Exam 1 - Classes 1 & 2 Flashcards
ovum
an egg, produced in the ovarian follicles
each month, one ovum matures & is released; cilia in the uterine tubes propel the ovum to the uterine cavity, where it is fertile for appx 24 hours before degenerating
ovum stage
period of time from conception until day 14
covering cellular replication, blastocyst formation, initial development of embryonic membranes, and establishment of primary germ layers
embryo
conceptus from the second or third week of development until appx the eighth week after conception, when mineralization (ossification) of the skeleton begins. This period is characterized by cellular differentiation and predominantly hyperplastic growth
fetus
unborn offspring in utero from appx the 8th week after conception until birth
teratogens
non-genetic factors that cause malformations and disorders in utero
amniotic fluid
fluid surrounding the fetus derived primarily from maternal serum and fetal urine
“Amniotic fluid is 98%-99% water and contains albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fructose, fat, leukocytes, proteins, epithelial cells, enzymes, and lanugo hair.”
umbilical cord
connecting stalk between the chorionic villi/placenta and the embryo; two arteries carry blood from the embryo to the chorionic villi, and one vein returns blood to the embryo
*note: the chorion is the fetal membrane closest to the intrauterine wall
placenta
afterbirth; specialized vascular disk-shaped organ for maternal-fetal gas and nutrient exchange; develops from the chorionic villi
normally the placenta implants in the thick muscular wall of the upper uterine segment
“the maternal-placental-embryonic circulation is in place by day 17, when the embryonic heart starts beating”
“the structure of the placenta is complete by the 12th week”
gravida
a woman who is pregnant
in documentation/obstetric history, the number of times a woman has been pregnant
parity
in documentation of obstetric history, the number of pregnancies in which the fetus or fetuses have reached 20 weeks of gestation
hCG
human chorionic gonadotropin
protein hormone used as the basis for pregnancy tests; detectable in maternal serum by 8-10 days after conception (2-4 days after implantation)
hCG ensures the continued supply of estrogen and progesterone needed to maintain the pregnancy
preterm (birth)
birth that occurs between 20 0/7 and 36 6/7 weeks of gestation
Preterm births are categorized as
- very preterm (< 32 weeks of gestation)
- moderately preterm (32 to 34 weeks of gestation)
- late preterm (34 to 36 weeks of gestation)
term (birth)
birth after 37 weeks of gestation
early term: 37 0/7 through 38 6/7 weeks
full term: 39 0/7 through 40 6/7 weeks
late term: 41 0/7 through 41 6/7 weeks
(twins/triplets, etc, count as 1 “term”)
postterm (pregnancy)
pregnancy that extends past 42 completed weeks of gestation (294 days or more from the first day of the last menstrual period)
viability
the capacity to live outside the uterus; infants born at 22 to 25 weeks of gestation are considered to be on the threshold of viability
surfactants
phosphoprotein necessary for normal respiratory function that prevents the alveolar collapse (atelectasis)
L/S ratio
lecithin/sphingomyelin ratio
ratio of lecithin to sphingomyelin in the amniotic fluid; used to assess the maturity of the fetal lung
lightening
sensation of decreased abdominal distention produced by uterine descent into the pelvic cavity as the fetal presenting part settles into the pelvis; usually occurs 2 weeks before the onset of labor in nulliparas
quickening
maternal perception of fetal movement (“feeling life”)
usually occurs between weeks 16 and 20 of gestation but may be felt earlier by multiparous woman
Hegar sign
softening of the lower uterine segment; classified as a probable sign of pregnancy; may be present during the second and third months of pregnancy (appx 6 weeks gestation) and is palpated during bimanual examination
Goodell sign
softening of the cervix, a probable sign of pregnancy, occurring during the second month
Chadwick sign
violet-blue color of the vaginal mucosa and cervix that is visible at approximately 6 to 8 weeks of pregnancy; caused by increased vascularity
estimated date of birth (EDB)
aka “due date”
approximate date of birth; usually determined by calculation using the Naegele rule
Naegele rule
method for calculating the estimated date of birth or “due date”; based on the woman’s accurate recall of her LMP (last mentrual period). Assumes the woman has a 28-day cycle and that fertilization occurred on the 14th day. (Box 14.1 on p265 of 12ed textbook)
*only 5% of women give birth spontaneously on the EDB as determined by the Naegele rule; most births occur between 7 days before and 7 days after the EDB
intimate partner violence (IPV)
the actual or threatened physical, sexual, psychological, or emotional abuse by a spouse, ex-spouse, boyfriend, girlfriend, ex-boyfriend, ex-girlfriend, date, or cohabitating partner
