test 2 - antepartum through fetal circulation Flashcards
1
Q
ambivalence is related to this trimester
A
1st trimester
2
Q
what is ambivalence and what are some possible causes
A
mixed or contradictory feelings towards the pregnancy; planned/unplanned, finances, ability to care for the child
3
Q
acceptance is related to this trimester
A
2nd trimester
4
Q
what are some hallmarks of the 2nd trimester
A
morning sickness, beginning to wear maternity clothes, thinking about nursery, baby becomes “real” to mom, seeks out other pregnant women or mothers for advice/comparison, quickening
5
Q
introversion is related to this trimester
A
3rd trimester
6
Q
what are some hallmarks of the 3rd trimester
A
strong emotion and attachment to baby, reality of labor kicks in (may feel anxiety about this), discomfort, burst of nesting energy
7
Q
when may mom experience labile emotions and body image issues (vulnerable/sensitive)
A
throughout pregnancy
8
Q
what is Rubin’s 1st psychological task in pregnancy
A
pregnancy validation
9
Q
what can we see as part of pregnancy validation
A
incorporation of fetus into body image (fetal embodiment)
10
Q
what is Rubin’s 2nd psychological task in pregnancy
A
fetal distinction
11
Q
what can we see as part of fetal distinction
A
mom views fetus as an individual being,
develops unique mothering identity, accepts body image,
becomes more dependent on support system
12
Q
what is Rubin’s 3rd psychological task in pregnancyp
A
role transition
13
Q
what can be seen during role transition
A
mom prepares to give up the fetus in the L&D experience,
anxiety (r/t child birth)
nesting
14
Q
what type of pregnancy symptoms are subjective
A
presumptive signs
15
Q
what are the presumptive signs of pregnancy
A
- amenorrhea
- N/V (morning sickness)
- breast changes
- urinary frequency
- quickening
- fatigue
16
Q
when does N/V typically appear and peak
A
~6-12wks
peaks at ~10wks
17
Q
what are some breast changes that may occur
A
fullness, tenderness, tingles, increased areola pigmentation
18
Q
what causes amenorrhea during pregnancy
A
increased HCG and metabolism changes
19
Q
what type of pregnancy symptoms are objective (diagnostic but not definitive)
A
- changes in cervix
- changes in uterine size, shape, consistency
- uterine souffle
- braxton hicks ctxn
- (+) pregnancy test
- changes in skin pigmentation
- ballottement
20
Q
what are the 3 cervical change signs
A
Goodells - softening
Chadwicks - increased pigmentation (deep red/purple)
Hagars - (soft spongy area ~6-8wks)
21
Q
when should the fundus be above the symphysis pubis
A
10-12wks
22
Q
when should the fundus be at the umbilicus
A
20-22wks
23
Q
what is Braun Von Fernald’s sign and when does it occur
A
softening and enlargement of uterus at implantation site; occurs at ~5-8wks
24
Q
what is Ladin’s sign, when does it occur, and how is it tested
A
softening in the anterior midline of the uterus; ~6wks; manual exam
25
what is McDonald's sign, and what does it evaluate
body of uterus can be flexed against cervix; baby growth and amniotic fluid
26
when should baby's height be equal to gestational age
16-32wks
27
what is Piscaceks sign
tumor-like enlargement of uterus at site of implantation
28
what is uterine souffle
soft, blowing sound of the blood through the placenta -- goes at the same rate as moms HR
29
when can mom expect to feel braxton hicks and how are they distinguished from real contractions
~28wks; painless and irregular, and goes away with activity
30
what is ballottement
passive fetal movement away from tapping stimulation towards teh lower area of the abd
31
what are some skin pigmentation changes mom could expect to see
abdominal striae - stretch marks
linea nigra - dark line down middle of abd
facial melasma (chloasma) - darkening of the skin on the forehead and around eyes (~16wks)
32
what type of pregnancy symptoms are diagnostic
positive signs
33
what are the positive signs of pregnancy
FHTs (12-20wks)
vaginal U/S
fetal movements (18-20wks)
34
what can be seen on a vaginal U/S from 4-6wks
gestational sac
35
what can be seen on a vaginal U/S from 8-10wks
fetal parts/heart movement
36
what can be seen on a vaginal U/S from 10-12wks
movement
37
how early can the beta-subunit radio immunoassay (RIA) test show a positive and how long does it take to perform
