Obstetrics & Neonatology Flashcards
Abortion
expulsion of the fetus, from any cause, before the 20th week gestation.
Abruptio placenta
a premature separation of the placenta from the wall of the uterus.
Amniotic fluid
a watery fluid that provides the fetus with a weightless environment in which to develop.
Amniotic sac
the fluid-filled, bag-like membrane in which the fetus develops.
Antepartum
before delivery
Atresia
the process by which an oocyte (egg) dies
Blastocyst
the term for an oocyte once it has been fertilized and multiplies into cells.
Bloody show
a plug of mucus, sometimes mixed with blood, that is expelled from the dilating cervix and discharged from the vagina.
Body (context of the uterus)
the portion below the fundus that begins to taper and narrow.
Breech presentation
a delivery in which the buttocks comes out first.
Cervical canal
the interior of the cervix
Cervix
the narrowest portion of the uterus that opens into the vagina
Cholestasis
a common liver disease that only occurs during pregnancy, in which the flow of bile is altered resulting in acids being released into the bloodstream, causing profuse and painful itching.
Chronic hypertension
a BP that is greater than or equal to 140/90mmHg, which exists prior to pregnancy, occurs before the 20th week of pregnancy, or continually persists postpartum.
Complete abortion
expulsion of all products of conception from the uterus.
Corpus luteum
the remains of a follicle after an oocyte has been released, and which secretes progesterone.
Crowning
the appearance of the infant’s head at the vaginal opening during labour.
Ectopic pregnancy
an egg that attaches outside the uterus, typically in a fallopian tube.
Embryo
the fetus in the earliest stages after fertilization
Endometrium
the innermost layer of tissue in the uterus.
Episiotomy
an incision in the perineal skin made to prevent tearing during childbirth.
External os
the junction where the uterus opens into the vagina
fallopian tubes
the vehicles of transportation of the ova from the ovaries to the uterus; also called ovaducts
fetus
the developing, unborn infant inside the uterus
first stage of labour
the stage of labour that begins with the onset of regular labour pains-crampy abdominal pains- during which the uterus contracts and the cervix effaces
follicle-stimulating hormone (FSH)
a hormone produced by the anterior pituitary gland which is important in the menstrual cycle.
footling breech
a delivery in which one or both of the feet dangle through the vaginal opening
fundus
the dome shaped top of the uterus
gestational diabetes
diabetes that develops during pregnancy in women who did not have diabetes prior
gestational HTN
high BP that develops after the 20th week of pregnancy, in women with previously normal BP, and resolves spontaneously after birth.
gestational period
the time it takes for the infant to develop in utero, normally 40 weeks
GnRF
a chemical released by the hypothalamus that stimulates the release of follicle-stimulating hormone
gravid
the number of all the pregnancies a woman has had, including those not carried to term
gravidity
a term used to refer to a uterus that contains a pregnancy, whatever the outcome.
Group B streptococcus
a bacteria that lives in the genitourinary and GI tracts of normal healthy people, but which can cause life-threatening infections in newborn babies.
human chorionic gonadotropin hormone
a hormone that sends signals to the corpus luteum that pregnancy has initiated.
