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Maternal/Child > Lecture 2 - Antepartum Family & Fetal Development > Flashcards

Lecture 2 - Antepartum Family & Fetal Development Flashcards

1
Q

What is supine hypotension?

A

When a pregnant patient lies supine and the weight of their abdomen compresses their vena cava and aorta - causes pre/syncope and hypoTN.

Intervention: Position pt on side until S/S subside and vitals stabilize.

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2
Q

What are the three stages of uterine development?

A

Menstruation (day 1) - shed on lining

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3
Q

What are the three stages of intrauterine development?

A
  1. Ovum/Pre-embryonic (Conception-Day 14)
  2. Embryo (Day 15-8 weeks)
  3. Fetus (9+ weeks)
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4
Q

What are the three primary germ layers? When are they differentiated?

A

Differentiated during 3rd week following conception

Ectoderm, Mesoderm, Endoderm

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5
Q

What is ectoderm?

A

Upper layer of embryonic disk
–> epidermis, NS, skin, nails, hair

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6
Q

What is mesoderm?

A

The middle layer of embryonic disk
–> Bones & teeth, muscles, circulatory systems

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7
Q

What is endoderm?

A

Lower layer of embryonic disk
–> digestive system, lungs, liver, glands

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8
Q

What is chorion?

A

The outermost fetal membrane - covers the fetal side of the placenta. Contains major umbilical blood vessels that reach over surface of the placenta.

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9
Q

What are the two layers of embryonic membranes?

A

Chorion - outermost
Amnion - innermost

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10
Q

What membrane holds amniotic fluid?

A

The amnion - innermost membrane

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11
Q

How much amniotic fluid is prevent at term?

A

700-1000 mL

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12
Q

What are the purposes of amniotic fluid?

A

–> Maintaining body temperature
–> Barrier from infection
–> Cushion to protect fetus and umbilical cord
–> Enhancing fetal lung development by filling lungs and expanding alveoli
–> Encourages symmetrical growth

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13
Q

What is oligohydramnios? What is it associated with?

A

Having less than 300mL of amniotic fluid
–> Associated with fetal renal abnormities

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14
Q

What is polyhydramnios? What is it associated with and what complications can it cause?

A

More than 2L of fluid
–> Associated with GI and other malformations
–> Risk of pre-term labour, subinvolution (PP hemorrhage), risk of cord prolapse and issues with engagement.

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15
Q

What is a yolk sac? What is its purpose? When does it disappear?

A

Aids in transferring maternal nutrients and oxygen which have diffused through the chorion to the embryo.
–> Completely separated from the embryo by week 5-6

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16
Q

What are chorionic villi?

A

Villi that branch from the chorion and burrow into the uterine lining - areas of gas and nutrient exchange.

Maternal blood is present in subvillous space.

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17
Q

When does the umbilical cord develop? How many blood vessels does it have?

A

Develops from the connective stalk by end of 5th week.
–> 2 arteries, 1 vein.

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18
Q

How long is the umbilical cord?

A

Ave 55 cm at term

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19
Q

What is Wharton’s jelly?

A

A mucoid connective tissue that prevents compression of blood vessels in the umbilical cord.

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20
Q

What is a Nuchal cord?

A

When the umbilical cord is wrapped around the fetal neck.
–> Document how many times it is wrapped

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21
Q

cont page 199 for cotyledons

A
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22
Q

What are the primary components of preconception care?

A
  1. Health promotion
  2. Risk factor assessment
  3. Interventions
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23
Q

What is a definition of infertility?

A

Those below the age of 35 who have been trying to conceive for a year.

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24
Q

When is the first week of a pregnancy?

A

First day of last menstrual period

Egg matures in ovaries from day 1-14, ovulation occurs on day 14

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25
Q

When is the fertile window?

A

Days 11-14 of menstrual cycle

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26
Q

What is lanugo?

A

Fine hair. Falls off round the 35 week mark
–> More common in pre-term babies.

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27
Q

What is the age of viability?

A

The age at which a baby has a reasonably good chance of surviving outside the uterus
–> 22-25 weeks at present with NICU support.

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28
Q

What is a zygote?

A

First 2 weeks of pregnancy
–> From fertilization to implantation.

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29
Q

What is gestational vs postconception age?

A

Gestational Age
–> Based on first day of last period

Postconception Age
–> Begins two weeks after last period - used when speaking about fetal development

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30
Q

Why is the 4-5 week mark of embryonic so significant?

A

Formation of most vital organs, hematopoiesis.

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31
Q

What is quickening?

A

When childbearing person begins to feel fetal movement
–> 18 weeks for first pregnancy, 16 weeks in following pregnancies.

