Quiz 3 Flashcards
Preterm Birth
20 0/7 wk - 36 6/7 wks
decreasing in US @9.5% 2015
highest among AA + hispanic
Spontaneous Preterm Labor
unintentional delivery <37wk
Cause: infection or inflammation
Non-Medically indicated
C-section/ labor absence of medical need
Medically indicated
healthcare provider recommends preterm labor delivery
Cause: preeclampsia
Cervical insufficiency
the inability of cervix to retain preg in absence of sign/symptoms of contractions, labor or both in 2nd tri
Multiple Gestation
1+ fetus from fertilization of 1 zygote
- divides or fertilization of 2 ova
monozygotic twin = 1 egg that divides at 1st week of gestation
dizygotic = 2 eggs fertilized
Placenta types
- monochorionic (1 chorion) - 70% monozygotic
- dichorionic (2 chorions) - always dizygotic
Twin pregnancy complications
Spontaneous delivery
HT + Preeclampsia
gestational diabetes
Antepartum hemorrhage
acute fatty liver
Abruptio placentae
Hyperemesis Gravidarum
Severe NV that causes dehydration, electrolyte imbalance + acid/base imbalance, starvation ketosis + weight loss.
-hypokalemia + natremia
- decrease urea
Peaks @ 9-20wks
Cause: increase of HCG, prog, + E, h.pylori, ambivalence towards preg.
Diabetes
Presentational - 1/2
Gestational - glucose intolerance (placenta creates HPL that antagonizes insulin, sparing glucose for fetus.)
Type1 : body isnt making insulin - body attacks destroys insulin producing cells
- glucose can’t get into cells + trys to get rid of extra w. kidney
Type 2: body is producing enough insulin but not properly produced overweight can’t stop insulin production. fat deposits on cell can’t open.
Challenge to manage because of
HPL
P
HgH
Corticotropin-releasing hormone
Shift energy source from ketone -> free fatty acid
Treatment:
Euglycemic control
minimize complication
prevent prematurity
-> keep the lowest possible glycosylated hemoglobin w/o going into hypoglycemia
Pregestational Diabetes
Blood glucose is elevated but below clinical threshold
Components:
Central adiposity > 35 in
Dyslipidemia
Hyperglycemia
HT
Maternal Risk:
DKA - 2nd tri
HT
Spontaneous Abortion
Polyhydramnios
Induction of Labor
UTI, Hypergly, Postpartum, post hemorrhage
exacerbation of diabetes symptoms
Fetal Risk:
Congenital defect
Prematurity
Hypogly, cal + mag
asphyxia
respir distress
Still birth
hyperbilirubinemia
polycythemia
Gestational Diabetes
a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. insulin less effective, a condition referred to as insulin resistance
risk:
<25 yr
HT, PCOS
Increase in maternal adiposity
insulin desensitizing hormone
Family history/ age/ race/ obesity history of macrosomia
Diagnosis: glucose testing 24-28 wk
Complications:
Macrosomia
Shoulder dystocia
HT + preeclampsia
preterm birth + stillbirth
C-section
Risks for baby
excessive birth weight
preterm
breathing difficulties
hypoglycemia
obesity + type 2 later in life
stillbirth
Prevention:
maintain healthy lifestyle, keep active, don’t gain more weight than recommended
Preeclampsia
Preeclampsia is a kind of high blood pressure some women get after the 20th week of pregnancy or after giving birth. s high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.
- Leading cause of maternal death
- 20wks 140/90 @ least 4 hrs apart + proteinuria >300mg or new systemic disease.
High Risk:
>35 yr
AA + low socioeconomic
previous preeclampsia with another preg
pregnant w. multiples
have diabetes + HT, kidney disease, AI
obese
family history of preeclampsia
SS
Headache that doesnt go away
Blurred vision
Epigastric pain
trouble breathing
NV
swelling in face + hands
weight gain - 2-5lbs per week
Proteinuria
Thrombocytopenia
Renal insufficiency
Impair live function
Pulmonary edema
Visual symptoms
Risk for fetus
Morbidity
intolerance of labor
still birth
placenta abruption
IUGR
Low birthweight
Treatment
Early detection
Delivery monitor
Hydra Liz one
Mg sulfate
Oral nifedipine
Labetalol
HELLP syndrome
HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems:
H–Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
EL–Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems.
LP–Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.
