infertility, conception through pregnancy Flashcards
1
Q
FSH: follicle stimulating hormone
A
Stimulates the follicle (which houses the eggs) to grow and mature
2
Q
LH-luteinizing hormone
A
After ovulation, converts the empty follicle into the corpus luteum and supports this structure(which in turn supports an early pregnancy until the placenta forms)
3
Q
estrogen
A
stimulates uterine growth and uteroplacental blood flow, cases a proliferation of the breast glandular tissue and stimulates myometrial contractility (at term)
4
Q
progesterone
A
The hormone of pregnancy-
- maintains the endometrium
- decreases the contractility of the uterus
- stimulates maternal metabolism and development of breast alveoli
5
Q
relaxin
A
relaxes the ligaments in the pelvis and softens and widens the cervix.
6
Q
prostaglandins
A
PGE: vasodilatory; smooth muscle relaxant (for uterine growth)
PGF: vasoconstrictive; smooth muscle contractor (for labor)
7
Q
GnRH
A
- what shows up on pregnancy test
- once egg is fertilized in uterine linning
8
Q
human chorionic gonadotropin
A
- high levels at beg of preg
- lower at end
- HCG starts being produced after implantation
- Remains low for duration of pregnancy
- Levels can be checked to evaluate state of pregnancy
- This is the hormone pregnancy tests test for
- HCG can also be tested by blood test, certain levels (amounts) correspond to weeks of gestation.
- If someone is miscarrying or having a pregnancy abnormality (ectopic preg, hydatidiform mole, genetic abnormality) then levels would be off what they should be at that gestation. - Multifetal pregnancies may cause increased levels of HCG
9
Q
HCG peaks at
A
60-70 days of gestation (weeks 8-10)
10
Q
hcg declines at
A
100-130 days of pregnancy (14- 19 weeks)
11
Q
infertility
A
inability to get preg for <12m
12
Q
reasons for infertility
A
- decrease sperm
- endometriosis
- ovulation disorders
- tubal occlusion
13
Q
intrauterine insemination
A
procedure use to place prepared sperm in the uterus at the time of ovulation
14
Q
in vitro fertiliation- embryo transfer
A
procedure of collecting clients eggs from the ovaries, fertiliizing the eggs in the labatory with sperm, and transfering the embryo to the uterus
15
Q
gamete intrafallopian transfer
A
- oocytes are retrieved and immediately placed with prepared motile sperm. both are placed together into a thin flexible tube. gametes are than injected into the fallopian tubes using surgical labroscopy
16
Q
donor oocyte
A
donated eggs are collected from a donor by IVF. eggs are inseminated. embroyos are placed in a recipents uterus. prior to implantation, the recipient undergoes hormonal therapy to prepare the uterus
17
Q
donor embryo
A
donated embryo is placed in the recipients uterus, which is hormonally prepared
18
Q
gestational carrier
A
couple completes the process fo IVF with the embryo placed in aother person, who will carry the preg. this is a contract agreement with the carrier having no genetic investment with the embryo
19
Q
surrogate mother
A
person is inseminated with semen and carries the fetus untill birth
20
Q
therapeutic donor insemination
A
donor sperm is used to inseminate a person
21
Q
embryonic development
A
The embryonic stage lasts from day 15 after fertilization until 8 weeks. All organ systems and external features are developing during this time. This is the most critical time, where the embryo is most vulnerable to malformations caused by environmental teratogens.
