Module 5: Pregnancy and Childbirth Flashcards
what is the most dangerous thing a woman can go through in their lifetime
childbirth
list races by maternal mortality from highest to lowest
- black
- native american and alaska native
- white
- asian and pacific islander
- hispanic
what cells are needed for fertilization
- egg cell
- sperm cell
define zygote
- fertilized egg cell
- sperm + egg
how many sperm cells are deposited per ejaculation
300-500 million
how many egg cells are released per month
1 (on average, can be more)
how does being pregnant with twins change your risk status
twin pregnancies and births are considered high risk
define dizygotic twins
- 2 eggs and 2 sperm cells create 2 zygotes
- have different genetic material
- as genetically related as any other siblings
define monozygotic twins
- 1 egg and 1 sperm cell create 1 zygote that will split into two embryos
- have identical genetic information
what is considered full term for twins
36 weeks
what is the only difference in the appearance of monozygotic twins and why
- fingerprints and footprints
- created by the way the baby grows in the uterus
which type of twin is considered safer and why
- dizygotic twins
- each baby has its own placenta and amniotic sac
which type of twin is considered more high risk and why
- monozygotic twins
- both babies share 1 placenta and amniotic sac
which cell is larger: egg or sperm
egg
why is it good to confirm a pregnancy early
- leads to earlier decision making
- allows mother to change behaviors to keep baby healthy
- more options for termination earlier on in the pregnancy
define teratogen
- anything that causes a birth defect
- smoking, alcohol, etc.
when do early signs of pregnancy typically occur
within the first 6 weeks
list early signs of pregnancy
- missed periods
- breast swelling/tenderness
- fatigue
- nausea/vomiting
- elevated body temperature
- mood swings
- frequent urination
should you be bleeding when you are pregnant
- should not have bleeding similar to a period
- may experience breakthrough bleeding or spotting while pregnant
how much can breasts grow during pregnancy
can increase 1-3 cup sizes
what happens to your blood volume when you’re pregnant
blood volume increases
why do pregnant women experience nausea/vomiting
hormones
how much does body temperature increase during pregnany
1-2 degrees
why is body temperature higher during pregnancy
blood volume increases
why do pregnant women experience mood swings
hormones
why do pregnant women experience frequent urination
- the growing baby in the uterus pushes on the bladder
- lower bladder volume
define amnion
- fetal sac that envelops the embryo
- flexible membrane
- contains pregnancy contents
define amniotic fluid
- provides protection and constant environment for floating embryo
- necessary for growth and development of the fetus
- keeps a constant temperature
- protects against excess movement
- clear/yellowish color
define placenta
- supplies fetus with oxygen and nutrients from the maternal bloodstream
- filters waste back to the mother for disposal
define umbilical cord
- connects the developing fetus to the placenta
- contains two arteries and one vein
- connected at the belly button of the fetus
- about 1 foot in length
when is the first trimester
1-12 weeks
when do most women find out they are pregnant
around 6 weeks
when does pregnancy officially begin
when the embryo implants into the uterine wall
what is considered full term for an average pregnancy
36-40 weeks
list symptoms that occur during the first trimester
- enlarged and tender breasts
- morning sickness (nausea and/or vomiting)
- extreme fatigue
- decreased interest in sex
- moodiness and irritability
- darkening of nipple and areola
does morning sickness only occur in the morning
no, but it may be more significant in the morning
what should you do to help morning sickness
eat small snacks like crackers, bananas, or toast
why might a pregnant woman have a decreased interest in sex
- hormones
- feeling sore, nauseous, or uncomfortable (physically or emotionally)
what causes a darkening of the nipple and areola during preganny
increased estrogen
when is the second trimester
13-27 weeks
list symptoms that occur during the second trimester
- morning sickness subsides
- gastrointestinal problems (heartburn, gas, constipation)
- breathing problems
- backache
- leg cramps and numbness/tingling of hands
- swelling of feet, hands, and ankles
when does an embryo become a fetus
after 8 weeks
why does morning sickness typically subside during the second trimester
