Prenatal Care: Routine Flashcards
When to start measuring fundal height?
20 weeks
Pre-pregnant size and shape of uterus?
size of fist/pear
Size and shape of 12 week uterus?
palpable at the top of the pubis symphysis
size of grapefruid
Size and shape of 16 week uterus?
1/2 way between the pubis symphysis and umbilicus
Size and shape of 10 week uterus?
at umbilicus
Size and shape of 36 week uterus?
At xiphoid process
Size and shape of 36-40 week uterus?
lower than xiphoid process - lightening
What is Nagel’s rule?
LMP - 3 months + 7 days = EDD
When is Hcg detectable in urine? What is the value in the plasma typically at that point?
Begins to rise 8 days after ovulation
8-11 days after fertilization hCG is detectable in urine
In plasma at that point: 50-250 mIU/L
How often does hCG double in the first 5-6 weeks?
every 1.5-3 days (typically draw 48 hours apart and expect doubling)
How often does hCG double in weeks 7&8?
every 3-3.5 days
When does hCG peak?
week 8-10
What is avg efw at 30 weeks?
3 lbs and will gain about 0.5 lbs weekly after that :)
What do you measure in a dating u/s < 13+6?
CRL
When do you change EDD based on u/s and LMP discrepancy prior to or at 8+6?
More than 5 days
When do you change EDD based on u/s and LMP discrepancy prior to or at 13+6?
More than 7 days
What do you measure at a dating u/s at 14 weeks and beyond?
BPD (biparietal diameter), HC (head circ), AC (abd circumference), FL (femur length)
When do you change EDD based on u/s and LMP discrepancy at 14+0 to 15+6?
More than 7 days
When do you change EDD based on u/s and LMP discrepancy at 16+0 to 21+ 6?
More than 10 d
When do you change EDD based on u/s and LMP discrepancy at 22+0 to 27+6?
More than 14 d
When do you change EDD based on u/s and LMP discrepancy at 28+0 and beyond?
More than 21 d
What are Presumptive Indicators of Pregnancy?
Subjective things, reported by patient
Amenorrhea
N/V
fatigue
urinary frequency
Breast tenderness
skin pigment changes
sustained BBT
Fetal movement felt by patient (quickening)
What are Probable Indicators of Pregnancy?
Objective, seen by provider, but not POSITIVE, could be explained by other things:
Abdominal enlargement
expression of colostrum
cervical softening
Hegar’s sign (softening of uterus)
Goodell’s sign (softening of cervix)
Chadwick’s sign (blue cervix)
Ballottement (palpate cervix and feel rebound)
BH ctx
Palpation of fetal outline/fetal movement by provider
+urine or +plasma hcg
Chadwicks sign
blue/purple cervix
probable pregnancy sign
6-8 weeks
Goddell’s sign
softening of cervix (6-8 weeks)
probable pregnancy sign
Hegar’s sign
softening of uterus
probable pregnancy sign
POSITIVE Pregnancy signs
Objective and can’t be explained by other things
(1) auscultation of FHR
(2) visualization of fetus on u/s
When does quickening usually occur in a primip?
about 20 weeks (partner usually can’t feel for another month)
feel like flutters
When does quickening usually occur in a multip?
about 18 weeks (partner usually can’t feel for another month)
feel like flutters
When does fetal movement become more regular?
24 WEEKS
When to start kick counts?
3rd trimester, if it is needed
before that, baby is not yet developmentally there
What does Maternal Serum AFP (MSAFP) test for?
Neural tube defects (spind bifida, anencephaly, gastroschisis, omphalocele)
When can we draw AFP?
15+0 to 21+6
What does Non-Invasive Prenatal Testing (NIPT) aka cell-free DNA Screen for?
