Exam 1 - week 7 Flashcards
1
Q
what is the fundus?
A
top part of the uterus
2
Q
What is the bottom of the uterus called?
A
cervix
3
Q
at what point during pregnancy does an embryo become a fetus?
A
9 weeks
4
Q
at what point during pregnancy is an embryo formed?
A
after implantation to uterus wall
5
Q
when does organogenesis occur?
A
implantation to 8 weeks (embryonic stage)
6
Q
Why is the embryonic stage a fragile period?
A
-most susceptible to damage from external sources, including teratogens, infections
(rubella or cytomegalovirus), radiation, and nutritional
deficiencies
7
Q
what is the fetal tissue on the placenta called?
A
chorionic villi
8
Q
what is the maternal tissue on the placenta called?
A
- decidua basalis
- cotyledons
9
Q
What is the function of placenta?
A
– Metabolic and gas exchange
– Hormone production
– Amniotic fluid regulation
- acts as a pass-through between the
mother and fetus, NOT a barrier. Almost everything the
mother ingests (food, alcohol, drugs) passes through to
the developing conceptus.
10
Q
How many vessels are in the umbilical cord?
A
3 vessels: 2 arteries (carries things AWAY from baby and to placenta) and 1 vein (carries things from placenta TO baby)
11
Q
What are the amniotic membranes? (2)
Which is inner and which is outer?
A
- Amnion: inner membrane (closer to fetus) (think of the in/”inner)
- Chorion: outer membrane
12
Q
What is the structure of the umbilical cord?
A
o Two umbilical arteries
o One umbilical vein
o Wharton’s jelly
13
Q
What is wharton’s jelly?
A
-A specialized connective tissue that surrounds these 3 vessels in the umbilical cord to prevent compression, which would cut off fetal blood and nutrient supply
14
Q
What is poloyhydramnios?
A
too much amniotic fluid (>2,000ml at term)
15
Q
What are the potential complications of polyhydramnios?
A
associated w maternal diabetes, neural tube defects, chromosomal
deviations, and malformations of the CNS and/or gastrointestinal tract that prevent
normal swallowing of amniotic fluid by the fetus
16
Q
what is oligohydramnios
A
too little amniotic fluid (less than 500ml at term)
17
Q
What are the potential complications of oligohydramnios?
A
-uteroplacental insufficiency and fetal renal abnormalities
18
Q
what is maternal mortality?
A
annual # of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental
or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 LIVE BIRTHS, for a specified year.
19
Q
What is something important to note about how the maternal mortality rates are calculated?
A
the statistics are out of a bigger denominator: 100,000 (this is bc it doesn’t happen “as” often)
20
Q
What is maternal morbidity?
A
Diseased state or condition / 1000 live births
21
Q
What is neonatal mortality?
A
of deaths in first 28 days of life/ 1000 live births
22
Q
What is infant mortality?
A
of deaths in first 12 months of life / 1000 live births
23
Q
What is perinatal mortality?
A
of stillbirths and deaths in the first week of life per 1,000 live births
24
Q
Define preterm
A
born prior to 37 weeks
25
define late preterm
born between 34 weeks and 37 weeks
26
define a full term pregnancy
born between 37-42 weeks
27
what are the categories of neonatal birthweights? (4)
o Very low birth weight (VLBW)
o Low birth weight (LBW)
o Small for Gestational Age (SGA) – Below the 10th percentile on growth chart
o Large for Gestational Age (LGA) – Above the 90th percentile on growth chart
28
Very low birth weight (VLBW) –
Less than 1500 g (3lb, 5oz)
29
Low birth weight (LBW) –
Less than 2500 g (5.5lbs)
30
Small for Gestational Age (SGA) –
Below the 10th percentile on growth chart
31
Large for Gestational Age (LGA) –
Above the 90th percentile on growth chart
32
define a post-term baby
born after 42 weeks
33
When does implantation occur?
