Exam 2 Flashcards
Risk Factors for post term pregnancy
Nulliparity, history of post term pregnancy, maternal obesity, carrying a male fetus, having a family history of post-term pregnnacy
Maternal risk for post term pregnancy
dysfunctional labor, operative birth, operative vaginal birth, perineal trauma, postpartum hemorrhage (associated with risk of macrosomia)
fetal risk in post term pregnancy
mec stainted fluid
areas of infarction and calcium on placenta
amniotic fluid normally begins to decrease at 38 weeks.. oligo incidence higher in post term pregnancy= cord compression and fetal distress during labor
risk of still birth after 42 weeks is twice as high
risk of death during first year of life is higher
labor stimulating activities
stripping of membranes
60mg castor oil PO (diarrhea and cramping)
unprotected intercourse
Induction for post dates/bishops scoring
42+ for sure a candidate >6 is a good bishops score 0= closed, 0-30, -3. firm, posterior 1= 1-3 cm, 40-50, -2, medium, midline ... 3 = >5 cm ect..
Post dates fetal surveillance
fetal movement count (daily) NST (twice weekly) BPP (twice weekly) modified Bpp (twice weekly) AFI (twice weekly) CST? weekly
Placenta Previa risk factors
AMA >35 multiparity prior c section infertility treatments smoking unexplained AFP multiple gestation short inter pregnancy interval prior uterine cutterage
Placenta previa Presentation
painless vaginal bleeding in late second or early third trimester
Placenta previa management
no digital exam!
asymptomatic previa- delivery 36-37 weeks, complicated deliver immediately
Risks for Placental Abruption
HTN!! short interpregnancy interval C sections PPROM smoking cocaine black or caucasian polyhydramnios multiple gestation uterine decompression thrombophelias uterine leiomyoma maternal trauma unexplained elevated AFP
Maternal Issues Placental Abruption
risk for shock, coagulopathy, renal failure, death
high recurrence rate
couvelaire uterus- blood seeping into uterine musculature
Placental Abruption Presentation
could be no s/s, especially with a concealed abruption
visible bleeding in a marginal placental separation
** hallmarks are visible bleeding and abdominal pain (uterine hypertonicity and tenderness)
Management- bleeding in second half of pregnancy
blood type, rh risk factors: Rhogam within first 48-72 hours (before 12 weeks dose if 50, after dose is 300) of bleeding onset
CBC, coags
ultrasound to see location of placenta (no digital exam!)
hospitalization for bleeding with previa
serial growth US for women with history of abruption
Complete pregnancy loss
history of heavy bleeding, cramping, passage of clots/tissue, followed by an abrupt decrease in pain and bleeding
complete passage of products of conception
cervix closed
uterus small
may see blood in vaginal vault
Incomplete pregnancy loss `
cramping intense, bleeding heavy
partial passage of products of conception
cervix open or closed
Delayed pregnancy loss (missed abortion or blighted ovum)
cervix closed
uterus small or appropriate for gestational age
amenorrhea may be only symptoms, FHT not heard
Early pregnancy loss medical management
oral or vaginal misoprostol for uterus less than 12 weeks.
4-16 hours to evacuate uterus
early pregnancy loss follow-up
1-2 weeks of pelvic rest
ovulation can return in 21 days, menses typically resumes in 6 weeks
no reason to wait to get pregnant again
follow up visit in 2 weeks- check for involution
fetal effects IUGR
** second highest cause of perinatal mortality, after prematurity not ALWAYS SGA still birth neonatal mortality delayed effects of CP and adult disease
Symmetric IUGR
smaller number and size of cells
happens early pregnancy
commonly caused by genetic, infectious, teratogenic insults
CMV, rubella, or drugs like phenytoin or valproate
occurred during period of hyperplasia
less likely to respond to antenatal interventions
Asymmetric IUGR
uteroplacental insufficiency
chronic fetal hypoxemia and malnutrition in utero
fetal cell size is small but normal in number
associated with HTN, preeclampsia, diabetes, renal disease, and abnormal placentation
IUGR diagnosis
fundal height measurement off by more than 3cm
consecutive US measurements made 2 weeks apart
targeted US for anatomy scan and AFV ( aneuploidy?)
IUGR causes
Aneuploidy
non-aneuploidy syndrome
viral infections
placental insufficiency
IUGR management
serial growth US 3-4 weeks apart
AC provides best measurements
serial doppler flow studies weekly or bi-weekly
NST weekly or bi-weekly
BPP
AFI- declining is sign of worsening placental function
Recommended fluid intake in pregnancy
3L/day or 8-12 8oz glasses a day
Caloric intake in pregnancy
No extra calories first trimester
2nd- 340/day
3rd- 450/day
Fats in pregnancy diet
20-35%
DHA (omega 3) is super important for brain and eye development
may prevent preterm birth
pregnancy fish recommendations
consume 2 servings (12 oz) of fish per week
supplement with fish oil if fish is not eaten
NO shark, swordfish, king mackerel, tilefish
canned chunk light tuna has less mercury and can eat 2x/week, limit albacore to 6oz per week
remove skin and surface fat from fish before cooking
Carbs in pregnancy
175g/day
complex carbs
Protein in pregnancy
71g/day
high-protein diets should be avoided
meat, fish, poultry eggs, dairy products, tofu, soy, legumes, nuts, seeds
Iron in pregnancy
first trimester- requirements reduced needed in second, peaks in end of third 27mg/day (found in PNV) heme iron- found in meat is better non-heme in plants and ferrous sulfate take with vitamin c tannins decrease absorption
Calcium in pregnancy
1000mg/day 19-5- years old 1300mg/day 14-18 milk, yogurt, cheese more fat, less calcium fortified like orange juice and calcium
Vitamin D
600-4000IU
achieve circulating level of 40-60ng/ml
