Exam 1 - OB Flashcards
how do you use naegele’s rule to determine due date?
date of LMP
+ 7 days
- 3 months
(adjust for year if needed)
what is GTPAL? describe each component
Gravida: # pregnancies (including current)
Term: # pregnancies 38 weeks or more
Preterm: # pregnancies after 20 weeks, but before 38 weeks
Abortion: # pregnancy losses before 20 weeks (spontaneous or therapeutic)
Living children
what is GP?
Gravida: # pregnancies including current)
Para: # times carried past 20 weeks + AND delivered
Fundal height measurement
measuring fetal growth in cm. from symphysis pubis to fundus. cm will usually match gestational week (+/- 2 weeks)
re: fundal height, where would 12 weeks measure?
pubic bone
re: fundal height, where would 20 weeks measure?
umbilicus (halfway up stomach = halfway through pregnancy)
re: fundal height, where would 36 weeks measure?
around xiphoid process
Presumptive signs of pregnancy (7)
things the pregnant person FEELS (subjective)
- amenorrhea
- N/V
- breast changes
- uterine growth
- quickening
- urinary frequency
- fatigue
what is quickening?
“fluttering” sensation - when pregnant person feels fetal movement
when does quickening occur for multigravida + primagravida?
multi: earlier - 16 weeks
prima: later - 18-20 weeks
what are probable signs of pregnancy? (8)
things the examiner finds that makes them suspect pregnancy
- braxton hicks
- abdominal enlargement
- chadwick’s sign
- hegar’s sign
- goodell’s sign
- ballottement
- pregnancy test
- hyperpigmentation
what is chadwick’s sign?
blue-ish color of cervix
what is hegar’s sign?
softening of lower uterus
what is goodell’s sign?
softening of tip of cervix
what is ballotement?
fetal rebound when tapped with finger
what are the positive signs of pregnancy?
signs that can only be explained by pregnancy
- fetal movement
- fetal heart sounds
- palpation of fetus
- visualization of fetus (US)
name some CV changes in pregnancy (4)
- increased BP + CO
- increased HR (10-15 bpm)
- supine hypotension
- orthostatic hypotension
name some lab changes in pregnancy (CBC) - (4)
- increased RBCs
- increased WBCs
- decreased H+H (b/c of increased plasma volume)
- normal platelets
what is supine hypotension in pregnancy related to? and what can we do for this?
pressure on vena cava b/c of fetus → tingling, dizziness, pain → lay on side or wedge hip
the orthostatic hypotension experienced in pregnancy is because of what?
progesterone
if a pregnant person had iron deficiency anemia (Hgb <11 / Hct <33%), what could we do for them?
give iron supps (w/vit C or citrus juice for maximum absorption)
name some respiratory changes in pregnancy? (6)
- O2 demands increase
- RR increases
- chest expands b/c of shifting organs + growing uterus/fetus
- dyspnea
- nasal + sinus congestion
- epistaxis
what kind of breathing would you often see in pregnancy b/c of increased pressure on the diaphragm?
chest breathing
with nasal + sinus decongestion and nose bleeds, what should pregnant people avoid + what is safe to use?
avoid nasal sprays + pharmaceutical decongestants
can use: saline + humidity
name some GI changes in pregnancy? (8)
- increased salivation
- bleeding gums
- heartburn
- N/V
- gallstones
- constipation
- hemorrhoids
- flatulence
name some ways we can we mitigate N/V in pregnancy (5)
- small frequent meals
- crackers or toast before getting out of bed
- limit liquids during meals
- ginger ale + lemon bevs
- hard candies
what interventions can we use for constipation in pregnancy?
fiber + fluids
what interventions can we use for increased salivation/bitter taste in mouth in pregnancy?
hard candies. avoid starchy foods.
what interventions can we use for bleeding gums in pregnancy?
soft toothbrush. oral hygiene. avoid irritating foods. adequate nutrition.
what interventions can we use for flatulence in pregnancy?
avoid spicy + gas-producing foods. have small meals
what interventions can we use for heartburn in pregnancy?
avoid spicy foods. sit up after eating. don’t eat right before bed. have small frequent meals.
what interventions can we use for hemorrhoids in pregnancy?
sitz bath. witch hazel.
name some integumentary changes in pregnancy (8)
- hyperpigmentation (nipples, areola, vulva)
- chloasma
- stretch marks
- linea nigra
- dry + itchy skin
- angiomas
- acne
- thickened hair
integumentary changes in pregnancy are r/t what?