Aneuploidy: trisomy 21, trisomy 18, trisomy 13, monosomy X (turner’s syndrome), Klinefelter (XXY), triple X (XXX), Jacob’s Syndrome (XYY)
Microdeletions: prader-willi, angel man, cri du chat, etc
Biologic Sex of the baby
IT IS THE LOWEST false positive rates of all the screenings
When can NIPT be done?
10 weeks until the end of pregnancy
This is the earliest screening option
1-2 week turn around time
Disadvantages of NIPT?
It is just screening - need to f/u with diagnostic testing
If multiple pregnancies: not specific to the fetus (can’t say if it pertains to one or both babies)
Can be expensive
Zygote
diploid cell with 46 chromosomes that results from the fertilization of the ovum by a spermatozoan
Blastomere
Mitotic division of the zygote (cleavage) yields daughter cells called blastomeres
Morula
Solid ball of cells formed by 16 or so blastomeres, enters uterine cavity 3 days post fertilization
Blastocyst
after the morula reaches the uterus, a fluid accumulates between blastomeres, converting the morula to a blastocyst; inner cell mass at one pole becomes the embryo and the outer cell mass is the trophoblast
Embryo
stage in prenatal development between the fertilized ovum and the fetus (between the 2nd and 8th week inclusive)
Fetus
developing after the embryonic stage
When does implantation occur?
Blastocyst implants into the endometrium about day 6-7 after fertilization
How are oxygen and glucose transported across the placenta?
facilitated diffusion
What vessels are in the umbilical cord?
2 arteries: Carry deoxygenated blood from fetus to placenta
1 vein: carries oxygenated blood from placenta to fetus
Wharton’s jelly
connective tissue that surrounds and protects the umbilical cord
What are the risks if the umbilical cord is extremely short?
abruptio placentae or uterine inversion
What are the risks of a really long umbilical cord?
vascular occlusion by true knots and thrombi
What is Polyhydramnios?
an excess of amniotic fluid
Amniotic fluid index (AFI) >/= 24 cm
Maximum vertical pocket (MVP) >/= 8
S/s of polyhydramnios?
S>D, difficulty auscultating FHR, difficulty palpating fetal parts
Cause of polyhydramnios?
50-60% idiopathic
Associated with: fetal anomalies, fetal infection, twin to twin transfusion syndrome, maternal DM (including GDM), isoimunization, multiple gestation
What risks are caused by polyhydramios?
increased risk of PPH, PTL, cord prolapse with ROM, associated with erythroblastosis
Management of Polyhydramnios?
Treat only if symptomatic and if benefits outweigh risks
Monitor with serial NSTs and BPPs, starting at 34 weeks
(1) Amniocentesis: to reduce fluid volume if polyhydramnios is severe (AFI > 35 cm), amniotic fluid can also be tested for fetal lung maturity and chromosomal studies
(2) Indomethacin: impairs production of lung liquid, increased fluid movement through fetal membranes or decreased fetal urine production
Oligohydramnios
decreased amniotic fluid volume
Amniotic Fluid Index (AFI) </= 5 cm
MVP < 2
Conditions associated with oligohydramnios:
Fetal:
- urinary tract obstruction or renal agenesis
- chromosomal abnormalities
-congential anomalies
-growth restriction
-demise
-post-term pregnancy
-ROM; PROM
Placental:
-abruption
-twin-to-twin transfusion syndrome
Maternal:
-Uteroplacental insufficiency
-hypertensive disorders
-DM
Drugs:
- Prostaglandin synthesis inhibitors
-ACE-I
Prognosis for early-onset oligo
DM poor outcome, risk of pulmonary hypoplasia increased; if d/t PROM increased still birth risk
Prognosis for late-onset oligo
more c/s for fetal distress
Management of oligo
u/s eval for fetal anomalies and growth restriction
Amnioinfusion in IP period for tx of repeated variable decels
When is the period of organogenesis?
begins in 3rd week after fertilization through 8 weeks
all major organ systems are formed except for lungs
4th week: partitioning of heart, arm/leg buds, body stalk that becomes umbilical cord forms
6th week: head much larger than body, heart is completely formed, fingers and toes present
How early is urine hcg positive?
