Objective 2 Flashcards
none
null
primi
one
multi
several
of pregnancies regardless of duration including current one
gravida
a person who has never been pregnant
nulligravida
a person who is pregnant for the first time
primigravida
a person who has two or more pregnancies
multigravida
of births where the infant (alive or dead) was 20 weeks or more at the time of birth
does not consider # of babies (twins etc)
para
a person who has given birth to their first child after 20 weeks gestation, regardless of whether the child was alive at birth or now living
primipara
a person who has given birth to two or more children, regardless of whether the children were alive at birth or is now living
multipara
a person who has not completed a pregnancy past 20 weeks gestation
nullipara
prenantal age of the developing fetus calculated from the first day of the pregnant persons last menstrual period
gestational age
a fetus that has reached the stage (usually 22-24 wks gestation) where it is capable of living outside the uterus
viability
what does GTPAL stand for?
gravidity, term, preterm, abortions, living children
what are the 4 phases of childbearing period?
preconception
antepartum
intrapartum
postpartum
identifies risk factors that may be changed before conception
preconception care
what are the prenatal goals?
Promote the health of the mother, fetus, newborn, and family
Decrease risk factors
Teach healthy habits
Educate in self-care
Develop a partnership with parents and family
Provide physical care and support
Prepare parents for parenthood
why is prenatal care important?
Decrease # of low-birth-weight infants
Decrease mortality and morbidity for moms and newborns
frequency of deaths
mortality
incidence of illness
morbidity
who does prenatal care?
Obstetricians
Family practitioners
Registered midwives
when does prenatal care take place?
Conception to 28 weeks
Every 4 weeks
29-36 weeks
Every 2-3 weeks
37 weeks to delivery
Weekly
what does prenatal care consist of?
Laboratory and diagnostic tests
Urinalysis
Protein, glucose, ketones
Detects infection, renal disease, and hypertension
Detects diabetes
Complete blood count (CBC)
Detects various problems including anemia, infection, cell abnormalities
Rh factor
Determines risk for maternal-fetal blood incompatibility
Routine assessments
Prenatal education
what are the routine assessments at each prenatal visit?
risk factors
VS
urinalysis
blood glucose
fundal height
fetal movement counting
fetal heart rate
emotional health
any discomforts
what is full term?
40wks (280days)
what is Nagele’s rule?
Determine 1st day of LNMP
Add 7 days
Count forward 9 months
Correct year if necessary
Cessation of menses, in a healthy and sexually active person, is often the first sign of pregnancy. however, strenuous exercise, changes in metabolism and endocrine dysfunction, chronic disease, certain meds, anorexia nervosa, early menopause, or stress may also be the cause
amenorrhea
Occur in up to 80% of all pregnancies. Morning sickness describes the symptoms, but they may occur at any time of date. Distaste for certain foods or their odours may be the main symptoms. Begins between the first and second missed periods and usually improved by 12 to 16 weeks
nausea/ fatigue/ drowsiness
Tenderness and tingling as hormones from the placenta stimulate growth of the ductal system in prep for breastfeeding
breast changes
Common in early months of pregnancy. The enlarging uterus, along with the increased blood supply to the pelvic area exerts pressure on the bladder. Occurs in the first semester until the uterus expands and becomes an abdominal organ in the second trimester
urinary frequency
Fetal movement felt by the pregnant person, is first perceived at 16-20 weeks of gestation as a faint fluttering in the lower abdomen in a primigravida. Pts who have given birth previously often report quickening as early as 14 weeks
quickening
Softening of the cervix and vagina caused by increased vascular congestion
goodells sign
The purplish or bluish discoloration of the cervix and vaginal mucosa caused by increased vascular congestion
chadwicks sign
Softening of the lower uterine segment. Because of the softening, it is easy to flex the body of the uterus against the cervix, which is known as McDonald sign
hegars sign
Rather irregularly at the onset of pregnancy. By the end of the 12th week, the uterine fundus may be felt just above the symphysis pubis, and it extends to the umbilicus between the 20th and 22nd weeks
enlargement uterus/abdomen
Irregular, painless uterine contractions that begin in the second trimester. These give the sensation of the abdomen being hard and tense and they may become progressively more noticeable as term approaches and are more pronounced in multigravidas
braxton hicks contractions
A manoeuvre by which the fetal part is displaced by a light tap of the examining finger on the cervix, and then the part rebounds quickly. Uterine or cervical polyps may cause the sensation aswell
ballottement
Use maternal urine or blood to determine the presence of hCG.