- hormonal changes
2. stretching of the skin
name some MS changes in pregnancy (6)
- low back pain
- lordosis
- increased mobility of pelvic joints
- difficulty walking
- leg cramps
- separation of abdominal muscles
interventions for all MS changes in pregnancy (6)
- good posture
- correct lifting
- support belts
- firm mattress
- supportive shoes
- exercise + movement
name some urinary changes in pregnancy (4)
- increased urinary frequency
- UTI risk
- yeast infection risk
- increased GFR
what interventions can we do for urinary changes in pregnancy (r/t urinary frequency)?
kegel exercises + perineal pads
interventions for UTI + yeast infection risk in pregnancy (6)
- pee after sex
- avoid baths (shitty advice)
- clean cotton undies
- wipe front to back
- pee when you gotta go
- get proper fluids
what hormones INCREASE during pregnancy? (4)
- estrogen
- progesterone
- hCG
- hPL
+
prostaglandins (hormone-like)
the _______ acts as an endocrine organ in pregnacy + produces lage amts of ________
placenta
hormones
progesterone in pregnancy is responsible for what? (2)
KNOW
- maintaining the pregnancy
2. relaxing the smooth muscle (vascular relaxation)
estrogen in pregnnacy is responsible for what? (2)
- uterine development
2. f+e balance
Human placental lactogen is responsible for what in pregnancy?
maternal metabolism
prostaglandins are responsible for what in pregnancy?
initiating labor
during pregnancy, there’s a decrease in which hormone?
FSH
there’s an increased need for ______ during pregnancy, which in turns calls for an increased need for what?
glucose
insulin
name some neuro changes in pregnancy (3)
- syncope
- carpal tunnel
- fatigue
name some reproductive changes in pregnancy
- breast changes
- uterine enlargement
- cervical + vaginal changes
out of these vaccines, which are OK to have during pregnancy?
- varciella
- influenza intranasal
- influenza
- rubella
- tdap
influenza, tdap
(NO LIVE VIRUSES)
(wait 1 month after pregnancy to get vaccines, according to ATI)
what is expected total weight gain during pregnancy (for single bebe) for person of avg weight?
25-35 lbs
what is expected weight gain for person of avg weight in 1st trimester?
2.2-4.4 lbs total
what is expected weight gain for person of avg weight in 2nd and 3rd trimester?
1 lb/week
what is expected total weight gain during pregnancy for person that’s underweight?
28-40 lbs
what is expected total weight gain during pregnancy for person that is overweight?
15-25 lbs
how many extra calories/day is adequate pregnancy nutrition?
350-450
what is the most critical time in embryonic development? why?
first 8 weeks - b/c organogenesis
embryo definition according to time frame
implantation → 8 weeks gestation
fetus definition according to time frame
week 9 → birth
what is the purpose of the placenta? (3 things)
- prevent mixing of fetal + maternal blood
- gas exchanged
- hormone production
3 main structures to support fetal development
- placenta
- amniotic sac + fluid
- umbilical cord
what is purpose of amniotic sac + fluid (4)
- hold + cushion fetus
- allow for movement
- MS development
- maintain thermal environment
what is polyhydramnios? oligohydramnios?
poly: excess amniotic fluid
oligo: too little amniotic fluid
the umbilical cord contains how many arteries and how many veins?
2 arteries
1 vein
“AVA”
with the umbilical cord, the arteries carry ______ blood, while the veins carry _______ blood.
arteries: deoxygenated
veins: oxygenated
opposite of usual
re: fetal circulation, what are shunts for?
to bypass lungs + liver b/c not fully developed
when do shunts close?