2-8 days after implantation
a few hours
38
what is the RIA test used to dx
ectopic pregnancy or trophoblastic dz
39
how does the immunoradiometric assay (IRMA) test work and how long does it take
detects low levels of HCG with radioactive antibodies;
about 30 mins
40
how early can the enzyme-linked immunosorbent assay (ELISA) test detect a positive
as early as 7-9 days after conception or 5 days before first missed period
41
how does the ELISA test work and how long does it take
substance that results in color change after binding; quick and sensitive
42
what does the direct ELISA test for
antigens
43
what does the fluoroimmunoassay (FIA) test identify and how long does it take to perform
identify and follows HCG concentration; takes 2-3 hours; extremely sensitive
44
what does the indirect ELISA test for
antibodies
45
what kind of test is given OTC and how does it work
enzyme immunoassay; sensitive to low levels of HCG in the urine
46
what is uterine growth during pregnancy due to
hypertrophy (muscle fibers become 7-11x longer and 2-7x weaker) and
hyperplasia (new muscle fibers)
47
what is the blood volume that the uterus contains at birth compared to usually
10mL -> 5,000mL (1/6 of total volume)
48
how are the ovaries affected in pregnancy
decreased FSH and increased estrogen and progesterone secretion
49
how is the vagina physically effected in pregnancy
increased blood supply and relaxed connective tissue (d/t inc estrogen)
50
how is the vagina chemically affected in pregnancy
increased pH to inhibit bacteria (pH 3.5-3.6)
51
what does discharge look like d/t inc pH in the vagina
thick and white
52
how are the kidneys affected in pregnancy
increased GFR, tubular resorption, renal plasma flow, excretion of drugs - d/t increased blood flow and waste
decreased BUN and absorption of glucose - d/t increased filtering of urea
52
how are the breasts affected in pregnancy
hyperplasia of areola tissue
hypertrophy of Montgomery follicles
(d/t inc estrogen and progesterone)
53
when does the bladder receive the most pressure in pregnancy
1st and 3rd trimester
54
what organ has the most increased vasculature in pregnancy
the bladder
55
how are the ureters affected in pregnancy and what risk factors are there as a result of these changes
dilated and elongated and inc risk of UTI d/t sag and stasis of urine
56
how does inc progesterone affect the GI system
relaxation of smooth muscle -> constipation, flatulence, bloating
57
increased venous pressure and decreased tone in the GI system during pregnancy can lead to what
hemorrhoids
58
increased estrogen causes what effects in the endocrine system
increased: thyroxine (T4), BMR
decreased: TSH
59
how is the parathyroid affected by pregnancy
increased activity parallels fetal Ca++ requirements - doubles at 15-32wks mirroring fetal bone development
60
what role does the anterior pituitary play in pregnancy
FSH & LH - make pregnancy possible
thyroptopin: stimulates thyroid and ACTH
ACTH: controls release of cortisol affecting BP, inflammation, and metabolism
61
what gland secretes prolactin and what role does prolactin play
secreted by anterior pituitary and initiates milk production and lactation
62
what does the posterior pituitary secrete and what roles do they play in pregnancy
ocytocin: stimulates contractions and milk let down
vasopressin (ADH): increase BP by vasoconstriction
63
what role do the adrenals play in pregnancy
estrogen causes hypertophy of the adrenals causes inc coritco-steroid and aldosterone secretion (which increases Na+ resorption by kidneys)
64
what hormones does the placenta secrete and what are they responsible for
relaxin - soften cervix and inhibit uterine activity
estrogen - growth and development of fetus
progesterone - (dec) inhibit uterine ctxn and menses causing hormones
HCG
HPL (human placental lactogen) - inc fatty acids in maternal circulation
65
what effects does HPL have during pregnancy
- inc fatty acids in maternal circulation -> dec metabolism of glucose
- prepares body for BF and regulates metabolism
- promotes breast growth and differentiation
- regulate insulin sensitivity
66
when is HPL detectable and when does it peak
detectable ~6wks and peaks at 30wks
67
when does diabetogenesis occur
late pregnancy
68
