Exam 1 Study Guide Flashcards
What screening tests are performed during the first trimester to detect congenital anomalies?
-First Trimester screening
-triple screen
-quad screen
-MAFP
-Level II ultrasound/ targeted ultrasound
What is the level II ultrasound/ targeted ultrasound? Why is done at 18 weeks
complete scan of fetal anatomy ; when fetuses begin to develop at own pace
If something shows abnormal or high risk for a congenital condition on a screening tool, we may recommend our patient get
diagnostic tests
What is the first trimester screening?
-combination of fetal ultrasound and maternal blood testing to determine risk of genetic defects
What three things does the triple screen assess?
-AFP
-hCG
-estriol
What four things does the quad marker screen assess? (done during 16-18 weeks of pregnancy)
-hCG
-AFP
-estriol
-Inhibin A
MAFP test assesses (during weeks 15-18 of pregnancy)
-only amount of AFP
-abnormal findings may yield the quad marker screening
Low levels of AFP indicate a risk for
down syndrome
High levels of AFP can indicate a risk for
neural tube defects
Levels higher than expected for hCG and Inhibit A increase risk for
down syndrome
Levels lower than expected range for estriol can indicate
down syndrome
What is amniocentesis? What does it test for?
-transabdominal aspiration of amniotic fluid from the uterus
-performed between 15-20 weeks
Should bladder be empty or full for amniocentesis?
empty to prevent risk of puncture
What may be injected during amniocentesis if the mother is RH negative
Rho(D) immune globulin
Nursing actions during amniocentesis?
-baseline vital signs and FHR
-monitor VS, FHR, and uterine contractions throughout and 30 min after procedure
-allow client to rest for 30 min prior
Complications of amniocentesis include
-leakage of amniotic fluid
-maternal or fetal hemorrhage
-infection
-fetal damage or death
-miscarriage and preterm labor
Nursing actions to monitor for complications after amniocentesis
monitor VS, FHR, temp, respiratory status, uterine contractions, vaginal discharge
What is chorionic villus sampling?
-sampling is the assessment of a portion of the developing placenta
Why is CVS an advantage over amniocentesis
-can be done at 10-13 weeks
-results are quicker
The potential for fetal anomalies and death is higher in amniocentesis or CVS?
CVS
Should bladder be full or empty during CVS
-full bladder
Complications of CVS include?
-spontaneous abortion
-fetal limb loss
-miscarriage
-chorioamnionitis an rupture of membranes
What occurs during placenta previa?
-placenta implants in the lower segment of the uterus
-may cover all or part of the cervical opening
Partial and complete previa will result in?
c-section
Placenta previa will result in bleeding during which trimester?
3rd
Expected findings with placenta previa?
-painless bright red bleeding
-baby breeched, transverse, etc
-soft non-tender uterus
-fundal height greater than expected
-VS WDL
-reassuring FHR
-decreasing urinary output
Laboratory tests to monitor during placenta previa ?
-HGB and HCT
-CBC
-blood type and RH
-coagulation profile
-Kleihauer - Betke test
Nursing care for placenta previa
-assess for bleeding, leakage, or contractions
-NO vaginal exams or anything inserted into vagina
-Pt is on BR with oxygen equipment available
-IV fluids, blood products, and medications (betamethasone)
Why is betamethasone given during placenta previa
used to develop lungs in the fetus
What is placental abruption?
-premature separation of the placenta from the uterus (can be partial or complete detachment)
What is the leading cause of maternal death?
placental abruption
When does placental abruption usually occur?
