OB test 1 Flashcards
Ductus venosus
oxygenated blood enters through umbilical vein. 1/3 of blood is directed away from liver to inferior vena cava.
Foramen ovale
between R and L atria. 50-60 % goes to left atria, the rest goes to right atria, flow to lungs is restricted by the narrow pulomary artery and pulmonary blood vessels, causing a high pressure in R side of <3.
Ductus arteriosus
connects pulmonary artery and the descending aorta during fetal life. perfusion only.
Fetal Lungs
Contain no air, O2 is delievered through placenta - umbilical vein to ductus venosus.
alveoli secrete fluid to keep them partically open, before delivery start to close so when they take 1st brath dont take much fluid in.
newborn GI
Immature shincter, thats why they spit up a lot.
1st stool - dark and tarry, 2nd stool - green-brown, loose.
Breast milk stool- seedy, mustard type, can stool up to 10x/day = natural laxative
formula stool- yellow-brown, only go 1-2 x/day.
babies stomach only the size of a walnut, commonly are overfed.
newborn urinary system
most newborns void immediatley after birth, indicationg adeqaute renal function.
Full kindey function doesnt happen until 3-4 months.
6-10 wet diapers a day.
newborn immune system
Immature WBC- trabel slow.
Look out for cahnges in activity, color, tone and/or feelings. wont generally see a fever like in adults.
IgG- cross placenta
IgM - after babys born-exposed to environment
IgA- found in colstrum (breast feeding)
thermoregulation
important to keep babies warm, have think skin and little sub-q fat.
Dry babies off completely, warm stethoscope beforing touching the baby, keep a hat on them, they loose heat through head.
Do not over heat the baby either, dangerous as well.
Newborn hepatic system
BS should not be less then 40.
Bilirubin- too much can be toxic to the baby.
Iron is stored in liver/spleen. have enough if breat feed for 3-6 months, supp if not.
Two types of jaundice:
patho- happens within 1st 24 hrs.
physiological- happens after 1st 24 hrs
to test: push finger on skin, when life, if yellow means jaundice.
Newborn hematologic system
Risk for clotting deficiency due to having a Vit K deficiency, they can not produce Vit K until about a week after birth, they get an IM of it at birth.
Range for normal <3 rate
120-160
take apical <3 rate for a complete min.
can be higher if baby crying.
range for normal respirations
30-60
periods of apnea <20 secs is normal
Range for normal temp
36.5-37.3 C or 97.7-99.1 F
NO rectal temps ! only axillary !
range for normal weight
2500-3999 grams or 5#8oz - 8#13oz)
Small for gestational age (SGA)
infants that are below the 10th percentile in size on growth chart.
Problems: perinatal asphyzia (unable to tolerate stress of labor), hypo/hyperthermia, polycythemia, meconium aspiration
Appearance: head disproportionally large, thin skin, wasted appearance of extermities, thin cord, decreased sub-q fat and breat tissue.
Large for gestational age (LGA)
Infants who are about the 90% on intrauterine growth charts.
Problems: bith trauma, hypoglycemia, polycythemia, jaundice secondary to hyperbilirubinemia
risk factors: maternal diabetes, genetics, mutiparity, hx of macrosomic infant, post date gestation, maternal obesity, male fetus
Stork bites
reddish pink areas on eyelids of around neck, that blanch when pressed on, go away by 2 years.
Vernix Caseosa- thick white substance that provides a protective covering for baby in utero, sometimes born with some still on them, more term thy are , the less there is.
Lanugo
fine har that covers fetus intrauterine, some are born with it still on them, found on shoulders, forehead, sides of face, upper back,
Vernix Caseosa
thick white substance that provides a protective covering for baby in utero, sometimes born with some still on them, more term thy are , the less there is.
Mongolian spots
bluish-black marks that look like bruises - found on darker skin tones around sacral areas, sometimes found on shoulders, arms and buttocks.
Document these at birth so they arent mistake as bruises.
Erythema toxicum
newborn rash- common- goes away.
