Quiz Units C & D Flashcards
Is conception a single process?
No. It is a sequence of events which includes: Gamete formation (egg and sperm), Ovulation, Fertilization and Implantation.
Where is the egg released from?
The ruptured ovarian follicle
What increases the motility of the uterine tubes so that cilia can capture the egg and propel it towards the uterine cavity?
Estrogen
When is the fertilized egg viable?
24 hours after ovulation
Can ova move on their own?
No
Normal ejaculation produces about 1 _____ of semen, which contains about _____ million - _____ million sperm cells.
1 tsp. 200-500 million
How long does it take them to get to the uterus, and how long are they viable?
4-6 hours. 2-3 days.
What helps the sperm penetrate the protective layers of the ovum?
Enzymes produced by its acrosomal cap
Where does fertilization occur?
In the Ampulla, which is the outer 3rd of the uterine tube.
When does fertilization occur?
When there is a Zona reaction, which is when the sperm is enclosed within the outer membrane, and it becomes impenetrable to other sperm.
When is conception complete?
When the head of the sperm enlarges to become the male pronucleus and the tail degenerates. The nuclei fuse and the chromosomes combine, restoring the diploid number (46)
When does implantation (nadation) occur?
7-10 days
What is the endometrium called after implantation?
The decidua
In the 3-4 days the Zygote takes to travel the uterine tube cleavage occurs. How much does it grow in size, and what is it then called?
It does not increase in size at all, and the 16 cell ball is called a morula.
What are the 3 stages of intrauterine development called?
Ovum/preembryonic (1st 14 days), embryo (day 15-8wks), and fetus.
When do the primary germ layers differentiate? Name them.
During the embryo stage. Endoderm, mesoderm, and ectoderm
What does the ectoderm differentiate into?
Epidermis, glands, nails, hair, nervous system, lens of the eye, tooth enamel, and the floor of the amniotic cavity
What does the mesoderm differentiate into?
Bones, teeth, muscles, dermis, connective tissue, cardiovascular system, spleen, and urogenital system
What does the endoderm differentiate into?
Epithelium lining the respiratory tract, digestive tract, and glandular cells of associated organs
What is Nagele’s rule?
A way to approximate the due date. From the 1st day of LMP, add 9 months and 7 days, or subtract 3 months and add 7 days and 1 yr
What’s the difference between the G/P system and GTPAL?
G/P is just # of times pregnant/# of times delivered & GTPAL divides parity into Term and Preterm and adds Abortions and # Living
What are some s/s of Turner’s syndrome?
Thick, webbed neck, wide set nipples, cardiac anomalies, recessed chin, learning disabilities, low set ears
What is Turner’s syndrome?
A chromosomal abnormality that only affects females.
What are the s/s of Kleinfelter’s syndrome?
Small testes, gynomastia, long legs, minimal body and facial hair, infertile
What causes Down’s syndrome?
An abnormality in the # of chromosomes.
Describe multifactorial transmission defects.
Most common type, combination of environmental and genetic, causes cleft palate, neural tube defects, congenital heart disease, pyloric stenosis
What is a classic sign that a neonate might have pyloric stenosis?
Projectile vomiting
What is a “congenital” condition, and what besides genetic defects can cause them?
Congenital means present at birth. They can be caused by teratogens, like chemicals, drugs, radiation, infections, and maternal disease like PKU and DM
What is the best preventative for LBW babies and preterm delivery?
Good nutrition before and during pregnancy
What is the difference between mitosis and meiosis?
Mitosis = cell divides and makes 2 identical cells. Meiosis = cell divides and each has only 23 chromosomes (sex cells)
How long is pregnancy?
10 lunar months/9 calendar months or 280 days
What 2 layers surround the ovum?
The Zona Pellucida (inner) and the corona radiate
What happens if an egg is not fertilized?
It disintegrates and is reabsorbed
When is the egg very susceptible to teratogens?
During the preembryonic stage
What are the 2 fetal membranes called?
The chorion (inside) and the amnion (outside)
If baby has too little amniotic fluid (< 300 mL) it is called _____?
Oligohydramnios
If baby has too much amniotic fluid (> 2 L) it is called _____?
Polyhydramnios
What does oligohydramnios often signal?
Renal insufficiency
What does polyhydramnios signal?
GI problems, malformations
What is amniotic fluid derived from?
Maternal blood
How much fluid is present at full term?
About 800-1200 mL
How many arteries and veins are in the umbilical cord? How big is it?
2 arteries and 1 vein. About the size of an adult finger
What fluid keeps the vessels within the umbilical cord from compressing?
