Lecture 2 Flashcards
How long does pregnancy last?
40 weeks from first day of LMP
Nagele’s rule
add 7 days to LMP then subtract 3 months OR add 7 days and count 9 months forward
(assumes gestational age of 280 days)
gold standard diagnostic test for determining pregnancy
ultrasound
1st trimester
conception to end of week 12 (13 weeks)
2nd trimester
weeks 13-26
3rd trimester
weeks 27-40
gravida (GTPAL)
number of times a woman has been pregnant
term (GTPAL)
number of pregnancies DELIVERED at 37 weeks gestation and beyond
preterm (GTPAL)
pregnancies delivered from 20 weeks to 36w 6d
abortion (GTPAL)
pregnancies ending before 20 weeks
living (GTPAL)
number of currently living children
late preterm
babies born between 34 weeks and 36 weeks
parity
number of pregnancies carried to viable gestational age (20 weeks and on)
S/S of pregnancy
amenorrhea, breast tenderness, N+V
probably signs of pregnancy
positive pregnancy test (+HCG), chadwick’s sign
Chadwick’s sign
normal pink tinge of vagina/vulva is darkened or a bit blue
Goodell’s sign
softening of the cervix
3 positive signs of pregnancy
fetal movement, FHR, confirmed by ultrasound
progesterone in early stages of pregnancy
important for uterine relaxation so uterus does not shed lining to maintain pregnancy and helps prepare breasts for milk production
progesterone during pregnancy
side effets caused by it
relaxes muscles and acts as a stimulant to increase breathing to get more O2 into the body
- what causes constipation and heartburn
HCG
- stimulates corpus luteum to secrete estrogen and progesterone until placenta takes over at week 14
- indicator for being pregnant
HCG causes what symptom during pregnancy
morning sickness
Cause of fluid buildup/edema during pregnancy
vessel compression by baby
linea nigra
dark line on stomach caused by hormone induced excess production of pigment
chloasma
“pregnancy glow” brownish pigment production of the face and forehead beginning around 16th week of pregnancy and fades after delivery
urinary system
increase in urine production because kidneys work to filter mothers waste and fetus waste
physiological change in urinary system
increase in glomerular filtration rate due to increased renal plasma flow along with dilation of pelvis and ureters
lack of progesterone during pregnancy will cause…
preterm uterine contractions which may lead to miscarriage
GI changes
- displacement of esophageal sphincter and progesterone relaxes it even more leading to heartburn
- increase in gastric pressure due to mechanical compression
- slowing of digestive system due to muscle relaxation causing constipation
- increased calcium absorption
positive part of slowing of GI during pregnancy
allows for more nutrients to be picked up such as iron
respiratory changes
displacement of diaphragm due to uterus size
- ventilation increase around 50%
- increase in respiratory rate
- once baby ‘drops’ it is easier to breathe
cardiovascular changes
increased blood volume and enhanced coagulation due to demand from uterus, fetus, and placenta and to protect from bleeding at delivery
- volume is increased but very diluted
- cardiac output increases 50%
human placental lactogen is produced in which trimester
1st; just before week 13
prolactin
secreted from anterior pituitary to prepare breasts for lactation
insulin
production is increased in response to antagonistic effects of estrogen and progesterone
oxytocin
secreted from posterior pituitary to stimulate uterine contractions and milk ejection from breasts
- also helps control postpartum bleeding
estrogen functions during pregnancy
- vascularizes uterus and placenta
- transfers nutrients
- support fetal growth
(has antagonistic effect to insulin)
progesterone as a medication
can be given to a mom who has had premature labor in the past to inhibit early contractions of uterus
immune system during pregnancy
slightly lowered so it does not attack baby
- decrease is NK cells and increase in T cells
insulin in early pregnancy
increased insulin sensitivity and glycogen content
insulin in late pregnancy
decreased insulin sensitivity and glucogenogenesis
bone thickness
decreased in early pregnancy and increased in late pregnancy
primary level of prevention during pregnancy
focused on nutrition, comfort, knowledge
secondary level of prevention during pregnancy
screening for maternal and fetal well being
- weight, urine, blood, HR, growth, movement
tertiary level of prevention during pregnancy
management of pregnancy related concerns, HTN/GDM screening
- 1st trimester prenatal tests
- ABO/Rh, STI screening, urine for protein
