theresa maurer Flashcards
largest diameter of fetal head
occipitomental 12.5
shoulder pain in pregnancy
rupture of tubal pregnancy
risk of babys born to women over 35?
trisomy 21
severe preeclampsia risks
abruptio placenta
risks of getting taxoplasmosis
uncooked meat, animal feces, soils
sex chromosome abnormality x
turner syndrome females missing x chromosome
most effective family planning method
symptothermal
fetal head at the level of ischial spines
station 0
cephalohematoma
blood vessels between cranial bone and periosteal layer ruptures and leads to bleeding in subperiosteal space
“Midwives believe that every woman has a right to a safe, satisfying birth in the setting of her own choice, with respect for human dignity, cultural sensitivity, and informed choice.”
philosophy of care
In which portion of the fallopian tubes does fertilization normally occur?
ampulla
A prenatal factor that may cause a hemorrhage
grand multipara
During an abdominal examination of a woman at term, the midwife feels the cephalic prominence on the same side as the fetal parts. This is indicative of which of the following?
vertex (occipital) presentation
The increased activity of the endometrial glands during the luteal phase of the female reproductive cycle is stimulated by
progesterone
The endometrial glands become increasingly active during the luteal phase of the reproductive cycle as a result of progesterone production. Increased progesterone levels activate the secretory changes necessary for pregnancy and increase the endometrium’s supply of glycogen, arterial blood, amino acids, and water, which are vital in maintaining pregnancy.
cause of nausea and vomiting in early pregnancy
Hormonal imbalances, especially high levels of human chorionic gonadotropin (hCG), usually cause the nausea and vomiting characteristic of early pregnancy
neonates first growth spurt
Most babies experience their first growth spurt 6-10 days after delivery; this spurt usually is evident by the neonate’s increased milk intake or wanting to nurse more frequently. Additional growth spurts typically occur at 3 months and again at 4 to 6 months and last about 48 hours.
Fetal heart rate variability is not affected by
maternal sleep
FHR variability is the normal irregularity of the cardiac rhythm caused by the continuous interaction of the fetus’s parasympathetic and sympathetic nervous systems.
what does fetal sleep do to the FHT variability
During fetal sleep, nerve impulses to the heart are slowed, thereby slowing the FHR. A slower FHR increases the variability; conversely, a faster FHR decreases the variability.
trepanema palladom
spiral bacteria causes syphyllis
dysnpea
labored breathing
dysuria
painful urination
positive Ortolanis sign
hip dysplasia, clunking of the hips
refer to physcian
papanicolau test
pap smear that screens for uterine or cervical cancer
average heart rate of quiet awake newborn
120-140 bpm
During the first 10-12 weeks of pregnancy, the corpus luteum
secretes progesterone to maintain the pregnancy
Constipation during pregnancy is usually the result o
prolonged stomach emptying time and decreased intestinal motility
vitamin k routinely given
newborns lack the intestinal bacteria with which to synthesize vitamin k
ROA findings
round, firm object low in the pelvis, small parts on the mother’s left side, and a soft rounded shape in the fundus
contractions with a frequency of 3 minutes?
contractions that last for 30 seconds with a 2 1/2 minute rest in between
During pelvimetry, a primigravida is found to have a diagonal conjugate of 10 cm. Based on this information, the midwife would expect her labor to be
prolonged, with failure of the head to engage
cord protruding from a laboring woman’s vagina. The first action would be to
apply manual pressure to the presenting part and have the mother assume a knee-chest position
normal breathing pattern for a full-term baby is predominately
normal breathing pattern for a full-term baby is predominately
signs of hypoglycemia in a newborn
jitteriness, lethargy
The blue coloration of a newborn’s hands and feet is called
acrocyanosis
Infants of diabetic mothers are at risk for which of the following problems?
respiratory distress(delayed surfactant production) , hypoglycemia (drastic drop in glucose levels), macrosomia, preterm (moms high blood sugar)
Risk of stillbirth or neonatal loss with untreated syphilis
40 % loss, 100% transmission rate
40% congenital syphilis
stages of syphilis
treponema pallidum
primary- chancre, lesion, 10-90 days after infection, antibody response not present until 3-6weeks
secondary- rash 4-12 weeks after infection, rash on palms, hands and soles of feet, alopecia, condylmata lata (contagious)
Latent - Early- period of one year after initial infection
Late-after 1 year of initial infection
no evidence of disease
Tertiary- high morbidity- ulcers gumma on internal organs,
Neurosyphilis can occur at any stage, nerve palsies, meningitis.
