Exam 1 Week 1 Flashcards
What is Maternal Morbidity? How is measured?
:A condition outside of normal pregnancy, labor, and childbirth that negatively affects a woman’s health during those times
-per 1,000 live births
What is Maternal Mortality? How is it measured?
:Pregnancy related deaths that occurred during or within 1 year following pregnancy resulting from complications of pregnancy itself
-per 1,000 live births
PRMR stands for =
Definition =
Pregnancy related mortality ratios
of pregnancy related deaths per 1000 live births
of deaths in first 28 days of life/1000 live births =
Neonatal Mortality
of deaths within 1st year of life/1000 live births =
Infant Mortality
of stillborns and deaths in the first week of life/1000 births
Perinatal Mortality
Preterm Neonates Categories 1) 2) 3) 4)
1) Very premature
2) Moderately premature
3) Late preterm
4) Term
___ weeks is minimum to reach viability, or fetal weight greater than ____
24
500g
Very Premature =
less than 28 weeks
Moderately Premature =
28-34 weeks
Late Preterm
34 wks 0/7 days - 36 wks 6/7 days
Term
anything between beginning of 38-42 wks
Neonatal birth weight categories 1) 2) 3) 4) 5)
1) Extremely low birth weight
2) Very low birth weight (VLBW)
3) Low birth weight (LBW)
4) Normal birth weight
5) Macrosomia (High/excessive) birth weight
6 aspects of child birth that are changing with time?
1) Birth Environment
2) Involvement of fathers/significant others
3) Labor Pain Management
4) Induction/Interventions
5) C-sections
6) Postpartum care
What is considered Normal Birth Weight?
2500 - 4000g
What is considered Macrosomnia (High/excessive) Birth Weight?
> 4000 g
What are the two major factors of poor neonatal health outcomes?
- Prematurity
- Low birth weight
What is considered preterm?
prior to the END of 37th week of gestation
What is considered Early Term?
37 wks 0/7 days - 38 wks 6/7 days
Some goals for Healthy People 2020
- Dec fetal and infant deaths
- Dec in maternal mortality rates
- Dec in cesarean births
- Dec in low birth weight neonates
- Dec in use of tobacco and illicit drugs during pregnancy
- Inc in maternal prenatal care
- Inc in number of mothers who breastfeed
Where does fertilization take place?
ampulla of the fallopian tube
The union of the ovum and sperm forms a zygote (46 chromosomes) by the process of _______
Meiosis
Once the zygote is formed what happens?
A series of mitotic cell divisions take place
Cleavage cell division continues to form a _____ : a mass of ___ cells
Morula, 16
The inner cell mass is called a _______ which forms the _____ and _____
Blastocyst
Embryo, Amnion
The outer cell mass called the _______ forms the ______ and _____
Trophoblast
Placenta & Chorion
Implantation occurs __-__ days after conception in the ______
7-10 days
endometrium
After implantation, the endometrium becomes the ______ (______)
Decidua (placenta)
What is considered the embryonic stage? Why is it significant?
During implantation to 8 weeks
During this stage organogenesis occurs
What things can impact organogenesis (3)? During which time?
1) Risk of malformation
2) Teratogen exposure
3) Infection exposure
During embryonic stage aka from implantation to 8 weeks
When does the embryo become a fetus?
at 9 weeks
What is the fetal tissue called?
Chorionic villi = vascular processes of the chorion of the embyro entering the formation of the placenta
What are the two tissues of the placenta?
Maternal Tissue and Fetal tissue
Chorionic villi acts as the area of _____ between the maternal and fetal _____, and has the same genetic material as the _____ cells
exchange, circulation, fetal
What is the term for the maternal tissue of the placenta that is part of the endometrium?
Decidua Basalis
What are the Cotyledons?
The separations of the decidua basalis
Which side of the placenta is more beefy and vascularized?
Maternal tissue
When the placenta is expelled how do you which side is which?
The DULL side is the maternal decidua
The SHINY side is the fetal mebranous side
What are the functions of the placenta?
1) Metabolic and gas exchange
2) Hormone production
3) Amniotic fluid regulation
5) Cushion and sock absorption
The umbilical cord is made out of what?
2 Arteries, 1 vein (AVA), and covered in Wharton’s Jelly
What is the function of Wharton’s Jelly?
It is a gelationous substance that covers, provides insulation, and protects the umbilical cord from compression
What is the purpose of the vein and arteries of the umbilical cord?
