🤰🏾- Exam 1 Flashcards
Para
Refers to number of births 20wks or after , regardless of born alive or stillborn
Term
37wks- 41wks + 6days
Preterm
20wks - 36wks + 6days
Post term
Anything after 42wks
GTPAL
G- pregnancies
T- term (37+ wks)
P- preterm (20-36.5 wks)
A- abortions
L- current living
Nullipara
A woman who has never been pregnant or has not completed a pregnancy of at least 20wks
Nagele’s rule
First day of last menstrual period (LMP) , subtract 3 months , add 7 days plus 1 year
Gestational age 5-8 wks
Woman misses period
Nausea, fatigue, tingling of breast
Uterus size of a lemon
Positive Chadwick, goodell and hegar signs
Gestational age 9-12 wks
- nausea usually ends by 10 to 12 wks
- uterus size of an orange
- fetal heartbeat with Doppler
Gestational age 13-16 wks
- fetal movement at 16wks
- uterus in abdomen
- fundus midway between symphysis pubis and umbilicus
**colostrum present
-blood volume increases
Gestational age 17-20wks
- heartbeat heard with fetoscope
- skin pigmentation increases
- areolae darken
- melasma and Linea nigra present
- Braxton hicks contractions palpable
- fundus at umbilicus level at 20 wks
Melasma
Brownish pigmentation of the face during pregnancy
Aka chloasma and “mask of pregnancy”
Gestational age 21-24 wks
-relaxation of smooth muscles of veins and bladder increases the chance of varicose veins and UTI
Gestational age 25-28 wks
Period of greatest weight gain and lowest hemoglobin level begins
Lordosis may cause backache
Gestational age 29-32 wks
- heartburn common as uterus presses on diaphragm and displaces stomach
- Braxton hicks more noticeable
- lordosis increases
- waddling gait develops
Gestational age 33-36 wks
- shortness of breath caused by upward pressure on diaphragm
- difficulty finding comfort during sleep
- umbilicus protrudes
- pedal or ankle edema present
Gestational age 37-40wks
- woman is uncomfortable
- cervix softens , begins to efface
- mucous plug often lost
Growth changes in uterus during pregnancy
Nonpregnant uterus
Weight: 70g/2.5oz
Capacity: 10ml
Term uterus
Weight: 1100-1200g/2.4-2.6lb
Capacity: 5L
Uterine growth occurs as a result of ?
Hyperplasia in early pregnancy caused by estrogen and growth factors
Hypertrophy in later pregnancy due to muscle fibers stretch in all directions to accommodate growth
The fundus is normally located at the umbilicus at what gestational age
20 weeks
The fundus reaches its highest level when
The xiphoid process At 36 weeks gestation
Lightening
Descent of the fetal head into the pelvic cavity
Presumptive indications
Are subjective changes that are experienced and reported by the woman
These changes are the least reliable indicators of pregnancy because they can be caused by conditions other than pregnancy
Examples of presumptive indications
Amenorrhea Nausea and vomiting Fatigue Urinary frequency Breast and skin changes Quickening
Quickening
The first movements of the fetus felt by the mother
Probable indications
Are objective findings that can be documented by an examiner
Primarily related to physical changes in the reproductive organs
Examples of probable indications
Abdominal enlargement Goodell sign Hegar sign Ballottement Braxton hicks contractions Palpation of fetal outline Uterine souffle Positive pregnancy test
Goodell sign
Softening of the cervix due to pelvic vasocongestion
Hegar sign
Softening of the lower uterine segment that allows it to be easily compressed at 6 to 8 weeks of pregnancy
Ballottement
When the cervix is tapped, the fetus floats upward in the amniotic fluid. A rebound is felt by the examiner when the fetus falls back
Near mid pregnancy
Uterine soufflé
In late pregnancy - a soft, blowing sound may be auscultated over the uterus
This is the sound of blood circulating through the dilated uterine vessels and it corresponds to the maternal pulse
Funic soufflé
The soft, whistling sound heard over the umbilical cord and corresponds to the fetal heart rate
Examples Positive indications
Only 3 signs accepted as positive confirmation of pregnancy :
Auscultation of fetal heart , fetal movement detected by an examiner and visualization of the embryo or fetus
Chadwick sign
Bluish purple discoloration of the cervix, vagina and labia during pregnancy as a result of increased vascular congestion
Supine hypotension syndrome
When the pregnant woman is in the supine position, the weight of the uterus partially occludes the vena cava and the aorta.
