Maternity/Women/Postpartum Flashcards
Naegele’s rule
calculation of expectation of date of delivery for pregnant clients:
last menstrual start period minus 3 months + 7 days + 1 year.
How to do a gestational diabetes mellitus screening? What dates do you use?
two step process: 1 hour glucose challenge test (GCT) that DOES NOT require fasting beforehand. The 1 hour GCT can be performed any time of day. If serum BG < 140 mg/dl, GDM is unlikely and no need for testing. If >140 mg/dl, client requires 2 or 3 hour glucose toelrance test (GTT) to diagnose GDM. patient ingests a 50 g glucose solution and nurse draws blood 1 hour later.
What is toxoplasmosis?
parasitic infection, acquired from infected cat feces or ingestion of undercooked meat or soil-contaminated fruits/veggies. The infection can be trasnferred to the fetus and potentially cause serious fetal harm (malformations, stillbirth, blindness, mental disability_. take precaution by washing produce to decrease exposure risk.
What is leukorrhea?
milky, thin white vaginal discharge normal during pregnancy. due to increased progesterone and estrogen. if discharge changes color, becomes malodorous, or causes itching/burning, further investigation is needed.
What hemoglobin levels in pregnancy are considered low?
<11 in first or third trimester, <10.5 g/dL in second trimester (risk for anemia)
what drug is contraindicated in pregnancy?
NSAID in third trimester especially, due to risk of causing premature closure of the ductus arteriosus in the fetus. in 1st and 2nd trimesters, only take NSAId if the benefits outweighs the risks and under the supervision of a healthcare provider.
Is metronidazole safe for use during pregnancy?
Yes, it is an anti-infective but expect dark-colored urine as an expected side effect that is not a cause for concern.
What is intrahepatic cholestasis of pregnancy?
a liver disorder exclusive to pregnancy. it can manifest with intense, generalized itching but no rash. itching on soles the hands and feet and worsens at night. it increases the risk of intrauterine fetal demise and requires priority assessment by the provider. management includes lab testing for elevated bile levels, fetal surveillance (biophysical profile, nonstress test), meds (ursodeoxycholic acid) and labor induction at 37 weeks gestation. this condition resolves after birth.
What is chloasma?
hormonally stimulated increase in pigmentation over the birdge of nose and cheeks that usually appears in second trimester. benign and fades postpartum.
what is PUPP?
pruritic urticartial pupules and plaques of pregnancyis a dermatologic condition that causes discomfort but is not harmful to patient. pruritic, raised lesions form within abdominal striae, spare the umbilicus, and may spread to the thighs, arms, legs, and back.
What are the features of a ruptured ectopic pregnancy?
unilateral abdominal pain, hypotension (dizziness, tachycardia), referred shoulder pain. the intra abdominal bleeding can lead to that referred shoulder pain.
What is hyperemesis gravidarum?
excessive nausea and vomiting, weight loss, often requiring fluid replacement and antiemetic therapy. the condition is not usually life threatening.
what is hydatifiorm mole?
molar pregnancy. It is a type of gestational trophoblastic disease that results from abnormal fertilization. IT causes rapidly growing trophoblastic tissue that is initially benign but may lead to gestational trophoblastic neoplasia (GTN) (e.g. invasive mole, choriocarcinoma). the fetus is replaced by edamatous, cystic chorionic villi. If the trophoblastic tissue continues to grow or metastasize after evacuation of a molar pregnancy, levels of human chorionic gonadotropin will continue to increase. The importance of avoiding pregnancy is important to monitor rising hCG levels, which may indicate malignant GTN. Patients experiencing molar pregnancy should anticipate intermittent, dark brown vaginal discharge until the pregnancy is evacuated.
What is the expected weight gain during pregnancy?
weight gain should be 1.1-4.4 lb during first trimester regardless of BMI. If your BMi is normal prepregnancy, the patient should gain 25-35 lb over the course of the pregnancy. Gain 1 lb per week during second and third trimester.
What are signs of hypovolemic (hemorrhagic) shock from ruptured ectopic pregnancy?
dizziness, hypotension, tachycardia
What are dietary sources of folic acid?
asparagus, turnip/mustard green, fortified breakfast cereal, cooked dried beans, lier, broccoli, spinach, green peas, fresh cooked beets, pasta, rice, tomato juice, oranges, peanut butter. Remember it is a water soluble B vitmin essential for RBC production. you need at MINIMUM 400 MCG a day to decrease the change of neural tube defects.