Wharton’s jelly
What hormones are produced during pregnancy?
Hcg, HPL, estrogen, progesterone
When is Hcg produced?
It starts 8 days after conception. It is at its max at 50-70 days, then decreases
What is HPL?
Human Placental Lactogen
What does HPL do?
Like growth hormone. Stimulates maternal metabolism to provide for placenta
When is fetal circulation in place and the beating of the heart?
By day 17
What is the functional unit of utero placental circulation and how many are there?
Cotyledons. 15-20
When is a fetus considered viable?
20 wks or at least 500 grams
When is a lost fetus considered an abortion?
Less than 20 wks
What is considered a term baby?
37-40 wks
What is considered a preterm baby?
20-36 wks
If a mom is pregnant for the first time with triplets, she is considered gravida _____.
- Gravida is the # of pregnancies, regardless of the # of babies involved.
Define parity.
The # of pregnancies that reach 20 wks
What is Couvade’s syndrome?
When the father feels symptoms of pregnancy
What are some presumptive indicators of pregnancy?
Missed period, positive home test, Amenorrhea, N/V, fatigue, morning sickness, urinary frequency, quickening (18-20 wks)
What are some probable s/s of pregnancy?
Uterine enlargement, Braxton Hicks ( painless contractions), Darkening of pigmentation, Chadwik’s sign (discoloration of vaginal mucosa), Hagar’s sign (lower part of uterus softens), Ballottement (feel their fetus rebound), positive pregnancy test (Hcg), uterine souffle (blood rushing thru placenta)
What are the positive s/s of pregnancy?
Examiner feels fetal movement, FHR, visualization (by ultrasound)
What are some test run immediately when pregnancy is determined?
V/S, fetal heart tones, urine protein
What is the proper Hgb for a pregnant woman?
11-12 (normal is 12-26). <11 is anemic. It drops b/c of dilution due to the increase in blood volume
What happens to RBCs during pregnancy?
Normally they are 3.8-5.1, but when pregnant they rise to 4.6-6.5
What happens to WBCs during pregnancy?
They rise from a normal level of 5-10 to 15-25
How many extra Kcal does a pregnant woman need?
300 per day
What does oxytocin do during pregnancy?
Contracts the uterus
What does prolactin do during pregnancy?
Milk production
Where is estrogen produced from during pregnancy?
Ovaries and placenta
What is the function of estrogen during pregnancy?
Stretch marks, sodium and water retention (dependent edema), enlarge uterus/breasts/cervix, vascular changes
What is the function of progesterone during pregnancy?
Maintains endometrium, inhibits contractility, promotes breast duct development
What is the function of Hcg during pregnancy?
Stimulates estrogen
What is the function of HPL during pregnancy?
Increase glucose, which stimulates the pancreas and liver and increases pigmentation
What is the function of Relaxin during pregnancy?
Relaxes and stretches connective tissue, including the cervix
What is the definition of a high risk pregnancy?
A pregnancy in which the life or health of the fetus or mother is jeopardized by a disorder unique to the pregnancy
What helps prevent infant and maternal morbidity?
Timely interventions
What is a TORCH screening?
Toxoplasmosis, other (hepatitis), rubella, cytomegalia virus, herpes. These cause 2% of the major malformations during pregnancy
When is a MMR given?
30 days after delivery, because it is a live virus
What is the U.S. infant mortality rate, and what is Healthy People 2020’s goal?
Currently it is 7.8/100,000 live births (23rd among industrialized nations). 3.3 is the goal.
What are considered “high risk” categories?
Multiple births, Rh incompatibility, 3 pregnancies in 2 years, smoking (LBW & early ROM), drugs <11, LBW (higher mortality), alcohol (FAS, learning disability, wide set eyes, nose flattened)
What risk increases when a pregnant woman is unmarried?
PIH and mortality
What is an NST and how is it administered?
Non stress test. FHR is monitored. Should see an increase of at least 15 bpm over at least 15 secs, over a 20 min period
What is a CST and how is it done?
Contraction stress test. Nipple stimulation, prolactin or pitocin is given
If everything is okay during a NST, it is said to be _____.
Reactive
If the FHR is 110 or less, what is the problem and what is done?
The baby is asleep and a buzzer or horn is used to wake it up
What is PIH?
Pregnancy Induced Hypertension - another name for preeclampsia
What is variability?
Change in heart rate of the baby
What are accelerations?
An increase in FHR
What are the 5 levels of long term variability and what are the ranges?