@ birth
re: fetal circulation, this is the name of the shunt that connects umbilical vein to inferior vena cava (bypasses liver)
Ductus venosus
re: fetal circulation, this one is the opening in the septum of heart between R and L atria
foramen ovale
re: fetal circulation, this is the name of the shunt between pulmonary artery + descending aorta (bypass lungs)
Ductus arterosus
when should 1st prenatal appt occur?
within 1st 12 weeks
what are the components of ongoing monitoring with prenatal appts?
VS (pregnant person + fetus) fundal height weight fetal movement urinalysis
re: prenatal care, when does group B strep screening happen?
35-37 weeks (3rd trimester)
you’re smart and would be able to identify these on an exam or in real life, so memorized lists aren’t needed, but here’s some prenatal assessment pieces if you want… ◡̈
Physical assessment, weight, vitals, pelvic exam, labs, OB hx (contraceptives, complications), nutrition, family, meds, psychosocial, feelings around pregnancy, environmental exposures/hazards, work conditions, exercise, lifestyle, social support, substance use, abuse hx or risk
what things should a pregnant person avoid?
saunas, hot tubs, ETOH, smoking, OTC meds, substances, teratogens
what kinds of feelings are common with pregnant people in 1st trimester?
ambivalence
what kinds of feelings are common with pregnant people in 2nd trimester?
body image issues + nesting
what kinds of feelings are common with pregnant people in 3rd trimester?
over being preggo but excited for bebe
re: hormones, what is happening during the follicular phase?
estrogen, FSH + LH increasing
estrogen peaks during which phase of the menstrual cycle?
ovulation
ovulation happens at what day of menstrual cycle?
day 14
right after ovulation, the empty follicle turns into what?
corpus luteum
re: hormones, what is happening during the luteal phase?
estrogen decreases
progesterone increases
re: menstrual cycle, if pregnancy occurs, what will release progesterone + estrogen until the placenta is formed
corpus luteum
what is the term for abnormal implantation of placenta?
placenta previa
when does bleeding usually begin with placenta previa?
after 24 weeks
what are the s+s of placenta previa? (3)
- Painless bright red bleeding
- Relaxed, soft uterus, nontender
- Abnormal fetal positioning
are fetal vital signs usually normal or abnormal with placenta previa?
usually normal
main intervention for placenta previa
pelvic rest: no vaginal exams, inserts, sex, etc
if placenta previa isn’t urgent, what interventions occur? (3)
- Bed rest
- monitor VS
- monitor I+O
knowing placenta previa can cause premature birth, what interventions should we begin for the fetus?
steroids for fetal lung development
what is placental abruption?
premature detachment of placenta from uterus
placental abruptions can be various types. what are they?
complete or partial (detachment)
concealed or apparent (bleeding)
s+s of placental abruption (use acronym - DETACHED)
Dark red bleeding Extended fundal height Tender, firm uterus Abdominal pain Concealed bleeding Hard abdomen Experience DIC Distressed fetus (Decels)
SUDDEN, INTENSE, LOCALIZED uterine pain is often associated with which complication in pregnancy?
placental abruption
what are some risk factors for placental abruption? (4)
- HTN
- trauma
- multifetal pregnancy
- substance use
what condition is described as HTN after 20 weeks w/ protein in the urine ?
preeclampsia
diagnostic BP of preeclampsia (values)
140/90 2x or more, 4 hours apart
risk factors for preeclampsia (8)
- young or old pregnancy (<19 or >40)
- multifetal pregnancy
- Primiparity
- Obesity
- CKD
- Chronic HTN
- Fam hx
- Other underlying health conditions
s+s of preeclampsia (4)
- elevated BP
- HA
- irritability
- edema
severe preeclampsia is associated with damage to what?
organs
s+s of severe preeclampsia (11)
- visual disturbances (blurred vision)
- BP 160/110
- pulmonary edema
- Extensive peripheral edema (dependent - side they’re laying on)
- elevated liver enzymes
- epigastric + RUQ pain
- N/V
- proteinuria
- elevated creatinine
- oliguria
- hyperreflexia w/ankle clonus (3+ or 4+)
what 2 things should we ALWAYS ask in assessment with pre eclamptic patients?
- do you have a HA, blurred vision or any visual disturbances?
