MIH #2 Flashcards
Alterations in pelvic support
Structural Disorders: Uterus and Vagina
Benign neoplasms
Ovarian cysts, uterine polyps, leiomyomas
the uterus tilts posteriorly and cervix rotates anteriorly.
Uterine displacement
After pregnancy The ligaments go back the normal within 2 months.
Uterine displacement
Back pain, painful sex, more severe PMS due to alteration of structures.
Uterine displacement
Can note during labor or post. Can see on ultrasound.
Uterine displacement
Cystocele-
protrusion of the bladder through the vagina causes- childbirth, age, obesity.
S/Sx Cystocele-
urinary incontinence and sensation of heaviness in the vagina
Rectocele-
herniation of the anterior rectal wall through vaginal tissue.
Genital Fistulas-
perforation between genitals and other organs.
Genital Fistulas S/Sx;
urine, gas, and feces coming out of vagina
Urinary Incontinence- occurs in __ of females.
75%
Urinary Incontinence
Involuntary leakage of urine.
Urinary Incontinence Risk factors
age obesity, smoking, hx of vaginal delivery, increase in carotene (the more pregnancies) the more risk.
Uterine prolapse and Genital fistulas Tx:
surgical intervention
Related to decrease pelvic muscles that is caused by
child birth
Can be congenital(present at birth)-
structural disorders
Uterine prolapse-
uterus protrudes through the vagina- more serious than uterine displacement. Bc risk for infection- insides are falling out.
Ovarian cysts are
Dependent on hormonal influences associated with menstrual cycle
most common ovarian cysts.
Follicular cysts-
Occur in normal ovaries of young females.
Follicular cysts-
Typically are not going to experience any symptoms unless rupture which causes pelvic pain.
Follicular cysts-
If the cyst does not rupture then it is going to shrink within 2-3 cycles
Follicular cysts-
Small follicular cysts-Tx:
Nsaids,
contraceptives(suppress ovulation, the hormones influence the cyst)
Large follicular cysts-Tx:-
surgical removal
endocrine imbalance
Polycystic Ovarian Syndrome (PCOS)-
Estrogen-elevated
Polycystic Ovarian Syndrome (PCOS)-
Testosterone-elevated
Polycystic Ovarian Syndrome (PCOS)-
LH-elevated
Polycystic Ovarian Syndrome (PCOS)-
FSH- decreased
Polycystic Ovarian Syndrome (PCOS)-
Multiple cyst formation, lots of follicular cysts causes increase of estrogen in body
Polycystic Ovarian Syndrome (PCOS)-
Polycystic Ovarian Syndrome (PCOS) Clinical manifestations-
can vary.
Obesity, hirsutism- excessive hair growth, irregular menses, infertility, and glucose intolerance (High levels of insulin)
Polycystic Ovarian Syndrome (PCOS) Medical management-
managed with oral contraceptives and metformin (type two diabetes tx, glucose)
Polycystic Ovarian Syndrome (PCOS) Nursing Interventions-
tx or intervene any physical problem and consider psychological aspects
Uterine polyps- Originate in __ and or ____ tissue.
endometrium, cervix
Tumors arise from the mucosa of the cervix
Uterine polyps-
May be removed surgically.
Uterine polyps-
If in the cervix its going to be an outpatient sugery. If endometrium surgery longer stay
Uterine polyps-
Most common age group multiparous (multiple pregnancies>2) women >40 years.
Uterine polyps-
All polups surgically removed are send to pathology to determine
bengin or malignant
Want the pt to be on pelvic rest (no tampons, sex, douching) for one week bc increase risk of infection
Uterine polyps post op
If any s/sx of infection or excessive bleeding seek medical attention
Uterine polyps post op
AKA fibroid tumors, fibromas, myomas, or fibromyomas
Leiomyomas
MOST common type of benign tumor-
Leiomyomas
most common in African American women, nulliparous (never been pregnant) women and obese women
Leiomyomas
Is it slow growing? Yes
Leiomyomas
Originates from the muscle of the Uterus muscle
Leiomyomas
Rarely becomes malignant
Leiomyomas
Growth is influenced by ovarian hormones.
Leiomyomas
Spontaneously shrink after Menopause due to decrease in cirulainting ovarian hormones
Leiomyomas
Typically asymptomatic.
Leiomyomas
if tumor is big they expense complications.
Leiomyomas
Leiomyomas small tumors:
abnormal uterine bleeding- risk for anemia.
Leiomyomas Big tumors-
back pain, lower abdominal pressure, interfere with bowel movements- constipation and cause dysmenorrhea.
Influenced by estrogen- neoplasms.
Leiomyomas
Can effect implantation and the maintance of pregnancy.
Leiomyomas
Could be caused by chronic miscarriages or preterm labor.
Leiomyomas
Leiomyomas Medical Management
NSAIDs, oral contraception’s, Growth Hormone agonist. Help decrease size of the fibroid.
Leiomyomas Medical Management Uterine artery embolization performed-
cut off supply to fibroid which causes to shrink
Leiomyomas Surgical Management Laser or Operative removal-
smaller fibroids that are easier to destroy.
Leiomyomas Surgical Management Surgical intervention-
myomectomy for removing large fibroid. Comparing size to 12 week fetus.
considerations when removing entire uterus.
