OB Unit 2 Flashcards
0
Q
The uterus
A
- Weight almost 17 times the pre-pregnant weight
- Capacity from 10 ml to 5000ml – 500 X the pre-pregnant state
- Enlargement due to hypertrophy of preexisting myometrial cells
- Influence of estrogen
- Distention caused by growing fetus
- 16% of the total maternal blood volume is contained within the vascular system of the uterus
- Braxton-hicks contractions start around the 4th month
- Fundal height – measure from symphysis pubis to top of fundus
- 10-12 weeks – fundus slightly above symphysis
- 20-22 weeks – fundus at level of umbilicus
- Measurement should correlate within 2 cm’s with weeks gestation
- Fetal movements palpated by caregiver at 18 weeks
- Ballottement – fetus moves then returns to original position when uterus is tapped sharply
- 4-5 months
- Ultrasound evaluation
- Detect gestational sac 5-6 weeks after LMP
- Fetal heart activity at 6-7 weeks
1
Q
Reproductive system includes
A
- uterus
- cervix
- ovaries
- vagina
- breasts
2
Q
The Cervix
A
- Estrogen stimulates the glandular tissue
- Vaginal discharge
- Thick, sticky mucus accumulates in cervical canal forming “plug”
- Prevents ascent of organisms into uterus
- Abnormal discharge associated with vaginal infection
- Vascularity
- Softening of cervix – Goodell’s Sign
- Bluish discoloration of cervix & vagina- Chadwick’s Sign
- Softening of isthmus of uterus – Hegar’s Sign
3
Q
The ovaries
A
- Corpus luteum continues to function for 10-12 weeks
4
Q
The Vagina
A
- Vagina
- Estrogen causes thickening of mucosa, loosening of connective tissue & in vaginal secretions
- Secretions acidic which inhibits bacterial growth but allows proliferation of yeast organisms
5
Q
The Breasts
A
- Breasts
- Tenderness & tingling one of 1st signs noted when miss period
- Both estrogen & progesterone causes changes necessary for lactation
- Nipples more erectile
- Areolas darken
- Superficial veins more prominent
- Colostrum present after 12th week
6
Q
Respiratory system during pregnancy
A
- Increased oxygen requirements
- Progesterone ¯ airway resistance allowing a 15-20% in O2 consumption
- Normal 16-24 breaths/min – thoracic breathing
- Nasal stuffiness & nosebleeds (epistaxis) result of estrogen induced edema and vascular congestion
7
Q
The cardiovascular system during pregnancy
A
- Blood volume progressively increases
- Rapid in 2nd trimester
- Peaks mid-3rd trimester at approximately 40-45% above non-pregnant levels
- Heart rate 10-15 bpm
- BP ¯ slightly
- Lowest point during 2nd trimester
- High BP associated with:
- PRE-ECLAMPSIA/TOXEMIA - increase in BP after 20 wks gestation accompanied by proteinuria
- Greater than 140/90
- ECLAMPSIA - severe form characterized by seizures, liver involvement & possible coma
- Can occur in first 48 hrs AFTER delivery
- GESTATIONAL HYPERTENSION - increase in BP after 20 wks gestation with NO protein in the urine
8
Q
The cardiovascular system and pregnancy cont.