screening for syphilis
diagnostic
VDRL- screening for antibodies to nontreponemal antigens
RPR- rapid plasma
Titers for current syphilis infection and previosly treated syphilis
4 fold increase in titer for current
low titer no increase
adequate treatment 4 fold decrease
five digit para system
1- term births after 36 weeks
2-premature births 28-36 weeks or less 2500 grams
3 pregnancies end /abortions before 28 weeks
4 living children
5 births of multiple gestation
embryonic period
fertilization to 10 weeks or (8 weeks by fertilization)
fetal period
10 weeks to birth
piskaceks sign
the uterus is irregular contour misplaced and to the right because of implantation in the upper posterior
8-10 weeks, out of pelvis
when does the heart beat in utero
4 weeks
when can you hear the heart beat in utero with a fetoscope
20 weeks
when can you hear a heartbeat in utero with a doppler
12-20 weeks
hagers sign
the softening of the uterine isthmus at 6 weeks
goodells sign
softening of the cervix 6 weeks
chadwicks sign
bluish coloration of vulva and vaginal portion of the cervix 6 weeks
Naegles Rule
add 7 days to the first day of LMP and subtract 3 months from that to get EDD
how many days is average pregnancy
280 by LMP, 266 by fertilzation
how many lunar months is pregnancy
10 lunar months
weeks of 1st trimester
1-12 weeks
weeks of 2nd trimester
13-27 weeks
weeks of 3rd trimester
28-40 weeks
antepartal
LMP to true labor starts
intrapartal
true labor start to birth
prenatal
LMP to birth
postnatal
after birth
metrrohagia
abnormal uterine bleeding
menorrhagia
excessive uterine bleeding
jarishh herxheimer reaction
when early syphilis is treated it is common reaction , malaise, fever, influenza type, headache, fetal distress
Hemolytic disease of the neonate may be produced by the union of
Rh- mother with Rh- father
condylmata lata
warts on genitals from secondary syphilis highly contagious
condylmata acuminata
genital warts caused by HPV 6 & 11
homans sign
dorsiflexion of the foot to check DVT
raises leg to 10 degrees, then passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand.
Deep calf pain and tenderness may indicate presence of DVT.
dysuria
painful urination
hematocrit
amount of rbc’s in packed in given blood volume %
small dip at 28 weeks is normal because of blood volume expansion
an increase at 28 weeks from baseline is not normal and may indicate metabolic toxemia
hemoglobin
protein on rbc
carries oxygen
Iron deficiency anemia about 45% of anemias
lower hemoglobins at higher elevations, less change
do liver enzyme tests and albumin
2 gram drop by 28 weeks maybe a slight rise again at term
peak blood volume expansion
28-30 weeks by 50-60%
chorionic villi
14 days after fertilization , attach to decidua and anchor embryo chorion sac to decidua, frondolosum fetal contribution to placenta
decidua
uterine lining in pregnancy, 3 layers,
basalis-under implantation
caspularis- goes over embryo
parietalis- rest of uterus
quickening
16-20 weeks weeks fetal movements felt by mother
progesterone
secreted by corpus luteum
maintains endometrial lining
placenta makes progesterone and takes over around 8-10 weeks
makes decidua cells in endometrium
decreases contractility in uterus
develops lobes in alveolar system of breasts
decreases gastric motility, muscle tone in bladder and ureters
estriol
estrogen of pregnancy weak form of estrogen secreted by placenta
estradiol
most potent estrogen 95% in circ-ovaries
estrone
postmenopause conversion in fat cells
prolactin
when estrogen and progesterone drop at birth the ant pituatary makes prolactin
sustain milk production and balance composition of milk
A positive direct Coombs test done on the cord blood indicates the presence of:
antibodies coating the baby’s red blood cells
folic acid
coenzyme in DNA synthesis, healthy cell division, neuro development,reduce neural tube defect
400 mcg recommended in pregnancy
calcium
needs are higher in pregnancy because of PTH, parathyroid levels. lactation takes a lot of calcium from bones
low birth weight correlated with
perinatal mortality small head mental issues cerebral palsy learning disab visual and hearing defects neurological defects poor growth
perinatal period
22 weeks to 7 days after birth WHO