As early as 1 week after conception
What hormones do the corpus luteum secrete?
Progesterone; corpus luteum persists until about 12 weeks under influence of hcg, it is responsible for the secretion of progesterone to maintain endometrium and pregnancy until the placenta takes over production
Epulis
focal swelling of gums, resolves after birth
Pregnancy-related mouth changes
gingivitis is common, may cause gum bleeding
increased salivation
Epulis
Pregnancy-related esophageal changes
decreased LES pressure and tone
widening of hiatus with decreased tone
heartburn is common
Pregnancy-related stomach changes
decreased gastric emptying
incompetence of pyloric sphincter
Decreased gastric acidity and histamine output
Pregnancy-related intestine changes
decreased tone and motility
altered enzymatic transport across villi –> increased absorption of vitamins and minerals
Displacement of intestines, cecum and appendix by the enlarging uterus
Pregnancy-related gall-bladder changes
decreased tone
decreased motility
Pregnancy-related Liver changes
Altered production of liver enzymes
altered production of plasma proteins and serum lipids
Genitourinary pregnancy-related changes
Dilation of renal calyces, pelvis, and ureters, resulting in increased risk of UTIs
Decreased bladder tone
Renal blood flow increases 35-60%
Decreased renal threshold for glucose, protein, water-soluable vitamins, calcium and hydrogen ions
Glomerular filtration rate (GFR) increases 40-50%
All components of the renin-angiotensin-aldosterone system increase, resulting in the retention of sodium, water, resistance to pressor effect of angiotensin II and maintenance of normal BP
Musculoskeletal pregnancy changes
Relaxin and progesterone affect cartilage and connective tissue
- results in loosening of sacroiliac joint and symphysis pubis
-encourages development of characteristic pregnancy gait
Lordosis b/c center of gravity changes
Respiratory changes of pregnancy:
Level of diaphragm rises 4 cm d/t enlargement of uterus
Thoracic circumference increases by 5-6 cm
Residual volume is decreased
mild respiratory alkalosis occurs because of decreased PCO2
Congestion of nasal tissues
Respiratory rate changes very little, but tidal volume, minute ventilatory and minute oxygen uptake all increase
Some women experience physiologic dyspnea due to increased tidal volue and lower PCO2
Hematologic changes of pregnancy:
Blood volume increases 30-50% from non-preg levels
Plasma volume expands, resulting in physiologic anemia
hgb avg 12 g/dL
Some women need Fe supplementation
hypercoagulable state: because fibrinogen (factor 1) and factors VII-X increase
Cardiovascular changes of pregnancy
Cardiac volume increases by 10% and peaks at 20 w
Resting pulse increases by 10-15 bpm with peak at 28 weeks
Slight cardiac shift up and to the left d/t uterus enlarging
90% of women develop a physiologic systolic heart murmur
May have exaggerated splitting of S1, audible 3rd sound or soft transient diastolic murmur
Cardiac output increased
Diastolic BP is lower in 1st and 2nd tris because of development of new vascular beds and relaxation of peripheral tone by progesterone –> decreased flow resistance
Skin Pregnancy Changes
palmar erythema
spider angiomas
varicose veins and hemorrhoids
hyperpigmentation (b/c P and E have melanocyte-stimulating effect)
cholasma, freckles, nevi, recent scars darken
linea nigra
increased sweat and sebaceous activity
change in connective tissue results in striae gravidarum
Hair changes in pregnancy
estrogen increases length of growth phase of hair follicles
mild hirsutism
Pituitary gland pregnancy changes
Prolactin levels are 10 times higher at term than non-preg state
enlarges by more than 100%
Thyroid changes in pregnancy
Increases in size by 13%