-after 20 weeks gestation
Risk factors for placenta abruption
-maternal HTN
-MVA or other traumas
-cocaine and smoking
-multifetal pregnancy
-premature rupture of membranes
Expected findings of placenta abruption
-sudden onset of intense localized uterine bleeding with dark vaginal bleeding
-uterine board-like tenderness
-fetal distress
-findings of hypovolemic shock
-hypertonicity contractions
Laboratory tests used with placental abruption
-Hgb and Hct (decreased)
-coagulation factors decreased
-clotting defects (DIC)
-Kleihauer -Betke tests
What may be used to test fetal well-being during placental abruption
Biophysical profile and fetal well-being
Nursing care for placental abruption
-palpate uterus for tenderness and tone
-perform serial monitoring of fundal height
-assess FHR pattern
-provide emotional support
What is the treatment for placental abruption
Immediate birth
What is an ectopic pregnancy?
the abnormal plantation of a fertilized ovum outside of the uterine cavity usually in the fallopian tube
What is the second most common cause of bleeding in early pregnancy and a leading cause of infertility
ectopic pregnancy
Risk factors for ectopic pregnancy?
STI’s, reproductive technologies, tubal surgery, IUDs
Expected findings for ectopic pregnancies
-unilateral stabbing pain
-tenderness in lower quadrant
-scant dark red or brown vaginal spotting
-radiating shoulder pain
-hemorrhage and shock findings
Rapid treatment for ectopic pregnancy includes?
-medical management is rupture has not occurred and tube preservation desired
-methotrexate: inhibits cell division and embryo enlargement
-salpingostomy: done to salvage fallopian tube if not ruptured
-laparoscopic salpingectomy: performed when the tube is ruptured
Nursing care during ectopic pregnancy?
-replace fluids, maintain electrolyte balance
-client education: do not take vitamins with folic acid and avoid sun exposure
Presumptive signs of pregnancy
amenorrhea, fatigue, nausea and vomiting, urinary frequency, breast changes, uterine enlargement
Best way to remember presumptive signs
-think they could be caused by something else
Probable signs of pregnancy
-abdominal enlargement
-Positive pregnancy test
-Hegar’s sign: softening and compressibility of lower uterus
-Chadwick’s sign: deepened violet-blueish color of cervix and vaginal mucosa
-Braxton-hicks contractions
-fetal outline felt by examiner
Positive signs of pregnancy
-auscultaion of fetal heart sounds
-fetal movements felt by examiner
-visualization of the embryo or fetus
What is a non-stress test?
most widely used technique for antepartum evaluation of fetal well-being performed during the third trimester
What does the non-stress test evaluate
-relationship between FHR and fetal movement during a 20-30 minute period
Reactive non-stress test results will show
-two or more accelerations within a 20 minute period
Nonreactive stress test results will show
fewer than two accelerations in a 40 minute period
What can we do to stimulate fetal movement during the non-stress test
-give juice, ice water, or leave on for longer
A disadvantage of the non-stress test includes
high rate of false nonreactive strips
If a non stress test shows to be non-reactive, the patient will then have to have
a contraction stress test or BPP
What is a Biophysical Profile test (BPP)
-a real time ultrasound to visualize physical and physiological characteristics of the fetus and observes for fetal biophysical responses to stimuli
Essentially, a BPP is a combination of
FHR monitoring and fetal ultrasound
Indications of a BPP include
-nonreactive stress test
-suspected oligohydraminos (not enough) or polyhydraminos (too much) amniotic fluid
-suspected fetal hypoxemia or hypoxia
What is being assessed during a BPP
-FHR, fetal breathing, body movements, fetal tone, amount of amniotic fluid
A score of 8-10 with a BPP indicates?
normal
A score of 4-6 on the BPP indicates
abnormal, suspect chronic fetal asphyxia
A score of less than 4 on the BPP indicates
abnormal, strongly suspect chronic fetal asphyxia
How is the nipple-stimulated contraction stress test performed
-lightly brushing palm on nipples for two minutes which stimulates the release of oxytocin, and then stopping the nipple stimulation when a contraction begins. The same process is repeated after a 5 minute rest period
What pattern of contractions must be completed to use as assessment data during the nipple stimulating stress test?
-3 contractions within a ten minute time period
-duration must be 40 to 60 seconds
What should be avoided to prevent pre-term labor with a contraction stress test?
tachysystole of the uterus: uterine contractions of 90 seconds or 5 contractions in 10 minutes
what is a oxytocin stimulated contraction test?
