Exam 2

Question 1

Fertilization and Implantation

Answer 1

Fertilization occurs in the outer third of the fallopian tube
Implantation occurs 6-10 days after conception
Trophoblast sends chorionic villi into the endometrium for nutrients.
Becomes a fetus at day 15

Question 2

Umbilical Cord

Answer 2

Two arteries take blood away from fetus and one vein returns it
Wharton’s jelly surrounds the blood vessels preventing compression

Question 3

Nuchal cord

Answer 3

when the cord is wrapped around the fetus’ neck

Question 4

Placenta

Answer 4

In place by day 17 when the heart starts beating
Placenta allows metabolic exchange
Placenta produces HCG (human chorionic gonadotropin), HPL (human placental lactogen, estrogen, and progesterone
Also provides respiration, nutrition, excretion, and storage of nutrients

Question 5

Amniotic fluid

Answer 5

Surrounds the baby and allows weightlessness
First trimester most fluid comes from the mother
Second trimester the fetus starts contributing
helps maintain fetal body temperature, is a source of oral fluid and repository for waste, helps maintain electrolyte balance, cushions fetus from impact

Question 6

First part of fetal development

Answer 6

Spine and heart develop first
New organs are developed during the first eight weeks
fetus is most at risk from teratogens during this time period

Question 7

Fetal Circulation

Answer 7

Foramen Ovale is open between the atria
Ductus Arteriosus is open between the pulmonary artery and the aorta
Ductus Venous bypasses the liver

Question 8

Ultrasounds

Answer 8

Early ultrasounds help to confirm pregnancy and determine molar vs regular
Later ultrasounds check for the correct development of anatomy

Question 9

L/S ratio

Answer 9

Lecithin is a very important surfactant, its levels in comparison to sphingomyelin (which remains at constant levels) should be 2:1 before birth

Question 10

Respiratory development

Answer 10

Development begins in week 4 and continues through week 32
Betamethazone used to hasten lung development in premature birth

Question 11

Mono vs dizygotic twins

Answer 11

Mono is one egg that splits into two fetus
Dizygotic are two eggs that become two fetus

Question 12

Lightening

Answer 12

When the fetus moves further down towards the birth canal
Can actually feel heavier

Question 13

Quickening

Answer 13

The first movement detected by the mother

Question 14

Presumptive signs of pregnancy

Answer 14

amenorrhea, fatigue, enlarged/sore breasts, increased urination, perceived movement, emesis/nausea

Question 15

Probable signs of pregnancy

Answer 15

Positive Pregnancy test, ballottement (feeling for the fetus), braxton Hicks contractions, Goodell’s sign, Chadwick’s Sign, Hegar’s Sign

Question 16

Positive signs of pregnancy

Answer 16

movement felt by doctor or nurse, heart beat detected, ultrasound, delivery of the baby

Question 17

Braxton Hicks contractions

Answer 17

false contractions before labor

Question 18

Goodell’s sign

Answer 18

softening of the cervix

Question 19

Chadwick’s sign

Answer 19

bluish color of the vulva and cervix

Question 20

Hegar’s sign

Answer 20

lower uterus/cervical isthmus is soft

Question 21

Naegel’s rule

Answer 21

Technically you subtract three months, add seven days, then add one year
But fr you should just add nine months and seven days

Question 22

Initial visit

Answer 22

Thorough review of systems, health history, family history, and psychosocial history
Urine, blood, and cervical samples collected
STI testing completed
TB skin test
Urine tested for UTI, protein, glucose, and leukocytes

Question 23

Glucose Tolerance Test

Answer 23

Make them drink a very sugary drink and see where their blood sugar lands
Over 200 indicates diabetes
Completed between 24-28 weeks of pregnancy

Question 24

Quad screen

Answer 24

Measures AFP (alpha-fetoprotein) - made by the baby, HCG (human chorionic gonadotropin) made by the placenta, estriol made by the placenta and the baby’s liver, and inhibin A made by the placenta
Completed between weeks 15–18 of pregnancy

Question 25

Adolescent pregnancy

Answer 25

Stigma Don't often follow most prenatal care recommendations not physically developed enough for pregnancy

Question 26

Pregnancy > 35

Answer 26

Greater risks for hypertension and diabetes Increased chance for miscarriage, stillbirth, placenta previa, and mortality

Question 27

Centering

Answer 27

Group care setting for pregnant folks Group based education and social support provided Resulted in better outcomes for maternal knowledge and prenatal care

Question 28

Pica

Answer 28

Consuming non food substances Often soil or hair

Question 29

Vitamins

Answer 29

B9, folate - reduces risk of neural tube defects, also important in RBC production B6 - essential for metabolism, production of RBCs, antibodies, and neurotransmitters B12 - production of nucleic acids, protein, and RBCs, also important to neural function C - tissue formation and absorption of iron

Question 30

First stage of labor

Answer 30

Early phase, dilation from 0 to 5cm, irregular contractions every 5-30 minutes that last 30 seconds a piece, then there are regular contractions 3-5 minutes that last one minute Active phase: 60-90 second contractions every30 seconds to 2 minutes that last until the cervix is fully dilated

Question 31

Second stage of labor

Answer 31

lasts from full dilation of the cervix until the baby is born

Question 32

third stage of labor

Answer 32

delivery of the placenta

Question 33

Five P's of labor

Answer 33

Power - primary powers are the involuntary contractions, secondary powers are the woman pushing Passenger - remember fetal lie, position, and attitude Passageway - shape of pelvis Position of the mother - supine, hands and knees, squatting Psychological response

Question 34

Fetal positions

Answer 34

Cephalic - head first, with vertex means the baby's head is in flexion mentum/brow - chin or face first occiput - occipital bone first (posterior facing is best) Sacral - sacrum or legs first Shoulder - likely in transverse lie, shoulder is first

Question 35

Leopold's maneuvers

Answer 35

Feel the top Then the sides then the bottom then all over again Used to determine where the back is so you can know where to put the fetal monitor

Question 36

Pain management contraindications

Answer 36

Contraindications: mom doesn't want it, maternal hemorrhage, maternal hypotension, allergy to anesthetic, some types of cardiac conditions

Question 37

Signs of impending labor

Answer 37

bloody show (mucus plug) rupture of membranes lower back pain weight loss uterine contractions Increased energy (nesting) lightening

Question 38

Non-pharmacological pain options

Answer 38

Acupressure or acupuncture TENS unit Water therapy Aromatherapy Music breathing techniques

Question 39

pharmacological pain options

Answer 39

Sedatives - relieve anxiety and allow sleep Opioids - cross the placenta and can affect the fetus, that's why fentanyl with its short half life is so good Spinal anesthesia - puncture and blood patch combo anesthetic and opioids intrathecally to use less of both Laughing gas offers less pain control, but is not nearly as sedating

Question 40

accels

Answer 40

normal in response to movement

Question 41

decels

Answer 41

normal when early (aka matched with contractions) concerning when late concerning when variable intervene with late or variable decels by discontinuing oxytocin, assist with position change, and administer o2

Question 42

variability

Answer 42

how much the heart rate changes on average over 10 minutes without counting gigantic variables absent is undetectable to the naked eye minimal is 1-5 moderate is 6-25 marked is greater than 25 moderate variability predicts normal acid base balance

Question 43

baseline heartrate

Answer 43

fetal heart rate on average over at least two minutes without a contraction