Prenatal Flashcards
Review stages of pregnancy, signs of pregnancy, physical and psychological changes, prenatal tests, and complications.
1
Q
How many weeks is the first trimester of pregnancy?
A
Week 1 to week 13.
2
Q
At how many weeks is the second trimester of pregnancy?
A
Week 14 to week 27.
3
Q
At how many weeks is the third trimester of pregnancy?
A
Week 28 to week 40.
4
Q
At what week of gestation can the sex of the fetus be determined?
A
At week 12 by ultrasound.
5
Q
What is the normal 1st trimester fetal heart rate?
A
160 - 170 beats per minute
6
Q
What is the normal heart rate of a fetus by the end of the 3rd trimester?
A
110 - 160 beats per minute
7
Q
What are some risk factors for a difficult pregnancy or loss of the fetus?
A
- age: <20 years old or >35 years old
- obesity
- abuse and violence
- diabetes or cardiac disorders
- drugs/smoking/alcohol
- medications
8
Q
How often are prenatal visits?
A
- every 4 weeks from confirmation of pregnancy until end of 2nd trimester
- every 3 weeks from 28 to 36 weeks (starting at 3rd trimester)
- then weekly until delivery
9
Q
What are the general assessments for every prenatal visit?
A
-
pregnant woman assessment:
- blood pressure
- weight
- urine screening for proteins (pre-eclampsia)
-
fetus assessment:
- fundal height (of woman)
- fetal ultrasound for heart tones and growth
10
Q
What is Nagele’s rule?
A
Calculating the due date of the baby:
- due date = + 9 months + 7 days (adjust the year) from the date of when the last period started
11
Q
Define:
Gravida and Para
A
- Gravida: the number of total pregnancies (including present one)
- Para: the number of births after 20 weeks
12
Q
What does GTPAL stand for?
A
- Gravida: number of pregnancies
- Term: births after 37 weeks
- Preterm: births before 37 weeks
- Abortions (miscarriages)
- Living children
13
Q
What is a presumptive sign of pregnancy?
A
- quickening (feeling movement of fetus)
- nausea/vomiting
- sore breasts
- missed period
14
Q
What is a probable sign of pregnancy?
A
A pregnancy test that comes back positive and the signs detected by the HCP such as:
- Heger’s sign
- Goodell’s sign
- Chadwick’s sign
15
Q
What is Heger’s sign?
A
A probable sign of pregnancy when the lower part of uterus starts to get soft at about week 6.
16
Q
What is Goodell’s sign?
A
A probable sign of pregnancy when there is softening of the cervix at about week 9.
17
Q
What is Chadwick’s sign?
A
A probable sign of pregnancy when the cervix turns a bluish-purple color at about week 6.
18
Q
What is ballottement?
A
A probable sign of pregnancy of when the fetus rebounds when the HCP presses on the uterus.
19
Q
What are Braxton-hick contractions?
A
A probable sign of pregnancy of irregular contractions.
20
Q
What hormone indicates a positive pregnancy test?
A
Human chorionic gonadotropin (HCG) indicates a positive pregnancy test (which is a probable sign of pregnancy).
HCG can be detected in urine in as early as 8 days after conception.
21
Q
What is a positive sign of pregnancy?
A
- fetal heart rate is detected by doppler and fetoscope
- HCP can feel the fetus move on palpation
- fetus is seen on ultrasound
22
Q
What is the fundal height?
A
A measurement from the top of the fundus to the symphysis pubis as measured in centimeters.
It estimates the gestational age.
23
Q
Complete the sentence:
After week 18, the fundal height in centimeters = number of ______ pregnant.
A
After week 18, the fundal height in centimeters = number of weeks pregnant.
24
Q
The fundal height and gestational age of fetus can be off by how many centimeters?
A
Fundal height and gestational age can be off by plus or minus 2 centimeters.
Ex: a fundal height of 20 cm can indicate that the fetus is somewhere between 18 and 22 weeks old.
25
What are the **physical and psychological changes** in pregnancy caused by?
**Hormones**.
26
What **cardiovascular changes** does a pregnant woman go through?
* lower than normal hemoglobin and hematocrit
* heart rate increases
* blood pressure changes
## Footnote
Changes are due to increased blood volume.
27
What hemoglobin and hematocrit levels is considered **anemia** in a pregnant client?
* Hemoglobin: **\< 10**
* Hematocrit: **\< 30%**
## Footnote
Pregnant clients have a slightly lower hemoglobin and hematocrit due to increased fluid volume.
