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Antepartum (UPenn) > Health education (including childbirth) > Flashcards

Health education (including childbirth) Flashcards

1
Q

Describe treatment modalities for musculoskeletal discomforts during pregnancy, including alternative and complementary therapies.

A
  • Kegels
  • Pelvic tilts
  • Swimming/aquatic therapy
  • Chiropractic
  • Short term acetaminophen
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2
Q

Identify possible effect of pregnancy on female and male sexual response

A
  • Female sexual desire often hindered by symptoms of pregnancy (N/V, sore breasts, fatigue), especially in the 1st trimester
  • Female sexual desire may increase 2nd trimester, not always. May have increased blood flow to genitals and easier orgasm or may not
  • 3rd trimester gravid abdomen + physical discomforts may make traditional sex less appealing
  • Men may experience loss of libido, erectile dysfunction, premature ejaculation, fears of harming pregnancy
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3
Q

Identify variations in sexual practice including positions for intercourse and alternatives to vaginal intercourse for both comfort, safety, and sexual satisfaction.

A
  • Absolute contraindications: unexplained vaginal bleeding, placenta previa, premature ROM or cervical dilation
  • Relative contraindications: hx of preterm birth, multiple gestation
  • As pregnancy progresses: man-on-top/face-to-face less frequent. More appropriate positions: women-on-top/side/all-fours/rear entry. Mutual masturbation.
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4
Q

Risks of vaccines recommended in pregnancy

(Flu, Tdap, HepB)

A

All: Allergic reaction, injection site reaction, fever (usually mild). HA and fatigue and aches (not HepB)

  • ***Contraindicated if not feeling well

Flu: Hoarseness, sore, red or itchy eyes, cough, itching. Increased risk for Guillan Barre (1-2 cases per million people)

Tdap: (Generally mild, can be moderate): N/V/D/stomach aches, chills

  • ***Contraindicated if hx of bad reaction to Tdap, seizures of nervous system problem, Guillan Barre
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5
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Grantley Dick-Read

A

Book “Childbirth Without Fear” (1940’s)

Fear-tension-pain syndrome: fear increases tension → tension increases pain. Knowledge of childbirth can decrease fear

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6
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Lamaze

A
  • 6 weeks of classes.
  • Pavlovian approach.
  • Relaxation, breathing techniques, continuous support from partner and trained nurse. Purpose was to keep women quiet.
  • 6 healthy birth practices:
  1. Let labor start on its own
  2. Move around and change positions
  3. Continuous support
  4. Avoid interventions
  5. Avoid being on your back
  6. Keep mother and baby together
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7
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Bradley

A
  • 12 weeks of classes.
  • Husband/partner as active advocate to avoid medications/procedures (antiestablishment).
  • Nutrition and exercise.
  • Relaxation techniques and guided imagery. Coping mechanisms.
  • Immediate contact with newborn and immediate breastfeeding.
  • Morphed into Birthworks
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8
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

LeBoyer

A
  • Birth Without Violence.
  • French MD who went to India
  • Help develop a spiritual connection between mom and baby.
  • Conciousness of the baby as it enters the world → born into a basin of warm water and slowly lifted out into the dark
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9
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Kitzinger

A
  • British anthropologist
  • Birth as empowering, sexual and psychological experience for a woman.
  • Massage, touch, visualization – flow with contraction instead of blowing it away.
  • “Puppet strings relaxation”
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10
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Birthworks

A
  • Process, not a method.
  • Develop womens self confidence, trust, faith, education, introspection.
  • Each women finds her own way in L&D
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11
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

ICEA

(International Childbirth Education Association)

A
  • Family centered maternity care.
  • Freedom of choice
  • Alternatives in childbirth.
  • Draws from other models
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12
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Hypnobirthing

(Maria Mongon)

A
  • Inspired by Dick-Read.
  • Relaxation to eliminate fear.
  • Get yourself into state of hypnosis (partner may help) → state of deep relaxation → endorphins → natural analgesia
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13
Q

Identify the various philosophies of childbirth educators and the teaching content of childbirth education programs:

Birthing from Within

(Pam England)

A
  • Childbirth as a right of passage.
  • Cultural/social event not medical.
  • Self discovery.
  • Do different activities: art, aromatherapy → get to a deeper place of awareness, bond with group.
  • Soul searching in collaboration with partner in L&D.
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14
Q