- do you have any epigastric or RUQ pain?
could be sign of worsening leading to eclampsia :(
if someone is in hospital for preeclampsia, what precautions should they be on? what does this include?
seizure precautions:
suction, O2, airway kit, IV access, padded bed rails, low stimulus
if preeclamptic patient is in active seizure, what care do we provide?
turn on side maintain airway stay with them + keep safe/free of injury monitor start and stop time assess fetal HR monitor administer O2 @ 10L
re: fetal heart rate, at what rate are we worried that the fetus isn’t doing well?
<110
re: eclampsia + mag sulfate, which antihypertensive should not be given with mag. why?
NO nifedipine - can cause cardiopulmonary arrest
re: eclampsia, which drug class should not be given with asthmatic patients? (b/c of bronchoconstriction)
LOLs / beta blockers
ex: labetolol
MOA of mag sulfate. why do we give this drug?
MOA: suppress CNS
use: seizure prevention
what s+s should we teach our clients to expect with mag sulfate administration? (5) think of MOA
- hot
- flushing
- sedation
- N/V
- weakness
what baseline measurement should we give before administering mag sulfate?
baseline respiratory status
how often should respiratory rate be assessed with mag sulfate administration?
KNOW
q 15-30 min
how often should neuro assessments happen with mag sulfate administration?
KNOW
at least hourly
therapeutic level for mag sulfate
4-7
toxic level for mag sulfate
> 7
s+s of mag sulfate toxicity (5)
- absent DTR
- respiratory depression
- bradycardia
- sudden drop in BP
- oliguria
what antidote can we administer for mag sulfate toxicity?
calcium gluconate
what is HELLP syndrome? (think of acronym)
Hemolysis of RBCs –> anemia + jaundice
Elevated Liver enzymes
Low Platelets
re: HELLP syndrome, what s+s would go along with elevated liver enzymes?
epigastric pain
N/V
tx for HELLP syndrome
fresh frozen plasma or platelets
impaired glucose tolerance that BEGINS during pregnancy
gestational diabetes
ideal blood glucose range (pregnant person)
70-110
when should the glucose tolerance test occur?
24-28 weeks
re: gestational diabetes, describe the 1 hr test 1 hr test:
no prep needed. drink 50g glucose + test 1 hr later
re: glucose tolerance test, what’s a positive result? and if they get a positive result, what happens next?
KNOW
130 or greater
next step: 3 hr test
protocols/steps/rules for 3 hr glucose tolerance test (3)
- fasting
- avoid caffeine
- avoid tobacco
what is the only antidiabetic med approved for use during pregnancy ?
Glyburide
ectopic pregnancy
when fertilized egg implants in site other than uterus (usually fallopian tube)
1 s+s of ectopic pregnancy
unilateral stabbing pain in lower abdomen
what is sign of ruptured ectopic pregnancy?
cullen’s sign (bluish tint around the belly button)
what is Hydatidiform mole?
abnormal tumor forming in uterus where placenta should be - excessive tissue growth
what is hallmark sign of hydatidiform mole? and 2 others?
- Hallmark: rapidly growing uterus **
- High hCG
- Extreme N/V
when is the rh factor relevant in pregnancy?
when pregnant person is rh negative + fetus is rh positive
when is rho gam administered?
@ 28 weeks and then within 72 hrs after birth
how long should we monitor patient after administration of rho gam?
20 mins to watch for allergic rxn
the purpose of this test in pregnancy is to detect antibodies (both maternal + fetal)
coombs test
what is indirect coombs test?
testing maternal blood for rh + antibodies
what is direct coombs test?
testing fetal blood for maternal antibodies
what happens if you get a positive coombs test?
more frequent monitoring
what is the term for excessive N/V for prolonged period (beyond 16 weeks)?
hyperemesis gravidarum
interventions for hyperemesis gravidarum (5)
- monitor F+E
- watch for dehydration: skin turgor, mucous membranes,
- check I+O
- monitor weight
- eat frequent, small meals of bland foods → then transition to soft diet and eventually normal diet
WHEN + HOW do we diagnose group B step in pregnant person?
vaginal + rectal culture @ 35-38 weeks
tx for group B strep in pregnancy
PCN or ampicillin during labor