Laying on your LEFT side corrects it
Progesterone and respiratory changes
Relaxes smooth muscle in the respiratory tract
Heightened awareness of the need to breathe
Estrogen and respiratory changes
Increased vascularity of mucous membranes
Causes increased nasal congestion and epistaxis
Relaxin and respiratory changes
Causes relaxation of the ligaments around the ribs
Relaxes skeletal muscle and cartilage
Ovaries and reproductive system changes
Ovulation ceases due to increased levels of estrogen and progesterone inhibiting the release of FSH and LH
Ptyalism
Excessive salivation
Progesterone and gi changes
Relaxes smooth muscle , which decreases gi motility , which can lead to constipation
Angiomas
Tiny red elevations branching in all directions
Look like red moles to me
Diastasis recti
Separation of the rectus abdominal muscles
HCG
Prevents deterioration of the corpus luteum so that it can continue producing estrogen and progesterone until the placenta is sufficiently developed and takes over
Estrogen
GROWTH
stimulates uterine growth
Increased vascularity
Prepares breast for lactation
Hyperpigmentation
Progesterone
MAINTENANCE
maintains endometrial lining / prevents menstruation
Relaxes smooth muscle
Increased respiratory sensitivity to CO2 (urge to breathe)
Suppress immune response - prevents rejection of the fetus
HPL
Human placental lactogen
Primary function to increase the availability of glucose for the fetus
What is the recommended weight gain during pregnancy
11.5 to 16 kg (25-35 lbs)
Pattern of weight gain
First trimester: gain 0.5 to 2 kg (1.1-4.4 lb)
0.35 to 0.5 kg (0.8-1lb) per week thereafter
Calorie intake during each trimester
First: no additional calories needed
Second: increase by 340 per day
Third: increase by 452 per day
Most common simple carbohydrate
Sucrose (table sugar)
Complex carbohydrates
Present in starches such as cereal, pasta and potatoes - supply vitamins, minerals and fiber
Fiber
Nondigestible product of plant foods , important source of bulk in the diet
Stimulates peristalsis, prevents constipation and slows gastric emptying causing a sensation of fullness
Fats help in the formation of
Fetal nerve, brain and visual development and visual function
Examples of Food sources for omega 3 fatty acids
Salmon, flaxseeds and oil, soybeans, walnuts
RDA of protein during pregnancy
Should be increased to 71 g daily
Compared to 46g for non pregnant females
Examples of sources of protein
Fish, egg, beans , peas , nuts, soybeans
Tofu from soybeans is a good source of protein , calcium and iron
Fat soluble vitamins
K A D E
Water soluble vitamins
B C
Women during child bearing age should consume how much folic acid
400 micrograms daily
Once pregnancy occurs should increase to 600 mcg daily
Folic acid
Deficiency results in neural tube defects, which can lead to spina bifida or skull/brain malformations
Also cleft lip, cleft palate, some heart defects, premature birth, LBW, abruptio placentae
What is the goal of iron consumption during pregnancy
To prevent iron-deficiency anemia
For best results iron should be taken with
Water or a source of vitamin c like orange juice
** don’t take with coffee, tea or milk **
Calcium is important in
Mineralization of fetal bones and teeth
Calcium is best absorbed when taken with
Vitamin d (eggs, cereal) to increase absorption
PICA
Eating substances not usually considered part of a normal diet
Ex: ice, clay or dirt and laundry starch
A multifetal pregnancy should gain how much
Woman with twins should gain 5.5 to 9kg (12-19lbs) more than a woman with a single fetus
Or
17 to 25kg (37-54lbs)
Puerperium
The first 6 weeks after the birth of an infant
Aka postpartum
Involution
The changes the reproductive organs, particularly the uterus, undergo after childbirth to return to their nonpregnant size and condition
Descent
The fundus descends by approximately 1 cm, or 1 fingerbreadth per day after delivery
By 14th day, it has descended into the pelvic cavity and can’t be palpated abdominally
Afterpains
Intermittent uterine contractions
Are afterpains more uncomfortable for primipara or multipara
Multipara , Because of repeated stretching of muscle fibers
