Pregnancy, Conditions related to Pregnancy and Labor and Delivery Flashcards
Exam 1
Gametes
Ova and Sperm
How are gametes created?
Creation of gametes (ova and sperm) through meiosis
How many chromosomes per gamete?
Each gamete has 23 chromosomes (22 autosomes & 1 set sex chromosome).
When is sex of fetus determined?
Males: XY; Females – XX ( sex determined at fertilization)
How many oocytes are females born with?
Females are born with 1 to 2 million oocytes in their ovaries.
In males, when does spermatogenesis being?
In males, spermatogenesis does not begin until puberty.
What is formed during oogenesis?
In the female, one ovum and three polar bodies are formed through oogenesis.
What does one spermatogonium give rise to?
One spermatogonium gives rise to four spermatozoa.
Female Reproductive Hormones: HPO axis is:
H-P-O Axis: interactions between hypothalamus, pituitary (anterior), & ovaries –
What does the HPO axis do?
Regulates female reproductive cycle.
Female Reproductive Hormones: Low levels of progesterone and estrogen lead to what?
Low estrogen and progesterone levels stimulates hypothalamus to produce gonadotropin-releasing hormone (GnRH).
GnRH causes the anterior pituitary to release:
GnRH causes the anterior pituitary to release:
Follicle-stimulating hormone (FSH) and
Luteinizing hormone (LH).
Follicle-stimulating hormone
FSH - responsible for maturation of ovarian follicles to release eggs for fertilization.
When do levels of LH peak?
LH levels peak @ approximately 14 days before menses - causes ovulation
Two phases of the ovarian cycle?
- Follicular phase
- Luteal phase
Follicular phase (when is it and how long)
(day 1 through ovulation, approximately days ~10 to 14 ( in a 28-day cycle)
What occurs during the follicle phase?
Primordial follicle matures under influence of follicle stimulating hormone(FSH) and luteinizing hormone (LH) until ovulation
What kind of phase is the follicular phase?
Variable phase
Ovulation- how long is it?
Ovulation (day ~14 of a 28-day cycle)- occurs due to surge in LH
Luteal phase- how long is it?
Luteal phase (day ~15 through day 28 of a 28-day cycle)
What occurs during the luteal phase?
Ovum leaves follicle
Corpus luteum – develops DT LH, produces progesterone
Estrogen production diminished
What kind of phase is the luteal phase?
Fixed phase
After ovulation, what is the ovarian follicle called?
After ovulation, ovarian follicle is called a corpus luteum.
What are the phases of the Menstrual (Endometrial or Uterine) Cycle?
- Menstrual phase (day 1-6)
- Proliferative phase(day 7-14)
- Secretory phase (day 15-26)
- Ischemic phase (day 27-28)
Menstrual phase (day 1-6)
Endometrium shed; estrogen low; cervical mucus scant, viscous opaque
Proliferative phase(day 7-14)
Endometrium and myometrium thickness increases
Estrogen peaks prior to ovulation
(Temperature increases up to 1 degree)
Mittelschmerz – sharp pain on side of ovulation
Secretory phase (day 15-26)
Estrogen drops, progesterone rises, vascularity increased, readies for implantation
Ischemic phase (day 27-28)
Hormone levels both drop; spiral arteries vasoconstrict; blood vessels rupture, blood to stromal cells, preparing to be shed
After ovulation, how long are ova available for fertilization?
After ovulation, ova are viable for fertilization for 6 to max 24 hours.
Sperm may be capable of fertilizing an egg for how long?
Sperm may be capable of fertilizing an egg for as long as 5 days.
Where does fertilization occur?
Fertilization generally occurs in the fallopian tube (ampulla).
Cortical reaction
Once egg is fertilized- other sperm are blocked from penetration through process called a cortical reaction.
After conception, what happens to sperm and egg chromosomes?
After conception, the 23 chromosomes from sperm +23 chromosomes from egg, create a diploid zygote with 46 chromosomes.
After diploid zygote formation, what occurs?
1.Doubling of cells
- Morula (day 3 to 4)
- Blastocyst (day 5-7)
Confirming Pregnancy: What is produced at the time of pregnancy?
Human chorionic gonadotrophin (hCG) hormone-produced at the time of implantation.
