The rest of Maternal for MIDTERM Flashcards
From ovulation to fertilization
OVUM
From fertilization to implantation
ZYGOTE
From implantation to 5-8 weeks
EMBRYO
From 5-8 weeks until term
FETUS
Developing embryo or fetus and placental structures throughout pregnancy
CONCEPTUS
The earliest age at which fetuses could survive if they were born at that time, generally accepted as 24 weeks, or fetuses weighing more than 400 g
AGE OF VIABILITY
Liz Calhorn asks how much longer her doctor will refer to the baby inside her as an embryo. The conceptus is an embryo
a. Until the time of fertilization.
b. Until the placenta forms.
c. From implantation until 20 weeks.
d. From implantation until 5 to 8 weeks.
d. From implantation until 5 to 8 weeks.
● The length of the embryo is about 0.75 cm; weight is about 400 mg.
● The spinal cord is formed and fused at the midpoint.
● The head is large in proportion and represents about one third of the entire structure.
● The rudimentary heart appears as a prominent bulge on the anterior surface
● Arms and legs are bud-like structures; rudimentary eyes, ears, and nose are discernible.
End of Fourth Gestational Week
● The length of the fetus is about 2.5 cm (1 in.); weight is about 20 g.
● Organogenesis is complete.
● The heart, with a septum and valves, beats rhythmically.
● Facial features are definitely discernible; arms and legs have developed
● External genitalia are forming, but sex is not yet distinguishable by simple observation.
● The abdomen bulges forward because the fetal intestine is growing so rapidly
End of Eighth Gestational Week
● The length of the fetus is 7 to 8 cm; weight is about 45 g.
● Nail beds are forming on fingers and toes.
● Spontaneous movements are possible,
although they are usually too faint to felt by
the mother.
● Some reflexes, such as the Babinski reflex,
are present.
● Bone ossification centers begin to form.
● Tooth buds are present.
● Sex is distinguishable on outward
appearance.
● Urine secretion begins but may not yet be
evident in amniotic fluid.
● The heartbeat is audible through Doppler technology.
End of 12th Gestational Week (First Trimester)
● The length of the fetus is 10 to 17 cm; weight is 55 to 120 g.
● Fetal heart sounds are audible by an ordinary stethoscope.
● Lanugo is well formed.
● Both the liver and pancreas are functioning.
● The fetus actively swallows amniotic fluid, demonstrating an intact but uncoordinated swallowing reflex; urine is present in amniotic fluid.
● Sex can be determined by ultrasonography.
End of 16th Gestational Week
● The length of the fetus is 25 cm; weight is 223 g.
● Spontaneous fetal movements can be sensed by the mother
● Antibody production is possible.
● Hair, including eyebrows, forms on the head;
vernix caseosa begins to cover the skin.
● Meconium is present in the upper intestine.
● Brown fat, a special fat that aids in
temperature regulation, begins to form behind the kidneys, sternum, and posterior neck.
● Passive antibody transfer from mother to fetus begins.
● Definite sleeping and activity patterns are distinguishable as the fetus develops
● biorhythms that will guide sleep/wake
patterns throughout life.
End of 20th Gestational Week
● The length of the fetus is 28 to 36 cm; weight is 550 g.
● Meconium is present as far as the rectum.
● Active production of lung surfactant begins.
● Eyelids, previously fused since the 12th
week, now open; pupils react to light.
● Hearing can be demonstrated by response
to sudden sound.
● When fetuses reach 24 weeks, or 500 to 600
g, they have achieved a practical low-end age of viability if they are cared for after birth in a modern intensive care nursery.
End of 24th Gestational Week (Second Trimester)
● The length of the fetus is 35 to 38 cm; weight is 1,200 g.
● Lung alveoli are almost mature; surfactant can be demonstrated in amniotic fluid.
● Testes begin to descend into the scrotal sac from the lower abdominal cavity.
● The blood vessels of the retina are formed but thin and extremely susceptible to damage from high oxygen concentrations (an important consideration when caring for preterm infants who need oxygen).
End of 28th Gestational Week
● The length of the fetus is 38 to 43 cm: weight is 1.600 g.
● Subcutaneous fat begins to be deposited in the former stringy. “little old man” appearance is lost).
● Fetus responds by morement to sounds outside the mother’s body.
● An active Moro reflex is present.
● Iron stores. which provide iron for the time
during which the neonate will ingest only breast milk after birth, are beginning to be built.
● Fingernails reach the end of fingertips.
End of 32nd Gestational Week
● The length of the fetus is 42 to 48 cm; weight is1,800to2,700g(5to61b).
● Body stores of glycogen, iron, carbohydrate, and calcium are deposited
● Additional amounts of subcutaneous fat are deposited
● Sole of the foot has only one or two crisscross creases compared with a full crisscross pattern evident at term.
