Extra OB stuff from Pam Flashcards
from fertilization until pregnancy is 10 wks GA
embryo
10 weeks GA to birth
fetus
birth - 1 year
infant
How long is 1st trimester?
conception → 12-14 wks GA
How long is 2nd trimester?
12-14 wks GA → 24-28 wks GA
How long is 3rd trimester?
24-28 wks GA → delivery
uterine contractions before 37 weeks that cause cervical changes
preterm labor
Maternal cardiovascular changes in pregnancy
CO increases by 30-50%
systemic vascular restance decreases (decrease in BP)
maternal pulmonary changes in pregnancy
increase in tidal volume by 30-40%
TLC decreases by 5%
Maternal GI changes in pregnancy
nausea and vomiting
increase in GERD
constipation
Maternal renal changes in pregnancy
increased risk of pyelonephritis
increased GFR
Maternal hematological changes in pregnancy
plasma volume increases by 50%
RBC increases by 20-30%
hypercoagulable state
Maternal MSK and dermatological changes in pregnancy
shift in center of gravity
increased spider angiomas
palmar erythema
hyperpigmented nipples/umbilicus/abdominal midline/perineum/face
Common routine problems with pregnancy
back pain, constipation, dehydration, edema, GERD, hemorrhoids, PICA, round ligament pain, urinary frequency, varicose veins
bluish discoloration of vagina and cervix
Chadwick sign
softening and cyanosis of the cervix at or after 4 weeks
Goodell sign
softening of the uterus after 6 weeks
Ladin sign
fetal movement
quickening
Presumptive signs and symptoms of pregnancy
"felt by woman, not proof of pregnancy but will make you suspect it" fatigue (12 wk) breast tender (3-4 wk) N/V (4-14 wk) amenorrhea (4 wk) urinary frequency (6-12 wk) hyperpigmentation of skin (16 wk) quickening (16-20 wk) uterine enlargement (7-12 wk) breast enlargement (6 wk)
Probably signs and symptoms of pregnancy
"observed by examiner, more reliable indicators of pregnancy but not definitive" Braxton Hick contractions (16-28 wk) (+) pregnancy test (4-12 wk) abdominal enlargement (14 wk) ballottement (16-28 wk) Goodell sign (5 wk) Chadwick sign (6-8 wk) Hegar sign (6-12 wk)
Positive signs and symptoms of pregnany
“definitve and unmistakable signs of pregnancy”
US verification of embryo/fetus (4-6 wk)
fetal movement felt by clinician (20 wk)
auscultation of fetal heart tones via Doppler (10-12 wk)
routine tests in prenatal care → initial visit and first trimester
hematocrit blood type and screen RPR/VDRL - syphilis rubella antibody screen Hep B surface antigen gonorrhea and chlamydia cultures PPD PAP smear UA and culture HIV offered screen for aneuploidy (11-13 wk) chorionic villus smaple (9-12 wk)
increased level of MSAFP/triple or quad screen is correlated with increased risk for ______
neural tube defects
Decreased level of MSAFP/triple or quad screen is correlated with increase risk for
aneuploidies → Downs Syndrome
what are some routine tests done in the 2nd trimester?
MSAFP/triple or quad screen (15-18 wk)
OB ultrasound (18-20 wk)
cell free DNA
amniocentesis
what are some things you want to check on with the OB ultrasound at 18-20 wks?
gender, amniotic fluid volume and genetic anomalies, placental location and gestational age
what does cell free DNA screen for?
genetic anomalies
what are some routine screens done in the 3rd trimester → 27-29 wks?
hematocrit
RPR/VDRL - syphilis
glucose loading test
rhoGAM
what do you culture mom for at 36 weeks? If she is positive what do you treat her with?
Group B strep
IV PCN @ labor
If mom is found to have active HSV, what does this indicate?
C-section needed
How often are visits in the 1st and 2nd trimester?
5-6 weeks apart
How often are visits after 30 weeks?
How often after 37 weeks?
increased frequency
weekly after 37 weeks
how many extra calories does a woman need in pregnancy per day?
300 calories/day
what supplements does mom need in 2nd and 3rd trimester?
iron, calcium vitamin D
why should women avoid unpasteurized milk and dairy, hot dogs and luncheon meat, refrigerated pate, refrigerated smoked seafood, raw and undercooked seafood, eggs and meat
listeriosis
If your patient is underweight, what is the recommended range of total weight gain in pregnancy?
28-40 lb
If your patient is normal weight, what is the recommended range of total weight gain in pregnancy?
25-35 lb
If your patient is overweight, what is the recommended range of total weight gain in pregnancy?
15-25 lb
If your patient is obese, what is the recommended range of total weight gain in pregnancy?
11-20 lb
what is the recommended amount of exercise in normal pregnancy
150 min moderate intensity aerobic activity/week
what are some concerns about exercising in pregnancy?
joints are more relaxed (increase risk of injury)
balance may be off (falls)
breathing affected
What are some precautions a pregnant woman should take when exercising?
drink plenty of water
supportive bra
avoid overheating
avoid lying flat
what types of exercises should a pregnant woman avoid?
contact sports, skydiving, activities that may cause falls, hot yoga, activities about 6000ft in altitude
can pregnant women work?
yes as long as there are no complications and the environment is safe
when should pregnant women avoid sexual activity?
unexplained vaginal bleeding leakage of amniotic fluid cervical incompetence placenta previa preterm labor or risk of
when can pregnant women travel?
safe until 36 wks
when is the best time for pregnant women to travel
14-28 wk
when traveling what are pregnant women at increased risk for?
DVT
What conditions is travel for pregnant woman not recommended?
preeclampsia, PPROM, preterm labor
when are flu and TdaP vaccine recommended in pregnancy?
between 27-36 wks
what are TORCHH infections?
toxoplasmosis other (syphilis,VZV, parvovirus B19) rubella cytomegalovirus herpes virus HIV
settling of fetal head into the pelvis → occurs 2+ weeks before labor begins in 1st pregnancies
lightening
cervix softens, effaces, and dilates to release the mucous plug → days to weeks before labor
Bloody Show
painless uterine contractions, tighening or pressure, begin at 28 weeks gestation and increase with GA
Braxton Hicks Contractions
How can you make Braxton Hicks Contractions disappear?
walking
contractions that are regular and increase in intensity and duration with walking → felt in lower back and radiates to lower abdomen
bloody show
dilation and effacement
fetus is engaged
true labor
contractions are irregular → stop when walking and felt in abdomen above umbilicus
no cervical change
fetus is ballotable
False labor
surgical excision used to enlarge the vaginal opening → make decision on whether to do or not in the 3rd stage of labor
episiotomy
indications of labor induction
prolonged ROM fetal demise severe preeclampsia diabetes HTN post term pregnancy (>42 wk)
what do you use to ripen the cervix in labor induction?
PGE1 (misoprostol)
PGE2 (dinoprostone)
artificial rupture of membranes
amniotomy
what is used to induce active labor?
oxytocin