Leiomyomas Surgical Management Hysterectomy-
Severe bleeding, risk for infection, pt signed consent.
Leiomyomas Surgical Management Hysterectomy-
Stay in hospital for couple days after procedure, manage pain and psychosocial considerations- depressed
Leiomyomas Surgical Management Hysterectomy-
If causes excessive bleeding or obstructing other organs causes hysterectomy.
Leiomyomas Surgical Management Hysterectomy-
Malignant Neoplasms:
Endometrial Cancer, Ovarian Cancer, Cancer of the Cervix, Cancer of the Vulva, Cancer of the Vagina
Slow- growing w/ a good prognosis
Endometrial Cancer
Endometrial Cancer MOST SIGNIFICANT risk factor
Obesity, nulliparity, infertility, late onset menopause, diabetes, hypertension, PCOS, Hx of ovarian or breast cancer, hormonal imbalance
Endometrial Cancer Cardinal sign of endometrial cancer:
abnormal uterine bleeding!!
Endometrial Cancer s/sx:
bloody mucous vaginal discharge, accompanied by lower back pain, abdominal pain
Endometrial Cancer Dx studies-
pap, endometrial biopsy, pelvic exam could reveal a mass
Most common cancer of reproductive system
Endometrial Cancer
Over __ women are diagnosed with some type of gynecological cancer annually
100,000
Obesity,- For occurrence of
gynecological cancer
Tamoxifen use increase risk for
gynecological cancer
Does not spread
Endometrial Cancer
Endometrial Cancer TX:
hysterectomy even if caught in early stages. Chemotherapy common tx for advanced stages.
antiestrogen meds.
Endometrial Cancer Most significant risk factor-
hormonal imbalance
2nd most common reproductive cancer
Ovarian Cancer-
Ovarian Cancer- Symptoms are vague-
urinary urgency, frequency, abnormal bloating, and increase in abdominal girth, pelvic abdominal pain. Or when eating feeling fullness quickly.
Ovarian Cancer- Definitive screenings/tests do not exist-
when found it is at a very advanced stage.
Unknown cause
Ovarian Cancer-
Ovarian Cancer- Risk factors:
Nulliparity (no births)
Infertility
Previous breast cancer
Family history
Ethnicity- European Americans higher risk
Ovarian Cancer-Treatment
Surgical removal-, cytoreductive surgery- remove some of the masses from big tumor to make smaller,
antineoplastic surgery, chemotherapy, & radiation- 3 used in combination
3rd most common type of reproductive cancer.
Cancer of the Cervix
begins as lesions to the cervix and spread to vaginal mucosa, pelvic wall, and to bowel or bladder.
Cancer of the Cervix
Incidence highest in Hispanic women.
Cancer of the Cervix
90% of cervical cancers are caused by
HPV.
Cancer of the Cervix Dx:
Reliable method-pap smear, detects 90% of malignancies
Colposcopy- magnified cervix to see abnormal cells
Biopsy- removal of cervical tissue to see if cells are malignant
Cancer of the Cervix Medical-surgical management-
radiation, cryosurgery- remove tumor, laser ablation
If Cancer of the Cervix is invasive-
hysterectomy indicated.
hysterectomy non electively or sooner than women would like-
psychosocial aspects bc cannot have children ever again.
Not many symptoms- could experience pain after intercourse, rectal bleeding, hematuria if it is spread, back and leg pain
Cancer of the Cervix
Abnormal bleeding leads to anemia
depending on the extent of the cervical cancer
Cancer of the Cervix
Combination of radiation and chemotherapy
Cancer of the Cervix
4th most common GYN cancer
Cancer of the Vulva
Slow growth, metastasize fairly late
Cancer of the Vulva
90% survival rate
Cancer of the Vulva
Most common site labia majora
Cancer of the Vulva
Cancer of the Vulva Treatment:
Laser surgery
Cryosurgery
Electrosurgical excision
Vulvectomy
1%-3% of GYN cancer (extremely rare)
Cancer of the Vagina
50% of cases occur between the ages of 70-90 years
Cancer of the Vagina
Cancer of the Vagina Potential causes:
Vaginal irritation
Vaginal trauma
Genital viruses
Occurrence 1 out of 100 women.
Cancer & Pregnancy
Cancer during reproductive years is
infrequent.
A lot of therapeutic concerns occurs- faces choice with
continuing or terminating pregnancy.
Fetus is most at risk for congenital anomalies due to treatment of the cancer during to
1st trimester.
Cancer & Pregnancy Therapeutic issues
Continue or terminate the pregnancy
Timing of therapies such as chemo, radiation therapy, and surgery is affected
Most frequent types of cancer that occur during pregnancy
breast, cervical, leukemia, Hodgkin disease, melanoma, thyroid, colon
Cancer & Pregnancy Treatment options
Chemo or Radiation
Pregnancy after cancer treatment
Delay of __ from end of therapy to conception is advised.
2 years
If becoming pregnant before 2 years Increasing chance of
miscarriage and teratogenic
Cancer & Pregnancy Types of threats to fetus-
risk for death, chemo and radiation- impact growth and development of the fetus.
A woman has just been diagnosed with asymptomatic uterine fibroids. The client asks the nurse, “Do I need to have my uterus removed?” Which is the best response by the nurse?
“Your practitioner can help you decide whether you need a hysterectomy.”
not scope of practice.
