutrients)
Baby gets oxygen from placenta
Makes hormones
Protects fetus from immune attack by mother
Removes waste products from fetus (CO2)
Presumptive signs of pregnancy
Amenorrhea, fatigue, breast tenderness, nausea & vomiting, urinary frequenc, quickening, breast enlargement
Probable signs of pregnancy
Braxton hicks contractions, abdominal uterine enlargement, positive pregnancy test, ballottement, hegars sugn, Chadwick’s sign, goodwills sign
Hegars sign
Chadwick’s sign
Goodells sign
Softening of lower uterine segment or isthmus
Bluish-purple coloration of vaginal mucosa and cervix
Softening of cervix
Positive signs of pregnancy
Ultrasound verification, fetal movement felt by clinician, auscultation of fetal heart tones via Doppler
Naegele’s rule for EDB
First day of LMP
Subtract 3 months
Add 7 days
Add a year
Pre-term
Term
Post-term
Pre : less than 37 weeks
Term : 37 - 42
Post : more than 42 weeks
GTPAL stands for
GP is
Gravida (total pregnancies)
Term births (> 37 weeks)
Preterm births (between 20 - 37 wks)
Abortions/miss (ends before 20wks)
Living children
Gravida (pregnancies)
Para (number of births)
How is fundal height measured
Expected location in pregnancy
From the symphysis pubis to top of uterus
20 weeks - level of umbilicus; 20cm
What is vena cava syndrome
In the supine position the uterus can compress the inferior vena cava which reduces venous return, cardiac output & blood pressure , with increasing orthostatic stress
GI system adaptations during pregnancy
Dental problems; gingivitis
Ptyalism (excessive salivation)
Decreased peristalsis & smooth muscle relaxation
Hemorrhoids
Reflux - heartburn
Nausea & vomiting
Cardiovascular system changes during pregnancy
Increased blood volume, cardiac output & heart rate
BP decreases in 2nd trimester
Increased RBCs & plasma volume
Hypercoagulable state
Increased WBC count
Musculoskeletal changes during pregnancy
Waddle gait
Lordosis
Softening & stretching of ligaments & joints
Psychological changes
A
I
A
M
C
Ambivalence: conflicting feelings
Introversion: mother increasingly preoccupied with herself & fetus
Acceptance: bring reality & validity to pregnancy
Mood swings
Changes in body image
1st trimester discomforts
Urinary frequency, fatigue, breast tenderness, constipation, epistaxis
Nausea & vomiting (eat small, frequent meals, bland, low fat)
Foods for morning sickness
Dry crackers, ginger, hard candy, gum
Counting fetal movements
Relaxed & comfortable
Same time each day
Be aware if decrease in movement
Count to 10 method - contact HCP if longer than 2 hours
When traveling mother should
Braxton hicks contraction
Amount of water per day
Walk around every 2 hours
Hydrate, rest in side lying, breathing techniques
2 liters / 8 glasses
Nutritional considerations during pregnancy
PICA
Lactose intolerance
Vegetarians
Pica - pregnant women wanting to eat weird things like soil, clay, pebbles, paint chips, chalk (driven by iron deficiency)
Lactose - substitute foods include dairy free products or calcium enriched, peanuts, almonds, seeds, salmon
Vegetarians - protein (soy, beans, nuts, grains). Iron (meat alternatives & vitamin C rich). Calcium (soy, tofu, calcium fortified OJ). Vitamin B12 (fortified soy foods & B12 supp)
Foods to avoid during pregnancy
Artificial sweeteners
Seafood high in mercury (shark, swordfish, king mackerel, tuna, tilefish)
Processed foods (hot dogs, deli meats)
Refrigerated smoked seafoods
Salads made in stores
Maternal weight gain related to BMI
Normal, underweight, overweight, obese
Normal BMI (18.5-24.9) = 25-35lbs
Underweight BMI (<18.5) = 28-40lbs
Overweight BMI (>25) = 15-25lbs
Obese BMI (30+) = 11-20lbs
Epidural block is
Interventions before
During
After
Most common form of pain relief
Before: assess vitals/ BP, administer IV bolus to hydrate & avoid hypotension, assess FHR
During: assist provider with placement of epidural & placement of patient in lateral or sitting position
After: Monitor BP & assess for side effects, monitor contractions, assess FHR
True vs false Labor
Contraction timing (false: irregular & not together) (True: come at regular times & get closer together)
Contraction activity (false: they stop when walking or resting) (true: they continue despite resting)
Contraction strength (false: usually weak) (true: get steadily stronger)
Contraction pain (false: felt only in front) (true: starts in back & moves to front)
Signs of labor
Cervical softening or dilation
Increased energy
Lightening: fetal begins to descend
Bloody show: mucous plug
Braxton hicks contractions
Spontaneous rupture of membranes
Pelvis shapes
Gynecoid : favorable for V delivery
Android: male shaped; unfavorable
Anthropoid: usually adequate
Platypelloid: not favorable
Effacement & dilation
Effacement is the shortening & thining of the cervix
Dilation is how open the cervix gets
Cervix must dilate to 10cm & 100% effacement for delivery
Main fetal presentations
Cephalic (vertex) - head down
Breech - pelvis down
Shoulder - scapula first
Malpresentation will lead to cesarean
Fetal station refers to
0 station is
What is engagement
The presenting part to the level of the ischeal spines
0 - level to the ischeal spines
Engagement is when presenting part is at 0
1st stage of labor is
Includes what 3 phases & dilation + effacement
The longest of all stages
Latent (dilation 0-3cm; efface 0-40%)
Active (dilation 4-7cm; efface 40-80%)
Transition (dilation 8-10cm; efface 80-100%)
Second stage of birth
Degrees of tear
Episiotomy is
Full dilation ; lasts about 30-50min
Birth of head, shoulders, body
1st degree tear - least severe
4th degree - goes down to anus
A surgical laceration to prevent rupture during labor
3rd stage of labor
Signs of placental separation
4th stage
Birth of infant to placental separation
Uterus rises upward, umbilical cord lengthens, trickle of blood from vagina, uterus changes shape to globular
Restorative stage 1-4hrs pp
Recovery, interactions & care of newborn
