Pregnancy I Flashcards
What is the function of the Skene duct?
Lubrication and antimicrobial properties
What happens to the Bartholin duct opening during arousal?
It swells
Where is the perineum located?
Between vagina and anus
When might the perineum need to be cut or tear?
During labor
What is the fundus?
Hollow organ farthest from cervix
What is the function of the cervix?
Helps keep the baby in the uterus
What is the size of the cervix?
About 2-3 cm
How does the cervix feel under normal conditions?
Elasticity of nose
Describe the external os.
Round
How does the external os change after pregnancy?
Smiley face shape
Where is the uterus located?
Behind the bladder
What can happen if the bladder is too full during childbirth?
Baby can’t come down
What can happen postpartum if the bladder is too full?
Fundus cannot come back down
What are the two types of influences on childbearing?
Hereditary and Environmental
What is a genetic counselor?
A professional who provides guidance and support on genetic disorders and inherited conditions.
What are autosomal dominant traits?
Expressed by dominant gene on a non-sex chromosome
What is the chance of passing on an autosomal dominant trait to a child?
50%
Give examples of autosomal dominant traits.
Huntington’s disease, neurofibromatosis
What are autosomal recessive traits?
Expressed if a person receives two copies of a recessive gene
Name some examples of autosomal recessive diseases.
Tay-Sachs, sickle cell, cystic fibrosis, PKU
Need two carriers for the trait to be expressed in an autosomal recessive trait t/f
TRUE
What are some examples of autosomal recessive disorders?
PKU, Tay Sachs, Sickle cell
What is the chance of gene expression when both parents are carriers of an autosomal recessive trait?
1/4 or 25%
What is the chance of not having the disease when both parents are carriers?
25%
What is the chance of being a carrier for the gene when both parents are carriers?
50%
What are X-Linked traits?
Males usually affected, females carriers
Give examples of X-Linked traits.
Color blindness, Duchenne’s muscular dystrophy, hemophilia A, Turner syndrome
What are some common symptoms of Turner syndrome?
Less fertility, barrel chest, altered appearance
How is X-linked inheritance different from other types with inheritance?
Dads don’t pass it on to sons
What is a trisomy?
Extra copy of a chromosome
What is monosomy?
Missing a chromosome
What is polyploidy?
One or more extra sets of chromosomes
What are structural chromosomal abnormalities?
Missing, added, or rearranged part of a chromosome
What is a possible cause of spontaneous abortion in the first trimester?
Polyploidy
Which gender is fragile X syndrome more commonly seen in?
Males
What is an example of Monosomy?
Turner syndrome
What is an example of a structural abnormality?
Fragile X syndrome
Substances that can cause abnormalities in fetal development
teratogens
What are the effects of teratogens in embryonic development?
Abnormalities in organ development, growth, and function
What can teratogens lead to?
Birth defects or developmental disabilities
When do teratogens have the most impact?
During the first trimester of pregnancy
Name three examples of teratogens mentioned in the text.
Psych meds, alcohol, tobacco
What are some teratogens that can influence the environment?
Alcohol, Aminoglycosides, Anticonvulsant agents, Antihyperlipidemic agents (statins), Antineoplastic agents, Antithyroid drugs, Cocaine, Diethylstilbestrol (DES), Folic acid antagonists, Lithium, Mercury, Retinoic acid, Tetracycline, Tobacco, Warfarin
What are some infections that can influence the environment as teratogens?
Cytomegalovirus, Herpes simplex virus, HIV, Parvo, Rubella, Syphilis, Toxoplasmosis, Varicella, Zika
What should you do if someone has chicken pox?
Keep them away from babies less than 1 year and pregnant moms.
What is one role of the nurse in genetic counseling?
Recognize need for genetic counseling and gather medical history. provide education & emotional support.
What should you consider when talking to moms?
Family history, medical history, risk factors (teratogens)
Why are hot tubs bad for babies and what is the limit?
Too much heat can be bad, no more than 10 minutes for sure, preferably not at all though.
What should all pregnant women take?
Folic acid
What is the process of fertilization?
Sperm and ovum unite to form a zygote.
What is the lining of the uterus called during pregnancy?
Decidua.
What hormone is secreted by the zygote?
hCG.
What can occur around week 2 of pregnancy after implantation?
Spotting.
What is the process of implantation?
Zygote enters uterus and implants in the fundus in the uterus
What happens during the preembryonic period? and how long does it last?
