Labor and Delivery (Young) Flashcards
a term pregnancy is 40 weeks from …
last menstrual period
viability is at ___ weeks
24 weeks
pre term is at ___ weeks
37 weeks
early term is at ___ weeks
37, 38
term is at ___ weeks
39, 40
post term is at ___ weeks
42
goal of initial visit when pregnant?
screen, ID high risk factors, and anticipate problems
what age is considered advanced or at high risk
35
*but really its 37
What is monitored as the pregnancy progreses
diabetes, anemia, STD, weight gain, BP, GBS,
how much weight should a women gain for a healthy pregnancy?
25-30 lbs (+5 for each additional fetus)
is a form of malnutrition
obestiy
What are the 9 essential aa? Where do we get them?
histidine, isoleucine, leucine, lysine, methionine, cysteine, phenylalanine, thyrosine, threonine, tryptophan, valine
meat, fish, soy
What are the 3 types of HTN in pregnancy?
pre-existing
gestational
pre-eclampsia
HTN med that should never be taken while preggers? why?
ACEi bc it causes malformation of organs during the first trimester
2 characteristic findings in pre-eclampsia
htn and proteinuria (nephrotic syndrome)
pre-eclampsia is only seen ____ weeks
after 20 weeks
why “pre-“ eclampsia
eclampsia means convulsions so it is the syndrome before it gets to that point
what is the Rh factor?
rhesus D Ag
what is the significance of Rh factor and prenancy?
mom is Rh- and baby is Rh+ –> mom makes Ab to the fetal Ag –> mom become sensitized – > mom gets pregant with 2nd Rh+ babt –> she “rejects” pregnancy
how is Rh factor “treated”
give mom rhogam shot… this is IgGs that coat fetal RBCs so that mom cannot see the Ag. given prior to birth (have 72 hrs where it is affected) when the blood can mix
if you get gestational diabetes, do you have an increased risk to get DM later in life?
yes (40-50% do)
is gestation diabetes like type I or II DM
type II = insulin independent
what is the most important risk factor for gestational diabetes
obesity
the alpha structure of hCG is very similar to the alpha structure of …
TSH and insulin
when are the fetal organs surveyed for anatomic abnormalities
18-20 weeks (this is when they are big enough to see on ultrasound, even though they were developed at 12 weeks)
what are the 3 things ultrasounds can give you info on
structure (where and how many)
blood flow
amniotic fluid volume
what is the range for baseline fetal HR
110-160 BPM
what is viability?
ability to live outside the uterus
What is preterm vs pre-mature
an birth/delivery is pre-term and baby is pre-mature
what 3 things signal the onset of labor
contractions, bleeding, and rupture of membranes
what is the % of normal pregnancies?
75%
what are the major complications of pregnancy
infection, preterm labor, pre-eclampsia, prior C.S, not vertex
what are the phases of labor
latent = <4 cm dilated
active (1st) = 4-10 cm dilated
pushing (2nd)
delivery of placents (3rd)
**also can throw in transitional at 7-8 cm dilated
what is the definition of labor
regular, phasic contractions sufficient to cause progressive dilation of the cervix
why are uterine contractions phasic?
fetus is perfused during the uterine diastole
what is the duration of each phase of labor?
latent has no limits
active: friedman curve (1-2cm/hr)
pushing: 3 hr or 2 hr
placental delivery: 1 hr
what are the 7 cardinal movements for delivery
engagement descent flexion internal rotation extension restitution (external rotation) expulsion
how to determin if the placenta was delivered correctly
is it intact
are there 3 vessels
is there bleeding
what can be lacerated during birth?
cervix, vaginal wall, perineum, vulva
what are the degress of perineum lacerations
1st: skin only
2nd: defect in underlying tissue but NOT thru anal sphincter
3rd: into or through the sphincter
4th: defect of rectum
What are the 2 toold for assisted vaginal delivery
forceps and vacuum
term used for managin pre-term labor (it stops preterm labor)
tocolytic
what is the C/S rate in the US
30-35%
What are the complications for a vaginal birth after C/S
ruptured uterus (scar is weaker) repeat C/S
can you have a vaginal birth after C/S
yes
what are the risks assc with a C/S
bleeding, infections, intra-abd scarring, uterine rupture, placenta accreata (next pregnancy)
