Exam 2 Flashcards
Fertilization and Implantation
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
Umbilical Cord
Two arteries take blood away from fetus and one vein returns it
Wharton’s jelly surrounds the blood vessels preventing compression
Nuchal cord
when the cord is wrapped around the fetus’ neck
Placenta
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
Amniotic fluid
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
First part of fetal development
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
Fetal Circulation
Foramen Ovale is open between the atria
Ductus Arteriosus is open between the pulmonary artery and the aorta
Ductus Venous bypasses the liver
Ultrasounds
Early ultrasounds help to confirm pregnancy and determine molar vs regular
Later ultrasounds check for the correct development of anatomy
L/S ratio
Lecithin is a very important surfactant, its levels in comparison to sphingomyelin (which remains at constant levels) should be 2:1 before birth
Respiratory development
Development begins in week 4 and continues through week 32
Betamethazone used to hasten lung development in premature birth
Mono vs dizygotic twins
Mono is one egg that splits into two fetus
Dizygotic are two eggs that become two fetus
Lightening
When the fetus moves further down towards the birth canal
Can actually feel heavier
Quickening
The first movement detected by the mother
Presumptive signs of pregnancy
amenorrhea, fatigue, enlarged/sore breasts, increased urination, perceived movement, emesis/nausea
Probable signs of pregnancy
Positive Pregnancy test, ballottement (feeling for the fetus), braxton Hicks contractions, Goodell’s sign, Chadwick’s Sign, Hegar’s Sign
Positive signs of pregnancy
movement felt by doctor or nurse, heart beat detected, ultrasound, delivery of the baby
Braxton Hicks contractions
false contractions before labor
Goodell’s sign
softening of the cervix
Chadwick’s sign
bluish color of the vulva and cervix
Hegar’s sign
lower uterus/cervical isthmus is soft
Naegel’s rule
Technically you subtract three months, add seven days, then add one year
But fr you should just add nine months and seven days
Initial visit
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
Glucose Tolerance Test
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
Quad screen
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
Adolescent pregnancy
Stigma
Don’t often follow most prenatal care recommendations
not physically developed enough for pregnancy
Pregnancy > 35
Greater risks for hypertension and diabetes
Increased chance for miscarriage, stillbirth, placenta previa, and mortality
Centering
Group care setting for pregnant folks
Group based education and social support provided
Resulted in better outcomes for maternal knowledge and prenatal care
Pica
Consuming non food substances
Often soil or hair
Vitamins
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
First stage of labor
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
Second stage of labor
lasts from full dilation of the cervix until the baby is born
third stage of labor
delivery of the placenta
Five P’s of labor
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
Fetal positions
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
Leopold’s maneuvers
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
Pain management contraindications
Contraindications: mom doesn’t want it, maternal hemorrhage, maternal hypotension, allergy to anesthetic, some types of cardiac conditions
Signs of impending labor
bloody show (mucus plug)
rupture of membranes
lower back pain
weight loss
uterine contractions
Increased energy (nesting)
lightening
Non-pharmacological pain options
Acupressure or acupuncture
TENS unit
Water therapy
Aromatherapy
Music
breathing techniques
pharmacological pain options
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
accels
normal in response to movement
decels
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
variability
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
baseline heartrate
fetal heart rate on average over at least two minutes without a contraction