- happens after fertilization
22
Q
embryoblast
A
becomes baby
23
Q
blastocyst
A
embrotic cavity
24
Q
trophoblast
A
membrane and placenta
25
Fetal heart beat should be SEEN on US
after 6 weeks
26
fetal heart beat should be heard
via doppler after 10 weeks
| Assessed at each prenatal visit
27
fetal movement should be felt
around 16-20 weeks
| Maternal education and “fetal kick counts” in 3rd trimester
28
what week does fetal stage start
9 weeks
29
what day does fetal heart start beating
17 days
30
embryo weeks
0-9w
31
first 8 weeks
most major organ develop
| - most dangerous time, at risk for chemicals, diseases, toxins
32
20 w skin
downy hair (lenuva), vernex white waxy lotion, protect skin
33
full term
40 w
| 10m
34
presumptive
```
fatigue
breast tenderness
neausea and vomiting
amenorrhea
urinary freqeuncy
hyperpigmentation
fetal movements
uterine enlargement
breast enlargement
```
35
probable
```
braxton hicks contractions
postive pregnancy test
abdominal enlargement
ballottement
goodell's sign
chadwicks sign
hegars sign
```
36
positive
- ultrasound verification
embryo or fetus
- fetal movement felt by experienced clinician
- auscultation of fetal heart tones via doppler
37
calculating due date
1 year - 3 months + 7 days
38
uterus changes
- increase size
- increase weight
- increase fibrous connective tissue
- braxton hicks
- cervical softening
- mucus plug
39
endocrine
placenta
thyroid
pituitary
placenta
- produces HCB, HPL
- nutrients to fetus
- waste away from fetus
thryoid
- increase size and activity
- increase basal metabolic rate
- increase parathyroid activity
pituitary
- enlarges 9th month
- produces fsh, lh, thyrodtropin, andrenotropin and prolactin
40
cardio vascular changes
- increase blood volume (30-40%)
- increase hr
- increase cardiac palpitations
- heart enlargement
- murmurs
- pseudoanemia: more plasma volume less rbc
41
musculoskeletal changes
- increase lumbosacral curve
- altered center of gravity
- duck waddling gait- gooy ligaments
42
gastrointestimal
N/V normal with hormonal changes, constipation is very common due to intestines being displaced by enlarged uterus, GI motility is decreased for increased absorption
43
skin changes
Chloasma- increased in pigmentation on the face (‘the mask of pregnancy’), linea nigra- dark line of pigmentation from the umbilicus to pubic area, striae gravidarum- stretch marks on abd and thighs, Spider nevi (spider veins) and palmar erythema due to progesterone
44
fundus hight
```
12
20
after 20
36
40
```
12 weeks: fundus just above pubic bone
20w: at belly botton hole
after 20w: 1cm per week above umbillical cord
36w: at level of ziphoid process
40 w: uterus comes down
45
vena cava syndrome
- enlarged uterus compress the inferior vena cava and the lower aorta when pt. is supine
- reduced venois return to heart
- symtoms include decreased BP, light headedness, syncope, racing hert, sweating, fetal heart rate changes
**** turn on left side laterally- blood flow back
46
healthy weight to gain
25-35lbs
47
nutritional needs
- Increase in protein (basic growth),
- iron (increase maternal RBCs, 2x pre-preg recommendation),
- folate 600mcg/day (prevent neural tube defects),
- calcium 1000 mg/day
- Increase of 340- 452 calories / day
Fluid- 8-10 glasses (2.3 L)/ day (water, fruit juice, milk)
48
iron
- Double amt recommended pre-pregnancy-(anemia is very common in pregnancy)
- best absorbed between meals and when given with Vit C.
- Milk and caffeine interfere with absorption.
- Food sources- beef liver, read meats, fish, poultry, dried peas, beans, fortified cereals and breads. Iron supplements can cause constipation- stool softener may be needed
49
nutrition avoid
- Limit caffeine (no more than 200mg/day)
- No alcohol
- Pica- craving to eat nonfood substances, like chalk, dirt, red clay. CALL DOC
50
TORCH
“TORCH”- acronym for the following infections:
- Toxoplasmosis
- Other: Varicella, Parvovirus,
- Syphilis, Listeria, & Coxsackie Virus, Zika
- Rubella
- Cytomegalovirus (CMV)
- Herpes Simplex Virus (HSV)
- All are associated with potential for significant negative fetal outcomes including fetal death if infection occurs during pregnancy
- Often mild or even NO symptoms in mother
- Often limited or no treatment available
* *PREVENTION, PREVENTION, PREVENTION!!!!!!!
Toxoplasmosis
- Avoid eating raw or undercooked meat, avoid contact with feces of infected cats
Parvovirus (Fifth’s disease),
- Coxsackie (Hand, Foot & Mouth), CMV
Check status of those with high exposure risks-day care workers, etc. Precautions if non-immune.
Listeria
- Avoid eating unpasteurized cheeses (cantaloupe outbreak in 2011)
Rubella, Varicella
- Immunization available but not given during pregnancy – check status, precautions if non-immune, immunize postpartum.
Syphilis, Herpes
- Safe sex practices (condoms), suppressive therapy for HSV in the weeks before labor to prevent an active outbreak and transmission to baby.
