Prenatal Care and Normal Pregnancy Flashcards
During pregnancy, this organ system has the earliest and most dramatic changes
Cardiovascular
Marked increase in cardiac output during pregnancy up to what percentage range?
30-50%
Increase in total body oxygen consumption during pregnancy by what percentage?
20% more than non-pregnancy state
What amount of a mother’s CO is going through the uterus at term which also makes the risk for post partum hemorrhage significant?
1/5 of CO goes through uterus at term
What is the primary fuel for the placenta and fetus?
Glucose
Pregnant patients are considered hypercoagulable because the mother’s blood volume increases by what percentage by term?
35%
The mother needs what extra amount of iron in a normal pregnancy?
1000mg iron
Pubic symphysis separates at about what week(s)?
28-30 weeks
Determined by the presenting fetal part in the birth canal in relation to the ischial spines halfway between the pelvic inlet and outlet
Fetal Station
What are the two most common causes of overestimation in the amount of descent of fetus?
Molding – fetal cranial bones alternate their relationship
Caput succedaneum – edema of the fetal scalp from pressure on fetal head by cervix (swelling)
What are the types of fetal lie?
Cephalic – 95% of cases
Occipitoposterior position
Compound positions
Mentum anterior face presentation
Breech
fundic
Fetus body in relation to mom is called what?
fetal lie
What is the most common type of fetal lie?
Cephalic
What type of fetal lie is described below?
95% of cases
Three subtypes
Cephalic
What type of fetal lie is described below?
Associated with longer labors
Occipitoposterior Position
What type of fetal lie is described below?
One or more limbs prolapse alongside presenting part
C-section needed
Compound Positions
What are the three subtypes of the cephalic fetal lie?
Vertex/Occiput (Most common - we WANT this!)
Brow
Face
Which subtype of the cephalic fetal lie is the most common and the presentation we want?
Vertex/Occiput
What type of fetal lie is described below?
Chin towards mom’s abdomen
Need C-section
Mentum Anterior Face Presenation
What type of fetal lie is described below?
Troublesome presentation with three types
Breech
What is the most common type of breech presentation?
Frank Breech
What are the three types of the cephalic fetal lie?
Frank Breech 65%
Complete Breech 10%
Incomplete Breech 25%
Which type of multiple gestation is described below?
Division of fertilized ovum
Monozygotic
Which type of multiple gestation is described below?
Two separate ova are fertilized
Dizygotic
With each additional fetus, the length of gestation decreases by approximately how many weeks?
2-3 weeks
Increased perinatal morbidity is how much greater in multiple gestations than a single birth?
3-4x greater than single
What is the most significant cause of morbidity in multiple gestations?
preterm labor and delivery
Spontaneous abortions and congenital abnormalities is how much greater in multiple gestations than a single birth?
2x as common
List some risk factors for multiple gestations?
IUGR
Hydramnios
Preeclampsia
Post partum hemorrhage
Placental abruption
Congenital anomalies
Umbilical cord accidents
Fetal demise (Increased risk of losing one or more fetuses from delivery)
Net flow from one twin to the other
AV anastomes
Donor and recipient twin
Twin-Twin Transfusion Syndrome
50% of cases
Deliver of a single fetus because of the intrauterine demise and
resorption of one embryo/fetus
Vanishing Twin Syndrome
In multiple gestations, need to get an ultrasound every how many weeks starting at 16-18 weeks?
3-4 weeks
What laboratory test can aid in predicting preterm labor?
Fetal fibronectin
What are some risks/complications of the mother of multiple gestations?
Prolapsed umbilical cord (Risk of multiple gestations)
Uterine atony - Overdistended uterus, Higher risk for postpartum
hemorrhage
What stage of labor is described below?
Onset of labor to full dilation (10cm)
Latent: 6 hours
Active: 3-7 hours
First stage
What stage of labor is described below?
complete dilation until fetal delivery
Greatest rate of descent
Pushing can begin
Two hours
Second stage
What stage of labor is described below?
delivery of fetus to delivery of placenta
Uterus rises in abdomen, gush of blood, lengthening of umbilical cord
= placenta has separated from uterus
5-30 minutes
Third stage
What stage of labor is described below?
delivery of placenta until 2 hours post partum
Time when patient undergoes significant physiological adjustment
Likelihood of serious complications is at it’s greatest
Fourth stage
What type of contraction is described below?
Over the fundus/fundal location
About 1min lasting
Radiate to lower back and lower abdomen
Become increasingly intense and frequent – not relieved by anything
During contraction, uterus not easily indented
True Contractions
What type of contraction is described below?
False labor
Irregular, short lasting
Not associated with dilation of the cervix
Discomfort characterized as over the lower abdomen and groin areas
May resolve with ambulation, hydration, or analgesia (true contractions won’t be relieved)
Can indent the uterus
Braxton Hicks
When should a patient in labor go to the hospital?
Contractions 5 minutes apart for one hour
Broken bag of water
Blood-tinged mucus as the cervix begins to efface
Cervix often significantly effaced before onset of labor especially in
nulliparous women
“Bloody show”
Occurs in late pregnancy
Shape of abdomen changes and baby feels lighter because the
head has descended into the pelvis (lower abdomen is more
prominent)
Increased frequency of having to urinate due to baby head
“Lightening”
These maneuvers helps determine fetal lie, presentation, and position
Leopold’s Manuevers
Baby obstructs venous return 🡪 decreases cardiac output 🡪 leads to
hypotension
Preferred position – dorsal lithotomy position used instead
Supine Hypotensive Syndrome
Most common major operation performed in US
C- Section
What are some indications for a C-section?
Hemorrhage from placental previa
Abrupto placentae
Prolapse of the umbilical cord
Uterine rupture
It is not recommended to perform a C-section before how many weeks?
39 weeks
Having a C-section puts the patient at higher risk for what complication?
Higher risk for endometritis
Assess newborn’s condition
Scores assigned at 1 minute and 5 minutes
Assess every 5 minutes until 20 minutes if scores are less than 7
Should not be used to define birth asphyxia
NOT used to predict neonatal outcomes (ex: neuro)
APGAR Scoring
The APGAR scoring of 7-10 is indicative of what?
great, no active resuscitation
The APGAR scoring of 4-6 is indicative of what?
mild to moderate depressed infant
The APGAR scoring of less than 4 is indicative of what?
poor, severely depressed and requires immediate resuscitative efforts
