EXAM 1 Flashcards
DEFINE BALLOTTMENT
When provider pushes in mom’s cervix the cervix rebounds as if there is a fetal head on other side
PROBABLE SIGN
What is Goodells sign
Softening of cervix indc pregnancy
What is Chadwick’s sign
bluish color of the vulva, vagina, and cervix
What is Hegar’s sign
the lower part of the uterus is soft (can squeeze the uterus through insertion of fingers through vaginal pushed against hand up top
PROBABLE SIGN
what are the positive signs of fetal presence
doc/nurse sees’feels visible movment
on ultrasound
fetal hr
baby is delivered
Describe the function of hormones’ w/ in the 1st trimester (0-13 weeks)
the corpus luteus (follicle that just released an egg, will die if their egg isn’t fertilized) in the ovaries secretes estrogen and progesterone to support the fetus and creation of placenta. Also decreased GnRH to stop cycle
estrogen’s steadily rises until week 38.5: suppresses FSH and LH, grows the fetus’s organs, increase’s maternal tissue growth (mammary glands and uterus)
Describe the function of hormones’ w/ in the 2nd trimester (14-26 weeks)
the placenta takes over for the corpus luteum in the ovaries and secretes estrogen and progesterone to support the fetus and creation of placenta
What is the effect of estrogen on mom’s body?
mask of pregnancy (hyperpigmentation around face)
suppresses FSH and LH (except at high levels such as during ovulation)
grows the fetus’s organs
increase’s maternal tissue growth (mammary glands and uterus)
increase blood volume
increase Na and water retention
What is the effect of progesterone on mom’s body?
secreted by corpus luteus
maintains endometrium (no early miscarriages), makes period lining during luteal phase
inhibits contractions
aids in duct development
decreases smooth muscle tone which can turn into constipation and heartburn and varicose veins
What does HCG do?
Stimulates the corpus luteum in the ovaries to secrete estrogen and progesterone to support the fetus and create the placenta
eventually taken over by placenta by beginning of 2nd trimester
How do you measure the position of the fundus?
The relationship between the symphysis pubis (cartilage between anterior pelvis) and the fundus (top, meaty part of the uterus)
- Have pt lay on back
- use taper measure to measure the distance between the symph pub and fundus
See if length matches the gestational age of the pregnancy
the fundus is positioned just above the symphysis pubis. About hoe many weeks gestation is she?
12 weeks (+/-2cm)
the fundus is positioned at the belly button. About how many weeks gestation is she?
20 weeks (+/-2cm)
the fundus is positioned at the xiphoid process. About how many weeks gestation is she?
36 weeks (+/-2cm)
where do you expect the fundus to be at 36-40+ weeks?
down about 4cm from the xiphoid process
How do you calculate a woman’s estimated due date
add 7 days to LMP and count forward 9 months
what is the fertile pd for a 28 day cycle
days 9-16
high levels of estrogen can cause
_____ on microscope slide
ferning
what would the characteristics of a woman’s cervical mucus be during their early follicular phase, ovulation, and luteal phase?
follicular phase: Spinnbarkeit 6cm (white)
ovulation: Spinnbarkeit 12cm (clear)
luteal: Spinnbarkeit 3cm
define menarche
occurrence of first menstrual period
define menorrhagia
Regularly occurring bleeding excessive in
duration and flow (longer than 7 days)
Soaking through pad/tampon in 1 hour, clots, gush
define metrorrhagia
Bleeding at irregular intervals
define oligomenorrhea
infrequently occurring menses at intervals
greater than 35 days
polymenorrhea
Menses at intervals of 21 to 24 days or fewer
hypomenorrhea
Regular bleeding in less than normal amount
primary Amenorrhea
No menses by age 14 in the absence of secondary sex
characteristics
No menses by age 16 in the presence of secondary sex
characteristics
secondary Amenorrhea
Absence of menses for 3 cycles or 6 months in women who have
previously menstruated
labs for Amenorrhea
Amenorrhea workup:
ßHcG, TSH, prolactin,
FSH & LH may be ordered
if ovarian failure
suspected
Progesterone challenge
test
what are some lifestyle habits that may cause dysmenorrhea
smokers, and women who are obese
primary vs. secondary dysmenorrhea
Primary - when ovulation is established
excess prostaglandins
Usually starts 6-12 months following 1st pd
Lasts 48-72 hours
Secondary - usually with underlying pelvic pathology
What are the trimesters of pregnancy
First: week 1 through 13
Second: weeks 14 through 26
Third: weeks 27 through 40
what are the sounds made by uterine arteries called
Uterine souffle. Should be the same as the maternal pulse
when would Quickening-first recognition of fetal movement expected to be present
14 to 16 weeks for multips (already has a kid)
18-20 weeks for primips
what are Montgomery’s tubercles
hypertrophied sebaceous glands on areolas (lubricate things for breastfeeding)
Blood volume and composition increases by
30-50% = dilution of iron causes anemia
what is a Daily fetal movement count (DFMC)
count number of kicks in 1 hr
Further evaluation needed: mom reports decreased activity or no FM in 12 hours
how do you use Ultrasonography to determine baby’s gestation
CROWN TO RUMP LENGTH CAN INDICATE GESTATIONAL AGE
how do you use Ultrasonography to determine 5 fetal variables
breathing movement
body movement
tone
amniotic fluid volume (all found via ultrasound)
what is IUGR
Intrauterine growth restriction, or IUGR, is when a baby in the womb (a fetus) does not grow as expected.
