Maternity Flashcards
Presumptive Signs of Pregnancy
Period absent (amenorrhea; 3+ months)
Really tired
Enlarged breasts
Sore breasts
Urination frequency increased
Movement perceived (quickening)
Emesis and nausea
Probable Signs of Pregnancy
Positive pregnancy test
Return of fetus when tapped (ballottement)
Outline of fetus palpable
Braxton hicks contractions
A softening of cervix (Goodell’s sign)
Bluish color to cervix (Chadwick’s sign)
Lower uterine segment softens (Hegar’s sign)
Enlarged uterus
Positive signs of pregnancy
Fetal movement felt by HCP
Electronic device detects fetal heart sounds
The delivery of the fetus
Ultrasound detects the fetus
See movement of the fetus (by HCP)
Naegele’s Rule
1st day of last menstrual period + 7 days - 3 months + 1 year = estimated due date (EDD)
Fetus development Weeks 1-4
fertilized egg grows, water tight sac forms around it creating the amniotic sac, placenta develops, primitive face is formed and heart tube develops
Fetus development Weeks 5-8
facial features continue to develop, neural tube is well formed, 6 weeks heartbeat can be detected by U/S
Fetus development Weeks 9-12
hands, arms, fingers, feet and toes are fully developed, will begin to open and close hands, by end of third month fetus is fully formed; all organs and limbs are present and will continue to become functional, circulatory and urinary symptoms are functional
All or nothing effect
If exposed to harm before the end of month 1 the placenta will either not develop and attach and miscarriage will occur OR there is no effect and placenta will develop and attach and pregnancy continues
the embryo is referred to as a fetus beginning at week ___
8
The risk of miscarriage goes down after the first trimester because _______________ and the most symptoms are experience in this time because
most of the development has already taken place; symptoms occur because of all the development going on
Fetus development Weeks 13-16
fetal HR now audible with doppler consistently, facial features develop and nervous system is starting to function
Fetus development Weeks 17-20
fetus is developing muscles and is exercising, hear and lanugo begin to develop, skin becomes coated with vernix caseaosa
Fetus development Weeks 21-24
eyelids begin to open, fetus responds to movement or increased maternal HR
If born prematurely baby may survive if born after ____ weeks
23 weeks but will require a very long NICU stay
Fetus development Weeks 25-28
fetus begins to develop body fat and hearing is fully developed, changes position frequently and will respond to stimuli (sound, pain, light). Fetus likely to survive if born after the 7th month
Fetus development Weeks 29-32
Kicking increases and there is rapid brain development, fetus can see and hear
Fetus development Weeks 33-36
lungs complete development, there are coordinated reflexes and fetus becomes more responsive to stimuli
Fetus development Weeks 37-40
Labor can happen any time, movement decreases as space becomes tighter in the womb, if not in right position provider will discuss changing fetal position prior to delivery
term = ___ weeks
full term = ___ weeks
term = 37
full term = 40
Nutrition in pregnancy
lean protein options are ideal, healthy fats for development of fetal organs and placenta, about 300 additional calories to support their growing fetus
Folate or folic acid helps to
prevent birth defect of the spine and brain (neural tube defects)
Iron
helps mother create more blood and oxygen carrying capacity to support fetal oxygenation
DHA
omega 3 fatty acid important for eye and brain development in fetus
Iodine
vital for fetal brain and nerve growth
calcium and vitamin D
fetal bone and teeth development, and overall maternal health in pregnancy
foods to avoid in pregnancy
fish high in mercury, cold deli meats, raw meats and eggs, unpasteurized dairy products, liver, unwashed produce, alcohol, caffeine (no more than 200mg/day)
Drugs to avoid in pregnancy
NSAIDs, ACE inhibitors, ARBS, Retin A, sulfonamide an fluoroquinolone abx, codeine, warfarin, benzos, castor oil, mineral oil, bismuth subsalicylate, isotretinoin
prenatal / antepartum testing
blood type, Rh factor, STI testing, glucose test, UA, U/S, NST, GBS, kick counts
infant is put at risk for erythroblastosis fetalis when
mother is Rh negative and baby is Rh positive
Rhogam is given at ____ weeks and ____ weeks if mother is Rh ____
28 and 40 weeks; Rh negative
Rhogam
contains small amount of Rh proteins that stops blood from making Rh antibodies
Oral glucose tolerance test
done at 28 weeks, 50g glucose, BG checked 1 hr later, if greater than 140 (7.8mmol/L), the 3 hr glucose test is done
3 hr glucose tolerance test
done only if 1 hr is failed, fasting 8 hrs, 100g glucose drink, BG checked at 1hr, 2hr, 3hr; pass = no gestational diabetes, fail = + gestational diabetes
NST assesses
fetal well being and oxygenation of placenta, evaluates changes in fetal heart rate with movement
increase in fetal heart rate with movement (contraction) = _________ which is a _____ sign
acceleration = good sign
decrease in fetal heart rate with movement (contraction) = ________ which is a _____ sign
deceleration = bad sign
Reactive NST
at least two accelerations of 15bpm for 15 seconds in a 20 minute period
Non-reactive NST
not at least two acceleration of 15 bpm for 15 seconds in 20 min
fetal HR deceleration with movement is a sign that the fetus will not tolerate ______
labor
NST 3 N’s
Nonstress test, non-reactive, not good!