Primipara severe afterpains due to twins, large babies or if blood clots are present
Lochia rubra
Days 1-3 after childbirth
Consists almost entirely of blood, small particles of decidua and mucus
DARK RED OR RED-BROWN COLOR
Lochia serosa
Days 3-10
Composed of serous exudate, erythrocytes, leukocytes and cervical mucus
PINK/BROWN TINGED COLOR
Lochia alba
Day 10-14
Composed of leukocytes, decidual cells, epithelial cells, fat, cervical mucus and bacteria
WHITE, CREAM OR LIGHT YELLOW COLOR
Scant
Less than 2.5cm (1in) stain on peripad
Light
Less than 10cm (4in) stain
Moderate
Less than 15cm (6in) stain
Heavy
Saturated peripad in 1 hour
Excessive
Saturated peripad in 15 mins
Dyspareunia
Discomfort during sex
Can occur postpartum due to vaginal dryness
Round os vs slit os
Nullipara cervix is round
Para cervix is slit
Postpartum plasma volume
Is decreased .. via diuresis and diaphoresis
Changes in postpartum blood values
Increased WBC (up to 30,000mm3
Decreased HNH
Changes in postpartum coagulation
Increased risk of forming blood clots and thrombus formation
What 2 substances may be present in the urine for the first few postpartum days
Protein - related to uterine involution
Acetone - suggests dehydration
Urinary retention and bladder distention may cause what
UTI and increased postpartum bleeding
Uterine atony
Decreased contraction of the uterine muscles
Caused by displacement of the uterus UPWARD and LATERALLY by a full bladder
Primary cause of excessive bleeding
Post puncture headache
May occur after a subarachnoid (spinal) block due to CSF leakage
Maybe most severe when the woman is in an upright position and are relieved by assuming a supine position
How does breastfeeding affect ovulation and menstruation
Delays the return of both - resume as early as 12 weeks or as late as 18 months
*most non-nursing mothers resume at 6-8 weeks postpartum
Prolactin vs oxytocin
Prolactin - after expulsion of the placenta , estrogen and progesterone decline allowing prolactin to initiate milk production within 2 or 3 days postpartum
Oxytocin - necessary for milk ejection or “let-down” causes milk to be expressed from the alveoli into the lactiferous ducts during suckling
Approximately how much weight is lost during childbirth
4.5 to 5.8kg (10-13lb)
Includes weight of the fetus, placenta and amniotic fluid
Additional 5-8lbs from diuresis and 2-3lbs from involution and lochia are lost by the end of the first week
What does BUBBLE-E stand for
Breast Uterus/fundus Bladder Bowel Lochia Episiotomy/perineum Edema/emotional status
What does REEDA stand for ? Used to asses incision sites
Redness Edema Ecchymosis Discharge Approximation
Homans sign
Discomfort in the calf with dorsiflexion of the foot
May indicated deep vein thrombosis
Signs of paralytic ileus
(Lack of movement in the intestines)
Abdominal distention, absent or decreased bowel sounds and failure to pass flatus or stool
RhoGAM
Should be administered within 72hrs after childbirth to prevent the development of maternal antibodies that would affect subsequent pregnancies
Rubella vaccine
The vaccine is a live virus. Advise woman to not become pregnant for at least 28 days after receiving the vaccine
What temperature is common for the first 24hrs after birth
Up to 38’C (100.4’F)
Maybe caused by dehydration or normal postpartum leukocytosis
Breathing is initiated by which factors
Chemical, mechanical, thermal and sensory factors that stimulate the respiratory center in the medulla and trigger respirations
Chemical factors that trigger respirations
A decrease in PO2 , pH and an increase in PCO2 in blood cause impulses from these receptors to stimulate the respiratory center in the medulla
Mechanical factors that trigger respirations
During vaginal birth the fetal chest is compressed pushing fetal lung fluid out of the lungs
Fluid passes out of mouth or nose or is suctioned as the head emerges from the vagina
Thermal factors that trigger respirations
The temperature change that occurs with birth stimulates the initiation of respirations
Sensory factors that trigger respirations
Tactile, visual, auditory and olfactory stimuli occur during and after birth to stimulate sensors
