Exam 2 Flashcards
Normal Fasting glucose levels
In glucose intolerance
<90
100 - 125
Fetal/newborn complications of diabetes in pregnancy
Birth defects
Macrosomia (large birth weight)
Stillborn
Hypoglycemia
Respiratory distress syndrome
Higher lifetime risk of obesity & glucose intolerance
Insulin requirements during pregnancy
1st trimester
2nd & 3rd
Labor
hPL is
1st - decrease in need for insulin (minimal fetal needs & low hPL)
2 & 3 - increased insulin requirements (placental maturation & high hPL)
Labor - increased energy = increased insulin needs
Human placental lactogen
OGTT is
What levels indicate GDM
What HbA1C level is a risk for GDM
Oral glucose tolerance test
Fasting > 95
75g 1Hr GTT > 180
75g 2Hr GTT > 153
- A1C greater than 7%
Maternal HIV transmission
How to treat HIV
Reduce instrumentation of what during labor
- Vertical transmission to baby through pregnancy, birth & breastfeeding (perinatal transmission)
- Treat with antiretroviral therapy AZT (start at 14 weeks till birth & IV during labor)
- episiotomies & fetal scalp electrodes
Gestational HTN is
How to diagnose
- Onset of HTN without proteinuria after 20th week (normal BP prior)
- BP of 140/90 on 2 counts 4-6hrs apart
Preeclampsia is
Risk factors
- HTN after 20 weeks with proteinuria
- primigravidity, obesity, preexisting medical condition, multi fetal pregnancy
Severe preeclampsia is
Signs/symptoms
Treatment
Management
BP > 160/110
- headache, blurred vision, oliguria, pulmonary edema, Epigastric pain
- Control BP, prevent seizures (quiet environment, sedatives), mag sulfate for neuro protection (baby)
- Assess vision & LOC, DTRs, edema, lung sounds… protect from injury
What is eclampsia
Signs & symptoms
Management
Preeclampsia with seizure activity or coma
- headache, blurred vision, epigastric pain, altered mental status, tonic-clinic convulsions, coma
- ensure patent airway, administer O2, fetal monitoring, mag sulfate
HELLP syndrome stands for
What is it
Betamethasone indication
Hemolysis, elevated liver enzymes, low platelets
- life threatening (high death risk) obstetric complication, clinically progressive
Hepatic dysfunction
- used to stimulate lung maturity in fetus
Magnesium sulfate is
administered by & therapeutic lvl
Toxicity & Antidote
Signs & symptoms of toxicity
Used to prevent seizures
- always IVPB & maintain therapeutic level 4-7
- >8 meq & antidote is calcium gluconate
- hyporeflexia, respiratory depression, decreased urine output, hypotension, cardiac arrest
Alpha-Fetoprotein analysis (AFP) detects what problems
Elevated vs low
Elevated AFP - neural tube defects, hydrocephaly, Turners syndrome
Low AFP - Down’s syndrome (trisomy 21)
Amniocentesis is
Preparation
Management
Danger signs
Collection of amniotic fluid for analysis
- no special diet restriction, stop anticoagulant meds, empty bladder, fetal monitoring, rhogam (for rh-)
- monitor vitals & fetal monitoring, observe puncture site, rest
- fever, leak of amniotic fluid, vaginal bleeding
Chorionic villus sampling (CVS) is
Potential risk
Diagnostic test for chromosome abnormalities & other inherited disorders (cannot detect neural TD)
- bleeding & hemorrhage, miscarriage, infection, digital or limb deficiency
Nonstress test (NST)
Reactive
Non-reactive
Indirect measure of uteroplacental fxn
- 2 FHR accelerations from baseline of at least 15bpm for at least 15 seconds
- absence of 2 FHR accelerations using 15 by 15 criteria in a 20 min time frame
Biophysical test BPP is
Scoring based on
Interpretations
A screening for uteroplacental insufficiency made up of 5 components
- 5 components for total of 10 points
2 points if present / 0 points if absent
Body movements - 3 or more limb movements
Fetal tone - one or more full extensions or flexions of trunk or limb
Fetal breathing - one or more breathing movements of >30 sec
Amniotic fluid volume - one or more pockets of fluid measuring 2cm
NST - reactive (2pts) non reactive (0 pts)
- score of 8-10 is normal / 5-6 is suspicious indicating compromised fetus / <4 is abnormal
Amniotic fluid analysis
How to confirm rupture of membranes
Cloudy or foul smelling indicates infection
Amniotic fluid is alkaline & a sample of fluid is taken w a nitrazine swab which turns blue if it is amniotic fluid
Best location to auscultate FHR
Clearly heard in back of fetus
Cephalic presentation - lower quadrant of maternal abdomen
Breech presentation - on or above umbilicus
Fetal monitoring
Intermittent vs continuous
Internal vs external
Intermittent : handheld (every 30 min low risk or 15 min high risk) / continuous : electronic monitor (10-20 minutes on entry into labor) to detect FHR changes & oxygenation
Internal : spiral electrode / external : ultrasound transducer (FHR) & tocotransducer (contractions)
Criteria for using internal monitoring of FHR
