Prenatal Labor Delivery Flashcards
First Trimester
- how many weeks gestation
- how do you determine gestational age?
- what are the most accurate ways for determining due date?
1-12wks gestation is first trimester
Gestational age determinatinon:
- add 7days to LMP then subtract 3mo = Naegeles Rule
- History: using the date of the LMP
- uterine size
- US
Most accurate:
- LMP
- Crown rump length
- Biparietal diameter (13-25wks)
- femur length (13-25wks)
(1st trimester)
Twins:
-factors increasing the likelihood of twins
-risks
Factors:
- advancing age
- increased parity
- family hx from either parent
- obese andd tall women
- fertility drugs
Risks:
- preterm birth can lead to bedrest early in pregnancy
- intrauterin growth retardation or unequal growth
(1st trimester)
Urine is checked each visit for glucose and protein, T/F??
What are some labs that are checked during the first trimester?
Why do we always get a urine culture?
True,
Labs;
- UA
- CBC (anemia, thalassemia)
- Rubella immunity
- Varicella immunity
- syphillis (mandated)
- Hep B (iff mom has chronic hep B she can pass this onto baby in utero)
- blood type and RH determination and aby screen
- HIV (retest as well at 36wks)
- lipids, PPD, Hgb A1C, thryoid if indicated.
Always get urine culture b/c of asymptomatic bacteriuria! Associated with risk of preterm birth, low birth weight, and perinatal mortality
(1st trimester)
Tx of asymptomatic bacteriuria?
Acute Cystitis Dx and tx
Tx: Sulfisoxazole, amoxicillin, augmentin, nitrofurantoin, cefpodoxime proxetil
*CANNOT give FQs, interfere with cartilage in baby and tetracyclines stain teeth.
Acute cystitis:
- dx:
- -UA and midstream urine culture
- tx:
- -amoxicillin*, augmentin, notrofurantoin, cephalexin
(1st trimester)
Rh aby screen is drawn at how many weeks gestation if mother is Rh negative?
WHen is Rh negative mother given rhogam?
if mom is Rh negative Rh aby screen is done at 28wks gestation.
RH neg mom given rhogam when..
- miscarriage, trauma, amniocentesis, postpartum, ectopic pregnancy
- at 28wks gestation regardless of what her Rh aby status is (negative or positive)
(1st trimester)
Prenatal genetic screening:
-what 3 markers yeild an 82-87% detection of downs syndrome?
-what is chorionic villous sampling?–what weeks gestation is the earliest this can be done?
Downs:
- hCG level, pregnancy associated plasma protein a (PAPP-A), and nuchal transparency
- women to have increased risk of aneuploidy with these tests should be offered chorionic villous sampling
Chorionic villous sampling:
- procedure go get fetal DNA for testing for downs or other abnormalities
- done via US guidance through the vagina or by abdomen
- should not be done before 10weeks gestation b/c of increased pregnancy loss.
(2nd trimester)
-what tests are included in the quadruple screen? what does this look for?
- What is maternal serum alpha fetal protein (MSAFP) used for?
- -what is indicated if MSAFP is high? low?
Quadruple screen:
- serum alpha-fetoprotein (AFP)
- hCG
- unconjugated estrodiol
- inhibin A
- improve the detection of downs syndrome
MSAFP is used to detect abnormalities in the fetus.
- if MSAFP is high it could indicate neural tube defects, ancephaly, multiple gestation.
- if MSAFP is LOW this indicates down syndrome.
(2nd trimester)
Amniocentesis:
-indications
Indications:
- prenatal genetic studies (MC)
- assessing fetal lung maturity
- evaluation of fetal infection
- degree of hemolytic anemia
- evaluation of dx neural tube defects
- therapeutic = removal of excess amniotic fluid
How often does the mom go in for check ups through out her pregnancy What is checked at each one of these visits?
How much weight gain is normal during pregnancy?
prenatal visits every 4wks until 28wks then q 2wks until 34-36wks then every week!!
At each visit maternal weight, BP, uterine growth, urine dipstick, fetal activity, and fetal heart rate are checked.
20-25lbs
Common sx of pregnancy?
HA (Comm in early pregnancy)
N/V
heartburn
constipation
fatigue
back pain (later in pregnancy)
round ligament pain
edema
hemorrhoids
vaginal discharge
pica
Complications of first trimester:
- causes of vaginal bleeding
- evaluation of bleeding during 1st trimester
-when pregnancy is complicated by vaginal bleeding before the 20ths week its termed what?
vaginal bleeding:
- ectopic pregnancy
- threatened miscarriage
- inevitable misscarriage
- vanishing twin
- vaginal tract bleeding
- implantation bleeding
Evaluation:
- pelvic US, may follow with transvaginal US**
- CBC with type and cross and Rh
- serum beta hCG
vaginal bleeding before the 20th week is termed a THREATENED ABORTION
2nd trimester:
- how many weeks gestation?
- what is fundal height at 20wks?
- each week gestation fundal height should grow how many cm?
- when does mother begin to feel fetus move around?
Weeks 13-27 is considrered 2nd trimester.