what occurs that triggers diabetogenesis
insulin becomes more protein bound and is less reactive -- insulin also destroyed in the placenta
69
when does CO peak during pregnancy
increases 30-50% and peaks at 25-30wks and remains high
70
plasma and RBCs increase up to ___
1.5L
71
what is hydremia of pregnancy
the ability to withstand bloodloss d/t disproportional blood volume increase of RBCs
72
hydremia of pregnancy increases the bodies need for ____
iron
73
what lab values related to the blood are increased in pregnancy
absolute RBC, Hgb, plasma fibrinogen, clotting factors, WBC, ESR,
74
what lab values related to the blood are decreased during pregnancy
albumin, Hct
75
decreased Hct causes what kind of anemia in pregnancy
pseudo-anemia d/t dilution of hct
76
HCT changes during pregnancy
32-42% - decreased
77
Hgb level changes during pregnancy
10-14g/dL - increased
78
PLT level changes during pregnancy
increase from 150,000 3-5 days pp
79
PTT changes during pregnancy
slightly decreased from 12-14sec
80
fibrinogen levels during pregnancy
2.3-6.2g/dL - increased
81
WBC levels during pregnancy
5,000-15,000/mm3
82
progesterone has what effects on the respiratory system during pregnancy
decreases airway resistance, CO2 levels
increases O2 consumption and tidal volume
83
what PO2 level does the fetus need to survive in mom
62
84
estrogen causes what respiratory effects in pregnancy
increased vascular congestion of nasal mucosa -> rhinitis, nasal stuffiness, epistaxis (nose bleeds)
85
what integumentary changes occur in pregnancy
estrogen and progesterone increase MSH from 2nd month forward causing increased pigmentation on abd and face
86
musculoskeletal effects of pregnancy
increased need for Ca++, relaxin and progesterone cause waddling gate, symphysis pubis spread
87
what is diastasis recti
when the abd muscles split in pregnancy
88
how many calories should be consumed /day during pregnancy
2300-2400 cal/day
89
how much iron should be consumed /day during pregnancy
30mg
90
where does the fetus store extra iron
in the liver for after birth
91
what are good food sources of iron
organ meats, dried fruits, green leafy veggies, eggs, fortified cereals
92
what should be taken with iron to aid in utilization
vitamin C
93
how much protein should be consumed /day during pregnancy
60-65mg/day
94
what leads to inc pro needs
increased GFR => increased amino acid loss => inc need for pro
95
food sources of protein
meats, eggs, legumes, dairy
96
what is the total weight gain that can be seen in pregnancy
25-35lb
97
how much weight is gained in the first trimester
2-4lb
98
how much weight is gained in the 2nd and 3rd trimesters
1lb/week
99
when do we primarily see gain in mom
second trimester
100
when do we primarily see gain in baby
3rd trimester
101
what is considered inadequate weight gain
<2.2lb/month in 2&3 trimesters
102
what is considered excessive weight gain
≥6.6lb/month
103
when is the first trimester
LMP - 13wks
104
when is the second trimester
14-26wks
105
when is the third trimester
27-40wks
106
what vitamins are not stored in the body and must be taken daily
water soluble vitamins C and B
107
what vitamin prevents macrolytic megoblastic anemias and neural tube defects
folic acid
108
what B vitamins are needed for DNA and RBC production
B9 and B12
109
what is anecephaly
missing or incomplete skull bones and underdeveloped brain
110
what is spina bifida occulta
very minor, characterized by a dimple above the buttocks
111
what is spina bifida menignocele
meninges and CSF are presenting outside the body, WITHOUT NEURAL ELEMENTS
112
what is spina bifida myelomeningocele
meninges and CSF are presenting outside the body WITH NEURAL ELEMENTS such as the spinal cord
113
what is the RDA of folic acid when pregnant and lactating
600mcg/day when pregnant and 500mcg/day when lactating
114
what is the RDA of folic acid if there is a family hx of neural tube defects
1000mcg/day
115
what is the RDA of calcium for <19yo
~1300 mg/day
116
what is the RDA of calcium for >19yo
~1000 mg/day
117
what does EDC stand for
estimated date of confinement
118
what does EDD stand for
estimated date of deliver
119
what does EDB stand for
estimated date of birth
120
what is Negeles rule
first day of LMP - 3mo + 7days + 1 year = EDD
121