IV administration of oxytocin to induce uterine contractions
Why is the oxytocin-stimulated contraction test not used as first line?
-contractions started with oxytocin can be difficult to stop and can lead to preterm labor
Contraindications of oxytocin stimulated contraction test?
-placenta previa, vasa previa, preterm labor, multiple gestations, previous classic incision from a cesarean birth, reduced cervical competence
What is a positive result of the stress test?
-abnormal finding
-consistent late decelerations with 50% or more of the contractions
Late decelerations on the contraction stress test is indicative of
uteroplacental insufficiency
Variable decelerations during the contraction stress test is indicative of
cord compression
Early decelerations on the stress tests may indicate
fetal head compression
A negative (normal finding) on the CST presents as
-in a 10 minute period, with 3 uterine contractions, there are no late decelerations of the FHR
Complications of the contraction stress tests include
potential for preterm labor
What is quickening?
slight fluttering movements of the fetus felt by the client
When is quickening felt?
16 - 20 weeks
What are monozygotic twins?
‘identical’ from one ovum and one sperm
What are dizygotic twins?
‘fraternal’ from two ova and 2 sperm
Do identical twins usually have one or two placentas?
one common placenta
Do fraternal twins have one or two placentas
two placentas
the formation of dizygotic twins
two ova, two sperm –> two blastocysts –> two amnions and two chorions
the formation of monozygotic twins
-one sperm, one ovum –> one blastocyst –> one chorion and two amnions
How long does gestation last
280 days, 40 weeks, 10 lunar months, 9 calendar months
When is the first day of pregnancy considered
1st day of LMP
what is the embryonic stage?
day 15 through 8 weeks gestation
The embryonic stage is the most critical time in
the development of organ systems
What stage are embryos most vulnerable to malformations caused by environmental teratogens
embryonic stage
What is the fetal membrane in the embryonic stage?
amnion and chorion
The amnion is the ____ membrane and the chorion is the ______ membrane
inner ; outer
What does the amniotic fluid do?
cushions against impact, maintains a stable temp, allows symmetric development, prevents membrane from adhering to developing fetal parts, allows room and buoyancy for fetal movement
The placenta prevents direct contact between
fetal and maternal blood
What are the functions of the placenta
- transfer oxygen and nutrients
- remove waste products and carbon monoxide into maternal blood
- make hormones
- transfer antibodies from mother to fetus
What hormones are produced by the placenta?
- chorionic gonadotropin
- prolactin
- estrogen
- progesterone
- relaxin
the umbilical cord is comprised of
two arteries and one vein
The arteries in the umbilical cord carry _____ blood from fetus to mother whereas the vein carries _____ blood from mother to fetus
deoxygenated ; oxygenated
Vessels in the umbilical cord are surrounded by
Wharton’s jelly
All organ systems are present by
the end of week 8
When is the fetal stage?
9 weeks gestation until pregnancy ends
Amniotic fluid during the fetal stage may be made of
-fetus’ urine, diffusion from maternal blood
During the fetal stage, amniotic fluid increases
weekly to about a quart
Heart beat is detectable by doppler at
8 weeks
eyes, ears, nose, and mouth recognizable at
8 weeks
Quickening is first felt at about
20 weeks
Primitive breathing movements are noticed at about
20 weeks
Vernix caseosa is noticeable at
20 weeks (cheesy skin cream)
Lanugo is seen first at about
20 weeks
What week is the embryo in a c-shaped body and has a rudimentary tail?
5
What week is the head rounded and nearly erect with eyes that have shifted forward and closer together. Eyelids are also beginning to form?
