Maternity I Flashcards
What are 4 risk factors for maternal mortality?
age <20 or >35
lack of education
unmarried
non-caucasian
What are the 4 leading causes of maternal mortality in the US?
pre-existing conditions
hemorrhage
HYPERtension
infection
The US is ____ in the world for maternal mortality.
50th
How many women die per day giving birth in the US?
2-3
What are 2 benefits of vaginal delivery versus c-section?
exposure to mother’s flora
better breathing
What cells react to HPV? Where are they located?
transformation cells in the ectocervix (the outer, visible part of the cervix)
What is the isthmus?
the lower part of the body of the uterus that stretches and thins during pregnancy
What’s up with the os?
there’s an internal AND external os before reaching the inner body of the uterus
Why does being an adolescent make for a higher risk pregnancy?
they are psychologically unprepared
their hips may not be wide enough
they may not understand the importance of prenatal care
the may try to hide the baby with tight clothes
What is the normal duration range of the menstrual cycle?
21-35 days
What is the average age that girls begin menstruating?
12.8 years old
How long can an egg live?
24-48 hours
How long can sperm live?
72 hours
What are the 3 phases of the ovarian cycle? What days do they fall?
follicular (1-14)
ovulation (14)
luteal (15-28)
What happens during the follicular phase?
ovary follicles grow to form a mature egg
FSH and LH are secreted
Estrogen climbs
What causes the rupture of the mature follicle and subsequent release of the egg? When does this occur?
surge of LH hormone during ovulation
What stays behind in the ovary when the mature egg is released?
the corpus luteum (shell of the follicle)
secretes progesterone to keep potential pregnancy going
When is estrogen at its peak?
ovulation
When is progesterone (the pregnancy hormone) at its peak?
luteal phase
What vital sign changes during the luteal phase?
increase in body temp by 0.5 to 1 degree Fahrenheit
When are LH and FSH at their lowest?
during the luteal phase
WTF if the role of the corpus luteum?
it secretes progesterone which interacts with the endometrium to prepare it for implantation.
What is the corpus?
the main body of the uterus
How do you calculate the fertile period of a woman?
take the first of her last period and subtract 14 days
What term describes too MUCH amniotic fluid? Too little?
too much: Hydramnios (over 2000mL) associated with renal
too little: Oligohydramnios (under 500mL) associated with maternal diabetes and CNS malformation
Amniotic fluid is ____% water
98%
Are the amniotic fluid’s contents fluid or stable?
they are constantly changing.
What are 4 functions of amniotic fluid?
maintains temperature
allows symmetric G&D
cushions fetus from trauma
prevents cord compression
What are the 3 genetic variations that can cause Down’s syndrome?
trisomy 21 ***
mosaic
translocation
How long is the fertile period?
120 hours (5 days)
What is fetal nuchal translucent suggestive of?
Trisomy 21
What increases the risk of Trisomy 21?
maternal age
What are 2 defining characteristics of Down’s syndrome?
Simian crease
Open mouth with protruding, large tongue
What is Tay-Sachs? What population is most a risk?
an autosomal recessive disorder Ashkenazi Jews
What factors would influence a family to seek genetic counseling?
maternal age >35
paternal age >50
Which antibodies are present during the fetal stage of development?
IgG - crosses the placenta
IgM - produced by the fetus
IgA - not produced by fetus
When is surfactant produced?
Week 24
Since fetal circulation bypasses the right side of the heart b/c they don’t use their lungs, what structures do they use instead?
foramen ovale
ductus arteriosus
ductus venosus
What vitamin do babies lack?
vitamin K
When does development of the brain/spinal cord occur?
3-4 weeks
When can fetuses hear? taste? see?
hear- 4 months
taste- 5 months
see- 7 months
When does sex differentiation occur?
week 7, but we can’t tell until week 20
how likely is it to pass down an autosomal dominant disorder? autosomal recessive?
dominant - 50%
recessive - 25%
What is the role of the placenta as an interface b/w mother an baby?
protects fetus from immune attack by the mother if they are respectively Rh- and Rh+
What is Wharton’s Jelly?
tissue surrounding the vein and 2 arteries to prevent compression
Function of hCG?
preserves corpus luteum and progesterone production (basis for pregnancy test)
Function of progesterone?
maintains endometrium
decreases uterine contractility
Function of estrogen?
enlarges breast and genital tissue
relaxation of pelvic ligaments and joints
Function of relaxin?
relaxation of pelvic ligaments
softens cervix
Function of hPL or hCS?
regulates metabolism
development of breasts for lactation
increases glucose availability for fetus
Where is oxytocin released?
posterior pituitary
Function of oxytocin?
stimulates uterine contractions
decreases bleeding after delivery
ejects milk during BF
What is meconium?
baby’s first stool
contains bile
forms during week 12
What is vernix caseosa?
slimy, cottage cheese covering fetus that protects it from amniotic fluid
What is lanugo?
fine hair
How many weeks is a term pregnancy?