7 to 10 days after conception in the endometrium (uterine wall)
34
What is the endometrium?
mucous membrane lining the uterus, which thickens during the menstrual cycle in preparation for possible implantation of an embryo.
35
When does a blastocyte become an embryo?
after implantation (7-10 days after conception)
36
When is the embryonic stage?
implantation to 8 weeks
37
When is organogenesis most critical?
1st trimester/embryonic stage
38
During the 1st trimester, there is the greatest risk of (3 things)
- malformation
- teratogen exposure
- infection exposure
39
When does an embryo become a fetus?
9 weeks
40
Fetal tissue is made up of:
```
chorionic villi (finger-like projections on the chorion)
-(part of the chorionic plate, makes up the fetal tissue of the placenta)
```
41
Maternal tissue is made up of:
- decidua basalis (basal plate of placenta)
| - cotyledons
42
What is placenta's function?
– Metabolic and gas exchange
– Hormone production
– Amniotic fluid regulation
-filters (?)
43
What are the 2 layers of the amniotic membranes?
- amnion (inner membrane, closest to fetus. This is actually what produces amniotic fluid)
- chorion (outer membrane)
44
What is the structure of the umbilicus? (3 main components)
o Two umbilical arteries
o One umbilical vein
o Wharton’s jelly
45
function of the umbilical arteries
brings blood from baby to placenta
46
function of the umbilical vein
brings blood from the placenta to the baby
47
What is the meconium made up of?
it's from the amniotic fluid that the baby consumes in utero
48
function of amniotic fluid
-maintains constant body temp for fetus
-permits symmetric growth development
-cushions fetus from trauma
-allows umbilical cord to be relatively free from compression
-promotes fetal movement to enhance musculoskeletal development
o Essential for fetal growth and development, esp fetal lung development
o Babies breath the fluid through lungs. They also swallow it
49
what is polyhydramnios
too much amniotic fluid (>2,000ml at term)
50
average amount of amniotic fluid at term
approx 1 liter (1,000ml)
51
3 important fetal structures:
* Ductus Venosus
* Foramen Ovale (closes after baby is born. Connects R and L atrium)
* Ductus Arteriosus
52
Main function of fetal structures
allows blood to bypass the lungs so that it can bring oxygen to the developing organs
53
what is the ductus venosus?
- part of the fetal circulation
- goes away shortly after birth
- Creates a shortcut for blood to go from the umbilical vein to the inferior vena cava (allows for the liver circulation to be skipped over)
54
what is the foramen ovale?
- part of the fetal circulation
- goes away shortly after birth
- anatomic opening btwn the R and L atrium (creates a shortcut so some of blood can bypass the lungs)
55
what is the ductus arteriosus?
- part of the fetal circulation
- goes away shortly after birth
- Connects main pulmonary artery to the aorta (creates a shortcut so some of blood can bypass the lungs)
56
When is the 1st trimester?
1-13 weeks
57
when is the 2nd trimester?
14-26 weeks
58
when is the 3rd trimester?
27-40 weeks
59
what is nagel's rule?
- how to estimate delivery date
| - first day of LMP minus 3 months plus 7days and 1 year
60
In gravida para term, what does para mean?
(# of pregnancies NOT # of infants. So a 1st time pregnant women that gives birth to twins is still G1P1 )
o description of pregnancy outcome (REGARDLESS OF HOW MANY BABIES ARE IN “LITTER”)
o single number: pregnancies that have reached viability
o 4 number system TPAL: used to defines specific outcomes of all pregnancies
61
in gravida para term, what does gravida mean?
(# of pregnancies)
o pregnant / prior number of pregnancies
o primi-gravida: 1st pregnancy
o multi-gravida: 2nd or more pregnancy(ies)
62
In TPAL, what does T stand for?
o T: number of pregnancies that have reached Term
63
In TPAL, what does P stand for?
o P: number of pregnancies that have been delivered Preterm
64
In TPAL, what does A stand for?
o A: number of pregnancies that ended prior to age of viability—usu prior to 20 weeks. Voluntarily or spontaneously (abortions and miscarriages)
65
In TPAL, what does L stand for?
o L: number of living children (this accounts for twins and triplets, etc)
66
what are the 3 categories of the S/S of pregnancy?
