Prenatal Care, Labor and Delivery Flashcards
human gestation lasts _ days from LMP
280
objective findings of preg
- Chadwick sign (blueish)
- Hegar sign
- Goodell’s (cervix softening)
- Melasma/cholasma
- linea nigra
- inc in basal bod temp
fetal heart detected w. doppler at
10 wk
fetal heart by auscultation at
20 wk
uterus rises to umbilicus at
20 wk
McDonald’s Measurements
top of mother’s uterus to pubic bone in cm
fetal movements at
18-20 wk (nullipara)
16-28 (multipara)
Why does the belly fall at 40nk
amniotic fluid diminishes
uterus = smaller, lower
baby drops, “lightening”
prevention of toxoplasmosis
- no raw meat, no seafood, no hand washing, gloves when changing cat litter or gardening
- wash produce/cutting boards w/ bleach
- cook/freeze meats
rule of thumb for weight gain during preg
10% of body weight +15lbs
hyperemesis gravidium is associated w/ high
hCG
- mult preg
- chorioCA
- hypERthyroid
- mult preg
pre-eclampsia
- alt in angiogenesis
- incomplete remodeling of uterine spiral arterioles
- abnml placental vascular development
proteins implicated in pre-eclampsia
- sFlt-1
- VEGF
- PIGF
sFLT-1 and NO in preeclampsia
inversely related
(xs sFLT-1 receptor binds up VEGF, can’t stim NO)
–> reduced placental blood vessel growth
–> preeclampsia
diabetes and pregnancy
insulin resistance increases in pregnancy
criteria for pregestational diabetes
-for 1st trimester or early 2nd trimester…
HbA1c > 6.5%
fasting plasma glucose >126 mg/dL
2-hr glucose > 200 mg/dL
circulating cell free DNA
NOT pt of routine prenatal lab assessment
screens for common trisomies and possibly sex
group __ strep should be done between 35-37 weeks
B
retest if negative
cervical ripening - process
- inc collagen solubility
- alt in ground substance
- ripening in cervix and corpus
cervical ripening hormonal methods
- oxytocin
- PGE2,1
- progesterone antagonist
role of calcium in labor
when Ca++ is removed, phosphorylation ceases and m. relaxes
labor INHIBITED
oxytocin role in labor
inc in number and sensitivity by term
-raises intracellular free Ca levels –> stim actomyosin formation and musc contractio
If ________ occurs early, spontaneous preterm labor will ensue
dysregulation of decimal inflammatory signaling
risk fx for spontaneous preterm birth
- cervical shortening
- lower GI infection
- undernutrition
- anemia
- cigarette smoking
role of CRH in labor
- derived from placenta in lg amounts
- secreted into maternal circulation in 3rd trimester
-rises EXPONENTIALLY during pregnancy, peaks at END
-high CRH delivery early or late?
early
- low CRH delivery early or late?
late
release of _____ from decide can result in preterm labor
prostaglandins, cytokines, chemokine, ROS from decidua
preterm labor risk fx
- prior preterm birth
- # of prior preterm births and gestational age
- prior preterm twin birth
- SHORT cervical length
- smoking
- hx of cervical surgery (LEEP)
the ___ the cervical length, the greater the risk of preterm birth
the SHORTER the cervical length, the greater the risk of preterm birth
first stage of labor
between onset of labor and full cervical dilation
latent and active phase
second stage of labor
between full cervical dilation and delivery
- descent/expulsio
- active role of pushing
third stage of labor
fetal delivery to placenta delivery
4 signs of placental separation
- lengthening of umbilical cord
- gush of blood
- fundus –> globular, more anteverted against abd
- fundus rises as placenta moves down
cardinal movements of labor (7 distinct)
engagement descent flexion internal rotation extension external rotation/restitution expulsion