Inner part of zygote develops into fetus and outer part develops into the placenta. two weeks.
What hormone stimulates estrogen and progesterone and protects pregnancy?
HcG. will protect the pregnancy until the placenta takes over in a few weeks.
What can implantation cause?
Spotting or small bleeding, which can be confused for a light period —they think theyre not pregnant
What happens during the embryonic period?
Development of the central nervous system (CNS)
What happens during week 3 of the embryonic period?
CNS develops
What happens during week 4 of the embryonic period?
Neural tube closes
What happens during week 5 of the embryonic period?
Heart begins to beat
What is the importance of folic acid?
Prevents spina bifida
When does the heartbeat begin?
5th week
What happens during Week 6 of the embryonic period?
Upper and lower extremities are defined
What happens during Week 7 of the embryonic period?
Face more human looking
What happens during Week 8 of the embryonic period?
Well-defined fingers & toes, external genitalia begins to differentiate
At what week does external genitalia begin to differentiate?
Week 8
What happens during the fetal period?
Fetal movements, urine production, gender determination
What happens during weeks 9-12 of the fetal period?
Fetal movements, urine production, gender determination
What happens during weeks 13-16 of the fetal period?
Rapid body growth
What happens during weeks 17-20 of the fetal period?
Increased fluttering movements, development of eyebrows, head hair, lanugo, and vernix
When does the first trimester end?
12th week
At what week does the baby close its eyes?
9 weeks
When will the baby open its eyes again?
26 weeks
What happens during weeks 21-24 of the fetal period?
Little subcut fat, red and translucent skin, surfactant barely produced, can survive - ICU babies
What happens during weeks 25-28 of the fetal period?
Plumper, eyes open, rotates to head down position
What happens during weeks 29-32 of the fetal period?
Toenails & fingernails & skin pigmentation
What happens during weeks 33-38 of the fetal period?
Mainly gaining weight
How does the fetus look during weeks 33-38 of the fetal period?
More plumper with abundant subcutaneous fat
What is fertilization age?
Not really used in practice
How is gestational age determined?
By last menstrual period
What is the typical range for gestational age?
38-42 weeks
What is the key function of the placenta?
Respiration
Describe the fetal side of the placenta.
Smooth
Describe the maternal side of the placenta.
Rough where it attaches to uterus
What is the composition of the umbilical cord?
2 arteries & 1 vein (AVA)
What do the arteries in the umbilical cord carry?
Deoxygenated blood & waste products
What does the vein in the umbilical cord return?
Oxygenated blood and nutrients
What does the placenta do?
Remove waste and provide nutrients and oxygen to the baby.
Is the placenta intact when it comes out?
Yes.
How should the placenta come out?
it should come out intact
What are the two fetal membranes?
amnion and chorion
What is the function of amniotic fluid?
cushioning
temp control
prevents membranes from attaching
provides room to move
What structure surrounds the amnion?
chorion
What is oligohydramnios?
Low levels of amniotic fluid
What is hydramnios?
High levels of amniotic fluid (or polyhydramnios)
What is the ideal volume of amniotic fluid?
700-800 mL
What is the volume of oligohydramnios?
less than 400 mL
What are some possible causes of oligohydramnios?
Poor placental perfusion, fetal kidney failure
What are some potential complications of oligohydramnios?
Poor lung development, premature rupture of membranes
What is the volume of amniotic fluid in hydramnios or polyhydramnios?
Over 2000 mL
What condition is associated with uncontrolled diabetes in the mother?
Polyhydramnios
What are some possible complications of polyhydramnios?
Malformation of CNS, Cardiovascular system issues, GI tract issues
What are presumptive indicators?
amenorrhea
n/v
fatigue
urinary frequency
What is amenorrhea?
Absence of menstruation
What is the prevalence of nausea and vomiting in pregnancy?
60-80% in 1st trimester but 45% in 3rd trimester
What are the least reliable indicators?
presumptive indicators
What are subjective changes that can indicate pregnancy?
breast changes, hyperpigmentation, fetal movement, N/V, fatigue, fetal mvmt, urinary frequency
What are breast changes that can indicate pregnancy?
Enlargement and tenderness.
What is hyperpigmentation and how can it indicate pregnancy?
Darkening of the skin, particularly around the nipples and genital area.
What is Chadwick’s sign?
Blue colored cervix, vagina, and vulva
What is Goodell’s sign?
Softening of the cervix
What is Hegar’s sign?
