OB Test # 2 Antepartum Flashcards
Define Amenorrhea
The absence of menstruation
Define Quickening
The first movements of the fetus felt by the mother
What are the 6 “Presumptive Indications” of pregnancy?
1) Amenorrhea
2) N & V
3) Fatigue
4) Urinary Frequency
5) Breast Changes - Tenderness and fullness
6) Quickening
Define Chadwick’s Sign
The bluish/purplish color change of the labia, vagina, and cervix that becomes obvious during weeks 5-8 of pregnancy.
Define Goodell’s Sign
The softening of the cervix due to pelvic vasoconstriction that becomes obvious during weeks 5-8 of pregnancy.
Define Hegar’s Sign
Softening of the lower uterine segment (the Isthmus)at 6-8 weeks of pregnancy.
Define Ballottement
Rebound of the fetus when the cervix is tapped during vaginal examination.
Define Braxton Hicks Contractions
Irregular, usually mild uterine contractions that occur throughout pregnancy and become stronger in the last trimester.
Uterine Soufflé Vs. Funic Soufflé
1) Uterine Soufflé - Sound of blood flow through the uterine vessels, corresponds to maternal pulse.
2) Funic Soufflé - Sound of blood flow through the umbilical cord, corresponds FHR.
What are the 7 “Probable/Objective Signs” of pregnancy?
1) Abdominal Enlargement
2) Goodell’s, Chadwick’s and Hegar’s Sign
3) Ballotement
4) Braxton Hicks Contractions
5) Changes in the cervix
6) Uterine Soufflé
7) Leopold’s Maneuver
8) Pregnancy Tests
9) Changes in skin pigmentation
What are the 3 “Positive Signs” of pregnancy?
1) Auscultation of fetal heart rate sounds
2) Fetal movements felt by an examiner
3) Visualization of an embryo or fetus
Define Couvade
Pregnancy related symptoms and behavior in expectant fathers.
Define Alpha-fetoprotein
Plasma Protein produced by the fetus.
What is the usual reason for performing an Amniocentesis during the last trimester of pregnancy?
To determine Lung development
When is the most accurate time to determine gestational age through ultrasound?
First Trimester
Describe the following classifications of Hypertension in Pregnancy?
1) Gestational Hypertension
2) Preeclampsia
3) Eclampsia
4) Chronic Hypertension
1) Gestational Hypertension - BP > 140/90 that develops after 20 weeks of pregnancy buts returns to normal within 6 weeks postpartum. Protein urea not present.
2) Preeclampsia - BP > 140/90 that develops after 20 weeks of pregnancy and is accompanied by proteinuria.
3) Eclampsia - Progression of preeclampsia to generalized seizures.
4) Chronic Hypertension - BP > 140/90 that existed before pregnancy or developed before 20 weeks of gestation.
Adolescents with poor prenatal care are at increased risk for what two conditions during pregnancy?
1) Preeclampsia
2) Anemia
Why is the older mother at greater risk for postpartum hemorrhage?
Because of Uterine Myomas
During labor, the nurse is aware that the woman’s vital signs are best assessed between contractions. What is the rationale for this?
The contractions ⬇ blood flow to the placenta, therefore increasing the woman’s blood volume and altering her vital signs. ( BP will ⬆ and Pulse RAte will ⬇).
Why should continuous electronic fetal monitoring be used when oxytocin is administered?
Because utero placental exchange may be compromised. The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This ⬇ entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal O2 reserves.
Prior to a woman’s receiving an epidural block during labor, an important nursing measure is to administer at least 500mL of LR solution. What is the rationale behind this nursing measure?
It fills the vascular system with fluid to prevent hypotension due to vasodilation.
What is an important nursing intervention after a woman in labor has had an epidural block?
Monitor the woman’s bladder - the epidural block ⬇ the sensation of a full bladder, so the woman may not be aware of her need to void.