7
What area is most likely to be damaged during childbirth?
perineum (between vagina and anus)
What is an episiotomy?
when a cut is made at the vagina to help with tearing (no longer common practice)
What hormone is produced during pregnancy?
human chorionic gonadotropin hormone (HCG)
How to calculate GTPAL
G = gravidity
T = # term deliveries 37 weeks or greater
P= # preterm deliveries less than 37 weeks
A = # abortuses < 20w or < 500 g
L = # living children
The patient is in her 3rd pregnancy. She has had 2 previous pregnancies, delivered at term, and has 2 living children. Calculate GTPAL
G3T2P0A0L2
this patient is not currently pregnant. she had 4 previous pregnancies, 2 delivered at term, 1 preterm, and 1 abortion, and has 3 living children. Calculate GTPAL
G4T2P1A1L3
this patient is not currently pregnant. she’s had 1 previous pregnancy, delivered preterm, and her child has deceased. Calculate GTPAL
G1T0P1A0L0
What is Naegele’s rule?
-take the first day of the last menstrual cycle
-subtract 3 months
-add 7 days (ADJUST THE YEAR!)
What is gravidity?
total number of times a patient has been pregnant
-nulligravida = 0
-primigravida = 1
-multigravida = 2nd or more
What is parity?
number of pregnancies that reached > 20 w or fetus 500g or more
Nullipara means
-never had pregnancy greater than 20 weeks or fetus 500g
Primipara means
had pregnancy before, delivered at 20 w or greater or fetus was 500g or more
-fetus could have been born alive or dead
Multipara means
2 or more pregnancies before, delivered at 20w or more or fetus 500g or more
What is fundal height?
the distance between your pubic bone and the top of your uterus (measured in cm)
When does fundal height begin being used in pregnancy?
20 - 24 weeks
How do we know if fundal height is on track?
After abut 20 weeks of pregnancy, fundal height should be almost equal to gestational age
ex: @ 28 weeks, fundal height should be 28 cm
What is urinary frequency during pregnancy?
When the woman feels she has to go more often because of the pressure exerted on the bladder
Does the amount of urine being produced increase in pregnancy?
No –> just the amount of times they go
When does urinary frequency begin in pregnancy?
first trimester
During the second trimester, does urinary frequency increase or decrease?
may decrease because the baby is moving up in the abdomen
Does urinary frequency increase or decrease during the third trimester?
increases again when baby begins effacement
Facial edema, blurred vision, seeing floaters, edema in the hands, severe headaches, and epigastric pain are danger signs during pregnancy that may indicate
hypertensive condition or preeclampsia
Burning during urination is a danger sign during pregnancy which may indicate
UTI
severe vomiting is a danger sign during pregnancy and may indicate
hyperemesis gravidarum
Diarrhea is a danger sign during pregnancy and may indicate
DHD, fluid and electrolyte imbalances
Are fever and chills considered a danger sign with pregnancy?
yes
Are abdominal cramping and vaginal bleeding considered danger signs of pregnancy?
yes
After 38 weeks, a gush of fluid from the vagina may indicate
beginning of labor
Before 38 weeks, a rush of fluid from the vagina may indicate
a pregnancy danger sign
Abdominal pain and changes in fetal activity (I.e no fetal movement) may indicate
danger sign of pregnancy
Flushed dry skin, fruity breath, rapid breathing, increased thirst, increased urination, and headache are danger signs of pregnancy. What may they indicate?
hyperglycemia
Concurrent occurrence of clammy pale skin, tremors, irritability and lightheadedness are danger signs of pregnancy. What do they indicate>
hypoglycemia
Dehydration of a pregnant mother may increase risk of
pre-term labor
If a client experiences one of the danger signs of pregnancy, what should they do?
-at least contact the provider immediately
Danger signs should be discussed with the client at what time?
At each pre-natal visit. Focus on danger signs most common in their current point of pregnancy
What is supine hypotension?
-when a pregnant client lays on their back, the vena cava is compressed by the uterus which reduces blood supply to the fetus
Symptoms of gestational hypotension
lightheadedness and faintness, pallor, clammy skin
What may happen to the fetus during supine hypotension?
hypoxia
How to alleviate supine hypotension
-lay on left side
-semi sitting position with the knees slightly flexed
-if on back / supine, place pillow under the hip
What is polydramnios?
presence of too much amniotic fluid
-dx with a BPP test
What is oligohydramnios?
not enough amniotic fluid
-dx with a BPP test
A mom may present with these sx if she has polyhydramnios?
shortness of breath, abdominal pain, swelling in the legs
What may polyhydramnios cause in the fetus?
