OB 1 Flashcards
What is the goal of genetic counseling?
To identify risk
What’s the earliest genetic testing available?
Chorionic Villus Sampling; at 10-13 weeks
How is Chorionic Villi Sampling done?
Abdominal or vaginal; tissue sample of placenta
What does the patient need to do before Chorionic Villi Sampling?
Drink water and make bladder full
What are some risks of Chorionic Villi Sampling?
Spontaneous abortion, Fetal limb loss (especially prior to 9 weeks gestation), chorioamnionitis, rupture of membranes
What’s Amniocentesis?
Taking a sample of amniotic fluid to check genetic risk. Need enough fluid to test. Great for information purpose, but very high risk
When can amniocentesis be done?
15 weeks - birth
What are some risks of amniocentesis?
Infection, miscarriage, bleeding, rupture of membrane, fetal damage/death, bladder damage
What is Alpha-Fetoprotein (AFP) test?
Maternal blood testing; screening tool used to detect neural tube defects
When can AFP test be done?
15-18 weeks
What does low AFP level indicate?
Risk for Down Syndrome
What does high AFP level indicate?
Risk for neural tube defects or open abdominal defect
What is placenta previa?
When placenta implants in the lower segment of the uterus; may cover all or part of cervical opening
What happens if the cervical opening is covered by the placenta?
No vaginal delivery, no matter how much the placenta is covering the cervical opening
Why does painless vaginal bleeding occur in 3rd trimester with placenta previa?
As the cervix begin to dilate, placenta tears, which causes bleeding
What are some expected findings of placenta previa?
Painless, bright red vaginal bleeding during 2nd - 3rd trimester, higher than expected fundal height
Why is pelvic/vaginal exam contraindicated in placenta previa?
You don’t know where the placenta is before the ultrasound; we don’t want to perforate or separate the placenta because placenta = baby’s O2 supply.
we also don’t want to cause more bleeding
Can placenta previa patients ambulate how many times as they want closer to labor?
No. Strict bedrest
What’s placental abruption?
Premature separation of the placenta from the uterus; meaning that baby has lost their O2 supply
When does placental abruption occur?
After 20 weeks of gestation
What’s the leading cause of maternal death?
Placental abruption
What’s the biggest difference between placenta previa and placental abruption?
Placenta previa causes painless vaginal bleeding while placental abruption causes painful vaginal bleeding
What are some expected findings in placental abruption?
Sudden onset of intense localized uterine pain, profusely bleeding dark red blood, “board-like” abdomen, uterine tenderness, contractions with hypertonicity, fetal distress
What do contractions with hypertonicity mean and why is it bad for the fetus?
Uterine muscle squeezing constantly and not relaxing. More stress to the baby & decreased O2 and blood flow
What’s the biggest and most important nursing assessment with placental abruption?
FHR monitoring, make sure baby is okay
What’s the only management for placental abruption?
Delivery. Therefore prepare for emergency C-section but may deliver vaginally; but it will be a very rapid labor
What’s ectopic pregnancy?
Abnormal implantation of the ovum outside of the uterine cavity. very dangerous
What are some expected findings of ectopic pregnancy?
Unilateral stabbing pain & referred shoulder pain, tenderness in lower quadrant, scant dark red or brown vaginal spotting
What’s the treatment for ectopic pregnancy if it’s ruptured?
Laparoscopic salpingectomy. it has to be rapid because it’s fatal to mom
What’s the treatment for ectopic pregnancy if it’s not ruptured?
Methotrexate to dissolve pregnancy and/or salpingostomy
What are some preSUmptive signs of pregnancy?
Amenorrhea, fatigue, n/v, quickening, urinary frequency, breast changes, uterine enlargement
What are some prOBable signs of pregnancy?
Pregnancy test, abdominal enlargement, Braxton Hicks contractions, fetal outline felt by examiner, Hegar’s sign, Chadwick’s sign, Goodell’s sign
What’s Hegar’s sign?
Softening and compressibility of lower uterus
What’s Chadwick’s sign?
Deepened violet-bluish color of cervix and vaginal mucosa (indication of uterus becoming vascular)
What’s Goodell’s sign?
Softening of cervical tip
What are the positive signs of pregnancy?
Auscultation of fetal heart sounds, fetal movements felt by examiner, visualization of the embryo or fetus by ultrasound
What’s a nonstress test?
Hook to the monitor and see if the baby is moving for 20-30 minutes. Mom pushes the button when movement felt
What does the “reactive” result of a nonstress test indicate?
Baby is moving within normal range; > 2 accelerations within a 20-minute period
What does “nonreactive” result of a nonstress test indicate?