uterine growth failure causes
uteroplacental insufficiency- asymetric growth, body and organs small, brain large
protein deficiency-malnutrition- symetric all organds, brain body are reduced and cells
most cellular brain growth
28 weeks to 6 months peak
15 weeks to age 2
prematurity birth weight
below 2500 grams- 5lbs 8 oz
optimal birth weight
3500-4000 grams- 7’lbs 12 oz, to 8 lbs 14 oz
above 3000 best
calories needed in pregnancy
calories for multiple gestation
2500 calories- 500 + then regular
addition 500 for each fetus
calcium intake recommended in pregnancy
1200 mg
iron recommended in pregnancy
30 mg daily
maintain fetal and maternal hemoglobin in preg
blood loss at birth
Vitamin C recommended in pregnancy
80-250 mg per day
protein recommended in pregnancy
80 grams of protein
calories and protein relationship
the amount of calories must match the protein otherwise the body will burn protein as energy and it will be insufficient
nutritional evaluations
initial visit
20 weeks
28 weeks - peak of brain growth
36 weeks
persistant nausea past the first trimester
severe emotional problems
hyperemesis gravidarum
hydatidiform mole
causes of nausea in 1st trimester
hormonal changes- Hcg + progesterone
slowed perstalsis
enlarged uterus
gastric overload
nausea relief
small frequent meals dry crackers when waking sweet to eat before bed restriction of fats acupressure bands B6
ptyalism
excessive salvation
causes nausea
starch increased acidity increase salvation
fatigue
metabolic changes ends after 1st trimester
exercise and good nutrition
heartburn/reflux
causes
relief
reversed peristalsis of acidic-hydrochloric acid
relaxation of cardia in stomach
decrease gastro motility, smooth muscle relaxation
avoid fats, spicy, avoid heavy meals at bed, small freq meals, antiacid, milk, papaya enzymes
constipation
cause
relief
decrease peristalsis by relaxation of smooth muscle form progesterone.
fluids, prune juice, rest ,warm liquids, natural fiber, laxatives, exercise
hemorrhoids
cause
relief
relaxation of vein walls, pressure, constipation, congested pelvic veins
witch hazel, avoid straining, constipation, sitz bath, epsom salt compress,
leg cramps
relief
calcium phosphorous
dorsiflexion
exercise
Candida predispose s/s cause diagnosis treatment
pregnancy, broad spec antibiotics, diabetes, high sugars, HIV- recalcitrant and recurring non curable candida, increased estrogen in preg, inc Ph
white-yellow adherent plaques on cervix/vagina, cottage
itching, no odor
microscopic eval, budding spores
miconzole (monistat) suppository
clotrimazole(gyn-lotrimin) oral,
femstat, terconazole(terazole) vag cream
contraindicated Fluconazole (Diflucan)
Bacteria Vaginosis Gardnerella vaginalis
s/s
cause
diagnosis
major change in flora, increases ph 5-6, from lactobacillus to aneorbic bacteria.
s/s increased ph, scanty thin, homologous milky gray white discharge, whiff test, fish odor.
diagnosis- micro exam of clue cells & symptoms, adherent bact, black dots, jagged cell
flagly, metronizadole
treatment choice for bacteria vaginosis
flagyl, metronidazole
most common cause of bartholinitis
microbial infection
hormones elevated in ovulatory phase
estrogen, FSH, LH
hormones elevated in luteal phase
progesterone
Chlamydia predisposed s/s diagnosis treatment risks
most popular STD
increased risk with oral contraceptives
50% asymptomatic, mucopurulent discharge at cervix, edematous congested cervix
diagnosis- positive cervical culture, endocervix inside
treat with antibiotics- erythrimycin, azithromycin, treat partners!
doxycycline- contraindicated for preg and lactation
coexisting vag infections, salpignitis (inflammed fallopian), PID, cysticitis, urethracitis,
risks: transmission at birth, opthalmia, pneumonia,
infertility, ectopic, PROM, Preterm
coexists with: trich and gonorrhea
cysticiitis
inflammation of bladder
salpiginitis
inflammation of fallopian tubes
contraindicated agents for STD in pregnancy
tetracycline, doxycycline, podofilox
women with gonorrhea should also be treated for chlamydia, T or F
tue
Gonorrhea s/s diagnosis treatment risks
gram negative cell, diploccal bacteria
low ab pain, urethra tender, discharge bart and skene glands, PID, discharge, abnormal bleeding, yellowish purulent.
