NUR 360 - Exam 1 Flashcards
serousal layer
outer layer of uterus
myometrium
middle layer made of smooth muscle - responsible for contracting during labor
endometrium
inner mucus layer
fundus
top of uterus where contractions start
isthmus
lower uterine part just above cervix
where is the site for c-section?
isthmus
what does it mean for the cervix to “efface”?
thins and shortens
what hormones do the ovaries produce?
estrogen
progesterone
testosterone
what hormones are the ovaries sensitive to?
FSH + LH
what is the role of estrogen in the cycle?
thickening of endometrial mucosa
when is estrogen the highest?
follicular phase
what 4 supplies does estrogen supply to the uterus?
glycogen, amino acids, electrolytes, and h2o
what hormone does estrogen inhibit?
FSH
what hormones does estrogen stimulate?
LH
what is the role of progesterone in the cycle?
vaginal epithelium grows and cervical mucous becomes thick
what is the effect of progesterone on the breasts?
glandular tissues increases in size and complexity
prep for lactation
what does progesterone do during ovulation and secretory phase?
increase body temp
what hormone does a fertilized egg produce?
hCG
how long is the corpus luteum producing progesterone?
until week 10 of pregnancy
what is the role of progesterone during pregnancy?
maintain lining of uterus until placenta is mature
what hormone supresses uterine contractions?
progesterone
what hormone supresses the maternal immunologic response to reject pregnancy?
progesterone
what makes cervical mucus?
bartholin gland
normal cervical mucus pH
4-5
ovulation mucus pH
7.5
how long is the ova viable?
6-24 hours
when is the sperm most healthy?
first 24 hours
what do fallopian tube enzymes do?
remove protective coating from sperm
what is the acromosomal reaction?
when sperm comes in contact with ovum
how do sperm get to the ovum?
sperm enzymes penetrate layers of the ovum
what is the endometrium called during pregnancy?
decidua
how is the decidua maintained?
estrogen, progesterone, and hCG
what can increase the chance of having twins?
increased maternal age, infertility treatment, first 3mo of marriage, more babies one has,
what can decrease the chance of having twins?
winter/spring in norhtern hemisphere and malnutrition
mono chorionic-diamniotic
- most common
- one chorion, two amniotic sacs
dichorionic-diamniotic
- 25% chance
- two chorions, two amnionic sacs
monochorionic-monoamniotic
- FATAL
- one chorion, one amniotic sac
when does implantation spotting occur?
7-10 days after fetilization
amnion
innermost embryonic membrane
chorion
outermost embryonic membrane
chorionic villi
finger like projections that delivery o2 and nutrients to fetus - used for prenatal testing
what is hCG doing in early pregnancy?
doubles every 48h until 10 weeks
what is hCG effect on hormones?
- stimulates estrogen and progesterone
- prevents ovulation and menstruation during pregnancy
immunologic capabilites of hCG
stops body from rejecting pregnancy
role of hCG in male fetuses
stimulates testosterone and develops genitals
what are the 8 roles of amniotic fluid?
- cushion
- control embryo temp.
- support symmetrical growth
- prevent embryo from sticking to amnion
- free movement
- prevent crushing of umbilical cord
- wedge during labor
- tells us if fetus is healthy and maturing
oligohydraminos
too little amnionic fluid
polyhydraminos
too much amniotic fluid
what is the umbilical cord protected by?
whartons jelly
how are blood vessels organized in the umbilical cord?
2 arteries and 1 vein spiral in cord
are there nerves in the umbilical cord?
no
what is a nuchal cord?
umbilical cord around neck
when does the placenta develope?
14 weeks but could start working as early as 11 weeks
what are the cotyledons?
15-20 subdivisions of the placenta that have their own vascular system
when does the placenta start producing hormones?
produces estrogen + progesterone at 11-12weeks
what viruses cross the placenta easily?