Confirming pregnancy: How does hCG increase?
hCG doubles approximately every 48 to 72 hours.
What do at home pregnancy tests do?
Home pregnancy tests detect hCG in the urine.
False negatives can occur in pregnancy test, what should a woman do?
If a woman thinks she is pregnant, but urine test was negative, she should repeat the test in 3 to 7 days.
Signs and Symptoms of Pregnancy-Confirming Pregnancy: Presumptive symptoms
Women describes symptoms
Fatigue
(12 weeks)
Breast tenderness
(3 to 4 weeks)
Nausea and vomiting
(4 to 14 weeks)
Amenorrhea
(4 weeks)
Urinary frequency
(6 to 12 weeks)
Hyperpigmentation of skin
(16 weeks)
Fetal movements (quickening)
(16 to 20 weeks)
Uterine enlargement
(7 to 12 weeks)
Breast enlargement
(6 weeks)
Signs and Symptoms of Pregnancy-Confirming Pregnancy: Probable signs of pregnancy
Slide 13
Positive signs of pregnancy
Ultrasound verification of embryo or fetus
(4 to 6 weeks)
Fetal movement felt by experienced clinician
(20 weeks)
Auscultation of fetal heart tones via Doppler
(10 to 12 weeks)
Intrauterine Development- Preembryonic stage:
Fertilized ovum becomes a morula and then blastocyst before entering the uterus.
Intrauterine Development- Embryonic stage (weeks 2-8)
Implantation by the end of week 2.
Neural tube fuses at the center and tubular heart begins to beat in week 3.
Respiratory and digestive tracts begin to form and the neural tube fusion is complete in week 4.
Limb buds appear in week 5.
In week 6, the heart is in its final form.
In week 8, the first brain waves are detectable.
Intrauterine Development- Embryonic stage (week 2)
Implantation by the end of week 2.
Intrauterine Development- Embryonic stage (week 3)
Neural tube fuses at the center and tubular heart begins to beat in week 3.
Intrauterine Development- Embryonic stage (week 4)
Respiratory and digestive tracts begin to form and the neural tube fusion is complete in week 4.
Intrauterine Development- Embryonic stage (week 5)
Limb buds appear in week 5.
Intrauterine Development- Embryonic stage (week 6)
In week 6, the heart is in its final form.
Intrauterine Development- Embryonic stage (week 8)
In week 8, the first brain waves are detectable.
Intrauterine Development 9-24 weeks: (week 9-12)
In weeks 9-12, fetal movements begins,
Kidneys begin to function
genitalia fully differentiated
Intrauterine Development 9-24 weeks: (week 13-16)
In weeks 13 to 16, oogenesis established in females, blood vessels visible under the skin, ridges that will form in the finger, hand, foot and toe prints are present
Intrauterine Development 9-24 weeks: (week 20)
By the 20th week, fetal swallowing is present and insulin production begins
Lanugo and vernix cover the body
Intrauterine Development 9-24 weeks: (week 24)
Lungs begin to form surfactant
Intrauterine Development 28-38 weeks. (28 weeks)
By the 28th week, testes descend in males, the fetus often moves to a head down position, and blood is produced in the bone marrow.
Intrauterine Development 28-38 weeks. (29-34 weeks)
In weeks 29 to 34, subcutaneous fat deposits begin and the fetal heart rate variability is more pronounced due to central nervous system maturity.
Intrauterine Development 28-38 weeks. (33-38 weeks)
In weeks 33 to 38, visual acuity is 20/600, vernix occurs only in skin creases, and lanugo only on upper back and shoulders. The lungs and central nervous system mature while the fetus continues to grow and gain weight.
Placenta
A circulatory interface between the mother and the embryo/fetus.
Where does the placenta form?
Forms at the site of blastocyst implantation.
What does the placenta attach with? Where does it expand over?
Attaches with finger-like projections known as chorionic villi.
Expands over the inner surface of the uterus until about 20 weeks’ gestation.
Two sides of the placenta:
Fetal surface is smooth and translucent, called “shiny Schultze”.
side has red, meaty appearance, called “dirty Duncan”.
Three primary purposes of the placenta
Serves three primary functions:
- circulation(gas exchange),
- waste excretion, and
- hormone production.