What is pica?
abnormal , compulsive cravings for nonfood items like ice, chalk, clay, dirt and paper. often accompanied with iron deficiency anemia .
Can HSV be transmitted during birth?
It can be transmitted to infant in utero, perinatally or postnatally as a result of direct contact with virus particles shed from infected vulva, vagina, cervix or perineum. Neonatal HSV has serious morbidity (permanent neurologic sequelae) and mortality. Immediate antiviral therapy like acyclovir helps reduce the risk of transmission to the newborn
What week is term gestation?
usually 39 weeks
What factor places a pregnant client at risk for preterm labor?
preterm birth is 37 weeks and 0 days gestation. infection (such as periodontal disease, UTI) is strongly associated with preterm labor, particularly when untreated. infection causes release of inflammatory mediators such as prostaglandins, which are uterotonic (promote contractions) and contribute to cervical softening.
other factors: hx of spontaneous preterm birth in a single pregnancy (**single largest independent risk factor),
previous cervical surgery such as cone biopsy since it weakens cervical support,
tobacco and/or illicit drug, maternal ages <17 or >35, maternal undernutrition, being a non-hispanic black women
What are the issues for infants born with fetal alcohol syndrome?
permanent neurodevelopmental abnormalities or dysmorphic facial features:
microcephaly, short palpebral fissures, epicanthal folds, flat midface, smooth philtrum, thin upper lip
the teratogenic risks of alcohol consumption for patients include miscarriage, preterm birth, low birth weight. NO AMOUNT OF ALCOHOL IS SAFE DURING PREGNANCY.
what is the differential diagnoses of antepartum bleeding? (4 cases)
normal labor, placental abruption, placenta previa, uterine rupture
What are common clinical features in:
normal labor, placental abruption, placenta previa, and uterine rupture
normal labor – intermittent pain with contractions, small amount of blood tinged mucus (bloody show)
placental abruption – sudden-onset vaginal bleeding, abdominal bleeding, hypertonic/tender uterus, tachysystole (frequent uterine contractions)
placenta previa – painless vaginal bleeding, ultrasound finding of placenta covering cervical os
uterine rupture – sudden-onset vaginal bleeding, constant abdominal pain, cessation of uterine contractions, loss of fetal station, fetal deterioration
What is placental abruption?
sudden-onset vaginal bleeding, abdominal bleeding, hypertonic/tender uterus, tachysystole (frequent uterine contractions)
occurs when the placenta separates prematurely from uterine wall, causing hemorrhage beneath the placenta. Abruptions are classified as partial, complete, or marginal and may be overt (visible vaginal bleeding) or concealed (bleeding behind placenta). risk factors include abdominal trauma, hypertension, cocaine use, hx of previous abruption, and preterm premature rupture of membranes.
What are lab values to look at during third trimester?
hemoglobin >11 g/dl
hematocrit >33%
RBCs 5-6.25 x 10^6/mm^3
platelets 150,000 – 400, 000 / mm^3
What is physiologic anemia of pregnancy?
reflected in lower hemoglobin and hematocrit values
what is aortocaval compression syndrome: cause and treatment
stablization after trauma: uterine displacement is the first step to address supine hypotension (due to aortocaval compression and decreased venous return to the heart) and promote blood circulation to the fetus. client should be tilted laterally on a backboard to promote venous return and protect client from further potential spinal injury.
manifestations: hypotension, pallor, dizziness. Reassess blood pressures after uterine displacement to identify persistent hyptoension since these symptoms mimic complications of trauma.
what type of birth should a patient have if they are diagnosed with placenta previa?
placenta implants near the cervis, and can cause massive blood loss and maternal/fetal compromise during cervical dilation and effacement. the increased risk of hemorrhage means a CESAREAN birth is planned for after 36 weeks gestation and prior to onset of labor.
What foods should a pregnant client stay away from?
unpasteurized, unwashed fruits and veggies, deli meat and hot dogs, raw fish/meat. avoid fish high in mercury like shark, swordfish, king mackerel, tilefish). avoid liver because high amount of vitamin A can be teratogenic.