Eclampsia
occurrence of seizure activity in the presence of preeclampsia
- can be ante, intra + post partum
It can be triggered by cerebral vasospasm, hemorrhage, ischemia, edema
Warning:
persistent headaches
epigastric pain
NV
hyperreflexia w. clonus
restlessness
Treatment
Mg sulfate + hypertensive
Placenta Previa
1/200
The placenta attaches to the lower uterine segment near/over cervix vs. on the body of the fundus
Risk Factors:
scarring
large placenta
infertility, nonwhite, low socio, short interpreg
diabetes, smoking cocaine use
Painless bleeding
Maternal risk:
Hemorrhagic + hypovolemia shock
Blood loos
Fetal Risk:
Disruption of blood flow
Morbidity + morality
Management:
Avoid vaginal exam
Monitor fetal vitals
Check Amniocentesis + BPP - lung maturity
Placenta Abruption
Partial complete detachment of placenta
- hematoma forms + destroys the placenta around it
Grade:
1(mild) least amount of separation
2 (moderate)
3 (Severe) more separation + blood
Risk Factor
decreased placenta perfusion
HT
Seizure
Blunt trauma to the maternal abdomen
history of abruption
smoke/cocaine use
SS
Sudden onset of intense pain
board-like rigidity to the abdomen
uterine irritability
tachystole
vaginal bleeding
port wine stain amniotic fluid
Management
assess fundal height
girth measurement
shock
weigh pads
Placenta Accreta
The partial/complete placenta invades and becomes inseparable from the uterine wall.
0 leads to hemorrhage + may need a hysterectomy
- 3000 - 5000 mL blood loss
Abortion
Spontaneous or elective termination of pregnancy <20wks
Induced: medical/surgical abortion before fetal viability
Elective: at the request of the woman but not for a medical reason
Therapeutic: abortion because of abnormalities
Spontaneous: nonviable intrauterine preg w. either empty gestational sac or gestational sac containing embryo/fetus w/o heart activity 126/7 wks —> miscarriage
Termination of preg done transcervical by dilation of the cervix, evacuation, fetus out by cuttage, scrapping + vacuum
Meds: mifepristone +misoprostol
Ectopic Pregnancy
Fertilized egg grows outside uterus as a result in blastocyst implanting itself other than endometrial lining
- stunted growth + will be nonviable.
- 95% happen in fallopian tube, 5% other ovary, abdominal cavity, cervix
- most are tubual + tube lacks submucosal layer but can’t support the growth of the tropoblast
Risks:
Pelvic inflam disease
infertility
endometriosis
STI
smoking
Gestational Trophoblastic Disease
Spectrum of placental-related tumors
- group of rate disease in which abnormal cells grow inside the uterus after conception
MOLAR: hydatidiform mole cili turn into cyst in uterus ~ grape like
NONMOLAR: gestational trophoblastic disease- almost always malignant
SS: Bleeding, NV, HT, no fetal heartbeat +movement
Substance Abuse during Preg
Most prevalent in 1-2tri; may be associated w. abnormalities like still birth, fetal growth restriction, neurological development - hyperactivity
Screening for gestational diabetes
1 Hr - if over 140 test at 3hrs if positive if they have 2+ criteria (fasting 95mg, 1hr 180 mg, 2hr, 155, 3hr 140). If neg retest at 32 wks
If neg at 1 hr - routine prenatal; care
Glycosylated hemoglobin alc should be less than or equal to 6%
Preg Complications
RH Factor
ABO Incompatibility
Ectopic Preg
HSV
GBS
Preeclampsia
Gestational Trophoblastic Disease
Rh Alloimmunization
Rh is inherited protein found on the surface of RBC
Rh- doesnt have protein
Rh+ has protein
Rh- women at risk of having baby w. hemolytic anemia w/o treatment fetus will have jaundice, anemia, brain damage, HF + death
Sensitized woman when Rh+ from infant mixes with Rh- mother = creation of Ab
Cause: molar preg, ectopic pre, spontaneous abortion, therapeutic, manual removal of placenta, amniocentesis + CVS
Tests: indirect coombs (Ab screen), testing father/amnio, early birth, intrauterine transfusion(Correct anemia), exchange transfusion(erythropoietin+ fe)
Prevent sensitization
give RhoGam at 28 wks + 72 hrs after birth
ABO Incompatibility
Mother type O infant A/B
Maternal serum Ab cross placenta
- hemolysis of fetal RBC
- mild anemia
-jaundice
Not treated antenatally or prophylactic
GBS
Group B Strep.
