Quiz 3 Flashcards

1
Q

Preterm Birth

A

20 0/7 wk - 36 6/7 wks

decreasing in US @9.5% 2015
highest among AA + hispanic

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2
Q

Spontaneous Preterm Labor

A

unintentional delivery <37wk

Cause: infection or inflammation

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3
Q

Non-Medically indicated

A

C-section/ labor absence of medical need

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4
Q

Medically indicated

A

healthcare provider recommends preterm labor delivery
Cause: preeclampsia

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5
Q

Cervical insufficiency

A

the inability of cervix to retain preg in absence of sign/symptoms of contractions, labor or both in 2nd tri

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6
Q

Multiple Gestation

A

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
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7
Q

Placenta types

A
  1. monochorionic (1 chorion) - 70% monozygotic
  2. dichorionic (2 chorions) - always dizygotic
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8
Q

Twin pregnancy complications

A

Spontaneous delivery
HT + Preeclampsia
gestational diabetes
Antepartum hemorrhage
acute fatty liver
Abruptio placentae

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9
Q

Hyperemesis Gravidarum

A

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.

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10
Q

Diabetes

A

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

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11
Q

Pregestational Diabetes

A

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

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12
Q

Gestational Diabetes

A

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

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13
Q

Preeclampsia

A

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

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14
Q

HELLP syndrome

A

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.

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15
Q

Eclampsia

A

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

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16
Q

Placenta Previa

A

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

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17
Q

Placenta Abruption

A

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

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18
Q

Placenta Accreta

A

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

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19
Q

Abortion

A

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

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20
Q

Ectopic Pregnancy

A

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

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21
Q

Gestational Trophoblastic Disease

A

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

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22
Q

Substance Abuse during Preg

A

Most prevalent in 1-2tri; may be associated w. abnormalities like still birth, fetal growth restriction, neurological development - hyperactivity

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23
Q

Screening for gestational diabetes

A

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%

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24
Q

Preg Complications

A

RH Factor
ABO Incompatibility
Ectopic Preg
HSV
GBS
Preeclampsia
Gestational Trophoblastic Disease

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25
Q

Rh Alloimmunization

A

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

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26
Q

ABO Incompatibility

A

Mother type O infant A/B

Maternal serum Ab cross placenta
- hemolysis of fetal RBC
- mild anemia
-jaundice
Not treated antenatally or prophylactic

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27
Q

GBS

A

Group B Strep.
In GI/GU

Treatment: decrease the bacterial load to limit exposure to fetus

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28
Q

Hydatiform Mole

A

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

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29
Q

Polyhydraminos

A

excessive amniotic fluid >2000mL
associated with fetal GI anomalies + maternal diabetes

Treatment:
remove amniotic fluid

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30
Q

Oligohydramnios

A

scanty amniotic fluid <500mL
risk: fetal adhesion + malformations
Treatment: amniofusion

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31
Q

Neonatal assessment

A

2hrs after birth - general survey, physical assessment, gestational assessment + pain assessment

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32
Q

Dubowitz Neurological Exam

A

assessed 33 responses in 4 areas
1. habituation - response to repetitive light/sound stimuli
2. movement + muscle tone
3. reflexes
4. neurobehavioral items

33
Q

Ballard Maturation

A

assesses physical + neuromuscular activity + maturity
- less time than dubowitz
classifies if neonate is avg for gestational weight, lga or sga

34
Q

Periods of reactivity/inactivity

A

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

35
Q

Brazeiton Neonatal Behavioral Assessment Scale

A

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

36
Q

Infant Danger Signs

A

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

37
Q

Ballard Tool

A

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

38
Q

Newborn Vitals

A

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

39
Q

Caput succedaneum

A

swelling under the skin of the scalp - fluid filled
crosses suture lines

40
Q

Cephalhematoma

A

collection of blood from broken blood vessels that build up under scalp
- doesnt suture line

41
Q

Craniosynostosis

A

premature closure of suture
- restricts growth perpendicular + compensatory overgrowth in unrestricted regions

42
Q

plaglocephaly

A

develops when an infant’s soft skull becomes flattened in one area, due to repeated pressure on one part of the head

43
Q

Milia

A

white dots on skin

44
Q

Erythema Toxicum

A

papules on skin last up to 5 days

45
Q

Skin Variations

A

Vernix Caseosa
Forceps marks
telangiectatic nevi
mongolian spots
nevus flammeus
stork bites