A
- Stasis of blood in lower extremities b/c of pressure from enlarging uterus
- Slight edema of lower extremities normal (Dependent edema)
- Generalized edema associated with pre-eclampsia/toxemia
- Varicosities of veins in legs, vulva & rectum (hemorrhoids)
- Postural hypotension
- Supine hypotensive syndrome or vena cava syndrome
- Result of ¯ blood return to heart; ¯ blood pressure
- Always lie on left side or place pillow under right hip
- Physiologic anemia of pregnancy
- RBCs 35% while plasma volume 50%
- Necessary to transport additional O2 needed
- Need for iron
- Hematocrit lower than pre-pregnancy levels
- Greater than 33%
- Plasma volume more than cells
- Hemoglobin
- Greater than 11g/dL
- Less than 11g/dL require nutritional counseling or iron supplement
- WBC production
- Up to 15,000
- Increase primarily in the granulocytes
- Need to look at differential
- Plasma fibrinogen & various clotting factors (Factor VII, VIII, IX, X)
- Pregnancy described as “hypercoagulable state”
- Risk of developing blood clots during pregnancy
- Associated with early pregnancy loss
9
Q
Gastrointestinal system and pregnancy
A
- Nausea & vomiting – “morning sickness”
- Result of HCG & changed CHO metabolism
- Constipation and bloating
- Result of effects of progesterone on smooth muscle
- Delayed gastric emptying, decreased peristalsis
- Heartburn
- Reflux of gastric secretions into lower esophagus
- Relaxation of cardiac sphincter
- Upward pressure from the enlarging uterus
- Hemorrhoids
- 3rd trimester associated with constipation & pressure on vessels
- Gallstone formation
- Prolonged emptying time of gallbladder caused by progesterone
- Elevated cholesterol in bile
10
Q
Urinary tract and pregnancy
A
- 1st trimester pressure from enlarging uterus causes frequency
- ¯ During 2nd trimester when uterus becomes an abdominal organ
- Reappears during 3rd trimester when presenting part descends into pelvis
- Glycosuria may be seen b/c kidney unable to reabsorb all glucose filtered by glomeruli
- Could be a sign of GDM so need to check
- Urinary tract infections increases risk for pre-term labor
11
Q
Skin and Hair during pregnancy
A
- Changes in skin pigmentation stimulated by estrogen, progesterone & other hormones
- Primarily in areas that are already pigmented
- Areola, nipples, vulva, perianal area
- Linea nigra
- Chloasma
- More prominent in dark-haired women
- Aggravated by exposure to sun
- Striae gravidarum
- Result from ¯ connective tissue strength due to steroid levels
- Hair loss – ¯ during pregnancy; 1st 1-4 months after birth
12
Q
Musculoskeletal system during pregnancy
A
- Joints of pelvis relax
- Result of hormone “relaxin”
- Waddling gait
- Low backache
- Center of gravity changes causing lumbar spinal curve
- Avoid high heeled shoes
- Diastasis recti
- Pressure of enlarging uterus causes rectus abdominis muscle to separate
- Will need to regain muscle support after pregnancy to support subsequent pregnancies
13
Q
The eyes during pregnancy
A
- Intraocular pressure ¯ & cornea thickens
* Contacts may become “uncomfortable”
14
Q
Metabolism and pregnancy
A
- Most functions INCREASE!
- B/c of increased demands of growing fetus
- Water metabolism
- Increased water retention
- Level of hormones affects sodium & fluid retention
- Lowered serum protein
- Intracapillary pressure & permeability
- Needed for fetus, placenta, amniotic fluid, blood volume, etc.
- Nutrient metabolism
- Fetus greatest demand for protein & fat during 2nd half of pregnancy
- Fetus doubles weight during last 6-8 weeks
- Fats more completely absorbed
- Intake of dietary fat or ¯ CHO intake can lead to ketonuria
15
Q
The endocrine system during pregnancy
A
- ENDOCRINE SYSTEM
- Basal metabolic rate as much as 25%
- Anterior pituitary
- FSH and LH
- Prolactin – responsible for initial lactation
- Increases early in pregnancy
- High levels of estrogen & progesterone inhibit lactation until after birth
16
Q
The endocrine system during pregnancy cont.
A
- Posterior pituitary
- Vasopressin (antidiuretic hormone)
- Causes vasoconstriction which results in blood pressure
- Helps regulate water balance
- Oxytocin
- Causes uterine contractions
- High levels of progesterone prevent contractions until near term
- Stimulates ejection of milk from breasts
- Pancreas
- Progressive need for increased amount of insulin as pregnancy progresses
- Pregnancy hormones decrease woman’s ability to use insulin
- B/c of insulin needs, and ¯ ability of pancreas to meet demand - gestational diabetes may result
17
Q
The endocrine system during pregnancy
A
- Hormones produced by placenta
- HCG – Human Chorionic Gonadotropin
- Stimulates estrogen & progesterone production by the corpus luteum
- Basis of pregnancy tests
- HCS – Human Chorionic Somatomammotropin
- Antagonist of insulin
- Amount of circulating free fatty acids needed for maternal metabolic needs
- ¯ Maternal metabolism of glucose to allow fetal growth
- Estrogen
- Increases vascularity causing vasodilation
- Promotes enlargement of the genitals, uterus & breasts
- Causes relaxation of pelvic ligaments & joints
- Alters metabolism of nutrients
- Causes retention of fluid in body – peripheral edema
- Progesterone
- Plays greatest role in maintaining pregnancy
- Maintains endometrium
- Prevents uterine contractions
- Cause fat to be deposited in subq tissues
- Helps develop acini & lobules of breasts
18
Q
Endocrine system cont.