Precipitate Birth Vs. Precipitate Labor
1) Precipitate Birth - A birth that occurs without a trained attendant present.
2) Precipitate Labor - An intense, unusually short labor (usually less than 3 hours).
What are the role of the following female hormones during the female reproductive cycle?
1) Estrogen
2) Progesterone
3) Prostaglandines
1) Estrogen - Development of secondary female sex characteristics, follicle maturation, and proliferation of the endometrial mucosa.
2) Progesterone - ⬇ uterine motility and contractility, proliferation of the endometrium, and secretion of cervical mucous.
3) Prostaglandins - Promote smooth muscle contraction
What is the role of GnRH, FSH and LH during the female reproductive cycle?
1) GnRH - Causes anterior pituitary to release FSH and LH
2) FSH - Maturation of follicle
3) LH - ⬆ production of progesterone, release of mature follicle from ovary.
Describe the 2 phases of the Ovarian cycle.
1) Follicular Phase (Days 1-14) - Graafian follicle appears by day 14.
2) Luteal Phase (Days 15-28) - Begins when ovum leaves follicle.
Describe the 4 phases of the Endometrial Cycle.
1) Menstrual Phase - Menstruation occurs in response to low levels of estrogen and progesterone.
2) Proliferative Phase - The endometrial glands enlarge in response to increasing estrogen levels.
3) Secretory Phase - The endometrium undergoes slight cellular growth due to estrogen, and progesterone cause marked swelling and growth.
4) Ischemic Phase - Begins if fertilization does not occur.
After ovulation, how long might the ovum remain viable?
24 hours
How long might sperm remain fertile inside the female?
72 hours to 5 days
Define Spinnbarkeit. What is it’s purpose?
Spinnbarkeit - Clear, slippery, stretchy quality of cervical mucus during ovulation. This quality promotes passage of the sperm into the uterus and Fallopian tubes.
Define the following terms:
1) Sterility
2) Primary Infertility
3) Secondary Infertility
4) Fecundity
1) Sterility - Inability to achieve pregnancy
2) Primary Infertility - Those who have never conceived
3) Secondary Infertility - Those who have conceived on the past but cannot now.
4) Fecundity - The state of being fertile; capable of producing offspring.
What are the main causes of infertility?
1) Ovulatory Dysfunction - ⬆ with age, includes PCOS (Polycystic Ovarian Syndrome), Hypothyroidism, and hyperprolactinemia.
2) Tubal and Peritoneal Pathology - Includes endometriosis, tubal scarring from PID, Asherman’s Syndrome, uterine curette (D&C).
3) Male Factors
4) Uterine pathology - Relatively uncommon.
5) Lifestyle & Environmental Factors - i.e., smoking, alcohol and drugs.
6) Obesity
Spontaneous Miscarriage increases from 10% in younger women to 40% at age 40, even with assisted reproductive technology. What is the cause of this increase?
This increase is due to progressive follicular depletion and a high incidence of abnormalities in aging oocytes.
What is Adrenal Hyperplasia?
Excessive or deficient production of sex steroids.
Where does “Actual Fertilization” occur?
In the ampulla (outer third) of the fallopian tube.
While hCG is a reliable marker of pregnancy, it cannot be detected until after implantation. What is the implication of this?
This results in false negatives if test is performed during the very early stages of pregnancy.
How many Amnions, Chorions, and placentas are involved in the following types of pregnancies?
1) Monozygotic
2) Dizygotic
1) Monozygotic - 2 Amnions, 1 chorion, and 1 placenta
2) Dizygotic - 2 Amnions, 2 Chorions and 2 placentas
(T/F) Dizygotic pregnancies are associated with ⬆ rates of PTL, anemia, PPH, C-section and SGA.
True
The first 14 days of fertilization is known as what? And what is this pre embryo called?
1) first 14 days of fertilization is known as the “Pre-embryonic stage”.
2) This pre-embryo is known as the “Morula”.
What is the period of week 3 through 8 of fertilization called?