hormones begin to balance out
define hyperemesis gravis
- extreme vomiting during pregnancy
- causes dehydration and malnutrition
- may need to be hospitalized
why might a pregnant woman experience gastrointestinal problems (heartburn, gas, constipation)
compression of internal organs (stomach, intestines)
why might a pregnant woman experience breathing problems
- compression of lungs
- lung volume decreases
why might a pregnant woman experience backache
the change in the center of gravity with more weight anterior causes a pregnant woman to lean backwards to maintain balance
why might a pregnant woman experience leg cramps and numbness/tinging of hands
compressive pressure on abdominal aorta that supplies blood to these areas
where do pregnant woman typically get leg cramps
calves
when is the third trimester
28-40 weeks
list symptoms that occur during the third trimester
- leg cramps continue and worsen
- backache continues and worsens
- breathlessness continues and worsens
- braxton-hicks contractions
- production of colostrum
- pelvic and buttock discomfort
describe braxton-hicks contractions
- false labor
- body getting ready for actual labor
- cramps all over body
what is the main difference between braxton-hicks contractions and real labor contractions
- braxton-hicks contractions happen in multiple areas
- real labor contractions start in the fundus of the uterus
what are colloquial names for colostrum
- pre-milk
- liquid gold
describe colostrum
- first milk produced
- couple of tablespoons in volume
- thicker than regular breastmilk
- full of antibodies
what immune system is a baby born with
no immune system
where do babies get antibodies after they are born
breastmilk (colostrum)
why might a pregnant woman experience pelvic/buttock discomfort
- hips are widening
- separation of pubic symphasis
how much weight do women gain on average during pregnancy
25-30 pounds
define preconcpetion care
the steps a woman can take before she decides to become pregnant to ensure that she is in good health when conception occurs
when is it recommended to start taking prenatal vitamins
3 months before conception
list aspects of preconception care
- prenatal vitamins (folic acid)
- proper immunizations
- healthy behaviors
- nutrition
what does folic acid prevent
neural tube defects (spina bifida, anencephaly, microcephaly)
define spina bifida
- neural tube defect
- spinal column doesn’t close completely so the spinal cord is exposed
- needs surgery
- may cause loss of function in all or part of body
define anencephaly
- neural tube defect
- absent portions of the brain
define microcephaly
- neural tube defect
- small/undeveloped brain
- associated with intellectual and developmental disabilities (IDDs)
how much folic acid should a woman planning on conceiving consume per day
400 micrograms
what foods contain folic acid
- beans
- legumes
- dark leafy greens
- nuts
- seeds
- some citrus fruits
why should you get all proper immunizations as a part of preconception care
to form antibodies that you can transfer to you baby through breastmilk
how many extra calories does a pregnant woman in the third trimester need per day
200-300 calories extra per day
what are the benefits of exercising during pregnany
- feeling better throughout pregnancy
- shorter labor
- quicker recovery from birth
how long is the typical first labor
16-24 hours
what forms of exercise should pregnant women engage in
- activities they have done pre-pregnancy with some modifications (running, weights)
- swimming
- walking
- low impact aerobics (yoga)
- kegel exercises
describe kegel exercises
- strengthen pelvic floor muscles for labor and post-labor
- can prevent incontinence following labor
- can practice by stopping peeing midstream
what forms of exercise should pregnant women NOT engage in and why
- horseback riding: puts pressure on cervix, falling danger
- skiing/snowboarding: falling danger, likely to fall on stomach
list effects of smoking during pregnancy
- reduction of fetal blood flow
- ability of fetus to metabolize vitamins is reduced
- premature labor and low birth weight
- increased chance of hemorrhaging and stillbirth during delivery
- hospital stays are longer
- mother heals slower
- increases likelihood of SIDS
why does smoking cause a reduction in fetal blood flow
nicotine is a vasoconstrictor
what is defined as low birth weight
under 5.5 pounds
why does smoking cause low birth weight
- nicotine causes decreased blood flow (vasoconstriction)
