OB Exam 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