Embryonic Stage
What 4 anatomic structures are developed in week 6 of fertilization?
1) 4 chamber of the heart are formed
2) Face, ears, digits develop
3) Midline gap closes
4) Tail begins to recede
What anatomic structures are developed in week 7 of fertilization?
1) Internal organs form (liver, intestines, kidneys, etc.)
What anatomic structures are developed in week 8 of fertilization?
1) External genitalia differentiates
Describe Toxoplasmosis and the risk factor for contracting it. Also, what 9 conditions can result.
1) Toxoplasmosis gondii - An obligate intra cellular protozoan that infects animals.
2) Risk Factors - Eating raw or undercooked meat, eggs, vegetables or fruit. Drinking in pasteurized milk and cat feces.
3) Toxoplasmosis can lead to - Chorioretinitis, miscarriage, retardation, microcephaly, hydrocephalus, anemia, jaundice, deafness, and seizures.
What are the implications of Syphillis on the newborn?
1) Stillbirth
2) Developmental delay
3) Seizures
4) Death
What are the implications of becoming infected with Rubella during the 1st trimester of pregnancy?
1) Stillbirth
2) Fetal Anomalies
3) Therapeutic abortions
4) Congenital Rubella Syndrome
What are the most common malformations associated with Congenital Rubella Syndrome (CRS)?
1) Cataracts
2) Cardiac Defects
3) Deafness
How long should a woman wait to get pregnant after receiving a Rubella vaccination?
1 month
What is CMV and what complications are caused by it?
1) Cytomegalovirus (CMV) is a member of the herpes virus group.
2) Complications:
a) Hearing and vision loss
b) Seizures
c) Developmental Delay
d) Mental Retardation
What are weeks 9-40 of fertilization called?
The a Fetal Stage
What are the characteristics of the Fetal Stage?
1) Longest period of prenatal development
2) All major systems are present, only growth and refinement
3) Teratogens less likely to damage already formed structures, however, they can continue to damage the CNS
What are the 6 highlights of weeks 9-12 of the fetal stage?
1) Body proportions change
2) Eyes close and do not open until week 26
3) Blood forms
4) Urine production
5) Fetal heart tone can be heard by Doppler
6) Gender easily determined
What are the 6 highlights of weeks 17-20 of the fetal stage?
1) Vernix covers the fetus
2) Lanugo grows on body
3) Brown fat starts to develop
4) Eyebrows and head hair appear
5) Myelination of nerves begin
6) Heart beat detectable with regular fetoscope
What are the highlights of weeks 21-24 of the fetal stage?
1) Skin is translucent
2) Surfactant begins to forms
What are the highlights of weeks 25-28 of the fetal stage?
1) SQ fat develops
2) Eyes open
3) Fetus may assume head down position
What are the highlights of weeks 29-32 of the fetal stage?
1) Skin thickens
2) Nails present
What are the highlights of weeks 33-40 of the fetal stage?
1) Mainly gaining weight
2) Lungs mature
3) Lanugo and vernix disappear
4) Breast tissue palpable
5) Testes descend
What complications may occur as a result of the Herpes Simplex Virus (HSV)?
1) Blindness
2) Learning disabilities
3) Spasticity
4) Psychomotor retardation
An infant infected with HIV may be Asymptomatic at birth, but soon after may develop what complications?
1) Opportunistic Infections such as pneumonia, meningitis, thrush and bacterial infections.
2) Enlarged liver and spleen
What interventions can be used to reduce an infants chance of becoming congenitally infected with HIV to 2%?
1) Abstain from breast feeding
2) Use of Antiretrovirals (AZT & ZDV) during pregnancy (but after the 14th week only) and during labor.
3) Antiretroviral therapy for baby after birth for 6 weeks
3)
What are the implications of an infant of a mother who is positive for Group B Streptococcus (GBS) during pregnancy?
The infant can get:
1) Pneumonia
2) Meningitis
3) Sepsis
What further complications can arise in an infant who develops GBS sepsis?