Milia
White cysts, 1-2 mm in size, they disappear without treatment.
Occur on face over forhead, nose, cheeks, and chin
Harlequin sign
half pale. half red- usually fixes it self
Nevux flammeus/vasculosus
Flammeus (port-wine stain) permanent, flat, pink to dark reddish-purple mark that varies in size.
Vasculosus (strawberry hemangioma) enlarged capillaries in the outer layers of the skin. dark red and rasied with a rough surface. can get larger for 5-6 months but usually goes away by early school years.
Molding is important why?
to help the babys head get into a shape that it can move through the birth canal.
babies head should move bakc into shape.
The soft spot should close after how long?
14-18 months, allows for brain to develop
Caput succedaneum
often appears over vertex of newborns head as a result fo pressure againts mothers cervix.
the edematous area crosses suture lines, is soft, and varies in size.
resolves quickly and generally disappears within 12-48 hrs after birth.
Cephal hematoma
Bleeding between the periosteum and the skull, as the result of pressure during birth.
occurs on one or both sides of head over parietal bones or sometimes occipital bone. swelling may not present at birth but may develop within first 24-48 hours.
does not cross sutures lines.
preterm labor (PTL) risk factors
maternal medical conditions, present and past OB conditions, fetal conditions, social and enviornmental factors,
Diabetes, drugs, lupus, infections, STDS, can cause an unsuccessful pregnancy
pre-term characteristics
birth weight <5.5, scrawny look, head >chest, poor tone, minimal sub-q fat, undescended testes, lots of lanugo, soft ear pinna, fused eyelids, spongy skull bones, absent to few sole and palm creases, minimal rugae or prominent labia and clitoris, think skin, visible veins, lots of vernix
problems with premature babies
problems with: respirations, thermoregulation, fluid and electrolyte balance, infections, and pain.
they should be be prone, laying on side to decrease secretions.
Post-term problems
if placenta function decreased, the amniotic sluid will decrease, could lead to a compressed umbilical cord.
If not getting enough 02 and nutrients the baby can become hypoxic or malnurished.
Fetus may pass meconium which is bad if the baby aspirates it.
Post-term characteristics
dry, cracked wrinkled skin, long thin extermities, creases cover entire soles of feet, wide-eyed, alert expression, abundant hair on scalp, thin umbilical cord, limited vernix and lanugo, meconium stained skin, long nails
Transient-tachypnea of the newborn (TTN)
liquid in lungs removed slowly or incompletely, will see grunting, nasal flaring, tachypnea and retractions, usually resolves in 24-48 hours.
Seen commonly in c-section babies, sent to nicu.
Treatment: supportive, NPO, 02, neutral thermal environment, assessment.
Meconium aspiration
happens when the baby has its first bowel movement when he has not delivered yet, and then the baby aspirates some of it.
10-15% of babies have meconium before delievery of those 5% get meconium aspiration
Usually happens to hypoxic babies that dont handle labor well.
Get put on ECMO (<3/lung machine), dont usually do well, can die.
hyperbilirubinemia: Pathological jaundice
Happens with first 24 hours, starts in face,moves down.
Put them by light (phototherapy), breast feed to help excrete through urine and stool.
Can result in kernicterus = staining of brain - learning disabilites, mental disorders, could cause death.
Usually happens with RH incompatibility or ABO incompatibilty.
Zygote
The developing baby from conception through the first week of prenatal life.
Increases in size as it travels towards the uterus
Fertilization and conception
Usually takes place in the ampulla (outer most 1/3 of the fallopian tube). sperm enters the egg (conception)
The union of the sperm and egg (fertilization)
Blastocyte has two parts..
trophoblast - placenta and membranes
embryoblast - embryo
pre-embryonic stage of development
conception through week 2.
Around the 4th day after conception, the fertilized ovum, now called a zygote, enters the uterus.
In this stage teratogens either kill the baby or nothing happens.
Embryonic stage of development
day 1 of week 3 thru last day of week 8.
Basic structures of all major organs are completed during this time.
