OB: Prenatal Care/Nml Pregnancy 16% Flashcards
PPP 382
APGAR score is taken how long after birth?
at 1 and 5 minutes after birth
repeat at 10 minutes if abnormal
PPP 382
what is the first ‘A’ in APGAR?
Appearance
skin color changes
(PPP 382)
how do we grade the first ‘A’ in APGAR?
0 = blue-grey, pale all over
1 = acrocyanosis: body pink but blue extremities
2 = pink baby (no cyanosis)
(PPP 382)
what is the P in APGAR?
Pulse
(PPP 392)
how do we grade the P in APGAR?
0 = no pulse
1 = HR < 100
2 = HR >= 100
(PPP 382)
what is the G in APGAR?
Grimace
reflex irritability
(PPP 382)
how do we rate the G in APGAR?
0 = no response to stimulation, flaccid
1 = grimaces feebly, only w/ stim
2 = pulls away, sneezes or coughs, active motion, cries, coughs, pulls away
(PPP 382)
what is the second ‘A’ in APGAR?
Activity
muscle tone
(PPP 382)
how do we rate the second ‘A’ in APGAR?
0 = no activity/muscle tone
1 = some flexion, arms/legs flexed
2 = flexes arms and legs, resists extension, “active movement”
(PPP 382)
what is the R in APGAR?
Respiration
(PPP 382)
how do we rate the ‘R’ in APGAR?
0 = absent
1 = weak, irregular
2 = strong, crying (nml 30-60/min)
(PPP 382)
what is Appearance 1 for APGAR?
acrocyanosis: body pink but blue extremities
(PPP 382)
what is Appearance 2 in APGAR rating?
pink baby (no cyanosis)
(PPP 382)
what is a normal score range for APGAR?
> = 7
(PPP 382)
what is a “fairly low” APGAR score range?
4-6 = fairly low
(PPP 382)
what is critically low for APGAR score?
<= 3
(SmartyPance)
what is fetal attitude?
Fetal attitude: relationship of fetal parts to one another
(SmartyPance)
what is ‘fetal lie’?
Fetal lie: relationship of fetal cephalocaudal axis (spinal column) to maternal cephalocaudal axis
(SmartyPance)
what is ‘fetal presentation’?
Fetal presentation: fetal/presenting part enters pelvic inlet first
(SmartyPance)
what are the two positions of fetal attitude?
fully flexed (normal) (chin on chest; rounded back with flexed arms, legs)
not flexed
(SmartyPance)
what are the three positions of ‘fetal lie’?
Longitudinal (ideal): fetal spine lies along maternal
Transverse: fetal spine perpendicular to maternal
Oblique: fetus at slight angle
(SmartyPance)
what are the three positions of ‘fetal presentation’?
cephalic (head first)
breach (bottom first)
breach (shoulder first)
(SmartyPance)
a breach presentation may be ______, ______, or _______.
A breech presentation may be frank, complete, or incomplete
(SmartyPance)
what is the treatment for breach presentation?
External cephalic version at or near term, followed by a trial of a vaginal delivery if the version is successful
and planned cesarean delivery if breech presentation persists
(SmartyPance)
how often do twins come along?
1 out of every 80 births
Twins occur in 1 out of every 80 births
(SmartyPance, PPP 363)
what are monozygotic twins?
Monozygotic (Identical) – multiple (typically two) fetuses produced by the splitting of a single zygote
formed from the fertilization of 1 ovum that splits (increased risk of fetal transfusion syndrome and discordant fetal growth
(SmartyPance PPP 363)
what are dizygotic twins?
Dizygotic (Fraternal) – multiple (typically two) fetuses produced by two zygotes
due to fertilization of 2 ova by 2 different sperm (66%)
(SmartyPance)
What kind of twins are fraternal twins?
Dizygotic (Fraternal) – multiple (typically two) fetuses produced by two zygotes
(SmartyPance)
what are polyzygotic twins?
Polyzygotic – multiple fetuses produced by two or more zygotes
(SmartyPance)
how are twins usually diagnosed?
DX: Often diagnosed at first screening ultrasound
(SmartyPance)
clues that there are twins growing?
Extra fetal heart tones
Elevated maternal alpha-fetoprotein (AFP)
Fundal height is usually greater than dates
(SmartyPance)
what do we do with the prenatal visits once we know there are twins?
Prenatal visits should occur more frequently to monitor and prevent maternal complications
(SmartyPance)
what is the most common complication for twins?
The most common complications are spontaneous abortion and preterm birth
(PPP 363)
how do we diagnose multiple gestations with lab?
elevated levels of beta-hCG
and
maternal serum alpha-fetoprotein higher than normal
(OnlineMedEd)
definition of labor
labor = contractions with cervical changes
contractions (regular or irregular) with cervix >= 3 cm (less than 3 cm is false labor)
(SmartyPance)
what does parturition mean?
labor
(SmartyPance)
what do we monitor for infant well-being during the birthing process?
Heart rate and the pattern is an indicator of infant well-being
(SmartyPance)
what is the normal heart rate in a newborn?
120-160 bpm
(SmartyPance)
what is an indication of fetal distress?