1) Apnea
2) Shock
3) Disseminated Intravascular Coagulopathy (DIC)
4) Peripheral gangrene
5) Mortality
What is the treatment for pregnant women who are GBS positive?
Penicillin/Ampicillin treatment during birth will prevent the cross-infection from occurring.
Describe the following pregnancy categories of over the counter drugs: A, B, C, D, X
1) Category A - no fetal risk
2) Category B - Animal studies show no risk, but no human studies have been done.
3) Category C - No adequate animal or human studies are available, or animal studies show teratogenic effects but no human studies have been done.
4) Category D - Evidence of human risk exists, but the benefits can outweigh the risks.
5) Category X - Severe fetal risk (benefits never outweigh the risks)
What are the effects of Tobacco in the baby?
1) Fetal hypoxia (IUGR causing LBW)
2) ⬆ risk of miscarriage
3) Stillbirth and Premature birth
4) ⬆ risk for SIDS
5) Neurologic and intellectual developmental problems later in school years
Fetal Alcohol Syndrome (FAS) is one of the most common causes of mental retardation, but which 3 clinical symptoms are characterized by FAS?
1) Prenatal and postnatal growth restriction
2) CNS impIrment such microcephaly, low IQ, high activity level, and short attention span.
3) Recognizable facial features such as short palpebral fissures, flat mid face, indistinct philtrum, thin upper lip, and small chin.
What is the most common endocrine disorder associated with pregnancy and what associated complications should be watched for in the 1st, 2nd and 3rd trimesters?
Diabetes Mellitus - 1st trimester: watch for hypoglycemia
2nd and 3rd trimester: watch for hyperglycemia
Which 3 hormones are increased during the 1st trimester of pregnancy?
1) Estrogen
2) Progesterone
3) Insulin
How are the following affected during the 2nd and 3rd trimester of pregnancy?
1) HPL and HGH
2) Tolerance to glucose
3) Insulin resistance
4) Hepatic Glycogen Stores
5) Hepatic production of glucose
1) HPL and HGH - Increased
2) Tolerance to glucose - Decreased
3) Insulin resistance - Increased
4) Hepatic Glycogen Stores - Decreased
5) Hepatic production of glucose - Increased
What are the influences of the following maternal disorders on the baby?
1) Diabetes
2) Heart Disease
3) Phenylketonuria
1) Diabetes - Congenital cardiac disease, anencephaly, and macrosomia.
2) Heart Disease - Stresses cardiovascular system and causes congenital cardiac disease.
3) Phenylketonuria - Microcephaly and cardiac disease.
What are the four most common problems in EARLY pregnancy?
1) Spontaneous Abortion
2) Ectopic Pregnancy
3) Hydatiform Mole (aka molar pregnancy)
4) Hyperemesis Gravidarium
What are the 5 common causes of Spontaneous Abortion?
1) Chromosomal Abnormalities
2) Teratogens
3) Faulty Implantation
4) Maternal Infections
5) Maternal Hormonal Deficiencies
What are the 3 SxS of Spontaneous Abortion?
1) Cramping
2) Backache
3) Bleeding
What are the treatments involved for Spontaneous Abortion?
1) Bed rest
2) Abstinence from sex
3) D&C if incomplete abortion or hemorrhage
What is an Ectopic Pregnancy and what are the 3 SxS?
1) Ectopic Pregnancy - an implantation of a fertilized ovum in an area outside the uterine cavity.
2) SxS : Missed menstrual period, one-sided abdominal pain, Vaginal spotting.
What symptoms would the patient experience if the tube ruptures because of an Ectopic Pregnancy!
Hypovolemia Shock - Patient may have shoulder or neck pain with minimal or external bleeding.
What are the 6 risk factors associated with Ectopic Pregnancy?
