Exam 1

Question 1

What are the terms and timeframe from egg to fetus? What is conceptus? Age of viability?

Answer 1

Ovum: From ovulation to fertilization

Zygote: From fertilization to implantation

Embryo: From implantation to 5–8 weeks

Fetus: From 5–8 weeks until term

Conceptus: Developing embryo and placental structures throughout pregnancy

Age of viability: The earliest age at which fetuses survive if they are born is generally accepted as 24 weeks or at the point a fetus weighs more than 500–600 g.

Question 2

How long is an ovum viable? Sperm? What does that mean for a successful fertilization window?

Answer 2

ovum is capable of fertilization for only about 24 hours (48 hours at the most). After that time, it atrophies and becomes nonfunctional.

functional life of a spermatozoon is also about 5 days

total critical time span during which sexual intercourse must occur for fertilization to be successful is about 6 days (5 days before ovulation plus 24 hours afterward).

Question 3

From where is the ovum released? What is released with the ovum? Why? What helps propulsion in the fallopian tube?

Answer 3

the graafian follicle of an ovary with ovulation

it is surrounded by a ring of mucopolysaccharide fluid (the zona pellucida) and a circle of cells (the corona radiata).

which increase the bulk of the ovum and serve as protective buffers against injury

currents initiated by the fimbriae—the fine, hairlike structures that line the openings of the tubes. A combination of peristaltic action of the tube and movements of the tube cilia help propel the ovum along the length of the tube.

Question 4

What is an average amount of ejaculation and sperm within?

Answer 4

2.5 mL of fluid containing 20 to 200 million spermatozoa per milliliter or an average of 400 million sperm per ejaculation

Question 5

Fertilization requires what 3 factors?

Answer 5

Equal maturation of both sperm and ovum

Ability of the sperm to reach the ovum

Ability of the sperm to penetrate the zona pellucida and cell membrane and achieve fertilization

Question 6

What is occurring over the 3-4 days as the zygote travels down the fallopian tube?

Answer 6

mitotic cell division, or cleavage, begins.

The first cleavage occurs at about 24 hours. Cleavage divisions continue to occur at a rate of about one every 22 hours, so by the time the zygote reaches the body of the uterus, it consists of 16 to 50 cells.

Question 7

The zygote consists of 2 types of cells, inner and outer. What are they called and what do they eventually become?

Answer 7

The cells in the outer ring are trophoblast cells. They are the part of the structure that will later form the placenta and membranes.

The inner cell mass (embryoblast cells) is the portion of the structure that will form the embryo.

Question 8

When does implantation occur?

Answer 8

8-10 days after conception

Question 9

What is the purpose of the placenta and membranes?

Answer 9

serve as the fetal lungs, kidneys, and digestive tract in utero as well as help provide protection for the fetus Produce estrogen, progesterone and HcG

Question 10

What is couvade syndrome?

Answer 10

many partners experience symptoms such as nausea,
vomiting, and backache to the same degree or even more intensely than their
partners during a pregnancy; some begin to gain weight along with their partner

Question 11

What is the Hegar’s sign?

Answer 11

Hegar’s sign is the softening and compressibility of lower uterus

Question 12

Why does the period cease during pregnaancy? (Amennorhea)

Answer 12

suppression of FSH due to elevated estrogen

Question 13

What happens t the cervix during pregnancy? Why? What is Goodell’s sign?

Answer 13

– in response to the increased level of circulating estrogen
produced by the placenta during pregnancy, the cervix of the uterus becomes more vascular and edematous than usual.

Goodell’s sign is the softening of the cervical tip

Question 14

What does estrogen do to the vagina?

Answer 14

the vaginal epithelium and
underlying tissues increase in size as they become enriched with glycogen.

The resulting increase in circulation changes the color of the vaginal walls from their normal light pink to a deep violet,
which is known as Chadwick’s sign.

Question 15

What happens with ovulation and the pituitary gland during pregnancy?

Answer 15

ovulation stops with pregnancy because of the active
feedback mechanism of estrogen and progesterone produced early in
pregnancy by the corpus luteum and late in pregnancy by the placenta. This
feedback causes the pituitary gland to halt production of FSH and luteinizing
hormone; without stimulation from FSH and LH, ovulation does not occur.

Question 16

What happens to the thyroid during pregancy?

Answer 16

the thyroid gland enlarges to produce
increased levels of protein-bound iodine, butanol-extractable iodine, and
thyroxine to such an extent a woman’s basal body metabolic rate increases
by about 20 %.

Question 17

What is melasma?

Answer 17

Melasma – pigmentation increases on the face. When melasma appears in
pregnant women it’s referred to as “Chloasma” or the mask of pregnancy
Chloasma is triggered by hormonal changes that occur during pregnancy.

Question 18

What is the linea nigra? Striae gravidarum? What skin irritation can occur due to estrogen? What is diastasis recti?

Answer 18

Linea nigra – dark line of pigmentation from the umbilicus extending to the
pubic area.