Umbilical vein brings oxygenated blood to baby
Umbilical arteries take DE-oxygenated blood away from the baby
2 types of amniotic membranes-purpose and location?
Amnion-inner membrane near the baby, produces the amniotic fluid
Chorion-outer membrane further from the baby, toward the mom
What are the two amniotic fluid abnormalities?
1) Polydramnios
2) Oligohydramnios
What is the Ductus Venosus?
What does it bypass?
This is the duct that shunts a portion of the blood from the umbilical vein directly to the inferior vena cava
Bypassing the LIVER
What is the Foramen Ovale?
What does it bypass?
The opening between the left and right atrium that allows blood to flow straight to left atrium by
Bypassing the LUNGS
What is the Ductus Arteriosus?
What does it bypass?
Vessel that shunts blood from pulmonary artery straight to the aorta and to the circulation
Bypassing the LUNGS
What is the process of fetal circulation?
1) The umbilical vein carries oxygenated blood from the maternal side of the placenta
2) Crosses through the ductus venosus into the inferior vena cava and then to right atrium
3) Crosses the Foramen ovale from right atrium to left atrium
4) Some blood is pumped to the pulmonary artery passing a small amount of blood to the lungs-just enough to supply organ/stimulate growth
5) The larger portion of blood passes from the pulmonary artery though the patent ductus arteriousus into the descending aorta, and into circulation
6) Finally blood returns to placenta through the two umbilical arteries and process is repeated
How long is pregnancy? Days, weeks, months?
280 days, 40 weeks, 10 months
Once the zygote starts to move, it takes ___ days to reach the endometrial cavity.
3
Ovum is thought to be fertile for how long?
Once fertilized it will begin to secrete ______
6-24 hours
hCG
Explain the “all or none” theory
During the first 14 days, terotogenic exposure will either cause death of the embryo or nothing at all.
What is the window of greatest vulnerability for the embryo?
15-60 days, when major organogenesis occurs
Why is exchange across the placenta minimal in the first 3-5 months?
due to thickness and decreased permeability which gradually increases until final month when placenta begins to age
When does the completion of maternal placental and fetal circulation occur?
17 days after conception (when the embryonic heart begins to function)
When does the placenta develop into its own discrete organ? (having both transport and endocrine functions)
14 weeks
What caused the umbilical cord to appear twisted or spiraled?
utero fetal movement
What is nuchal cord?
When the umbilical cord encircles the infant’s neck
amount of amniotic fluid at 10 weeks? after 20 weeks?
30 cc, 700-1000cc
Color of normal amniotic fluid?
What is Meconium? What could it indicate?
Clear
First feces of an infant, makes fluid dark green/brown which could also indicate fetal distress
Production of fluid varies by
excreting and swallowing by fetus
Functions of amniotic fluid
Cushions, Thermoregulation, freedom of movement for musculoskeletal development, and keeps umbilical cord free of compression
Polyhydramnios
What 3 abnormalities is it associated with?
> 2000 ml at term
Maternal/fetal issues -
1) maternal diabetes
2) neural tube defects,
3) chromosomal deviations or malformations of CNS or GI tract that prevents normal swallowing of amniotic fluid by fetus
Oligohydramnios
What abnormalities is it associated with?
Uteroplacental insufficiency and Fetal renal abnormalities
VLBW =
less than 1500 lb
LBW =
less than 2500 lb
1st trimerster =
2nd trimester =
3rd trimester =
0-13 wks
14-26 wks
27-40 wks
Naegle’s rule determines what?
What is the formula?
Due date
LMP (first day of last menstrual period) - 3 months + 7 days + 1 year
What is EDC? it is now typically referred to as?
“Estimated date of confinement”
EDD (estimated date of delivery)
In the case of women who have irregular menses or absent menses, how do we determine gestational age?
early ultrasound
Naegles Rule Practice
1) Patient Prima Gravida, 26 yo female, LMP = 9/1/16
What is her expected date of birth?
LMP = 9/1/16
- 3 months = 6/1/16
+ 7 days = 6/8/16
+ 1 year = 6/8/17
Gravida
of pregnancies
Prima Gravida =
Multi Gravida =
1st pregnancy
2nd or more pregnancies
Para
of pregnancies delivered NOT number of infants
Side note: Para = birth after 20 wks gestation regardless of whether infant born alive or not, preterm or not, miscarried or terminated
Description of pregnancy outcomes described by terms:
Gravida and Para
Practice Question
1) Woman is pregnant for first time and has twins; what is her gravida para?