- reduced blood flow can decrease nutrition to the fetus
- decreased nutrition can cause lower birth weight
define SIDS
- sudden infant death syndrome
- infant death (under 1 year) from no known cause
- association with smoking
what is the leading cause of preventable birth defects
drinking alcohol while pregnant
how does drinking alcohol while pregnant affect the fetus
- alcohol passes through the placenta
- decreases glucose and oxygen to the fetal brain
what conditions does drinking while pregnant cause
- fetal alcohol syndrome (FAS)
- alcohol-related birth defects (ARBD)
describe fetal alcohol syndrome (FAS)
- spectrum disorder (different severities)
- distinct physical features
- intellectual and developmental disabilities (IDDs)
- less impulse/emotional control
- shorter attention span
what are the distinct physical features caused by fetal alcohol syndrome (FAS)
- small head
- low nasal bridge (flat nose)
- epicanthal folds (webbing at the corner of the eye)
- small eye openings
- flat midface (less pronounced cheekbones)
- shorter nose
- smooth philtrum (above lips)
- thin upper lip
- underdeveloped/small jaw
describe alcohol related birth defects (ARBD)
- creates problems with internal organs
- kidney problems, hearing loss, heart problems, issues with bone growth/development
when during pregnant is drinking alcohol most dangerous
during the 1st trimester
describe the difference between screenings and diagnostic testing
- screenings are done to assess risk and determine is further diagnostic testing is needed
- diagnostic testing is used to get answers/diagnoses
what screenings are done during the first trimester
- ultrasound tests
- maternal blood tests
describe the ultrasound screenings done during the first trimester
- vaginal ultrasounds are performed early in pregnant; abdominal ultrasounds are performed later
- done to confirm pregnancy and check fetal position and growth
what conditions does maternal blood tests done in the first trimester screen for
- down syndrome (trisomy 21)
- trisomy 18
what does trisomy 21 and trisomy 18 mean
- trisomy 21 (down syndrome) means there is a third copy of the chromosome 21
- trisomy 18 means there is a third copy of the chromosome 18
how do maternal blood tests screen for fetal genetic abnormalities
some of the fetal DNA is in maternal blood as it is passed through the placenta
what increases the risk of a baby having down syndrome
increased maternal/paternal age
what are the effects of trisomy 18 on a baby
- born low birth weight (under 5.5 pounds)
- heart defects
- small head
what percent of babies with trisomy 18 live past their first year
5-10%
what screenings are done during the second trimester
- multiple marker screening
- detailed ultrasound exams
describe multiple marker screenings performed during the second trimester
- taking a sample of maternal blood
- can detect abnormalities in the health of the baby’s internal organs (liver, kidneys, heart)
describe the detailed ultrasound exams performed during the second trimester
- can take over 1 hour
- performed by a sonographer
- take the measurements of the baby
what diagnostic tests can be performed during pregnancy
- chorionic villus sampling (CVS)
- amniocentesis
- cordocentesis
what do diagnostic tests during pregnancy test for
genetic testing on the fetus
when is chorionic villus sampling (CVS) done
10-12 weeks
what tissue is taken during chorionic villus sampling (CVS)
placenta
what is the width of the placenta
width of two hands
describe how chorionic villus sampling is performed
- an ultrasound is used to guide a catheter through the cervix and into the uterus
- a sample of the placenta is taken
- there is no interference with the amniotic sac
when in an amniocentesis done
15-20 weeks
what tissue is taken during an amniocentesis
amniotic fluid
describe how an amniocentesis is performed
- an ultrasound guides a needle through the abdomen and into the amniotic sac
- a sample of amniotic fluid is collected
- the amniotic sac will heal on its own
describe the risk for miscarriage if you have an amniocentesis
- 0.06% risk for miscarriage
- the same as the average risk for miscarriage at this time in the pregnancy; amniocentesis does not increase the risk for miscarriage
when is a cordocentesis done
18+ weeks
what tissue is taken during a cordocentesis
blood from the umbilical cord
what type of diagnostic test during pregnancy is the highest risk and why
- cordocentesis
- damaging the cord can terminate the pregnancy
why is cordocentesis only done after 18 weeks
