OB exam 1 Flashcards
Para
Number of pregnancies that reached viability. Dead or alive. Greater than 20 weeks.
Gravida
Is or has been preg. Includes abortions.
Primigravida
First pregnancy
Primipara
Has given birth to one child past age of viability
Multi gravity
Has been preg previously
Multipara
Has carried two or more pregnancies to viability.
Nulligravida
Has never been and is not currently preg
Post term
Pregnancy that goes beyond 42 weeks plus 6 days
Preterm
Preg that has gone beyond 20 weeks but has not completed the full 38 weeks plus 6 days
Term
Beginning of 38 weeks and went to the end of the 42nd week plus 6 days
Viability
Capable of. Living outside uterus. 22-25 weeks
Fertilization
Union of ovum and spermatozoon. Occurs in the outer third of Fallopian tube
Implantation
Contact between growing structure and uterine endometrium. 8-10 days after fertilization
Decidua
Shedding the lining of the uterus
Chorionic villi
Join with soft tissue to make placenta
Babies body
Placenta is
Pumps blood
The reservoir
2 arteries 1 vein. In placenta
Vein brings oxygenated blood.
Ductus arterioles
Bypass lung
Foramen ovale
Bypass right ventricle.
NST
Want 2 accelerations of 15 bpm, lasting 15 seconds, within 20 minutes.
Positive NST/CST
BAD! Want it to be negative.
Biophysical profile
NST, fetal breathing, gross body movement, fetal tone, quantity of fluid, grade placenta.
Fetal kick count
Over 6 per hour.
Fundal height
Should be at belly button at 20 weeks.
Fungal height
Measure from pubic symphysis to fundus.
Maternal serum alpha feto protein. MSAFP
If more than specific amount than suspect neural tube defect. If lower suspect downs.
Chorionic villus sampling CVS
Get DNA from placenta .can be done before 12 weeks.
Pericutaneous umbilical sampling PUBS
Done under general anesthesia. Take blood from cord. Done late. 36 weeks.
Amniocentesis
To get DNA. 1 weeks.
Pseudocyesis
False pregnancy.
Presumptive signs of preg
Amenorrhea Breast soreness NV Frequent urine Quickening. Linea negra, melasma, striae gravidarum
Probable signs of pregnancy
Lab test 95-98% reliable.
Home test, if neg repeat in week.
Hegar-vaginal exam to feel uterus and baby.
Goodell-cervix become soft
Chadwicks-cervix become engorged with blood and become bluish.
Braxton hicks- contraction of uterus to help blood flow and growth.
Fetal outline felt.
Accelerations
Increase HR of baby to we know brain is being oxygenated.
If flat than baby could be asleep or in bad shape.
Placental function
Lungs- o2 and co2 exchange. GI-absorbe nutrients Renal- filter urea and other waste. Liver-processes moms blood for iron. Endocrine- maintains pregnancy and prevents another. Prepares breasts for lactation. Thermal control. Immune- mostly bacterial stuff.
Whartens jelly
Cushions cord.
HCG hormone produced to…
Continue to manufacture progesterone.
Where does contraction start?
Top middle of fundus then goes down and in.
During contraction 02 is temporally cut off.
Not completely.
Compromise=
Hypoxemia deteriorating to severe hypoxia. Can lead to cerebral palsy.
Decrease in oxygen can be from
Contractions HTN Hypo(supine, hemorrhage, anesthesia) Hypovolemia Anemia Alterations in fetal circ. (Cord compression)
Use Doppler 1st stage; 2nd stage
Q15-30 min
Q5-15 min
If water breaks, check?
FHT, cord may be compressed.
Position changes
Put in knee chest position (on back, hips off bed)
Never trendelenberg!
Internal monitoring
IFM direct
External monitoring
EFM, indirect
IUPC
Shows intensity of contraction, duration, and resting tone.
Can pull or push fluids.