Gravida = # of pregnancies Para = # of births
G 1 P 1
TPAL
T = # of pregnancies that have reached term
P = # of pregnancies that have been delivered preterm
A = # of voluntary or spontaneous abortions (usually prior to 20 wsk (not 24 in this system)
L = # of living children
What is considered Post term/Postdate?
greater than 42 wks
Practice Question
2) Woman is pregnant now. She has a 2 year old at home who was delivered full term; she had one spontaneous miscarriage
What is her Gravida and Para?
What is her Gravida and Para using TPAL?
G = # of pregnancies Para = # of births after 20 weeks gestation
G=3 P= 1
T = # of term births P = # of preterm births A = # of abortions L = # of living children
T = 1 P = 0 A = 1 L = 1
G 3 P 1011
Practice Question
3) Patient Mary Ann has given birth 4 times, 2nd child died of leukemia at age 3.
What is her Gravida and Para using TPAL?
G = # of pregnancies T = # of term births (infants) P = # of preterm births (infants) A = # of abortions L = # of living children
G = 4 T = 4 P = 0 A = 0 L = 3
List the 3 phases of s/s of pregnancy
1) Presumptive
2) Probable
3) Positive
Presumptive signs and symptoms
N/V, missed period, breast tenderness, fatigue
Probable signs and symptoms
(things the examiner can see but still not positive)
1) Goodell’s sign
2) Chadwicks sign
3) Hegar’s sign
4) Ballotement
5) Urine pregnancy test
Goodell’s sign
Softening of the cervix (feels like your lips instead of normal when it feels like your nose)
Chadwick’s sign
Bluish-purplish discoloration of mucous membranes of cervix, vagina, and vulva due to vasocongestion of pelvic vessels
Goodell’s and chadwicks are signs caused by …
increase in vascularity of the uterus
Hegar’s sign
softening of uterus (softening of isthmus between cervix and body of uterus)
Ballottement
Examiner feels “floating fetus” sensation an examiner can feel by pushing up against the cervix and feeling the rebound as the fetus goes up and then floats back down
Tests that indicate a 100% Positive pregnancy
- Ultrasound/Sonogram of heartbeat
- FHR (fetal heart rate) by doppler done at 10-12 wks
- Fetal movement
What is hCG?
Human chorionic gonadotropin = is the earliest biochemical marker of pregnancy (“numerical” analysis, and is what is in OTC pregnancy tests)
Pregnancy tests are based on recognition of _____ or ______
Urine pregnancy test may be positive as early as ___ days after conception, in theory it can be detected _____ a missed period
hCG or B subunit of hCG
4, before
1) Values of hCG ______ with growing pregnacny
2) Used most often to verify _____ w/spotting or risk of _____
3) hCG is present in maternal serum when?
1) increase
2) “growth”, “problem”
3) 8-10 days after fertilization (just after implantation)
What are the hormones of Pregnancy?
1) Progesterone
2) hCG
3) Estrogen
4) hPL
5) Prostaglandins
Function of Progesterone
Where is it secreted from?
Inhibits uterine activity (contractions)
Great role in maintaining pregnancy and preparing breast tissue (develops acini and lobules)
Corpeus luteum
Where is hCG secreted from
Trophoblast in early pregnancy which stimulates continued estrogen and progesterone secretion by corpus luteum (that maintains pregnancy until placenta can function around week 12)
Function of estrogen
promotes growth of uterine/breast tissues
Function of hPL (human placental lactogen)
Where is it produced?
1) increases circulating free fatty acids to meet maternal metabolic needs and decreases maternal metabolism of glucose to favor fetal growth
2) insulin antagonist (increasing uptake of glucose to the fetus)
3) triggers milk production
Produced by synctiotrophoblast
Prostaglandin function
stimulates labor
Adaptations to Pregnancy
Cervix)
Uterus)
Cervix increases vascularity
Uterus changes in size, shape, position
Size and Height of uterus at 12 weeks
Grapefruit
Fundal height at pubic symphysis
Height of uterus at 20-24 weeks (22 +/-)
Umbilicus
How to measure height of fundus
Measure in cms with tape measure from pubic symphysis (pubic bone) to top of fundus, should correspond to weeks of gestation
(wk 24 = 24 cms)
+/- 2cm is normal
Pressure on bladder is more when? How is it relieved?
Greater at beginning of pregnancy, relieved as fundus grows upward
If there is a Lag in uterine growth what does it indicate?