How is the placenta connected to the fetus?
Connected to fetus via umbilical cord
What does the umbilical cord contain?
Contains one large vein that carries oxygenated blood to the embryo/fetus and two smaller arteries that carries deoxygenated blood to the placenta.
What is the umbilical cord covered in?
The umbilical cord is covered in Wharton jelly, which helps support and protect vessels. (prevents compression)
Why would the umbilical cord appear twisted?
Often appears twisted, likely from fetal movement.
What does the umbilical cord serve as?
Serves as a conduit for blood traveling to and from the embryo/fetus
Amniotic fluid
Helps maintain a constant body temperature for the fetus (1º warmer than mother)
Cushions the fetus from trauma
Allows the umbilical cord to be relatively free of compression
Promotes fetal movement to enhance musculoskeletal development
What does the amniotic fluid permit?
Permits symmetric growth and development
What is the amniotic fluid made from?
Made from fluid from maternal and fetal blood and later fetal urine
How much amniotic fluid is present at birth?
1,000-1,200 ml at birth
Where is the umbilical cord formed?
Formed from the amnion
What is considered the lifeline from the mother to the growing embryo?
Lifeline from the mother to the growing embryo
At term, how long is the umbilical cord?
At term, the average umbilical cord is 22-in (55 cm) long and about 1-in wide
Endocrine System Changes: How long does the gestational parent supply thyroid hormones to the fetus?
Gestational parent supplies thyroid hormones to the fetus until the 12th week of pregnancy when the fetus can produce on its own.
What type of hormones is critical to fetal neurological development?
Thyroid hormones is critical to fetal neurological development.
How is thyroid hormone during pregnancy?
Thyroid hormones often increase during pregnancy.
What needs increase steadily during pregnancy? When?
Insulin needs increase steadily beginning in the second half of pregnancy.
What type of parents develop gestational diabetes?
Patients who are pregnant whose pancreases cannot keep up with increased insulin demands develop gestational diabetes.
What increases in the second trimester of pregnancy? What does this increase promote?
Cortisol levels increase in the second trimester of pregnancy and may promote lung and neurological development.
What is oxytoxin produced by?
Oxytocin is produced by the posterior pituitary and has a role in producing contractions, postpartum uterine contraction, and milk ejection.
What is the role of oxytocin?
Oxytocin is produced by the posterior pituitary and has a role in producing contractions, postpartum uterine contraction, and milk ejection.
Integumentary System Changes: What is common?
Striae gravidarum (stretch marks) are common on the breasts, abdomen, and thighs.
Striae gravidarum
(stretch marks)
How does Striae gravidarum appear initially?
Striae gravidarum may initially appear dark or red and then become paler or silvery over time.
Integumentary System Changes: What is often found on the skin of darker skinned patients?
Linea nigra, a dark line from the pubic symphysis to the fundus, is more often found in pregnant patients with darker skin and gradually disappears after pregnancy.
Integumentary System Changes: What happens to moles, freckles and areolae during pregnancy?
Nevi (moles), macules (freckles), and areolae darken.
Integumentary System Changes: Having to do with skin tone, what changes during pregnancy?
Chloasma (also known as the mask of pregnancy) darkens with sun exposure and disappears after pregnancy.
Integumentary System Changes: What happens to blood vessels during pregnancy?
Blood vessels dilate and become more prominent in early pregnancy due to increased estrogen levels.
Integumentary System Changes: Palmar erythema
Palmar erythema is caused by increased blood flow and is harmless and painless.
Is increased blood flow to the hands
Integumentary System Changes: How is the hair during pregnancy?
Hair grows longer and thicker in pregnancy due to estrogen stimulating the hair follicles.
Body hair tends to be more course and abundant after pregnancy.
Integumentary System Changes: When does hair growth return to normal?
Hair growth returns to normal during the first 4 months after delivery.
Integumentary System Changes: How are nails during pregnancy?
Nails may become softer, harder, or more brittle during pregnancy.
Respiratory System Changes: How is oxygen consumption during pregnancy?
Oxygen consumption increases 15% to 20% during pregnancy.
Respiratory System Changes: How is tidal volume during pregnancy?