-increased preterm births
-fetal malpresentation
-cord prolapse
-upper GI obstruction, neural tube defects, trisomy 13 and 18, abdominal wall defects
What may oligohydramnios cause in the fetus?
-reduces cord compression –> fetal death and hypoxia
-birth defects
-miscarriage
-preterm birth
-still birth
What is a neural tube defect?
when the neural tube does not close properly
(the neural tube closes to form brain, skull, back, and spine)
What are the three most common neural tube defects
spina bifida, anencephaly, myelomeningocele, meningocele, and encephalocele
What happens during Spina Bifida?
the spine does not develop completely
What happens during anencephaly?
the brain and skull does not develop properly
How can neural tube defects be prevented?
the intake of folic acid
How much folic acid should clients of childbearing age take when not pregnant. How much should they take when pregnant?
400 mcg, 600 mcg
What foods are high in folate?
-leafy vegetables, dried peas and beans, seeds, orange juice. Breads, cereals, and other grains sometimes contain folic acid
If monozygotic twins implant in the womb and then split immediately, what will we see
shared placenta and separate inner sacs
are monozygotic twins of the same sex?
yes
If monozygotic twins separate before implanting in the womb, what will we see
separate placentas and separate inner sacs
If monozygotic twins implant in womb and then split after, what will we see?
shared placenta and shared inner sac
Risks associated with twins include?
-high risk for preterm labor
-polyhydramnios
-hyperemevis gravidarum
-anemia
-preclampsia
-postpartum hemorrhage
Fetal/newborn risks of twins?
-prematurity and intrauterine growth restriction
-respiratory distress
-birth asphyxia
-congenital anomalies
-twin to twin transfusion syndrome
-conjoined twins
What is twin to twin transfusion syndrome?
transfusion of blood from one twin (Donor) to the other twin (recipient)
Systolic blood pressure throughout preganncy
-slight or no increase from pre-pregnancy levels
diastolic blood pressure throughout pregnancy?
-slight decrease around 24-32 weeks, but will gradually return back
Gestational hypertension is commonly caused by
vasospasm contributing to poor tissue perfusion
Factors of gestational hypertension
-occurs after week 20
-BP 140/90 on two separate occasions, 4 h apart
-no proteinuria, no edema
-BP back to base line 12 weeks after postpartum
Factors of preeclampsia
-GH with addition of proteinuria 1+ or more
-transient headaches, irritability, edema
Factors of severe preclampsia
-BP greater than 160/110
-3+ proteinuria
-oliguria
-creatinine elevated (1.1)
-headaches and blurred vision
-hyperreflexia with clonus
-extensive peripheral edema
-epigastric and RUQ pain
-thrombocytopenia
-hepatic dysfunction
-heart failure
Factors of eclampsia:
-severe preclampsia
-new onset of seizures or coma
-preceded by: headache, severe epigastric pain, hyperreflexia
What is HELLP syndrome?
-severe preeclampsia involving hepatic dysfuntion
What is the acronym for HELLP sydrome
hemolysis –> anemia and jaundice
Elevated liver enzymes –> associated with lab tests, nausea, and vomiting
Low Platelets –> less than 10,000 , thrombocytopenia , s/s of bleeding
what can we expect to see in clients with preeclampsia
severe continuous headache, nausea blurring of vision, flashes of lights or dots behind the eyes
Risk factors for hypertension, preeclampsia, and eclampsia
-maternal age < 19 or > 40
-first pregnancy or multi fetus gestation
-DM, obesity
-autoimmune disorders
-chronic HTN
Nursing care during gestational HTN
-assess LOC
-I and O’s, DW
-monitor VS
-perform NST, kick counts
When patients have a history of early onset preeclampsia , what may be started?