● Amount of lanugo begins to diminish.
● Most fetuses turn into a vertex (head down)
presentation during this month
End of 36th Gestational Week
● The length of the fetus is 48 to 52 cm (crown to rump, 35 to 37 cm); weight is 3,000 g (7 to 7.5 16).
● Fetus kicks actively, sometimes hard enough to cause the mother considerable discomfort.
● Fetal hemoglobin begins its conversion to adult hemoglobin.
● Vernix caseosa starts to decrease after the infant reaches 37 weeks gestation and may be more apparent in the creases than the covering of the body as the infant approaches 40 weeks or more gestational age.
● Fingernails extend over the fingertips.
● Creases on the soles of the feet cover at
least two thirds of the surface.
● In primiparas (ie, women having their first baby), the fetus often sinks into the birth canal during the last 2 weeks of pregnancy. giving the mother a feeling the load she is carrying is less. This event, termed lightening, is a fetal announcement that the fetus is in a ready position and birth is nearing.
End of 40th Gestational Week (Third Trimester)
symphysis-fundal height measurement
McDonald’s rule
least indicative, could easily indicate other
conditions
Presumptive signs
objective so it can be documented by an examiner
Probable signs
● Demonstration of a fetal heart separate from
the mother’s
● Fetal movements felt by an examiner
● Visualization of the fetus by ultrasound
Positive signs
an imaging test that uses sound waves to make pictures of organs, tissues, and other structures inside your body
Ultrasonography
list some examples of presumptive sign of pregnancy
-breast changes
-nausea, vomiting, amenorrhea
-frequent urination
-fatigue
-uterine enlargement
-quickening
list some examples of probable signs of pregnancy
-serum laboratory
-Chadwick’s sign
-Goodell’s sign
-Hegar’s sign
-evidence on ultrasound of gestational sac
-ballottement
list examples of positive signs of pregnancy
-evidence by ultrasound of fetal outline
-fetal heart audible
-fetal movement
formula of EDC for primigravida
date of quickening + 4 months + 20 days
formula of EDC for mulitgravida
date of quickening + 5 months + 4 days
This method estimates the age of gestation relative to the height of the fundus of the uterus above the symphysis pubis
Bartholomew’s Rule of four
When the LMP falls between April-Dec
what is the formula
Subtract 3 months, add 7 days then add 1 year
When the LMP fall between Jan-Mar
what is the formula
add 7 days then add 9 months
Number of pregnancies that have reached viability regardless of whether the infants were born alive
Para
Woman who is or has been pregnant
Gravida
Woman who is pregnant for the first time
Primigravida
Woman who has given birth to one child past age of viability
Primipara
Woman who has been pregnant previously
Multigravida
Woman who has carried two or more pregnancies to viability
Multipara
Woman who has never been and is not currently pregnant
Nulligravida
infants born at 37 weeks or after
full-term
infants born before 37 weeks
preterm
what does GTPALM stand for
Gravida
Term
Preterm
Abortion
Living Children
Multiple Pregnancies
Preliminary Signs of Labor
● Lightening (descent if the fetal presenting part into the pelvis)
● Increase in Level of Energy (increase in epinephrine release initiated by a decrease in progesterone)
● Slight loss of Weight ( increase urine production)
● Braxton Hicks Contractions
● Ripening of the Cervix
● Begin and remain irregular
● Felt first abdominally and remain confined to the abdomen
and groin
● Often disappear with ambulation or sleep
● Do not increase in duration, frequency, or intensity
● Do not achieve cervical dilation
False Labor Contractions
● Begin irregularly but become regular and predictable
● Felt first in lower back and sweep around to the abdomen in
a wave
● Continue no matter what the patients level of activity
● Increase in duration, frequency, and intensity
● Achieve cervical dilation
True Labor Contractions
Components of Labor
- Passage (pelvis) - Is of adequate size and contour
- Passenger (the fetus) - Is of appropriate size and in an
advantageous position and presentation - Powers of labor (uterine factors) - Are adequate
- Psyche (A woman’s psychological outlook) - Which may
either encourage or inhibit labor. This can be based on the person’s past experiences as well as present psychological state
refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum
The Passage
The body part of the fetus that has the widest diameter is the _______, so this is the part that is least likely to be able to pass through the pelvic ring
head
is a change in the shape of the fetal Skull produced by the force of uterine contractions pressing the vertex of the head against the not-yet-dilated cervix
Molding
○ In complete flexion
○ The spinal column is bowed forward, the head is
flexed forward that the chin touches the sternum, the arms are flexed and folded on the chest, the thighs are flexed onto the abdomen, and the claves are pressed against posterior of the thighs.