- 2nd trimester prenatal tests
anatomy US, GDM (glucose screening), urine for protein
- 3rd trimester prenatal tests
administer Rh immunoglobulin AT 28 WEEKS and delivery, GBS culture
ABO/Rh during pregnancy
- if mom is negative and baby is positive give winrho so in future pregnancies mother immune system does not attack baby
- fetus antigens can enter mothers blood during delivery
Nuchal translucency screening
helps assess risk for down syndrome by assessing neck folds, extra fluid, and nasal bone
- can be completed from 11w 4d to 13w 6d
safe vaccines for pregnancy
whooping cough, flu, covid
*hyperemesis gravidarum
hyperemesis during 1st trimester to point of electrolyte imbalance which will cause increased HR and decreased BP
- decreased K
- increased Na
hypertension in pregnancy
140/90 WITHOUT protein in the urine
- diagnosed at 20 weeks gestation or later
preeclampsia definition
high BP with protein in the urine and causes damage to organs beginning after 20 weeks
symptoms of preeclampsia
severe headaches, double or blurry vision, upper abdominal pain, N+V, SOB, decreased urine
- can lead to HELLP syndrome
preeclampsia and birth
may lead to induction after 34 weeks
preeclampsia management
magnesium sulfate, antihypertensives for BP greater than 160/110, fetal assessments
HELLP syndrome acronym
Hemolysis (RBC destruction)
Elevated Liver enzymes
Low Platelet count
S+S of HELLP syndrome
severe headache, fatigue, excess weight gain, nausea, abdominal pain, NOSE BLEED
- tell tale and emergency sign is nose bleed (may not be able to have an epidural due to low platelets)
delivery of baby due to HELLP syndrome prior to 34 weeks
medication
give mom 2 doses of beta blockers given 24 hours apart to help with fetal lung development then deliver
GDM
inefficient insulin resistance due to pancreas failing to produce insulin leading to hyperglycemic state and causes ketosis (body cannot keep up with changes when pregnant)
effects of GDM on mom and baby
- increase risk of uterine rupture
- possibly not enough sugar for fetal brain development
- can make baby be large for gestational age
- GDM diagnosis
test should be performed between weeks 24-28 and not at 35 weeks or more
- fasting blood glucose and/or hemoglobin A1C (HbA1c)
- 11.0 blood glucose and higher
- lab values of GDM test
- if greater than 7.8 at 1 hour then a glucose tolerance test is needed
- if value is 11 or higher then its GDM
polyhydramnios
definition and complications
excess amniotic fluid
- can lead to preterm birth, PPH due to uterine distension, placental abruption
polyhydramnios treatment
amnioreduction
oligohydramnios
definiton and causes
low amniotic fluid volume
- can be caused by premature rupture of membranes, fetal anomalies, dehydration
first sign of oligohydramnios
smaller than expected fundal height measurement
treatment of oligohydramnios
- sometimes drinking 2L of water in 2 hours helps
- amnioinfusion
5 P’s of labor
- passenger
- passageway
- powers
- position
- psychological response
passenger (5 P’s of labor)
fetus and placenta
passageway (5 P’s of labor)
birth canal (pelvis and soft tissues)
cervix during labor
- changes from long thick structure to paper thin
- moves from posterior to anterior
- dilates from closed to 10cm
pelvic joints during labor
become stretchy late in pregnancy and during labor
gynecoid pelvis
optimal shape
- well rounded, wide
android pelvis
wedge shaped, flat, narrow
- heart shaped
anthropoid pelvis
long and narrow, straight side walls
- very long, looks like lion head
platypelloid pelvis
oval shaped, very wide, round, flat
- looks more circular
power (5 P’s of labor)
contractions, bearing down
primary power
involuntary uterine contractions
secondary power
voluntary action of pushing
effacement
thinning and shortening of the cervix
position (5 P’s of labor)
woman, fetus
- work with gravity, ambulation helps, birthing balls
psychological response (5 P’s of labor)
knowledge, support, coping
average labor length
10-18 hours
inhaled anesthetic
nitrous oxide (laughing gas)
- good for early labor (latent phase)
- have nurse in room at all times
- metabolized by respiratory system so it cannot harm fetus
systemic opioids
used when epidural is not an option
- affects baby; will come out stunned with decreased resps
regional anesthesia (epidural)
best to give when patient is around 4 cm dilated
- only want it for 8-10 hours
general anesthesia
used in emergency c-sections if no time for epidural
primipara
giving birth for the first time
multipara
has given birth to at least 1 viable baby
nullipara
has never given birth