1) Hx of STDs
2) Hx of previous ectopic pregnancies
3) Failed tubal ligation
4) IUD use
5) Multiple induced abortions
6) Maternal age > 35
How is an Ectopic Pregnancy therapeutically managed?
1) If tube is intact and embryo is < 3.5 cm - Administer Methotrexate (which inhibits cell division in the embryo and causes spontaneous abortion) or Salpingostomy.
2) If tube is ruptured - Control bleeding and prevent shock. Salpinectomy is performed.
Explain Salpingostomy Vs. Salpingectomy
1) Salpingostomy - To make an opening in the fallopian tube to remove the implanted fertilized ovum.
2) Salpingectomy - The removal of the fallopian tube because it has ruptured during an ectopic pregnancy.
Describe the disorder of Hydatiform Mole (aka Gestational Trophoblastic Disease).
Hydatiform Mole - When tissue around a fertilized egg (that normally would have developed into the placenta) develops into an abnormal cluster of grape-like cells.
What are the two types of Hydatiform Mole and what are the causes of each?
1) Complete - Empty egg fertilized by normal sperm (associated with cancer).
2) Partial - Too many chromosomes
What are the 5 SxS of Hydatiform Mole.
1) ⬆ hCG
2) Brownish vaginal bleeding (Prune juice)
3) Uterus larger than gestational age
4) No fetal heart tones
5) N & V
Hyperemesis Gravidarium may lead to what 4 complications?
1) Weight loss
2) Dehydration
3) Ketosis
4) Electrolyte imbalance (especially hypokalemia)
What are the 5 risk factors associated with Hyperemesis Gravidarium?
1) Young age
2) First pregnancy
3) Problem with N & V in previous pregnancy
4) Hx of intolerance to oral contraceptives
5) Previous gallbladder disease
What is the therapeutic management involved with Hyperemesis Gravidarium?
1) Drug therapy - Phenergan, Benadryl, Reglan and Zofran
2) IV Fluids with potassium
3) Offer small frequent portions of food with no strong odors or taste. Simple carbs may be tolerated best.
The cease of ovulation because of pregnancy is marked by high levels of which 2 hormones?
High levels of Estrogen and Progesterone
(T/F) The number of cells in the uterus do not increase during pregnancy, instead they stretch and hypertrophy.
True
(T/F) The vaginal environment becomes more acidic during pregnancy. Why or why not?
True - This decreases bacteria, however it favors the growth of yeast.
Describe where the top of the fundus may be palpated during the following weeks of pregnancy:
1) 12 weeks
2) 16 weeks
3) 20 weeks
4) 36 weeks
1) 12 weeks - Above the symphysis pubis
2) 16 weeks - Halfway between the symphysis pubis and the umbilicus
3) 20 weeks - At the umbilicus
4) 36 weeks - At the Xyphoid process
List the 5 maternal changes in the breasts related to pregnancy.
1) Estrogen stimulates growth of ductal tissue while progesterone stimulates growth of lobules
2) HPL stimulates breast growth
3) By wks 12-16 women produce colostrum
4) Areolas darken and veins become prominent
5) Striae develop
What might dimpling of skin in the upper quadrant of the breast (shoulder side) indicate during pregnancy?
May be indicative of cancer in the later stages
What are the 4 cardiac maternal changes related to pregnancy?
1) Splitting of the first heart sound and a murmur (normal)
2) ⬆ Blood volume (but BP remains the same)
3) ⬆ cardiac output
4) ⬆plasma fibrinogens
5) ⬇ Hct causing anemia
6) ⬇ Hgb causing need for iron
What is the expected normal estimated blood loss for vaginal birth and C-section?
1) Vaginal birth EBL - 500 mL
2) C-section EBL - 1000 mL
Describe Vena Caval Syndrome and what simple intervention can help prevent it?
Vena Caval Syndrome - Hypotension caused by the gravid uterus compressing the vena cava (reducing blood flow return to the heart) when the woman lays supine.
* Have the woman lay on her side to prevent or relieve it.