If there is Excess growth, what does it indicate?
1) IUGR (intraauterine growth retardation)
2) Oligohydramnios
1) Obesity
2) Fibroids
3) LGA (large for gestational age)
4) Twins
5) Polyhydramnios
How do the Breasts change?
1) Fullness, heaviness
2) Heightened sensitivity from tingling to sharp pain
3) Areolae becomes darker, more pigmented
4) Montgomery glands more obvious (lubricate), increase in fibroglandular tissue (makes breasts nodular)
5) Colostrum by 16 weeks, supervicial veins may dilate/more prominent
(colostrum may appear after 12th week)
Cardiovascular changes in
1) blood volume and what does it cause
2) cardiac output
3) iron demand
1) Blood volume increases by 50% mostly in blood plasma not bc’s -causes physiologic anemia due to hemodilution
2) cardiac output increases
3) iron demand increases
What heart sound is normal to be heard in 90% of women?
What happens to pulmonary vascular resistance?
1) Systolic murmur
2) decreases
How does the
1) Pulse change?
2) Blood pressure change?
3) Coagulation change?
1) Increases in 10-15 bpm in 2nd trimester
2) Decreases in 2nd trimester
3) Increased coagulation times in factors 7 -10, (hypercoaguble) to prevent hemorrhage during birth (hepatic enzymes and clotting factors tend to favor clotting)
Venous stasis in late pregnancy is due to
decreased blood return to the heart, it pools in the extremities, creating increased risk for thrombotic event
What happens to the pressure on the inferior vena cava from the weight of the uterus, what does it lead to?
What should you teach the mother not to do?
Increased pressure on the inferior vena cava from weight of uterus, it may lead to supine hypotensive syndrome
Teach the mother to avoid lying on back, and instead lie on the left side as it enhances uteroplacental flow
Changes in Respiratory System
1) Change to what type of breathing?
2) What 4 factors increase?
3) What happens to nasal passages?
1) thoracic breathing
2) metabolic rate, respiratory rate, tidal volume, oxygen demand and consumption
3) congestion d/t vasodilation and estrogen induced edema
Gastrointestinal adaptations (4)
What do you want to assess for? Can be indicative of what weird tendency of mother?
1) N/V worst in 1st trimester
2) Increased salivation (ptyalism)
3) Heartburn d/t increased relaxation of gastric sphincter
4) Hemmorrhoids, constipation
Assess for Iron Deficiency Anemia, PICA (craving for non food substances: starch, clay, dirt) can be indicative
GI changes cont..there is also
Changes in ____ and ____ metabolism
relaxation of _____ sphincter
_____ gastric emptying time
_____ intestinal motility
hCG, CHO
Gastric
Delayed
Delayed
Changes in metabolism
1) Changes in ______ metabolism so that baby can get _____
2) ______ resistance to insulin, so baby can get ____
3) ______ gallbladder emptying time
4) Less tolerance for _______ foods, increased risk for ________, ________
1) Carbohydrate, more
2) Increased, more glucose
3) Delayed
4) fatty foods, gestational diabetes, gallstones
Renal Changes
1) Increased _____ from ______
2) ______ of ureters/____ pressure
3) ______ resorption of _____
4) Some glucose ____ at serum levels _______, ________ may spill as well
5) Possible ______ of urine in ureters
What do you want to watch out for?
1) GFR, increased Cardiac output
2) Stasis, increased
3) Increased, Na
4) spills, less than 160, amino acids
5) Stasis
UTI -bc there is a tendency for amino acids and glucose to be in urine as a result of increase in GFR and renal plasma flow combined with stasis in ureters
Integumentary changes (3)
Due to what?
1) Melasma - skin problem that causes brown-gray patches on face
2) Linea Nigra -pigmented line in the middle of the abdomen
3) Striae -stretch marks
These occur d/t increased estrogen and progesterone
Musculoskeletal changes (4)
1) Change in center of gravity (waddling gait)
2) Increased hormone relaxin to relax connective tissues
3) Diastasis recti abdominas (separation of abdominal muscles)
4) Increased lordosis
Maternal and Social Adaptations include (5)
1) Accepting the pregnancy
2) Indentifying with mother role
3) Reordering personal relationships
4) Establishing relationship with fetus (emotional attachment)
5) Preparing for childbirth
Psychological Adaptations in the
1st trimester)
2nd trimester)
3rd trimester)
1) Ambivalence (mixed feelings), “not real”
2) Self absorbed, pregnancy becomes real
3) Fears about baby’s well being and delivery
Generally: Emotional Lability throughout
Rubin’s developmental tasks of pregnancy
1) Ensuring _____ ______ through pregnancy, labor, and birth
2) Seeking ______ of child by others
3) Seeking _____ and _____ of herself as mother to infant
4) Learning to ______ ______ on behalf of one’s child
1) Safe Passage
2) Acceptance
3) Acceptance, Commitment
4) Give oneself
Paternal adaptations (4), what is Couvade syndrome?
