OB Week 1 Flashcards
Test 1
OB Week 1
What is EDD?
Estimated date of delivery
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What is EDC
Estimated date of confinement
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How is the estimated date of a baby’s birth is calculated from:
The 1st day of a baby’s birth is calculated from the the 1st day of the woman’s last normal menstual period.
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Nagel’s Rule
- Subtract 3 months from first day of last LMP
- Add 7 days
- Correct the year if necessary
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Any pregnacy loss before the 20th week or weighing less than 500 grams. Abortion can be either spontaneous” (SAB) or “therapeutic” TAB
Abortion
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A birth occurring between 34 0/7 weeks and 36 6/7 weeks of gestation (71% of all preterm births & about 12% of all births)
Preterm Birth
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A birth occuring after the 42 nd week
Post term Birth
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A birth occuring between 34 0/7 weeks and 36 6/7 weeks of gestation (71% of all preterm births & about 12% of all births.
Late Preterm
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The # of times a women has been pregnant (including this pregnancy), regardless of duration or outcome.
Gravida
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The # of pregnanies a women has completed past 20 week, regardless of whether infanct is born alive or dead. (refers to number of pregnancies not fetuses).
Para
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More complex method of describing “PARA”
TPAL method
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Is often recorded in 4 numbers
PARA
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The number of term deliversis (after 37 weeks)
T= Term
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The number of premature deliveries (> 20 and < 37 wk)
P= premature
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A= the number of abortions (either spontaneous or therapeutic)
A= abortions
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L= the number of living children
L= Living
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A women who is pregnant for the 1st time
Primigravida
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A women who has been pregnant more than once.
Multigravida
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A women who has never completed a pregnancy past weeks 20 weeks.
Nullipara
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A women who has given birth 2 or more times over 20 weeks of gestation.
multipara
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A women giving birth for the first time of a pregnancy over 20 weeks gestatiion.
primapara
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PLACENTA Size
6-10” and 1” thick
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Placenta weight
1 lb to 1.5 lbs.
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Placenta structure
Divided into sections or segments called Cotyledons.
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Placenta has two sides
- Fetal side- shiny and smooth in appearance, the amniotic sac is attached to it.
- Maternal side- dark red and rough in appearance.
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Psysiology and functions of Placenta 1 A
Endocrine Gland: produces several hormones necessary for normal pregnancy
- HCG (human chorionic gonadotropin)
- Estrogen
- Progesterone
- Human Placental Lactogen
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Pacenta also functions as 2 A:
Site of nutrient and O2 exchange and fetal waste excretion
- Occurs in the Intervillous space.
- About 150ml of the mother’s blood is briefly outside of her circulatory system while it bathes the Chorionic Villi.
- These are “treelike” structures that are derived from fetal tissure.
- The blood is exchanged 3 to 4 times per minute in this space.
- Maternal and Fetal blood do not mix.
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Placenta also function as 3 A.
- Blocks certain harmful substance- most Bacteria and some Viruses are too large to pass through the placenta.
- Maternal antibodies- many immunoglobulins are passesed to the fetus giving passive immunity to diseases, such as measles.
- Metabolic functions- substances are synthesized in the placenta (glycogen, cholesterol, fatty acids)
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Umbilical Cord- 1 A
The lifeline between mother and fetus
-20” -22” long, 1 “ thick.
Contains 3 vessels: 2 arteries and 1 vein, which are prtected by “wartons jelly”.
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Umbilicial Cord- 2 A
If abnormal # of vessels present- often associated with fetal anomoloies (heart and/or kidneys).
- The arteries carry “dirty blood” away from the fetus. The vein carries “clean” blood to the fetus.
- Central insertion into the placenta is normal.
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Fetal Membranes
-Called the Bag of Waters
-Consists of two layers
+AMNION- innermembrane, next to the fetus
+Chorion- outer membrane, next to the mother
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Fetal Membranes functions to:
House the fetus for the duration of pregnancy, protect fromoutside world, prevent vertical transmission of infection.
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Is made up mainly from fetal unine, fluid from maternal blood, castoff cells, verniz and fetal wast products.
Amniotic Fluid-1 A
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Its function is to cushion fetus and prtect frominjury, to keep infant at stable 98.6 tempature, to allow room for fetal movement and growth.
Amniotic Fluid- 2 A
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Normal volume -500 to 1000 ml at term.
Amniotic Fluid- 3 A
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Oligohydramnios
- Too little amniotic fluid (<500 ml)
- Complications: poor fetal lung development, compression syndrome
- Associated with fetal kidney abnormalities or inadequate blood flow throgh placenta.