Ruptured membranes
Cervical dilation at least 2cm
Presenting fetal part low enough to place scalp electrode
Skilled practitioner to insert spiral electrode
Normal FHR
Bradycardia & causes
Tachycardia & causes
110-160 bpm
< 110 : heart block, maternal hypotension or hypothermia, severe hypoxia, maternal HR, 2nd stage labor, hypoglycemia,
> 160 : prematurity, maternal fever, fetal anemia, cardiac arrhythmias, maternal hyperthyroidism, drugs, fetal hypoxia
Variability of FHR
Absent
Minimal
Moderate (normal)
Marked
Why is variability important
Causes of decreased variability
Irregularity fluctuations of baseline FHR
-Fluctuation undetectable
-Fluctuation range < 5bpm
-Fluctuation range between 6-25bpm
-Fluctuation rate > 25bpm
Reflects intact neuro system & optimal fetal oxygenation
MOST important factor of FHR
- hypoxia, drugs, fetal sleep, prematurity, congenital abnormalities
FHR accelerations
Sign of
Interpreting fetal heart rate patterns
Category 1
Category 2
Category 3
Abrupt increase in FHR above baseline ; more than 15bpm above baseline lasting >15sec but < 2 min
Sign of fetal well being
1 - normal tracing (normal fetal acid-base balance)
2 - indeterminate tracing
3 - an abnormal tracing (predictive of abnormal fetal acid-base status)
Early deceleration
Late deceleration & intervention
Variable deceleration & intervention
- Response to fetal head compression (mirrors contraction ; no intervention required)
- caused by uteroplacental insufficiency (begins AFTER peak of contraction & returns to baseline AFTER end of contraction ; notify provider, reposition, discontinue pitocin, provide O2, IV fluid bolus)
- umbilical cord compression (V U or W shaped, abrupt onset, followed by an acceleration, often falls below 100bpm ; reposition, increase IVF, provide O2, vaginal exam)
What is pitocin used for
Indicated
It is used to stimulate uterine contractions
Indicated for initiation or improvement of contractions for reasons of maternal or fetal concern
Involution is 
Fundus descends
Cervix
Contraction of muscle fibers, regeneration of uterine epithelium
- descends 1-2cm every 24hrs (12hrs PP @ umbilicus)
end of 10 days fundus is fully descended
- returns to pre-pregnancy state by week 6
Lochia rubra
Lochia serosa
Lochia alba
Lochia amount
Scant
Light/small
Moderate
Large/heavy
- 3-4 days after birth (bright red)
- 3-10 days after birth (pinkish brown)
- 10-14 days after birth (white / light brown)
1-2 inch (10ml)
4 inch (10-25ml)
4-6 inch (25-50ml)
Pad saturated within 1 hr
Cardiovascular adaptations
Cardiac output
Bradycardia
WBC count
Coagulation factor & assessment
Temperature
- Cardiac output remains high for first few days PP & gradually returns to normal within 3 months
- 40-60 bpm first 2 weeks PP
- WBCs elevated for first 4-6 days PP
- hypercoagulable state = risk for thromboembolism (assess w homans sign)
- slightly elevated first 24hrs PP
Urinary adaptations PP
Urinary retention
Displacement of uterus
Must urinate within 12 hours & diuresis (increased urination) present 2-3 days
- retention is a major cause of uterine atony which allows excessive bleeding
- upward & to the side
Breast assessment PP
Secretions occur
Prolactin & oxytocin
Engorgement relief if breast feeding
Engorgement relief if not feeding
Size, contour, engorgement
Check for cracks or redness
Presence of colostrum
-Secretion typically appears 4-5 days after childbirth
- Prolactin AP initiates milk production
Oxytocin PP promotes milk letdown
- frequent emptying, warm showers & compresses b4 feeding, cold compress between feedings
- tight bra, ice, avoid stimulation
Stages of attachment
Proximity
Reciprocity
Commitment
- physical & psychological experience of parent being close to infant (contact, emotional, individualization)
- infants behaviors initiate parental response ; complimentary behavior & sensitivity
- enduring nature of the relationship
Engrossment : partner physiological adaptation includes
Visual awareness of newborn
Tactile awareness of newborn
Perception of newborn as perfect
Strong attraction to newborn
Awareness of distinct features of NB
Extreme elation by father
Increased self-esteem
Factors affecting attachment
Parents background
Infant health at birth
Care practices
Separation immediately after birth
Intensive care environment
What are postpartum blues
Characterized by
When do symptoms begin
When does it become PP depression
Transient emotional disturbances
- anxiety, irritability, insomnia, crying, sadness, loss of apetite
- begin 2-4 days PP & resolve by day 8
- if emotional disturbances last more than 10 days
Ovulation & return of menstruation
Nonlactating women
Lactating women
- menstruation returns 7-9 weeks PP
- anywhere from 2-18 months (depends on breastfeeding pattern)
Breastfeeding not a form of contraception