Similar to mother, accepting pregnancy, identifying with father role, reordering personal relationships, emotional attachment to fetus, preparing for childbirth
Sympathetic response to their partner’s pregnancy
Components of Initial Interview
1) Reason for seeking care
2) Medical surgical history, OB/GYN history, Nutrition history, Family/Social history (smoking, ETOH, drugs)
3) Current medications (include supplements and herbals
4) RISK FACTORS (environmental, age, genetic history)
5) History of physical abuse
6) EDD
7) Review of systems
Risk Factors for a pregnant woman
1) Preexisting medical conditions
2) Genetic Factors
3) Age (>35)
4) Environment
5) Teratogens
What are some medical conditions that increase risk for pregnancy complications?
What viral infections?
What does smoking and alcohol do to the baby?
No more than how much caffeine/day?
Thyroid disorders, DM, HTN, history of exposure to DES, acute MI, seizures, abruption, PROM (premature rupture of membranes), PTL (preterm labor)
Rubella, syphillis, HSV, toxoplasmosis, CMV
Smoking restricts fetal growth, Alcohol passes placental barrier and results in fetal blood alcohol levels similar to mother
300 mg/d
Routine Lab Tests (5 groups)
1) CBC, COOMB test Blood type, Rh, Antibody Scren, Urine culture and protein
2) Rubella, varicella, syphilis (VDRL), HIV, hepatitis B
3) Thyroid panel (look for anemia), Genetic panel
4) Pap (if 21 or older and due for pap)
5) GC (Neisseria Gonorrhea)/Chlamydia
Hydrops fetalis
Abnormal collection of fluid that indicates fetal complications, in this case is d/t fetal hemolysis -> anemia-> heart failure in the case of Rh incompatibility
Additional Testing at
18-20 weeks)
24-28 weeks)
28-30 weeks)
35-37 weeks)
1) Second Trimester Sonogram (fetal structures “anatomy screen” and positions)
2) Screen for Gestational Diabetes
3) RhoGam if indicated
4) Group B Strep
Describe the test for gestational diabetes?
1) 1 hour glucose test after 50gm of oral glucose, must be 135-140, if above 140 then proceed to a
2) 3 hour glucose test where Fasting = 95, 1st hour = 180, 2nd hour = 155, 3rd hour = 140
What is RhoGam?
Given at 28 wks and postpartum for all Rh negative women
What is GBS? Why do we test for it?
What is the prevalence?
GBS is a common bacteria found in the gut, we swab for it at the perineum and if present, we give antibiotics to prevent baby from getting very sick with GBS syndrome
1/3 women have it, 50% give it to baby, 3% of those get GBS syndrome
Other “additional tests” done that aren’t specified to a specific time frame (4)
Biophysical Profile (measures pockets of amn fluid that contains fetal urine to see if theres enough output), Amniotic Fluid Volume, Non-Stress Testing, Contraction Stress Test
Genetic Testing (serum) for what conditions?
1) Trisomies 18, 21
2) Hemoglobinopathies
3) Cystic Fibrosis
4) Fragile X (developmental disability)
5) SMD (stereotypic movement disorder)?
What type of tests do we utilize for aneuploidy and neural tube defects?
“Multiple marker tests”
1st trimester markers (for an/ntd)? When is this test done?
PAPP-A (pregnancy associated plasma protein A)
Beta hCG
at 11-13 weeks
Note: beta hcg is what makes women nauseous
2nd trimester markers (for an/ntd)? When is this test done?
"Quad Screen" AFP (alpha-fetoprotein) uE3 (unconjugated estriol) hCG inhibin A
20 wks
If AFP is increased = ?