-low dose aspirin therapy
What antihypertensive medications may be used in preeclampsia/ G HTN
-methyldopa
-nifedipine
-hydralazine
-labetalol
what type of antihypertensive drugs should pregnant women avoid
-ACE inhibitors (-pril) and Angiotensin II receptor blockers (ARBs, -sartan)
What medication is given in ecampsia and severe preeclampsia to perform CNS depression and reduce risk of seizures
magnesium sulfate
Sx of magnesium sulfate toxicity
B blood pressure decreased
U urine output less than 30 mL/hr
R respirations less than 12/min
P patella reflex absent
Magnesium sulfate toxicity and how it affects the heart
causes dysrhythmias
Magnesium sulfate toxicity and how it affects DTR/s
absence of deep tendon reflexes
if magnesium toxicity is expected, the nurse should?
-discontinue the infusion
-administer calcium gluconate
What should we monitor while our clients is on magnesium sulfate?
-VS, I & O (may use indwelling catheter), presence of headache and visual disturbances, fetal HR and activity
What is hyperemesis gravidarum?
-excessive N and V extending past 16 weeks
-can lead to weight loss, DHD, electrolyte imbalances, and ketonuria
Expected findings with hyperemesis gravidarum
-excessive vomiting
-DHD, electrolyte imbalance
-increased pulse rate, decreased BP
-poor skin turgor, dry mucous membranes
-weight loss
The most important initial laboratory test for hyperemesis gravidarum is
-urinarlysis for ketones and acetones
-may have elevated urine specific gravity
Will Na, K, and Cl be elevated or decreased in hyperemesis gravidarum
decreased due to poor intake
Will those with hyperemesis gravidarum develop metabolic acidosis
yes (secondary to starvation)
Will those with hyperemesis gravidarum develop metabolic alkalosis?
yes (secondary to excessive starving)
Patients with hyperemesis gravidarum will have increased or decreased levels of thyroid hormones
increased (most have hyperthyroidism)
Will HCT be increased or decreased with hyperemesis gravidarum
-increased due to inability to retain fluid
Nursing care for hyperemesis gravidarum?
monitor I & O, assess skin turgor and mucous membranes, monitor VS, monitor weight, have client remain NPO until vomiting stops
Why is IV lactated ringers given for hyperemesis gravidarum?
replenish hydration
What is another name for vitamin B6?
-folic acid
-pyridoxine
Other than IV lactated ringers, what may also be given to treat hyperemesis gravidarum
Vitamin b6 and other supplements as needed /tolerated
What antiemetic can be prescribed but used cautiously to treat hyperemesis gravidarum
metoclopramide
Are liver enzymes elevated in hyperemesis gravidarum?
yes
Discharge teaching for hyperemesis gravidarum?
advanced clear liquids and bland foods –> start with crackers/toast/cereal –> soft diet normal diet
In severe cases of hyperemesis gravidarum, what may be considered to increase nutrition
feeding tube or TPN
What is the ideal blood glucose level during pregnancy?
60-99 mg/dL fasting, less than or equal to 120 2 hr after meals
What are increased risk to fetus from gestational diabetes
-macrosomia, birth trauma, electrolyte imbalances, neonatal hypoglycemia
Why may urinal and vaginal infections occur in a fetus whose mom had GDM
increased glucose in the urine
is polyhydramnios a risk factor in GDM?
yes (can lead to placental abruption, preterm labor, pp hemorrhage)
Hyperglycemia can lead to excessive fetal growth known as
macrosomia
Can ketoacidosis occur with GDM?
yes
What four things will gestational hypertension lead to?
