Maternal Health Flashcards
What is Naegele’s rule
Determines expected date of delivery based on last menstrual period
3 Calender Months + 7 days
What is gravida/gravidity
A woman who is pregnant/number of pregnancies
Nulligravida
Never been pregnant
Primigravida
Pregnant for the first time
Multigravida
A woman who has had 2+ pregnancies
What is parity
The number of pregnancies that have reached viability (20 weeks of gestation) whether the fetus was born alive or not
What are the three categories of gravida/gravidity
Nulligravida, primigravida, multigravida
What are the three categories of parity
Nullipara, primipara, multipara
Preterm
0-20 weeks
Pregnancies that have reached 20 weeks but ended before 37 weeks
Term
37-42 weeks
Pregnancies that have lasted between week 37 to week 42
Blood + urine test to confirm pregnancy
Detects hCG human chorionic gondadotropin within 10 days post conception
Presumptive signs of pregnancy
-N +V
-Amenorrhea
-fatigue
-Breast enlargement + tenderness
Probable Signs of pregnancy
-Chadwicks sign (vaginal mucosa turns blue/purple)
-Hegar’s signs (softening of uterus)
-Braxton hicks (false contractions)
-Positive pregnancy test
Positive signs of pregnancy
-Fetus viewed on ultrasound
-Fetal heart beat picked up on ultrasound/Doppler
GTPAL
Gravida (number of pregnancies)
Term (number of births that reached over 37 weeks)
Pre-term (number of births that reached under 37 weeks)
Abortion (number of elective or spontaneous abortions prior to 20 weeks)
Living Children (number of living children)
1st trimester (weeks S+S and considerations)
-0-12 weeks
-Morning sickness
-Mother needs to make lifestyle changes (stop smoking + proper eating habits)
-Heart tone can be heard by 12 weeks
-Begin folic acid supplementation until 12 weeks
-0.5-2 kg weight gain
Mother needs emotional support at this time as ambivalence occurs
2nd trimester (weeks, S+S and considerations)
-13-28 weeks
-Fundus rises out of symphysis at 12-13 weeks
-Fundus at umbilicus at 20 weeks
-N+V decreases
-Weight gain 0.5kg per week
Maternal supplementation
-Folic acid until end of 12th week of pregnancy to prevent spina bifida
-Iodine during pregnancy and breastfeeding. Iodine supports production of maternal and fetal thyroid hormone which regulates development of fetal brain and nervous system
-Iron because volume of blood in your body increases in pregnancy, resulting in an increased amount of iron needed. The body uses iron to make more blood to supply oxygen to baby. Not enough iron stores can result in anemia.
3rd trimester (weeks, S+S and considerations)
-29-40 weeks
-Preparing for birth
Expected (normal) weight gain during pregnancy
13 kgs
Vaccinations for pregnant women
Boostrix (whooping cough, diptheria and tetanus) at 16-26 weeks
-flu vaccine (at any stage)
-COVID-19 vaccine (6 months after last COVID vaccine or infection)
Quickening (what is it? When does it occur)
-When a pregnant mother feels fetal movement
-Occurs 16-20 weeks
Is spotting normal at 28 weeks?
Yes. The lower part of the uterus thins during the 3rd trimester causing the area over the cervix to bleed
Management for varicose veins
-Encourage exercise
-Don’t stand for long periods of time
-TED stockings
-Elevate legs
Is baby weight loss after birth normal
Yes. Babies carry extra fluid during birth and lose 7-10% of their birth weight in the first couple of days. This weight should be regained within 2 weeks after birth
Normal weight for newborns
2500 - 4000 grams
When to suspect post-natal depression
If baby blues continues for 2 weeks following birth
Bloody show
A bloody show occurs because the cervix starts to soften and thin (efface) and widen (dilate) in preparation for labor. Occurs late in pregnancy
Spina bifida
Spina bifida is when a baby’s spine and spinal cord does not develop properly in the womb, causing a gap in the spine.
What is a teratogen
Agents in fetal environment that either cause a birth defect or increase the likelihood of a birth occurring
What happens if a pregnant women is infected with Rubella
-Has a teratogenic effect during the first trimester
-Can cause hearing impairment, cognitive +motor changes, blindness, cardiac defects, restricted growth
-Post 16 weeks defects are rare
Can I consume alcohol when I’m pregnant
No. It increases risk of miscarriage, premature birth, low birth weight + can cause fetal alcohol syndrome
-Drinking six alcoholic beverages a day or a single episode of binge drinking in the first trimester can cause fetal alcohol syndrome
Can I smoke when I’m pregnant
No. It increases risk of miscarriage + early labor
-Smoking restricts uterine blood vessels = decreased uterine blood flow + O2 supply to fetus = impaired neurodevelopment + hypoxia
What foods should I avoid and why
Foods that carry risk of listeria infection e.g., soft cheese, pate, unpasteurized dairy, processed meat, precooked cold meat, pre-prepared/refrigerated salads, food containing raw eggs.