HIV, cytomegalovirus, rubella, polio
its harder for bacteria to cross the placenta but which one can?
treponema pallidum (syphillus)
what is the endocrine function of the placenta?
provide glycogen, cholesterol, and fatty acids
what is hPL?
human placental lactogen hormone that stimulates breast growth
what does hPL regulate?
moms glucose, fat, and protein
goodells sign
softening of cervix
chadwicks sign
bluish color of cervix
hegars sign
softening of isthmus
ballottement
fetal movement
what is a qualitiative pregnancy test?
urine test to detect if hCG present
what is a quantitative pregnancy test?
maternal serum test detects how much hCG and 48h doubling
gravida
of pregnancies
nulligravida
never been pregnant
primigravida
first pregnancy
multigravida
2+ pregnancies
para
of pregnancies carried to 20 weeks
what is the edge of viability?
22-25 weeks
term
delivered 37+ weeks
preterm
delivered 20-36 weeks
1 trimester
0-13 weeks
2 trimester
14-26 weeks
3rd trimester
27-40 weeks
intrapartum
active labor
naegeles rule
LMP - 3 months + 7 days + year if needed = due date
non invasive tests
- nuchal translucency
- maternal serum
- quad screen
invasive tests
- CVS
- amniocentesis
purpose of nuchal translucency and maternal serum tests
assess risk of chromosomal abnormalities and neural tube defects
what is the first trimester alternative to amniocentesis?
CVS test
what can the CVS test not determine?
spina bifida or analcephaly
what does the quad screen screen for?
- hCG production
- alpha-fetoprotein
- estriol
- inhibin A
what does decreased AFP mean on a quad screening?
downsyndrome
what does increased AFP mean on a quad screening?
neural tube defects
what does increased hCG+inhibin A mean on a quad screening?
downsyndrome
what does decreased estriol mean on a quad screening?
downsyndrome
when can a transvaginal ultrasound be performed?
1st trimester
when can an abdominal ultrasound be performed?
2nd + 3rd trimester
how often do you visit the provider during the first and second trimester?
every 4 weeks
when is the anatomy scan?
20 weeks
how often do you visit the provider in the 3rd trimester?
every 2 weeks until 36 weeks then every 1 week
can an HIV mom breastfeed?
yes
what causes fatigue?
increased metabolic needs of mom + fetus
what can cause acute pain?
stretching of round ligaments
what can cause constipation?
increase of progesterone can cause sluggish bowels
risks of sex during pregnancy
- rupturing of membranes
- bleeding
- preterm labor
how much should calories increase during the 2nd trimester?
340 cals
how much should calories increase during the 3rd trimester?
462 cals
how come pregnancy women are more prone to dehydration?
increased basal metabolic rate
effects of dehydration
preterm labor
how much liquid to consume a day?
8-10 glasses
what vitamin is NOT stored in the liver?
vit C
what are the B vitamins?
thiamine, riboflavin, niacin
what are the effects of folic acid deficiency
neural tube defects
how much weight should a mom gain during pregnancy if she is at a normal weight?
25-35lbs
how much weight should an underweight mom gain?
28-40lbs
how much weight should an overweight mom gain?
15-25lbs
how much weight should an obese mom gain?
11-20lbs
how much weight should you gain in the first trimester?
2.2-4.4lbs
how much weight should you gain in the 2nd and 3rd trimester?
1lb per week
if you have maternal PKU, what foods should you avoid?
high protein and aspartame
pica
eating non-nutritional things due to anemia
dysuria
pain when urinating
couvade
dad/partner mimics pregancy symptoms
how much does the uterus weigh during pregnancy
50-1000g
when does quickening start?
20 weeks
when does urinary frequency start?
1st and 3rd trimester
when does fundus reach umbilicus?
20 weeks
how much should the fundus grow?
1cm per week until 36 weeks
what creates the mucous plug?
endocervical glands
how does the cervical os change after birth?
changes from dimple to slit
when do you start producing colostrum?
20 weeks
how does estrogen change the respiratory tract?
estrogen induced edema causes stuffiness
how does tidal volume change during pregnancy?
increases up to 40%
how does blood volume change during pregnancy?
increases up to 45%
how does pulse change during pregnancy?
increases by 10-15 bpm
how does blood pressure change?