Consistent decelerations after a contraction can indicate fetal distress
(SmartyPance)
what are two types of fetal monitors used during the birthing process?
External fetal monitor – on the maternal abdomen
Internal fetal monitor – electrode attached to the infants head
(PPP 379)
STAGE I of LABOR:
define it
name and describe the two phases
STAGE I = onset of labor (true regular contractions) to FULL DILATION OF CERVIX TO 10 CM
LATENT PHASE = cervix effacement w/ gradual cervical dilation
ACTIVE PHASE = rapid cervical dilation (usually beginning at 3-4 cm)
(PPP 379)
STAGE II of LABOR
define it
name and define the two phases
STAGE II = time from full cervical dilation until DELIVERY OF THE FETUS
PASSIVE PHASE = complete cervical dilation to active maternal expulsive efforts
ACTIVE PHASE = from active maternal expulsive efforts to delivery of fetus
(PPP 379)
STAGE III of LABOR
define it
give three signs of placental separation
STAGE III = postpartum until DELIVERY OF PLACENTA (0-30 minutes usually, avg is 5 min)
Three signs of Placental Separation
- gush of blood
- lengthening of umbilical cord
- anterior-cephalad movement of the uterine fundus (becomes globular and firmer) after placenta detaches
(placental expulsion is due to downward pressure of the retroplacental hematoma, uterine contractions)
(PPP 379)
what is sometimes called the 4th stage of delivery?
the period 1-2 hrs after delivery where mother is assessed for complications
(PPP 379)
what are the 7 cardinal movements of labor?
- engagement (fetus enters pelvic inlet)
- descent (head passes into pelvis (aka “lightening”))
- flexion (fetus head flexion)
- internal rotation (fetal vertex moves so sagittal suture is parallel to AP diameter of pelvis)
- extension (vertex extends, passes beneath pubic symphysis)
- external rotation (fetus externally rotates after head is delivered so shoulder can be delivered)
- expulsion
(SmartyPance)
what are the three phases of the first stage of labor according to SmartyPance?
EARLY (aka LATENT)
ACTIVE
TRANSITION
(SmartyPance)
how is STAGE I EARLY phase of labor defined?
EARLY - 0-30% effacement 0-3 cm dilation 8-12 hrs duration irregular contractions
(SmartyPance)
how is STAGE I ACTIVE phase of labor defined (four characteristics)?
80% effacement
3-7 cm dilation
3-5 hrs duration
contractions regular
(SmartyPance)
how is STAGE I TRANSITION phase of labor defined (four characteristics)?
100% effacement
7-10 cm dilation
0.5-2 hrs duration
contractions intense
(SmartyPance)
what three P’s are used to describe the second stage of labor by SmartyPance
Power
Passenger
Passage
(SmartyPance)
what are four fetal heart rate changes?
Accelerations
Early decelerations
Variable decelerations
Late decelerations
(SmartyPance)
describe “accelerations” in terms of fetal heart rate changes
accelerations = increase of baseline 15 bpm for 15 seconds –> response to fetal movement –> reassuring
(SmartyPance)
describe “early decelerations” in terms of fetal heart rate changes
early decelerations = mirror images of contractions –> fetal head compression –> benign
(SmartyPance)
describe “variable decelerations” in terms of fetal heart rate changes
variable decelerations = rapid FHR drop wtih a return to baseline with variable shape –> cord compression –> benign if mild or moderate –> worrisome if severe
(SmartyPance)
describe “late decelerations” in terms of fetal heart rate changes
LATE DECELERATIONS = FHR drop at the end of contraction –> uteroplacental insufficiency –> ALWAYS WORRISOME
(SmartyPance)
Physiology of Pregnancy: Uterine changes
hypertrophy, hyperplasia, mechanical stretching
20x larger, volume grows from 10 mL to 5L
stronger
(SmartyPance)
Physiology of Pregnancy: cervix changes
Formation of mucus plug; seals endocervical canal
↑ vascularity → purplish-blue color
Mild softening due to edema, hyperplasia (Goodell’s sign); ↑ softening in third trimester
(SmartyPance)
physiology of pregnancy: placenta changes
Develops where embryo attaches to uterine wall
Expands to cover 50% internal uterine surface
Functions as maternal-fetal organ for metabolic, nutrient exchange
Secretes estrogen, progesterone, relaxin, hCG
(SmartyPance)
physiology of pregnancy: vaginal changes
↑ vascularity → bluish-purple color
Loosening of connective tissue → ↑ distensibility
Leukorrhea
pH of 3.5–6.0 → protects against bacterial infections
(SmartyPance)
physiology of pregnancy: breast changes
↑ size, weight, nodularity, blood flow, vascular prominence
↑ activity of Montgomery’s tubercles (sebaceous glands)
Progesterone ↑ alveolar-lobular development; prevents milk production during pregnancy (inhibits prolactin)
Estrogen ↑ growth of lactiferous ducts
Secretion of colostrum begins week 16
(SmartyPance)
physiology of pregnancy: C/V changes
Mild hypertrophy
↑ heart rate by 15–20 beats/minute
Stroke volume ↑ 30%,
cardiac output (CO) ↑ 30-50% (by term);
↓ BP due to progesterone-induced vasodilation;
BP = CO × systemic vascular resistance (SVR)
Supine hypotensive syndrome
Gravid uterus elevates pressure veins draining BLE → slowed venous return, dependent edema, varicose veins, hemorrhoid
(SmartyPance)
physiology of pregnancy: heme changes
increase blood volume
total RBC volume goes up ~30%
increase WBC count (5,000 - 12,000/mm3) (nml = 4,500 - 11,000?)