In this stage teratogens exert the greatest affect on fetal development.
Fetal stage of development
week 9 through delivery
Dramatic growth and refinement occur during this stage. Teratogens may damage already formed structures but less likely to cause major stuctural alterations.
Amniotic fluid (AF)
about 450-750 ml @ 40 wks
it should be transparent and odorless.
Functions: temp regulation, cushion againts trauma, allows for movement and development.
baby will swallow fluid and then void it back into the fluid, some most of the end AF is urine.
low fluid could mean kidney issues for baby.
Fetal veins do what..
pick up 02 and nutrients and give them to baby.
fetal arteries do what..
retuen waste and carbon dioxide, whic is diffused, transported to maternal veins.
Metabolic placental function
Synthesizes substances needed by fetus and placenta
Transfer functions of placenta
Gas exchange, nutrient transfer, waste removal, antibody transfer, hormone transfer.
IGg- can cross placenta
Endocrine placental functions
produce 5 hormones:
hcG - early on in preg can test blood/or urine to see if its a viable preg. If it goes down during preg then could be miscarrying.
HPL, estrogen, progestrone - relazes smooth muscles, and relaxin.
placenta perfusion
blood in the intervillous space is changed about 3-4 times per min, requiring circulation of 450-750 ml/min
maternal vasoconstriction causes
hypertension
maternal vasodilation causes
hypotension
s/s of decreased CO
decreased HR
Surfactant
is produced around 24-34 weeks, most is produced by 33 weeks.
diabetics have slow production of it.
hyperinsulinemia babies will have decreased surfactant production
Fetal Cardio
by 5th wk <3 is beating and 4 chambers present.
Viability
That ability of the fetus to survive outside the uterus
MI state law says 20 wks
clinically its 24 wks
presumtive signs of pregnancy
amenorrhea
fatigue
N/V
urinary frequency
skin changes
breast changes(color, size, tenderness)
vaginal and cerivcal color changes(chadwicks sign-darkish purple color)
fetal movement (quickening)
probable signs of pregnancy
abd enlargement
cervical softening (Goodell’s sign)
thining of uterine lining (hegar’s sign)
ballottement - can palpate on uterus and fetus will rise and fall and doc will feel this
braxton hicks contractions
palpation of fetal outline
uterine souffle- sound that can be heard that is made from the exchange of fluids from mom to baby
positive pregnancy test
positive signs of pregnancy
Fetal <3 rate ausculated via fetoscope or doppler
fetal movement felt by examiner
ultrasound verification of fetus
Fundal height
less than 12 wks - in pelvis
12 wks = at symphsis pubis
20 wks - at umbilicus
36 wks - at zyphoid
Cardio changes in pregnancy
<3 goes up 10-20 beats, arythmias and palpatations are common
Total volume- increase overall, plasma increased about 1000, RBCs increase about 500, hgb does down.
Cardiac output is increase 50-60%
progestrone increase- relaxes smooth muscles so the BP does not go up
can get supine hypotension due to presure on vena cava when lying flat.
hemodilution (physiological anemia pregnancy)
result of there being more plasma in the mom then there is RBCs.
Normal about or RBCs they are just diluted by the plasma
Dick-read childbirth education method
His theory was that fear of childbith results in tension and pain. To prevent the fear-tension-pain cycle, he developed a method of slow breathing in early labor and rapid chest breathing in advanced labor.
Bradley childbirth education method
First to include father as a support person. Abd breathing to increase relaxation and breath control is taught in classes that last baout 12 wks. emphasizes avoidance of all medication and other interventions.
Lamaze childbirth education method
Involves concentration and conditiong to help the woman respond to contractions with relaxation and various techniques to decrease pain.
Nagele’s rule
take the 1st day of LMP minus 3 months and add 7 days.. that gives you and estimated due date
comprehensive hx done on inital visit to OB/GYN
current pregnancy -LMP, EDD
OB/GYN hx - GTPAL
medical hx
surgical hx
nutritional status
review of systems
tertogen exposure
psychosocial hx
hx of abuse
medications (OTC & Rx)
allergies
family hx
Overal risk assess- risk for complications
inital visit PE
VS
Heat to toe
Additional OB assess
-funfal height
-fetal <3 rate
-speculum exam-cervix
-bimanual exam: ovaries size and shape, uterine size, contour, tenderness, and position.
