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2ND YEAR- MCN LEC > Pregnancy and Labor Monitoring > Flashcards

Pregnancy and Labor Monitoring Flashcards

1
Q

Woman who currently is not pregnant & has never been pregnant

A

Nulligravida

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2
Q

Woman who is pregnant for the 1st time

A

Primigravida

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3
Q

Woman who has been pregnant more than once

A

Multigravida

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4
Q

Number of pregnancies that led to a birth > 20 wks AOG
(not by number of fetuses delivered)

A

Parity

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5
Q

Parity of each Para

A
  1. Nullipara- Woman who never completed a pregnancy >20 wks AOG
  2. Primipara- Woman who has delivered a fetus with an estimated AOG of at least 20 wks
  3. Multipara- Woman who has completed >2 pregnancies to >20 wks AOG
  4. Grand Multipara- Woman who has had at least 5 births (live or stillborn) that are at least 20 wks AOG
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6
Q

number of times a woman has been pregnant
(irrespective of outcome)

A

Gravidity

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7
Q

Obstetric Score

A

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

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8
Q

Trimesters of Pregnancy and weeks

A

1st Trimester until 14 weeks AOG
2nd Trimester until 28 weeks AOG
3rd Trimester until 42 weeks AOG

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9
Q

Maternal Periods

A

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)

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10
Q

Pediatric Period

A

Perinatal Period- interval from birth to 28 days

Neonate- birth to 28 days

Infant- 29 days to 1 year

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11
Q
A
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11
Q
A
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12
Q
A
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13
Q

Diagnosis of Pregnancy

A
  1. Amenorrhea
  2. Lower Reproductive Tract & Uterine Changes at 6-8 weeks age of gestation
  3. Breast and Skin Changes at 6-8 weeks age of gestation
  4. Fetal Movement
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13
Q

abrupt cessation of menstruation
highly suggestive in healthy reproductive-aged women with cyclical predictive menses

A

Amenorrhea

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14
Q

Lower Reproductive Tract & Uterine Changes
at 6-8 wks AOG

A

Chadwick sign
Goodell’s sign
Hegar’s sign
Cervical mucus changes

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15
Q

vaginal mucosa becomes dark-bluish red & congested

A

chadwick’s sign

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16
Q

cervical softening and change in position

A

Goodell’s sign

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17
Q

softening of isthmus

A

hegar’s sign

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18
Q

increased progesterone; ferning

A

cervical mucus changes

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19
Q

Breast and Skin Changes at 6-8 weeks age of gestation

A

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

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20
Q

increase MSH

A

Striae

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21
Q

mask of pregnancy

A

Chloasma/Melasma

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22
Q

darkening of the linea alba

A

Linea nigra

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23
Q

collagen breakdown

A

Striae Gravidarum

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24
Q

increase estrogen

A

Spider Telangiectasia

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25
Q

Fetal Movement

A

Dependent of parity and habitus
Primigravid- 18-20 weeks AOG
Multigravid- 16-18 weeks AOG

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26
Q

Diagnostic Test

A

B-hcG
Gestational Sac
Pseudogestational Sac
Transvaginal Sonography
Yolk Sac
Pregnancy of Unknown Location

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27
Q

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

A

beta human chorionic gonadotropin

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28
Q

brightly echogenic ring with anechoic center confirms with certainty an intrauterine location for the pregnancy
Seen at 5th week AOG

A

Yolk Sac

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28
Q

Small anechoic fluid collection
1st sonographic evidence at 4-5 weeks
Implants eccentrically in endometrium