biophysical profile (BPP)
noninvasive assessment of a fetus using ultrasound and the nonstress test
includes: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume
amniocentesis
procedure in which a needle is inserted through the abdominal and uterine walls under ultrasound guidance into the amniotic fluid; some fluid is withdrawn and is used for assessment of fetal health and maturity
alpha-fetoprotein (AFP)
fetal antigen; elevated levels in amniotic fluid are associated with neural tube defects and open abdominal wall defects
Coombs test (indirect and direct)
indirect: determination of Rh-positive antibodies in maternal blood
direct: determination of maternal Rh-positive antibodies in fetal cord blood
* a positive test result indicates the presence of antibodies or titer
physiologic anemia
a modest decrease in the hemoglobin concentration and hematocrit in pregnancy, caused by the relative excess of plasma
supine hypotension
fall in blood pressure caused by impaired venous return when gravid uterus presses on ascending vena cava, when woman is lying flat on her back; aka “vena cava syndrome”
antepartum
the period before childbirth; pregnancy
intrapartum
the time period of childbirth, from the onset of labor to the delivery of the placenta
postpartum
the time period after childbirth, from birth until maternal organs return to their nonpregnant state
para (term & preterm)
para = delivery
in documentation, refers to the number of pregnancies in which the fetus has reached 20 weeks gestation
para term = delivery at or after 37 weeks gestation
para preterm = delivery between 20.7 to 36.6 weeks gestation
(twins/triplets, etc, count as 1 “term”)
abortions
termination of pregnancy; in obstetric history, the number of pregnancies that ended before fetal viability (whether natural or induced)
spontaneous abortion: pregnancy that ends as a result of natural causes before fetal viability; aka “miscarriage”
induced abortion: purposeful interruption of a pregnancy before 20 weeks of gestation
living
in documentation of obstetric history, the number of living children a patient has
(twins, triplets, etc, count individually)
multiples
multifetal pregnancy - pregnancy in which there is more than one fetus in the uterus at the same time
presentation
the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor
cephalic presentation: head first (~97%)
breech presentation: buttocks, feet, or both first (~3%)
shoulder presentation: shoulder first (<1%)
Leopold’s maneuver
abdominal palpations used to determine fetal position; Box 19.5 on p387 of 12ed textbook
Q1 - Which fetal part is in the uterine fundus?
Q2 - Where is the fetal back located?
Q3 - What is the presenting fetal part?
position
the relationship of a reference point on the presenting part of the fetus to the front, back, or sides of the mother’s pelvis
lie
the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
the two primary lies are:
longitudinal/vertical
and
transverse/horizontal/oblique
attitude
the relation of the fetal body parts to one another
the most common/normal attitude is called “general flexion” - see Fig 16.2 on p320 of 12ed textbook
molding
slight overlapping of skull bones that alters the shape of the fetal head during labor; permits adaptation to the various diameters of the maternal pelvis
the heads of most newborns assume their normal shape within 3 days after birth
vertex
type of cephalic presentation in which the presenting part is occiput; the most common presentation
(see Fig 16.2, p320, 12ed textbook)
station
a measure of the degree of descent of the presenting part of the fetus through the birth canal; the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines
(see Fig 16.6, p322, 12ed textbook)
bloody show
vaginal discharge that originates in the cervix and consists of blood and mucus; increases as cervix dilates during labor
effacement
the shortening and thinning of the cervix during the first stage of labor; degree of effacement is expressed in percentages from 0% to 100%
generally progresses significantly in first-time term pregnancy before more than slight dilation occurs
in subsequent pregnancies, effacement and dilation of the cervix tend to progress together
dilation
the enlargement or widening of the cervical opening and the cervical canal that occurs once labor has began
the diameter of the cervix increases from being closed to full dilation (appx 10cm) to allow birth of a term fetus
cardinal movements
aka “the mechanism of labor”
see Fig 16.12, p329, 12ed of textbook
the turns and other adjustments necessary in the human birth process
1 - engagement 2 - descent 3 - flexion 4 - internal rotation 5 - extension 6 - external rotation 7 - expulsion
“The pneumonic Every Day Fine Infants Enter Eager and Excited is often used to help with remembering these mechanisms of labor.”