BP decreases slightly- lowest during 2nd trimester
how does cardiac output change?
up 30-50%
what position compresses vena cava?
laying on back
why does RBC increase?
for increased oxygen carrying capacity
what causes pseudoanemia?
increase in plasma volume
what increases the risk for thrombosis?
clotting
why are pregnant ppl at increased risk for gallstones?
slow emptying of gallbladder causes increased levels of cholesterol in bile
how does glomerular filtration rate change?
increases 50%
what is the proteinuria level for preeclampsia patients?
> 300mg/24hrs
where is spider nevi?
face, neck, chest, arms
how long does hair shedding last?
1-4mo PP
what causes waddling gait?
relaxation of pelvic joints
diastasis recti
ab muscles seperate in 3rd trimester
can diastasis recti be prevented?
yes, with exercise
what causes carpal tunnel syndrome?
median nerve compression
what system causes the BMR to increase?
endocrine system causes it to increase by 20-25%
what hormone stimulates colostrum?
prolactin
labor dystocia is more common in what age group?
teens
what are the 3 types of anemia?
- folic acid
- sickle cell
- iron deficiency
what IM injection is given to anemic patients?
imferon
crack can cause what placental disease?
abruptio placentae- placental detaches from uterine wall
symptoms of neonatal abstinence syndrome
- high pitched cry
- increased moro (falling) reflex
- nasal flaring
what disease can cause an increased risk of PP hemorrage?
HIV/AIDS
what do you treat HIV with?
antiretrovirals
if an HIV patient has a high viral load, when should a c/s be done?
38 weeks
what does TORCH stand for?
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
how can you get toxoplasmosis?
cat litter + raw meat + raw goats milk
how do you diagnos toxoplasmosis?
test igG/igM, test amniotic fluid at delivery, ultrasound
how do you treat the mom for toxoplasmosis?
- spiramycin
- sulfa drug + pyrime drug
- folinic acid
fetal risk of toxoplasmosis
- blindness
- retinochoroditis (teens)
- microcephaly
- coma
- convulsions
- cognitive defects
what does 1:18 immunity against rubella mean?
immune
what does 1:8 immunity against rubella mean?
at risk
fetal risks of rubella
- congenital heart disease
- cerebral palsy
- deafness
where is cytomegalovirus found?
ALL body fluids
how does cytomegalovirus affect adults, kids, and fetuses?
not harmful in adults/kids but fatal in fetus
when is cytomegalovirus the greatest risk to fetus?
1st trimester
fetal risks pf cytomegalovirus
- microcephaly
- hydrocephaly
- small for gest. age
- intellectual disability
how is herpes transmitted to baby?
birth canal
if the primary infection of herpes was close to the birth site then what is the rate of infection?
30-50%
what is the maternal treatment for herpes?
acyclovir started at 36 weeks
what is the herpes treatment for a neonate?
acyclovir started at birth
fetal risk of herpes
- fever/ hypothermia
- jaundice
- seizures
- poor feeding
early onset fetal risks of GBS
pneumonia, spesis, apnea
late onset fetal risks of GBS
meningitis, pneumonia
long term fetal risks of GBS
neuro complications
two common reasons for 1st trimester spontaneous abortion
- chromosomal abnormalities
- uterine/cervical issues
threatened cervix
cramping, bleeding, backache, but cervix is closed
imminent/inevitable cervix
dilated cervix
incomplete cervix
some products of conception retained - usually placenta
complete cervix
all products of conception passed
missed cervix
fetus dies but is not passed
if you do not get a dead fetus out within 6 weeks, what disease can occur?
Disseminated Intravascular Coagulation
recurrent
consecutive losses in 3 or more pregnancies
ectopic pregnancy
implantation in fallopian tube
treatments for ectopic pregnancy
- surgical removal
- methotrexate (IM or PO)
- rhogam if Rh negative
symptoms of ectopic pregnancy
severe one sided pain