In GI/GU
Treatment: decrease the bacterial load to limit exposure to fetus
Hydatiform Mole
Grape Like Cysts
1. complete: fertilization of empty ovum (no embryonic tissue found)
2. Partial: some fetal tissue; normal ovum but 2 sperm 1/1500birth
SS:
Rapidly growing uterus, vaginal bleeding, NV.HT. Abnormally high hcg
Management:
no preg for 1 yr, monitor for malignancy
Polyhydraminos
excessive amniotic fluid >2000mL
associated with fetal GI anomalies + maternal diabetes
Treatment:
remove amniotic fluid
Oligohydramnios
scanty amniotic fluid <500mL
risk: fetal adhesion + malformations
Treatment: amniofusion
Neonatal assessment
2hrs after birth - general survey, physical assessment, gestational assessment + pain assessment
Dubowitz Neurological Exam
assessed 33 responses in 4 areas
1. habituation - response to repetitive light/sound stimuli
2. movement + muscle tone
3. reflexes
4. neurobehavioral items
Ballard Maturation
assesses physical + neuromuscular activity + maturity
- less time than dubowitz
classifies if neonate is avg for gestational weight, lga or sga
Periods of reactivity/inactivity
cycle through
initial period of reactivity 15-30 mins post birth
increased respiration, rapid HR, grunting, flaring
Relative inactivity - 30 mins -2hrs infant will sleep
Second period of reactivity cycle through active/quiet alert
interested in feeding/sucking
Brazeiton Neonatal Behavioral Assessment Scale
28 behaviors items, 18 reflex - 6 categories
1. habituation: decrease stim from repetitive stim protects from overstim
2. orientation: the ability to focus on visual auditory stim
3. motor maturity: control/coordinate motor activity
4. self quieting: comforting self
5. social behaviors: response to cuddling
6. sleep wak states - 2 sleep 4 wake
Infant Danger Signs
Tachypnea
retraction of chest wall
grunting/ flaring
lethargy
abnormal temp
hypogly
abdominal distension
failure to pass meconium in 48 hrs
failure to void in 24 hrs
convulsions
jaundice <24hrs
jitteriness
cant keep constant temp
Ballard Tool
Assessment of physical maturity characteristics
- skin
transparent friable -1
gelatinous translucent -0
smooth pink visible veins 1
superficial peeling rash few veins 2
cracking pale areas 3
parchment deep cracking 4
leathery cracked wrinked 5
lanugo - diabetic moms have babies w. more hair on back
non
sparse
abundant
think
bald areas
mostly bald
Sole
smooth sole / small foot
>50mm no crease
faint red marks
anterior transverse cease only
creases anterior 2/3
cracked lethary
Ear/eye formation
lids fused loosely -1 / tightly -2
lids open pinna flat stays folded
Slightly curved pinna, soft recoil
well curved pinna soft ready recoil
formed and firm instant recoil
thick cartilage
Genitals
Smooth flat scrotum/clitoris prominent
clit prominent small minora/scrotum empty
tests in upper cancl rare rugue/ clitoris prominent, enlarging minora
majora + minora equally prominent/testes descending
testes down good rugae/ majora large
testes pendulous deep rugae/ majora covers clit and minora
Breast
imperceptible
barley
flat areola no bud
stippled areola
raised areola
full areola 5-10mm
Neuromuscular
Posture
Square window
arm Recoil
Popliteal angle
scarf sign
heal to ear
Newborn Vitals
Pulse 110 - 160 bpm (sleep <70)
Respiration 30 -60
BP: 70-50mmHg - 90/60 @ day 10
Temp: Ax 97.7-99
skin 96.8 - 97.7
97.8 - 99
Caput succedaneum
swelling under the skin of the scalp - fluid filled
crosses suture lines
Cephalhematoma
collection of blood from broken blood vessels that build up under scalp
- doesnt suture line
Craniosynostosis
premature closure of suture
- restricts growth perpendicular + compensatory overgrowth in unrestricted regions
plaglocephaly
develops when an infant’s soft skull becomes flattened in one area, due to repeated pressure on one part of the head
Milia
white dots on skin
Erythema Toxicum
papules on skin last up to 5 days
Skin Variations
Vernix Caseosa
Forceps marks
telangiectatic nevi
mongolian spots
nevus flammeus
stork bites
Reflexes
Tonic-neck
Moro
Grasping
Rooting
Sucking
Babinski
Trunk incurvation