Normal pregnant women is euthyroid because of estrogen-induced increase in thyroxin-binding globulin (TBG)
TSH doesn’t cross placenta
Adrenal gland changes in prenancy
no enlargement
2 fold increase in cortisol in serum
pancreas gland changes in pregnancy
hypertrophy and hyperplasia of B cells
Insulin resistance as a result of the placental hormones, especially hPL
Recommended weight gain for BMI < 18.5
Underweight
28-40 lbs total
1 lb-1.3 lb/week in 2nd and 3rd tris
Recommended weight gain for BMI 18.5-24.9
Normal weight
25-35 lbs total
0.8-1lb/week in second and third tris
Recommended weight gain for BMI 25-29.9
Overweight
15-25 lbs total
0.5-0.7 lb/week in second and third tris
Recommended weight gain for BMI 30 or more
Obese
11-20 total
0.4-0.6 lb/week in second and third tris
First tri psyche
ambivalence
adjustment
focus on physical changes and feelings
Second tri psyche
acceptance
period of radiant health
more aware of fetus as a person
Third tri psyche
Introversion
Period of watchful waiting
concerned with baby’s needs
Weeks of 1st tri
1-13
Weeks of 2nd tri
14-26
Weeks of 3rd tri
27-36
Preterm
< 37 weeks
Late preterm
34-36+6
Early term
37-38+6
Term
37 weeks-42 weeks
Post-term
after completion of week 42
Gravida
Number of times a woman has been pregnant regardless of pregnancy outcome
Para
The number of pregnancies carried to the 20th week of gestation or the delivery of an infant weighing more than 500g regardless of outcome
Grand multipara
woman given birth more than 7 times
GTPAL
G = gravida, # pregnancies
T = term babies >/= 37 weeks
P = preterm babies, 20-36+6
A = abortion, any fetus born < 20 weeks
L = current living children
What are the critical diameters for pelvic evaluation?
Inlet, midplane, outlet
First Trimester Genetic Screening:
What are the components?
When is it done?
What does it test for?
Components: PAPP-A (pregnancy-associated plasma protein), hCG and NT u/s, mother’s age
When: 10-13 weeks
What: risk for trisomy 18 and 21
Second Trimester Genetic Screening aka quad screen aka multiple marker screen:
What are the components?
When is it done?
What does it test for?
Components: quad screen: MSAFP (maternal serum alpha-fetoprotein), estriol, inhibin A, and hCG**
An u/s is also performed between 18 and 20 weeks to ID anatomic defects
When: 15-22 weeks
What: NTD, trisomies 18 and 21
**triple screen is MSAFP, estriol, hCG; quad screen includes inhibin A)
Combined first and second trimester screen
Combines the 1st and 2nd trimester screening test for a more accurate risk assessment of trisomy 21
Cell-free DNA test (NIPT)
serologic screening test on mother that analyzes the small amount of DNA that is released from the placenta into the bloodstream of the mother
What: Aneuploidies –> Trisomies 13,18,21; problems with sex chromosomes, sex of baby; Also microdeletions
When: as early as 10 weeks, no end date
What do results of genetic screening aneuploidy tests indicate?
Positive: increased risk for aneuploidy compared to general population, but it is only screening and NOT diagnostic; Does NOT mean that the fetus definitely has the disorder, follow up with diagnostic testing like CVS, or amntiocentesis
Negative: fetus has a lower risk for aneuploidy relative to the general population, however, this is only a screening, not COMPLETELY ruled out!
What are you trying to confirm with the FIRST trimester ultrasound?
- Confirm that there is a pregnancy
- Location of pregnancy: is it in the uterus?
- Confirm the NUMBER of fetuses/gestational sacs
- Confirm viability: is there a FHR?
- Confirm dating/compare to LMP by CRL (if in first tri)
When to screen for GDM?
24-28 weeks
When do you repeat antibody screen for RH neg mom?
26-28 weeks
When GBS?
35-37 weeks
Good for 5 weeks
What is the frequency of prenatal visits?