diagnose by culture endocervical,
treatment: Ceftriaxone, cephalosporin,treat partners, treat for chlymadia same time and screen syphilis
risks: transmission at delivery, blindness, PROM, preterm, endometritis, salpi
PID
risk factors
s/s
diagnosis
combo of endometritis, salpi, ovarian abcess, organisms of gonorrhea and chlamydia, BV. ascension from IUD, douche
s/s bilateral abdomen pain, discharge, dysuria, frequent, metrorrhagia, fever vomit, tender cervix
diagnosis- combo of presenting s/s, postive ab guarding, positive cervical motion tender, pos bilateral adenexal tender, mucopurulent discharge
hospital IV with broad spectrum antibiotics if abscess,fever, nausea, HIV, pregnancy or no hospitalization, treat partners and womenfor
gonorrhea and chlamydia
symptoms of anaphylactic shock
s/s
treatment
urticaria (hives), rhinitis (mucous in nose), dyspnea (trouble breathing), pallor, hypoxia, cyanosis, convulsion, pupil dilation, cardiac arrest
epinepherine, corticocosteroids, oxygen
calendar rhythm method
regular cycles only
14 days prior to onset of next menses
2-3 sperm survivial
1 day ovum survivial= 9 fertile days
subtract 20 days from length of short cycle
subtract 10 days from long cycle
HPV and cancer, true statement
HPV alone does not result in neoplastic changes, cofactors are necessary for developing cancer risk
ovulaton mucus method
based on cervical changes via estrogen in cycle
- dry days = after menstruation
- start of wetness = start of fertile phase
- mucous increase, clear, slippery, stretchy, egg white= spinnbarkeit. max fertile days
- last day of musous of spinn sensation = peak day= ovulation occurs within hours or up to 1 day
- sensation disappears mucous becomes tacky= 3 days after peak day still fertile
- postovulatory peak days on 4th day after peak day
- dryness until menstruation
basal body temp method
detects actual ovulation
progesterone released at ovulation increases temp by .5-1 degree
take temp same day everyday after 5-6 hours of sleep
rectal most accurate
mittleschmertz
midcycle pain - pain off center lower ab follicle rupture
spotting or breakthrough bleed, increase sex interest, mood, cervial mucus ferning from estrogen,
lacto ammenorrhea
98% protection if mother is full breastfeeding, 1st 6 mos, no bleeding after 56 days postpartum
presumptive signs of preg
Amenorrhea (no period) Nausea — Breast enlargement and tenderness. Fatigue. Poor sleep. Back pain. Constipation. Food cravings colorations- linea negra, nipples
probable signs
hagers sign- soft cervix 6 weeks goodells- soft isthmus chadwick- bluish ballotment braxton hicks pregnancy test
positive signs of pregnancy
ultrasound
fht
functions of the placenta
provides fetus with oxygen and gas exchange
passage of nutrients
excretes waste
protect fetus with transfer of antibodies
hormones for pregnancy-hcg, hPl, estrogen, progesterone
fetal circulation in umbilicus
2 arteries deoxygenated blood leaves fetus
1 vein- oxygen rich blood returns to fetus
philosophy scope
each woman unique birth of choice, natural processes, family centered, participation,
abortion performed weeks
in 1st trimester by D&C
2nd trimester salting out, hysterectomy, prostoglandins
Initial labs
pelvic exam, physical, labs
pap, GC, blood type, indirect Coombs, sickle cell prep, VDRL, RPR (syphylis), hep B, rubella,Varicella, Hemog hemoticrit, urinalysis. CBC
HIV, AFP or triple screen (15-18 weeks)
labs at 28 weeks
gestational diabetes, repeat, VDRL, indirect coombs if rh neg), if titres are neg at 28 weeks give Rhogam at 28 weeks.
Downs syndrome (trisomy 21)
s/s
screening history
chromosomal disorder when there is an extra copy of a chromosome
s/s- poor muscle tone, slanted eyes, eyes to ear, bulging eyes
AFP or MSAFP(triple screen) between 15-18 weeks
AFP are too low in downs syndrome
AFP testing
produced in yolk sac and later fetal liver
test for genetic abnormalities
increases until 20 weeks
high #’s indicated leaking from fetus from open neural tube defect.
test at 15-18 weeks for accuracy, dates may change results, multips
high risk age 35+, diabetes, history, prior abnormal results
MSAFP (triple screen)
maternal serum AFP= AFP, estriol and Hcg
downs syndrome= dec AFp, dec estriol, increase Hcg
test at 15 weeks
gestation dating can have abnormal results can be retested at ultrasound dates 16-20 week ultrasound.
serum levels of Hcg
detected at 9 days doubles every two days peaks at 10 weeks rapid increase- hydatiform mole, multips slow rising- ectopic pregnancy dropping Hcg- pregnancy loss, more than 12 weeks gestation
fetal kick counts
3rd trimester- 34-36 weeks low risk
28 weeks high risk
10 in 10 hour period
same time each day
effected by smoking behavior, amniotic fluid amount, less fluid less movements, smoking slows fht for 80 minutes!