Decreased Hgb during pregnancy may cause the need for iron therapy, but increasing iron in the diet may not me sufficient. Name one simple intervention that can help this.
Drink more OJ and Tomato juice - VitaminC helps with the absorption of iron.
What are the 3 Respiratory Maternal changes related to pregnancy?
1) ⬆ in O2 consumption
2) Progesterone causes relaxation of smooth muscle, which can result in Dyspnea and fainting
3) Vascular congestion of nasal mucosa causes occasional stuffiness and nosebleeds.
What are the 5 GI maternal changes related to pregnancy?
1) Ptyalism - Estrogen causes gum bleeding and salivation
2) Pica - Craving for dirt, starch and other nonnutritive substances
3) Progesterone causes relaxation of the esophageal sphincter, leading to heartburn. (Stomach takes longer to empty)
4) Constipation and hemorrhoids are common
5) N & V are common
(T/F) Progesterone causes smooth muscles to relax during pregnancy.
True - Results in conditions such as heartburn and constipation
What are the 5 GU related maternal changes related to pregnancy?
1) Bladder doubles in size due to relaxed muscle
2) ⬆ risk for UTIs and pyelonephritis
3) Pressure on bladder causes stress, urge incontinence and nocturia.
4) ⬆ GFR and renal plasma flow to excrete fetal and maternal waste
5) Glycosuria is common
What are the 4 Integumentary maternal related changes to pregnancy?
1) Hyperpigmentation - i.e., chloasma (use sunscreen) and Linda Nigra.
2) Striae Ggravidarum
3) ⬇ Hair growth
4) Hyperactive sweat and sebaceous glands
What are the 4 Musculoskeletal maternal changes related to pregnancy?
1) Relaxin hormone causes relaxation of pelvic joints leading to waddling, and change in center of gravity.
2) Lordosis in later stages of pregnancy
3) ⬆ need for calcium and phosphorous
4) Separation of rectus abdominis
What are the 2 main CNS maternal changes related to pregnancy?
1) ⬇ Attention, concentration and memory (normal)
2) Sleep problems (normal)
What are the 3 Endocrine maternal changes related to pregnancy?
1) Estrogen produced by the placenta causes growth of the uterus and breast ductal system. It also causes hyperpigmentation and vascular changes.
2) Progesterone produced by the Corpus Luteum, then the placenta, maintains the endometrial lining of the uterus, prevents miscarriage by relaxing smooth muscle throughout the body, stimulates breast lobes and lobules, and facilitates fat stores for energy.
3) Human Placental Lactogen (HPL) promotes fetal growth by ⬆ availability of glucose to the fetus and promotes breast development for lactation.
What is the recommended weight gain for the following women:
1) Normal weight
2) Underweight
3) Ovwerweight
1) Overweight - Total of 15-25 lbs
2) Normal weight - Total of 25-35 lbs
3) Underweight - Total of 28-40 lbs
What is the recommended pattern of weight gain for pregnant women?
1) 1st Trimester - 3 1/2 lbs
2) 2nd and 3rd Trimesters - 0.9 lbs per week
What are 8 effective methods used to overcome Nausea and Vomiting during pregnancy?
1) Eat dry crackers or toast before rising then get out of bed slowly.
2) Drink fluids separately from meals
3) Avoid greasy, fried or fatty foods
4) Try foods containing ginger or peppermint or combine salty and tart foods like potato chips and lemonade.
5) Increase protein intake especially before bedtime
6) Take prenatal vitamins at bedtime instead of in the morning
7) Take more naps and rests
8) Useban acupressure band that applies pressure over a point approximately 3 fingerbreadths above the wrist crease on the inner arm.
What are 8 effective methods used to overcome Heartburn during pregnancy?
1) Eat small meals and avoid fatty spicy foods
2) Eliminate smoking Nd drinking of carbonated beverages
3) Try chewing gum
4) Take a tablespoon of cream before meals
5) Walk or sit upright after meals
6) Avoid bending over
7) Wear loose fitting clothes
8) Take deep breadths and sip water
What is the “Maternal Focus” in each trimester of pregnancy?
