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Practice Topics Exam 5 > Pregnancy and Labor > Flashcards

Pregnancy and Labor Flashcards

1
Q

Pregnancy is how long

A

38-42 weeks from conception to delivery
Counted from the first date of the last menstrual period
Typically 4 weeks pregnant when first positive test

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2
Q

Pregnancy - trimesters - total weight gain

A

3 trimesters

Total weight gain is 20-35 pounds (depends on BMI)

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3
Q

First trimester

A

Fertilized ovum implanted 7-10 days after fertilization

Majority of fetal systems formed but not function fully

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4
Q

First trimester is when

A

0-12 weeks

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5
Q

First trimester - symptoms

A

Emotional changes begin
Fatigue, n/v, inc urinary freq
MSK complaints may begin

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6
Q

First trimester - weight gain

A

0-3 pounds

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7
Q

Second trimester is when

A

13-27 weeks

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8
Q

Second trimester - symptoms

A

Begin to show

Most women feel great - more energy

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9
Q

Second trimester - fetus weight

A

1-2 pounds

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10
Q

Second trimester - fetus

A

Eyebrows, eyelashes, fingernails formed

Movement felt around 20 weeks

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11
Q

Third trimester is when

A

28-40 ish weeks

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12
Q

Third trimester - uterus

A

5-6 times its normal size and 20 times its normal weight
Contracts regularly
Pelvic organs become abdominal organs

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13
Q

Third trimester - common complaints

A

LBP, rib pain, freq urination, incontinence, fatigue, SOB, constipation, LE edema

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14
Q

Hormone charts

A

Day 21-28 drop in estrogen and progesterone

At ovulation, body temp rises about 1/2 degree

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15
Q

Endocrine changes - estrogen

A

Size inc in uterus and breasts
Contributes to CT changes
Estroiol inc to 1000x pre-pregnancy

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16
Q

Endocrine changes - relaxin

A

Peak level in 1st trimester and remains elevated
Inhibits uterine contraction, softens the cervix
Relaxes ligaments

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17
Q

Endocrine changes - progesterone

A

Smooth mm relaxation - GI constipation, uterus, veins have dec peripheral resistance
Inc sens to CO2 (hypervent)
Inc core temp 1/2 degree

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18
Q

CV changes - blood volume

A

BV 50%

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19
Q

CV changes

HR x SV = CO

A

HR x SV = CO (all inc and peak mid gestation)

Baseline HR inc about 12 bpm

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20
Q

CV changes - BP

A

Slight dec in BP initially then normal

Peripheral res dec, CO inc so BP doesn’t change much

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21
Q

CV changes - heart

A

Heart arrhythmias

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22
Q

CV changes - plasma and RBCs

A

40-60% inc in plasma, but only 30% inc in RBC

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23
Q

CV changes - venous pressure

A

Inc venous pressure in LE with standing
Varicose veins
Hemorrhoids

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24
Q

CV changes - IVC

A 
Pressure rises in IVC
Worse in late pregnancy
Worse in supine 
Worse in supine with ex
Leads to symptomatic supine hypotension
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25
Q

CV changes - aorta

A

Can be partially occluded in supine

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26
Q

Pulmonary changes - ribcage

A

AP and transverse in all diameters (2cm each)
Subcostal angle from 68 to 103 degrees
Ribcage elevates and does not always come back down
Diaphragm elevates passively 4cm

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27
Q

Pulmonary changes - Upper resp tract

A

Capillary dilation - inc secretions

28
Q

Pulmonary changes - hyperventilation

A

Inc tidal volume

Steady freq

29
Q

Pulmonary changes - oxygen

A

20% inc in oxygen consumption

30
Q

Pulmonary changes - work of breathing

A

Inc and dec functional residual capacity - dyspnea with exercise early

31
Q

Renal system changes

A

Micuration - detrusor relaxation, bladder is displaced ant and sup
Inc urinary freq

32
Q

Thermoregulatory changes

A

BMR inc
Heat production inc
300 extra calories a day

33
Q

Psych changes

A

Preg related depression
Post partum depression
Edinburgh postnatal dep scale can be used to screen

34
Q

MSK changes - abdominal mm

A

Stretched to elastic limits
Esp RA
Can lead to diastasis Recti
Reduced mechanical advantage

35
Q

MSK changes - PFM

A

Stretched up to 30% from inc weight

Birth trauma - pudendal nerve stretch, tearing, episiotomy

36
Q

MSK changes - CT and joint

A

Hypermobility

37
Q

Postural and balance changes

A 
COG shifts upward and forward
Subocc tighten
Lumbar paraspinals tighten
Thoracic kyphosis inc
Changes often persist into infant care@
38
Q

