Pregnancy and Labor Monitoring Flashcards
Woman who currently is not pregnant & has never been pregnant
Nulligravida
Woman who is pregnant for the 1st time
Primigravida
Woman who has been pregnant more than once
Multigravida
Number of pregnancies that led to a birth > 20 wks AOG
(not by number of fetuses delivered)
Parity
Parity of each Para
- Nullipara- Woman who never completed a pregnancy >20 wks AOG
- Primipara- Woman who has delivered a fetus with an estimated AOG of at least 20 wks
- Multipara- Woman who has completed >2 pregnancies to >20 wks AOG
- Grand Multipara- Woman who has had at least 5 births (live or stillborn) that are at least 20 wks AOG
number of times a woman has been pregnant
(irrespective of outcome)
Gravidity
Obstetric Score
GP(T-P-A-L)
G Gravidity number of pregnancies regardless of outcome
P Parity number of past pregnancies that reached >20 weeks
T Term number of term infants delivered (>37 wks)
P Preterm number of preterm infants delivered (20- 36 6/7 wks)
A Abortion number of abortion/ miscarriage (<20 wks)
ectopic pregnancies as well as molar gestations are included
L Live Babies number of living children
Trimesters of Pregnancy and weeks
1st Trimester until 14 weeks AOG
2nd Trimester until 28 weeks AOG
3rd Trimester until 42 weeks AOG
Maternal Periods
Abortion- <20 wks AOG or <500g
Preterm- <37 wks AOG
Term- 37-42 wks AOG
Post-term- >42 wks AOG
Puerperium- time after delivery (4-6wks)
Pediatric Period
Perinatal Period- interval from birth to 28 days
Neonate- birth to 28 days
Infant- 29 days to 1 year
Diagnosis of Pregnancy
- Amenorrhea
- Lower Reproductive Tract & Uterine Changes at 6-8 weeks age of gestation
- Breast and Skin Changes at 6-8 weeks age of gestation
- Fetal Movement
abrupt cessation of menstruation
highly suggestive in healthy reproductive-aged women with cyclical predictive menses
Amenorrhea
Lower Reproductive Tract & Uterine Changes
at 6-8 wks AOG
Chadwick sign
Goodell’s sign
Hegar’s sign
Cervical mucus changes
vaginal mucosa becomes dark-bluish red & congested
chadwick’s sign
cervical softening and change in position
Goodell’s sign
softening of isthmus
hegar’s sign
increased progesterone; ferning
cervical mucus changes
Breast and Skin Changes at 6-8 weeks age of gestation
Breast engorgement
Striae: increase MSH
Chloasma/Melasma: mask of pregnancy
Linea nigra: darkening of the linea alba
Striae Gravidarum: collagen breakdown
Spider Telangiectasia: increase estrogen
increase MSH
Striae
mask of pregnancy
Chloasma/Melasma
darkening of the linea alba
Linea nigra
collagen breakdown
Striae Gravidarum
increase estrogen
Spider Telangiectasia
Fetal Movement
Dependent of parity and habitus
Primigravid- 18-20 weeks AOG
Multigravid- 16-18 weeks AOG
Diagnostic Test
B-hcG
Gestational Sac
Pseudogestational Sac
Transvaginal Sonography
Yolk Sac
Pregnancy of Unknown Location
basis for endocrine assays of pregnancy
produced by syncytiotrophoblast
main function is to prevent involution of corpus luteum
Alpha subunit: identical to LH, FSH, TSH
Beta Subunit: used for pregnancy detection
beta human chorionic gonadotropin
brightly echogenic ring with anechoic center confirms with certainty an intrauterine location for the pregnancy
Seen at 5th week AOG
Yolk Sac
Small anechoic fluid collection
1st sonographic evidence at 4-5 weeks
Implants eccentrically in endometrium
Gestational Sac
Fluid collection with in the endometrial cavity with an ectopic pregnancy
Pseudogestational Sac
If equivocal findings
Serum serial hCG levels helps to differentiate
Pregnancy of Unknown Location
Embryo is seen as a linear structure adjacent to yolk sac with cardiac activity
after 6 weeks
Crown rump length is predictive of gestational age within 4 days
12 weeks
Symptoms- Nausea, vomiting
Urinary frequency/ urgency
Quickening
Breast enlargement
Signs- Amenorrhea
Chadwick sign
Chloasma or melasma
Linea Nigra
Striae gravidarum
Spider telangiectasia
Breast changes
Thermal changes
Signs of Symptoms of Presumptive Evidence
Symptoms- Abdominal distention
Braxton-hicks contraction
Signs- + pregnancy test
Abdominal enlargement
Outlining of fetal parts
Hegar sign
Goodell sign
BallotementSigns and Symptoms of Probably Evidence