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Polyhydramnio
Also called “Hydramnios”
- Too much amniotic fluid (>2000 ml)
- Associated with fetal CNS or GI tract abnormalities that prevent the normal fetal cycle involving ingestion of amniotic fluid.
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NEWBORN ASSESSMENT
- INITIAL ASSESSMENT
- Respiratory functions-1st
- Circulatory function-1st
- Gestational age assessment.
- Comprehensive physical exam.
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General SURVEY of NEWBORN
- Appearance
- Symetry, any obvious deformities, size, smell, muscle tone, sex posture
- Behavior
- Crying, lethagic, responsive, relfexes, jittery.
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Measurements of NEWBORN.
-Normal Length- 18-22” or 45-55 cm
-Head circumference- 13-15” or 32-38 cm
(measure right above eyebrows)
-Chest circumference- 12-14” or 30-36 cm
(measure at the nipple line)
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Normal weight of a NEWBORN
- 2500-4000gms
- 5 lbs, 8 oz -8 lbs, 13oz.
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AGA - Weight of NEWBORN
appropriate for gestational age
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SGA- Weight of NEWBORN
small for gestation age (below normal)
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LGA- Weight of NEWBORN
Large for gestation age (above normal)
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VITAL Signs- Tempature-Newborn
Temperature- first is usually taken axillary (36.5-37.3 C or 97.7-99.1 F) but may be taken rectally, PRN (36.5-37.5C or 97.7-99.8F)
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Vital Signs- Pulse -Newborn
-120-160 bpm, unless sleeping (100) or crying (180)
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Vital Signs-Respiration -Newborn
30-60 with periodic breathing (brief periods of 5-10 sec. pauses-apnea is common) AOP.
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Vital Signs-B/P-Newborn
If suspected heart problems or premature infant; average systolic 65-95mm Hg, average diastoic 30-60 mm Hg.
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SKIN of NEWBORN
- Color - Pink
- Pink with blue hands and feet (Acroyanosis)
- Mottled (lacy appearance)
- Pale (white)
- Normal Peeling
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Harlequin
Vasomotor instability along the vertical axix, No clincial significance.
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Harlequin signs
ichyocis refers to a relatively uncommmon group of skin disorder charcterized by the precessance of exessive amounts of dry surface scales. It is regarded as a disorder of karatinzation or confication and it is due to abnormal epidermal differation or metaboloism.
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Skin appearance 2 a
- Vernix - white chessy substance
- Lanugo-fina hair (usually on shoulders, ears and back)
- Milia (usually on chin or nose)- keratin filled epithethial cysts which occur in up to 40% of newborns.
- Sebaceous Hyperplasia- lecsion are more yello than milia, sometiime referred to as “miniature puberty of the newborn” (hormonal exposure)
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Skin appearance NEWBORN 3 a
-Rashes/Marks
-Erythema Toxicum-(NEWBORN RASH)
-Forceps Marks
-Mongolian Spots
-Birthmarks
-Portwine stain
Stork bit/Nevi
-Strawberry mark
-Cafe au lait
-Petechia
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Head of NEWBORN- 1 A
Size 1” (2-3cm) larger than chest C
If larger -the normal growth curve is indicate of hydrocephalus.
< 32 cm micorcephaly
-Shape
-Round
-Molding - suture lines overlap and head elongates.
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Head of Newborn - 2 A
Caput Succedaneum- head elongates and there is also edem of the soft tissue
-Cephalchematom- hemorrhage into the cranial bone, selling and bluish color on one side of the head- does not cross the suture line.
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Head of Newborn- 3A
Anterior one is diamond shaped-closes at about 18 months.
- Posterior one is trangular shaped- closes by 2-3 months.
- Palpate for softness
- Should be flat, not bulging.
- Bulging may indicate; infection or increased ICP; may bulge when crying.
- Sunken may indicate dehydration.
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Head of Newborn-4a
- Facial nerplasy; usually mandibular branch)
- Eyes-shape, slanted, hemorrhages, edema, strabismus, color by 6th month.
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Newborn Nose-assess
Patency of each nares to r/o “Cjpama; Atesia” a narrowing or blockage of the nsasal airway by tissue.
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Newborn Mouth-assess
For cleft lip and palate, for neonatal teeth Epstein’s pearls, thrush.
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Newborn HAIR assess
Fine with consistent hair pattern (abnormal hair patterns indicated genetic abnormatlites
-Unusual Hair Whorls.
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Newborn Ears
- Normal Shape, Cartilage firm (term)
- Patent
- Even with eyes (low set ears indicate congentiatl abnormalites)
- Pits or tages (kidney US)
- Hearing screen done before DC home!!!