A

Gestational Sac

28
Q

Fluid collection with in the endometrial cavity with an ectopic pregnancy

A

Pseudogestational Sac

29
Q

If equivocal findings
Serum serial hCG levels helps to differentiate

A

Pregnancy of Unknown Location

30
Q

Embryo is seen as a linear structure adjacent to yolk sac with cardiac activity

A

after 6 weeks

31
Q

Crown rump length is predictive of gestational age within 4 days

A

12 weeks

32
Q

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

A

Signs of Symptoms of Presumptive Evidence

33
Q

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

A

Signs and Symptoms of Probable Evidence

34
Q

Signs of Positive Evidence

A

Fetal heart tones
Perception of fetal movement by examiner
Ultrasound evidence

35
Q

Determining AOG by LMP

A

add the number of days from LMP to date of consultation then divide by 7 days

36
Q

Determining EDD using LMP

A

Jan - Mar : LMP + 9 mos + 7 days
April - Dec : LMP - 3 mos + 7 days + 1 yr

37
Q

Best heard along fetal back
110-160 BPM

A

Fetal Heart Tones

38
Q

AOG AND METHODS

A

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

39
Q

Symphysis pubis to fundus
Bladder must be emptied before measuring
20-34 wks gestation, fundic height correlates closely with gestational age in weeks

A

Fundic Height

40
Q

Expected height of uterine fundus by month of pregnancy

A

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

41
Q

Labor Monitoring

A
  1. Internal Examination
  2. Electronic fetal monitoring
42
Q

Internal Examination

A

Cervical dilatation
Cervical effacement
Station
Membrane

43
Q

ave diameter of cervical opening
measured in cm
admits tip - 10cm (fully dilated)

A

Cervical dilatation

44
Q

degree of decrease in cervical length
measured in %
uneffaced-fully effaced

A

Cervical effacement

45
Q

level of presenting part in relation to ischial spines (station 0)
minus (-), zero, plus (+)

A

Station

46
Q

bag of water
unruptured / intact
rupture

A

membrane

47
Q

Phases of Uterine Contractions

A

Increment
Acme
Decrement

48
Q

“building up” or increasing contraction; longest phase

A

Increment

49
Q

peak of a contraction

A

acme

50
Q

period of “letting up” or decreasing contraction

A

decrement

51
Q

Characteristics of Uterine Contractions

A

DUration
Frequency
Interval

52
Q

from beginning of one contraction to end of the same contraction

A

Duration

53
Q

from beginning of one contraction to beginning of the next contraction

A

frequency

54
Q

resting time between contractions to allow placental perfusion

A

interval

55
Q

how to read a CTG

A

DR: Define risk
C: Contractions
BRa: Baseline rate
V: Variability
A: Accelerations
D: Decelerations
O: Overall impression

56
Q

CTG define risks:

A

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

57
Q

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

A

contractions

58
Q

average heart rate of the fetus within a 10/20-minute window
normal FHB 110-160 BPM

A

baseline fetal heart rate

59
Q

baseline heart rate greater than 160 bpm

A

fetal tachycardia

60
Q

baseline heart rate less than 110 bpm

A

fetal bradycardia

61
Q

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

A

variability

62
Q

variabilities

A

absent variability- amplitude range undetectable
minimal- 5 bpm
moderate- 6 to 25 bmp
marked- 25 bpm

63
Q

abrupt increase in baseline fetal heart rate of more than 15 bpm for more than 15 seconds

A

acceleration

64
Q

abrupt decrease in baseline fetal heart rate of more than 15 bpm for more than 15 seconds

A

decelerations

65
Q

early deceleration is due to

A

head compression

66
Q

variable deceleration is due to

A

umbilical cord compression

67
Q

late deceleration is due to

A

uteroplacental insufficiency

68
Q

very concerning as it is associated
with high rates of fetal morbidity and mortality
indicates

A

sinusoidal pattern

69
Q

sinusoidal pattern indicates

A

Severe fetal hypoxia
Severe fetal anaemia
Fetal/maternal haemorrhage

70
Q

Reassuring overal impression

A

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

71
Q

non reassuring variability

A

fetal tachycardia/ bradycardia
absent variability
minimal variability
late deceleration

72
Q
A

2ND YEAR- MCN LEC (4 decks)

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