Every 4 weeks until 28 weeks
Every 2 weeks until 36 weeks
Weekly from 36 weeks until 40 weeks
Biweekly 41+
Nausea and Vomiting of Pregnancy:
How common is it?
What to do about it?
N+V: 50%; N only 25%; None: 25%
This is different from hyperemesis gravidarum (0.3-3% of pregnancies)
Non-pharm therapies:
- take PNV 3 months prior to conception to decrease liklihood and intensity of NVP!
- avoid triggers (like odors) that provoke symptoms
- small, frequent meals every 1-2 hours
- avoid spicy or fatty foods
- eat foods high in protein
- eat bland or dry foods such as crackers or toast before getting out of bed
- d/c PNV with Fe until NV has resolved, but continue folic acid
- Acupressure, acupuncture, acoustic stimulation at P6
Pharm:
- 1 g ginger per day in divided doses
- pyridoxine (vit B6) 25 mg BID or TID PO
- doxylamine 12.5 mg BID or QID with pyridoxine PO
- metoclopramide 5-10 mg q6-8 hrs PO
- promethazine 25 mg q 4 hours per rectum
Common discomforts: Breast tenderness
good supportive bra
careful lovemaking
reassurance that it will soon pass
Common discomforts: Backache:
Consider Dif Dx: musculoskeletal strain, sciatica, sacroiliac joint problem, PTL, UTI
Massage, Application of ice or heat, hydrotherapy, pelvic rock, good body mechanics, pillow in lumbar area when sitting or between legs when laying on side, pregnancy support harness/girdle, good bra, supportive low-healed shoes
Sacro-iliac joint problems: sacroiliac belt
Common Discomforts: Fatigue
reassure normal first tri problem and will likely pass
mild exercise and good nutrition
decrease activities, have planned rest
Decrease fluid intake in evening to decrease nocturia
Common Discomfort: Heartburn
small frequent meals
decrease amount of fluids taken with meals; drink fluids between meals
Papaya enzymes (also fresh, dried, juice)
Elevate head of bed 10-30 degrees
Slippery elm bark throat lozenges
Antacids
Proton pump inhibitors and H2 blockers (cat B)
Common discomforts: Constipation
Increase fluids and fiber
Prune juice or warm beverage in the am
encourage exercise
Stool softeners
Common Discomforts: Hemorrhoids
Avoid constipation or straining with bowel movement - good potty posture!
Elevate hips with pillow or knee-chest position
Sitz baths
wich hazel or epsom salt compresses
Reinsert hemorrhoid with lubricated finger
Kegel exercises
Topical anesthetics - preg cat C if combined with steroid
Common Discomforts: Varicosities
Support stockings - apply prior to getting out of bed
avoid restrictive clothing
perineal pad if vaginal varicosities
Rest periods with legs elevated, avoid leg crossing
Common Discomforts: Leg Cramps
Decrease phosphate in diet (no > 2 glasses of milk per day)
Massage affected leg
DO not point toes, flex ankle to stretch calf
keep legs warm
walk, exercise
calcium tablets
Magnesium tablets
Common Discomforts: Presyncopal episodes
change positions slowly
push fluids
regular caloric and glucose intake
avoid lying flat on back
avoid prolonged standing and sitting
Common Discomforts: Headaches
Rule out migraines/pathologic HA causes
head, shoulder, neck massage
Acupressure
Hot or cold compresses
rest
follow regular sleep schedule
warm baths
meditation and biofeedback
Aromatherapy
eat smaller and more frequent meals
Mild analgesic: acetaminophen 325 mg, 1-3 tablets q 4 hours prn
Common Discomforts: Leukorrhea
Rule out vaginitis and STI
Good perineal hygiene
wear cotton undies and change often
panty liners (unscented)
avoid douching and feminine sprays
Common Discomforts: Urinary frequency
Rule out UTI
decrease fluids in evening to avoid nocturia
avoid caffiene
Common discomforts: Insomnia
warm bath
hot drink (warm milk, chamomile tea)
quiet, relaxing, minimally stimulating activities
avoid daytime napping
good sleep hygiene
Common discomforts: Round ligament pain
Rule out other causes of abdominal pain: appendicitis, ovarian cyst, placental separation, inguinal hernia
Warm compresses, ice compresses
hydrotherapy
avoid sudden movement or twisting motions
flex knees to abdomen, pelvic tilt
support uterus with pillow when lying down
maternity abdominal support girdle
Common Discomforts: skin rash
ice
oatmeal bath