A
- Prostaglandins during pregnancy
- Proposed that they aid in ¯ placental vascular resistance
- ¯ Levels may contribute to pre-eclampsia/toxemia
- Also believed to play a role in initiation of labor
19
Q
NUTRITIONAL NEEDS BEFORE CONCEPTION
A
- 1st trimester critical b/c embryonic & fetal organ development
- Folic acid recommended PRIOR to conception
20
Q
NUTRITIONAL NEEDS DURING PREGNANCY
A
- RDA for almost all nutrients during pregnancy
- Increased nutritional needs determined by stage of pregnancy
- Factors affecting increased needs:
- Uterine-placental-fetal unit
- Maternal blood volume
- Maternal mammary development
- Metabolic needs
- Folic acid and iron are the only supplements needed with a well-balanced diet
- Folic acid 0.4 mg daily during childbearing years
- Iron needs double during pregnancy – recommend 30mg daily supplement
- Absorption when taken with Vit C source
- Decreased when taken with calcium, egg yolks, or caffeine
21
Q
Nutritional needs during pregnancy cont.
A
- Many care providers recommend pre-natal vitamins b/c of poor intake
- Increase of approximately 300-450 kcal/day in 2nd & 3rd trimester
- An additional 200 kcal with breastfeeding
- Inadequate caloric intake will reduce milk volume
- Breastfeeding mom does not need to avoid certain foods
- Protein requirements 50%
- The 2010 Dietary Guidelines for Americans recommend 8 to 12 ounces of seafood a week for pregnant women.
- Seafood is a great source of protein, and the omega-3 fatty acids
- Approximately 2 average meals of shrimp, crab, canned light tuna (conflicting information about the safety of eating any type of tuna during pregnancy), salmon, pollock, catfish, cod, or tilapia
- If vegetarian need to ingest grains, legumes, nuts, fresh fruits and veggies
- Calcium – same recommendations for nonpregnant and during pregnancy; 33% increase with lactation
- Need 4 serving from milk group instead of 2-3
22
Q
Nutritional needs during pregnancy
A
- Need 8-10 glasses of fluid/ day
- Dehydration increase risk of contractions and pre-term labor
- Sodas consumed in moderation b/c of sodium content
- Caffeinated beverages have a diuretic effect
- Sodium needs increase slightly during pregnancy
- Not recommended to entirely eliminate “salt” intake unless underlying medical conditions
- May season food to taste during cooking
- Avoid using extra salt at table, high salt containing foods such as potato chips, ham, sausage, sodium based seasoning, prepared foods
23
Q
Foods to avoid during pregnancy
A
- Avoid intake of food that could cause potential harm to developing fetus
- Fish/ shellfish containing potentially high levels of mercury
- King mackerel, shark, swordfish, cobia or tilefish
- Tuna is from the mackerel family
- Tuna continues to be a controversial subject as to its safety during pregnancy
- Most sources recommend avoidance of albacore tuna (canned white tuna) and tuna steak
- Can adversely affect developing CNS in baby
24
Q
Foods to avoid continued
A
- Avoid raw, undercooked or contaminated fish/ seafood
- Especially recommended to avoid sushi, oysters and clams
- If fish ingested from local waters, need to pay attention to local fish advisories – especially if water pollution is a concern
- Most sources recommend avoidance of albacore tuna (canned white tuna) and tuna steak
- Avoid undercooked meat, poultry and eggs
- Increased risk of bacterial food poisoning during pregnancy which could also affect fetus
- Cook hot dogs and processed deli meats, such as bologna until “steaming hot” or avoid them completely