28
How **high** does the heart rate of the pregnant woman increase due to increased blood volume during pregnancy?
Increases 10-15 beats per minute from the baseline.
## Footnote
Ex: if the heart rate is normally 60 bpm, it will increase to 70-75 bpm
29
What are the **blood pressure changes** of a pregnant woman?
* blood pressure ↓ in 1st and 2nd trimester - *hormonal changes cause vessel dilation*
* blood pressure ↑ in 3rd trimester - *due to increased blood volume being pumped to fetus*
30
What **interventions** help relieve morning sickness for a pregnant woman?
Eat crackers and small meals.
31
What **urinary changes** occur in a pregnant woman?
* 1st trimester **increased urination** is caused by hormone changes
* 2nd trimester urinary frequency **decreases**
* 3rd trimester **increased urination** is caused by increased pressure of fetus on bladder
32
What is **linea nigra** during pregnancy?
A **dark line** down the middle of the abdomen.
33
What is **chloasma** during pregnancy?
The "mask of pregnancy": **brown spots on the face.**
34
What are the typical **psychological changes** that occur to the woman when she finds out she is pregnant?
* ambivalent, excited or scared
* very emotional
## Footnote
Antidepressants are generally safe during pregnancy.
35
What is the **recommended weight gain** for a pregnant woman for the entire pregnancy?
**25 - 35 pounds** (11 - 16 kg)
36
What is the recommended **weight gain during the first trimester** of pregnancy?
**3 - 5 pounds** (1.4 - 2.3 kg)
37
What is the recommended **weight gain during the 2nd and 3rd trimesters** of pregnancy?
**1 pound per week** (0.5 kg per week)
38
How many **extra calories per day** are recommended during pregnancy?
About an **extra 300 calories**.
39
How many **extra calories per day are recommended while breastfeeding**?
An **extra 200-500 calories**.
40
What **vitamin supplements** are commonly prescribed to pregnant clients?
* **folic acid** - to prevent neural tube defects
* **iron** - to prevent anemia due to increased blood plasma
41
# Classification and indication:
**Rho D immune globulin**
* given to Rh-negative moms to prevent blood incompatibility between mom and baby's blood
* given after miscarriage or abortion to prevent Rh antibody formation
* given after birth to moms that give birth to a Rh-positive baby
42
What vaccinations are **contraindicated during pregnancy** or when planning to become pregnant?
**Do not** give measles, mumps, rubella (MMR) and varicella vaccines.
## Footnote
Vaccine can harm fetus.
43
What could **glucose** in the urine of a pregnant client indicate?
**Diabetes mellitus.**
44
What does **protein** in the urine of a pregnant client indicate?
**Infection or pre-eclampsia**.
45
What is a **fetal ultrasound**?
**A picture of the fetus**. It includes information such as:
* gestational age
* breathing
* movements
* tone
* amniotic fluid volume
46
What will the pregnant client need to **prepare** for a fetal ultrasound?
**Drink 2 glasses of water one hour before the ultrasound** in order to see the fetus and structures better.
47
What is a **biophysical profile**?
A non-invasive test that **checks the fetus**. It includes:
* ultrasound
* non-stress test
48
What is a **nonstress test**?
A non-invasive test of the fetus to **check fetal heart rate patterns** with an external monitor.
## Footnote
The pregnant client lies down with two belts around her waist. One belt measures the fetal heartbeat and the other measures contractions. It takes about 20 minutes.
49
What is a **reactive** nonstress test?
A **normal** finding and that the fetal heart rate went up normally. It indicates that the fetal heart rate is "reassuring":
* fetal heart rate increases at least **15 beats per minute** over the baseline (between 120 and 160 beats per minute)
* The increase in heart rate lasts at least **15 seconds** within a 20-minute timeframe
50
What is a **NON-reactive** nonstress test?
An **abnormal** finding and that the fetal heart rate did not increase enough. It indicates more testing is needed.
## Footnote
It can also indicate that the fetus was sleeping.
51
What is an **amniocentesis**?
It tests the amniotic fluid for **genetic disorders and fetal lung maturity.**
## Footnote
A needle is used to aspirate a small amount of amniotic fluid through the pregnant client's abdomen guided by ultrasound.
52
What are the **interventions** before and after an amniocentesis?