hyperemesis gravidarum
a condition of persistent N/V during pregnancy
incomplete abortion
expulsion of the fetus which results in some products of conception remaining in the uterus
induced abortion
intentional expulsion of the fetus
inevitable abortion
a spontaneous abortion that cannot be prevented
internal mucosa
the inner layer of tissue in the fallopian tubes
labour
the mechanism by which the baby and placenta are expelled form the uterus
luteinizing hormone
a hormone released by the anterior pituitary gland that stimulates the process of ovulation
meconium
a dark green material in the amniotic fluid that can indicate disease in the newborn; meconium can be aspirated into the infant’s lungs during delivery; the baby’s first BM
missed abortion
a situation in which the fetus has died during the first 20 weeks gestation but has remained in utero
molar pregnancy
occurs at the fertilization stage in pregnancy during which a malfunction of the egg or sperm results in an abnormal placenta and a fetus with an abnormal chromosome count, or which results in an empty egg
multigravida
a woman who has had two or more pregnancies, irrespective of the outcome
multipara
a woman who has had two or more deliveries
muscularis
the middle layer of tissue int he fallopian tubes
myometrium
the middle layer of tissue in the uterus
nullipara
a woman who has never delivered
oocyte
an egg produced from the female ovary
para
the number of pregnancies a woman has carried to more than 28 weeks, regardless of whether the fetus was delivered dead or alive
parity
number of live births a woman has had
perimetrium
the outer layer of protective tissue in the uterus
placenta
the tissue attached to the uterine wall that nourishes the fetus through the umbilical cord
placenta previa
a condition in which the placenta develops over and covers the cervix
postpartum
after birth
preeclampsia
a condition of late pregnancy that involves gradual onset of HTN, headache, visual changes, and swelling of the hands and feet; also called pregnancy induced HTN or toxemia of pregnancy
prenatal
the state of the pregnant woman before childbirth
primigravida
a woman who is pregnant for the first time
primipara
a woman who has had only one delivery
progesterone
a hormone that influences the second phase of the menstrual cycle, when the oocyte is either fertilized or dies
prolapsed umbilical cord
a situation in which the umbilical cord comes out of the vagina before the infant
pseudocyesis
a false pregnancy that develops all of the typical S/S of true pregnancy, but in which no actual pregnancy exists
Rh factor
a protein found on the RBC of most people
when a woman without this protein is impregnated by a man with this protein, the woman’s body can create antibodies against the protein and attack future pregnancies
second stage of labour
the stage of labour in which the baby’s head enters the birth canal, during which contractions become more intense and frequent
secretory stage
the second stage of the menstrual cycle
septic abortion
a life-threatening emergency in which the uterus becomes infected following any kind of abortion
serosa
the outermost layer of tissue in the fallopian tubes
shoulder dystocia
a condition in which the infant becomes trapped between the symphysis pubis and sacrum because its shoulders are larger than its head
spontaneous abortion
expulsion of the fetus that occurs naturally; also called miscarriage
stratum basalis
a permanent mucous membrane that makes up part of the outer endometrium
stratum functionalis
an inner mucous membrane that makes up part of the endometrium, and which is renewed following menstruation
supine hypotensive syndrome
low BP resulting from compression of the inferior vena cava by the weight of the pregnant uterus when the mother is supine
third stage of labour
the stage of labour in which the placenta is expelled
threatened abortion
expulsion of the fetus that is attempting to take place but has not occurred yet; usually occurs in the first trimester
tocolytics
drugs used to delay preterm labour
transverse presentation
a delivery in which the fetus lies crosswise in the uterus; one hand may protrude through the vagina
umbilical cord
the conduit connecting the mother to the infant via the placenta; contains two arteries and one vein
uterine cavity
the interior of the body of the uterus
uterine inversion
a potentially fatal complication of childbirth in which the placenta fails to detach properly and results in the uterus turning inside-out
uterus
a muscular inverted pear-shaped organ, that lies situated between the urinary bladder and the rectum
vagina
a tubular organ lined with mucous membranes, which is the lower portion of the birth canal.
acrocyanosis
a decrease in the amount of oxygen delivered to the extremities. The hands and feet turn blue because of narrowing of small arterioles toward the end of the arms and legs.
Apgar (appearance)
completely pink: 2
body pink, extremities blue: 1
centrally blue, pale: 0
Apgar (pulse)
> 100: 2
<100, >0: 1
absent: 0
Apgar (grimace)
cries: 2
grimaces: 1
no response: 0
Apgar (activity)
active motion: 2
some flexion in the extremities: 1
limp: 0
Apgar (respiratory)
strong cry: 2
slow and irregular: 1
absent: 0
choanal atresia
a narrowing or blockage of the nasal airway by membranous or bony tissue; a congenital condition.
Often bilateral and because neonates are obligatory nasal breathers, it is life-threatening.
cleft lip
an abnormal defect or fissure in the upper lip that failed to close during development.
cleft palate
a fissure or hole in the palate that forms a communicating pathway between the mouth and nasal cavities.
diaphragmatic hernia
a defect in the muscle of the diaphragm more common on the left side which results in passage of loops of bowel with or without other abdominal organs, through the diaphragm muscle into the chest cavity.