1) 1st Trimester - Acceptance of the pregnancy
2) 2nd Trimester - Accepting the baby
3) 3rd Trimester - Preparing for parenthood
What are the 3 maternal attitudes/feeling that are prevalent during the 1st trimester?
1) Uncertainty
2) Ambivalence (conflicting emotions)
3) Focus on self
What are the 3 maternal attitudes/feeling that are prevalent during the 2nd trimester?
1) Narcissism and introversion
2) Body image changes
3) Focus on fetus
What are the 5 maternal attitudes/feeling that are prevalent during the 3rd trimester?
1) Vulnerability
2) ⬆ Dependence
3) Nesting
4) Fear
5) Fatigue
What are the 8 SxS of Preterm Labor
1) Painful menstrual-like cramps
2) Dull low backache
3) Suprapubic pain or pressure
4) Pelvic pressure or heaviness
5) Leaking of fluid from vagina
6) Uterine contractions felt every 10 mins for an hour
7) Diarrhea
8) Change in character or amount of vaginal discharge
(T/F) Babies of teenage mothers are more likely to die in the first year of lifespan than babies of women in their twenties and thirties.
True
What are the 4 disadvantages of Advanced Maternal Age (AMA)?
1) ⬆ Risk for complications
2) Chromosomal abnormalities
3) HTN
4) PP Hemorrhage
What are the 3 advantages of AMA?
1) Maturity
2) Financial stability
3) Priorities are in place
When is the Transvaginal Ultrasound used and why?
Transvaginal Ultrasound - Most accurate between when used between weeks 6-10. It is used to confirm or establish gestational age by measuring crown to rump length.
When is the Transabdominal Ultrasound used and why is a full bladder necessary during the assessment?
Transabdominal Ultrasound - Used in the 2nd and 3rd trimesters and a full bladder displaces the intestines and elevates the uterus for better visibility of the fetus.
When is the Alpha-fetoprotein (AFP) Screening done and why?
AFP Screening used between weeks 16-18 to detect chromosome and neural tube defects ( Trisomy 21 and anencephaly).
When is Chorionic Villus Sampling (CVS) done and why?
CVS in done in the 1st trimester to access fetal cells for genetic, metabolic and DNA abnormalities.
What are reasons for performing an Amniocentesis during the 2nd trimester?
2nd trimester Amniocentesis used to detect genetic, metabolic, and DNA abnormalities.
What is the purpose of the Lecithin/Sphingomyelin test and what is the desired ratio of the two?
The Lecithin/Sphingomyelin test is used to check for lung development and a desired ratio of 2:1 (twice as much lecithin as sphingomyelin) generally indicates that surfactant is adequate and fetal lungs are mature.
What are the 4 risks/side effects of Amniocentesis?
1) Transvaginal spotting
2) Cramping
3) Amniotic fluid leakage
4) Chorioamnionitis
(T/F) The acceleration patterns on a Non Stress Test are affected by gestational age.
True
Define a Non Stress Test “Acceleration”
15 bpm above baseline and lasting 15 seconds
Explain the difference between Reactive and Non-Reactive on a Non Stress Test.
1) Reactive - Two or more accelerations within 20 mins
2) Non-Reactive - Insufficient accelerations over 40 minutes
Explain the purpose of the Contraction Stress Test (CST) and significance of a negative and positive test.
CST - Observes the FHR response to contractions and in doing so it identifies intrauterine hypoxia and evaluates uteroplacental function.
- Negative CST Result - No late or significant deceleration a (good).
- Positive CST Result - Late decelerations following 50% or more contractions (bad).
What are the 4 components of the Biophysical Profile (BPP)?