Tidal volume, or the amount of air exchanged in respiration, increases 40% to 50%.
Respiratory System Changes: Why would a pregnant person be in a state of physiological respiratory alkalosis?
Mild hyperventilation and sense of dyspnea results in a state of physiological respiratory alkalosis.
Patient who is pregnant “blows off” more CO2 than normal allowing for CO2 in fetal circulation to diffuse into the maternal blood stream while O2 diffuses to the fetus.
Respiratory System Changes: How is the diaphragm of a pregnant person?
Diaphragm elevates approximately 5 cm during pregnancy, to accommodate this change, ribs expand and the subcostal angle increases.
Respiratory System Changes: What would cause congestion of mucous membranes in pregnant persons?
Increased estrogen causes congestion of mucous membranes.
Respiratory System Changes: Congestion of mucous membranes in pregnant people can cause what?
This congestion can cause swelling of pharynx, trachea, larynx, while engorged capillaries may cause frequent nose bleeds.
Cardiovascular System Changes: How is cardiac output of pregnant person?
Cardiac output increases by as much as 50%.
Cardiovascular System Changes: What do hormones do to peripheral vascular resistance?
Hormones in pregnancy reduce peripheral vascular resistance to compensate for increased blood volume.
Cardiovascular System Changes: What happens to blood volume? What does this result in?
Total blood volume increases by 40% to 45% while red blood cell count increases by 30%. Result is physiological anemia of pregnancy.
Cardiovascular System Changes: What happens to wbc during pregnancy?
White blood cell count increases during pregnancy and may not indicate infection.
Cardiovascular System Changes: What is thought to prevent excessive postpartum bleeding in pregnancy?
Rise in fibrinogen and other clotting factors thought to prevent excessive postpartum bleeding puts pregnant persons at risk for blood clots, which could lead to pulmonary embolism or stroke.
Cardiovascular System Changes: What puts pregnant persons at risk for blood clots?
Rise in fibrinogen and other clotting factors thought to prevent excessive postpartum bleeding puts pregnant persons at risk for blood clots, which could lead to pulmonary embolism or stroke.
Cardiovascular System Changes: What happens to heart sounds during pregnancy?
Temporary changes in heart sounds are common and benign in pregnancy.
Urinary System Changes: How is blood flow to and through kidneys during pregnancy?
Blood flow to and through the kidneys increases by 80% during pregnancy.
Urinary System Changes: How is glomerular filtration rate during pregnancy?
Glomerular filtration rate increases about 50% during pregnancy.
Urinary System Changes: What is not uncommon in urine during pregnancy?
Not uncommon for persons who are pregnant to spill small amounts of glucose and protein into the urine.
Urinary System Changes: How does the threshold for thirst and release of ADH in pregnant people compare to nonpregnant people?
In pregnancy, the threshold for hydration at which thirst is cued and the release of antidiuretic hormone is lower than for persons who are not pregnant.
Urinary System Changes: How is salt and water absorption in pregnant persons compare to nonpregnant persons.
More salt and water is reabsorbed in pregnant persons than nonpregnant persons. (Water gain is approximately 1.6 L.)
Reproductive System Changes: How is breast growth during pregnancy?
In the breasts, the ducts, lobules, and alveoli grow to prepare for breastfeeding, and the breasts become fuller.
Nipples and alveoli appear darker.
Reproductive System Changes: What may leak from breasts?
Colostrum, a yellowish form of early milk, is produced and may leak from the nipple.
Reproductive System Changes: Size of the uterus
Between the 16th and 36th week of pregnancy, the size of the uterus (in cm) from the symphysis pubis to the fundus equals the number of weeks’ gestation.
Reproductive System Changes: What kind of contractions occur throughout pregnancy?
Braxton Hicks contractions occur throughout pregnancy.
Reproductive System Changes: What forms inside the cervical canal to create a barrier against pathogens?
Mucus plug (operculum) forms inside the cervical canal to create a barrier against pathogens.
Reproductive System Changes: How is the vulva, vagina and cervix during pregnancy?
Increased vascularity of the vulva, vagina, and cervix
How is the pH of the vagina during pregnancy?
pH of the vagina is slightly more acidic and prevents against bacterial pathogens.