Erb palsy
lack of movement in the shoulder due to nerve injury resulting from the stretching of the cervical nerve roots ( C5 and C6 most commonly) during delivery of the newborn’s head during birth. The effect is usually transient, but can be permanent.
free-flow oxygen
oxygen administration via oxygen tube and a cupped hand on patient’s face
bradycardia (newborn)
<100bpm
hypoglycemia (newborn)
<2.6mmol
hypotonia
low or poor muscle tone
hypoxic ischemic encephalopathy
damage to cells in the CNS from inadequate oxygen resulting in abnormal neurological examination.
intercostal retractions
skin sucking in between the ribs, seen when a patient creates increased negative intrathorax pressure to breathe
intussusception
an event where one part of the intestine telescopes into another part of the intestines and leads to a blockage in the intestine and potential for bowel ischemia
Klumpke paralysis
an injury of childbirth affecting the spinal nerves C7, C8, and T1 of the brachial plexus.
malrotation
a congenital anomaly of rotation of the midgut, the small bowel is found predominantly on the right side of the abdomen
oligohydramnios
decreased volume of amniotic fluid during a pregnancy; a risk factor associated with abnormalities of the urinary tract, postmaturity (birth after a prolonged pregnancy), and intrauterine growth retardation.
persistent pulmonary hypertension
delayed transition from fetal to adult circulation from high pulmonary vascular resistance.
Pierre Robin sequence
a condition present at birth marked by a very small lower jaw (micrognathia). The tongue tends to fall back and downward (glossoptosis), and there is a soft cleft palate.
polycythemia
abnormally high RBC count
polyhydramnios
an excessive amount of amniotic fluid that can cause preterm labour. It may be associated with disorders of swallowing or intestinal blockage.
premature
underdeveloped; the condition of an infant born too soon. Refers to infants delivered before 37 weeks
primary apnea
apnea caused by oxygen deprivation; usually corrected with stimulation, such as drying or gently slapping the newborn’s feet.
Usually preceded by an initial period of rapid breathing.
pulmonary hypertension
elevated BP in the pulmonary arteries from constriction; causes problems with blood flow to the lungs.
retinopathy of prematurity
a disease of the eye that affects prematurely born infants, thought to be caused by disorganized growth of retinal blood vessels resulting in scarring and retinal detachment; can lead to blindness in serious cases.
secondary apnea
when asphyxia continues after primary apnea, infant responds with a period of gasping respirations, falling pulse rate, and falling BP
small for gestational age
an infant whose weight is considerably less than 90% of infants of the same age
What questions should you ask of a third trimester pregnant woman with vaginal bleeding?
when did it start?
what activity were you doing when it began?
how much blood loss?
do you have abdominal pain?
What is the treatment for vaginal bleeding in a third trimester pregnant woman?
lay her on her left side 15lpm O2 NRB RTC NS IV large bore ECG loosely placed trauma pads over the vagina
What is the treatment for hyperemesis gravidarium?
15lpm O2 NRB IV NS 250ml Gravol, if indicated check BGL ECG Transport
What special considerations are there for pregnant women and their BP levels?
a pregnant woman may have a lot of blood loss before she shows signs of shock. Suspect shock from the MOI, not the presentation
How do you cut the cord?
clamp the cord at 20 cm from the infant’s naval, and another one 5 cm further.
cut between the clamps
How do you treat a prolapsed umbilical cord?
supine position with hips elevated as much as possible
100% supplemental O2 via NRB
instruct the woman to pant with each contraction, which will prevent her from bearing down
with two fingers, gently push the baby (not the cord) back up into the vagina until the presenting part no longer pushes on the cord.
while you maintain pressure on the baby, have your partner cover the presenting cord with dressings moistened with NS
Maintain that position and RTC
what are the indications for artificial ventilation of a newborn?
apnea
pulse < 100bpm
persistent central cyanosis despite breathing 100% O2