Ability to fold the body of the uterus
What does a pregnancy test check for?
hCG
What can cause a false negative in a pregnancy test? and how can you help prevent it?
Dilute urine, take sample first thing in the morning
What can cause a false positive in a pregnancy test?
Tumor, blood or protein in urine, certain medications (Parkinson’s or anticonvulsants)
What is ballottement? what can cause a false one?
provider taps cervix, Baby floats up in the cervix and then comes down. a tumor could also do this.
What is Braxton Hicks? What can cause a false one?
contractions, False contractions caused by intestinal gas
What is palpation of fetal outline?
Feeling the shape of the baby through the abdomen
What is uterine soufflé?
Hearing the flow in the uterus matching the mom’s heartbeat
What are some positive indicators during pregnancy?
Auscultation of fetal heart sounds, fetal movements detected by examiner, visualization of fetus
What are the landmarks for uterine growth?
12 weeks: above symphysis pubis, 16 weeks: midway symphysis pubis & umbilicus, 20 weeks: umbilicus, 36 weeks: xiphoid process
What happens during ‘lightening’?
Baby flips and head comes down
What are Braxton Hicks contractions?
Practice contractions that are not effective in delivering the baby, felt in the third trimester mostly
When should a pregnant woman go to the doctor regarding Braxton Hicks contractions?
If she has 5-6 in an hour
What is Chadwick’s sign?
bluish color
What is Goodell’s sign?
softening of the cervix because of hormones
What is the purpose of the mucous plug?
forms a plug so no bacteria goes to the membranes
What happens when the mucous plug breaks?
can have some blood happen when it breaks bc it does have some capillaries
plug comes out and bloody show is normal and is something to expect
What causes the pH in the vagina to become acidic?
Glycogen turns to lactic acid
Why are pregnant women prone to fungal infections?
Changes in pH
What stops during pregnancy?
ovulation stops
What is the role of progesterone during pregnancy? aka hormone of pregnancy””
Prevents tissue rejection and suppresses contractions. prevents miscarriage.
What stimulates the growth of mammary ductal tissue?
Estrogen
What stimulates the growth of lobes, lobules, and alveoli?
Progesterone
What do the Tubercles of Montgomery do?
help to lubricate nipple
Is breastfeeding allowed during pregnancy?
Yes, if there are no risk factors.
What happens to the heart during pregnancy?
Heart is pushed upward and to the left
What might be heard when listening to the heart during pregnancy?
Systolic murmur, this is alright
What happens to plasma volume during pregnancy?
Plasma volume increases
How does the increase in plasma volume affect blood thickness?
Blood is less thick, which helps prevent clots
What happens to RBC, HGB, and HCT levels during pregnancy?
Dilution of RBC, ↓ HGB/HCT
What term is used to describe the decrease in RBC, HGB, and HCT levels during pregnancy?
Pseudoanemia of pregnancy
What type of anemia may occur due to iron deficiency during pregnancy?
Iron deficiency anemia
When hemoglobin less than 11 during pregnancy during what stage is it actually anemia?
first and third trimester.
What is the threshold for hemoglobin levels in the second trimester?
Less than 10.5 -indicates iron deficiency anemia.
What type of anemia is present if the hemoglobin is less than 10.5 during the second trimester?
Iron deficiency anemia
How do you treat both types of anemia?
Iron supplements
What are the cardiovascular changes during pregnancy?
Increased cardiac output, decreased systemic vascular resistance, slight decrease in diastolic pressure
What is supine hypotensive syndrome?
Slight decrease of diastolic pressure when lying on back
What is the best position for side laying?
Left side
How can you remove pressure on the aorta while side laying?
Raise one of the hips with a pillow
What happens to clotting factors in the blood?
They increase
What happens to fibrinolytic activity in the blood?
It decreases
What is the function of fibrinolytic activity?
To protect from hemorrhage and increase the chance of blood clots
What happens to leukocytes in the blood?
They increase
What happens to erythrocytes in the blood?
They increase
Why is more iron needed?
To support increased erythrocyte production
What are the respiratory changes?
Oxygen consumption ↑
What happens to tidal volume?
Tidal volume ↑
Which hormones are involved in increased tidal volume and respiratory changes?
Progesterone, Estrogen
What does estrogen do to muscles?
Relaxes muscles
How does estrogen affect breathing?
Allows deeper breathing
What does estrogen do to vascularity?
Increases vascularity
What can increased vascularity in the face cause?
Nose bleeds, congestion, fullness in the ears
What happens to the voice due to estrogen?