Thermoregulation
The maintenance of body temperature
Characteristics that lead to baby heat loss
- thin skin
- blood vessels close to surface
- little subcutaneous fat
- more water weight
Evaporation
Air-drying of the skin that results in cooling
Dry baby as quickly as possible to prevent loss of heat - remove wet linens , use dry blankets
Conduction
Movement of heat away from the body occurs when newborns have direct contact with objects that are cooler than their skin
Prevent by warming objects that will touch the baby or skin to skin with mom
Convection
Transfer of heat from the infant to cooler surrounding air
Prevent by providing a warm, draft-free environment
Radiation
Transfer of heat to cooler objects that aren’t in direct contact with the infant
Prevent because incubators have double walls, placing cribs and incubators away from windows and outside walls
Providing cord care
Falls off within 10-14 days
The cord clamp is removed 24hrs after birth
Effects of cold stress
Metabolism of brown fat, increased metabolic rate, increased O2 and glucose consumption can lead to metabolic acidosis, hypoglycemia and jaundice
Normal range of erythrocytes in a newborn
4.8-7.1 million/mcL
Normal range of hemoglobin in newborns
15-24 g/dL
Normal range of hematocrit in newborns
44-70%
Polycythemia
Abnormally high RBC count
Polycythemia increases the risk for what
Jaundice and injury to the brain and other organs as a result of blood stasis
Normal range of leukocytes in the newborn
9.1-34 thousand/mm3
Breast milk 💩
Seedy and the color and consistency of mustard , with a sweet-sour smell
Formula fed 💩
Pale yellow to light brown-green color, firmer in consistency and stink
Glucose levels on day 1 vs after
Day 1: 40-60 mg/dL
Thereafter: 50-90 mg/dL
Risk factors for neonatal hypoglycemia
Prematurity Postmaturity Late preterm infant Intrauterine growth restriction Lga/sga Asphyxia Problems at birth Cold stress Maternal diabetes Maternal intake of terbutaline
Conjugation
A process in which the liver turns unconjugated bilirubin which is soluble in fat to water- soluble so that it can be excreted from the body
Kernicterus
Chronic bilirubin encephalopathy that causes permanent neurologic injury
Unconjugated bilirubin
Unconjugated bilirubin attaches to albumin in the blood and is carried to the liver
Factors that lead to increased bilirubin
- Increased bilirubin production
- increased break down of RBC
- less albumin
- liver immaturity
- blood incompatibility= ^ RBC breakdown
- delayed feeding = delayed est of normal flora
- Trauma
- fatty acids = greater affinity for albumin binding sites
- family background
Physiologic/nonpathologic jaundice (transient)
Is considered normal
Occurs AFTER the first 24hrs of life
Intake
Meconium
Nonphysiologic/pathologic jaundice (abnormal)
Occurs WITHIN the 1st 24hrs of life
Is a result of abnormalities causing excessive RBC destruction - blood incompatible, infection, etc
Treated with phototherapy
Immunoglobulin G
Only one that crosses the placenta
Passive temporary immunity to bacteria, bacterial toxins and viruses to which the mother has developed immunity
Immunoglobulin M
Production as a result of exposure to environmental antigens
Active immunity
Immunoglobulin A
Important in protection of the gastrointestinal and respiratory systems
Active immunity
Present in colostrum and breast milk
First period vs second period of reactivity
1st period - begins at birth and lasts for 30mins
Sleep
2nd period - lasts 4-6 hrs
Normal newborn respiratory rate
30 to 60 breaths per min
Choanal atresia
Blockage or narrowing of one or both nasal passages by bone or tissue
Normal ❤️ rate range of newborn for normal activity , crying and sleeping
Normal activity: 120-160 beats per min
Crying: elevate to 180 bpm
Sleeping: drop to 100 bpm
Normal range for axillary temp on a newborn
36.5-37.5’C (97.7-99.5’F)
Anterior fontanel
Diamond 💎 shaped
Closes by 18 months
Largest
Posterior fontanel
Triangle 🔺 shaped
Closes by 2 months
Smaller
Caput succedaneum
An area of localized edema that appears over the vertex of the newborns head as a result of pressure against the mothers cervix during labor
