Prenatal development, Pregnancy, & Prenatal care Flashcards
What are the 3 stages of prenatal development?
Pre-embryonic
Embryonic
Fetal
Pre-embryonic stage
Fetus is NOT a fetus yet
Starts as zygote → single cell from maternal & paternal gametes
Multiplies in undifferentiated mass, comes down & implants as a blastocyst at ~ day 14
Embryonic stage
From day 15 to end of 8 weeks post conception
MOST vulnerable → to teratogens
When developing human is an embryo
What happens during the embryonic stage?
Organogenesis → stage when embryo’s internal organs start to form & become functional
Fetal stage
Beginning of week 9 to 40 weeks
ALL organs are present → getting ready for delivery
Fetal stage:
By what week do the lungs begin to form surfactant?
24th week → makes lower airways slippery to expand & ↑ surface area for gas exchange
Test review: Mother’s membranes have ruptured at 19 wks. We know sepsis can occur. What is the risk of mom getting septic vs. baby making it to viability?
There is NO benefit to leaving the mother pregnant; ONLY risks
Viability at the very earliest is _____ weeks
22 weeks → intact survival is low
Risk is very high with fetus being so preterm
24 wks is better but still not great
What will happen when the baby starts to have practice breathing movements at 24 wks if there is not enough amniotic fluid?
The lungs will NOT develop → leads to hypoplastic lungs
List two things considered to be routine prenatal care
Ultrasounds
Fundal height measurements
What can happen if a mother is laid flat on her back?
Causes supine hypotension → dizziness; nausea; weakness
What is the first thing the nurse should do if a mother experiences supine hypotension?
Position change → onto her side
Fundal height measurements are done routinely after how many weeks gestation?
16 weeks
What should normal fundal height measurements be?
measured from pubic symphysis to the fundus → 1 cm per week of gestation
Ex. 28 weeks = 28 cm
Ex. 36 weeks = 36 cm
What 2 diagnostic tests can be done to assess fetal well being?
Non stress test
Biophysical profile (BPP)
What to look for with non stress tests?
Variability & looking for 2 accelerations of FHR in 20 min
positive → reassuring baby’s nervous sys is responding to changes in uterus
cannot perform reliably until 32 wks gestation
List the aspects of a biophysical profile (BPP)
NST → reactive = 2 points
Fetal movement → 2 discrete movements
Tone → is baby flexed
Breathing → practice breathing in utero
Amniotic fluid volume → if large pocket / 2 large pockets = 2 points
Grading scale for BPP
8/10 or 10/10 → reassuring
6/10 → monitor; baby might not be doing well
< 6/10 → deliver ASAP
Test Review: If we had a patient who was 30 wks gestation where would we expect her fundal height to be from the pubic symphysis?
30 cm
Explain Nagele’s rule
Determining due date (EDD)
→ determine date of LMP
→ subtract 3 months
→ add 7 days
GTPAL → what does each letter stand for?
G → gravida; how many times has she been pregnant
T → term births; 37 wks or >
P → preterm births; briths or losses from 20 wks to 36 wks 6 days
A → abortions/ miscarriages; any loss up to 19 wks & 6 days
L → living children
Ex. GTPAL problem:
The woman presents for prenatal care at the clinic. Prior to this pregnancy, she had 2 spontaneous losses at 9 & 12 weeks, respectively. She gave birth to 35 week twins four yrs ago & a 39 week singleton 18 months ago. One of the twins dies of SIDS at 4 mos of age. What is her GTPAL?
G → 5
T → 1
P → 1
A → 2
L → 2
Physiological changes of pregnancy
Every system changes
→ GI system
→ Breast changes
→ Reproductive system
→ Integumentary system
→ musculoskeletal system
What happens to GI system during pregnancy?
Progesterone slows everything
slows uterus to prevent contractions
peristalsis slows
→ nausea (early)
→ constipation
→ heartburn
→ gallstones