1. **before procedure** - get informed consent
2. **after procedure** - assess for signs of complications
* bleeding, infection, decreased fetal movement, and cramping
53
What is **quickening** in pregnancy?
The moment when the pregnant woman **starts to feel or perceive fetal movements in the uterus**.
## Footnote
It usually occurs between week 15 and 25. About 50% of women don't feel anything until after 24 weeks gestation.
54
What is a **kick count test**?
When the pregnant client **counts the number of kicks** by the fetus in a 2-hour period.
## Footnote
Notify the HCP if there are \< 10 kicks in two consecutive 2-hour periods.
55
What is a **fern test**?
Identifies the presence of an **amniotic fluid leak.**
## Footnote
It will make a fernlike pattern on a microscopic slide.
56
What is a **nitrazine test**?
Identifies the presence of **amniotic fluid** in vaginal secretions by putting a drop of fluid on a paper strip.
## Footnote
It will turn the paper blue if there is amniotic fluid.
57
What is a **contraction stress test**?
Performed at the end of pregnancy to determine how well the **fetus will cope with the contractions** of childbirth.
## Footnote
Contractions are induced by administering oxytocin (or nipple stimulation) and the contractions and heart rate of the fetus is recorded.
58
What is a **positive** contraction stress test?
| (Immediate complication)
Indicates a **bad finding** and that late decelerations of the fetal heart rate were noted.
## Footnote
Late decelerations are never a good finding.
59
What is a **negative** contraction stress test?
Indicates a **good finding** and that no late decelerations of the fetal heart rate were noted.
60
If a client is bleeding from a miscarriage or abortion, how many saturated pads are considered **hemorrhage**?
| (Immediate complication)
* \> 1 saturated pad/hour
* one pad that gets saturated within 15 minutes
61
What are the **insulin needs** for a pregnant client with diabetes mellitus?
During 2nd and 3rd trimester, pregnant **client needs more insulin**.
## Footnote
The hormones in the placenta block insulin.
62
# Describe:
**Disseminated intravascular coagulation** (DIC) during pregnancy
| (Immediate complication)
A serious **bleeding and clotting complication** in a pregnant client with eclampsia, placenta abruption, a dead fetus, placenta retention, or infection.
## Footnote
The clotting factors are becoming over or underactivated.
63
# Interventions:
**Disseminated intravascular coagulation (DIC)** during pregnancy
* give oxygen
* blood transfusions if bleeding
* heparin if clotting
* monitor kidney function
## Footnote
Blood clots can damage vessels in the kidneys.
64
# Describe:
**Hyperemesis gravidarum**
When a **pregnant client has severe nausea and vomiting.**
## Footnote
This puts her at risk of fluid and electrolyte imbalances.
65
# Interventions:
**Hyperemesis gravidarum**
* give IV fluids
* monitor intake and output
* antiemetics
66
# Describe:
**Endometritis**
An **infection of the lining of the uterus** that may cause peritonitis.
67
# Medications:
**Endometritis**
Antibiotics.
68
# Describe:
**Fetal utero in death**
Fetal death that occurs at \> 20 weeks gestation.
## Footnote
Pregnant client can develop DIC if fetus is left in client for more than 3 weeks.
69
# Interventions:
**Fetal utero in death**
* appropriate cultural and religious care
* therapeutic communication
* possible touching of baby
* private room
* may be moved off maternity floor or away from any babies
70
# Describe:
**Hepatitis B**
A **viral infection** that can be transmitted to baby through blood, sputum, vaginal secretions, semen, and breast milk.
71
# Prevention:
**Hepatitis B**
* if pregnant client is positive for Hep B, clean newborn right away
* administer Hep B immune globulin and vaccination
* mom can breastfeed newborn as long as baby got vaccination
72
# Describe:
**HIV and AIDs**
A **viral infection** that can be transmitted to baby through blood, semen, vaginal secretions, or breastmilk.
## Footnote
Procedures that increase the mixing of blood increases the risk of the baby getting HIV.
73
# Prevention:
**HIV and AIDs in newborn**
* avoid internal scalp electrodes and episiotomy
* bottle feed if mom is HIV positive
* clean baby well before shots - avoid mixing of blood
* no live vaccines are given to baby (no MMR or varicella)
* antivirals
74
# Describe:
**Gestational hypertension**
**New-onset hypertension during pregnancy** after 20 weeks gestation.
75
# Describe:
**Preeclampsia**
New-onset hypertension after 20 weeks gestation and protein in the urine.