What are the scores for the Biophysical Profile of a fetus
0-2 strongly suspect chronic asphyxia
10: normal
There difference between reactive, nonreactive, and unsatisfactory NST (non-stress test to determine fetal activity)
reactive NST
at least 2 15-bpm FHR accelerations lasting 15 seconds or more with fetal movements over 20 minutes (over 32 weeks gestation)
nonreactive NST
reactive criteria not demonstrated or met (flat-ish line despite contractions)
unsatisfactory NST
inadequate external monitor tracing of FHR
why would you perform a Contraction stress test (CST)
Indicated for pregnancies at risk for placental insufficiency or fetal compromise as a result of
IUGR
diabetes mellitus
Post term or 42 week’s gestation or more
nonreactive NST
abnormal or suspicious BPP
do it by Nipple-stim or Oxytocin-stimulated contraction test
don’t do if there is a risk of bleeding/infection
Why do an Amniocentesis
genetic concerns (16-18w) and lung maturity (30-35 weeks)
2 most frequent tests to test Fetal lung maturity
L/S (lecithin / sphingomyelin) ratio: 2 components of surfactant
Phosphatidylglycerol (PG)
lungs are mature if PG is present in conjunction with L/S ratio of 2:1 expected at at about 32-35 weeks’ gestation
when are fetus’ lung mature
32-35 weeks’ gestation
Preterm labor is defined as
cervical changes and uterine contractions occurring between 20 and 37 weeks gestation (when birth is considered a miscarriage)
characterized by uterine activity, discomfort, and vaginal discharge
Fix by Decrease activities that result in PTL symptoms or bed rest
what threshold is considered a Low birth weight:
less than 2500 grams at birth
when would you use betamethasone on L/D
Suppression of preterm birth by decreasing uterine activity: Tocolytics (Mag, nifedipine, terbutaline, indomethacin)
its an antenatal glucocorticoids that Accelerates fetal lung maturity & Reduces severity of respiratory distress in preterm births
Effective for 24-34 week gestation pregnancies
Tocolytic drugs
Terbutaline (Brethine)-beta adrenergic receptor
Nifedipine (Procardia)-calcium channel blocker
Indomethacin (Indocin)-prostaglandin inhibitor NSAID
Magnesium sulfate-calcium antagonist
at what point would pre-term labor inevitably become preterm birth?
Labor progressed to cervical dilation of 4 cm
How can you tell if a pt is Premature Rupture of Membranes (PROM)
test discharge for amniotic fluid
Nitrazine: amniotic fluid will be higher than 6.5-alkaline (rub paper on soaked pad to test PH)
Fern test: fluid on slide and let dry-fern pattern
When would PROM pts have to be induced if no labor starts?
If no labor in 12 hours, usually will induce-some will wait 24 hours
when is testing for Group B Streptococcus (GBS)
Testing routinely done between 35-37 weeks
Results valid for 5 weeks
Prophylactic antibiotics: 4 hours prior to delivery
Ampicillin or cephalexin
what is the Cullen sign
Ectopic pregnancy
Note @ 5-6 weeks: BRUISED BELLY BUTTON
what are the types of hydatidiform moles
Complete (or classic) mole, which results from fertilization of egg with lost or inactivated nucleus
Partial mole, a result of two sperm fertilizing normal ovum
Prophylactic cerclage is placed at _______ weeks of gestation
11 to 15
A Miscarriage is _____
Pregnancy ending before 20 weeks
most common cause is chromosomal abnormalities
Some r/t hormonal deficiency (progesterone)
Difference in pain between placenta previa and placenta abrupta
previa painless, abruption painful
Diabetes during pregnancy affects on baby
BABY STARTS TO PRODUCE INSULIN ON THEIR OWN TO COMPENSATE FOR MOM’S HYPERGLYCEMIA, CAUSING THEM TO BECOME LARGER AND OFTEN HAVE CARDIAC ISSUES.
(CHECK GLUCOSE X3, NORM RANGE 45)) baby at risk of crashing
will a breastfeeding mom or a non-breast feeding mom make more insulin?
non-brest feedin mom makes more insulin
gestational diabetes is when
perform 1hr oral glucose screening, positive if greater than 130-140
Unable to meet increased insulin demand during 2nd & 3rd trimester
Insulin either not produced by pancreas or not utilized by cells appropriately
medications for gestational diabetes
Oral hypoglycemics (glyburide, glipizide, metformin)
Insulin therapy-only option in the past
Difference between chronic and gestational hypertension
chronic (hypertension before 20 weeks) gest (hypertension after 20 weeks)
Difference between chronic/gestational hypertension and pre-e
new onset proteinuria & pathologic edema
BABY ISNT GETTING ENOUGH NUTRIENTS D/T POOR PERF FROM VASOSPASM SO PLACENTA TELLS MOM’S BODY TO DECREASE THE DIAMETER OF VASCULATURE TO INCREASE PRESSURE OF FLOW THROUGH PLACENTAL VASCULATURE
Eclampsia vs. pre-e
eclampsia is Seizure activity in preeclamptic woman
what 3 things cause gestational hypertension
VASOSPASM, INTRAVAS COAG OF BLOOD, AND INCREASED PERMEABILITY OF VASCULATURE (PROTEINURIA) CAUSE HYPERTENSION
Mild Preeclampsia parameters
BP greater than 140 systolic or 90 diastolic (>20 weeks gest.)
