Module 9 & 10 - Fetal Well-Being; Nutrition & Exercise Flashcards
T/F - Etiology is usually apparent in 1st trimester bleeding.
False - etiology is often unknown
T/F- Goal during dx with 1st trimester bleeding is one of exclusion.
True
All of the following are ___________ ________ of 1st trimester bleeding:
Polyps, cervivitis, vaginal infection, STI, implantation spotting (which is most often ____, ___ to ____
days after conception, lasting only a day or two; a
minority of pregnant women have this kind of
spotting), increased vascularization of the cervix in
pregnancy = increased friability, post-coital spotting due to increased friability
Normal etiologies;
scant, 7-11 days;
It is important to assess bleeding _________, __________, associated __________ & ___________, ___________ and __________.
severity, amount, associated signs and symptoms, pain, and cramping.
Pertinent past history for 1st trimester bleeding includes: previous \_\_\_\_\_\_\_\_ prior \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ disorders \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_
ectopic SABs medical risk factors fibroids
Physical exam for 1st trimester bleeding includes:(4)
Physical exam
• Vital signs
• Abdominal exam – pain, maybe FHT,s
• Speculum exam – observe internal and external
• Bimanual exam – CMT, adnexal masses, uterine
enlargement
_____________ _____________ is the most common early pregnancy complication.
Spontaneous abortion
_____% of SABs are in the 1st 12 weeks.
80%
____________ _____________ are the most common reason for SABs.
Chromosomal errors
SAB rate is ___ to ____ % of all conceptions.
25-30%
Risk factors for SAB include: (7)
Risk factors • Smoking • Alcohol • Immune factors (recurrent loss) • Inherited blood dyscrasias (recurrent loss) • Excessive caffeine, >500 mg daily • Environmental exposures • Pesticides, arsenic, lead, formaldehyde, benzene
(A) Inevitable (B) Missed (C) Incomplete (D) Threatened (E) Complete
_____ closed cervix, uterus appropriately sized,
_____ cervix dilated, increased bleeding with
cramps/ctx, products of conception can be at os
_____ small contracted uterus, open cervix,
scant bleeding/cramping
____ placental tissue remaining, cervix open,
POC can be at os, uterus smaller than expected for
gestational but not well contracted, variable
bleeding/cramping
____ in utero death of embryo prior to 20th wk with
retention of pregnancy for prolonged period of time.
Cervix closed, +/- bleeding
D) Threatened A) Inevitable E) Complete C) Incomplete B) Missed
_________ is key to diagnosis of SAB
• May see abnormal ____ ____, slow or absent____,or
___________
_______ ____ is adjunct to determine viability
• _________every 2-3 days
• Max levels at __ - ___ weeks, then declines
• Serial measures
Ultrasound;
yolk sac; FHT; hematoma
Serial b-hCG;
Doubles; 8-10 weeks;
Ectopic pregnancy occurs in about ___ % of pregnancies, clinical manifestations usually occur in the ___ to ___wk of pregnancy, but can occur later.
2%; 6-8 weeks
T/F - All women with an ectopic will be symptomatic when you see them.
False - many are asymptomatic
\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_: • Tubal ligation • Tubal pathology/surgery • Prior ectopic • IUD – especially Mirena \_\_\_\_\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_\_\_: • Infertility • Assisted reproduction technology • Prior hx of genital tract infection (Chlamydia, GC, salpingitis) • Multiple sex parters (secondary to increased risk for PID) • Smoking – risk is dose dependent \_\_\_\_\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_\_: • Prior cesarean • Douching
High; ectopic
Moderate; ectopic
Lower; ectopic
Signs/sx of ectopic may include ___________, ________________/____________, and _____________ (profuse if cervical pregnancy).
abdominal pain, amenorrhea/+preg test, bleeding
T/F- Women with an ectopic may experience normal pregnancy signs, like breast tenderness, nausea, etc.
True
Signs of a ruptured ectopic may include ___________ _________ (from blood irritating the diaphragm) and _________ to ___________ (from blood pooling in the cul de sac).
shoulder pain; urge to defacate
T/F - A pregnancy test should be done on all women of childbearing age who present with abdominal pain.
True
Evaluation for suspected ectopic should include:
• _______ exam for _______ mass
• Assess ________ _______ _______ (sometimes your
first clue on routine 1st visit exam)
• ___________ (may or may not see __________sac)
• Serial _______ (may see _____ rise, may be normal)
pelvic; adnexal
cervical motion tenderness
Ultrasound; extrauterine
B-hCG; slower
Midwifery management of ectopic is to ____________.
refer!