○ This position is advantageous for birth because it helps a fetus present the smallest anteroposterior diameter of the skull to the pelvis.
○ It also puts the whole body into an ovoid shape, occupying the smallest space possible
Optimal Position
○ Fetus is not as well flexed, chin is not touching the chest but is in an alert or military position/attitude.
○ Causes the next widest anteroposterior diameter, the occipitofrontal diameter, to present to the birth canal
Moderate Flexion
○ Presents the “brow” of the head to the birth canal
Partial Extension
○ Face presentation
○ Fetus is in complete extension, the back is arched
and the neck is extended
○ This unusual position usually presents too wide a
skull diameter to the birth canal for vaginal birth
○ May be an indication there is less than the usual amount of amniotic fluid present, which is not
allowing the fetus adequate movement space.
○ It may also reflect a neurologic abnormality in the
fetus, causing spasticity.
Complete Extension
refers to the relationship between the long axis of the fetus
with respect to the long axis of the mother
Fetal Lie
the most frequent type of presentation, occurring often as 96% of the time
Cephalic Presentation
means either the buttocks of the feet are the first parts that will contact the cervix
Breech Presentation
○ Attitude is moderate because the hips are flexed, but the knees are extended to rest on the chest.
○ The buttocks alone present to the cervix
Frank breech
○ Neither the thighs nor lower legs are flexed.
○ If one foot presents, it is a single-footling breech
○ If both feet present, it is a double-footling breech
Footling breech
○ The fetus has the thighs tightly flexed onto the abdomen
○ Both the buttocks and the tightly flexed feet present to the cervix.
Complete breech
in a transverse lie, fetus is horizontally in the pelvis so the longest fetal axis is perpendicular to that of the pregnant person.
Shoulder Presentation
refers to the settling of the presenting part of a fetus far enough into the pelvis
Engagement
refers to the relationship of the presenting part of the fetus to
the level of the ischial spines
Station
It is the effective passage of a fetus through birth canal involves not only position and presentation but also a number of different position changes
Mechanisms (Cardinal Movements) of Labor
list the mechanism of labor
-descent
-flexion
-internal rotation
-extension
-external rotation
-expulsion
■ Is the downward movement of the biparietal diameter of the fetal head within the pelvic inlet.
Descent
■ As descent is completed the fetal head touches the pelvic floor, the head bends forward onto the chest, causing the smallest anteroposterior diameter to present to the birth canal
■ Flexion is also aided by abdominal muscle contraction during pushing.
Flexion
■ As the head flexes at the end of descent, then occiput rotates so the head is the best relationship to the outlet of the pelvis.
■ This movement brings the shoulders, coming next, into the optimal position to enter the inlet
Internal Rotation
■ Almost immediately after the head of the infant is born, the head rotates a final time (from the anteroposterior position it assumed to enter the outlet) back to the diagonal or transverse position
External Rotation
■ As the occiput of the fetal head is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head.
■ The head extends, and the foremost parts of the head, the face, the chin, are born.
Extension
■ Once the shoulders are born, the rest of the baby is born easily and smoothly
Expulsion
The 3 Phases of contractions
-increment
-acme
-decrement
Intensity of the contraction increases
increment
The contraction at its strongest
acme
Intensity decreases
decrement
Is the shortening and thinning of the cervical canal
Effacement
Refers to the enlargement of widening of the cervical canal
Dilatation
Psychological outlook or state of feelings someone brings into labor
The Psyche
how many stages of labor
4
The first stage is divided into 3
list them
-latent
-active
-transition
○ begins at the onset of regularly uterine contractions
○ Contractions are mild and short (lasting 20 to 40 seconds)
The Latent Stage
○ Cervical dilation occurs increasing from 4 to 7 cm
○ Contractions grow stronger (lasting 40 to 60 seconds and occurs every 3 to 5 minutes in a row)
The Active Stage
○ cause maximum cervical dilatation of 8 to 10 cm.
○ Contractions reach their peak of intensity (occurring every 2 to 3 minutes with a duration of
60 to 70 seconds
The Transition Stage
● from full dilatation and cervical effacement to birth of the infant; with uncomplicated birth, this stage takes about 1 hour
what labor stage
stage 2
● Placental stage, begins with the birth of the infant and ends with the delivery of the placenta
what labor stage
stage 3
■ Shiny and glistening from fetal membrane
Schultze presentation
■ Raw, red, irregular and dirty from maternal surface.
Duncan presentation
○ Once separation has occurred, the placenta delivers either by the natural bearing-down effort of the birthing parent or by gentle pressure of the contracted uterine fundus by the primary healthcare provider.
Placental Expulsion
● stage includes the first few hours after birth. It signals the beginning of dramatic changes because it marks the beginning of a new family.
what labor stage
stage 4