Signs and Symptoms of Probable Evidence
Signs of Positive Evidence
Fetal heart tones
Perception of fetal movement by examiner
Ultrasound evidence
Determining AOG by LMP
add the number of days from LMP to date of consultation then divide by 7 days
Determining EDD using LMP
Jan - Mar : LMP + 9 mos + 7 days
April - Dec : LMP - 3 mos + 7 days + 1 yr
Best heard along fetal back
110-160 BPM
Fetal Heart Tones
AOG AND METHODS
5-6 weeks- Transvaginal sonography
10 weeks- Doppler ultrasound
16 weeks- Earliest heard with a standard stethoscope
20 weeks- Stethoscope in 80% of women
22 weeks- Stethoscope in all women
Symphysis pubis to fundus
Bladder must be emptied before measuring
20-34 wks gestation, fundic height correlates closely with gestational age in weeks
Fundic Height
Expected height of uterine fundus by month of pregnancy
AOG Fundic Height
12 weeks Uterus above pubic symphysis
16 weeks Midway bet umbilicus & pubic symphysis
20-22 weeks Level of umbilicus
28 weeks Bet umbilicus & xiphoid process
40 weeks Fundic height decreases
Labor Monitoring
- Internal Examination
- Electronic fetal monitoring
Internal Examination
Cervical dilatation
Cervical effacement
Station
Membrane
ave diameter of cervical opening
measured in cm
admits tip - 10cm (fully dilated)
Cervical dilatation
degree of decrease in cervical length
measured in %
uneffaced-fully effaced
Cervical effacement
level of presenting part in relation to ischial spines (station 0)
minus (-), zero, plus (+)
Station
bag of water
unruptured / intact
rupture
membrane
Phases of Uterine Contractions
Increment
Acme
Decrement
“building up” or increasing contraction; longest phase
Increment
peak of a contraction
acme
period of “letting up” or decreasing contraction
decrement
Characteristics of Uterine Contractions
DUration
Frequency
Interval
from beginning of one contraction to end of the same contraction
Duration
from beginning of one contraction to beginning of the next contraction
frequency
resting time between contractions to allow placental perfusion
interval
how to read a CTG
DR: Define risk
C: Contractions
BRa: Baseline rate
V: Variability
A: Accelerations
D: Decelerations
O: Overall impression
CTG define risks:
obstetric complications:
Multiple gestation
Post-date gestation
Previous cesarean section
Intrauterine growth restriction
Premature rupture of membranes
Congenital malformations
Oxytocin induction/augmentation of labour
Pre-eclampsia
maternal medical illness:
Gestational diabetes
Hypertension
Asthma
other risk factors
Absence of prenatal care
Smoking
Drug abuse
record number of contractions present in a 10/20 minute period
individual contractions are seen as peaks on CTG strip
assess & report contractions by duration, frequency & interval
contractions
average heart rate of the fetus within a 10/20-minute window
normal FHB 110-160 BPM
baseline fetal heart rate
baseline heart rate greater than 160 bpm
fetal tachycardia
baseline heart rate less than 110 bpm
fetal bradycardia
eat to beat fluctuations from baseline heart rate
result of interaction between nervous system, chemoreceptors, baroreceptors and cardiac responsiveness of fetus
indicates how healthy a fetus is at a particular time
variability
variabilities
absent variability- amplitude range undetectable
minimal- 5 bpm
moderate- 6 to 25 bmp
marked- 25 bpm
abrupt increase in baseline fetal heart rate of more than 15 bpm for more than 15 seconds
acceleration
abrupt decrease in baseline fetal heart rate of more than 15 bpm for more than 15 seconds
decelerations
early deceleration is due to
head compression
variable deceleration is due to
umbilical cord compression
late deceleration is due to
uteroplacental insufficiency
very concerning as it is associated
with high rates of fetal morbidity and mortality
indicates
sinusoidal pattern
sinusoidal pattern indicates
Severe fetal hypoxia
Severe fetal anaemia
Fetal/maternal haemorrhage
Reassuring overal impression
Baseline heart rate
110 to 160 bpm
Baseline variability
5 to 25 bpm
Decelerations
None or early
Variable decelerations with no concerning characteristics for less than 90 minutes
non reassuring variability
fetal tachycardia/ bradycardia
absent variability
minimal variability
late deceleration