Absent = 0-2, Minimal = 3-5, Average = 6-10, Moderate = 10-25, Marked = >25
What do you do if a NST is non-reactive after 40 minutes?
Run a BPP
What 3 things are tested in a BPP?
Moms blood (Coomb’s/AFP), amniotic fluid analysis after 14 wks (L/S ratio, Creatinine, AFP), PUBS (percutaneous umbilical cord sampling).
What does the L/S ratio show?
2:1 = Fetal lung maturity. 3:1 is diabetic
What drug matures babies lungs?
Betamethasone, which is a steroid. 12mg - wait 24 hrs, then give 12mg more
What should creatinine levels be?
> 2mg/dL = baby >36 wks
What do high AFP levels mean?
Usually done at 16-18 wks. >40ng/mL = indicates neural tube defects such as spina bifida/anencephaly, or abdominal wall defects (omphalocele). s Syndrome
What does a Coomb’s titer ratio of 1:8 and rising mean?
Significant Rh incompatability
If a woman is found to be hypertensive during pregnancy, what determines if it is chronic or PIH?
Chronic predates the pregnancy (before wk 20) or continues after day 42 Postpartum
Can chronic HTN and PIH occur at the same time?
Yes, they can be independent of each other or occur at the same time
What is MAP and what does it have to do with PIH?
Mean Arterial Pressure = systolic + 2(diastolic)/3; if >105 = PIH
Is maternal or fetal blood tested in direct Coomb’s? Indirect Coomb’s?
Fetal. Maternal.
Is it good or bad if a direct Coomb’s result is negative?
Good. No antibodies are present in mothers blood to harm the babies blood
Who gets Rhogam, when and why?
If mom is Rh-, then she gets Rhogam at 28 wks. If baby tests Rh+, then mom gets more Rhogam within 72 hrs of birth
What is the most common medical complication of pregnancy?
HTN
What is transient HTN?
Returns to normal within 12 wks of delivery
What is the difference between eclampsia and preeclampsia?
Eclampsia means seizures. Pre = before seizures
What BP numbers indicate mild preeclampsia?
140+ systolic, 90+ diastolic, 30+ over pt’s systolic baseline, or 15+ over pt’s baseline diastolic
What level of proteinuria indicates preeclampsia?
6mg/dL or higher, or a dipstick level of 2 or more
What must always be done when checking BP on a pregnant woman?
Same arm, same position, every time. 2 high measurements at least 24 hrs apart
Where does edema occur with preeclampsia? How do you tell if it is due to this?
Face and abdomen. Have them lay down for 12 hrs and if it goes away its not preeclampsia
What is the underlying cause of preeclampsia?
Vasospasms, which increases capillary permeability, which allows fluids to collect in tissues
Who gets PIH?
First time moms (new DNA), those with chronic renal disease, 40 yrs old, genetics, multiple births, diabetics, Rh incompatibility, obese women
What is often the first sign of preeclampsia?
High blood pressure
What is considered a normal DTR? Hyperreactive? Hyporeactive?
Normal = +2; Hyperreactive = >+2; Hyporeactive = <+2
What is it called if a DTR is +4?
Ankle clonus
What defines severe preeclampsia?
Systolic >160, diastolic >110, proteinuria >5 or +3/+4 on a dipstick, oligurea/output <150,000, HELLP syndrome, Severe fetal growth restriction
What is HELLP syndrome?
H = hemolysis, E = elevated, L = liver enzymes, L = low, P = platelets (dx by labs)
What are some s/s of HELLP?
Epigastric pain, due to liver involvement, nausea, general malaise, RUQ pain
What is considered a low platelet count?
<100,000
What is usually given for severe preeclampsia?
Magnesium sulphate, maybe platelets and FFP
What is the only cure for eclampsia?
Delivery of the baby
What is the therapeutic level of magnesium sulphate?
8
What is the function of magnesium sulphate?
Reduces the possibility of seizure by decreasing muscle excitability
How is magnesium sulphate administered?
Mom is placed on her left side, 4g loading dose, then 1-2g/hr
What needs to be checked if a pt is on magnesium sulphate and how often?
DTR’s q4hr
Can mom be at home during a severe case of preeclampsia?
No, she must be in the hospital
With all of this magnesium sulphate to reduce muscle activity, how can she deliver the baby?
Lots of Pitocin
If a fetus aborts before 20 wks or 500 grams, what is usually the cause?
Chromosomal abnormalities
What type of seizure does eclampsia produce?
Tonic-clonic
Name the 7 types of abortions
Threatened, inevitable, incomplete, complete, missed, recurrent, septic
What are the s/s for a threatened abortion?