Baby not moving within normal range; fewer than 2 accelerations in a 40-minute period. Further investigation needed
What’s a contraction stress test?
Assessing fetal response to contractions; determine how fetus will tolerate the stress of labor
Why is a contraction stress test risky?
When contractions occur, placental blood flow is decreased and oxygen is restricted
Why is oxytocin-stimulated contraction stress test much more risky than nipple-stimulated?
It’s performed when nipple-stimulated test fails; it requires IV administration of oxytocin to induce uterine contractions. Once that contraction starts, there’s no going back. High risk of preterm labor
When is a biophysical profile ordered?
With nonreactive stress test, suspected oligohydramnios or polyhydramnios, suspected fetal hypoxemia or hypoxia
What does the biophysical profile consist of?
FHR (110-160)
Fetal breathing (are they trying to breathe?)
Body movements (good moving?)
Fetal tone (flaccid vs moving)
Amount of amniotic fluid
What’s considered embryonic stage?
Day 15 - 8 weeks
Which fetal development stage is the most critical time in development of organ systems?
Embryonic stage; by the end of 8 weeks, all organs are present but not fully developed
When do moms need to be extra cautious about environmental teratogens?
During embryonic stage, when organs are forming
When is fetal stage?
9 weeks - end
What’s quickening?
Fetal movement felt by mother
When is quickening felt?
At about 20 weeks
What’s monozygotic?
“identical” twin; from 1 ovum and 1 sperm. Same genetic makeup therefore same sex and genotype
Usually shares placenta
What are some risks associated with monozygotic?
One can be bigger than another, getting all the nutrients.
What’s dizygotic?
“fraternal” from 2 ova and 2 sperm. 2 different genetic makeup. 2 placentas, 2 chorions, and 2 amnions
Describe the menstrual cycle
1st day of period to the 1st day of the next period; about 28 days on average
What are the phases of the menstrual cycle?
Menstrual (Day 1-6), Proliferative (Day 7-14), Secretory (Day 15-26)
When does uterine bleeding usually begins?
14 days after ovulation
When is the fertile period?
Ovum is only fertile for 24 hours after ovulation
How long does it take for an egg to implant?
About 6-10 days after fertilization
What are the 2 structures of blastocyst?
Embryoblast, which become embryo, and Trophoblast, which becomes placenta
Why does the placenta have same DNA as baby?
Because both the placenta and the embryo are made from the blastocyst
How does hormone impact the menstrual cycle?
After ovulation, estrogen and progesterone are secreted. If not pregnancy, both levels drop, leading endometrium to not being nourished anymore. This comes out as menstrual bleeding.
What’s estrogen’s role in pregnancy?
Crucial for maturing egg follicle
What’s progesterone’s role in pregnancy?
Thickens endometrium, relaxes uterus to maintain pregnancy
Therefore, if not enough progesterone, miscarriage
Which hormone helps release egg in ovulation and increase labor contractions and opening of cervix for birth?
Prostaglandins
What area is most likely damaged during childbirth?
Perineal body
What are the placenta functions?
Transfer oxygen & nutrients to fetus, remove waste products and CO2 away from fetus and into maternal blood, makes hormones, and transfers antibodies from mother to fetus
What’s the role of placental barrier?
Prevent direct contact between fetal & maternal blood
What hormones are produced during pregnancy by the placenta?
chorionic gonadotropin (HCG), Prolactin, Estrogen, Progesterone, Relaxin
What are the danger signs during pregnancy?
s/s of HTN or preeclampsia, burning during urination, severe vomiting, diarrhea, fever and chills, abdominal cramping, vaginal bleeding, changes in fetal activity, s/s hyper/hypo glycemia
Why do we worry about fever and chills during pregnancy?
Bacterial/viral infection that can cross placenta barrier and harm the baby
How to calculate due date using Nagele’s rule
1st day of LMP - 3 months + 7 days + 1 year (as needed)
What is supine hypotension?
Baby compresses inferior vena cava, leading to decreased venous return vausing hypotension
How is supine hypotension alleviated?
By lying on the side, especially left, for better blood flow to uterus or sit up semi-fowler’s
When does gestational HTN begin?
After 20 weeks of gestation
What’s the major difference between gestational HTN and preeclampsia?
Presence of proteinuria
What is preeclampsia?
Gestational HTN + possible headaches & visual disturbances, edema, and proteinuria
What’s severe preeclampsia?
Preeclampsia + BP >160/110, >3+ proteinuria, hyperreflexia, extensive peripheral edema, epigastric and RUQ pain
What’s eclampsia?