Musculoskeletal System Changes
Lordosis an exaggerated curve to the lumber spine, causes shift to the patient’c center of gravity and increases the risk of falls.
Musculoskeletal System Changes: What do relaxin and progesterone do?
Relaxin and progesterone increases mobility of pelvis for birth but makes joints less stable.
Musculoskeletal System Changes: What do Round ligaments do?
Round ligaments, which position and stabilize the uterus, can stretch and cause pain.
Musculoskeletal System Changes: What happens to Abdominal walls?
Abdominal walls separate at the midline (referred to as diastasis recti).
Musculoskeletal System Changes: Calcium
Increased calcium reabsorption due to increased parathyroid hormone. Not usually problematic unless the person has a large number of closely spaced pregnancies, or poor nutrition.
Gastrointestinal System Changes: Peristalsis changes?
Reduced peristalsis in gastrointestinal tract causes delayed stomach emptying and results in heartburn, constipation, and gallstones.
Gastrointestinal System Changes: Metabolic changes?
Metabolic rate increases 10% to 20% during pregnancy.
Gastrointestinal System Changes: How should patient meet metabolic changes?
To meet increased metabolic needs, the patient who is pregnant should consume 350 additional calories per day in the second trimester and 450 in the third trimester
Gastrointestinal System Changes: What does too little weight gain during pregnancy lead to?
Too little weight gain in pregnancy may result in a small-for-gestational age infant.
Gastrointestinal System Changes: What does too much weight gain during pregnancy lead to?
Too much weigh gain may result in complications such as pregnancy-induced hypertension or a greater risk for surgical delivery.
Discomforts in Pregnancy include:
- Fatigue
- Dyspnea
- Lightheadedness
- Supine hypotension
Discomforts in Pregnancy: Fatigue
Fatigue is particularly common in the early and late stages of pregnancy. Encourage resting or napping when possible.
Discomforts in Pregnancy: Dyspnea
Patients who are pregnant may experience dyspnea or difficulty breathing during pregnancy.
Improved posture may increase lung expansion.
Light exercise and stretching may help alleviate sensations of breathlessness.
Saline nasal sprays or humidifiers may help with chronic nasal congestion or nosebleeds.
Discomforts in Pregnancy: Lightheadedness
Lightheadedness is common. Teach patients to sit or stand slowly.
Discomforts in Pregnancy: Supine hypotension
Supine hypotension can occur from the pressure of the pregnant uterus when the patient lies on the back. Recommend a side-lying position.
Discomforts in Pregnancy: 4 more discomforts of pregnancy
- Edema
- Varicosities
- Temporary carpal tunnel syndrome
- Headaches
Discomforts in Pregnancy: Edema- what should you advise?
Edema is common during pregnancy. Advise light exercise, avoiding long periods of sitting or standing, and elevate the legs when possible.
Discomforts in Pregnancy: Some patients who are pregnant experience varicosities during pregnancy.
What should you advise?
- For hemorrhoids, recommend measures to avoid constipation.
- For varicose veins, recommend light exercise and avoiding long periods of sitting or standing. Compression stockings do not appear to help symptoms.
Slide 31: and 32, 33, 34 Discomforts of pregnancy
read it
Prenatal care of low risk patients: How often should prenatal care appointments be in the beginning?
Prenatal care appointments should be every 4 weeks until week 28.
Prenatal care of low risk patients: How often should prenatal care appointments be between 28 and 36 weeks’ gestation?
Appointments should be every 2 weeks between 28 and 36 weeks’ gestation.
Prenatal care of low risk patients: How often should prenatal care appointments be after 36 weeks?
After 36 weeks’ gestation, patients should be seen weekly for prenatal care
Prenatal appointments include:
Physical assessment
History since the last appointment
Vital signs and weight assessment
Fetal heart rate assessment
Fundal height measurement after 16 weeks of gestation
Pertinent education
What is the most indepth prenatal appointment?
The first prenatal appointment
The FIRST prenatal appointment should include:
Screening and Assessments
Lab tests
Patient education
Screening and assessments that should occur in the first prenatal appointment
Health history and determining due date
Medications or supplements taken by the patient
Psychological response to the pregnancy
Assessing for risk of genetic traits
Lab tests for first prenatal appointment
Blood type
Testing for HIV, gonorrhea, and chlamydia
Patient education for first prenatal appointment
Health promotion
Signs and symptoms to report to provider
What is naegele’s rule?