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Anencephaly
Major birth defect of the head in which a neural tube defect where only the brain stem grows and there is no brain tissue.
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Encephalocele
Another neural tube defect where the cranium does not close and the meniges protrude out of the head.
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Neck and Clavicles assess
Is the neck thick or webbed?
Do the clavicles feel intact, no crepitus?
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Chest assess Newborn
- Size - 1” smaller than head
- Shape-Cylinder shape is normal
- Asymmetry can be caused by Pneumothorax or Diaphragmatic Hernia
- Nipples, Location, distance apart, any accessory nipples
- May secrete a whitish substance “withces milk”
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Lung Sounds -assess
Clear or mosist, equal, bowel sounds in chest?
S/S of respiratroy distress: tachypnea, grunting, retraction, nasal flaring cyanosis
-Rate: Listen for 1 full minute
-Common to have faint crackles for the 1st few hours after birth.
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Heart Sounds Assess
- Assuculate for rate and rhythm
- Presence of murmurs (murmurs are common in the newborn period-90% are transient and considered normal)
- :ostem fpr 1 full minute
- Report any abnormal rate, rthms or sounds to pediatrician
- If suspected heart problems- take B/P on all four extemities & check peripheral pulses.
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Abdomen ASSESS
- Size: the same or smaller than chest
- Shape:round, dome shaped, no distention
- Bowel sounds:present,hypo, hyperactive
- Cord
- # of vessels
- clamp on tight (no skin attached), no bleeding noted color white at birth, dry in 24 hus, oderless
- Assess for any obvious deformities (Gastroschisis, Omphalocele)
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Genitalia: Assess Female
Labia may be swollen and red from delivery, hymenal tag
- Pseudomenses: may have a blood tinged vaginal discharge
- Whitsh drainage
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Genitalia: Assess Male
Rugae on scrotum, large and pendulous testes, should be descented at term.
-Hydrocele: enlarged scrotum due to excess fluid
-Examine for inguinal hernia
Check location of uniary meatus
+Hypospadias- urethral opening is on the underside
+Epispadias-urethral opening is on the upperside.
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Neonate with amgious genitalia
- Will require genetic testing to determine sex
- Check for an anus patency- check for stool (taking temp rectally) PRN per order
- Brick reddish uric crystal deposits in diaper
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Extremities- Arms and Hands
Symmetry 10 fingers Hand creases: may be abnormal in FAS (Fetal alcohol syndrome), in Down syndrome Simian crease, short fingers may be present -Polydactily-extra digits Syndactly-webbing of digits -brachical pulse.
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S/S of Hip Dysplasia
- Barlow’s manevber; dislocates the joint
- Ortanlani’s test: Hip click reducces an out of hip joint.
- One leg shorter
- Gluteal creases are asymmetrical.
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Treatment for Congenital Hip Dysplasia
- Goal: hip reduction and stability
- Timing is critical: before 2 months, adjusted Q2 weeks for 6-12 weeks
- May need surgery to reconstruct hip sockets if condition is severe
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Genitalia: Assess Male
Rugae on scrotum, large and pendulous testes, should be descented at term.
-Hydrocele: enlarged scrotum due to excess fluid
-Examine for inguinal hernia
Check location of uniary meatus
+Hypospadias- urethral opening is on the underside
+Epispadias-urethral opening is on the upperside.
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Neonate with amgious genitalia
- Will require genetic testing to determine sex
- Check for an anus patency- check for stool (taking temp rectally) PRN per order
- Brick reddish uric crystal deposits in diaper
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Extremities- Arms and Hands
Symmetry 10 fingers Hand creases: may be abnormal in FAS (Fetal alcohol syndrome), in Down syndrome Simian crease, short fingers may be present -Polydactily-extra digits Syndactly-webbing of digits -brachical pulse.
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Treatment for Congenital Hip Dysplasia
- Goal: hip reduction and stability
- Timing is critical: before 2 months, adjusted Q2 weeks for 6-12 weeks
- May need surgery to reconstruct hip sockets if condition is severe
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Legs and Feet -Assess
- Symmetry
- 10 toes
- Femoral pulse
- No club feet (ponseti casting is superior to surgery; 90 % effective if started 1st month
- Crease covering bottome of feet covering at least 2/3
- Wide space between big toe and 2nd toe is common in Down Syndrome.
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Back and Buttocks
- Straight spine
- SPina Bifida Occulta- dimple or tuft of hair
- Menigocele (sac with fluid only)
- Meningomyelocele (sac with fluid and spinal cord)