https://study.com/learn/lesson/7-cardinal-movements-labor-overview-examples-memorization.html
analgesia
alleviating the sensation of pain or raising the threshold for pain perception without loss of consciousness
anesthesia
encompasses analgesia, amnesia, relaxation, and reflex activity
Anesthesia abolishes pain perception by interrupting the nerve impulses to the brain. The loss of sensation may be partial or complete; sometimes with the loss of consciousness.
stages/phases of labor
in a woman without complications and a fetus in vertex presentation:
1st Stage - from the onset of regular uterine contractions to full dilation of the cervix
2nd Stage - from the time the cervix is fully dilated to the birth of the infant
3rd Stage - from the birth of the infant until the placenta is delivered
4th Stage - from the delivery of the placenta through at least the first 2 hours after birth
SROM
Spontaneous Rupture of (amniotic) Membranes
“her water broke”
rupture of amniotic membranes by natural means
AROM
Artificial Rupture of (amniotic) Membranes
aka “amniotomy”
rupture of amniotic membranes by artificial means, using a plastic amnihook or a surgical clamp
nitrazine (pH)
a pH indicator dye, used to test for rupture of membranes (“broken water”)
amniotic fluid is slightly alkaline; if the nitrazine turns blue, probable membrane rupture is confirmed (procedure described in Box 19.1, p381, 12ed of textbook)
episiotomy
surgical incision of the perineum at the end of the second stage of labor to enlarge the vaginal outlet, facilitate birth, and avoid laceration of the perineum; use is declining due to lack of EB research support
augmentation
stimulation of ineffective uterine contractions after labor has started spontaneously but is not progressing satisfactorily
induction
chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about birth
Bishop score
rating system to evaluate inducibility of the cervix; a higher score increases the rate of successful induction of labor
Cesarean
procedure which achieves the birth of the fetus by an incision through the abdominal wall and uterus
shoulder dystocia
emergent condition in which the head is born but the anterior shoulder cannot pass under the pubic arch to complete the birth of the entire fetus, resulting from a size discrepancy between the fetal shoulders and the pelvic inlet (due to actual fetal size or malpositioning)
prolapsed umbilical cord
emergent condition that occurs when the cord lies below the presenting part of the fetus (loops further into the birth canal than the presenting part); cord becomes compressed between the fetus and the birth canal. Fetal hypoxia resulting from prolonged cord compression (occluding blood flow for >5min) usually results in CNS damage or fetal death.
meconium
first stools of an infant; viscid, sticky, dark greenish brown, almost black; sterile & odorless
meconium stained amniotic fluid
emergent situation; meconium-stained fluid is green and indicates that the fetus has passed meconium before birth
major risk for Meconium Aspiration Syndrome (MAS), which causes a severe form of aspiration pneumonia and can lead to the death of the baby
amniotic fluid embolus
emergent situation; rare complication of pregnancy characterized by sudden, acute onset of hypotension, hypoxia, and hemorrhage caused by coagulopathy; respiratory & cardiovascular collapse, similar to anaphylaxis
- extremely rare; high mortality rate for mother & fetus
- neither an embolism or amniotic-fluid related; considered to be unpreventable
- occurs during labor, during birth, or within 30 minutes after birth