Depends of severity of the symptoms, age of pt and pt childbearing
Intentional prevention of pregnancy.
Contraception-
Keeping egg and sperm apart
Contraception-
Be aware of own personal beliefs.
Contraception-
Before educating make sure no bias.
Contraception-
Make sure not imposing own beliefs to clients beliefs.
Contraception-
device or practice to decrease the risk of conception
Birth Control-
Conscious decisions on when to conceive
Family Planning-
Who makes decision to practice contraception-
woman (main) and significant other. Not what the nurse thinks
understand pts need for education
Contraception-
Informed Consent
BRAIDED
B:
benefits
R:
risks- adverse effects from meds
A:
alternatives-nonpharmacological
I:
inquiries: chance to ask questions bc of many types
D:
Decisions- pt decides. Provider gives guidance.
E:
explanations- we make sure knowledgeable
D:
documentation- Education, informed consent, options discussed, rationales why this is the best option for the pt.
Half of pregnancies in US are
unplanned.
US has highest rate of unintended teen pregnancy.
Bc vary in states, access in contraceptives, abortion clinic access, cultures, stigma of birth control.
Public health office-
teen obtaining contraceptives
US is on the scale bc it is considered
wealthiest country
Speak teens alone, like an adult, giving education of
options/abstinence.
STDs/STIs educate S/Sx, condoms, getting tested-
getting over barriers of educating teens
Natural Family Planning- considers cultural and religious aspects.
Fertility Awareness Based methods (FABs)-
Only type of contraception that is recognized by roman catholic church.
Fertility Awareness Based methods (FABs)-
Pts are avoiding intercourse during fetal periods.
Fertility Awareness Based methods (FABs)-
Key Components
Avoid Intercourse during fertile periods
Combine charting menstrual cycle with abstinence
Track fertility
Approaches to natural family planning
Calendar-based methods
Symptom-based method
Biological Markers
App for fertility based awareness
Charting fetal cycles with
abstinence.
Vasal temperatures, tracking cycles, discharge, ovulation tests-
knowing fertile period.
Calendar based methods, calendar rhythm based on
standard days.
Depends on stress diet medications-
calendar based method
Assessing cervical mucous-
ovulation and vasal body temperature- symptom based
Biological markers utilizing at home-
ovulation tests at home
Phone apps-
tracking fertility to know optimal timing to avoid intercourse
Women need to know that ovum once it is released it is fertile for
24 hours
Methods of Contraception
Spermicides, Barrier Methods
Nonoxynol-9 (N-9) reduces sperm motility
Spermicides
Typical failure rate in the first year of spermicidal use alone is
29%
Barrier Methods
condoms, diaphragm, cervical caps, contraceptive sponge
Condoms:
Male & Female (Vaginal sheath)- Barrier methods- male, female condoms
4 types of traditional
Diaphragms
Is best that the female is formally fitted.
Diaphragms
Utilize spermicide and device should stay in place at least 6 hours after intercourse.
Diaphragms
Failure rate if used correctly- 14%
Diaphragms
FemCap available in U.S.- fit tighter around the cervical opening.
Cervical caps:
Is best that the female is formally fitted.
Cervical caps:
Utilize spermicide and device should stay in place at least 6 hours after intercourse.
Cervical caps:
Failure rate if used correctly- 14%.
Cervical caps:
Failure rate is 29% after vaginal birth with caps and diaphragm
Cervical caps and diaphragm
Contraceptive sponge
Today Sponge
Toxic shock syndrome (TSS) risks are present with
diaphragms, cervical caps and sponges
can occur with tampon use and leaving diaphragm, cervical cap and sponges in place for a long amount of time.
Toxic shock syndrome (TSS)
Caused by staphylococcus aureus.
Toxic shock syndrome (TSS)
Fever, discharge- S/sx of sepsis.
Toxic shock syndrome (TSS)
4 types of Diaphragms-
coil spring, arching, flat spring, wide seal rim
Hormonal methods
Available in varying formulations and administration
>100 different formulations available
Combined Contraceptives
Oral, Injections, Transdermal, Vaginal ring
Combined estrogen progestin.
Oral Combined Contraceptives
Taken PO.
Oral Combined Contraceptives
Easy to take and highly effective if taken correctly.
Oral Combined Contraceptives
relatively safe.
Oral Combined Contraceptives
Help to inhibit ovulation for hormonal methods.
Oral Combined Contraceptives
Suppressing surge of LH.
Oral Combined Contraceptives
both estrogen and progestin.
Combined injections-
Prevent surge of LH to suppress ovulation.
Combined injections-
Patches.
Transdermal
Placed weekly for 3 weeks and on 4th week the pt is patch free.
Transdermal
Rotating sites every time placing new patch on
Transdermal
both estrogen and progestin.
Suppressing surge of LH.
Transdermal
Combined inserted first 5 days of a cycle.
Vaginal Ring
After insertion pt required to have backup birth control 7 days after.
Vaginal Ring
Removed every three weeks. Ring free for 1 week.
Vaginal Ring
both estrogen and progestin.
Suppressing surge of LH.
Vaginal Ring
When educating s/sx from birth control put emphasis about cardiac problems-
HTN should not have combined contraceptives.
Warning signs to teach patients starting or taking combined oral contraceptives (COCs):
ACHES
A:
Abdominal pain may indicate a problem with the liver or gallbladder.