NST
indications
non reactive fetal movement
interuteroplacental insufficiencies
diabetes, IUGR, hypertension, PIH, preeclampsia, multips, oligiohydraminos, post dates, Rh isioimmunization, PROM
CVS
risks
chorionic villi sampling
.8% fetal loss risk
oligohydraminos, rupture of amnion, subchorionic hematoma, limb defects
done in 1st trimester
increased risk compared to 2nd trimester ACT
ACT aminocentesis
performed 15-16 weeks because of AFP levels genetic screening after 20 weeks- checks surfactant 99% successful detection risk:.5-1% fetal loss, SA, PROM, preterm
cordocentesis
percutaneous umbilical
fetal blood sampling
fetus DNA, detect treat Rh sensitization, cord blood gases, IUGR, fetal infection (rubella, cytomegalovirus)
can detect and TREAT infection
best indicator of fetal health in 3rd trimester
reactive NST
acceleration of fht in relation to fetal movement
NST indications
reactive- two accelerations of fht in 20 min period off baseline atleast seconds amp of 15bpm
nonreactive- fails number of accels in 20 min period
inconclusive- uninterpretable, vigorous fetus, no baseline- follow with ultrasound BPP
VAS
vibrocostic stimulation
BPP
criterias
indications
NS test combined with fetal behavior and AFI, amniotic fluid volume.
full oxygenated fetus variety, muscle tone, movement respiratory activity.
manning criteria used/vintzeleos placenta guarding
IUGR, oligohydraminos, diabetes, preeclampsia, postdates, nonreactive NST
weekly testing recommended
twice weekly for high risk UPI (placenta insufficiency) + NST
AFV
amniotic fluid volume
3rd trimester fetal urine- measures renal function
oligiohydraminos
low quantity of amniotic fluid
uteroplacental insufficiency
fetal hypoxia
fetal distress, meconium, postmaturity syndrome
poly hydraminos
high amniotic fluid volume
chromosomal disorders
diabetes
anomalies
BPP scores
10/10 low risk asphyxia 8/10 high risk- 24 hour re-eval 6/10 - equivocal- questionable 24 hour rtc 4/10- high risk- delivery 0-2/10 certain asphyxia-delivery
lung maturity tests
amniocentesis after 20 weeks
lecithin/sphingomyelin ratios L/S
phatidylgcerol PG test
criteria for screening for anomalies
age, personal family history, and screening tests
characteristics that effect the AFP
weight, age and race
Elevated AFP
spinabifida
abnormal AFP next step
confirm gestational dates, retest
Downs syndrome triple screen result
low AFP, low estriol, high Hcg
To reduce limb defects in CVS
perform after 10 weeks
Genetic amniocentesis performed when
15-20 weeks
Amniocentesis performed after 20 weeks checks what?
surfactant levels LS, PG, shake and tap
optical density assessments based on bilirubin in amniotic fluid is for what complication?
how is it obtained?
Rh isoimmunization
amniocentesis after 20 weeks
isoimmunization
production by an individual of antibodies against constituents of the tissues of another individual of the same species
low risk fetal kick counts start for low risk women
34-36 weeks
conditions that reduce maternal perception of fetal movement
polyhydraminos
olgiohydraminos
anterior placenta
Not obesity!
next step for nonreactive NST
immediate BPP and AFV
ATT auscilating acceleration test is alternative to ?
who for?
how?
interpretation?
NST-
low risk women beyond 34 weeks
listen fht for 6 minutes counting in 5 sec interval
find baseline, single accel is reactive, accel present when fht is up by 2 points
modified BPP
combines NST with AFI, cost effective, deviationss complete BPP ordered
doppler velocimetry
measures?
findings?
indicated?
measures ratio of systole and diastole bloodflow through the umbilical arteries to the placenta ratio
- fetal heart in systole, blood is rapid to placenta, even when in diastole.
- if fetal heart is in systole maybe modest flow but when heart is in diastole flow stops because of narrowed vessels (AEDV)absent end diastolic velocity- seen in IUGR
- reverse flow at diastolic end (REDV)
IUGR present or suspected
most accurate predictor of uteroplacental insufficiency
CST contraction stress test
contraindications for contraction stress test
placenta previa, dangerous labor, classical csection incision, myomectomy, risk of preterm labor
when is CST performed
how?
false pos rate?
26 weeks to term
breast stim or oxytocin challenge, induced ctx
30%
serial non stress tests
minimum once a week low risk
twice weekly for high risk
AFI at term
how measured?
5.0-23 AFI
add deepest pocket of each quadrant
limited obstetric ultrasound, 2nd -3rd trimester
cardiac activity fetal number fetal lie placental site BPP AFI
