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Maternal health > T1: Antepartum/Preg.Adaptations/Trends/Family/Culture > Flashcards

T1: Antepartum/Preg.Adaptations/Trends/Family/Culture Flashcards

1
Q

What does LMP or PMP stand for?

A

LMP: Last Menstrual Period

PMP: Previous Menstrual Period (the one B4 the LMP)

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2
Q

Meaning of Gravid:

A

Pregnant.

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3
Q

What expression is used regarding the number of deliveries greater than 20 weeks?

A

Para (Pr.)

Deliveries greater than or equal to 20 weeks.

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4
Q

What does nulligravida mean?

A

Never been pregnant.

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5
Q

What terminology do we use regarding a woman’s first pregnancy?

A

Primigravida.

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6
Q

Means “more than one pregnancy”:

A

Multigravida.

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7
Q

This means “never delivered beyond 20 weeks”:

A

Nullipara.

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8
Q

This means “first time delivering after 20 weeks”:

A

Primipara.

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9
Q

Also known as “mul-tips,” means more than one delivery past 20 weeks:

A

Multipara.

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10
Q

A pregnancy that is lost B4 20 weeks:

A

Abortion (AB).

SAB = Spontaneous
TAB = Therapeutic
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11
Q

TPAL stands for?

A

It is a classification of pregnancy history:

T is # of full-term births (38 wks +)

P is # of preterm births (20-37 wks)

A is # of abortions (less than 20 wks)

L is # of living children

AKA Parady #

Ex: Gr 3 Pr2103 = 2 full-term, 1 pre-term, 3 living

Twins + count as one birth.

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12
Q

How do we calculate delivery dates?

A

Naegle’s Rule (from 1800’s)
From First day of LMP
Minus 3 months
Plus 7 days.

EDC and EDD:
Estimated Date of Confinement (Due date)
Estimated Date of Delivery

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13
Q

If patient has LMP of 10/21, what would be their due date?

A

July 28.

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14
Q

What sort of information would we like regarding their pregnancy history?

A

Have they ever gone into early labor?

Ever had gestational diabetes?

Experience postpartum depression?

Preeclampsia?

Twins run in the family?

Any medications or supplements?

Diet and exercise.

Social Hx: smoking, alcohol, drug use

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15
Q

What lab work is done on the first visit?

A

Pregnancy test.

UA: glucose and protein dipstick

Serology for syphilis (it’s on the rise, damaging to the fetus and treatable)

CBC: Blood type and Rh factor

HIV, Hepatitis, STI’s are not done routinely but are always encouraged, esp. chlamydia.

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16
Q

What is performed each routine visit?

A
  1. Uterine palpation for position (Leopold’s Maneuvers).
  2. FHT: Fetal Heart Tones (Doplar at 12 wks, steth. at 18 wks)
  3. Measurement of fundal height (in centimeters).
  4. Urine dipstick for glucose and protein.
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17
Q

What test is routinely done around the 24th week?

A

GTT and hematocrit

Glucose Tolerance Test : looking for gestational diabetes

Hct looking for anemia (blood vol is increased)

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18
Q

What swab test is performed around 35-37 weeks?

A

Group B strep.

Swab around the vag/rectal area.

Can harm the baby and is treatable with antibiotics.

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19
Q

What is the total desirable weight to gain during pregnancy?

A

Approx. 25-35 pounds.

Depends on BMI

1st Trimester: 3-5 pounds
2nd and 3rd: 1 lb/week

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20
Q

What are some maternal risks of obesity in pregnancy?

A
  1. Infertility
  2. Gestational HTN/Preeclampsia
  3. Gestational DM
  4. Sleep apnea
  5. Infections
  6. Thromboembolic dx
  7. C/section
  8. Anesthesia problems
  9. PP hemorrhage (postpartum).
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21
Q

What are some risks for the fetus for obesity in pregnancy?

A
  1. SAB
  2. Intrauterine fetal death
  3. Neural tube defects
  4. Heart defects

note: mother’s sleep apnea also lowers O2 to the fetus.
The first trimester (when most of the baby is put together) should not be to lose weight, so pre-pregnant planning should be in effect.

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22
Q

How many additional calories are needed per day per trimester?

A

First: 150 cal/ day

2nd and 3rd: 350 cal/ day

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23
Q

What nutrients are needed to increase during pregnancy?