Striae gravidarum – stretch marks most notable found on the abdomen and
thighs.

• NOTE: woman may also have itching and scratches on palms of hands due to
  increased estrogen
• Diastasis recti is the separation of the abdominal wall.

Question 19

What happens to blood volume during pregancy?

Answer 19

to provide for an adequate exchange of nutrients across the
placenta and for adequate blood to compensate for maternal blood loss at
birth, the woman’s circulatory blood volume increases by 30% - 50% during

Question 20

What happens to the heart during pregnancy? Doe blood pressure rise?

Answer 20

to handle the increase in blood volume in the circulatory system, heart rate increases by at least 10 beats/min, causing her cardiac output to increase as much as 25% to 50%. Some women develop audible functional heart murmurs during pregnancy, probably because of the
increased blood volume and pressure from the diaphragm shifts heart position.

generally no, the blood is managed by the faster beating heart

Question 21

What is subine hypotension syndrome (vena cava syndrome)

Answer 21

When a pregnant
woman lies supine, the weight of the growing uterus presses the vena cava
against the vertebrae, obstructing blood flow from the lower extremities.
This causes a decrease in blood return to the heart and, consequently,
decreased cardiac output and hypotension

Question 22

What are probable signs of pregnancy?

Answer 22

Probable – changes that make the examiner suspect a woman is pregnant
- Chadwick – the resulting increase in circulation changes the color of the
vaginal walls from their normal light pink to a deep violet.
- Hegar – softening of the lower uterine segment
- Goodell – softening of the cervix
- Ballottement - When lower uterine segment is tapped on a bimanual examination,
the fetus can be felt to rise against the abdominal wall
- Braxton Hicks – periodic uterine tightening occur

Question 23

What are the only 3 positive signs of pregancy?

Answer 23

include fetal heart sounds
visualization of fetus by ultrasound
fetal palpated by an experienced examiner.

Question 24

What is the recommended protein intake? Fat? Which ones in particular?

Answer 24

34-46 g

Omega-3 fatty acids, particularly linoleic acid, are fats that are essential
for new cell growth but that cannot be manufactured by the body. Pregnant women
should ingest 200 to 300 mg of omega-3 acids daily

Question 25

Recommended calories for pregancy is?

Answer 25

300 increase
2200 normal
so 2500 for preganancy

Question 26

What is pyrosis? How to combat it?

Answer 26

Pyrosis – heartburn – eat smaller more frequent meals, avoid fatty (deep fried
foods) avoid spicey or highly seasoned foods. Do not lie down for 2 hours after
eating a mea

Question 27

What are the 3 stages of development in preganncy?

Answer 27

a. Pre-embryonic/Zygotic (first 2 weeks, beginning with fertilization).
b. Embryonic (weeks 3 to 8). Exposure to certain substances in the embryonic phase
may be harmful to the developing fetus.
c. Fetal (from week 8 through birth).

Question 28

Where does fertilization usually occur? What occurs immediately in the ovum at the time of fertilization?

Answer 28

in the outer third of a fallopian tube,
termed the ampullar portion.

Immediately after penetration of the ovum, the chromosomal material of the ovum and spermatozoon fuse to form a zygote. The fertilized ovum has 46 chromosomes.

Question 29

What occurs with the placenta, uterine (endometrial) lining during the fetal development stage? What is the lining now termed?

Answer 29

Embryonic and fetal structures – the placenta and membranes, which will serve as the fetal lungs, kidneys, and digestive tract in utero as well as help provide protection for
the fetus, begin growth in early pregnancy in coordination with embryo growth.

a. The decidua or uterine lining – after the fertilization, the corpus luteum in the ovary
continues to function rather than atrophying under the influence of hCG secreted by
the trophoblast cells. hCG causes the uterine endometrium to continue to grow in
thickness and vascularity instead of sloughing off as in the usual menstrual cycle.

decidua

Question 30

What is the endocrine function of the placenta? What does hCG do? Progesterone? Human placental lactogen?

Answer 30

act as a fail-safe measure to ensure the corpus luteum of the ovary continues to produce progesterone and estrogen so the endometrium of the uterus is maintained.

• Progesterone – estrogen is often referred to as the hormone of women and progesterone as the hormone of mothers. Although estrogen influences a female appearance, progesterone is necessary to maintain the endometrial
  lining of the uterus during pregnancy.
• Estrogen – estrogen (primarily estriol) is produced as a second product of the syncytial cells of the placenta. Estrogen contributes to the woman’s mammary gland development in preparation for lactation and stimulates uterine growth to
  accommodate the developing fetus.
• Human Placental Lactogen – is a hormone with both growth-promoting and
  lactogenic properties. It promotes mammary gland growth in preparation for
  lactation in the mother. It also serves the important role of regulating maternal
  glucose, protein, and fat levels so adequate amounts of these nutrients are
  always available to the fetus.

Question 31

What creates the amniotic membrane? What is the chorionic membrane? anion? What is it’s function? Do they have a nerve supply?