46
Q

Reflexes

A

Tonic-neck
Moro
Grasping
Rooting
Sucking
Babinski
Trunk incurvation

Protective
Blink
yawn
cough
sneeze
extrusion reflex

47
Q

Discharge teaching

A

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

48
Q

Apgar

A

HR + Auscultation
respiration rate
muscle tone
relex irritability
color

Score:
o-3 - severe distress
4-6 moderate difficulty
7-10 stable

49
Q

Neonatal period

A

birth - 28 days

need to maintain bodyheat
respiration f(x)
decrease risk of infection
proper hydration + nutrition
Proper care

50
Q

First breath

A

increase aveolar O2 + decreased Aterial pH –> dilation of pulmonary artery -> decrease vascular resistance -> increase blood flor -> increase O2 + Co2 exchange

51
Q

Signs of Respir distress

A

Cyanosis
abnormal resp pattern - tachy + apnea
retraction of chest wall
grunting
flaring
hypotonia

52
Q

3 Phases of transition

A
  1. reactivity 1-2 hrs
  2. sleep 1-4
  3. 2nd period of reactivity 2-8 hrs
53
Q

Circulatory changes

A

Systemic vascular resistance increase / pulmonary artery pressure - after cord clamp
Closure of shunts - foramen ovale, ductus arteriosus, ductus venosus

54
Q

difficult transition

A

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)

55
Q

Hematopoietic adaptations

A

Blood vol 80-90 ml/kg
increase of erythropoietin secreted
leukocytosis is normal - increase WBC

56
Q

GI adaptations

A

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

57
Q

Urinary Adaptation

A

limited capacity to concentration of urine
- cant reabsorb water to maintain organ f(x)
- void 24 hrs
-brick dust stains

58
Q

Hepatic Adaptation

A

40% of abdomin
iron storage
regulation of blood glucose– glycogen -> glucose >40mg
coagulation of blood
bilirubin conjucation

59
Q

Immunologic Adaptation

A

passive immunitiy
- Ab pass through placenta ; IgG by third tei
Active immunity
IgA in colostrum

60
Q

Newborn nutrition

A

Rapid weight gain
by 4-6 mo 2x weight
1yr 3x

100-120/kg /day

61
Q

Signs of effective breastfeeding

A

feeding >8 in 24 hrs
swallowing
Soft breasts after feeding
# of wet diapers increase
Stools begin to lighten

62
Q

Baby bottle syndrome

A

cavities when putting juice/soda in bottle. Hold baby while feeding.

63
Q

Alcohol use

A

Abnormal brain and neuron development
Lbw
Premature
FAS
leading cause of mental retardation

64
Q

Cocaine use

A

Cardiac maternal events - death
Abruption
Fetal effects - vasoconstriction neuroexfitation

65
Q

Opioid use

A

Withdrawal symptoms from neonate

66
Q

Smoking Tobacco

A

Decreased fertility
Increased risk of miscarriage
Previa
IUGR
cognitive impairment

67
Q

Cardinal signs of diabetes

A

Polyuria
Polydipsia
Weight loss
Polyphagia

68
Q

TD1 what are signs and symptoms of hypoglycemia

A

Diaphoresis and disorientation

69
Q

Newborn appears LGA while scoring low for neurological maturation what explains that outcome

A

Maternal diabetes

70
Q

Herpes simplex virus

A

1/6 infection
Fetal risk:
Spontaneous abortion
Preterm labor IUGR neonatal infection

Antiviral therapy after birth - acyclovir

71
Q

Mg sulfate toxicity

A

Urinary output 20mL/hr
Blood pressure 104/62
Respiration of 7
Absent reflex
Lethargy
Excitability

72
Q

NRP

A

N: provide warmth clear airway dry stimulate - rapid assessment
R; assess breathing
p: assess heart rate

73
Q

Evaporation

A

Cooling of moisture with air

74
Q

Convection

A

Heat from body is taken away from air

75
Q

Conduction

A

Heat is transferred to an object that you are touching

76
Q

Radiation

A

Heat is lost to an object further away

77
Q

Why is surfactant needed

A

Avelolar stability
Decreases surface tension
Increases compliance
L/S ratio

78
Q

APHAR SCORE

A

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