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32
Q

When does sex differentiation occur in fetal development?

A

possible by week 12.

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33
Q

Teratogens have the largest impact on fetal development in the first ____ weeks.

A

12

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34
Q

When is the placenta complete?

A

It is structurally complete at 12 weeks and continues to widen until 20 weeks. Then continues thickening.

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35
Q

What hormones are released by the placenta?

A

HGH, progesterone, estrogen, HPL (chorionic somatomammotropin)

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36
Q

What is the source and effects of HCG?

A

slide 23

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37
Q

progestrone

A

slide 23

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38
Q

estrogen

A

23

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39
Q

HPL

A

23

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40
Q

What are normal findings for the umbilical cord?
–> Vessels, length, location on placenta

A

AVA, 55cm, located centrally on placenta.

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41
Q

What are the three shunts seen in fetal circulation?

A

Ductus arteriosus
–> Between pulmonary arteries and

slide 26/7

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42
Q

Oxygenated blood from the placenta enters fetal body through umbilical vein. It is then shunted where by what structure?

A

Majority is shunted via ductus venosus into inferior vena cava, bypassing liver.
Enters R-atrium

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43
Q

right atrium

A

slide 27

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44
Q

right ventricle part two

A

27

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45
Q

What causes the foramen ovale to close into the fossa ovalis after birth?

A

Changes in pressure
–> Lower in RA and higher in LA following birth

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46
Q

What causes the ductus arteriosus to become a ligament following birth?

A

increase in oxygen levels

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47
Q

What causes the ductus venosus to change into a ligament following birth?

A

Closes with clamping of cord and d/t BV constriction caused by cold air and changes in oxygen.

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48
Q

What are dizygotic twins? How do they share….

A

Fraternal
–> Each with their own chorion, amnion, and placenta.

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49
Q

What are the three presentations of monozygotic twins?

A

slide 30

shared placenta can mean unequal distribution of blood flow, concern for tangling of umbilical cord

50
Q

What stimulates uterine enlargement?

A

Early: Estrogen + progesterone, increased vascularity, hyperplasia, hypertrophy, decidua

After month 3: Growing fetus, placenta, amniotic fluid

51
Q

How is uterine enlargement measured?

A

Fundus enlarges most

measurement 10

52
Q

slide 33

A

fundal height in relation to weeks

53
Q

What is Hegar’s sign?

A

At 6 weeks, the lower uterine segment softens - can be palpated vaginally.
–> Results in uterine anteflexion during 1st trimester, presses on bladder and causes urinary frequency.

54
Q

How do uterine walls change during 2nd trimester?

A

slide 37

55
Q

Late pregnancy uterine changes

A

37

56
Q

1st trimester changes

A

37

57
Q

When do Braxton Hicks Contractions occur? What are their purposes?

A

Irregular uterine contractions - occur after 4th month
–> Facilitate blood flow through intervillous spaces of placenta

58
Q

How do Braxton Hicks contraction differ from preterm labour?

A

–> BHCs usually cease with ambulation
–> Do not increase in intensity or duration
–> Do not cause cervical dilation

59
Q

Placental perfusion depends on maternal blood flow to uterus. How much blood usually travels through uterus at term?

A

450-650 mL/min at term

Compared to 50-200mls in non pregnant state

60
Q

uterine souffle

A

40

61
Q

funic souffle

A

40

62
Q

What cervical changes are observed at week 6 of pregnancy?

A

Goodell’s Sign
–> Softening of cervical tip d/t vascularity, hypertrophy, hyperplasia

Friability

63
Q

cervix nulliparous

A

41

64
Q

ballottement

A

41

65
Q

What is Chadwick’s sign? When is it observed?

A

A blue/purple hue to the cervix and vagina seen during pregnancy d/t increased vascularity.
–> Noted at week 6-8

66
Q

How does a multiparous vs nulliparous cervix differ?

A

43

67
Q

estrogen changes vaginal changes

A

45

68
Q

What is Leukorrhea?

A

A whitish mucous discharge seen during pregnancy

69
Q

What is the operculum?

A

A mucous plug that protects against bacterial invasion. Expelled when cervix effaces and dilates closer to birth.

70
Q

Breast changes d/t hormone changes

A

48

71
Q

What accounts for breast enlargement during the 2nd and 3rd trimester of pregnancy?

A

Mammary gland growth

72
Q

Lactation is inhibited by ____ after birth. However, colostrum may be expressed as early as ____

A

Inhibited by estrogen + progesterone

Expressed as early as 16 weeks - avoid expressing until 37 weeks.

73
Q

What causes cardiac hypertrophy during pregnancy?