C:
Chest pain or shortness of breath may indicate possible clot problem within the lungs or heart.
H:
Headaches (sudden or persistent) may be caused by cardiovascular accident or hypertension.
E:
Eye problems may indicate vascular accident or hypertension.
S:
Severe leg pain may indicate a thromboembolic process. Common in patient with nuvaring.
combined oral contraceptives (COCs): Other s/sx;
increase risk of stroke, Heart attack, pseudomenstration- vaginal bleeding or spotting.
People placed on contra for heavy menstrual periods or excessive bleeding/
common with IUDs
Ask patient baseline and follow up with them
combined oral contraceptives (COCs):
Oral contraceptives on antibiotics
must need back of contraceptives
Too much estrogen impacts Cardiovascular system-
causes dizziness, fluid retention, leg cramps, high blood pressure
Progestin-only Contraception
Oral, Injectable, Implantable
failure rate it 9%.
Oral
[Minipill]
Important for pts to take same time everyday.
Oral
[Minipill]
Progestin increase viscosity of the cervical mucous (thick) so sperm cannot move through and make it to the egg.
Oral
[Minipill]
Decreases motility of fallopian tubes.
Oral
[Minipill]
Also interferes with LH surge.
Oral
[Minipill]
Good for breast feeding moms.
Progestin only
Oral
[Minipill]
Highly effective. Long acting.
Injectable
[Depo-provera]
given every 11-13 weeks.
Injectable
[Depo-provera]
More unfavorable side effects- weight gain and depression more than the pill.
Injectable
[Depo-provera]
Slows down motility and increase viscosity of cervical mucous.
Injectable
[Depo-provera]
Inhibit LH surge but also inhibits FSH.
Progestin only
Injectable
[Depo-provera]
Duration: Rod inserted underneath the skin. Lasts three yrs. Progestin only
Implantable
[Nexplanon]
Good for Cardiovascular disease pts.
Progestin-only Contraception
Safer than combined contraceptives
Progestin-only Contraception
Causes S/E- weight gain, depression, acne, increases risk of yeast infections bc of thick cervical mucous.
Progestin-only Contraception
Small T-shaped device inserted into the uterine cavity
Intrauterine devices (IUDs)
ParaGard Copper T 380A (effective for up to 10 years)
There are four FDA-approved IUDs:
Mirena (releases levonorgestrel; effective for up to 5 years)
There are four FDA-approved IUDs:
Liletta (releases levonorgestrel; effective for up to 3 years)
There are four FDA-approved IUDs:
Skyla (releases levonorgestrel; effective for up to 3 years)
There are four FDA-approved IUDs:
The typical failure rate in the first year of use is 0.2%
IUDs
Offers no protection against STIs or HIV
IUDs
Important client education; signs of potential complications: ACHES
IUDs
Lasts from 3 to 10 years.
IUDs
Don’t offer protection with STDs.
IUDs
Important to educate on the S/E using the ACHES acronym
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain
IUDs
Levonorgestrel-
synthetic estrogen
Advanced practice or medical provider does this.
IUD
Can cause miscarriages, fertility issues
IUD
Permanent Sterilization:
surgical procedures intended to render a person infertile
Tubule occlusion- most common.
Female Sterilization-
Can have Transcervical sterilization and tubule reconstruction.
Female Sterilization-
Can grow back and get pregnant again.
Female Sterilization-
surgical interruption of a man’s vas deferens.
Male (Vasectomy):
Done with local anesthesia. outpatient setting.
Male (Vasectomy):
Not as intense procedure.
Male (Vasectomy):
Complications with swelling and infection.
Male (Vasectomy):
Additional Considerations
Emergency contraception, Start dose, Missed dose, COCs, Lactational Amenorrhea
should be taken ASAP after unprotected sex.
Emergency Contraception-
Or also Can be effective after 5 days of sexual intercourse.
Emergency Contraception-
Different types: most common are plan b. utilize copper IUD.
Emergency Contraception-
when pt is going to be contraceptive on the first day they experience bleeding (the first time).
Start Dose-
Or can do the quick start method is that they can start anytime but need to have backup birth control for 7 days.
Start Dose-
Prior to taking that pill they have to rule out pregnancy
Start Dose-
need to take missed tab and the next scheduled tab at the same time.
Missed Dose Combined Oral Contraceptives’
If they miss more than 3 doses they need to discontinue the pack allow for withdrawal bleeding and then in 7 days they can start back
Missed Dose Combined Oral Contraceptives’
Need to take pill asap and need to have backup for 48 hrs.
Missed Dose Progestin Oral Contraceptives
only applicable to women that are breast feeing exclusively bc of hormone stimulation can suppress ovulation.
Lactational Amenorrhea-
Can practice this as birth control abd can only be used if actual breast feeding around the clock. Temporary method.
Lactational Amenorrhea-
Ovum is released during ovulation -> Sperm enters the female reproductive system -> Sperm and Egg join in the outer 1/3 in the fallopian tube.
Conception
Sperm is fertile for __ and ova (eggs) fertile for
48 hrs, 24 hours
Occurs 6-10 days after fertilization.