Zika
- Avoid travel to high risk countries, use bug sprays/clothes to prevent mosquito bites, avoid contact with infected individuals
51
health promotion (X)
- No over the counter meds unless OBGYN/CNM ok’d
- No Alcohol (birth defects) or Tobacco (low birth weight)
- No Substance use
- No undercooked meat/poultry/eggs, sushi, soft cheeses(unpasteurized), seafood high in mercury, unwashed fruits/veggies, wet paint, kitty litter
- No hot tubs/saunas
52
health promotion (y)
```
Exercise good- ~ 30min moderate daily if not contraindicated
Avoid TORCH infections
Hair dye, massages, mani/pedi
Sexual intercourse
Travel
```
53
common discomforts of preg
Nursing Implications:
- N/V- 1st trimester dry crackers/toast before rising in the morning, small meals, avoid spicy, greasy, or gas-forming foods, encourage fluids in-between meals
- Constipation- 2nd/3rd trimesters, encourage plenty of fluids, high fiber diet, exercise regularly
- Breast tenderness- 1st trimester most freq, supportive bra needed
- Urinary freq- 1st/3rd trimesters, empty bladder freq, decrease fluid before bed, Kegels
- UTIs- common during preg, proper wiping, no bubble baths, use cotton underwear, looser pants, increase water intake, urinate before/after intercourse, don’t hold it, notify provider if urine is foul-smelling, bloody, or cloudy
- Fatigue- normal, freq rest
- Headaches- only normal in 1st trimester, hormonal/stress/lack of sleep, balanced diet, plenty of water, rest freq
- Heartburn- small freq meals, check with provider about over the counter antacids
- Hemorrhoids- 2nd/3rd trimesters, warm sitz bath, witch hazel pads (TUCKS), topical ointments
- Backaches- 2nd/3rd trimesters, exercise regularly, pelvic tilt exercises, proper body mechanics, side lying position
- SOB- mild common during 3rd trimester, maintain good posture, sleep with extra pillows, notify provider if worsening
- Leg cramps- 3rd trimester, extend affending leg, dorsiflex, heat over muscle or foot massage (not the calf!)
- Varicose veins/ edema- 2nd/3rd trimesters, rest with legs elevated, avoid constricting clothing, support hose, avoid sitting/standing in one position for too long, freq walking
- Gingivitis, nasal, epistaxis- due to estrogen levels, brush teeth gently, use humidifier, saline nose drops/spray
- Braxton Hicks- practice contraction, common during 3rd trimester, if it goes away with walking or change in position, not true labor. Your uterus is just practicing for the real thing
- Supine hypotension- lie on your side or semi-sitting with keens slightly flexed
54
initial labs
```
CBC (hgb/hct/plt)
Blood Type, Rh, ABS
Syphilis (RPR/VDRL
Rubella status
Hepatitis
HIV
Urinalysis/Urine culture
Gonorrhea & Chlamydia
Pap smear
*cystic fibrosis carrier screen
*TB testing
*varicella
```
55
28 week labs
- CBC
- Glucose tolerance test: greater than 140 FAIL
- ABS (if Rh negative)
56
35-37 week
GBS testing
retest sugar
1 Hr Glucose Tolerance Test- >140 mg/dL fail= needs further follow-up with 3 hr test
3Hr Glucose Tolerance Test- fasting, 1 hr, 2hr, and 3rd later (95, 180, 155, 140~ respectively. If 2 or more values are off= diagnosed with Gestational Diabetes
57
other optional test
```
Antenatal screening (Maternal alpha-fetoprotein or QUAD screening testing for genetic abnormalities)
Hep C (waterbirth)
TORCH
```
58
recommended immunizations
Tdap
| Influenza
59
not during preg immunizations
No Live vaccines!
```
*Rubella (MMR)- wait until postpartum!!!
HPV
Varicella
TB
Zoster
```
60
RH-
receive rogam
61
first semester danger signs
- Burning on urination (infection)
- Severe vomiting (Hyperemesis gravidarum)
- Diarrhea (infection)
- Fever/Chills (infection)
- Abd cramping/ vaginal bleeding (miscarriage, ectopic pregnancy)
62
2nd and 3rd
- Gush of vaginal fluid (not urine, rupture of membranes)
- Vag bleeding (placenta problems)
- Abd pain ( preterm labor, placental issue, ectopic preg)
- Change in fetal movements (may be fetal distress)
Persistent vomiting (hyperemesis)
- Severe headaches/blurred vision/edema of face or hands/ epigastric pain (pre eclampsia)
- Fever (infection)
- Dysuria (UTI)
- Flushed, dry skin, fruity breath, rapid breathing, increased thirst/urination, headache (hyperglycemia)
- Clammy pale skin, weakness, tremors, irritability, lightheadedness (hypoglycemia)