-placental abruption, kidney failure, preterm birth, fetal and maternal death
s/s of hypoglycemia
shaking, weakness, hunger, blurred vision, nervousness, headache, cool and clammy skin
s/s of hyperglycemia
3 P’s, nausea, abdominal pain, dry skin, flushed skin, fruity breath
Physical assessment findings of GDM
-s/s of hypo and hyper, shaking, rapid pulse, shallow respirations, vomiting, excessive weight gain
What is the glucose screening/ 1 hr glucose tolerance test
-50 g oral glucose –> assess glucose levels one hour later (done at 24-28 weeks)
Is fasting necessary during the one hour glucose tolerance test
no
A positive 1 hr glucose tolerance test will have a blood glucose of
130 to 140
If a client tests positive for the 1 hr glucose tolerance test, they must go for
oral glucose tolerance test
is fasting indicated for the 3 hr oral glucose tolerance test?
yes
-must fast overnight, avoid caffeine, and avoid smoking 12 hr before test
How is the 3 hr oral glucose tolerance test performed?
-fasting glucose obtained –> give 100 g glucose –> serum levels drawn at 1, 2, and 3 hr
What diagnostic procedures are done during GDM to asses the fetus?
BPP, amniocentesis to determine fetal lung maturity, non-stress test
Initial treatment for GDM is?
-diet and exercise (if levels remain high, insulin is begun)
what oral hypoglycemic agent may be used to treat GDM?
glyburide (most others are contraindicated)
Client education with GDM?
-perform daily kick counts
-adherer to diet
-exercise
-self - administration of insulin
-understand need for postpartum laboratory testing to include blood glucose levels
risk factors for cervical insufficiency?
-cervical trauma, short labors, early pregnancy loss, early dilation
What is cervical insufficiency?
expulsion of the products of conception occur (premature cervical dilation and effacement)
Expected findings with cervical insufficiency?
-pink- stained vaginal discharge or bleeding
-possible gush of fluid (membrane rupture)
-uterine contractions with the expulsion of the fetus
What is the treatment for cervical insufficiency?
cerclage (best results if done before 12-14 weeks) and removed at 36 weeks
What signs and symptoms do patients with cerclage/ cervical insuffiency need to report?
-rupture of membranes, infection, strong contractions less than 5 minutes apart, urge to push, severe pressure,
Why do clients with cervical insuffiency need to increase fluids
help relax uterus and prevent contractions
Should intercourse be avoided with cervical insuffiency? should activity be limited?
-intercourse must be avoided
-activity restrictions and BR may be common
What is a spontaneous abortion?
-when pregnancy ends before age of viability (20 weeks)
What type of abortion has sx of mild cramps, slight spotting, no tissue passed, and cervix remains closed
threatened
what type of abortion has mild to moderate cramps, moderate bleeding, no tissue passed, and the cervix is usually dilated?
inevitable
What type of abortion has severe cramps, heavy bleeding, tissue passed, and a dilated cervix (which may contain tissue in the cervical canal)
incomplete
what type of abortion contains mild cramps, minimal bleeding, passed tissue, and a closed cervix
complete (cervix closed after tissue passed)
What type of abortion has no cramps, no bleeding/ minimal spotting, no tissue passed, and cervix closed
missed
what type of aboriton is characterized by varied cramps, malodorous discharge, varied tissue passing, and a dilated cervix
septic
what type of abortion is characterized by varied cramps, varied bleeding, tissue passed, and dilated cervical opening?
recurrent
Risk factors for spontaneous abortions includes?
chromosome abnormalities, maternal illness, advanced maternal age, premature dilation, chronic maternal infections (STI), malnutrition, trauma, substance
Expected findings with spontaneous abortion
abdominal cramping, rupture of membranes, dilation of the cervix, fever, manifestations of hemorrhage (hypotension and tachycardia)
Why must an ultrasound be done for spontaneous abortion
-see if pregnancy is still viable/ assess FHR
What do we consider viable pregancy?
-placenta attached to uterus, FHR present
Do we do cervical exams for threatened spontaneous abortions?
no
What is a dilation and curettage (D&C) for spontaneous abortions?
-used to dilate uterine walls and scrape out uterine contents for inevitable and incomplete abortions
What is a dilation and evacuation (D&E)
dilation and evacuation of uterine contents after 16 wks gestation
Prostaglandin and oxytocin treatment may be used for what type of spontaneous abortion?