Protective
Blink
yawn
cough
sneeze
extrusion reflex
Discharge teaching
thermoregulation
feeding practices
skin/cord care
prevention of infection
security
stool/void patterns
safety - car seat sleep position, sids
Illness - >100 and <97.7, frequent vomiting refusal of 2x feeding, difficult awakening, breathing difficulties, cyanosis w/wo feeding, inconsolable, no wet diapers for 24 hrs
Before discharge
Hep B + HBig
PKU
Hearing screening
CHD
CDC newborn screen
Apgar
HR + Auscultation
respiration rate
muscle tone
relex irritability
color
Score:
o-3 - severe distress
4-6 moderate difficulty
7-10 stable
Neonatal period
birth - 28 days
need to maintain bodyheat
respiration f(x)
decrease risk of infection
proper hydration + nutrition
Proper care
First breath
increase aveolar O2 + decreased Aterial pH –> dilation of pulmonary artery -> decrease vascular resistance -> increase blood flor -> increase O2 + Co2 exchange
Signs of Respir distress
Cyanosis
abnormal resp pattern - tachy + apnea
retraction of chest wall
grunting
flaring
hypotonia
3 Phases of transition
- reactivity 1-2 hrs
- sleep 1-4
- 2nd period of reactivity 2-8 hrs
Circulatory changes
Systemic vascular resistance increase / pulmonary artery pressure - after cord clamp
Closure of shunts - foramen ovale, ductus arteriosus, ductus venosus
difficult transition
Maternal conditions - diabetes, HT
Fetus conditions - congenital anomalies
Antepartum - placenta / amniotic fluid
Delivery complications
Neonatal difficulties - lack of respir effort, blockage, impaired cardiac lung f(x)
Hematopoietic adaptations
Blood vol 80-90 ml/kg
increase of erythropoietin secreted
leukocytosis is normal - increase WBC
GI adaptations
small stomach - marble
as milk transitions fat increases more enzyme amylase lipase
meconium 8-24 hrs
weight loss 3-4 day; 3.5% formula, 7% BF
Urinary Adaptation
limited capacity to concentration of urine
- cant reabsorb water to maintain organ f(x)
- void 24 hrs
-brick dust stains
Hepatic Adaptation
40% of abdomin
iron storage
regulation of blood glucose– glycogen -> glucose >40mg
coagulation of blood
bilirubin conjucation
Immunologic Adaptation
passive immunitiy
- Ab pass through placenta ; IgG by third tei
Active immunity
IgA in colostrum
Newborn nutrition
Rapid weight gain
by 4-6 mo 2x weight
1yr 3x
100-120/kg /day
Signs of effective breastfeeding
feeding >8 in 24 hrs
swallowing
Soft breasts after feeding
# of wet diapers increase
Stools begin to lighten
Baby bottle syndrome
cavities when putting juice/soda in bottle. Hold baby while feeding.
Alcohol use
Abnormal brain and neuron development
Lbw
Premature
FAS
leading cause of mental retardation
Cocaine use
Cardiac maternal events - death
Abruption
Fetal effects - vasoconstriction neuroexfitation
Opioid use
Withdrawal symptoms from neonate
Smoking Tobacco
Decreased fertility
Increased risk of miscarriage
Previa
IUGR
cognitive impairment
Cardinal signs of diabetes
Polyuria
Polydipsia
Weight loss
Polyphagia
TD1 what are signs and symptoms of hypoglycemia
Diaphoresis and disorientation
Newborn appears LGA while scoring low for neurological maturation what explains that outcome
Maternal diabetes
Herpes simplex virus
1/6 infection
Fetal risk:
Spontaneous abortion
Preterm labor IUGR neonatal infection
Antiviral therapy after birth - acyclovir
Mg sulfate toxicity
Urinary output 20mL/hr
Blood pressure 104/62
Respiration of 7
Absent reflex
Lethargy
Excitability
NRP
N: provide warmth clear airway dry stimulate - rapid assessment
R; assess breathing
p: assess heart rate
Evaporation
Cooling of moisture with air
Convection
Heat from body is taken away from air
Conduction
Heat is transferred to an object that you are touching
Radiation
Heat is lost to an object further away
Why is surfactant needed
Avelolar stability
Decreases surface tension
Increases compliance
L/S ratio
APHAR SCORE
heart rate
0- absent
1 -60-100
2 >100
Respir
0-absent
1- slow irregular weak
2 cry
Reflex
0-no response
1-grimace
2-cry
Color
0 cyanotic
1pink and blue
2 pink
Muscle tone
0flaccis
1some flexion
2active motion