positive pregnancy test
May be detected as early as 10 weeks of pregnancy by using a doppler device. When assessing, the pts pule rate must be assessed at the same time to be certain that the fetal heart is what is actually being heard. 110-160bpm
fetal heartbeat
Can often be felt during the second trimester by an examiner and can also be seen with ultrasonography
fetal movements
what are the endocrine system chages?
Increase in hormone production- essential to maintain pregnancy
Table 4.2, pg 72
Placenta is a temporary endocrine organ during pregnancy
Produces lrg amts of estrogen and progesterone to maintain pregnancy
Produces hCG and hPL
what are the uterus changes?
Increases in size (60g to 1100g)
Capacity increases from 10mls to 5000mls
what are the cervix changes?
Color, consistency, mucous plug
what are the overies changes?
Production of eggs ceases
what are the vagina changes?
Bluish color r/t inc blood supply (chadwicks sign)
Vaginal secretions increase, dec vaginal PH (more acidic) for protection, glycogen levels icrease which contribute to candida albicans growth
what are the breast changes?
Increase levels of estrogen and progesterone to prepare for lactation
Colostrum “premilk” expressed = high protein, fat soluble vitamins and minerals
what are the respiratory system changes?
Oxygen consumption increases by 20-40%
Diaphragm rises
Ribs flare
Possible dyspnea
Congestion and swelling of nose, pharynx, mouth, trachea r/t inc in estrogen
Mom may complain of nasal stuffiness, epistaxis and voice changes
what are the cardiovascular system changes?
Blood volume increases by 40-50%
Heart rate increased by 10-15bpm
Hypercoagulability
Supine hypotension syndrome
Orthostatic hypotension
what are the GI system changes?
Displacement of stomach and intestines
Ptyalism (inc salivary secretions)
Tender oral mucosa, easy to bleed
Increase thirst and appetite
Decreased gastric emptying and delayed intestinal movement
Constipation
Pyrosis (heartburn)
Nausea & vomiting
Gallbladder problems
what are the urinary system changes?
Glomerular filtration rate increases
Glucose and protein in urine
Fluid retention
UTI’s
what are the integumentary chages?
Striae (stretch marks)
Spider Nevi
Sweat and sebaceous glands become more active
Pruritus
Pigmentation changes
what are the musculoskeletal system changes?
Low back aches
Relaxation of the pelvic joints
Waddling gait
Change in the center of gravity
Uses high-frequency sound waves to visualize structures within the body
Can do either on the stomach (more full bladder), or transvaginal (empty bladder)
ultrasound
what are the uses of ultrasound during pregnancy?
Visualize gestational sac
Identify site of implantation
Verify fetal viability or death
Identify a multifetal pregnancy
Diagnose fetal physical abnormalities
Determine gestational age
Locate placenta
Determine amount of amniotic fluid
Observe fetal movements
Uses ultrasound to measure the amniotic fluid pockets in all four quadrants
<5cm oligohydramnios insufficient amniotic fluid
5-19cm normal levels
>25cm polyhydramnios excess amniotic fluid
amniotic fluid volume
Should feel movements within 16-20 weeks
Mother records fetal kicks every day
Minimum of 6 kicks in 2 hours
kick count
A procedure in which a thin needle is inserted through the abdominal and uterine walls to collect a sample of amniotic fluid
Done between 15-17 weeks
The primary risk of having a spontaneous abortion
Early pregnancy:
Identifies chromosomal abnormalities and disorders
Late pregnancy:
Identifies severity of maternal-fetal blood incompatibility, and assesses fetal lung maturity
amniocentesis
Evaluation with an electronic fetal monitor of the FHR
Two accelerations of at least 15bpm lasting 15 seconds in a 20 min period and usual fetal movement patterns are considered normal in fetus >32 weeks
Identities fetal compromise in conditions related to poor placental function
non-stress test (NST)
Fetal HR and reactivity (NST)
110-160bpm
Should raise with movement
Fetal breathing movements
Episodes lasting greater than 60seconds with movement
Fetal body movements
Fetal tone (closure of hands)
Extension of limbs
Flexion
1 ep of extension
Volume of amniotic fluid in 4 quadrants (AFI)
biophysical profile (BPP)
what are the warning/danger signs requiring immediate attention?