Breastfeeding benefits

A
  • Baby benefits
    • Complete
    • Easy to digest
    • Has antibodies and human growth factor
    • Physical and cognative benefits in babies that BF as little as 2 weeks
    • Less likely to grow up obese
    • Feel warm/secure/comforted
  • Mother benefits
    • Decreases amount of bleeding, but can prolong
    • May help with weight loss
    • Delays return of menses
    • Reduces risk for: Breast/ovarian cancer, type II DM
    • Cheaper, can satisfy baby immediately
  • Better for the environment
  • Recommendations: exclusive breastfeeding for first 6 months of life, then continue breast milk until 1-2 years
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15
Q

What is a “Baby Friendly” hospital?

A
  1. Written breastfeeding policy
  2. Train all staff
  3. Inform all pregnancy women
  4. Initate breastfeeding within 30 minutes
  5. Show all mothers how
  6. Give newborns only breast milk
  7. Practice rooming in
  8. Encourage breastfeeding on demand
  9. No pacifiers
  10. Foster support groups
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16
Q

Cloth diapers vs disposable diapers

(from lecture)

A
  • Cloth less likely to cause asthma
  • Cloth may or may not be more expensive
  • Disposables take up 2% of landfill waste
17
Q

What is thimerisol?

A
  • Preservative derived from mercury
  • Removed from some vaccines in 2000
18
Q

Cord blood banking: good things to know

A
  • Chances of you or family member needing cord blood is very low: 1 in 2700
  • Can’t really do delayed cord clamping and get cord blood
  • All banks overseen by FDA
  • Private: $1700-2000 plus $125 yearly storage
    • More matches than bone marrow
    • Faster availability
    • Reduces risk of graft-vs-host disease
    • Fewer infections
  • Public:
    • Free
    • Less ethnic diversity
    • Can be used for research
19
Q

Benefits to a doula

(lecture)

A
  • Improved outcomes
20
Q

Circumcision facts

A
  • Risks
    • 2-5 complications/1000 circumcisions
      • Bleeding, infection, scarring, amputation, insufficient amount taken
    • Sensory changes
  • Benefits (uncommon/rare):
    • reduction in UTI in 1st year of life
    • reduction in penile and cervical cancer (in partner)
    • infection, hygeine, swelling
  • AAP position statement: not enough medical benefit to recommend routinely but enough to justify access to procedure.
    • Should be a parental decision
    • Provide analgesia
21
Q

Epidural facts

A
  • Potential adverse events:
    • maternal hypotension → fetal bradycardia
    • maternal hyperthermia → sepsis work up and antibiotics for both mom and baby
    • increased incidence of vacuum and forceps
    • spinal HA, numbness, pain, paralysis and death
    • can affect newborn sucking behavior
  • IV opoids can cause respiratory depression in newborn
  • No change in maternal satisfaction or APGAR scores with epidural or IV
22
Q

Weight gain counseling in 2nd + 3rd trimester

A
  • Normal BMI: 1 - 2 lb/week (25-35 lbs total)
  • Overweight: 3/4 lb/week (15-25 lbs total)
  • Obese: 1/2 lb/week (11-20 lb total)
23
Q

Food safety

(What to avoid, Cleaning/Cooking instructions)

A
  • Avoid
    • Soft cheese, unless pasteurized
    • Uncooked meats, refrigerated pates or spreads. Deli meat salads
    • Raw eggs, cookie dough
    • Raw or smoked fish
    • Shark, swordfish, tilefish, king mackrel
    • Raw sprouts
    • Raw/unpasteurized fruit juice or dairy products
  • Wash cutting boards with hot/soapy water
  • Wash and peel vegetablees and fruits
  • Wash hands after cooking hot dogs, deli/luncheon meats, and cook until steaming hot
24
Q

1st trimester warning signs

A
  • Vaginal bleeding
    • Differentials: post-coital (light), cervical lesions, vaginitis, ectopic, SAB
    • Do wet mount
  • Persistent N/V
    • Differentials: normal vs hyperemesis
  • Fever or chills
  • Dyuria, hematuria, inability to void
    • if treated for UTI → retest urine cx 4 weeks later
25
Q