-missed abortions
-induces uterine contractions to expulse products of conception
clients at risk for spontaneous abortion (i.e they have a threatened abortion) must be kept on
bed rest
What should nurses do with pads after spontaneous abortion
-observe the color, amount of bleeding, and amount of pads gone through
what are danger signs of spontaneous abortion
heavy, bright red vaginal bleeding, elevated temperature, foul smelling vaginal discharge
Clients that have had spontaneous abortions should do these to prevent infectoin
take abx, refrain from tub baths/sexual intercouse/ placing anything into vagina for 2 weeks
What should clients with a threatened abortion avid
tub baths, sexual intercourse, placing anything into the vagina for two weeks
What does pregnancy category A mean?
-no risk to fetus and was tested on pregnant women
What does pregnancy category B mean?
no risk to fetus when tested on animals
what should we advise clients to do regarding medications while pregnant?
-avoid all OTC medications, supplements, and prescription medications unless the provider supervising their care has knowledge of this practice
What are normal kick counts that our client should observe to minimize fetal risk
-clients should count fetal activity 2-3 times a day for 2 hr after meal or at bedtime
-feal movements of less than 3/h or movements ceased entirely for 12 h indicate a need for further evaluation
What is a fetal demise?
fetal death that occurs 20 weeks after gestation but before birth
How is fetal demise diagnosed?
-ultrasound with no fetal heart beat or fetal cardiac activity
The menstrual phase of the cycle lasts from days
1-6
the proliferative phase of the cycle lasts from days
7-14
the secretory phase of the cycle lasts from days
15-26
Uterine bleeding usually begins ____ days after ovulation
14
What days are considered a full menstrual cycel
1st day of period to the first day of the next period
what happens during the proliferative phase of the menstrual cycle?
-estrogen increases enlarging endometrial glands
-edometrium begins to thicken
-cervical mucous becomes thin, clear, stretchy, and alkaline
-think of proliferative as ovaries using estrogen to prepare for ovulation
What days are the proliferative phase
7-14 (ends day before ovulation)
What happens during the secretory phase?
-progesterone stimulates a thickened endometrium to become vascularized and filled with glycogen and lipids
-this is to prepare for implantation if it is to occur
If there is no fertilized egg by day 23 of the menstrual cycle, what happens during the secretory phase
estrogen and progesterone levels decrease and the corpus luteum begins to degeneratw
What happens during the menstrual phase
-blood is released into the uterus and sloughing of endometrial linginh begins
What is the fertile period?
-ova only fertile for 24 hours after ovulaton
How long do sperm remain viable
2-3 days
How long does it take for an egg to implant?
6 days
The role of estrogen in the menstrual cycle?
-maturing egg follicle to prepare for ovulation (during proliferative phase)
-peaks again during secretory stage to prepare for implantation
-drops off for menstrual phase if no pregnancy
The role of progesterone in the menstrual cycle??
-thicken endometrium to prepare for zygote
-relaxes uterus to maintain pregnancy
What stage of the menstrual cycle does progesterone peak
secretory
Both of these hormones drop off right before menstruation?
progesterone and estrogen
what is the role of prostaglandin hormones
-help release of egg in ovulation
-increases labor contractions and opening of the cervix for birth
What structure secretes progesterone during the menstrual cycle?
corpus luteum
A drop in basal body temperature predicts
ovulation
after ovulation, BBT spikes up
1/2 degree
Mucous changes during ovulation?
-mucous thins to allow sperm to reach ovum
what is spinnbarkeit
thin, clear, egg white sign of ovulation
Fertilization occurs in the outer 1/3 of the tube and forms
zygote
What is a cleavage?
-the splitting of the zygote as it travels the length of the tube (3-4)
What is the morula?
-16 cell morula gives rise to blastocyst with a hollow cavity
The blastocyst becomes what two structures?
-embryoblast –> embryo
-trophoblast –> becomes placenta
The blastocyst imbeds into the placenta how many days after conception?
6-10 days
What is the fundus?
the top of the uterus and where the t