the umbilical cord needs to be large enough the get a sample of blood from it without damaging it too badly
describe the diameter of the umbilical cord
quarter-sized diamter
describe how a cordocentesis is performed
- ultrasound guides a needle through the abdomen
- a sample of venous blood from the umbilical cord is taken
what is the risk of miscarriage with a cordocentesis
1-2% risk of miscarriage
define ectopic pregnancy
fertilized egg grows outside the uterine cavity
how many pregnancies are ectopic
- 20 in 1000
- 2%
describe the relationship between IUDs and ectopic pregnancies
IUDs do not cause ectopic pregnancies but if you become pregnant with an IUD, there is a good change that it will be ectopic (usually in the fallopian tube)
what are risk factors for ectopic pregnancy
- fallopian tube problems (scar tissue, endometriosis)
- pelvic inflammatory disease (PID)
what causes pelvic inflammatory disease (PID)
bacterial STIs (chlamydia and gonorrhea)
how long does it take pelvic inflammatory disease (PID) to form after infection from chlamydia or gonorrhea
years
what does pelvic inflammatory disease (PID) cause the formation of
scar tissue in the pelvic cavity
list symptoms of ectopic pregnancy
- abdominal pain
- spotting
- ruptured fallopian tube
what is the leading cause of pregnancy death in the first trimester
ectopic pregnancy
what percent of women with ruptured ectopic pregnancies die
10%
why can ectopic pregnancies be life-threatening
ruptured ectopic pregnancy can cause hemorrhaging (extreme bleeding)
are ectopic pregnancies viable
no, they must be surgically terminated
define gestational diabetes
- diabetes that develops during pregnancy
- similar to type 2 diabetes
what are the two things that can cause gestational diabetes
- insufficient insulin production
- insulin resistance
how many pregnant women have gestational diabetes
- 8 in 100
- 8%
when does gestational diabetes typically occur
in the second half of gestation
what are symptoms of gestational diabetes
- may or may not have symptoms
- symptoms: thirsty, increased urination, fatigue
how is gestational diabetes diagnosed
glucose test: drinking a sweet drink and getting blood tested
what are the two versions of the gestational diabetes glucose test
- short version: 1 hour
- long version: 24 hours
how is gestational diabetes managed during pregnancy
- diet/exercise
- insulin
does gestational diabetes resolve after pregnancy
- may resolve after birth
- may persist as type 2 diabetes in the mother
what are risks associated with the fetus of a mother with gestational diabetes
- “fat” baby
- premature labor/delivery
- underdeveloped organs at preterm birth (specifically the lungs)
define preterm delivery
labor before week 37
how many pregnancies result in preterm delivery
- 12 in 100
- 12%
describe the trend in the rate of preterm deliveries in the US
- increase rate of preterm delivery
- increased 3% in the last 20 years
list risk factors for preterm deivery
- previous preterm birth
- multiples
- maternal abnormalities or medical conditions
- late or no prenatal care
- mothers who smoke, drink, or use drugs
how long is full gestation for twins
36 weeks
how long is full gestation for triplets
34 weeks
define incompetent cervix
- condition where the cervix dilates too early
- causes preterm delivery
define preeclampsia
high blood pressure after 20 weeks gestation
define eclampsia
- high blood pressure after 20 weeks
- occurs after preeclampsia
- organs begin to shut down
- fatal conditions
how many pregnant women have preeclampsia
- 5-10 in 100
- 5-10%
how can preeclampsia be controlled
magnesium based drugs
which pregnancy complication has different rates of incidence for different races/ethnicities
preeclampsia
list symptoms of preeclampsia
- protein in urine
- face and hands swelling (pitting edema)
- sudden weight gain (1-2 pounds per day)
- blurred vision
- severe headaches
- dizziness
- stomach pain
what is the cure for preeclampsia
delivery of the baby
how many weeks of gestation is the earliest viable delivery
26-28 weeks
define miscarriage
pregnancy that ends before the 20th week
what percent of clinically diagnosed pregnancies end in miscarraige
10-15%
what factors are associated with miscarriage
- advanced maternal age (over 35)
- genetic/chromosomal anomalies
- smoking or drug use
- uterine abnormalities (placenta attachment, thin endometrium, heart-shaped uterus)
what are symptoms of miscarriage
- bleeding
- cramping
define stillbirth
intrauterine death of fetus after the 20th week