A
  • Need 30% more protein.
  • 50% more iron (esp. in the last trimester when the baby is storing iron).
  • Calcium… need adequate amt, most ppl don’t get enough. Needed for bone and cell formation.
  • 50% more folic acid
  • Increase in B6 1.9mg (1.3mg normal) , B12 2.6mcg (2.4 mcg normal) Lactating women 2mg B6 and 2.8mcg B12.
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24
Q

What are some foods to avoid during pregnancy?

A

Predator fish: Sword, Tuna, Mackerel, Shark.

Soft cheeses: Brie, Camembert, Feta, Blue, unpasteurized.

Deli salads

Cold cuts, hot dogs, smoked meats.

Wash all fruit and vegetables well.

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25
Q

Name some common teratogens:

A
  1. Medicine ex: aspirin can cause fetal cerebral bleeding.
  2. Herbal/homeopathic supplements ex: Cohosh can cause bleeding and preterm labor.
  3. Smoking (30% increased risk of stillbirth if smoke MJ)
  4. Alcohol
  5. Caffeine (New England Journal of Medicine = 30% increased risk of SAB if drink 1 cup of caffeinated beverage a day. Tea, coffee, soda, etc.)
  6. X-rays
  7. Viruses/other microbes. (Zika)
26
Q

What are the vaccines safe to receive in pregnancy?

A
  1. Injectable Flu (not nasal spray): Trivalent inactivated
  2. Hep A and B
  3. Pneumococcal
  4. Meningococcal
  5. Tdap - is received during EACH pregnancy between 27 and 36 weeks.
27
Q

What vaccines to AVOID during pregnancy?

A
  1. Live-attenuated intranasal influenza
  2. Measles/Mumps/Rubella (MMR)
  3. Varicella (chickenpox)
  4. Herpes Zoster
  5. HPV: Human Papillomavirus (under study)
28
Q

Which vaccines are considered safe with breastfeeding?

A

All except smallpox and yellow fever.

29
Q

No 103 temp greater than 10 minutes (no hot tub, sauna, tanning)

Gingivitis = preterm labor

Travel ok but need to get up and walk frequently to avoid clots.

A

No limit to employment if no problems.

Avoid jarring activities: horses, skiing…

No bikes = balance

Don’t lay on back (inferior vena cava) lay on LT

30
Q

When does the pregnant woman’s BP go down?
What is a normal WBC?
Why does the Hct go down?

A

In the 2nd trimester.

They can have a WBC of 15 with no infection (norm is 4-10).

Hematocrit and Hgb % decreases due to the higher blood volume, the higher plasma throws %’s off.

31
Q

How low can the Hct go down before concerned?

how low can Hgb go down before concerned?

A

Hct can go down to 35.

Hgb can go down to 10 (“pseudoanemia”)

32
Q

Besides an increase in circulating blood volume and WBC, a decrease in Hct and Hgb, the relaxation of smooth muscle and decrease in vascular resistance, what else happens to the cardiovascular system during pregnancy? CO? BP? Clotting times?

A

Cardiac output increases because of the extra blood. The heart can either beat faster or harder, or both. Hypertrophy is normal. Increase pulse is normal.

Increased BP is NOT normal. The BP usually decreases in the 2nd trimester.

Clotting time goes down because of the increase of fibrinogen to prevent bleed out after delivery. Increases the risk for clots though.

33
Q

What happens to the respiratory system during pregnancy?

A
  • Increase in O2 consumption due to increase of blood.
  • Respirations are deeper (not faster), the rib cage opens up to the sides to accommodate. Muscles and cartilage of the chest relax.
  • Hyperventilation can lead to dizziness/syncope.
34
Q

What happens to the ureters, peristalsis, UTI’s/nephritis, blood flow to kidneys, plasma filtration rate, and renal output during pregnancy?

A
  • Ureters are smooth muscle, so they relax or dilate.
  • Peristalsis slows creating a greater chance for urine stasis and UTI’s and nephritis.
  • The blood flow to the kidneys increases.
  • The plasma filtration rate increases, which leads to an increase in urine output. This also creates more room for error so it is normal to find trace glucose and trace proteins in the urine of a woman who is pregnant.
  • Due to these renal changes and also due to the increase of estrogen and progesterone (they increase water retention), she may experience dependent edema as well.
35
Q

What does the Mesoderm (middle layer) of the embryonic disk develop in to?