Labor - effacement

A

Thickness of cervix from 5cm to 1 mm

39
Q

Labor - dilation

A

Opening of cervix from diameter of a fingertip to 10 cm

40
Q

Labor - 3 stages

A 
1 = cervical dilation (labor)
2 = pushing and expulsion (delivery)
3 = placental expulsion and uterine involution (afterbirth)
41
Q

Vaginal birth - possible complications

A

Compromise to pudendal
Perineal tearing
Episiotomy
Inc strain against pelvic organs

42
Q

Vaginal birth - possible complications - Episiotomy - what percentage of vaginal deliveries

A

51-75%
Becoming less common
Can be harmful in some cases
Surgeons say easier to put back together - but worse because going through deeper layers than if were to just tear naturally

43
Q

PT during labor and delivery

A 
Is underutilized! 
Relaxation training
Breath control
Vasalva avoidance
TENS for LBP
Sacral mob for LBP
Position changes for slow progression of labor 
Alternate positioning
44
Q

Labor - important hx questions

A 
How long was stage 2
Did they have episiotomy
Did they have a tear
Did they have a ceserian 
How was their recovery
Any birth complications
45
Q

Ceserean delivery - rates

A

rose by 53% from 96 to 2007
32% of all deliveries
WHO recommends 10% though

46
Q

Vaginal birth after cesarean

A

Some doctors will not allow it because higher chance of complications
but ACOG says it is fine

47
Q

Vaginal birth after cesarean - what does research show

A

Risk of uterine rupture after VBAC is less than 1% when birth is at least 18 months after initial C section
Risk of fetal death in 6% of uterine ruptures

48
Q

Ceserian delivery - afterwards

A

Extended recovery
Major abdominal surgery
Conflicting emotions/feelings of failure

May offer protective effect for pelvic floor but not always! - still may have long stage 2 prior to C section and pregnancy itself is stressful to PFM

49
Q

C delivery is necessary or not

A

Absolutely necessary and appropriate in many situations

Absolutely unnecessary in other situations

50
Q

C delivery - reasons for unnecessary

A

Scheduled c sections for convenience of provider and mother
Perceived risk and insurance company intervention
VBAC

51
Q

Ceserian indications

A 
Genital or cervical disease
Premature labor with fetal distress
Fetal distress
Chronic disease
Malposition of placenta
Issues with multipl birth
Hemorrhage
Placenta abruption
Prolapsed umbilical cord
Malpresentation
Failure to progress 
Cephalopelvic disproportion
52
Q

Professional communication - Gravida

A

Base word for number of times pregnant

53
Q

Professional communication - Para

A

Base word for number of times given birth (alive or stillborn)

54
Q

Professional communication - Or in order like this 4, 1, 1, 4

A

1st - number of term deliveries
2nd - number of preterm deliveries
3rd - number of abortions
4 - number of living children

55
Q

Professional communication - Nullipara

A

No pregnancy beyond 20 weeks gestation

56
Q

Professional communication - Primipara

A

1 delivery beyond 20 weeks gestation

57
Q

Professional communication - Multipara

A

2 or more feliveries beyond 20 weeks gestation

58
Q

Professional communication - nulligravida

A

Never been pregnant

59
Q

Professional communication - Primigravida

A

Pregnant once, regardless of outcome

60
Q

Professional communication - Multigravida

A

More than one pregnancy

61
Q

High risk pregnancy

A

1 complicate dby disease

2 pregnancy in which one is at inc risk of morbidiity or mortality before, during or after delivery

62
Q

High risk conditions

A 
Preterm rupture of membranes
Premature onset labor
Incompetent cervix
Placenta previa
Preeclampsia
Multiple gestation 
Gestational diabetes
63
Q

High risk conditions - incompentet cervix is what

A

cervix opens too soon

64
Q

High risk conditioons - placent previa is what

A

Placenta implants low in uterus, may contribute to preterm labor or c section

65
Q

High risk conditions - preeclampsia

A

gestational hypertension, water retention and protein in urine; progresses to headaches, blurred vision, fatigue, nausea, SOB = medical emergency

66
Q

Acute care PT (1 to 3 days post partum)

A 
Underutilized!
Education 
Exercise sheet for HEP
Initiation of PFM 
Pain control
Posture and body mechanics
Post surgical considerations for C
Scar mobs
Expectations for incontinence
Return to exercise
DR care

Practice Topics Exam 5 (13 decks)

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