Quiz 1 Flashcards
Risk Factors for Poor Perinatal Outcomes
- preexisting medical conditions
- genetic factors
- age
- env
- teratogens
- risk for pregnancy complication
Nagael’s rule
Last menstrual period - 3 months + 7 days and ( 1 year = if necessary)
gravida
- number of pregnancies
- primi-gravida - 1st pregnancy
- multi-gravida - 2 or more pregnancies
para
- description of pregnancy outcomes; 2 methods
- single number - pregnancies that have reached viability
- four number (TPAL) system
TPAL
T - pregnancies that ended in term birth
P - pregnancies that ended in preterm birth
A - number of pregnancies that did not reach viability (<20 wks)
L - # of living children
Pregnancy Tests are based on
recognition of hCG or beta subunit of hCG
Pregnancy Hormones
- Progesterone: high from corpus luteum; inhibits uterine activity
- hCG
- Estrogen: promotes growth of uterine tissues
- hPL: human placental lactogen; insulin antagonist; triggers breastmilk production
- prostaglandin: stimulates labor
Signs and symptoms of pregnancy
- presumptive: missed period, breast tenderness, nausea
- Probable: goodell’s sign, chadwick’s sign, hegar’s sign, ballottement, positive uterine test
- positive: U/S; FHR; fetal movement
Goodell’s sign
softening of the cervix
Chadwick’s sign
bluish-purplish discoloration
Hegar’s sign
softening of the uterus
Ballottement
examiner feels “floating fetus”
1st trimester psychological adaptations
ambivalence; not real
2nd trimester psychological adaptations
self-absorbed; preganncy becomes real
3rd trimester psych adaptations
fears about baby’s well being; fears about delivery
musculoskeletal adaptations to pregnancy
- change in center of gravity
- increase in relaxin
- increased lordosis
lordosis
curvature of lumbar spinal vertebrae; “waddling gait”
relaxin
relaxes connective tissue
nutritional needs during pregnancy
- energy needs - weight gain
pattern for weight gain
25-35 lb total
- normal: 0.5-2kg during 1st trimester
- avg gain of 0.45 kg during last two trimesters
BMI <19.8 weight gain
28-40 lb
BMI >25 weight gain
15 to 25 lb
tissues of the placenta
fetal: chorionic villi
maternal: decidua basalis, cotyledons
function of placenta
metabolic and gas exchange
- hormone production
- amniotic fluid regulation
what carries oxygenated blood form maternal side of placenta
umbilical vein
pathway of blood to fetus
- from mother -> oxygenated blood via umbilical vein
- crosses ductus venosus to IVC then into right atrium
- cross foramen ovale to left atrium
- go to left ventricle then to aorta
- blood pumped to pulmonary artery (some)
- go through ductus arteriosus into descending aorta
- blood returns to placenta through umbilical arteries
early term
between 37 weeks 0 days and 38 weeks 6 days
full term
between 39 wks 0 days and 40 wks 6 days
late term
between 41 wks 0 days and 40 wks 6 days
postterm
between 42 weeks 0 days and beyond
reterm
less than 37 wga
viability
capacity to live outside the uterus, around 22 to 24 weeks since LMP, or fetal weight >500 g
reproductive system adaptations to pregnancy
- cervix: increased vascularity
- uterus: changes in size, shape, and position; increases in size with growing fetus; at 20 wks EGA near level of umbilicus
pre-eclampsia s/s
- dizziness, blurred vision, scotoma
- persistent headache
- edema: facial and hands
- sig weight gain (2 kg in 1 wk)
- epigastric pain
- oliguria
- seizures
foods to minimize/ eleminate
- mercury - tilefish, shark, swordfish, mackerel, tuna
- soft cheeses
- sushi
- undercooked foods
CV changes
- Blood volume increases by 50%
- increased cardiac output; increased demand for iron
- pulse increases in 2nd trimester until term (10-15 above norm)
- BP decrease in 2nd trimester, returns to normal at term
- coagulation in CF 7-10 and venous stasis (low bp when lying down)
spontaneous abortions
- 1st trimester: due to fetal genetic abnormalities
- 2nd trimester more likely related to maternal conditions
spontaneous abortion nursing assessment
- vaginal bleeding
- cramping or contractions
- VS, pain level
- client understanding