Cramping and bleeding
What is done if an abortion is inevitable?
A prompt D&E
What is done if an abortion is incomplete?
A prompt D&E
What is done for a complete AB?
Nothing, no interventions needed
What is a missed AB?
Baby has died, but labor hasn’t started. If labor hasn’t started within 1 month she is induced
What is a recurrent AB?
Miscarries every pregnancy, probably an incompetent cervix, so a circlage (stitching the cervix closed) is done, which must be undone for delivery
What is a septic abortion?
Infection causes death of fetus and must do an immediate termination, then put her on antibiotics
What drug is used first to start delivery on an aborted fetus?
Cytotec, which is a protaglandin that is inserted into the cervix to soften it for delivery
What is an ectopic pregnancy?
A pregnancy outside of the uterus. 2% of US pregnancies
Where do most ectopic pregnancies occur? Where else can they occur?
Fallopian tubes (95%). Abdomen, ovaries, and cervix
Who is most likely to have an ectopic pregnancy?
Smokers, IUD users, and those with congenital anomalies
What decreases the risk for an ectopic pregnancy?
Oral contraceptive use
Does an ectopic pregnancy increase the risk for maternal death?
Yes, 10% of maternal deaths are due to ectopic pregnancies
What are some s/s of an ectopic pregnancy?
N/V, abdominal discomfort/pain, increased temp, decreased BP, elevated WBC count (15,000+)
What causes a hydatidiform mole?
A fertilized egg that has had its nucleus lost or inactivated. It resembles a bunch of grapes
What are some s/s of a hydatidiform mole?
Hyperemesis, hCG is normal at first, then get abnormally high, then drops at about 59 days, higher fundus for gestational age
What causes a hydatidiform mole?
Decreased protein intake, Asian descent, age >35 yrs old, women with blood type A being with men that have blood type O
What can’t you do with a hydatidiform mole?
Never induce labor. If it doesn’t spontaneously abort, do D&E
What is a possible side effect of a hydatidiform mole and what is done to monitor for this?
Can become cancerous. hCG is checked for 12-18 months and she can’t get pregnant during this time period
What happens to hCG if a hydatidiform mole is malignant?
It rises instead of dropping at about 59 days. Check levels q2wks until normal, then q3wks, then monthly, then q2mo for a yr
What is another name for a hydatidiform mole?
A molar pregnancy, or gestational trophoblastic disease
What is a common cause of painless bleeding around 30 wks of pregnancy?
Placenta previa, which is when the placental attachment point covers or partially covers the cervical os
Can the baby be delivered vaginally if placenta previa has occurred?
Only if it is less than 30% covered
How is placenta previa managed?
Bedrest until viable, weekly NST or BPP, usually c-section. VS q15min, IV, fetal monitor, urine output
What don’t you do when placenta previa is diagnosed?
No vaginal or rectal exams
What is considered a normal urine output per hr?
1-2mL/kg/hr
What are the 3 types of placenta previa?
Marginal (close), partial, complete
What is an abruption?
Abruptio placentae. Placenta detaches from its attachment site. Painfull bleeding. 1/3 of infants die
What are some s/s of abruptio placentae?
Board-like abdomen, stabbing pain, DIC
What is done for abruptio placentae?
hCG, type and match, fibrinogen breakdown product test to look for DIC, (5mL’s of blood in a test tube should clot within 5 min) 18 gauge IV, O2 (mask referable), VS q5-15min, put in lateral position, no pelvic or abdominal exams, platelets/plasma, heparin after labs done, prepare for immediate birth
When do we screen for gestational DM?
24-28 wks
How do we screen for GDM?
Start with glucose challenge test - give 50mg of glucose, wait 1 hr, if BS >140, then give oral glucose tolerance test - 100mg glucose loading dose, ck BS at 1,2, and 3 hrs
What is the mortality rate for the babies of mothers with DM?
20% often have late fetal deaths
Are the babies of GDM mothers smaller than normal?
No, they are often large babies (4000 grams)
What are some risk factors for GDM?
Obesity, family hx, >30yrs of age, hx of hydramnios, baby over 9lbs, unexplained still birth
What can happen to women that have GDM in the long term?
Many develop type 2 DM later in life
What is the goal to control BS during the pregnancy?
Maintain BS at 95 or less. Maintain an accurate log (not by A1C), dietary log
How is GDM managed?
Exercise 3-4 times a week (shouldn’t require balance), diet restrictions, insulin, NST/BPP monitoring weekly
How is Hyperemesis Gravidarum defined?
