Maternity Sem Flashcards
What is the human genome project
is an international scientific research with the goal of determining the sequence of chemical base pairs which make up the human DNA, and identifying and mapping all genes of the human genome from both a physical and functional standpoint
Understand the growth and progress of a fertilized egg from conception to implantation onto the uterine wall
Ovum’s cell membrane surrounded by two layers, closest layer called zona pellucida, the outer layer, corona radiata.
These cells are held together by hyaluronic acid.
High estrogen increases peristalsis which helps move the ovum
-fertilization takes place in the ampulla of the fallopian tube
-prostaglandin in semen may increase uterine smooth muscle contractions
-Sperm must undergo capacitation and acrosomal reaction before fertilization takes place
Capacitation - removal of the plasma membrane
Acrosomal reaction breaks down the hyaluronic acid in the ovum
True moment of fertilization occurs as the nuclei unite
chromosomes pair up to produce the diploid zygote
another moment of fertilization is when the sex of the zygote is determined
First 14 days is called the preembryonic stage. Development after this consist of two phases: cellular multiplication and cellular differentiation
- as the zygote enters the period of rapid mitotic division called cleavage, in which these cells are called blastomeres.
0the blastomeres are held together by zona pellucida, which is under the corona radiata. Eventually becoming morula - Inside the layer of the blastomere is the blastocyst and the outer layer is called the trophoblast (zona pellucida), eventually becoming the chorion
- the blastocyst becomes the embryonic disc
- the trophoblast implants at the endometrium
Explore the common chromosomal anomalies
Klinefelter syndrome - M and extra X
Turner syndrome - F, a missing x
XXY syndrome - M, above average height
PKU - metabolic disorder , mental retardation
Sickle-cell - blood disorder that limits supply of oxygen because of shape
Down syndrome - both, extra or altered 21st chromosome
Primary cell layers
ECTODERM epidermis sweat glands sebaceous glands nails hair follicles lens of eyes sensory epithelium of intern and external ear, nose, mouth, anal cns and pns nasal cavity oral glands and tooth enamel pituitary and mammary gland
MESODERM dermis wall of digestive tract kid and ureter reproductive organ connective tissue skeleton muscle cardiovascular system pleura lymphatic tissue spleen
ENDODERM respiratory tract epithelium, pharynx, tongue, tonsils, thyroid lining of digestive tract primary tissue of liver and pancreas urethra bladder vagina
Identify prenatal diagnostic testing
Serum intergrated prenatal screening (sips) 10-13
-2 blood test
If risk of down’s or twins or HIV -> integrated prenatal screen (IPS) which includes SIPS and Nuchal translucency (NT ultrasound) 11-13
QUAD at 15
Hemoglobin - initially and 36 weeks
Rubella STS HIV Group B at 35-37w Urinalysis CBG - 24-28w Blood type
What are some assisted reproductive technologies
In Vitro Fertilization - egg and sperm are extracted, placed in tube
Gamete intrafertilization - eggs are removed and is placed in the Fallopian tube along with the sperm
Intrauterine insemination - intro of semen into the females vagina without sex
Zygote intrafallopian transfer - used when fallopian is blocked
intracytoplasmic sperm injection - when sperm is injected directly into an egg
Signs that women describe as subjective and objective on pregnancy
loss of period N&V tiredness frequent urination breast changes movement in abdomen
Goodwell’s sign -softening of cervis
chadwick’s sign - bluish purple discoloration of vagina
hegar’s sign - softening of isthmus
mcdonald’s sign - ease of flexing the body of the uterus against the cervix
Braxton hicks - false labour
uterine souffle - soft blowing sound
DIAGNOSTIC
- FHR (10-12)
- FETAL MOVEMENT (20w)
- U/S (4-5 w)
ESTIMATED BIRTH DAY EQUATION
last mentrual period - 3 months + 7 days
Why is prenatal care important and how often should a pregnant women have this care
To assess the women’s needs of risk of pregnancy’s psychological, emotional status. Should be assessed every 4 weeks for the first 28 weeks, every two weeks until 36, then every week until child birth
Describe the layers of the uterus and their purpose
Outermost layer is the perimetrium
middle layer is the myometrium
- consist of 3 distinct layers of involuntary muscles
- outer consist of longitudinal muscles that opens cervical effacement and expel fetus
- the middle layer is made up of interlacing muscle fibers in figure-eight patterns (stops bleeding)
- the inner muscle form the spincter at the fallopian tube an internal os