Listeria infection increases risk of premature labor or still birth + can cause infection in baby
Avoid high mercury seafood (e.g., shark, marlin, swordfish) because toxic to baby can cause nervous system damage)
Avoid smoking + alcohol
Avoid drinking >3 cups of coffee a day increased risk of miscarriage
Morning sickness (When does it occur and why does it happen)
Weeks 4-12
-GDF15 hormone is made in abundance by tissue in the placenta. It acts on the brain stem causing N +V. Some women are more sensitive to increased levels of GDF15 than others
Bleeding gums (what causes it)
Increased progesterone = increased blood volume + vasodilation making gums more vulnerable to bacteria + bleeding
Urinary frequency (when does it happen and what causes it)
-Common in 1st trimester and reoccurs in 3rd trimester
-Caused by increased progesterone + hCG which enhances blood flow to pelvic region
-Growing uterus pushes on bladder
Epistaxis (when does it occur and what causes it)
Common in 1st trimester
Nasal stuffiness
Increased progesterone = Increased blood volume = exacerbation of vascular congestion + bleeding.
HGH causes inflammation of mucous membrane lining nose
Heart burn (when does it happen what causes it)
Starts at 8 weeks
Increased progesterone causes sphincter to relax = stomach content moving up oesophagus
Constipation (when does it happen what causes it)
Starts first trimester
Increased progesterone = decreased GI motility = slows down passage of food through intestine (this is to allow increase absorption of nutrients from food)
Haemorrhoids (when does it happen and what causes it)
2nd + 3rd trimester
Increased blood flow to pelvic region + pressure from enlarged uterus = swelling of rectal veins
Faintness/dizziness (when does it occur and why)
First trimester
Progesterone = vasodilation of blood vessels to slow the return of blood
Oedema in lower legs (when does it occur and why)
2nd trimester until delivery
Increase in aldosterone + cortisol cause body to retain sodium + fluid
Increased progesterone causes vasodilation to slow venous return of blood causing it to pool in lower extremities. Increased pressure pushes fluid into instersitial space
SOB (when does it occur and why)
Begins 1st trimester
Expanding uterus pushes on abdomen = reduced lung capacity
Progesterone alters smooth muscle tone of airways = faster RR
Varicose veins (when does it occur and why)
Common 2nd + 3rd trimester
Progesterone = vasodilation + decreased valve function + increased blood volume
Lower back ache (when does it occur and why)
Common between 2nd + 3rd trimester
Increased release of relaxin causes ligaments in pelvis to loosen. Affecting stability of spine + separation of abdo muscles
Human chorionic gondadotropin hCG (what secretes it + function)
-Secreted by chorionic villi
-Maintains corpus luteum to regulate secretion of oestrogen + progesterone until placenta is formed (around week 12)
Human chorionic Somatomammotropin hCS (what secretes it + function)
-Chorionic villi + placenta
-Promotes fetal growth, increases breast growth, decreases mothers utilisation of glucose so it can be used for fetal growth
Relaxin (what secretes it + function)
-Placenta
-Contributes to cervix dilation
-Relaxes + softens ligaments in pelvis + symphysis pubis
Oestrogen (what secretes it + function)
-Corpus luteum (0-12 weeks) + from placenta (13-40 weeks)
-Stimulates myometrial growth + excitability
-Increases vascularisation of uterine tissue
-Stimulates growth of breast ducts
Progesterone (what secretes it + function)
-Corpus luteum (0-12 weeks) + from placenta (13-40 weeks)
-Preps endometrium for implantation
-Maintains endometrium
-Inhibits contractions of myometrium + smooth muscle (walls of GI tract + veins)
-Stimulates growth of milk alveoli in breast
Oxytocin (what secretes it + function)
Posterior pituitary gland
-Stimulate uterine contraction + “let down” reflex of milk
Human placental lactogen hPL (what secretes it + function)
-Placenta
-Prepares body for breastfeeding
-Regulates metabolism and insulin sensitivity to make sure the fetus gets enough nutrients
Virchow’s Triad
Pregnancy is a prothrombotic state; it has all components of Virchow’s triad: venous stasis, endothelial damage and hypercoagulability.
Blood supply to the umbilical cord
The umbilical arteries carry deoxygenated fetal blood toward the placenta for replenishment, and the umbilical vein carries newly oxygenated and nutrient-rich blood back to the fetus.
When does menstrual bleeding return after birth?
Not breastfeeding = 6-8 weeks, Breastfeeding = vary
How to “bring milk in”
Frequent breastfeeding, massage breast + lean in to make it easy for baby to latch breast
Ectopic pregnancy (what is it, S+S)
-Fertilized egg implanted outside of uterus
-Symptoms include abdominal rigidity; rapid, shallow respirations; tachycardia; and shock.
-Ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen, with spotting and cramping.
What causes venous stasis in pregnancy
-Growing uterus compresses the descending aorta and the inferior vena cava.
-Pressure forces blood to pool in leg veins rather than flowing upward.
-Causes decrease in venous return to the heart, a fall in cardiac output, and hypotension
Why does progesterone cause vasodilation in pregnancy
To accomodate the increase in blood volume