Fundal height at 20wks should reach the umbilicus and now fundal height can be measured at each visit
Each week gestation fundal height should grom 1 cm
Mom should begin to feel fetus move around 18-20wks
Complications of 2nd trimester
Premature labor
Vaginal bleeding: placenta previa, placental abruption
premature rupture of membranes
hypertension in pregnancy
preeclampsia
Can mom lay on her back past 20wks gestation?
NO, mamma cannot lay on her back, left lateral is preferred.
How many weeks gestation is considered 3rd trimester?
when do you screen for gestational diabetes?
–what is considered DM in Random serum glucose, fasting serum glucose, and glucose challenge test?
when do we test for group B strep?
28-birth
Screen for gestational DM at 28wks
DM If…
- random serum glucose greater than 200
- fasting serum glucose greater than 126
- glucose challenge test abnormal if greater than 130
test for group B strep 35-37wks; swab of vagina and rectum.
Braxton Hicks contractions:
- MC occur which weeks gestation?
- results in actual change in the cervix?
MC occur in last 2-3wkks gestation
DOES NOT result in a change in the cervix, this is what separates it from actual labor.
How frequent should contractions be before coming into the hospital for delivery? what are some other signs to come in?
Contractions every 5 minutes for 1 hour or very intense contractions should signal you to come in.
- -mother getting very uncomfortable or feeling preessure in pelivs
- -sudden gush or leaking of fluid from vagina
- significant vaginal bleeding
- decreased fetal movement.
if women presents with decreased fetal movement, we need to assess fetal well being, how do we do this? what is a reassuring test result?
assess fetal well being:
- mom reclines on her left side and the fetal heart sounds are recorded by a fetal heart monitor, they are recorded fro 20-30minutes.
- Mom presses a button when she detects fetal movement
- ***if the fetal heart rate accelerates AFTER movement for at least 3 episodes and there are no concerning decreases in heart rate the test is reassuring and no intervention is needed at that time.
Complications of the 3rd trimester
preeclampsia/eclampsia
HELLP syndrome
Vaginal bleeding
- -Premature labor
- -premature rupture of membranes
Labor and Normal Delivery
- what two key events occur during labor/delivery?
- the exam for delivery consists of what?
Two key events: dilation and effacement of the cervix.
Exam for delivery consists of:
- digital vaginal exam or the cervix:
- -consistency (hard vs soft)
- -effacement
- -dilation
-fetal station = position of the fetal head in the birth canal in relation to the ischial spines (0 = ischial spine, -1,-2,-3 = above ischial spine, +1,+2,+3 = below ischial spines
What are the stages of labor?
How much dilation occurs per hour during the active phase of stage 1?
Stage 1.
- latent phase = cervical effacement and early dilation
- active phase = begins when cervix is 3-4cm dilated
- onset of contractions to complete dilation(10) and effacement of cervix
Stage 2. Delivery of infant
Stage 3. Delivery of the placenta
Stage 4, Hour immediately after delivery
Dilation occurs 1cm/hr in primiparous women and 1.2cm/hr in multiparous women
How do you accurately measure intensity of contractions?
During labor/delivery what should the fetal heart rate be?
What should a good fetal heart rate strip look like?
What happens to fetal heart rate with umbilical cord compression?
Sinusoidal pattern of fetal heart tones indicates what?
measure intensity of contractions with internal uterine monitor.
Fetal heart rate should be 110-160BPM
Fetal heart rate strip should have variability and acceleration.
WIth umbillical cord compression babies HR goes down after contractions. Contraction is compressing the cord and is temporarily depriving blood and O2 to the baby.
sinusoidal pattern indicates baby is acidotic and needs to come out now!!!
What are the cardinal movements of labor? (Stage 2)
Engagement
Flexion
Descent
Internal rotation
Extension
External rotation or restitution
Expulsion
Can you pull on the umbilical cord to deliver the placenta?
NO!!!
With postpartum hemorrhage the HR and RR go up or down? whatn happens when the BP drops?
What is all included in evaluation of APGARS?
with hemorrhage the HR and RR go up, when BP drops the pt is already in shock.
Appearance (color) Pulse (HR) Grimace (reflex activity) Activity (muscle tone) Respiration
What is colostrum?
what does VBAC and TOLAC stand for?
Breech positioning is an automatic c-section, T/F?
Colostrum is the milk produced in the first 5 days of breastfeeding, has more minerals, protein, and IgG abys, less fat and sugar.
VBAC = vaginal birth after cesarean
TOLAC = trial of labor after cesarean
True!!!
How long after delivery does it take for uterus to return to normal size?
What is lochia?
How long after delivery can things be inserted into the vagina?
In the average nonlactingg woman the time to ovulation is how many days? in the lactating woman?
Uterus returns to normal size after 6wks
Lochia = discharge from uterus after birth as the dicidua differentiates into a superficial layer which sloughs off, heavy at first, may last for several weeks
Nothing in the vagina for 4wks after delivery.
In the nonlactating woman the average time to ovulation is 45days and in the lactating women its 189days