1. Presumptive
2. Probable
3. Positive
67
Examples of presumptive S/S of pregnancy
-things that the mother is aware of but the examiner may not be aware of
o Missed period, breast tenderness, nausea, fatigue (all of these by themselves can also happen from other causes (e.g. stress) but when you see them all together it COULD indicate pregnancy)
68
Examples of probable S/S of pregnancy
```
•objective--things that an examiner can see; these are more likely than just presumptive
o Goodell’s sign
o Chadwick’s sign
o Hegar’s sign
o Ballottement
o + Urine pregnancy test
```
69
What is goodell's sign?
-softening of the cervix (Make “ooo” sound in gOOOOdell and think about lips getting softer, same as cervix)
70
what is chadwick's sign
bluish-purplish discoloration of vaginal mucosa and cervix (d/t increased vascularization and oxygenation, normally it is pinkish in non-pregnant women)
71
what is hegar's sign
softening of the uterus (isthmus of uterus) (felt by a manual exam)
72
what is ballottement
examiner feels “floating fetus” (examiner can do a vaginal exam and “gently tap or bump” the fetus and it goes up and then comes back down)
73
How reliable are urine tests for pregnancy?
Most are 98% accurate
| False negative possible if done too early
74
Examples of positive signs of pregnancy?
o Visualization of fetus - Ultrasound
o Sonogram heartbeat
o Audible heartbeat
o Fetal movement felt by experienced clinician
75
what is Human chorionic gonadotropin (hCG)
the earliest biochemical marker of pregnancy (this is what’s in the OTC pregnancy tests)
76
How soon will a urine pregnancy test show up positive?
as early as 4 days after conception
77
what data or information does the blood test for hCG provide?
provides “numerical” analysis of pregnancy
values increase incrementally with growing pregnancy
used most often to verify “growth” w/ spotting or risk of “problem”
78
Hormone changes during pregnancy (what happens with hCG, progesterone, estrogen)
- hCG increases in beg of pregnancy and then drops off
- progesterone increases steadily throughout entire pregnancy and then drops at the end
- estrogen increases steadily throughout entire pregnancy and then drops at the end
79
role of (human placental lactogen (hPL) hormone
- insulin antagonist
| - triggers milk production
80
function of estrogen produced by placenta during pregnancy?
causes enlargement of a woman's breasts, uterus, and external genitalia; stimulates myometrial contractility
81
which hormone helps to inhibit (or quiet) uterine activity during pregnancy?
progesterone
82
which hormone stimulates labor?
prostaglandin
83
at 20 weeks gestation, where (approx) is the fundal height?
level of umbilicus
84
Does the fundal height continue to grow throughout all 40 weeks of pregnancy?
No!
- fundal height starts to "drop" after 36 weeks
- gradual process known as "lightening" when the baby is settling into the pelvis
85
What are adaptations to the breast during pregnancy?
```
o Fullness, heaviness
o Heightened sensitivity from tingling to sharp pain
o Areolae become more pigmented
o Montgomery’s tubercles
o Colostrum (possible) by 16 weeks
```
86
How much does the blood volume increase during pregnancy?
by 50% (mostly plasma increase)
87
What impact does the increase of blood have on the body during pregnancy?
-bc it is relatively mostly plasma that increases, it causes PHYSIOLOGIC ANEMIA due to hemodilution (can cause a decrease in mother's hematocrit)
88
CV system changes during pregnancy?