1) FHR acceleration
2) Fetal breathing, movements and tone
3) Amniotic fluid volume
4) NST and AFI
Interperet the following Biophysical Profile scores:
1) 8 to 10
2) 6
3) 5 or <
1) 8 to 10 - Normal (reassuring)
2) 6 - Equivocal (ambiguous)
3) 5 or < - Abnormal (delivery may be considered)
Describe the condition of Type 3/Gestational Diabetes (GDM).
Gestational Diabetes - A carbohydrate intolerance that develops in pregnancy, related to an ⬆ in estrogen, progesterone, and HPL.
What are the 4 tests used to diagnose Gestational Diabetes?
1) FBS (Fasting Blood Glucose > 126) or non-fasting > 200
2) GCT (Glucose Challenge Test done in wks 24-28)
3) GTT (Glucose Tolerance Test)
4) HBA1c (Glycohemoglobin - Shows hyperglycemia levels for past 4-8 weeks).
What are the 5 risks to the mother associated with maternal diabetes?
1) ⬆ Risk for gestational HTN
2) ⬆ Risk for infection
3) ⬆ risk for difficult birth because of macrosomia
4) DKA (diabetic Ketoacidosis)
5) Polyhydraminos
What are the 5 risks to the fetus/neonate associated with maternal diabetes?
1) ⬆ Risk Spontaneous Abortion or Perinatal Death
2) Congenital Malformations
3) Preterm Labor and Preterm Birth
4) Variations in fetal size, i.e., IUGR & LGA
5) At birth: hypoglycemia, hypocalcemia, hyperbillirubinemia, polycythemia, RDS and trauma.
Define Abruptio Placentae and list the 3 different types.
Abruptio Placentae - Premature separation of a normally implanted uterus. The three types are:
1) Marginal - Placenta separate at edges
2) Central - Placenta separates centrally and the blood is trapped
3) Complete - Total separation of placenta from the uterine wall
What are the 6 risk factors associated with Abruptio Placentae?
1) Maternal use of illicit drugs
2) Maternal HTN
3) Maternal cigarette smoking
4) A short umbilical cord
5) Abdominal trauma
6) Hx of Abruptio Placentae
What are the 5 SxS of Abruptio Placentae?
1) Bleeding (may be evident or concealed and mother may be hypovolemic)
2) Uterine tenderness and Abd pain
3) Excess uterine activity with poor relaxation
4) Fetal distress
5) Back pain
Define Placentae Previa and names the the 3 types.
Placenta Previa - Implantation of the placenta in the lower uterus. the three types are:
1) Low (Marginal) - Lower border of the placenta is more than 3cm from the internal cervical os.
2) Partial - Lower border of the placenta is within 3cm of the cervical os but not completely covering it.
3) Total - Placenta completely covers the cervical os.
What is the classic sign that a pregnant woman might be experiencing Placenta Previa?
The sudden onset of painless uterine bleeding in the last half of the pregnancy. It may cease spontaneously, only to recur later.
What are the risk factors associated with Placenta Previa?
1) AMA
2) Previous C-section or Placenta Previa
3) African American or Asian ethnicity
4) Cigarette smoking or cocaine use
What are the risk factors associated with Preeclampsia?
1) Primagravida
2) Age extremities
3) ⬆ BMI at contraception
4) African American
5) Multiple Gestation
6) Pregestational DM, HTN, Renal gall bladder
7) New FOB
List the nursing interventions to implement when a seizure occurs.
1) Stay with the woman and press emergency button
2) Turn woman on her side
3) Note time and sequence of seizure
4) Insert airway following the seizure and suction mouth and nose
5) Apply O2 if neede
6) Notify physician
6) Administer meds (Phenobarbitol or Magnesium sulfate)
Why would you turn a woman on her side if she is have an Ecclamptic seizure?
1) Prevents aspiration
2) ⬆ Placental functioning
What is the antidote for Magnesium Sulfate?
Calcium gluconate
What are the 6 highlights of weeks 13-16 of the fetal stage?
Quickening occurs