Occurs in the endometrium(inner lining of the uterus)
Implantation
When occurs pt can experience Bleeding or spotting
Implantation
Chorion
Amnion
Fetal Membranes
XX- female
XY-male- which determines sex of the fetus
Chromosomes- determine pts sex
Space for movement and protection
Amniotic Fluid
Promotes Thermoregulation
Amniotic Fluid
Transport Nutrients and fluid
Amniotic Fluid
Amniotic Fluid prevents
Adhering of the amnion to the fetus
Umbilical cord compression
800-1200mL present at birth
Amniotic Fluid
If too much amniotic fluid.
Polyhydramnios
Identified if amniotic fluid is>2000mL.
Polyhydramnios
It is associated with gastrointestinal malformations of the fetus.
Polyhydramnios
Too little amniotic fluid.
Oligohydramnios
Identified with volume that is less then 300 mL of amniotic fluid.
Oligohydramnios
Connection with renal malformation of the fetus.
Oligohydramnios
Interferes with fetal growth and development
Oligohydramnios
Lives in this for about 40 weeks
amniotic fluid
Fetus has a covering called vernix which protects skin for
maceration from amniotic fluid
amniotic fluid is made of up
Albumin, bilirubin, and uric acid
Tested for genetic studies-
amniotic fluid
Acts as cushion, keeps umbilical cord floating-
amniotic fluid
Protected by Wharton’s Jelly
Umbilical Cord
No Pain Receptors
Umbilical Cord
Umbilical Cord Three vessel cord
2 Arteries- take deoxygenated and bad stuff away from fetus
1 Vein- carries oxygen rich and nutrients to fetus
Some babies can be born with
multiple vessel cord
Intestines can be in the
umbilical cord
Endocrine gland
Placenta
Human placental lactogen
Placenta
Human chorionic gonadotrophin
Placenta
Develops during week 3
Placenta
Fully functional by week 12
Placenta
Regulates transport of gases, nutrients, and waste products
Placenta
Begins to age towards the end of pregnancy and becomes less functional
Placenta
Hormone secretion decreases
Placenta
Gradually less effective
Placenta
41 weeks of gestation can calcifying and be less effective of transporting nutrients/blood.
Placenta
Placenta Shiny shults-
fetal side
Placenta Dirty duncan-
maternal side
Want fetal side to be shiny,
new- membranes
Locus birth-
placenta attached to the baby to increase stem cells
Conception to day 14
Pre-Embryonic stage
Rapid cell division
Pre-Embryonic stage
Primary germ layers- tissues and organ form from and the embryonic membranes
Pre-Embryonic stage
Day 15 to week 8
Embryonic Stage
Structures of major organs are complete
Embryonic Stage
Organ systems are complete and functioning
Embryonic Stage
Teratogens!!! (3-8 week period)
Embryonic Stage
Educate- being aware of what putting in body if childbearing age and risky sex.
Embryonic Stage
Red flag weeks- 3-8 weeks more likely to develop
defects
MMR vaccine- teratogens.
The rubella can cause negative effects through the vaccine.
Education after to avoid pregnancy after 28 days after injection-
MMR
Safe for moms to breastfeed but pregnancy is contraindicated in
MMR- subcutaneous injection
Chemo, radiation, lead, CMV (cytomegdalo virus)-
can come contact with AC setting
1st trimerster
month 1, 2, 3
Month 1
1st trimester
Limb buds forming
Month 1
Hematopoiesis week
3
Day _ can hear
25
4th week-
GI developing
Liver-thyroid-bones-muscles-epidermis forming
Month 1
Neural tube-start of CNS.
Month 1
Encourage child bearing capabilities to take folic acid bc it helps promote development of
neural tube.
Green leafy veggies and orange juice found.
neural tube.
1/2inch <1 oz
Month 1
Ears, ankles, wrists
Month 2
Eyelids-SHUT
Month 2
Hematopoiesis continues
Month 2
5th week-
swallowing and voiding
Brain has 5 lobes
Month 2
*Rh FACTOR>
6 weeks
rH FACTOR
Proteins found on RBCs.
Second most important component when blood typing. + or -
1st most important- ABO
Pancreas and nerve fibers
Month 2
1in <1oz
Month 2
Fingers and toes
Month 3
Soft nails
Month 3
“baby teeth”
Month 3
Doppler ultrasound to hear HB abdomen
Month 3
Renal function
Month 3
Moving- feel fetal movement
Month 3
Adrenal cortex production hormones
Month 3
Sex characteristics
Month 3
Lanugo-thin hairs covering babies body.
Falls off at end of pregnancy
Month 3
2.5 inches >1oz
Month 3
Cardiac system is the first system that fully funcitons
1st Trimester
Cardiac anomalies develop first
few weeks of conception
White cheesy covering-
vernix
2nd trimester
month 4, 5, 6
-Moves, kicks, swallows
Month 4
-Handprints 16 weeks
Month 4
-Forming Meconium- waste product-black thick, tarry waste product. made in intestines.
Month 4
Intestines forms meconium at 13-16 week. First 24 hours after birth expelled.
Month 4
Can pass meconium during delivery process which can aspirate and cause
respiratory distress and infections.