how many pregnancies end in stillbirth
1 in 160
what are the causes of stillbirth
- same as miscarriage (maternal age over 35, genetic anomalies, smoking/drug use, uterine abnormalities)
- umbilical cord issues (cord compression, cord wrapped around the fetus’ neck)
what are symptoms of stillbirth
- bleeding
- cramping
- lack of fetal movement
how long can the baby stay in the uterus after the amniotic sac breaks
24 hours
why do we want to baby out of the uterus within 24 hours of the amniotic sac breaking
risk of infection and stillbirth
what are the 3 common signs that labor has begun
- uterine contractions every 5 minutes or less
- rupture of the amniotic sac membrane causing a leak of fluids
- bloody show: passage of the mucus plug when the cervix dilates
what happens to uterine contractions as labor continues
- time between contractions decreases
- intensity of contractions increases
describe how the amniotic sac breaking (water breaking) usually looks
- usually a gradual and slow leak of fluids
- can be a sudden gush but not usually
what are other signs that labor has begun
- diarrhea
- backache
- increased braxton-hicks contractions
why is diarrhea a sign of labor
hormones that cause uterine contractions (prostaglandins) can affect the large intestine
why is backache a sign of labor
hormones that cause uterine contractions (prostaglandins) can affect muscles in the back
what is the only way that labor is confirmed
pelvic exam
how many stages of labor are there
3
describe the first stage of labor
- laboring process
- the head of the baby engages with the cervix
- cervix dilates to 10 cm
- effacement of the cervix
which stage of labor takes the longest
stage 1
define vertex/cephalic delivery
head first
define breech delivery
anything but head first
what are the 2 phases of stage 1 of labor
- early
- active
what happens during the early phase of stage 1 of labor
cervical dilation from 0-3 cm
what happens during the active phase of stage 1 of labor
cervical dilation from 4-7 cm
define effacement
- thinning and softening of the cervix
- cervix becomes the thickness of the uterine walls
define the transition stage of labor
- between stages 1 and 2
- cervical dilation from 7-10 cm
- when the baby moves to face downward
why do we want a baby to be born head first
- easier to push
- less risk of stillbirth: baby can breathe on its own with its head out and won’t aspirate in utero
- shoulders won’t get stuck
why do we want a baby to be born facing downward
- the baby will flex its neck up which is easier when facing downward
- faster delivery
describe the second stage of labor
- pushing and delivery of the fetus
- takes 2-3 hours on average for the first pregnancy
describe the third stage of labor
- delivery of the placenta (afterbirth)
- can happen immediately after delivery of the baby or up to 30 minutes later
what happens to the placenta after the baby is delivered
it detaches from the uterine wall and will be expelled during the third stage of labor
what can be done to remove portions of the placenta that may still be in the uterus
- give medications to increase uterine contractions
- manual extraction of pieces of the placenta
what risk is associated with manual extraction of the placenta
infection
what types of pain relief are given during childbirth
- tranquilizers
- analgesics
- anesthetics
what do tranquilizers do
- take the edge off
- make you less nervous
what tranquilizers are given during childrbith
- valium
- xanax
how are tranquilizers administered during childbirth
IV
what do analgesics do
pain relief
what analgesic is commonly given during childbirth
demoral
how are analgesics administered during childbirth
IV
what is a common side effect of demoral
nausea
what do anesthetics do
block pain completely
what are the types of anesthetics that can be given during childbirth
- epidural
- spinal
- pudendal
define epidural
- anesthetic given during childbirth
- local anesthetic delivered through a catheter beside the spinal cord (in the epidural space)
- continuous (catheter stays inside)
- numbs from the waist down
define spinal
- anesthetic given during childbirth
- single anesthetic shot injected directly into the spinal fluid surrounding the spinal column
- less common than epidural
- lasts up to 6 hours
describe how an epidural or a spinal would be given
- patient sit on exam table
- patient hugs a pillow
- patient leans forward
define pudendal
- anesthetic given during childbirth
- injected into the area around the vagina and perineum