increase clotting factors
(SmartyPance)
physiology of pregnancy: respiratory changes
increase O2 consumption
increase tidal volume 30-50%
gravid uterus = pressure on diaphragm
hyperventilation
mild resp alkalosis
estrogen-induced edema in nose = congestion, epistaxis
(SmartyPance)
physiology of pregnancy: GI changes
Progesterone-induced smooth muscle relaxation, delayed gastric emptying, ↓ peristalsis → nausea, vomiting (AKA “morning sickness” );
constipation;
heartburn (pyrosis), esophageal reflux;
intrahepatic cholestasis of pregnancy due to ↓ gallbladder emptying time → ↑ risk of cholelithiasis
(SmartyPance)
physiology of pregnancy: urinary & renal changes
physical space problems b/w bladder and uterus = urinary frequency, nocturia, stress incontinence
increase GFR, increase size of kidneys
physiologic hydronephrosis
glycosuria, increase protein excretion (urine)
(SmartyPance)
physiology of pregnancy: integumentary changes
hyperpigmentation
increase cutaneous blood flow –> increase heat dissipation –> pregnancy “glow”
stretch marks (decrease connective tissue strength 2/2 increase adrenal steroid levels)
(SmartyPance)
physiology of pregnancy: MSK changes
lordosis
shift in center of gravity
diastasis recti = separation of abdominal rectus m.m.
increase joint mobility (waddling)
(SmartyPance)
physiology of pregnancy: endocrine changes
↑ size of pituitary gland
↓ thyroid-stimulating hormone (TSH); thyroid gland enlarges; ↑ total T3, T4
↑ parathyroid hormone (meets calcium need of developing fetal skeleton)
Physiologic hypercortisolism
“Diabetogenic state” of pregnancy
Reproductive hormones
hCG from placenta; estrogen, progesterone from corpus luteum
Suppressed FSH, LH due to feedback from estrogen, progesterone, inhibin
↓ oxytocin levels throughout pregnancy → ↑ labor onset → ↑↑ second stage of labor
(SmartyPance)
recommended increase in caloric intake for pregnant woman? how much weight should she gain?
300kCal/day
25-35 lbs
(SmartyPance)
how much folic acid does a pregnant mom need? how much calcium? how much iron?
folic acid = 600 mcg/day
calcium = 1,000 - 1,300 mg/day
iron = 27 mg/day
(SmartyPance)
how often does a mom need to come in for prenatal visits?
weeks 4 - 28: monthly
weeks 28 - 36: twice monthly
after week 36: weekly
(SmartyPance)
how much folic acid should be given for preconception moms? after conception?
preconception: 0.4 - 0.8 mg
postconception 4 mg
(SmartyPance)
how does ACOG define hypertension for pregnant women?
bp >140 mmHg systolic or >90 mmHg diastolic
(SmartyPance)
Naegele’s Rule
1st day of LMP + 1 year - 3months + 1 week
(SmartyPance)
when should be the first visit for prenatal care?
6 weeks after LMP
(SmartyPance)
when should fetal position be abdominally palpated?
36 weeks
(SmartyPance)
75 g 2-hour oral glucose tolerance test timing
26 - 28 weeks
(SmartyPance)
timing for Group B strep test?
35-37 weeks
(SmartyPance)
when is the best time to draw maternal serum alpha fetoprotein?
15-18 weeks
“maternal serum alpha-fetoprotein should be drawn at 15-18 weeks’ gestation; it screens for open neural tube defects.”
(SmartyPance)
standard first-visit tests
blood type and screen Rh type CBC IZ status urinalysis for protein pap smear
(SmartyPance)
which first-visit tests are repeated in 3rd trimester?
urinalysis
“the only study required on 1st and 3rd visits is urinalysis/urine dipstick”
(SmartyPance)
what are the four classic biometric parameters of fetal growth?
cerebellar diameter
abd circumference
femur length
biparietal diameter of the skull
(RR)
what sign associated w/ pregnancy is characterized by softening of the cervix?
GOODELL SIGN (softening of the cervix is known as Goodell sign. Chadwick sign is dusky blue/violet hue of cervix/vagina.)
(RR)
what is Hegar sign?
Hegar sign is characterized by a softening of the uterus
(RR)
what is Piskacek sign in pregnancy?
asymmetrical enlargement of the uterus due to lateral implantation
(SmartyPance)
when do we do the 1-hour post-Glucola blood glucose test?
b/w 24-28 weeks
(SmartyPance)
what is responsible for for 95% of anemias during pregnancy?
iron deficiency anemia