MD may proceed with medical mgt (_________) rather than surgery, if _________ and hCG
Methotrexate; unruptured;
A complete hydatidiform mole has ____ ____ _____. A partial mole has _______ _________ _________.
no fetal tissue; some fetal tissue.
Risk factors for molar pregnancy include _________ maternal _____, _________ maternal ______, and _____ _______ pregnancy.
younger maternal age, older maternal age, and previous molar pregnancy.
Multiparas begin feeling FM between ___ to ___ weeks; pimiparas begin feeling FM between ___ to ___ weeks.
16-18; 18-22
FM maximize around ___ weeks, then become ___ frequent.
34; less
FHT can usually be obtained with a doppler starting between ___ to ___ wks gestation.
10 to 12
Fingerbreadths are used to assess FH between __ to __ wks gestation. After__ wks a tape measure is used and normal is +/- __ cm of wks of gestational age
12 to 20; 20; 2cm
A _________ ________correlates with fetal survival for one week or more in 99% of cases.
reactive NST
A non-reactive NST correlates with poor fetal outcome in __% of cases.
20%
Normal AFI is __to __cm.
8 to 24;
A CST uses pitocin or nipple stim to create ___ contractions in a ____minute window. If the fetus has a negative fetal response (positive test) __________ is contraindicated.
3; 10; induction
Doppler velicometry is used in conjunction with other fetal well being tests to assess wellbeing of fetus with _________ ____________ __________
fetal growth restriction
Protein requirements are ___ to ___ gm/day in __ to ___ servings
70-75; 2-4
_________ __________ required increased protein.
_________ _________ and ___________ often have inadequate protein.
Bariatric patients
Low income and vegeterians
Carbohydrates: Daily serving: ___ - ___servings (___ gms/day and ___% of caloric intake) ___ oz is one serving.
Average intake is _________.
6-9; 175gm/day; 60%; 1oz is one serving
excessive
T/F - Adequate carbohydrate intake helps prevent ketosis.
True
_______ are good for body energy stores.
Fats
Fats should be limited to ___% or less of total caloric intake
30%
Omega-3 fatty acids (DHA)
May reduce the incidences of _________ ______ and _________.
__________ is a good source of DHA
preterm birth and preeclampsia;
salmon
True/False - Omega -3 fatty acids (DHA) important to neural and retinal membranes promoting increased infant cognitive ability, verbal IQ, and attention spans
True
Omega-3 fatty acids (DHA) cont.
Recommendations are to consume approx ____ -____mg/day = __ servings/week especially in 2nd & 3rd trimesters
200-300mg/day = 2servings/week
High doses (>__________ IU/day) of Vitamin ___ can cause teratogenic effects.
25,000; A
T/F - You should not eat foods high in vitamin A.
False - needed for eye and neuro development; previtamin A is food source and is safe
Vitamin ___ is folate/folic acid.
B
Folic Acid _____mcg/day prior to preg; ____mcg/day during preg; ______mcg day if hx of NTD to start _______ mos prior to conception.
400; 600; 4000; 6months
Need approx ___ mg/day of iron.
30mg/day
Calcium: need ___________mg/day; ____to ______servings (teens need ____ to ____ servings; _____mg/day)
1000; 3 to 4; 4 to 5;1300
Calcium needs increase around ___ wks due to fetal bone growth.
12
________________ is needed for the absorption of calcium. RDA is ______ mg
Vitamin D; 600
Water: ___ liters/day
3
Grains: \_\_\_oz per day Vegetables: \_\_ -\_\_\_cups/day; Fruits: \_\_\_cups/day; Dairy: \_\_\_-\_\_\_cups/day; Protein: \_\_\_-\_\_\_oz/day; Oils: \_\_\_tsp/day
Grains: 6oz/day Vegetables: 2-3cups/day Fruits: 2cups/day Dairy: 3-4cups/day Protein: 5-6oz/day Oils: 6tsp/day
________ should be eaten twice per wk as protein source due to benefits of DHA, which are fetal ________ and ________ development
Fish; brain and eye development
Recommended wt gain:
____ to ____;_____ in 1st; __-___ in 2nd/3rd
for the following:
BMI 30
30: 11-20; 0-1; 1/2
NTD is twofold the risk in __________ women.
overweight
Obese women have 3x increased risk of __________ and 5x increased risk of ____________.
3x - stillbirth; 5x - preeclampsia