Describe the four classic types of the pelvis
Gynecoid - favorable for birth
anthropoid - favorable
android - non
platypelloid - non
Name the two portion of the pelvic cavity and describe their purpose
False pelvis - serves to support the weight of enlarged uterus
True pelvis - The relationship of the true pelvis and fetal head is of paramount importance. The size and shape of the true pelvis must be adequate for normal fetal passage
What bones are not fused on the fetus’s head
two frontal
two parietal
occipital bone
Molding
when cranial bones overlaps under pressure
When do fontanelles close
posterior - 8 to 12 weeks
anterior - after 18 months
Locate the sutures and fontanelles
Coronal - between the frontal and parietal
frontal - between the two frontal
sagittal - between the parietal
Fetal landmark
Mentum - chin
sinciput - eyebrow
bregma - diamond shaped anterior fontanelle
Distinguish between cephalohematoma and caput succedaneum
Cephalohematoma is the collection of blood resulting from ruptured blood vessels between the surface of a cranial bone. Last for 2 weeks to 3 months
Caput Succedaneum is localized, easily identifiable area on the scalp, resulting from long and difficult labor. Compression of blood vessels and venous returned is slow. Edema, swelling and bleeding. Crosses suture line
-last for 12h to few days
Describe the common theories explaining the onset of labor
- Mechanical stretch releases prostaglandin
- neurological pressure on cervix releases oxytocin
- increase estrogen stimulates contractions
- prostaglandin hypothesis
- corticotrophin releasing hormone hypothesis
Stages of labor
1st Onset of reg.contractions to full dilation (includes latent, active & transition)
2nd Full dilation until birth of baby (includes latent/passive, decent/active & transition
3rd Birth of babe until delivery of placenta
4th First 1-4 hours after birth
Five factors in Labor 5 Ps
Passage (pelvis & soft tissue)
Passenger (lie, attitude, presentation, presenting part, position)
R/S between the passage & passenger
Physiologic forces (contractions & pushing)
Psychosocial-
Describe the mechanism of labor
1st stage - decent and flexion
2nd stage -
internal rotation (fetal ead must rotate to fit the diameter of the pelvic)
extension
restitution (shoulders of the fetus enter the pelvis inlet)
external rotation
expulsion
3rd stage placenta separation & expulsion
Signs of separation
Expulsion “Dirty” Duncan (maternal) or “Shiny” Schultz
Control of Bleeding
4th stage (close monitoring, attachment/BF time)
Nursing care during the stages of labor
(1) First phase–latent. Offer support and explanations. Instruct or reinforce breathing techniques (breathe slowly and deeply and use deep chest or abdominal breathing). Remind the patient to not push down during the first stage since it could causes cervical edema. It could also cause cervical lacerations and fetal hypoxia.
(2) Second phase–active. Continue to give support, offer encouragement, and give explanations. Include significant other in these procedures. Reinforce breathing and relaxation techniques. Accelerated shallow panting may be used, and also, effleurage (stroking movement used in massage, usually of the abdomen).
(3) Third phase–transition. Encouragement is especially important now since the patient is most likely losing control at this point. She may be nauseated or flushed and may vomit. Assist the patient to turn on her side or to sit up to prevent aspiration. Wipe her face and mouth with a cool cloth. Be aware that the patient may want to be left alone, but don’t leave; stay and support her. Remind the patient that this is the shortest stage and that the baby will be born soon. Encourage her to concentrate on relaxation and breathing techniques. Use more intensive breathing techniques (high chest, pant-blow). Make sure to give instructions in short, simple phrases. Remind the patient that she still can’t push even though she may have a strong urge to do so.
Third stage
Continue observation. Following delivery of the placenta, continue in your observation of the fundus. Ensure that the fundus remains contracted. Retention of the tissues in the uterus can lead to uterine atony and cause hemorrhage. Massaging the fundus gently will ensure that it remains contracted.
b. Allow the mother to bond with the infant. Show the infant to the mother and allow her to hold the infant.
Initial care of the newborn
Neck checked for cord Kept at level of vagina/head down Cord clamped & cut Dried & placed under radiant heater Apgar score performed at 1 & 5 mins Cord blood obtained for blood gases, group, type & possible stem cells PRN Reassure parents of babe’s well-being