Lowered voice
What are epulis? this happens during pregnancy
Growths that happen in gum from extra estrogen
What is ptyalism? this happens during preganacy
Excessive salivation
What is pyrosis? happens during preganacy.
Reflux due to relaxation of the sphincter. estrogen causes the relaxation.
How does pregnancy affect the tone and motility of the GI tract?
Slows down
What happens to the gallbladder during pregnancy?
Bile becomes thicker and more prone to gall stones
What is pruritis?
Itching caused by retained bile salts
What is stress incontinence?
Involuntary urine leakage during activities that increase abdominal pressure
What is nocturia and how does it affect pregnancy?
Increased need to urinate at night.
Why do some people experience nocturia?
Due to water and sodium retention during the day
What happens to the ureters?
They can become somewhat compressed
What can happen due to compressed ureters?
Increased risk of urinary tract infection or pyelonephritis
What causes hyperpigmentation?
Estrogen
Name two integumentary changes during pregnancy.
Angiomas and palmar erythema
What are striae gravidarum?
Stretch marks
What is melasma also known as?
Mask of pregnancy
What is a musculoskeletal change that can occur during pregnancy?
Waddling gait
What is the term for an excessive inward curve of the lower back?
Lordosis
What is diastasis recti?
Separation of abdominal muscles. sometimes they go back and sometimes they dont, might need surgery if it doesn’t resolve post partum
what can happen to blood glucose?
hypoglycemia possible between meals and at night.
What is the role of hCS in pregnancy?
allowing for more glucose to be available to baby
What does relaxin do?
helps inhibit urine activity, soften cervix, and relax joints in pelvis
What is a potential endocrine change during pregnancy related to glucose?
hypoglycemia between meals and at night
What is the goal of weight gain during pregnancy if the person has a normal BMI?
25-35 pounds
What makes up less than half of the recommended weight gain during pregnancy?
Fetus, placenta, and amniotic fluid
What is dependent edema?
Swelling due to fluid retention
What are some common feelings during the first trimester?
Uncertainty, ambivalence, unstable moods
What is one of the concerns during the first trimester?
How to cope with life and other family
What is the focus on during the first trimester?
Self
What is the primary focus during the second trimester?
Fetus
What are two psychological characteristics during the second trimester?
Narcissism, introversion
What is a common concern during the second trimester?
Body image
What may experience changes during the second trimester?
Sexuality
What are some common experiences during the third trimester?
Vulnerability, increasing dependence, trouble concentrating, preparation for birth
What are some common nightmares during the third trimester?
Deformity or harm
What does a pregnant person typically want during the third trimester?
Their partner close
What is a common behavior in the third trimester?
Nesting
What are some behaviors associated with maternal role taking?
Mimicry, role play, fantasy
What is mimicry in maternal role taking?
Mimicking behaviors, waddle gait, or posture
What is role play in maternal role taking?
Seeking holding or caring for infants
What is fantasy in maternal role taking?
Imagining what the baby might look like, having fearful fantasies
What is the search for role fit in maternal role taking?
Comparing oneself to other mothers to find a suitable role
What is grief work in maternal role taking?
Coming to terms with the loss of one’s former self
What is couvade?
the dad will take on the moms symptoms of pregnancy.
What are some symptoms experienced by dads during couvade?
Fatigue, cravings, weight gain
What are some potential effects of couvade?
Insomnia, restlessness, irritability
What is a major factor in emotional response for grandparents?
Age
What is the importance of the number and spacing of other grandchildren for grandparents?
It affects their response
What is the biggest focus for an IVF coordinator?
having empathy and making patients feel supported
What is the purpose of the IVF class?
to inform patients of expectations and provide standardized information
What do testosterone and anabolic steroids do to sperm count?
decrease it
When should someone start birth control in the IVF process?
on day 3 of their cycle
What is the purpose of starting antibiotics for spouses in IVF?
to prevent bacterial contamination when the egg is present
What drug is used to suppress ovulation in IVF?
Lupron
What is the most important check during the suppression phase of IVF?
suppression check, ensuring estrogen is as low as possible
What happens during the endometrial support phase of IVF?
progesterone is taken daily until week 10 of pregnancy
What does ICSI stand for in IVF?
intracytoplasmic sperm injection
What are some risks associated with IVF?
hyperstimulation syndrome, multiple pregnancy, miscarriage, ectopic pregnancy, infection, anesthesia risks, blood loss