-pelvic exam: pelvic measurements/adequacy
inital lab tests done on preggers
CBC, blood type and RH, antibody screen, rubella titer, TB skin test, HIV, HBSag, U/A & C&S, pap, GC/chlamydia, RPR/VDRL, triple/quad screen (MSAFP), GCT (glucola) - not always done, Ultrasound (not always done), GBS (not always done)
follow up visits done when?
monthly until 28 wks; q 2 wks 28-36 & q wk 36 wks to delivery.
CVS ( chorionic villus sampling)
done at 10-12 wks for genetic testing.
nonstress test (NST)
the mother is asked to void, and VS are take, she lies down with head slightly elevated and on her side to avoid supine hypotension.
reactive (reassuring) - the babies HR goes up at least 15 bpm for at least 15 secs after fetal movement or w/o FM
nonreactive (non reassuring)
Contraction stress test
done if a NST findings are non reactive.
Records the FHR in response to uterine contractions
negative (reassuring) - no late decelerations (decreases in the FHR persisting after the contractions ends) although the fetus was stressed by 3 contractions of at least 40 secs
positive (abnormal) - late decelerations accompanying at least 50% of contractions even when fewer than 3 contractions occur in 10 min.
healthy people 2010 prenatal care goals..
at least 90% of US women to begin antepartum care in 1st trimester.
Stages of labor
1st- onsent of labor to complete dilation and effacement
2nd- complete dilation to delivery of baby
3rd- delivery of baby to the delivery of placenta
4th - 1st 4 hours after delivery of placenta
3 phases of 1st stage of labor
LATENT - 1 - 3 cm
ACTIVE - 4 - 7 cm
TRANSITION - 8 - 10 cm
Fetal station
measurement of the fetal head to maternal ischial spines
At ischial spine = 0
above ischial spinea = negative numbers (-1, -2, -3, -4, -5)
below ischial spine = positive numbers (+1, +2, +3, +4, +5)
Depo-provera side effects
amenorrhea, weight gain, headaches,depression, hair loss, nervousness, decreased libido, breat discomfort, and spotting.
oral contraceptive side effects
breakthrough bleeding, weight gain or loss, fluid retention, amenorrhea, melasma.
risk for developing DVTs is higher when taking these especially in women who are smokers and/or over the age 35
Rubin’s stages
- Taking-in = 1 -2 days, this stage is all about the mom, she is mainly concerned about herself
- Taking-hold = this is the best time to teach the mom
- letting- go = this is when moms expectations are let go and she accepts reality. wanted a girl but got a boy
when is RhoGAM given and why?
If the mom is RH- and baby is RH+ she needs rhogam.
usually given around 20-28 wks gestation.
will be given if any trauma happends during preg.
given 72 hours after birth to help with next pregnancy
Hormones after delievery
estrogen, progestrin, relaxin go down right away
hcg hangs aruond for a while.
oxytocin is responsible for let down reflex, when baby sucks- the milk comes down
GI after delivery
motility is decreased may take a while to get back ti normal.
may not have a BM for a few days, resist urge to defecate, constipation common. Don’t force down. use stool softeners.
Hungry and thirsty after labor, small portions are best.
Urinary system after delivery
Kidneys return to normal after 2 -3 months
urinary output 3000 ml/day
make sure they are voiding after delivery and have the urge to go.
overdistention of bladder can cause UTI or hemorrhage, bladder causes uterus to rise, which releases pressure, causing hemorrhage.
VS post partum
temp can increase 24hrs r/t dehydration
pulse will decrease.. watch for tachycardia.. shouldnt have this
resp - normal within 6-8 wks
BP- small tranisent rise for 4 days because of the high volume
risk for DVTs
promote getting up asap, check homans sign
