Module 1 - OB Flashcards
Trimesters
1: 1-14
2: 15-27
3: 28-40
Definition of PPH
> 500 mL for vaginal birth
1000 mL for caeserean
Hegar’s sign
softening/compression of lower uterine segment
Goodell’s sign
softening of cervical tip
Chadwick sign
violet blue vaginal mucosa & cervix @ 6 weeks
When do Braxton Hicks contractions start
2nd trimester at 16 weeks
irregular, less frequent, go away
When can fetal movements be felt
20 weeks
Embryonic period
weeks 3-8
critical period of implantation + organogenesis
Fetal period
week 9 - 40
Parental adaptation stages
1) accepting the pregnancy
2) identifying with role of mother/father
3) reordering personal relationships
4) establish relationship w/ unborn child
5) prepare for birth experience
3 developmental tasks of expectant fathers
Ask Me Flamboyantly
1) announcement phase –> reaction to news of being pregnant
2) moratorium phase -> adjusting to new reality. period of introspection/soul-searching
3) focusing phase –> active involvement in pregnancy/relationship w/ child
Teratogens
environmental substances/exposures that cause functional/structural disability in developing fetus
Known human teratogens
drugs
chemicals
infections
exposure to radiation
certain maternal conditions: diabetes, PKU
When does teratogen have the greatest affect on growth/development?
during embryonic period (weeks 1-8)
Normal volume of amniotic fluid
700-1000 mL
oligiohydraminos
<300 mL of amniotic fluid
assoc w/ fetal renal abnormalities
Gravida
Gravidity
pregnancy
Multigravida
woman who has had 2+ pregnancies
Multipara
woman who has completed 2+ pregnancies to 20 weeks gestation or more
Nulligravida
woman who has never been pregnant & is not currently pregnant
Nullipara
not completed a pregnancy with a fetus/fetuses beyond 20 weeks
Parity
of pregnancies in which a fetus/fetuses have reached 20 weeks gestation
not affected if babies are born alive/stillborn
Primigravida
woman who is pregnant for the first time
Primipara
one completed pregnancy with a fetus
fetuses who have reached 20 weeks gestation
Viability
capacity to live outside uterus
usually 22-25 weeks gestation
Term
pregnancy from 37 weeks to 40
Preterm
pregnancy between 20-36 weeks gestation
Early Term
pregnancy between 37-38 weeks + 6 days
Full Term
pregnancy between 39-40 weeks + 6 days
Late Term
pregnancy in 41 week
Post Term
pregnancy after 42 weeks
What are TORCH infections
infections that can be passed from mom to baby in utero or during birth
have similar clinical manifestations
TORCH acronym
Toxoplasmosis
Other - syphilis, Zika, varicella-zoster
Rubella
CMV (cytomegalovirus)
Herpes simplex
GTPAL
Gravidity = total # of all pregnancies
Term births = 37+ weeks gestation
Preterm births = after 20-37 weeks gestation
Abortions = miscarriage, elective termination
L = # of children currently living
Signs of pregnancy
presumptive –> subjective changes/symptoms
probable –> objective changes observed by examiner
positive –> signs attributable only to living fetus
Presumptive signs
amenorrhea
fatigue
breast changes
Probable signs
Hegar sign
ballottement
pregnancy tests
Positive signs
fetal heart tone
visualizing fetus (sonography)
palpating fetal movements
Stages of gestation
ovum/pre-embyronic (0-2)
embryonic (3-8)
fetal (9-40)
When can HCG be detected in maternal serum?
as early as 10 days after conception
What is rhogam?
immune globulin given to Rh- mother
prevents production of maternal antibodies that attack fetal RBC antigen (if Rh+)
When is rhogam given?
1st dose = 28 weeks
2nd dose = 72 hours PP
What rubella titer would the postpartum client receive MMR or MMRV vaccine?
<10
When is Group B strep screening done?
first prenatal visit
When is GDM screening done?
24-28 weeks
When is EPDS done?
28-32 weeks in all pregnancies
What is a teratogen
What is a teratogen
environmental substances/exposures that can cause harm in the developing fetus
preventable disability
What 5 factors are considered when assessing exposure to a teratogen?
