Prenatal Care and Normal Pregnancy Flashcards
1
Q
normal APGAR range
A
7-10
2
Q
APGAR score is recorded at _
and _ minutes after birth
A
1 and 5
3
Q
an infant w. an APGAR score of _ to _ needs further eval and possible resuscitation
A
4-6
4
Q
what does APGAR stand for
A
appearance
pulse
grimace
activity
respiration
5
Q
normals for APGAR
A
a: 2 = active movement
p: 2 = pulse > 100
g: 2 = pulls away, sneeze
a: 2 = pink
r: 2 = crying
6
Q
apgar score > _ = good
apgar score of _ indicates resuscitation
A
6
4
7
Q
4 components of fetal position
A
size
attitude
lie
presentation
8
Q
most critical component of fetal size
A
head size
9
Q
_ disproportion is concerning for labor dystocia
A
cephalopelvic
10
Q
what is macrosomia
A
birth weight > 90th %ile for gestational age or > 4500 g
11
Q
macrosomia is associated w.
A
shoulder dystocia
birth injuries
12
Q
what is fetal attitude
A
relationship of fetal parts to one another
i wish it were how bossy/spicy/feisty your fetus is
13
Q
2 classifications of fetal attitude
A
fully flexed -> normal
not flexed
14
Q
describe full flexion
A
chin on chest
rounded back
flexed arms/legs
smallest diameter of head presents at pelvic inlet
15
Q
what is fetal lie
A
relationship of fetal cephalocaudal axis (spinal column) to maternal cephalocaudal axis
16
Q
3 types of fetal lie
A
longitudinal -> ideal
transverse
oblique
17
Q
fetal spine lies along maternal spine
A
longitudinal
18
Q
fetal spine is perpendicular to maternal spine
A
transverse
19
Q
fetal spine is at a slight angle to maternal spine
A
oblique
20
Q
what is fetal presentation
A
fetal part that enters the pelvic inlet first
21
Q
3 types of fetal presentation
A
cephalic
breech - bottom first
breech - shoulder first
22
Q
3 types of cephalic fetal presentation
A
vertex
brow
face
23
Q
mc type of cephalic presentation
A
vertex:
head completely fixed onto chest
occiput is presenting
24
Q
-fetal head partially extended
-sinciput (frontal bone) is presenting part
A
brow presentation
25
-fetal head hyperextended
-fetal face from forehead to chin is presenting part
face presentation
26
-head up
-bottom, feet, knees present first
breech
27
what are the 4 types of breech
frank
complete
incomplete
shoulder
28
hips flexed
knees extended
bottom presents
frank breech
29
hips, knees flexed
bottom presents
complete breech
30
-one/both hips not completely flexed
-feet present
incomplete breech
31
-transverse lie
-shoulders present first
shoulder breech
32
prevalence of breech birth decreases w.
increasing gestational age
33
25% of fetuses under _ weeks old are breech
28
34
dx for breech presentation
PE
US if unclear
35
tx for breech presentation
1. external cephalic version at or near term
2. followed by trial of vaginal delivery if version is successful
3. planned cesarean if persistent
36
24 yo G2P1 f in for 13 week office visit - fundal height and alpha fetoprotein are greater than expected for due date
multiple gestations
37
terms used for multiple births or the genetic relationship of their offspring
monozygotic
dizygotic
polyzygotic
38
multiple fetuses produced by the splitting of a single zygote
monozygotic (identical)
39
multiple fetuses produced by 2 zygotes
dizygotic (fraternal)
40
multiple fetuses produced by 2 or more zygotes
polyzygotic
41
3 clues for multiple gestation pregnancy
fundal height > than dates
extra fetal heart tones
elevated maternal AFP
42
management of multiple gestation pregnancy
more frequent prenatal visits
diet
induction vs c section at > 34 weeks
43
2 mc complication of multiple gestation pregnancy
**spontaneous abortion**
**preterm birth**
*also:
preeclampsia
anemia*
44
fancy word for labor
parturition
45
labor begins w. _
and ends w. _
uterine contractions
delivery of baby/placenta
46
term delivery is between _ and _ weeks gestation
37-42
47
_ is associated w. longer labor
nulliparas
48
premonitory signs of labor
cervical changes:
remoderling of cervix
cervical softening
spontaneous rupture of membranes (ROM)
49
what is the "blood show"
cervical softening -> expulsion of mucus plug -> pink tinged mucus
50
false labor is associated w.