Excessive vomiting during pregnancy with a weight loss greater than 5%. Often can’t swallow their own spit
What are some complications of hyperemesis gravidarum to be aware of?
Dehydration, electrolyte imbalances, ketosis, acetonuria
How is hyperemesis gravidarum managed?
NPO until no vomiting for 48 hrs, IV therapy, antiemetics (Inaspine/Reglan), restful environment, strict I&O
What are some early s/s of preterm labor?
Persistent, dull, low backache; vaginal spotting, cramping, abdominal tightening
What is the definition of preterm labor?
Consistent contractions before the end of the 37th wk. 4 contractions q20min, 1cm dilation, and >80% effaced
What is done if preterm labor is suspected?
Check for infection, Beta Strep status, give tocolytics like turbutylene/brething/procardia/endocin, do fetal kick count, magnesium sulphate (heart races)
If preterm labor can’t be stopped, what is done?
Betamethasone is given to mature lungs, especially if <34 wks. Give 2-12mg doses 24hrs apart. It lasts 7 days
What is a prolapsed cord and what can cause it?
The cord is below the presenting part of the fetus causing it to be compressed, which causes variable decelerations. Long cord (>100cm), malpresentation of the fetus
What is done for a prolapsed cord?
Trendellenburg, knee/chest, modified sims, O2 at 8-10L, continuous FHR monitoring, immediate delivery if dilated, C-section if not
What are the s/s of an emergency prolapsed cord?
Fetal bradycardia with variable decels, cord is seen or felt
What is done if the prolapsed cord is presenting in front of the fetal head and seen and/or felt in the vagina?
With gloved hand insert 2 fingers in the vagina, one on either side of the cord, relieve pressure on the cord
What is an AFE and what causes it?
Amniotic fluid embolism. Caused by debris and amniotic fluid entering moms blood stream, causing obstruction of pulmonary vessels, respiratory distress, and circulatory collapse
What are the s/s of AFE?
Restless, dyspnea, cyanosis, pulmonary edema, respiratory arrest, hypotension, tachycardia, shock, cardiac arrest, hemorrhage, uterine atony
What are some interventions for AFE?
O2 at 8-10L, ventilate, replace fluids, tilt at 30 degrees, PRBCs and FFP, hourly I&O, clotting panel, chem panel, renal function
What are some common problems associated with multiples?
Previa, premature ROM/birth, congenital malformations 2x more common, 2 vessel cord, preeclampsia, twin/twin transfusion, common in non-whites, hyramnios
All babies have jaundice to some degree, what causes it?
Bilirubin, which turns the skin yellow, is a breakdown product of RBC destruction, which occurs in the newborn due to RBC overabundance
What’s the difference between a direct Coomb’s and an indirect Coomb’s?
Direct is done on the baby and indirect on mom
When should Rhogam be given to a mom within 72 hrs of birth?
If baby is Rh+ and direct Coomb’s is negative
What test result on mom would indicate an Rh incompatibility and indicate the need for Rhogam?
If indirect Coomb’s was 1:8 and rising
What blood type is the universal donor? Universal recipient? Most common type in Indiana?
Universal donor = O-, Universal recipient = AB+, & Indiana = A+
Name the 5 P’s of the birthing process
Passenger, passageway, powers, position, psychological response
How much Rhogam is given?
300mcg of Rho D immune globulin. It lasts about 2-4wks
How would we describe the “lie” of the baby?
Relationship of maternal spine to fetal spine
How would we describe the “attitude” of the baby?
Relationship of baby’s small parts to each other, chin (flexion or extension), arms, legs
How would we describe the “position” of the baby and what are the 2 subunits of position?
Where baby is within mom’s 4 quadrants. Station and engagement
If baby’s feet are both in his face and he is presenting his posterior first, it is called a _____ presentation.
Frank breech
What is considered “zero” station?
The presenting part is at the ischial spines
Does the Toco transducer tell us how strong the contractions are?
Not accurately. We need to feel the contractions and use the “nose/chin/forehead” method
Whats the difference between primary and secondary powers?
Primary are involuntary, secondary are voluntary
What are some s/s preceding true labor?
Lightening as baby moves lower, increased mucous, Braxton Hicks contractions, bloody show
What are the stages of labor
Stage 1 (Latent = 0-3cm dilation)(Active = 4-7cm dilation)(Transitional = 8-10cm dilation), 2nd stage is complete dilation and delivery, 3rd stage is placental delivery, & 4th stage is postpartum