Is present at birth , usually resolves within 12 to 48 hrs after birth
Cephalhematoma
Bleeding between the periosteum and the skull , is the result of pressure during birth
May not be present at birth , may develop within the first 24 to 48 hrs
May take 2-3 months to resolve
The umbilical cord should contain how many vessels
2 arteries and 1 vein
*a two vessel cored maybe associated with chromosomal or renal defects
Erb’s palsy
Paralysis of the shoulder and arm muscles
Maybe caused by injury to the brachial nerve plexus
Polydactyly
Extra digits
Syndactyly
Webbing between digits
Talipes equinovarus
A birth defect in which the foot is twisted out of shape or position ;
Clubfoot
Foot turns inward and can’t be moved a midline position
Hip dysplasia
Instability of the hip joint occurs and the head of the femur can be moved in and out of the acetabulum
Hear a click= normal
Feel a clunk= not normal
Barlow test vs Ortolani test
Barlow test - laying supine, ADDUCT the hips
Ortolani test - laying supine, ABDUCT the thighs
Normal range of weight , height , head and chest circumference on a term baby 👶🏾
Weight: 2500 - 4000g (5.8-8lb 13oz)
Height: 19 - 21 inches (48-53cm)
Head: 13 - 15 inches (32-38cm)
Chest: 12 - 14 inches (30-36cm)
Hearing begins to develop when
By 23-24 wks gestation
Recommend weight gain during pregnancy based on BMI for underweight , normal weight , overweight and obese
Underweight: 28-40 lb
Normal weight: 25-35 lb
Overweight: 15-25 lb
Obese: 11-20 lb
Strabismus
Crossed eyes
Causes of tremors or jitteriness
Hypoglycemia
Hypocalcemia
Drug withdrawals
Moro reflex
Let infants head drop back approximately 30 degrees
Responds with sharp extension and abduction of arms
Disappears at 5-6 months
Palmar grasp reflex
Occurs when the infants palm is touched near the base of the fingers - the hand closes into a tight fist
Disappears at 2-3 months
Babinski reflex
Stroke lateral sole of foot from the heel to across base of toes - causes toes to flare outward and the big toe to dorsiflex
Disappears at 8-9 months
Rooting reflex
When the infants cheek is touched near the mouth , the head turns toward the side that has been stroked
Disappears at 3-4 months
Stepping reflex
When infants are held upright with their feet touching a solid surface - they lift one foot and then other , giving the appearance that they are trying to walk
Disappears at 3-4 months
Sucking reflex
When the mouth or palate is touched by the nipple or a finger, the baby begins to suck - difficulties maybe related to problems in the babies ability to suck and coordinate sucking with swallowing and breathing
Disappears at 1 year old
Tonic neck reflex
The baby extends the arm and leg On the side to which the head is turned and flexes the extremities on the other side
Maybe weak at birth , disappears at 4 months
Signs of neonatal hypoglycemia
Poor suck Jittery Tachypnea Tachycardia Grunting Low temperature Lethargy Asymptomatic
Cryptorchidism
Undescended testes
Lanugo
Fine, soft hair that covers the fetus during intrauterine life
Milia
White cysts
Occur on the face over the forehead, nose, cheeks and chin
Erythema toxicum
Red, blotchy areas with white or yellow popular or vesicles in the center
“Flea bite or newborn rash”
Nevus simplex
“Salmon patch, stork bite or telangiectatic nevus”
Flat, pink discoloration from dilated capillaries that occurs on the eyelids, just above the bridge of the nose, or at the nape of the neck
Nevus flammeus
“Port-wine stain”
Permanent, flat, pink to dark reddish-purple mark that varies in size and location and doesn’t blanch with pressure
*lesions located over the forehead and upper eyelid maybe associated with sturge-Weber syndrome , a neuro condition
Nevus vasculosus
“Strawberry hemangioma”
Dark red and raised with a rough surface , giving a strawberry like appearance
Cafe au lait spots
Permanent , light-brown areas that may occur anywhere on the body
*6 or more spots or large size associated with neurofibromatosis , a genetic condition of neural tissue
Gravida
A pregnant woman
Also refers to a woman’s total number of pregnancies, including the ones in progress