braxton hicks contractions
51
describe true labor contractions (5)
regular
increase in frequency/duration/intensity
produce cervical changes
pain begins at lower back -> radiates to abdomen
pain not relieved w. ambulation
52
decribe braxton hicks contractions (4)
irregular/intermittent
no cervical changes
pain in abdomen
walking relieves pain
53
how many stages of labor are there
4
54
first stage of labor begins w. _
and ends w. _
onset
full dilation (10 cm)
55
3 stages of the first stage of labor including timeline
early: 8-12 hr
active: 3-5 hr
transition: 30 min -2 hr
56
describe early/latent phase of labor
8-12 hr
contractions: q 5-30 min, 30 sec each
gradually increase
cervical dilation: 0-3 cm
effeacement: 0-30%
spontaneous ROM
57
describe active phase of labor
3-5 hr
contractions: q 3-5 min, >/= 1 min each
cervical dilation: 3-7 cm
effacement: 80%
progressive fetal descent
58
describe transition phase of labor
30 min - 2 hr
contractions: q 1.5-2 min, 60-90 sec each
cervical dilation: 7-10 cm
effacement: 100%
59
second stage of labor lasts from _
to _
full dilation
birth of infant
60
second stage is aka
pushing stage
61
navigation of fetus thru maternal pelvis during the second stage of labor is dicatated by
3 p's:
power
passenger
passage
62
frequency, duration, and intensity of uterine contractions
power -> physiologic contractions
63
physiology of uterine contractions involves
stimulation of the uterine _ and _ receptors (2)
myometrium
alpha and oxytocin
64
stimulation of _ receptor stimulates uterine contractions
alpha
65
steps of a uterine contraction
1. wave begins in fundus and proceeds downward
2. muscle shortens
3. increment (build up)
4. acme (peak)
5. decrement (gradual letting up)
6. fetal descent, effacement, dilation
66
the amt of pressure exerted by uterine contractions (intrauterine pressure) is measured in
mmHg
67
passenger portion of stage 2 of labor is affected by
fetal size, attitude, lie, presentation, breech
68
4 types of pelvis
gynecoid
android
anthropoid
platypelloid
69
-rounded pelvic inlet, midpelvis
-outlet capacity adequate
-optimal for vaginal delivery
gynecoid pelvis
70
-heart shaped pelvic inlet
-decreased midpelvis diameters/outlet capacity
-associated w. labor dystocia
android pelvis
71
-oval shaped pelvic inlet, midpelvis diameters
-outlet capacity adequate
-favorable for vaginal delivery
anthropoid pelvis
72
-oval shaped pelvic inlet, decreased midpelvis diameters
-outlet capacity adequate
-not favorable for vaginal delivery
platypelloid pelvis
73
which 2 types of pelvis are ideal/favorable for vaginal delivery
gynecoid
anthropoid
74
mechanisms of labor are called _ movements
cardinal
75
what are the 6 cardinal movements
descent
flexion
internal rotation
extension
restitution
expulsion
76
presenting part reaches pelvic inlet (engagement) before onset of labor
descent
77
fetal chin presses against chest, head meets resistance from pelvic floor
flexion
78
fetal shoulders internally rotate 45 degrees, widest part of shoulders in line w. widest part of pelvic inlet
internal rotation
79
fetal head passes under symphysis pubis and emerges from vagina
extension
80
head externally rotates as shoulders pass thru pelvic outlet under symphysis pubis and turns to align with back
restitution
81
anterior shouler slips under symphysis pubis, followed by posterior shoulder and rest of body - marks end of second stage of labor
expulsion
82
third stage lasts from _
to _
delivery of infant to delivery of placenta
83
what happens during the third stage of labor
-delivery of placenta, umbilical cord, fetal membranes
-uterus contracts firmly
-placenta begins to separate from uterine wall
84
what happens during the fourth stage of labor
-physiological adaptation to blood loss
-initiation of uterine involution
85
norma HR in newborn
120-160 bpm
86
fetal monitoring marker of fetal distress
consistent decelerations after contractions
87
2 types of fetal monitors
where is each one placed
external: maternal abdomen
internal: infant head
88
4 types of fetal HR changes
accelerations
early decelerations
variable decelerations
late decelerations
89
which type of fetal heart rate change is a normal response to fetal movement and is reassuring
accelerations
90
benign fetal HR change that mirrors images of contractions and indicates fetal head compression
early decelerations
91
-rapid FHR drop w. a return to baseline w. variable shape that indicates cord compression
variable decelerations
92
t/f: variable decelerations can be benign if mild or mod
t!
*worrisome if severe*
93
which fetal HR change is always worrisome
late decelerations
94
describe late FHR decelerations
drop at the end of the contraction
95
what do late FHR decelerations indicate
uteroplacental insufficiency