Diohenhydramine 25 mg PO q 4 hours prn itch
Derm referral prn
Common discomforts: carpal tunnel (tingling and numbness in fingers)
good posture
lying down
rest and elevate affected hands
Ice, wrist splints
Mild analgesic like acetaminophen 325 mg 1-2 tablets q 4 hours prn
Recommended daily calories in pregnancy
2500 per day
Recommended amt of protein in pregnancy
60 g/day at least
Category A
Adequate, well controlled studies in pregnant women have NOT shown increased risk of fetal abnormalities: ex: folic acid, levothyroxine
Category B
Animal studies have shown no harm BUT no adequate human studies OR animal studies showed an adverse affect, but adequate well controlled studies in humans failed to demonstrate risk: ondasteron, amoxicillin
Category C
Animal studies have shown adverse effect and No human studies OR no animal studies/human studies at all; sertraline, fluconazole
Category D
Studies in pregnant women showed risk to fetus, but benefits may outweigh the risks: phenytoin, lithium
Category X
Studies have demonstrated positive evidence of fetal abnormalities (animal or human); contraindicated in pregnant women or women who may become pregnant - methotrexate, warfarin
LIVE vaccines
Contraindicated in pregnancy
Give at least 4 weeks prior to pregnancy
Or give pp
MMR, var
Doppler Velocimetry blood flow assessment
Evals velocity of blood flow through fetal umbilical artery to the placenta
Used if uteroplacental insufficiency causing IUGR is suspected
Normal: ratio of systolic to diastolic blood flow (S/D ratio) is about 3; >3 abnormal
Amniocentesis
What is it
When do it
Risks
What: amniotic fluid is aspirated from amniotic sac and evaluated for genetics, lung maturity, NTD
When: 14-16 weeks for genetic eval or assessment of NTD; later in pregnancy for lung maturity, r/out amnionitis for fetal hemolytic disease (Rh or anti-D)
Risks: infection, bleeding, preterm labor, PROM, detal loss
***IF Rh negative - need to administer RhoGAM with amniocentesis
CVS (chorionic Villus biopsy)
What is it
when do it
Risks
What: sample of chorionic villi from placenta is aspirated either transabdominally or transcervically, outer trophoblastic layer is obtained (tissue has same genetics as fetus) and examined for genetic info
When: 10-13 weeks
Benefits: 3-4 weeks earlier than amnio, cultures grow rapidly resulting in early diagnosis
Risks: Infection, bleeding, miscarriage, risk of limb deformities (if performed prior to 9 weeks), tachnically more difficult, contraindicated in case of maternal blood group sensitization
Fetal Kick Counts (FKC)
Maternal Self-report of fetal movement to assess fetal wellness
When: start at 28 weeks if risks or 34-26 week if low risk, don’t start before 3rd tri, because fetus is not developmentally there yet
How:
- count FM for 30 minutes TID, 4+ mvmts per 30 min is reassuring
- if < 4 mvmts in 30 minutes, count for 1 hour
- if < 10 movements in 1 hour, contact provider
NST
Accelerations occur with fetal mvmt on EFM
Indications: decreased fetal mvmt, post-term, DM, HTN, IUGR
Reactive:
> 32 weeks: 2 or more accelerations in FHR of 15 or more bpm lasting for >/= 15 seconds within a 20 min period
28-32 weeks: >/= 10 bpm lasting 10 secs in 20 minutes
If not reactive in 20 min, go for 40 min
If not reactive in 40 minutes requires further evaluation (usually BPP; could be repeat NST or contraction stress test)
If unsatisfactory or inconclusive, FHR is uninterpretable/poor quality, sometimes caused by vigorous infant, repeat per institution protocol
Contraction stress test/oxytocin challenge test
Give oxytocin to stimulate contractions and then evaluate EFM for decels
Neg: no variable or late decels
Suspicious: presence of nonrepetitive decels, decreased variability
Positive: persistent late decels with 50% or more of contractions
contraindications: classical c/s or myomectomy, previa, risk PTL, GA < 37, multiple gestation
AFI
Amniotic Fluid Index
divide uterus into 4 segments and measure deepest vertical pocket of fluid in each quadrant via u/s; add up measurements
Normal: 5-24 cm
MVP
Maximum vertical Pocket
Identify the single deepest pocket of fluid
Normal: 2-8 cm
BPP
What is it?