Severe preeclampsia + new onset of seizure activity or coma
When can eclamptic seizures occur?
Before or during labor, or postpartum (48 hours after delivery) Therefore keep eclamptic patients in the hospital for more than 48 hours after birth
What is HELLP syndrome?
Severe preeclampsia + Hemolysis, Elevated Liver enzymes, and Low platelet count
What’s polyhydramnios?
Too much amniotic fluid; usually associated with gestational diabetes
What’s oligohydramnios?
Low amniotic fluid
What is hyperemesis gravidarium?
Morning sickness on steroids
What are some expected findings of hyperemesis gravidarium?
Electrolyte imbalance, dehydration, nutritional deficiencies, urine ketone might be present due to breakdown of proteins and fats
What are the treatments for hyperemesis gravidarium?
Give fluids and hope they grow out of it. Lactated ringers, vitamin B6 to help combat nausea, and antiemetics
What are some remedies that can help with nausea?
Always keep something light in stomach. sour candies, ginger, alcohol pads
What can be used in severe case of hyperemesis gravidarum?
Feeding tube or TPN might be used
What are the symptoms of threatened abortion?
Possible mild cramps, slight spotting, no tissue passing, closed cervix
Pregnancy may continue
What do you see when someone is having inevitable abortion?
Mild-moderate cramping, moderate bleeding, no tissue passing usually dilated cervix
What happens during incomplete abortion?
Severe cramps, heavy, profuse bleeding, some tissue passing, cervix dilated with tissue in cervical canal or passage of tissue
In what type of abortion is at high risk of infection and D&C or D&E needs to be performed?
Incomplete abortion
What does complete abortion look like?
Mild cramps, minimal bleeding, all tissue passing, cervix closed after passage
What’s the type of abortion that mother doesn’t know about it until their 1st ultrasound appointment?
Missed; no cramps, spotting, or tissue passing. closed cervix.
Died in utero
What’s a significant finding with septic abortion?
Malodorous discharge; severe infection after an abortion
Abortion treatment includes:
D&E or D&C, or prostaglandins and oxytocin to start labor and pass naturally
What is gestational diabetes?
Impaired glucose tolerance that is first recognized or begins during pregnancy
What’s 1-hour GTT for gestational diabetes diagnosis?
At 24-28 weeks; 50g oral load, check BG after 1 hour. If 130-140, need 3-hour GTT
What’s 3-hour GTT?
When 1-hour GTT is abnormal; check fasting glucose, 100g oral load, check BG 1, 2, and 3 hours post load. If 2 or more of the values elevated = diabetic
What does class A1 diabetes indicate?
No meds needed; diet controlled. usually hard for mothers due to pregnancy cravings
What does Class A1 diet look like?
3 meals/2 snacks, encourage bedtime snacks to prevent hypoglycemia at night, never skip meals, < 50% of calories from carbs
What does class A2 diabetes indicate?
Need meds; oral: glyburide and metformin. SubQ or pump insulin may be needed or not
What’s magnesium sulfate used for?
Prevent seizures in eclamptic patients
What does magnesium sulfate do?
Relaxes smooth muscle & vasodilates
What are the signs of magnesium sulfate toxicity?
RR <12/min, cardiac dysrhythmias, decreased LOC, low urine output, low BP, absence of DTR
What do you need to monitor (baby-wise) when giving magnesium sulfate?
Continous FHR monitoring, perform NST & kick counts to make sure baby is perfusing
What’s the antidote for magnesium sulfate?
Calcium gluconate
What’s cerclage?
Sewing cervix shut to prevent preterm labor on patients with cervical insufficiency
When is cerclage removed?
at 36-38 weeks; removal does not mean immediate labor
When should cerclage patient come to the hospital?
If feeling anything labor-like; if labor starts, cervix will dilate, and that stitch will be ripping the cervix if left unseen. Since uterus and cervix is very vascular, bleeding will be a problem
How does pregnancy affect BP?
Systolic: slight or no increase from baseline
Diastolic: slight decrease around 24-32 weeks, but will gradually return to baseline by the end of pregnancy
What pregnancy category medications are considered safe?
Category A, but consult provider before taking any medications
What are neural tube defects?
Birth defects of brain, spine, and spinal cord due to low folic acid level
How can neural tube defects be prevented?
Start taking folic acid even before trying to get pregnant
What is fundal height?
Measured in cm from symphysis pubis to top of the fundus
How do we know if fundal height is on track?
At 20 weeks, which is the half-way mark, fundal height should be at umbilicus
Textbook - 20cm at 20 weeks, 21cm at 21 weeks, etc.