First day of last menstrual period - 3 months + 7 days +1 year
Ex; First day of last menstrual period: September 12, 2022
Subtract 3 months: June 12, 2022
Add 7 days: June 19, 2022
Add 1 year: June 19, 2023
Estimated date of delivery: June 19, 2023
EDD
Calculation of estimated or expected date of delivery (EDD/ birth
(EDB)/confinement ( EDC)
What is an ultrasound used for (having to do with dates)
Use ultrasound to estimate due date (EDD) when last menstrual period date is unclear.
Best EDD dating – ultrasound prior to 20 weeks GA
Obstetric History includes:
Gravidity (G):
Parity (P):
Obstetric History: Gravidity (G)
Gravidity (G): number of pregnancies in a lifetime
Obstetric History: Primigravida
- first pregnancy
Obstetric History: Multigravida-
second pregnancy, etc.
Obstetric History: Parity
Parity (P): number of births (not the number of fetuses, e.g., twins) carried past 20 weeks of gestation
Obstetric History: Primipara
Primipara: one birth after a pregnancy of at least 20 weeks (“primip”)
Obstetric History: Multipara
Multipara: two or more pregnancies resulting in viable offspring (“multip”)
Obstetric History: Nullipara
Nullipara: para 0
GTPAL
GTPAL – Gravida/Para (Term, Preterm, Abortions, Living)
GTPAL: Term
Term: The number of pregnancies that have ended at term (37 wk plus)
GTPAL: Preterm
Preterm: The number of pregnancies that have ended preterm (20-37 weeks)
GTPAL: Abortion
Abortion: THe number of pregnancies that end by spontaneous or elective abortion before 20 weeks.
GTPAL: Living
The number of living children
What should you discuss that are factors that might influence the women’s expectation of child-bearing experience?
Discuss any religious, cultural or socioeconomic factors that might influence the woman’s expectations of the childbearing experience.
Psychologically: How does the woman seem about the pregnancy? Support systems, any fears or concerns on the part of the client?
Assess for risk of genetic risks
Slide 42 if you have time
You probably don’t
In addition to regularly scheduled appointments, patients should be evaluated for the following:
Leakage of fluid from the vagina
Vaginal bleeding
Reduced fetal activity
Headache that does not improve with acetaminophen
Right upper quadrant pain
Vision changes
Persistent contractions
New-onset lower back pain
Menstrual like cramps
Dysuria
Standard Schedule of Routine Fetal Assessments for Low-Risk Pregnancies:
First trimester- Screening for trisomies
Blood tests (12 wk)
Ultrasounds (11-13 wk)
Two blood tests done for screening trisomies
- Pregnancy-associated plasma protein: Low is abnormal
- hCG: high is abnormal
What does ultrasound do for screening of trisomies?
Nuchal translucency (measurement by ultrasound of the space at the back of the fetal neck):
Thick is abnormal
Rest of slide 45
no time
Types of Spontaneous Abortion/Miscarriage
- Inevitable
- Missed
- Septic
- Incomplete
- Threatened
Types of Spontaneous Abortion/Miscarriage: Inevitable
Patient experiences vaginal bleeding and cramping; cervix is dilated
Types of Spontaneous Abortion/Miscarriage: Missed
Missed- Pregnancy is no longer viable; but no cervical dilation, cramping, or bleeding is present
Types of Spontaneous Abortion/Miscarriage: Septic
Any spontaneous abortion that occurs with intrauterine infection
Types of Spontaneous Abortion/Miscarriage: Incomplete
Incomplete- Patient has experienced vaginal bleeding, cramping, and cervical dilation but not all products of conception expelled.
Will need a D and C
Types of Spontaneous Abortion/Miscarriage: Threatened
Patient experiences vaginal bleeding but cervix is not dilated. Viable
If a patient is RH negative and experience a miscarriage, but may have been exposed to RH positive blood of the fetus, what should the provider administer? Why?
