OB/GERI EXAM 2 Flashcards
What is the lowest level of surveillance we can do?
Fetal movement assessment
When is fetal movement assessment done?
o Ideally, it is done after dinner with the mother resting on her side for up to 2 hrs
Optimizes blood flow to baby
How does cigarette smoking affect newborn blood flow?
For every cigarette that the mother smokes, you have 2 hours of diminished blood flow to the baby which can erroneously influence test results
How much movement should you have during a Fetal Movement Assessment?
Mother should have at LEAST 10 movements in a 2-hour period
What are some advantages of the Fetal Movement Assessment
o Low tech
o Done as a daily assessment and early intervention
o Can be done on all pregnancies
o Reassuring for the mother
What are the three types of electronic fetal monitoring?
1) External monitoring
2) Internal fetal monitoring
3) intrauterine pressure catheter (IUPC)
What are the two types of belts on the external monitoring?
Tococonducer (belt on the top):
• Monitors for contractions and palpates for changes in tone of the abdomen where changes will occur
Lower belt: senses change in fetal HR
• B/c FHR found in lower half of abdomen
When would we use internal fetal monitoring?
1) Membranes must be ruptured
2) Cervix must be dilated
3) must be able to palpate anatomy of fetus so we know we are placing electrode over a bony prominence
What do we monitor with an intrauterine pressure catheter (IUPC)
to monitor compression pattern
What are the optimal positioning of the baby?
Right occiput anterior
Left occiput anterior
What are the components of the electronic fetal monitoring?
1) baseline
2) Variability
3) periodic changes (accelerations or decelerations)
What is variability in the electronic fetal monitoring?
Variation of the fetal heart rate around the baseline in amplitude of 5-10 bpm
It is indicative of the health of the PNS and is a snapshot of what is happening neurologically in the baby
What is acceleration
of the FHR from the baseline with an amplitude of 10-25 bpm
is indicative of the health of the SNS (fight or flight response)
What does FHR variability reflect?
reflects the health of the nervous system, chemoreceptors, baroreceptors and cardiac responsiveness
How does prematurity affect variability
Prematurity decreases variability therefore there is little rate fluctuation <28 weeks
When is variability present in the fetus?
should be present >32 weeks
fetal hypoxia, congenital heart anomalies and fetal tachycardia can cause a decrease in variability
Presumptive signs of pregnancy
cessation of menses
nausea and vomiting
breast changes-enlargement and tenderness
urinary frequency
fatigue
elevation of basal body temperature
Leakage of colostrum
Excessive salivation 4-14 weeks -> period that coincides with morning sickness
Quickening- the mother’s perception of fetal movements
Probable signs of pregnancy
physical symptoms that increase the likelihood that it is pregnancy that is causing these symptoms
chadwick’s sign
probable sign of pregnancy
blue or purple discoloration of the vulva and the vaginal mucosa, including the vaginal portion of the cervix that occurs around 8 weeks gestation
Hegar’s sign
softening and compressibility of the uterine isthmus
b/c of this softening the uterus may be anteflexed or retroverted
occurs around 6-12 weeks
uterus will be tilted back towards the rectum in early pregnancy instead of tilted forward as it should be
Piskacek’s sign
asymmetry of the uterus with a rough, irregular contour on one side
occurs around 4-5 weeks
Which probable sign of pregnancy is a sign in which the placenta is implanted that occurs around 4-5 weeks gestation
Piskacek’s sign
Mcdonald’s sign
an ease in in flexing the body of the uterus against the cervix that goes along with Hegar’s sign
Uterine isthmus
portion of uterus b/w cervix and upper body of uterus
because of this softening the uterus may be anteflexed or retroverted ~6-12 weeks
Goodell’s sign
- the softening of the cervix
- cervix will continue to be soft then develop a hardness/firmness to help it to not give away under pregnancy and result in miscarriage
- cervix will also form mucous plug during pregnancy which is a dense concentration of mucus that prevents anything from getting up to the vaginal vault and affecting pregnancy
At what gestation period does Goodell’s sign occurs?
5 weeks
Uterine souffle
the blowing sound of increased blood flow
ballotment
palpation of the fetal head
What are the three positive (definitive) signs of pregnancy?
1) Auscultation of the fetal heart tones
2) Fetal movement perceived by the provider
3) Visualization of the fetus
What are the two ways pregnancy testing is done to assess levels of hCG produced by the fetus?