Categories of teratogens
drugs & chemicals
physical agents
maternal illness
infectious agents
Which gestation period has highest risk for developing infant?
embryonic period
due to multiple organ systems developing at the same time
How do teratogens affect more than 1 organ system
embryonic period –> organogenesis of all major organ systems occurring at the same time
structures originating from common embryonic tissue (germ layers)
TORCH infections
maternal infections that can be passed to baby in utero, intrapartum or postpartum (breast milk)
TORCH acronym
toxoplasmosis (parasite)
other (syphilis, parvo b19, hep B, varicella-zoster, zika)
rubella
cytomegalovirus
herpes simplex virus
Types of herpes
HSV-1 –> above the waist (oral)
HSV-2 –> below the waist (genital)
both types of herpes can spread to either region
TORCH infections that can be passed during birth
syphilis
cmv
hsv
hep b
TORCH infections that can be passed in breast milk
higher risk in premature babies/SGA
CMV
Treatment for toxoplasmosi
spiraymycin
antibiotic/anti-parasitic
Endocrine organs during pregnancy
corpus luteum (12-17)
placenta (week 12)
Placenta hormones
progesterone
estrogen
human placental lactogen
relaxin
CRH
human chorionic gonadotropin
Progesterone function
suppress FSH/LH (ovulation)
relax smooth muscle of uterus
decreases bladder tone
inhibits lactation
acts on respiratory center to decrease threshold for PaCO2 = increase in minute ventilation
quiets immune response to foreign DNA
*levels decrease in later gestation to allow for childbirth
Estrogen function
enhances uterine lining
causes spider veins
causes N/V and later increased appetite
stimulates fetal adrenal glands to grow
Relaxin function
causes relaxation of pubic symphysis
+ pelvic ligaments to prepare body for child birth
dilates cervix during labour
inhibits uterine contractions to prevent preterm birth
relaxes blood vessels increasing perfusion to placenta and kidneys
hCG function
maintains corpus luteum –> progesterone secretion
stimulates male fetus to secrete testosterone
Prolactin function
*produced by APG
increase milk production
enlarged mammary glands
*progesterone inhibits lactation
Cervical dilation for childbirth
10 cm
Stages of first labour
beginning of contractions –> full cervical dilation
early/latent
active (</= 12 hours)
transition
Second stage of labour
lasts few minutes to hours
full cervical dilation –> birth of baby
Third stage of labour
delivery of placenta
umbilical cord clamped
usually lasts 5-30 minutes
Fourth stage of laboru
recovery period + fetal transition
skin-to-skin/BF initiated with baby
first 2-3 hours after birth
Induction of labour
forced labour either by giving medication, breaking amniotic sac
Episiotomy
cut made at opening of vagina to facilitate birth
can be made midline or at a diagonal
Types of assisted delivery
forceps
vacuum
increased risk of molding, caput and cephalohematoma
Types of pain medication during labour
nitrous oxide (laughing gas)
narcotics
pudendal block (local anesthesia inserted into a nerve in vagina)
epidural/spinal (regional anesthesia)
general anesthesia (rare)
Gestational hypertension
develops >20 weeks
recurrent HTN >140/90 on at least two separate occasions
NO proteinuria/signs of end-organ dysfunction
Pre-eclampsia
HTN
new onset proteinuria
signs of end-organ dysfunction
HELLP
hemolysis
elevated liver enzymes
low platelets
HELLP treatment
delivery of placenta
Severe pre-eclampsia treatment
magnesium sulfate (prevent seizures)
corticosteroids (promote fetal lung function)
anti-hypertensives
RF for pre-eclampsia
genetic conditions (family/maternal history)
late maternal age
primigravida
new partner
collagen vascular disease
multiple gestation
unknwon causes
Oxytocin function
produced by PPG
levels increase at labour
stretches cervix
facilitate uterine contractions
cause release of prostaglandins that also stimulate contraction
increases mother baby bond
Preterm
24-36+6
Late Preterm
34-36+6
Term infant
37-41+6
Post term
42+
Hematological changes of pregnancy
plasma volume increases by up to 1L (40-50%)
lesser increase in RBC (physiological anemia)
What placental hormone stimulates erythropoiesis?
placental lactogen
Which hormones relaxes blood vessels
progesterone
relaxin
increase in blood vessel drops blood pressure –> activates ADH/RAAS
Maternal cardiovascular changes
increased volume –> increased preload
increased contractility (Starling’s law)
decreased SVR = decreased afterload
cardiac output increased by 50%
Coagulation changes in pregnancy
increased # of clotting factors
platelets decrease (hemodilution + get stuck in intervillous space)
returns to normal 6-8 weeks postpartum
Risk of thrombosis after pregnancy
increases by 5.5x since platelets that were in the placenta now re-enter systemic circulation
Respiratory changes of pregnancy
increase in tidal volume (450-650)
expiratory reserve volume increases
increased O2 demand
compression of diaphragm by uterus –> SOB
hormones loosen ligaments in ribcage to allow for greater expansion
Acid-base changes in pregnancy
progesterone stimulates respiratory center –> increased RR + decreased PCO2
minor respiratory alkalosis with renal compensation
Renal changes in pregnancy
glycosuria (pregnancy = insulin resistance)
positive urine dipstick
hyponatremia normal (to allow for amniotic fluid)
Human chorionic gonadotropin
levels rise from day 8 peak 60-90
promotes angiogenesis in uterus
promotes cell diff to generate syncytiotrophoblast
blocks maternal immune system/macrophage activity