≥0.3 urine protein/creatinine ratio300mg proteinuria in 24 hour specimen
Severe preeclampsia parameters
BP greater than 160 systolic or 110 diastolic
Oliguria (less than 500cc in 24 hours) & elevated serum creatinine
Altered LOC or visual changes
Hepatic involvement: lab changes, epigastric and/or RUQ pain
Thrombocytopenia: platelets <100,000
Pulmonary edema or cyanosis
Fetal growth restriction
Eclampsia can happen up to ____ hours post partum
72
Later eclampsia can occur after 48 hours and up to 4 weeks post partum
what is HELLP syndrome
variant of severe preeclampsia involving hepatic dysfunction and characterized by:
(H)Hemolysis
(EL)Elevated liver enzymes
(LP)Low platelets
Can develop HELLP syndrome up to 72-96 hours post partum
May continue Magnesium for 24 hours as this is most critical period
MAGNESIUM _____________ REFLEXES. ALSO A _____________. CAN _________BP, BUT OFTEN WON’T AND WILL NEED BP MEDS ON TOP.
DEPRESSES
TOCOLYTIC
DECREASE
Oligohydramnios:
<300 mL of amniotic fluid (which can cause some renal issues)
Hydramnios
> 2000 mL of amniotic fluid (which can cause GI problems
amniotic fluid 32-39 weeks
700- 800 mL
amniotic fluid 41 weeks
500 mL
difference in amniotic fluid at 8 weeks vs. 16 weeks
8 weeks- less than 10 mL
16 weeks- 250 mL
umbilical cord length at term
40 to 70 cm
vasculature of umbilical cord
2 arteries carry DEOXYGENATED blood from the fetus to the placenta
1 vein carries OXYGENATED blood from the placenta to the fetus
3rd week of gestation
formation of blood occurs in the yolk sac
By 6th week
Blood type develops in the fetus
By 5th month
swallowing and peristalsis begins
8 weeks:
can detect EEG waves (brain waves
By 11 to 12 weeks
baby makes respiratory movements and extremity movements
By 16 to 20 weeks
mom can feel fetal movement
24 weeks:
babies start to respond to sound and they can see and taste
At about 20 weeks:
Baby produces insulin, but it’s still affected by mom glucose level
By week 7:
Sex differentiation occurs
what is the First organ system to develop
fetal circulation
normal fetal heart rate is
110 to 160 bpm
when in gestation do fetal lungs mature?
32-35 weeks’ gestation
contractions that are felt as early as 4 months
Braxton Hicks sign
Leukorrhea is
a white vaginal discharge in response to stimulation by estrogen and progesterone – eventually forms mucus plug which is kind of a barrier against bacteria in the neck of the cervix
Differentiation of alveolar epithelial cells into lactocytes (produce colostrum) is caused by
prolactin, progesterone, and human placental lactogenstimulate
TBV increases by ____%
40- 45
Norm BP/HR for pregnant person
BP remains the same or slightly decreases due to reduced systemic vascular resistance
HR increases 10- 20 bpm
What physiologic functions increase during pregnancy
Cardiac output increases by 30- 50%
Increase in RBC mass of (20-30%)
Increase in WBCs
Increases in clotting factors and decreases in coagulation inhibition
Maternal oxygen consumption increases by steadily (40% by term)
Tidal volume, the amount of air exchanged during normal inspiration and expiration, increases by 40%
Chronic mild hyperventilation (pH increases slightly- respiratory alkalosis)
renal ureters dilate more during pregnancy
More urine is stored and stagnant
Tubular reabsorption of sodium increases to meet those demands
Reabsorption of glucose occurs at a fixed rate – increased volume
food w/ mg
Magnesium: whole grains, dark green leafy vegetables
food w/ Zinc
oysters, red meat, poultry
food w/ Vitamin B
liver, seafood, poultry, eggs
what is Chorioamnionitis
a bacterial infection of the amniotic cavity
what is Funneling
the cervix stretches and gets thinner
difference between Shirodkar, McDonald cerclages
. Shirodkar – higher in cervix and more involved2. McDonald (purse string) – opening of cervix – easy to access procedure
What is the difference between asymptomatic bacteriuria, cystitis, and pyelonephritis?
bacteruira: no sx
cystits: sx
Pyelonephritis: kidney infection
the Gonadotropin-releasing hormone is released in the ______
Hypothalamus