Urine or blood serum
How often should hCG double during early pregnancy?
hCG should double every 2 days during early pregnancy
What is the easiest and least expensive method for a pregnancy test
- Urine based hCG that is done on the first morning void
- accurate after 10-14 days after the first missed menses
Benefits of serum hCG testing
Can detect a pregnancy earlier, is not dependent on the time of day and serial testing can be utilized to assess the potential viability of a pregnancy
What is Naegele’s rule for dating a pregnancy?**
the first day of the last menstrual cycle plus 7 days minus 3 months
Uterine sizing
8 weeks= egg
10 weeks= orange
12 weeks= grapefruit and at pelvic brim
Ultrasounds and dating a pregnancy*
the earlier the US the more accurate it is dating a pregnancy
Nulligravida
woman who has never been pregnant
Primigravida
woman pregnant for the first time
Multipara
woman who has had two or more births at more than 20 weeks gestation
mutligravida
woman in second or any subsequent pregnanct
What color is a non-pregnant uterus?
light pink
What color is pregnant uterus
burgundy d/t increased vascularity
How big is the placenta at term
8-10 inches
What is the placenta’s function
- supplying the fetus oxygen and nourishment
- removing carbon dioxide and waste materials
- producing hormones to maintain the pregnancy
- also produces amniotic fluid fetus lives in
How is the mother and fetus’s blood separated?
The two are separated by the semipermeable placenta membrane and their blood does not intermix in the placenta
-this membrane helps to protect the fetus from many environmental factors (bacteria, chemicals)
What can cross the placenta
some small molecules like alcohol, some viruses, and toxic chemicals
When does the placenta start to form?
During implantation
What is the first placental hormone produced?
hCG-secreted by the placenta so it’s only present during pregnancy
-can be found in maternal blood and urine as early as the first missed period and through the 100th day of pregnancy
Which hormone is necessary to maintain the endometrial lining of the uterus during pregnancy to provide nourishment to the feuts?
Progesterone- ESSENTIAL FOR MAINTAINING PREGNANCY**
- sometimes it is given as a supplement if a pregnancy is at risk
- it prevents preterm labor by reducing myometrial contraction
Which hormone stimulates the development of secondary female sex characteristics?
Estrogen
In pregnancy:
1) contributes to the woman’s mammary gland development in preparation for lactation
2) stimulates uterine growth to accommodate growing fetus
What tissue/organ mainly produces Relaxin
produced mainly by the corpus luteum
What are some important functions of relaxin?
-Known to mediate the hemodynamic changes that occur during pregnancy, such as increased cardiac output, increased renal blood blow, and increased arterial compliance by relaxing the tone of vascular bed so it can accomodate increase in circulating blood volume
Human Placental Lactogen
promotes mammary gland growth in preparation for lactation in the mother
also regulates maternal glucose, protein, and fat levels so that this is always available to the fetus as resource
What are the cardiovascular changes during pregnancy?
- slight cardiac hypertrophy
- upward cardiac displacement
- increased blood volume
- increased cardiac output
- increased pulse rate 10-15 bpm from prepregnant baseline
- increased tendency toward cardiac arrythmias
- relaxation of vascular bed tone
What are the respiratory changes during pregnancy?
- oxygen requirements increase
- increased chest expansion
- lower rib cage flares out (laterally)
- upward displacement of the diaphragm
- upper respiratory tract becomes more vascular and therefore more congested
- increased tidal volume and capacity but decreased reserve and residual volumes
What are the renal changes during pregnancy?
- renal pelves and the ureters dilate
- the enlarging uterus puts pressure on the bladder and ureters
- urine flow rate is slowed
- urinary tract infections are common (esp. ascending UTI)
- glomerular filtration increases
- renal blood flow increases
- increased renal function in lateral position
- decreased BUN, creatinine
- glucose present in urine normally
What are the integumentary changes during pregnancy?
- increased skin thickness and subdermal fat-harder to start IV
- Hyperpigmentation
- Increased hair and nail growth
- Increased sweat and sebaceous gland activity
- Increased circulation and vasomotor activity
- Cutaneous elastic tissues are more fragile resulting in increased tendency for stretch
What are the neuromuscular changes during pregnancy?
- center of gravity shifts
- lordosis develops
- relaxation and softening of connective tissues
- abdominal muscles weaken and separate
- increased tendencies toward headaches, syncope, muscle cramping and numbness
What are the gastrointestinal changes during pregnancy?
- Appetite fluctuates–> accompanied by morning sickness
- Intestinal secretions decrease
- Absorption of nutrients increases
- Tendency toward nausea early in pregnancy
- The colon is displaced
- Decreased gastric motility-influenced by progesterone
- Food cravings and changes in food taste
- Increased salivation
Gravida
TOTAL # of pregnancies regardless of gestation including the current pregnancy- includes miscarriages and elective terminations
Parity
any birth after 20 weeks gestation whether born alive or dead
Term
number of infants born at or after 38 weeks gestation
Preterm
number of infants born between 20 weeks and 38 weeks
Abortions
number of infants born before 20 weeks gestation whether born alive or dead- includes both spontaneous miscarriages and elective terminations of pregnancies and ectopic pregnancy
Living
number of children alive currently- living children are going to affect her psychological response
Uterus
comprised of muscle- increases not only in size but in thickness of muscle mass
it becomes very vascular to support the pregnancy
Where is the bladder located?