2nd + 3rd trimester warning signs

A
  • Leaking fluid or abnormal vaginal discharge
  • Sudden, sharp, or continuing cramping or abdominal pain
  • Vaginal bleeding
  • Contractions/cramping
  • Pelvic pressure
  • Persistant backache
  • Persistant severe HA not relieved by OTCs
  • Edema of face, hands, or unilateral lower extremity
  • Visual changes (blurry vision, spots)
  • Decreased fetal movement
  • Fever or chills
  • Dysuria or hematuria
  • Cord prolapse
26
Q

Vaginal bleeding differentials in 3rd trimester

A
  • Cervical (ie bloody show)
  • Placenta previa (painless, bright red)
  • Abruption (watch FHR)
    • Late decels → uterus doesn’t relax all the way in between contractions
    • Cigarettes, cocaine, fall (monitor 4 hours), HTN
    • U/S poor at identifying abruption so watch FHR
    • > 50% abruption → 100% neonatal mortality
27
Q

Factors that affect maternal perception of fetal movement

A
  • „Obesity
  • „Maternal position
  • „Fetal position
  • „Anterior placenta
  • „Amniotic fluid volume
  • „Tobacco use

*No definitive evidence that kick counts prevent still births

28
Q

ROM assessment

A

Subjective

  • „Thorough hx of events surrounding episode
  • „Review current GA
  • „Time of first episode
  • „Amount
  • „Color
  • „GBS status
  • „Consider differential diagnosis

Objective: PE

  • „Fluid flowing from the cervical os
    • Have pt cough/bear down if no pooling
  • „Collection of specimen
    • „Use Q-tip to obtain specimen from posterior fornix
    • „Do not use lubricant
  • „Prepare slide
    • „Thin smear on glass microscope slide
    • „Allow slide to completely dry, use low power
  • „Results
    • „Positive: pool/dye/fern
29
Q

Contractions triage

A
  1. Leaking of fluid
  2. Vaginal bleeding
  3. Fetal movement
  4. 4-1-1 contractions:
    • 4 minutes apart
    • Lasting 1 minute
    • For 1 hour
  5. Distance from hospital
30
Q

Quad/penta screening

A
  • Done between 15 - 20 weeks
  • Quad screening: AFP, hCG, uE3, DIA
    • About 80% detection
  • Penta screen: Quad screen + h-hCG
    • About 83% detection
  • High AFP → increased risk for NTD
  • Low AFP and high hCG and high DIA → increased risk for Downs
  • Algorithm assesses risk by looking at: maternal age, weight, race, GA at time of test, and maternal serum markers
    • usually reported at +/- or abnormal/normal with a numeric value attached
  • ***correct GA very important***
31
Q

1st trimester genetic screening

A
  • Done between 11-13 weeks
  • Nuchal translucency (NT) by ultrasound
  • Maternal serum free or total hCG and PAPP-A
  • If positive → option for CVS (10-12 weeks) or amniocentesis
  • Has slightly better detection rate for Down syndrome than 2nd trimester quad screen
32
Q

Integrated screening

(genetics)

A
  • Combines serum 1st –trimester/NT with 2nd –trimester quad screen
  • Has highest sensitivity and lowest false positive rate
  • Can also just do serum integrated screening without NT (if not available) but not quite as accurate
33
Q

Common prenatal genetic screens

(chart)

A
34
Q

Ultrasound signs of aneuploidy

A
35
Q

Amniocentesis

A
  • Generally done 15-20 weeks
  • Removes 20 mL of fluid
  • amniotic fluid AFP > 2.0 from MoM → tested for acetylcholinesterase (AChE), if present → open NTD
  • Prenancy loss rates 1 in 300-500 pregnancies
36
Q

Chorionic villus sampling (CVS)

A
  • Done 10 – 13 weeks
  • Removes small portion of placenta (20-25 mcg) by transcervical or transabdominal approach
  • Detects Downs and other chromosomal issues but not NTD.
  • Pregnancy loss rates 1 in 100-300
37
Q

Noninvasive prenatal testing (NIPT)

A
  • Detects trisomies 21, 13, 18
  • Plasma cell-free DNA → analysis of fetal circulating cells via massively parallel shotgun sequencing (thousands of individual reactions within a single machine conducted simultaneously)
  • Higher rate of detection and lower false positive rate than conventional testing
  • Not diagnostic because < 100% sensitivity and specificity
  • Offer to women > 35, with a prior history of child with trisomy, ultrasound findings congruent with aneuploidy, or women with a positive 1st or 2nd trimester serum screen

Antepartum (UPenn) (26 decks)

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