A

Increased blood volume + CA

74
Q

How does hear position change during pregnancy?

A

Diaphragm elevates
–> Heart is lifted upwards and rotated forward and left so apical pulse is shifted upward and laterally.

75
Q

pulse rate

A

49

76
Q

BP changes

A

51

77
Q

What is the physiologic anemia of pregnancy?

A

Decreased hematocrit + hemoglobin d/t increase in plasma that is ____ higher than increase in erythrocytes.

Can be prevented/treated with iron supplements

78
Q

What changes in blood occur during pregnancy?

A

Increase in blood volume
–> Plasma increase causes hemodilution

Increased leukocytes
Increases coagulability and venous stasis

79
Q

cardiac output 53

A
80
Q

Which position can prevent supine hypotensive syndrome in pregnancy?

A

Left side or use of wedge.

81
Q

resp changes 55

A
82
Q

Which structural changes occur to the renal system during pregnancy?

A

Ureter dilation leads to increased risk of urinary stasis (risk of UTI)

83
Q

How does GFR change during pregnancy?

A

GFR increases

84
Q

When is kidney function more and less efficient during pregnancy?

A

Most: lateral recumbent
Least: Supine

85
Q

Increase in melanotropin during pregnancy can cause hyperpigmentation in which forms?

A

Darkening of nipples, areolae, axillae, vulva

Chloasma (mask of pregnancy)

Linea nigra

86
Q

other integ changes 58

A
87
Q

Changes in center of gravity during pregnancy can cause which MSK changes?

A

Lordosis, curvature of thoracic area d/t weight of breasts.
–> Low backache
–> Waddling gait

88
Q

The pressure of enlarging uterus…

A

slide 59

89
Q

N&V during 1st trimester is caused by which hormone?

A

Increase in hCG + carbohydrate metabolism

90
Q

How do mineral requirements change during pregnancy?

A

Phosphorus + Calcium

91
Q

Why does appetite increase during 2nd trimester?

A

Increased fetal need and loss of N/V associated with 1st term.
Changes in taste and smell can also cause increased dietary habits

92
Q

ptyalism

A

60

93
Q

pyrosis

A

61

94
Q

constipation

A

61

95
Q

What might cause risk of gallstones during pregnancy?

A

Distension of gallbladder, increased emptying time, thickening of bile

96
Q

63

A
97
Q

What causes gestational diabetes?

A

Reaction that occurs in some d/t increased insulin resistance during pregnancy

98
Q

What are the presumptive signs of pregnancy?

A

Signs that are associated often with pregnancy, but that do not guarantee that one is occurring. Subjective.
–> Breast changes, amenorrhea, N/V, urinary frequency, fatigue, quickening

99
Q

What are probable signs of pregnancy?

A

Objective signs that indicate pregnancy
–> Changes in pelvic organs, hCG levels, Braxton Hicks, Ballottement

100
Q

hCG test

A

4

101
Q

What are the positive signs of pregnancy?

A

Definitive and objective signs of pregnancy
–> 4

102
Q

What is Naegele’s rule to estimate DOB of fetus?

A

First day of last menstrual period
–> Subtract 3 months, add 7 days

Ensure year is updated.

103
Q

What terms are used to describe gravidity?

A

Nulli - has never been pregnant for more than 20 weeks
Gravida - pregnant person
Prima - pregnant for first time
Multi - person who has been pregnant 2+ times

104
Q

parity 8

A
105
Q

GTPAL

A
106
Q

What is considered a stillbirth?

A

End of pregnancy lasting more than 2 weeks, or that weighed more more than or equal to 500 grams with no signs of life.

107
Q

How does the need to prenatal visits change over the course of a pregnancy?

A

The longer the pregnancy, the more frequent the visits.

108
Q

What is the provincial standardized documentation for prenatal care?

A

The 2017 Ontario Perinatal Record (OPR)

109
Q

folate before and after 46

A
110
Q

calories 16

A
111
Q

normal weight change with pregnancy

A

17

112
Q

herbal preparation 18

A
113
Q

t ace 19

A
114
Q

CFAM 22

A
115
Q

A mental health screening should be used routinely ____ during the antenatal period.

A

At least one.

116
Q

see table 11-4

A
117
Q

Protein in the urine during pregnancy can be a sign of what?

A

Pre-eclampsia

118
Q

nuchal translucency test (mention of 34, but this specific test is not.

A
119
Q

When is a routine morphology ultrasound done during pregnancy.

A

18-20 weeks

120
Q

CVS

A

35

121
Q

When would an amniocentesis be performed during pregnancy?

A

15-20 weeks.

Maternal/Child (2 decks)

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