- blood volume increase
- physiologic anemia d/t hemodilution
- increased demand for iron
- increased CO
89
changes in pulse during pregnancy?
increases in 2 trimester until term (10-15 above norm)
90
changes in BP during pregnancy?
decreases in 2nd trimester (returns to normal at term)
91
changes in coagulation during pregnancy?
decreased coagulation time (hypercoagulable)
92
Changes in blood flow during pregnancy?
* Pressure on the Inferior Vena Cava from weight of gravid uterus
* Decreases venous return to the heart
* Can decrease BP
93
can a woman lie on her back during pregnancy? Why or why not?
No! adds too much pressure on the inferior vena cava (can lead to "supine hypotensive syndrome")
94
what is supine hypotensive syndrome
- acute hemodynamic change
- causes woman to have Sx of weakness, light-headedness, nausea, dizziness, syncope
- happens when woman lays on her back
95
Changes in respiratory system during pregnancy?
```
o thoracic breathing
o increased metabolic rate
o increased oxygen demand and consumption
o relaxation of cartilage
o greater expansion
o congestion
```
96
changes in GI system during pregnancy?
o Nausea and Vomiting (once HCG starts to drop after 1st trimester, this goes away)
o Heartburn
97
changes in metabolism during pregnancy?
o Changes in carbohydrate metabolism
o Increasing resistance to insulin
o Delayed gallbladder emptying time
o Constipation / Hemorrhoids
98
what is PICA?
- craving for NON food substances (starch, clay, dirt, ice)
- not common
- assess for iron deficiency anemia
99
changes in renal system during pregnancy?
* increased GFR from increased cardiac output
* dilation of ureters / increased pressure on bladder
* increased resorption of Na
* some glucose spills at serum levels less than 160
100
changes in integumentary system during pregnancy?
o Chloasma
o Linea nigra
o Areola darken and enlarge / Montgomery Tubercles
o Striae Gravidarum
• Rate of hair growth may decrease (Avoid hair coloring? Research varies)
• Changes in finger nails (could get stronger OR weaker)
101
what is chloasma?
“the mask of pregnancy” “glow of pregnancy"
102
what are montgomery tubercles
tiny glands that surround the nipple not only to keep the breast lubricated, but also protect against infection to help keep the baby healthy
103
what is o Striae Gravidarum
stretch marks
104
changes in musculoskeletal system during pregnancy?
o change in center of gravity
o Increased hormone relaxin-- relaxes connective tissue
o diastasis recti abdominis
o “waddling gait”
o Increased lordosis (curvature of lower spine)
105
changes in maternal emotional and social adaptation
```
o Accepting pregnancy
o Identifying with mother role
o Reordering personal relationships
o Establishing relationship with fetus (Emotional attachment)
o Preparing for childbirth
```
106
Rubin's developmental tasks of pregnancy
* Ensuring safe passage through pregnancy, labor and birth
* Seeking acceptance of the child by others
* Seeking commitment and acceptance of herself as mother to infant
* Learning to give of oneself on behalf of one’s child
107
Rubin's developmental tasks of pregnancy in 1st trimester
- AMBIVALENCE
- "not real"
- woman focuses on herself
- acceptance of pregnancy by herself and others
- mother accepts idea of pregnancy but not of infant
- identifies what must be given up to assume new role
108
Rubin's developmental tasks of pregnancy in 2nd trimester
- self-absorbed
| - pregnancy becomes real (esp with quickening-sensation of fetal movement)
109
Rubin's developmental tasks of pregnancy in 3rd trimester
- concerns about baby's well-being
| - fears about delivery
110
Adaptation during pregnancy of other family members
```
Paternal adaptation
o Accepting pregnancy
o Identifying with father role
o Reordering personal relationships
o Establishing relationship with fetus
o Emotional attachment
o Couvade Syndrome
o Preparing for childbirth
Sibling adaptation / Grandparent adaptation
```
111
what is couvade syndrome
a reaction to pregnancy by fathers where they have a sympathetic response to partner's pregnancy
-physically, they may gain weight around the middle and experience nausea and other GI disturbances