If AFP is decreased =?
risk of NTD
risk of Down’s
Invasive tests for high risk women (2)
Chorionic villus sampling
Amniocentesis
Chorionic villus sampling =
Take from where? When is it done?
prenatal test that diagnoses chromosomal abnormalities such as downs, and other genetic disorders
Taken from placenta at 10-12 wks
Amniocentesis =
When can it be done?
prenatal diagnosis for chromosomal abnormalities (downs), fetal infections, and sex determination
15-17 wks
Visiting schedule during 1st, 2nd, 3rd trimesters
1st) monthly
2nd) 2-3 weeks
3rd) every 2 weeks, weekly in last month
Nursing assessments during patient visits include (5)
Weight BP Fundal height (size vs dates)/Fetal growth Urine for proteins, ketones, glucose Fetal heart beat and movement
Nuchal Translucency Test =
Measures thickness of fluid filled space behind fetal neck, should be under 4 mm, done by ultrasound
NT test should be done with what?
What does it indicate if greater than 4mm?
In conjunction with 1st trimester markers
In conjuction with 1st and 2nd markers, can have detection rate as high as 93-96% for trisomy 21
Nursing Assessments during Pt visits (5)
Weight BP Fundal height- size vs. dates, fetal growth Urine for protein, ketones, glucose Fetal heart beat and movement
Nursing Assessments specifically for mother (5)
1) Quickening
2) Preterm labor assessment
3) Leaking of fluid
4) Bleeding
5) Concerns, questions
Quickening =
fetal movement detected by mother; appx 20 wks
Required folic acid intake/day
poor folic acid intake = higher risk for
400 mcg
neural tube defects
Weight Gain
1) Total weight gain?
2) Weight gain each wk in 1st trimester?
3) Weight gain during last two trimesters?
1) 25-35 llbs
2) 1-4.4 lb/wk (0.5-2 kg)
3) 1 lb/wk (0.45kg)
Women need \_\_\_\_\_ extra calories Increased \_\_\_\_\_ (\_\_), \_\_\_\_\_, \_\_\_\_ needs
300
protein (60gms about 14g higher), iron, calcium
Foods to Avoid (4)
1) Mercury “5 fishes” Tilefish, shark, swordfish, mackerel, tuna
2) Soft cheeses (nonpasteurized) Brie, feta, mozzarella in water -> risk of listeria
3) Sushi
4) undercooked foods, raw fruits
Common Discomforts
N/V, urinary frequency, fatigue, breast tenderness, increased vaginal discharge, nasal stuffiness and nosebleeds, pytalism
Patient Teaching for 1st trimester discomforts N/V = Fatigue = Congestion = Pytalism =
N/V = eat dry crackers, small frequent meals high in carbohydrates and protein, herbal teas, accupressure, 250 mg ginger 4x daily
Fatigue = Rest when tired! ….no shit
Congestion = cool mist humidifier
Pytalism = decrease starch intake and increase astringent (mouthwash)
2nd trimester discomforts (4)
Heartburn Ankle edema Varicose veins Hemorrhoids Backache
3rd Trimester discomforts (7)
Constipation Backache Leg Cramps Faintness Dyspnea Carpal tunnel syndrome Braxton-Hicks contractions
Management of 2/3 trimester symptoms
Supportive shoes/stockings Back support/good posture/body mechanics Exercise/dorsiflexion of foot Diet modification Tums Stool softener Avoid supine position Monitor for preterm labor
Warning signs
Gush of fluid from vagina Vaginal bleeding Abdominal pain Fever (38.2/101) Dizziness, blurred vision, spots before eyes Persistent headache Persistent vomiting or persistent abdominal pain Edema in face/hands Significant weight gain (2kg/wk) Muscular irritability/convulsions Epigastric pain Oliguria Dysuria Absence of fetal movement
Signs of Preterm Labor
Mild menstrual like cramps without diarrhea
Constant dull, low backache
Suprapubic pain or pressure
Pelvic or lower abdominal pressure or heaviness
Leaking of water from vagina
Change in character of vaginal discharge
Uterine contractions every 10 min for 1 hour
Rupture membranes (your water breaks with a gush or trickle of fluid)
Extremely low birth weight
less than 1000 grams
Your patient is pregnant for the fourth time. At home she has a child who was born at Term. Her second pregnancy ended at 10 wks gestation. She then gave birth to twins at 35 wks but one twin died soon after birth.
What is the Gravida and Para using TPAL?
G = 4 (total # of pregnancies including the current one)
T = 1 (Number of term infants)
P = 2 (Number of preterm infants born 20-37 wks) Thus twins count as 1 pregnancy but 2 births
A = 1 (# of spontaneous or planned abortions)
L = 2
G 4 P 1 2 12