- given to lessen the pain of the “ring of fire” or before an episiotomy
describe the “ring of fire”
- area around the vaginal opening
- burning sensation felt as the baby is delivered and immense pressure is put on nerves
where is most likely to tear during childbirth
perineum
define episiotomy
- cutting of the vaginal opening/perineum to lessen the risk of tearing
- easier to suture back than if the perineum was torn on its own
define cesarean delivery
- surgical incision made in the wall of the mother’s abdomen and the uterus to deliver a child
- also known as c section
what is happening to the rates of c sections in the US
increasing
what percent of births are c sections
33%
how many births annually are c sections in the US
1.2 million
why do we now do horizontal incisions rather than vertical incisions
horizontal incisions leave a less visible scar
how wide is a c section incision
6 inches wide
list the layers of the body that are cut during a c section
- skin
- fat
- fascia
- abdominal muscles
- peritoneum
- uterus
describe how getting deep to the abdominal muscles is different than other layers during a c section
- all other layers are cut horizontally
- the abdominal muscles are separated vertically (no cutting)
how long does the average non-emergent c section take
15 minutes
how long does the average emergent c section take
3 minutes
list reasons for getting a c section
- cephalopelvic disproportion
- multiple births
- placenta previa
- fetal distress
- failure to progress
describe this reason for getting a c section: cephalopelvic disproportion
the baby’s head is too large to fit through the mother’s pelvis
describe this reason for getting a c section: multiple births
- we want to deliver multiples earlier than labor would usually start (full term = 36 weeks)
- reduces risk of stillbirth
- less distress on the fetus
describe this reason for getting a c section: placenta previa
- placenta attaches on or near to cervix
- placenta can tear and bleed if the cervix dilates for vaginal delivery
describe this reason for getting a c section: fetal distress
- placenta prematurely detaching limiting oxygen to the fetus
- baby has low heart rate or blood pressure
- baby defecates in utero; they can aspirate and get bacterial infections
define muconium
fetal defecation in utero
describe this reason for getting a c section: failure to progress
- cervix stops dilating even after medications
- can result in stillbirth or fetal distress
what percent of infertility in couples is due to female isues
25-35%
what percent of infertility in couples is due to male issues
25-35%
what percent of infertility in couples is due to both female and male issues
30-50%
what is often the cause of female infertility
ovulation disorders: not producing a viable egg
what is often the cause of male infertility
- azoospermia: no sperm in semen
- oligospermia: low sperm count
what is classified as oligospermia (low sperm count)
- under 10 million per ejaculation
- less than 5% of the average (300 million)
how can infertility be diagnosed among men and women
- ovulation test
- cervical mucus test
- postcoital test
- blood test for hormone levels
- hysterosalpingogram
- laparoscopic surgery
- semen analysis
define postcoital test
- testing how semen reacts to being inside the female body
- testing internal environment of uterus 6 hours after sex
define hysterosalpingogram
uterine x-ray used to identify blockages or scarring in the uterus or fallopian tubes
define laparoscopic surgery
- small incisions in the abdomen: 1 for camera, 2 for instruments
- checking for internal abnormalities
define semen analysis
taking a sample of semen to diagnose low sperm count
what are treatment options for infertility for women and men
- improve the quality of cervical mucus with estrogen and prednisone
- stimulate ovulation with medications
- surgery to open blocked sperm ducts or fallopian tubes
- artificial insemination
- in vitro fertilization
what medications can stimulate ovulation
- oral clomid
- gonadotropin releasing hormone
how does clomid stimulate ovulation
produces more follicles
what can commonly happen if you conceive while taking oral clomid
more likely to have multiples
how does gonadotropin releasing hormone stimulate ovulation
helps the egg develop and become viable
define artificial insemination
physician deposits sperm into the fundus of the uterus
define in vitro vertilization
- eggs and sperm are collected
- zygote is created outside of the body
- zygote is planted inside the uterus