-Placenta is fully formed
Month 4
-6-7in 5 oz
Month 4
-Sleep/wake intervals
Month 5
-Week 20: producing insulin
Month 5
-8-12 inches ½-1lb
Month 5
-Actively feeling fetal movement by mom
Month 5
-Lanugo all over
Month 6
-Eyes open
Month 6
-11-14 inches (28 cm long)
Month 6
1-1.5 lb (600g)
Month 6
24 weeks- marks period of
viability
Viable (better chance of surviving at extra uterine life) at end of
second trimester
Period of rapid growth
2nd trimester
3RD Trimester
month 7, 8, 9
Period of refinement and growth
3rd trimester
-Open and close eyes
Month 7
-Responds to light and sound
Month 7
-Storing fat
Month 7
-Testes descend into scrotum
Month 7
-15 inches 3 lbs
Month 7
-Rapid brain growth
Month 8
-Skull is soft/flexible- fit through birth canal and growth
Month 8
-Mature GI system
Month 8
-Fe (iron) stored
Month 8
-18 in 5 lb
Month 8
-FULL TERM 37-40 weeks
Month 9
-Brain ¼ size of adult
Month 9
-Gains ¼-1/2 lb per week
Month 9
[6-9 lb19-21 in]- full term infant
Month 9
Blood increase to head and placenta and no blood to the
Lungs by the shunt
Intrauterine life to extrauterine life shunts
open
Bradycardia =
fetal circulation compromised to help turn mom to left side
Fetal Heart, Placenta, Fetal tissues
Fetal Circulation
Decrease blood flow to fetal lungs
Fetal Circulation
Direct blood to placenta
Fetal Circulation
Fetus shunts blood to the lungs while in utero
Fetal Circulation
After birth–Infant breathes—shunts are no longer needed.
Fetal Circulation
Chemoreceptors active closure to shunts
Fetal Circulation
increase blood flow to head and decreasing blood to lungs
Fetal Circulation
When compromised fetal circulation-
fetal HR dropping.
Turn mom and place on left side lying which enhances fetal circulation.
Significantly impacted by maternal help
Respiratory system of the fetus
20-24 weeks
Stabilizes Alveoli
Surfactant
Alveoli aren’t mature until
35-37 weeks
L/S ratio
(lecithin/sphingomyelin)
Want it to be: 2:1 ratio indicates lung maturity
L/S ratio
Maternal use of steroids can stimulate production.
L/S ratio
If mom is (premature) 34 weeks prg and in labor likely to give steroids to enhance or speed up fetal maturity in the fetal respiratory system.
L/S ratio
Not given for full term and healthy baby.
L/S ratio, steroids
substance in the alveoli to stabilize it for good gas exchange
Surfactant-
Reduce surface tension to make it easier to breathe for the baby-
surfactant
Amniocentesis test to test the
LS ratio
FERTILIZATION OF A SINGLE OVUM BY ONE SPERM
Monozygotic
Identical
Monozygotic
Monozygotic Risk:
HX of dizygotic twins in Female history
Use of fertility drugs
Multifetal Pregnancy Dx:
Polyhydramnios
Asychronous FHR
utilizing an ultrasound to visualize
Likelihood of multifetal pregnancy IF
HX of dizygotic twins in Female history
Use of fertility drugs
Multifetal Pregnancy Often end in prematurity
Premature rupture of membranes
FERTILIZATION OF 2 OVA BY TWO SPERM
Dizygotic
FRATERNAL/NONIDENTICAL
Dizygotic
Use of fertility drugs increase the risk for
multifetal
___ are more likely to use fertility drugs, higher risk for multifetal pregnancy
Older women
End in premature rupture in membranes- early labor.
Its considered high risk.
GTPAL
Gravidity, Term birth, Preterm, Abortion, Living
Gravidity-
a Pregnancy
Term Birth-
occurs after 37 weeks.
Preterm-
birth from 20-36 weeks and 6 days.
Abortion-
medical abortion(therapeutic) or spontaneous abortion.
Living-
how many children the woman has alive
Nulligravida-
Never been pregnant
Primigravida-
Pregnant for the first time
Multigravida-
Pregnant at least a second time
Five digit System
Gravity, Term, Preterm, Abortion, Living
Signs of pregnancy
Probable, Positive, Presumptive
observed by the practioner.
Probable
Softening of the cervix- assessed as early as five week-Goodell’s sign.
Probable
Chadwix sign-bluish purple discoloration to the cervix.
Occurs bc so much blood flow going to the uterus which is bleeding the cervix.
Noted at 6-8 weeks gestation.
Probable
Hegar sign- softening of the lower portion of the uterus.
Noted as early as 6-12 weeks gestation.
Probable
Positive pregnancy test- test for hormone HCG.
Probable
Practitioner taps on cervix and the baby bounced up and down- ballottement.
Fetus haws to be a significant size not performed until 16 weeks gestation.
Probable
definitive evidence that fetus present.
Positive-
Only be attributed to the presence of a fetus.
Positive-
Ultrasound done 5-6 weeks gestation.
Positive-
Fetal hr detected around 6 weeks gestation.
Positive-
Palpation of the fetus and the outline of the fetus-palpating the abdomen at significant sigh 18-22 weeks.
Positive-
subjective signs.
Presumptive-
Fatigue, breast changes(heaviness in breast), darkened areola, nausea, increase urinary frequency
Presumptive-
quickening- fetal movements ex:gas bubble that is quickening doesn’t occur 16-20 weeks gestation.
Presumptive-
Amenorrhea. Is there something other than pregnancy that can cause
Presumptive-
important part of pregnancy
Uterus
Increases in size and weight.