Answer 31

e. The amniotic membranes – the chorionic villi on the medial surface of the
trophoblast gradually thin until they become:
* Chorionic membrane – the outermost fetal membrane.
* Amniotic membrane or amnion – forms beneath the chorion. This not only
offers support to amniotic fluid but also actually produces the fluid.

no

Question 32

What is normal amniotic fluid levels? What is hydraminos? Oligohyframnios?

Answer 32

ormal fluid is 800 to 1200 ml.

excessive amniotic fluid or hydramnios (more than 2000 ml) will result.

oligohydramnios (less than 300 ml).

Question 33

What is the function of the umbilical cord?

Answer 33

The umbilical cord – formed from the fetal membranes (amnion and chorion) and
provides a circulatory pathway that connects the embryo to the chorionic villi of the
placenta. Its function is to transport oxygen and nutrients to the fetus from the
placenta and to return waste products from the fetus to the placenta. An umbilical
cord contains only one vein (carrying blood from the placental villi to the fetus) and
two arteries (carrying blood from the fetus back to the placental villi). It is
surrounded by connective tissue, which prevents compression of the blood vessels.

Question 34

What is the oramen ovale? Ductus ateriosis?

Answer 34

the bulk of this blood is shunted as it enters the
right atrium into the left atrium through an opening in the atrial septum, called the
foramen ovale. A small amount of blood that returns to the heart via the vena cava

The larger portion of even this blood is shunted
away from the lungs through an additional structure, the ductus arteriosus, directly
into the descending aorta.

Question 35

What does not cross the placenta from mother to fetus?

Answer 35

insuling

Question 36

What give passive immunity at 20 weeks?

Answer 36

immunoglobulin (Ig) G maternal antibodies cross the placenta into
the fetus as early as the 20th week and certainly by the 24th week of intrauterine life
to give a fetus temporary passive immunity against diseases for which the mother
has antibodies.

Question 37

How do you calculate due date?

Answer 37

3. Naegele’s rule: Take the first day of the client’s last menstrual cycle, subtract 3 months,
   and then add 7 days and 1 year, adjusting for the year as necessary.

Question 38

What is AFP? What does it determine if found high or low? When is it measured

Answer 38

Maternal serum (a-Fetoprotein) AFP is a substance produced by the fetal liver
that can be found in both amniotic fluid and maternal serum. If abnormally high,
can mean open spinal or abdominal wall defect. If the level is low, then
chromosomal defect such as Down’s syndrome. Traditionally assessed at 15 to
18 weeks.

Question 39

What is quadruple screening?

Answer 39

• Quadruple screening – quadruple screenings analyzes four indicators of fetal
  health; AFP, unconjugated estriol, hCG and inhibin A (a protein produced by the
  placenta and corpus luteum associated with Down’s syndrome.

Question 40

What/when is viability?

Answer 40

Viability = The point in time when an infant has the capacity to survive outside of the uterus. There
is not a specific weeks of gestation, however, infants born between 22 to 25 weeks are
considered on the threshold of viability. However, when determining a woman’s para
status the age of viability is considered 20 weeks.

Question 41

What is para? Primipare? Multipara? Grand mulitpara? gravida? primagravida? multigravida? nulligravida?

Answer 41

Para = The number of pregnancies that have reached viability (20 weeks gestation) regardless
of whether or not the infants were born alive
Primipara = A woman who has given birth to one child past the age of viability
Multipara = A woman who has carried two or more pregnancies to viability
Grand multipara = A woman who has carried five or more pregnancies to viability
Gravida = A woman who is or has been pregnant
Primigravida = A woman who is pregnant for the first time
Multigravida = A woman who has been pregnant previously
Nulligravida = A woman who has never been pregnant

Question 42

What is assessed with G T P A L?

Answer 42

G: Gravida = pregnancies
T: Term = the number of full-term infants born at 37 weeks or after
P: Preterm = the number of preterm infants born after 20 weeks and before 37 weeks
A: Abortions = the number of spontaneous miscarriages or therapeutic abortions
L: Living = the number of living children

Question 43

What are the 4 pelvis shapes? How does the shape affect birth?

Answer 43

Gynecoid – or “female” pelvis has an inlet that is well rounded forward and
backward and has a wide pubic arch. This pelvic type is ideal for childbirth.
* Android – or “male” pelvis, the pubic arch forms an acute angle, making the
lower dimensions of the pelvis extremely narrow. A fetus may have difficulty
exiting from this type of pelvis.
* Anthropoid – or “ape-like” pelvis, the transverse diameter is narrow; the
anteroposterior diameter of the inlet is larger than usual. Even though the inlet
is large, the shape of the pelvis does not accommodate a fetal head as well as a
gynecoid pelvis.
* Platypelloid – or “flattened” pelvis has a smoothly curved oval inlet, but the
anteroposterior diameter is shallow. A fetal head might not be able to rotate to
match the curves of the pelvic cavity.