when is Negeles rule not accurate
irregular periods/amenorrhea, ovulating during BF, oral contraception, previous miscarriage/abortion
122
how accurate is the height of the fundus method for estimating gestation
+/- 2 weeks
123
when is estimating gestation by the height of the fundus inaccurate
late in pregnancy, obesity, presence of uterine fibroids or hydramnios
124
where should the fundus be at 10wks
symphysis pubis
125
where should the fundus be at 20 wks
umbilicus (20cm)
126
where should the fundus be at 26wks
26cm
127
where should the fundus be at 8mo
xyphoid process
128
what happens with the fundus at 9mo
it drops -- referred to as the lightening
129
what is McDonalds rule of estimating gestation of ≤20 wks
if ≤20 wks: height of fundus in cm x 8/7 = # of weeks
130
what is McDonalds rule of estimating gestation if >20wks
fundal height in cm correlates with gestation
131
what tests does the biophysical profile (BPP) consist of
ultrasound and a non-stress test
132
what are the scores for the BPP
8-10 = normal
6 = borderline
4 = bad
133
how long does the BPP take
30-70 mins
134
what are the 5 variables measured in BPP
- breathing movements (≥1 ep of ≥30 dec in ≥30 mins)
- gross body movements (≥3 in 30 mins)
- fetal tone (≥1 ep of active extention with return to flexion)
- qualitative amniotic fluid volume (≥1 pocket at least 2cm)
- reactive NST or FHR
135
what is the oxytocin challenge test (OCT)/contraction stress test (CST)
toco monitor is applied and records baseline vitals for 15 mins, then oxytocin is administered IV to simulate a ctxn and analyzing how the fetus withstands a ctxn
136
what is measured during the OCT/CST
O2 from placenta and FHR
137
when is the OCT/CST done
if the non-stress test was inconclusive/didn't work
138
what is the OCT/CST contraindication
- premature rupture of membranes
- incompetent cervix/cerclage
- multiple gestation
139
what are the indications for an OCT/CST
IUGR, gestational diabetes, post term (≥42wks), non-reactive NST, abnl/suspicious BPP
140
what does a negative OCT/CST mean
good -- no late decels
141
what does a positive OCT/CST mean
bad -- late decels with 2/3 ctxn
142
what is positive OCT/CST associated with and possibly require
insufficient placental respiratory reserve - associated with IUFD, fetal distress, or poor condition at birth -- may require CS asap
143
what does a suspicious OCT/CST mean
1 late decel or questionable results -- test rescheduled
144
how is the NST (non-stress test) conducted
TOCO applied to monitor FHR and uterine activity - mom pushes a button when movement is felt & look for accelerations with movement
145
when is the NST administered
begin after 30wks and 2x/wk
146
what is a reactive NST
good -- two true accelerations of 15BPM inc lasting 15+ seconds with fetal movement in 20 mins
147
what is a non-reactive NST
reactive criteria not met -- may admin glucose to wake up baby or admin VST, FAS, and BPP
148
what is an unsatisfactory NST
inconclusive
149
what is the antepartum fetal well-being test
fetal movement is recorded in 1h segments over 24hw
150
what is normal for the fetal well-being test
10 movements in 3h -- avg of 3/h
151
what is the cardiff test
counts 10 fetal movements in 10h on 2 consecutive days
152
what is considered a failed cardiff test
<10 movements in 10h on 2 consecutive days or no movements in 10h on any single day
153
what is tested for fetal lung maturity
L/S ration, PG level, and lamellar body counts
154
what is L/S
lecithin/sphingomyelin - surfactant which lowers surface tension of the alveoli during expiration
155
what are the pregnancy ratios of L/S
30-32wks => L/S are equal
35wks => L/S = 2:1
156
when are the lungs considered mature
L/S ration ≥ 2:1
157
when is the L/S ration not accurate
meconium/blood in AF
mom is diabetic
158
what can accelerate lung maturity
chronic stress
159
what can occur as a result of immature lungs at birth
respiratory distress syndrome (RDS)
160
what is the PG level
phospholipid present at 36wks and inc until term
(+) result = good
161
when is testing the PG levels indicated
contaminated specimens and to confirm L/S ratio
162
what is the LBC test
tests phospholipid lamellar body counts
- accurate with DM
163
how is LBC tested
testing in amniotic fluid -- should be >50,000