Contraction Stress test
done when NST is non-reactive, always done in hospital as oxytocin is given to induce contractions, checks to see if baby will tolerate labor and shows signs of stress
Negative contraction stress test
Normal; baby did NOT have any decels in response to contractions
Positive contraction stress test
Bad; baby had decels with contractions indicating distress in response to movement
variability
fluctuation in fetal HR; absent, marked, or moderate
absent variability
very little to no fluctuation in FHR, bad sign
Marked variability
can be good or bad
moderate variability
ranges between 6 and 25 bpm; good sign
early decelerations
mirror the contraction; when contraction rises or falls decel also falls or rises as uterus compresses head/neck (stimulates vagus nerve causing HR to drop), not an issue as long as HR returns back to baseline when contraction ends
variable decelerations
do not match with contraction; decel is not dependent on contraction, likely cord compression or pressure on umbilical vein causing drop in HR, this is ALARMING! as fetal blood is suddenly being restricted, emergency C-section
Late decelerations
decels are late compared to contraction (decel begins after contraction began instead of at same time), indicates placental insufficiency, can be caused by epidural turned up to fast, sudden maternal hypotension, severe dehydration or anemia, can indicate sudden hemorrhage, emergency C-section
VEAL CHOP
Variable Deceleration -> Cord Compression
Early Deceleration -> Head Compression
Accelerations -> Okay!
Late Deceleration -> Placental Insufficiency
Reassuring NST signs
baseline HR normal: 110-160 bpm
moderate variability
accelerations
Non reassuring NST signs
fetal tachycardia >160bpm
fetal bradycardia <110bpm
decrease variability
variable decelerations
late decelerations
Non-reassuring fetal HR nursing interventions
lay mother on left side
increase IV fluids
oxygen
notify HCP
discontinue pitocin
GTPAL
Gravidity - # of pregnancies including current, twins only count once (one pregnancy)
Term - # of pregnancies to term, 37+ week gestation, twins only count once
Preterm - # of preterm births, between 20 and 36+6 weeks gestation, twins only count once
Abortions - # of pregnancies ending prior to 19+6 weeks, spontaneous or termination, twins count only once
Living children - # of children currently alive, twins count twice
Hyperemesis Gravidarum
extreme morning sickness, intense n/v during pregnancy
Morning Sickness vs. Hyperemesis Gravidarum
nausea that may cause vomiting vs. nausea with excessive, persistent vomiting
nausea subsides around 20 weeks vs. n/v does not subside
vomiting does not cause dehydration vs. can cause dehydration, weight loss, electrolyte imbalances
can keep some food down vs. cannot keep any food down
Hyperemesis Gravidarum management
sit up after meals, small portions, drink in between meals not with, nothing too spicy, hot, or cold (limit irritation), promethazine, IVF, TPN
Preeclampsia
htn occurring >20 weeks, BP >140/90 2 times, 4 hrs apart, protein in urine, can lead to eclampsia
preeclampsia S&S
increased BP
sudden, big weight gain
proteinuria
facial puffiness
pedal edema
preeclampsia management
delivery, prepare for preterm baby, magnesium sulfate (prevent maternal seizures), betamethasone (help develop baby’s lungs), antihypertensives
antihypertensives that can be given during pregnancy and what can’t
Yes: labetalol, nifedipine, hydralazine
No: ACE Inhibitors, ARBs
HELLP Syndrome
hemolysis, elevated liver enzymes, low platelet count
no known cause but preeclampsia or eclampsia have much higher risk
needs very quick treatment and is life threatening
HELLP S&S
epigastric substernal pain (d/t liver enzymes being high), n/v and indigestion (d/t liver enzymes), severe headaches/blurry visions (due to high bp), severe swelling, SOB
HELLP syndrome management
corticosteroids, antihypertensives, administration of blood products/components, delivery
Gestational Diabetes
pancreas is unable to deal with increased insulin requirements of pregnancy
glucose tolerance test is done at ______ weeks
24-28 weeks
Gestational diabetes complications
macrosomia (large baby), preeclampsia, hypoglycemia in new born
cholestasis
maternal liver condition that typically occurs in later pregnancy causing bile acids to enter the bloodstream, as bile acids rise, fetal safety is significantly compromised. Bile acids in the bloodstream causes intense itching that is mostly on the soles of the feet and palms of the hands
cholestasis complications
mother: severe itching and scratching can lead to scarring, results in lower vitamin K-dependent factors, can impact the ability to clot
baby: preterm birth, lung problems d/t aspiration of meconium, death
cholestasis tx
no known prevention focus is on recognition and intervention, give Ursodiol early in third semester (before 36 weeks) it helps to lower bile acids in the blood and can relieve some of the symptoms of itching, if before 36 weeks the fetus is closely monitored with NSTs at least twice weekly, if after 36/37 weeks plan to deliver no matter what
ectopic pregnancy
an egg is fertilized but implants outside the uterine cavity (fallopian tube, cervix, abdomen)
ectopic pregnancy symptoms
dizziness or fainting, n/v, abdominal or pelvic pain, loss of appetite, when rupturing/ruptured can quickly become hemodynamically unstable
ectopic pregnancy therapeutic management
prevent rupture (detect with U/S), methotrexate (stops embryo from being able to grow), Rh immune globulin (prevents erythroblastosis fetalis if mom is Rh negative)