TOCO
Electrical fetal monitoring, shows contractions. Do not use gel.
Fetal ultra sound
Use gel.
Detects movement, not sound.
Apply to babies back.
Spiral electrode
Internal monitor.
Shows dysrhythmias with no artifact.
Accurate short term variability STV
Must be 2cm dilated. And head in pelvis.
Augmentation
Having contractions but give ptosin to make them stronger.
Kangaroo care
Warm baby by putting on moms bare chest
How many extremities do we take baby BP
2
First VS taken
RR. 30-60 normal.
Take for 1 full minute!!
When taking measurements of baby
Head, chest, belly.
Head should be the biggest.
TOLAC
Attempts to labor by women that has previously had a C-section.
VBAC
Successful trail of labor resulting in vaginal birth.
Contractions are:
Involuntary, neural, hormonal, and pharm influences.
Relaxation period must be how long?
60 seconds to reprofuse blood.
3 stages of contraction
Increment, Acme, decrement.
Hyper tonus
Resting state.
< 25 mmhg.
Normal resting tone- 5-25.
Average 8-12
Monte vedeo units, MVU
Anything between 150-200 is adequate. Shows contractions are strong enough to give birth.
If over 300 stop ptosin. Baby is being stressed.
Dystocia
Slow labor; abnormal; cant get contractions started.
NADIR
Shows depth of de-accelerations.
Duration and intervals are measured in?
Seconds.
Coupling
Two contractions at once.
Depends on position of baby.
Hyperstimulation
One contraction after another. No 60 seconds.
Could be from abruption (uterus shedding placenta)
Tetany
Long contraction.
Shouldn’t last of 90 seconds.
Variability contraction
Good variability shows well being.
Push and pull of nervous system.
Marked variability, good or bad?
Bad. Turn mom to left side to improve o2 and circulation to uterus.
Periodic changes happen?
With each UC
Episodic
Not associated with UC.
Early decelarations
Response to fetal head compression.
Late decelerations due to?
Uteroplacental insufficiency. Not good, low o2
Variable decel due to?
Cord compression.
Early decel
Baby could be breached
cephalo pelvic disproportion
Pelvis too small
As hypoxia continues you will see:
Late decels
> loss of accels
>loss of variability
> rising or lowering baseline.
Actions for hypoxia:
Get help! DC oxytocin(ptosin), aminoinfusion. Put on left side. Fluid bolus LR or NS to slow contraction O2 by mask 8-10L check BP.
If hypoxia than what meds?
Epinephrine if BP is the problem
Terbutaline if contractions are the problem
Possibly mag sulfate.
To assess fetal well being:
Scalp stimulation
Scalp sampling (to do ABG)
Spiral electrode test
Recommended auscultation:
Q15 in first stage
Q5 in second stage.
Q10 thereafter. Review tracing that often.
What to chart
Baseline rate Variability FHR, changes with characteristics. Contraction patterns Interventions, response, communication
Goal for hypoxia
Detect early to prevent acidosis, and brain injury.
Danger signs 1st trimester
Severe persistant vomiting.
Abd pain and vaginal bleeding
Infection
Danger signs 2nd trimester
Maternal- Preeclampsia Premature rupture of membranes. Premature labor Fetal- Decreased fundal height. Absence of fetal movement.
Danger signs 3rd trimester
Maternal- Gestational diabetes Placenta previa Abruption Fetal- Hypoxia
Prolactin
Milk manufacture
Estrogen
Duct sprouting
Progesterone
Lobule formation
Oxytosin
Let down.
Let down, hypothalamus
Sucking stimulates nerve fibers in the nipple, message goes up spinal column.
Let down, pituitary gland
Responds by releasing hormones prolactin and oxytocin.
Pro- stim milk production
Oxy- stimulate muscle contraction of uterus.
Breast feeding should be done how long on each side?
10 minutes
Should have How many wet diapers per day?
At least 6