Located anteriorly to the uterus and vaginal vault
Where is the uterus located?
It leans forward on top of bladder but during postpartum period, if the bladder becomes distended it will displace the uterus and make it harder to stop a hemorrhage
Where is the rectum located?
It is located immediately behind the uterus and the vaginal vault
Where are the ovarian tubes located?
They are located at the sides of the uterus and wrap around the ovary and secures it in place
Where is the fimbriae located?
located at the end of the fallopian tube that captures the gg to move it along the uterus
What is the age of bioavailability
when essential systems are only minimally functional by 24 weeks but now it’s 23 weeks
Advantages of chorionic Villus Sampling
short waiting time for test results
allows for early detection of fetal disorders
Disadvantages of chorionic villus sampling
- increased risk of injury to the fetus
- inability to detect neural defects
- potential for repeated invasive procedure
- risk of contamination of specimen w/ maternal mother’s cells
- risk of failure to obtain placental tissue
- risk of leakage of amniotic fluid
- risk of intrauterine infection
- risk of rH alloimmunization
Negative Contraction Stress Test
late or significant variable decelerations
-good thing in this test bc it shows that baby has a negative rxn to contractions
Positive Contraction Stress Test
late decelerations following 50% or more contractions
Equivocal suspicious
intermittent late decelerations or significant variable decelerations
Neuromuscular system changes during pregnancy
1)center of gravity shifts
2)lordosis develops
3)relaxation and softening of connective tissues
abdominal muscles weaken and separate
4)increased tendencies towards headaches, syncope, muscle cramping, and weakness
Gastrointestinal changes during pregnancy
1) appetite fluctuates- accompanied by morning sickness
2) Intestinal secretions decrease
3) absorption of nutrients increases
4) tendency toward nausea early in pregnancy
5) the colon is displaced
6) decreased gastric motility-influenced by progesterone
7) food craving and changes in food taste
8) increased salivation
How much folic acid should pregnant women intake during pregnancy
400 mcg of folic acid
How much calcium should pregnant women intake?
1200-1500 mgm
How much weight should the average weighed woman gain during pregnancy?
25-30 lbs
How much weight should an underweight pregnant women gain?
28-40 lbs
Pica
unusual non-nutritive food during pregnancy
ex) ice, soap powder, organ meats
How much weight should a woman expecting twins gain?
35-40 lbs
How much weight should an overweight women gain?
15-25 lbs
Ambivalence during 1st trimester
not abnormal during pregnancy adaptation
What are Rubin’s Four Developmental Tasks of Pregnancy
1) Ensuring safe passage through, pregnancy, labor, and birth
2) Seeking acceptance of this child by others
3) Seeking commitment and acceptance of herself as mother to infant
4) learning to give oneself on behalf of one’s child
What are the lab tests done during the first trimester?
o CBC o Blood type and Rh o Antibody screen o Rubella titre o Urinalysis, o RPR (for syphilis in pregnancy) o HIV testing o Glucose o TORCH studies o toxoplasmosis, other infections, rubella, cytomegalovirus, HSV
Which two STDs do we perform cervical cultures for to prevent a severe level of conjunctivitis that can cause blindness?
Cervical cultures for gonorrhea, chlamydia
Why do we perform a pap smear during the first trimester?
to identify abnormal cells and tx if necessary
How often are prenatal visits during pregnancy?
1) every 4 weeks for the first 28 weeks’s gestation
2) every 2 weeks until 36 week’s gestation
3) after week 36, every week until birth
4) beyond full term-> a couple times a week
How much folic acid do we want mom to take in during pregnancy?
400 mcg*
notice it’s micro
How much calcium do we want mom to take in during pregnancy?
1200-1500 mg
Prenatal Care in 1st Timester
1) Cervical cultures for chlamydia and gonorrhea
2) pap smear
3) other testing depending on interview that include:
- TB test
- Cystic Fibrosis
- Genetic testing (ex. hx of losses)
- Ultrasound
Toxoplasmosis
parasitic infection found in cat feces and contaminated food
-tell mother to avoid cat litter boxes or getting a cat during pregnancy
When does the mother start to form colostrum?
At about 5 months in the 2nd trimester
What are the routine and standard repeat assessments in prenatal care?
1) UA
2) Weight
3) BP
4) Fundal height assessment
5) fetal heart rate assessment