What can cause fundal height to be bigger than expected?
polyhydramnios, placenta previa, molar pregnancy
What can cause fundal height to be measured small?
Nicotine use, HTN
What is urinary frequency during pregnancy?
Pregnancy hormones and increased blood volume increase filtration, increasing the amount of urine production
Happy kidneys
Also because uterus is compressing bladder
What is a fetal demise?
Fetal death after 20 weeks; stillbirth.
What is fetal demise associated with?
Hyperglycemia and ketoacidosis, congenital anomalies, infections, postdates, etc.
Explain fetal circulation
Umbilical vein -> ductus venosus (liver to heart) -> Foramen ovale (r. atrium to l. atrium) -> ductus arteriosus (from heart to down) -> umbilical artery
Lung bypass because fetus is in amniotic fluid therefore alveoli filled with fluid
What are some skin changes during pregnancy?
Chlosama/melasma, linea nigra, striae gravidarum
Where does chorionic villi develop out of?
Trophoblast; extended into the endometrium. within placenta
What’s the function of amniotic fluid?
It’s like sterile urine; it cushions against impacts to the maternal abdomen, maintains a stable temperature, allows symmetric development, prevents membranes from adhering to developing fetal parts, barrier to infection
What’s the inner fetal membrane called?
Amnion
What’s the outer fetal membrane called?
Chorion
How many arteries & veins are in the umbilical cord?
2 arteries and 1 vein
Why do we worry about blood clots, especially during postpartum?
Because of increased clotting factors during pregnancy; it’s a normal change
What can help with leg cramps due to expanding uterus partially obstructing blood return from veins in legs?
Calcium
What’s the desired outcome for “Count to Ten” method of fetal movement testing?
10 distinct movements in 1-2 hours
What kind of vaccine do we not give to pregnant people?
Live virus vaccine since it can cross placenta barrier
How can sex lead to preterm labor?
Semen has prostaglandins and oxytocin; those can start labor
Why do we need emergency Birth Pack easily accessible at bedside with patients with preeclampsia?
Cure for preeclampsia is to deliver the baby, and sometimes they can get into labor very fast
What is hydatidiform Mole (molar pregnancy)?
Bening proliferative growth of the placental trophoblast. Chorionic villi develop into cysts in a grape-like cluster; embryo fails to develop
Prune-like vaginal bleeding with uterus size larger than gestational weeks indicates
Molar pregnancy
What’s the treatment for molar pregnancy?
Suction & curettage to evacuate tissue. if not removed completely, it will keep coming back. Avoid pregnancy until cleared
Can UTI lead to preterm labor?
Yes, the cramps can lead to it
Why are you prone to hypoglycemia in the first trimester?
Fasting glucose decreases by 10% during first trimester; trying to adapt to baby’s portion of energy too
What can iron deficiency anemia cause in relation to birth?
Preterm birth and low birth weight
What is the primary mechanism to stop hemorrhage from the uterine arteries after childbirth?
Contraction of the uterine smooth muscle that compresses arteries - massage the fundus so muscles can contract
Signs of ovulation include:
Basal body temperature drops slightly, then spikes 1/2 a degree, positive test for spike in luteinizing hormone
In which stage of fetal development is most vulnerable to medications and chemicals?
Embryonic stage, because that’s when organ formation occurs
Amniotic fluid embolus frequently leads to
DIC; monitor bleeding
For diabetic patients, educate to
Check fetal kick counts daily to make sure they are perfusing
What are some common discomforts of pregnancy?
Breast tenderness, urinary frequency, epistaxis
Why is dysuria a complication of pregnancy?
Could be UTI with cramps or other kidney - bladder infection (ex. pyelonephritis, etc.) that can also cause cramping and lead to preterm labor
Is it normal to feel whether you are happy with pregnancy or not during first few months of pregnancy?
Yes
What kind of foods are good calcium source if patient does not like milk?
Dark green leafy vegetables
Why does the nurse use an acoustic vibration device during the nonstress test?
To awaken sleeping fetus
What can cause development of placenta abruption?
Blunt abdominal trauma, cocaine use, cigarette smoking.
Fetal position and maternal age is not a risk factor
What medication is used to mature fetus’s lungs?
Betamethasone (corticosteroid)
What are some risk factors for hyperemesis gravidarum?
diabetes, multifetal pregnancy, gestational trophoblastic disease
What are some risk factors of preterm labor?
UTI, multifetal pregnancy, hydramnios, DM, uterine abnormalities
What are some contraindications for magnesium sulfate use?
Fetal distress, vaginal bleeding, cervical dilation greater than 6 cm
When there’s any kind of problem during pregnancy, educate mom to
check kick count daily