37-42
Describe GPTAL
Gravida - total pregnancies Para - preterm births after 20 weeks Term - births over 37 weeks Abortion- # of pregnancies ended before 20 weeks Living children
How do you use Naegele’s Rule?
used to calculate date of delivery
- 1st day of last period
- (+) 9 months
- (+) 7 days
What are the ONLY positive signs of pregnancy?
US verification
Fetal movement felt by clinician
Doppler finding of heart
What is Hegar’s Sign?
softening of the lower uterine segment/isthmus at 6-12 weeks
What is Chadwick’s Sign?
blue coloration of the vagina/cervix at 6-8 weeks
What is Goodell’s Sign?
softening of the cervix at 5 weeks
How do you measure fundal height?
top of pubic bone to top of fundus
20 cm should be 20 weeks(at umbilicus)
When does fundal height stop correlating to weeks of pregnancy?
36 weeks
Describe the cardiovascular changes that happen during pregnancy.
50% increases in plasma by week 30 which results in “physiologic anemia” (hematocrit <11)
pregnancy is a hyper coagulable state.
HR increases by 10-15
What happens to BP during pregnancy?
standard during the 1st and 3rd trimester
DROPS by 5-10 in the 2nd trimester
What BP is considered HYPERtension in pregnancy?
140/90
Do normal HgB and HcT increase or decrease during pregnancy?
increase in plasma causes decrease in HgB and HcT.
What is the term for excessive saliva that is normal in pregnancy?
ptyalism
what 5 integumentary changes happen to the mother during pregnancy?
hyperpiguentaion of breasts and genitalia
melasma or cholasma (butterfly face - 70% of women)
linea nigra
striae gravidarum (stretch marks)
vericosites (poor circulation r/t poor venous return)
Who would receive Rhogam? When?
an Rh (-) mother with an Rh (+) baby at 28 weeks gestation and again 72 hours after birth
When do pregnant women experience urinary frequency? Why?
trimesters 1 and 3
NOT 2
glomerular filtration rate (GFR) speeds up
What should mom eat when she gets morning sickness?
Crackers Cheerios Cheese Ginger Lemonade
During which trimester will mom experience Leukorrhea?
1st trimester
cottage cheesey, acidic secretions
How do you distinguish between a yeast infection and leukorrhea?
a yeast infection looks like leukorrhea but presents with itching
Amount of water recommended during pregnancy?
2L/day
Fetal movement count
“count to 10” method
if longer than 2 hours, call HCP
What methods are allowed during L&D?
Lamaze method - breathing and relaxation
Bradley - partner coached childbirth
Dick-Reed (natural childbirth) - fear reduction via knowledge
What vaccinations MAY be given during pregnancy? Which may NOT be given?
Yes:
TRIM-H (keep it trim-hunny, jus a lil) Tetanus Rabies Influenza (deactivated) Meningococcal Hep B
No:
I M Telling Vou B, do not take these vaccines: Influenza (activated) MMR Typhoid Varicella BCG
When is the rubella vaccine recommended?
after birth prior to discharge
nursing mothers OK
getting pregnant again NOT OK for 28 days
How many pounds should be gained for each BMI during pregnancy?
Underweight: 28-40 lbs
Normal: 25-35 lbs
Overweight: 15-25lbs
Obese: 11-20lbs
Foods high in mercury to AVOID:
SSKOTT Shark Swordfish King Mackerel Orange Roughy Tuna Tilefish
Foods low in mercury you can EAT:
Shrimp Salmon Tuna (canned light) Talapia Catfish Cod Pollock
Which supplement should NOT be taken with antibiotics or estrogen?
calcium
What needs to be kept balanced with calcium?
vitamin D
What supplements should be taken before and during the early weeks of pregnancy?
Folic acid and iron - hard to get the needed amounts just through diet
Sources of Folic Acid
Dark leafy greens
What foods that may contain the bacteria Listeria should be avoided during pregnancy?
processed meat
soft cheese
smoked seafood
salads made in stores
What should not be taken with vitamin C?
antacids with aluminum
What should not be taken with vitamin A?
antibiotics and warfarin
How should iron supplements be taken?
withOUT food
What is the mucous plug called?
operculum