- Not recommended to entirely eliminate “salt” intake unless underlying medical conditions
- Need to cook eggs until the egg yolks and whites are firm. Raw eggs can be contaminated with the harmful bacteria salmonella. Avoid foods made with raw or partially cooked eggs, such as eggnog, raw batter, hollandaise sauce and Caesar salad dressing
Avoid unpasteurized foods such as Brie, Feta, Camembert, Blue cheese, Mexican-style cheeses, such as queso blanco, queso fresco and panela
25
Q
BASIC TEACHING FOR THE PREGNANT WOMAn includes the areas of
A
*Fetal activity Monitoring
* Decision related to feeding method for infant – Breast vs Bottlle
* Breast preparation
* Bathing
* Travel
* Exercise
Exercises to prepare for childbirth
* Sexual activity
* Dental care
* Immunizations
* Complementary & alternative therapies
26
Q
Fetal activity monitoring
A
- Recommended to begin at 28 weeks
- Lie down on left side and count fetal movements
- Should have at least 10 movements in 2 hrs
- ¯ Movement or no movement indicate possible fetal hypoxia
- Fetal activity affected by fetal sleep, sound, time of day, blood glucose level, cigarette smoking, or drug use
27
Q
Exercise during pregnancy
A
- Normal participation can continue thru uncomplicated pregnancy
- Contraindications
- ROM, pre-eclampsia/toxemia, incompetent cervix, persistent vaginal bleeding, preterm labor, IUGR
- Is not a time to begin new activities
- Improves self image, promotes regular bowel function, control weight gain, associated with improved postpartum recovery
- Avoid exercising in supine position
- Walking, swimming & stationary cycling best b/c ¯ risk of injury
- Avoid overheating
- Have potential teratogenic effect on fetus, risk of miscarriage and neural tube defects
- Core body temp should not be above 100.4
- Advised to avoid hot tubs, saunas, or extremely hot baths
- May soak in hot tub for 10 mins if temp maintained at less than 98 degrees
28
Q
DANGER SIGNS IN PREGNANCY
A
- Sudden gush of fluid from vagina
- ——-Premature rupture of membranes
- Vaginal bleeding
- ——-Abruptio placenta, placenta previa, bloody show, miscarriage
- Abdominal pain
- ——-Premature labor, abruptio placenta
- Temperature above 101
- ——-Infection
- Dizziness, blurred vision, spots before eyes
- ——-Toxemia or preeclampsia (PIH)
29
Q
Danger signs in pregnancy cont.
A
- Persistent vomiting
- —–Hyperemesis gravidarum
- Severe headache
- —–Toxemia or preeclampsia (PIH)
- Edema of hands, face, legs and feet
- —–Toxemia or preeclampsia (PIH)
- Convulsions/seizures
- —–Eclampsia
- Epigastric pain
- —–Severe toxemia / pre-eclampsia/ PIH, HELLP
- Oliguria
- —–Renal impairment, decreased fluid intake, toxemia or preeclampsia (PIH)
- Dysuria
- —–Urinary tract infection
- Absence of fetal movement
- —–Maternal medication, obesity, fetal death
30
Q
COMMON DISCOMFORTS: FIRST TRIMESTER
A
- Nausea and vomiting
- Urinary frequency
- Fatigue
- Breast tenderness
- Increased vaginal discharge
- Nasal stuffiness
- Epistaxia
- Ptyalism
31
Q
COMMON DISCOMFORTS: SECOND AND THIRD TRIMESTERS
A
- Heartburn
- Ankle edema
- Varicose veins
- Hemorrhoids
- Constipation
- Backache
- Difficulty sleeping
- Leg cramps
- Faintness
- Dyspnea
- Flatulence
- Carpal tunnel syndrome
- Round ligament pain
32
Q
Psychological adjustments during the first trimester
A
- Ambivalence
- Disbelief
- Introspective and passive
- Emotionally labile – mood swings
33
Q
Psychological adjustments during second trimester
A
- Begins to see baby as separate person
- Excited about having a baby
- Emotional lability persists