Biophysical Profile
Procedure using u/s to evaluate 5 fetal variables to assess fetal risk - BPP is better than CST to eval fetal risk
What are the components of BPP?
5 components:
(1) NST
fetus is evaluated via u/s for 30 minutes to observe:
(2) muscle tone
(3) breathing movements
(4) gross body movements
(5) AFV
BPP Scoring:
(1) Breathing movements: one or more episodes in 30 minutes (none = 0, present = 2)
(2) Body Movements: 3 or more discrete body or limb movements in 30 minutes (none = 0, present = 2)
(3) Tone: one or more episodes of extension with return to flexion in 30 minutes (none = 0, present = 2)
(4) Qualitative AFV: at least one pocket of amniotic fluid that measures at least 2 cm in 1 perpendicular planes (none = 0, present = 2)
(5) NST: reactive = 2, non-reactive = 0
Add up to get final score from 0-10
BPP scoring interpretation criteria:
8-10: normal
6: equivocal, repeat testing
0-4: abnormal
How to evaluate fetal lung maturity
Take amniotic fluid sample
Lecithin/sphingomyelin ratio (L/S ratio)
- Lecithin is elevated after 35 weeks
- sphingomyelin is constant
- ratio of 2:1 or greater is indicative of fetal lung maturity except in DM
How soon after conception can hcg be detected in urine
1 week
Does the respiratory rate of a woman change in pregnancy?
NO changes very little, do have dyspnea
What is naegle’s rule based on?
28 day menstrual cycle
280 day (10 lunar month) avg. pregnancy length
How do you count twin pregnancy in Gs and Ps?
Counts as ONE G and ONE P,
So if someone was pregnant, ob hx of 1 twin birth at 37 weeks, both living:
G2P1002
What is being identified in leopolds?
1st: lie
2nd: presentation
3rd: position
4th: attitude
Clinical pelvimetry of adequate pelvis:
Pubic arch of 90 degrees
diagonal conjugate of > 11.5 cm
Who should NOT breastfeed?
HIV + and untreated
Active TB
illicit drugs
taking chemo
What is benefit of CBE?
knowlege decreases fear
Decreased need for analgesia and anesthetics in labor
Where does amniotic fluid come from?
produced by amniotic epithelium/fetal functions: water transfers across the amnion and through fetal skin. In the second trimester the fetus starts to swallow, inspire, and urinate amniotic fluid
What are the parts of the placenta?
trophoblasts, chorion, amnion, chorionic villi, intervillous spaces and decidual plate
Conceptus
all tissue products of conception: embryo (fetus), fetal membranes, placenta
Which structure in human reproduction produces the most diverse and greatest quantity of steroid and protein hormones?
Trophoblast
Piskacek’s sign
noting a palpable lateral bulge or soft prominence one of the locations where the uterine tube meets the uterus