76
What are the **assessments** for gestational hypertension and preeclampsia?
* assess for headaches
* take blood pressure
* get urine sample to check for proteins
## Footnote
These are all signs of hypertension.
77
# Describe:
Eclampsia
| (Immediate complication)
The onset of **seizures** for a pregnant client with preeclampsia.
78
# Describe:
HELLP syndrome
| (Immediate complication)
A condition that can cause **severe bleeding** in a pregnant client.
## Footnote
The cause is not known but associated with gestational hypertension and preeclampsia.
79
What are the characteristic **signs and symptoms** of HELLP syndrome?
* **H:** Hemolysis
* **EL:** Elevated Liver enzymes
* **LP:** Low Platelets
## Footnote
All these findings increase the risk of bleeding in a pregnant client.
80
# Interventions:
**HELLP** syndrome
* possible bedrest
* antihypertensives and magnesium sulfate to prevent eclampsia and pre-eclampsia
81
# Describe:
"TORCH" screening
Screening the pregnant client for **infections that are highly toxic to growing fetus.**
* **T:** Toxoplasmosis
* **O:** Other infections
* **R:** Rubella (German measles)
* **C:** Cytomegalovirus
* **H:** Herpes simplex virus
82
# Teaching:
**Toxoplasmosis**
Avoid raw meat and cleaning out the kitty litter box.
## Footnote
Bacteria is in raw meat and cat feces.
83
What are the **"Other" infections** for "TORCH"?
* Group B Streptococcus
* HIV
* syphilis
* parvovirus
* hepatitis B virus
* West Nile virus
## Footnote
These are all infections that are highly toxic to growing fetus.
84
# Medications:
**TORCH infections**
Antivirals or antibiotics.
85
# Interventions:
What are the **interventions** for sexually transmitted infections during pregnancy?
* screen pregnant client for infections
* if positive, give antibiotics, antivirals, or antifungals
* have partner tested and treated
86
# Interventions:
Tuberculosis in a pregnant client
* if x-ray is needed, perform after 20 weeks gestation and use lead shield on pregnant client
* TB skin test is safe during pregnancy
* Give antituberculosis drugs during pregnancy
87
# Interventions:
**Tuberculosis** in newborn
* if skin test is positive in newborn, they will get antituberculosis drugs for at least 6 months
* if mom's sputum culture comes back negative, newborn does not need to be isolated from mom
88
# Describe:
Ectopic pregnancy
When the **embryo is fertilized outside of the uterus**, usually in the fallopian tube.
89
What are the **characteristic signs and symptoms** of an ectopic pregnancy?
* vaginal spotting that is dark red or brown
* if it ruptures, it causes increased pain that radiates to the shoulder
90
# Interventions:
Ectopic pregnancy
1. **give methotrexate** - to prevent the fetus from developing
2. **prepare for laparotomy** - to remove fetus and tube
3. **give rho D immune globulin** (if woman is Rh-negative) - helps to prevent bleeding
91
What are some **risk factors** for infertility?
* **Woman**
* maternal obesity
* maternal age \> 35
* nutritional deficiencies
* **Man**
* alcohol and drug abuse
* exposure of testes to heat (sauna use)
* endocrine disorders that decrease testosterone
92
What are **kegel exercises** for?
**Strengthening the pelvic floor muscles in preparation for birth**. They can also help prevent incontinence later in the pregnancy and postpartum life.
## Footnote
A kegel exercise is like pretending you have to urinate and then holding it. (Men can do them also to strengthen the muscles for bladder control and sexual function).
93
# Define:
primigravida
Pregnant for the first time.
94
# Define:
nullipara
Never given birth.
95
How often are doctor's appointments for a pregnant woman?
* 1st and 2nd trimester: once a month visits
* 28-35 weeks pregnant: once every 2 week visits
* 36 weeks - delivery: once a week visits
96
What are the risk factors to the unborn fetus if the woman has a low hemoglobin and hematocrit?
There is an increased risk of low birth weight, pre-term delivery or death utero.
## Footnote
Prevent a low hemoglobin and hematocrit by taking iron supplements.
96
What are the risks if a pregnant client is obese?
There is an increased risk of gestational diabetes, pre-eclampsia and/or a difficut labor.
96
# Teaching:
Obese pregnant woman
* teach to eat a healthy diet
* do not go on a "diet" during pregnancy
* keep appointments
* perform kegel exercises to increase pelvic floor strength