A

The muscles, bone, dermis, connective tissue, circulatory system, urinary system, and reproductive organs.

36
Q

What does the Endoderm (inner layer) of the embryonic disk develop in to?

A

The digestive system, and respiratory track.

37
Q

What does the Ectoderm (outer layer) of the embryonic disk develop in to?

A

The epidermis, nervous system, and special sense organs (eyes, ears, taste buds, and olfactory bulb).

38
Q

What do we call the endometrium after implantation has occurred?

A

The Decidua.

39
Q

What is the name of the fertilized egg for the first 3-4 days?
The following 3 days after that?
When it implants?
After implantation?

A

Zygote.

Morula.

Blastocyst.

Embryo.

40
Q

How long is the pre-embryonic stage of growth?

A

From fertilization to implantation, 1-2 weeks.

41
Q

How long is the embryonic stage of growth?

A

From implantation up to 8 weeks gestation (weeks gestation begin with the 1st date of LMP).

A period of development/differentiation.

All internal organs have been developed during this stage and are functioning to a certain extent. They are developed by 8 weeks… just need further development.

42
Q

How long is the fetus stage of growth?

A

8 weeks to term.

A period of growth.

43
Q

What are the 5 major functions of the placenta?

A
  1. Passage of nutrients: carbs, fats, proteins, water, calcium, iron, and vitamins.
  2. Transfer of waste: CO2, and nutritional waste.
  3. Gas exchange: O2, CO2
  4. Barrier (semi-permeable membrane): large molecules can’t pass through (maternal blood cells), large bacteria can’t. However, many viruses, drugs, other organisms, fetal antigens/bodies CAN pass through.
  5. Hormone production: necessary to support the pregnancy: progesterone, estrogen and placenta-lactagen sp?
44
Q

What are the functions of the amniotic fluid?

A
  1. Allows freedom of movement: MSK development and prevents cord compression.
  2. Keeps the temperature constant.
  3. Acts as a shock absorber. Protects from any external maternal injuries.
  4. Provides even pressure. Allows body structures to mold evenly.
45
Q

What do we call the fetal opening between the Rt and Lt atria?

The vessel connecting the pulmonary artery to the aorta?

The vessel connecting the umbilical vein to the inferior vena cava?

A

Foramen Ovale.

Ductus Arteriosus.

Ductus Venosus. Bypasses the fetal liver.

46
Q

What does the Chorion layer of cells develop in to?

A

The placenta.

47
Q

What does the Amnion layer of cells develop in to?

A

The amniotic sac.

48
Q

What does the connecting stalk/body develop in to?

A

The umbilical cord.

49
Q

How long is the umbilical cord in a full term baby?

A

Approx. 22” long.

50
Q

What direction, what does it carry, and how many are there, in the umbilical vein?

A

Carries oxygenated blood to the fetus from the mother. There is one. This vein is similar to the pulmonary vein in that they carry oxygenated blood.

51
Q

What direction, what does it carry, and how many are there, in the umbilical arteries?

A

The 2 small umbilical arteries carry unoxygenated blood away from the fetus to the mother.

52
Q

What is Wharton’s jelly?

A

The soft inner portion of the umbilical cord that protects the vein and arteries.

53
Q

When does the heart begin to beat?

A

4 weeks

54
Q

When are all of the internal organs present?

A

8 weeks

55
Q

When are we able to hear the heart beat via doppler?

A

12 weeks

placenta is not functioning.

56
Q

When can the fetus react to light?

A

16 weeks

57
Q

Quickening is experienced at how many weeks?

A

16-20 weeks

Lanugo is present at 20 weeks.

Considered “viable.” (20-24)

58
Q

At what week is the vernix caseosa present?

A

24 weeks

59
Q

When does the fetus respond to sound?

A

28 weeks

60
Q

What week does the fetus really begin to put on weight?

A

32 weeks

61
Q

About what week is the fetus around 19” long, 6 lbs and well padded with subQ fat?

A

36 weeks

62
Q

At this time the fetus has abundant vernix, but lanugo is mostly gone:

A

40 weeks.

20”, 7 lbs.

Maternal health (5 decks)

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