Uterus
12-14 weeks palpating the __ above the symphysis pubis.
Uterus
22-24 weeks gestation palpating at the umbilicus.
Uterus
As the fetus grow the __ expands.
Uterus
Cervix- dilates and allows the passage of the fetus.
Cervix-
Increases in vascularity, softens, increase in mucous production which causes mucous plug
Cervix-
When closer to labor the mucous plug and come out in a big chunk or little pieces.
MUCOUS PLUG-
acts as barrier against infection.
MUCOUS PLUG-
Labor is near (within two weeks)-
after mucous plug falls out.
Increased in secretions
Leukorrhea
Stimulated by hormones to prepare for lactation
Perineum-
support pelvic structures.
During child birth it can be lacerated.
Intricate system of tissues that manufactures and stores breast milk
Breasts
Stimulated by hormones to prepare for lactation
Breasts
as early as 16 weeks gestation.
Colostrum-
Colostrum can form.
Breasts
Not until estrogen levels decrease that complete lactation can occur.
Breasts
Can see striae gravidarum (stretch marks) during pregnancy.
Breasts
Heart Displaced to the LEFT
Pregnancy
Cardiac Output Increases about 30-50%. Increase to provide adequate perfusion due to compensation.
Pregnancy
Cardiac Volume increases
Pregnancy
Vital signs- HR- increase 10-15 bpm above baseline,
Help maintain cardiac output.
__ sometimes increases during first trimester but will go back to normal after.
BP
Abnormal finding- increase in BP during pregnancy,
it is scary and often.
Increase in fluid and hormonal fluctuations-
increase bp in 1st trimester.
Peripheral Changes in pregnancy
Edema, coagulation
fluid retention.
EDEMA-
Compression of the Iliac veins and inferior vena cava by the by the
uterus.
It is important that moms do not lay on back while pregnancy
uterus is growing.
Decreases perfusion to the placenta thus decreasing perfusion to the baby.
Compression of the Iliac veins and inferior vena cava by the by the uterus.
Coagulation-hypercoagulable state as a protective mechanism
Pregnancy
Clotting factors increase-
protective mechanism.
During childbirth mom does not excessive bleeding or hemorrhage that leads to death.
coagulation
D-Dimer increases in
pregnancy. Increase risk for DVT, hemorrhage.
Diaphragm- raise and flare in the ribs..
Pregnancy
RR unchanged- may experience SOB with activities
Pregnancy
Slight hyperventilation
Pregnancy
Oxygen consumption increases- 15%-20%
Pregnancy
Dyspnea
Pregnancy
Nasal stuffiness + epistaxis(nose bleeds)- estrogen vascularizes more.
Pregnancy
Nasal tract vascularization is increased.
Pregnancy
Vascular change due to estrogen
Pregnancy
Bladder has a reduced capacity- due to
uterus or fetus is taking up more space.
Ureters/kidneys increase in size.
Pregnancy
Urine formation is slightly increased
Pregnancy
Nocturia- increase frequency in urination at night
Pregnancy
Bladder becomes more sensitive bc of increase in pressure from the uterus/fetus.
Pregnancy
Increase in urinary elimination.
Pregnancy
Goes back to non pregnant size (smaller but not the same)-
kidneys, uterus, bladder.
Brownish splotchy mask like discoloration.
Melasma-
Common in dark complexed females and fades after birth.
Melasma-
A hyperpigmented line that is midline down the abdomen will fade after birth. Can take years to fade
Linea Nigra-
Striae Gravidarum- stretch marks due to pregnancy.
A reddish, purplish discoloration. Fade after pregnancy.
Striae Gravidarum-
pink or reddish discolored palms. Will disappear after birth.
Palmar erythema-
Spider veins. Remain after birth. Does not fade or go away
Angiomas-
abnormal lumbar curvature gets deeper. Change in center of gravity so the females stance widens.
Exaggerated Lordosis-
Hormonal Influences
Pelvic expansion
Increased softening and elasticity of ligaments
Abdominal muscles stretch
typically related to electrolyte imbalances.
Muscle cramps-
can occur only during pregnancy
Carpel Tunnel-
R/t edema pressure on median nerve
Carpel Tunnel-
Usually occurs in late third trimester
Carpel Tunnel-
Carpel Tunnel s/sx
paresthesia, pain and swelling/edema in upper extremities-wrist area.
Swelling can decrease but May need PT even after pregnancy
Carpel Tunnel
Concern for the mom hard to hold baby, write etc
Carpel Tunnel
Increase salivation
GI pregnancy
Increased appetite and thirst
GI pregnancy
Nausea and vomiting- occur due to hormonal changes. rarely is n/v harmful to the fetus.
GI pregnancy
Delayed gastric emptying and intestinal motility
GI pregnancy
GERD- gastroesophageal reflux disease. Due to hormonal changes.
Increase in the softening of the esophagus and is related to increase progesterone.
GI pregnancy
Delayed gallbladder emptying
GI pregnancy
Pica- non food cravings.
Indicator of anemia-can be underlying cause (dirt, ice-no nutritional value, chalk). Can impact weight gain
GI pregnancy
Estrogen- influences changes with the uterus, breast and skin.
Endocrine pregnancy
Progesterone- responsible for maintaining pregnancy.