Sudden gush of fluids from vagina
Vaginal bleeding
Abdominal pain
Epigastric pain
Decreased or absent fetal movements after 26-28 weeks
Persistent vomiting- hyperemesis
Significant edma of faces and hands
Severe persistent headache
Blurred vision or dizziness
Chills with fever over 37.8c
Painful urination or reduced urine output
Feeling something is ‘just not right’
Excessive naueas and vomiting that interferss with the nutritional status of mom and baby
Fetal growth may be restricted due to reduced delivery of blood, oxygen, and nutrients to the fetus
hyperemesis gradidarum
Abnormal implantation of placenta in lower part of the uterus
Three degrees: low lying/marginal, partial, and total
Signs & symptoms:
Painles, bright red vaginal bleeding
Fetal presentation often abnormal
Postpartum complications:
Infection
Hemorrhage
Maternal shock/fetal compromise
Fetal anemia
placenta previa
Premature separation of the normally implanted placenta
Partial (marginal or central) or total detachment
S&S:
Dark vaginal bleeding, or concealed
Abdominal pain or lower back pain uterus is firm; may be tender
Often accompanied by impaired blood clotting (DIC)
PP complications:
Infection
Hemorrhage
Maternal shock/fetal compromise
Fetal anemia
placenta abruption
Unintentional termination of pregnancy before the age of viability (22 wks). Often referred to as a miscarriage
spontaneous abortion
Intentional termation of a pregnancy before the age of viability
induced abortion
Labor that occurs after 20 weeks gestation and before 37 weeks
preterm labor
Fertilized ovum implanted outside uterine cavity
Signs & symptoms:
Possible sudden severe lower abdominal pain
Vaginal bleeding
Signs of hypovolemic shock
Shoulder pain may also be felt
ectopic pregnancy
Hypertension that develops after 20 wks gestation in the normotensive women
gestational hypertension
Increase in BP that occurs after 20 wks, with or without proteinuria, with end organ involvement
S&S:
With or without proteinuria
Presence of one or more of:
Headache, visual disturbances
Epigastric pain & nausea
Low platelets (thromboytopenia)
HELLP H hemolysis of RBC’s, EL- elevated liver enzymes, LP- low platelets
Elevated uric avid, creatinine & liver enzymes
preeclampsia
Hypertension that involves one or more tonic-clonic seizures
eclampsia
Autoimmune destruction of beta cells of the pancreas = insulin deficiency
type 1 DM
Typically caused by insulin resistance; genetic predisposition
type 2 DM
Diabetes that existed before pregnancy
pregestational DM
Glucose intolerance with onset during pregnancy. In true GDM, glucose usually returns to normal by 6 weeks PP
gestational DM
what are the predisposing factors of GDM
BMI greater than 30 KG
Hx macrocosmic infant; greater than 4000g
Member of high risk group
Greater than age 35
Unexplained stillbirth orcongenital abnormalities
Hx previous GDM
Family Hx DM
Using corticosteroids
Glucose challenge test results: 7.8-11 mmol/L
Parasite acquired by contact with cat feces or raw meat. Transmitted through the placenta
toxoplasmosis
The organism can be found in the womens rectum, vagina, cervix, throat or skin. A culture of the rectum & vagina is rountinely taken at 35-37 weeks gestation. All positive cultures required antibiotic treatment during labour
group b streptococcus infection
The newborn acquires the disease by contact with untreated mother. If the mother has active pulmonary TB, the infact must be ketp in a separate area
tuberculosis (TB)
Pregnancy alters self-cleaning actions due to pressure on urinary structures and prevents the bladder from emptying completely. The retained urine becomes more alkaline
urinary trac infections (UTI)
Bordella pertussis is a respiratory pathogen that can cause critical issues with infants less than 6 months old. When pregnany, the mother will receive TDAP vaccine if required at the 26-32 week mark of pregnancy with the intention of increasing antibodies in prep for birth
pertussis