After her miscarriage, the provider administers Rho (D) immune globulin (RhoGAM) to prevent her from developing antibodies.
Why should you not want antibodies of the opposite RH?
If she made antibodies, a future pregnancy could be affected (hemolysis of RBCs of Rh+ fetus).
In a physical examination, what is included with the pelvic examination?
Pelvic examination -Examination of external and internal genitalia
What are the types of pelvic shapes?
Pelvic shape: gynecoid, android, anthropoid, platypelloid; pelvic measurements
Tests of Fetal Well-Being
- Ultrasound
- Amniocentesis
- Nonstress test
- Contraction Stress Test
- Fetal kick count
Tests of Fetal Well-Being: Ultrasound include
Transvaginal - first trimester
Abdominal- once uterus rises out of pelvis (after 10-12 weeks)
Tests of Fetal Well-Being: When is amniocentesis done?
2nd trimester
Tests of Fetal Well-Being: Nonstress test
Reactive v nonreactive
Tests of Fetal Well-Being: Nonstress test- when are they done?
More frequently in high risk pregnancies
Tests of Fetal Well-Being: Contraction Stress Test (CST)
Not used as much, must stimulate contractions
Tests of Fetal Well-Being: Fetal Kick Count
> 10 fetal movements (kicks) in 2 hours
Level I Basic US
Calculate gestational age (crown –rump length - CRL)
Detect gestational sac (5 weeks after LMP)
Identify number of fetuses
Document fetus alive
Detect gross fetal structural anomalies
Determine fetal position
Locate the placenta
Estimate amniotic fluid volume
Evaluate maternal pelvic masses
Level II US
Evaluates gestational age
Measure fetal growth
Perform specific examinations of the brain, heart, kidney, and cord insertion
Quantify amniotic fluid volume
Determine placental location
Performed after 18 weeks
Prenatal Diagnostic Studies: Amniotic Fluid
Slide 52
What are Chromosomal Abnormalities? Types of chromosomal abnormalities?
Abnormalities of chromosome number
Abnormalities of chromosome structure (Treaher – Collins, Fragile X)
Monosomies; trisomies
Polyploidy-more than two complete sets of chromosomes.
Abnormalities of chromosome structure (Treaher – Collins, Fragile X) occur why?
Deletions
Inversions
Translocations
Sex chromosome abnormalities?
Turner syndrome (45X)
Klinefelter syndrome (47XXY)
Screening Recommendations for Congenital Defects?- What defects to screen for?
Cystic fibrosis
Tay-Sachs disease
Sickle cell anemia
Alpha and beta thalassemia
Blood and ultrasound screening for trisomies between 11 and 13 weeks (recommended for all women)
Additional blood screening ideally between 15 - 16 weeks for trisomy 21, trisomy 18, and neural tube defects such as spina bifida (recommended for all women)
Recommended Weight Gain in Pregnancy: In pregnancy, women with a normal BMI (18.6-24.9) should gain how much weight?
Normal BMI (18.6–24.9) should gain 25–35 lb.
Recommended Weight Gain in Pregnancy: In pregnancy, women with a underweight BMI (<18.5) should gain how much weight?
Underweight BMI (<18.5) should gain 28–40 lb.
Recommended Weight Gain in Pregnancy: In pregnancy, women with a overweight BMI (25–29.9) should gain how much weight?
Overweight BMI (25–29.9) should gain 15–25 lb.
Recommended Weight Gain in Pregnancy: In pregnancy, women with a obese BMI (≥ 30) should gain how much weight?
Obese BMI (≥ 30) should gain 12 lb or less.
By trimester, women should gain:
1–5 lb in the first trimester.
1 lb/week in the second and third trimesters.
Leopold’s Maneuvers: When is the fetal heartbeat best monitored?
The fetal heartbeat is best monitored when the transducer is placed over the fetal back.
Leopold’s Maneuvers
The nurse palpates the woman’s abdomen to determine the fetal position, presentation and engagement
Preparing for Birth
Childbirth Classes
Birth Plans
Pain Management
Breathing and relaxation techniques
Pharmacologic v. non – pharmacologic techniques
Support Person(s)
Partner, family member, doula
Feeding Plan for Infant
Breastfeeding v. bottle feeding
Contraceptive Plan