Endocrine pregnancy
hCG- responsible for morning sickness- hyperemesisgravaderum.
Endocrine pregnancy
Oxytocin- stimulate milk ejection during lactation and uterine contractions.
Endocrine pregnancy
Fetus relies on maternal glucose
Pancreas
Thyroid gland
Endocrine pregnancy
Pulls glucose from maternal supplies
Fetus
Depletes maternal stores
Fetus
During 1st trimester results in a decrease in maternal
blood glucose (low blood sugar)
2nd trimester- maternal tissue sensitivity to insulin begins to
decline
If baby is large for gestational age we have to monitor for
hypoglycemia (checking BGL before and after feedings)
Only until babies endocrine system kicks in-
dextrose IVs help hypoglycemia.
Estimated due Date/Estimated Date of confinement (EDC)
Diagnosis of Pregnancy
Period of physical and psychological preparation for birth and parenthood
Prenatal Period
Nagaele’s Rule
+7 to 1st day of Last Menstrual Period, -3 month +1 year (if applicable)
Most deliver +/- __ from Estimated due Date
2 weeks
April 13th 2023 date of LMP.
-3 month= Jan, +7 day= 20th, +1 year= 2024
Jan 20th, 2024
9 months span-
pregnancy
Holistic-
family centered care
Family supports the
patient
1 year after birth stops prenatal care
prenatal birth-
before conception
Any female of child bearing age-
prenatal care
Education to support the
mom.
Supports birth
control/contraceptive care.
Adaptations to Pregnancy- biggest mile stone if mom
verbalizing pregnancy
Normal for mom to have mood swings due to
hormonal changes
Paternal Adaptations to Pregnancy
Couvade Syndrome
Maternal Adaptations to Pregnancy.
Acceptance of the pregnancy
Identifying as a mother
Establishing personal relationship with the fetus
Preparation for child birth
Partner experiences symptoms of the pregnant women like cravings, nausea. Increase of cravings and appetite- pregnancy like symptoms.
Couvade Syndrome
depending on the age. Rebel.
Sibling regression
May feel the baby is the burden (babysit, cant move in with lives).
Sibling regression
Include the siblings in the plan of care no matter the age
Sibling regression
Grandparents-
support, role models. Expected role
Various stages of accepting the pregnancy-
mom and significant other
Health history, Drug use, Family history, History of any type abuse
Prenatal Interview
Spinal disorders, sexual abuse, mental disorders, genetic disorders, allergies, experiencing PICA, OTC drugs and illicit drugs, prescribed.
Prenatal Interview
Physical Exam (H to T),
Prenatal Interview
Lab tests- CBC, UA, Syphilis, gonorrhea, and chlamydia testing. Informed Consent to test for HIV.
Prenatal Interview
Group B strep
Prenatal Interview
can change with each pregnancy.
Group B strep
done between 35-37 weeks gestation, swab from vagina to the rectum.
Group B strep
Not an STI.
Group B strep
Determines prophylactic tx with antibiotics while in labor.
Group B strep
Can be transmitted to baby going through birth canal and become septic.
Group B strep
Fundal height (abdomen- determines height of the uterus, top part of uterus (fundus),
Fetal Assessments
FHTs(fetal heart tones),
Fetal Assessments
EGA(estimated gestational age),
Fetal Assessments
Labs- r/t fetus genetic testing.
Fetal Assessments
child care, birthing preferences, feeding preferences.
Education
Starting discuccion from prenatal care. What are the plans after birth.
Education
if decreased fetal moment light red bleeding contact provider immediately,
Education
reiterate at every visit.
Education
sexual practices- can still get STD (condoms).
Education
first trimester- libido
less likely
Preterm Labor
Fetal Assessments
Hormonal changes- fluctuations in libido
second trimester
Normal VS Abnormal discomforts-
as the pregnancy progresses likely to become more uncomfortable due to growing size of the fetus.
Normal for
N/V, back pain, hormonal changes.
Abnormal-
bright red vaginal bleeding, uterine contractions- preterm (before 37 weeks), any changes in fetal movement.
Nutrition- prenatal vitamins daily,
Pregnancy education
Hygiene, breastfeeding- education after delivery
Pregnancy education
physical activity- no extremely strenuous but still stay active.
Pregnancy education
No amount of alcohol is considered safe during pregnancy.
Pregnancy education
Mom stay hydrated if not- electrolyte imbalances which causes uterine contractions (prevent preterm contractions)
Pregnancy education
Body mechanics, Rest
Pregnancy education
Immunizations- no live vaccines. MMR or Varicella
Pregnancy education
OKAY to receive during pregnancy: Flu, hep b, TDAP
Pregnancy education
not all vitamins, herbal supplements or OTC are safe for pregnancy.
Pregnancy education
NSAIDS are not good. Acetaminophen can be good
Pregnancy education
Childbirth goals-
support system, medications
Cultural Influences-
how they view pregnancy and how the childbirth practices will be
Adolescents- pregnant,
less likely to receive prenatal care.
Educate not shaming them.
comorbidities, genetic concerns, increase fertility due to taking infertility drugs
Advanced Maternal Age/Delayed Childbearing- older than 35 years old-
care for child?, premature births, restructuring their life’s-career, effects other siblings.
Advanced Maternal Age/Delayed Childbearing- older than 35 years old-
