Toni - Week 1 - Exam 1 Flashcards
What are the 4 functions of amniotic fluid?
Protection, Temperature Control, Fetal Growth, and Movement
T/F: Amniotic fluid volume is constantly changing
TRUE
How does the mother help create amniotic fluid?
Amniotic fluid is derived in part from maternal blood moving across the amnion
How does the fetus add and remove fluid volume?
Adds to amniotic fluid via urine
removes amniotic fluid by swallowing
How much does amniotic fluid increase at term?
Volume increases weekly to a LITER at term
What is oligohydramnios?
Too little fluid - could result from fetal kidney problems
What is polyhydramnios?
Too much fluid - could result from GI tract problems
What is the chorion?
the outer sac next to uterine wall
what is the amnion?
the INNER sac next to fetus. Thin & translucent, but high in tensile strength. originated from the blastocyte
What type of jelly is a characteristic of the umbilical cord and what is its function?
It is Wharton’s Jelly and it’s a thick substance that protects the vessels
How many vessels does the umbilical cord have?
3 vessels - 2 arteries and 1 vein (AVA)
- 2 arteries carry DE-OXYGENATED blood from fetus to placenta
- 1 vein carries OXYGENATED blood to the fetus
What is the average length of the cord at term?
22 inches
When the umbilical cord is cut, can the mother /fetus feel pain?
No, it lacks sensory neurons. Good to reassure fathers/partners that this will not hurt.
Where does the placenta develop and what size is it at term?
Placenta develops at the site of embryonic attachment; it’s 1/6 the size of newborn - placenta develops the size of the newborn.
What are the 4 functions of the placenta?
fetal gas exchange, nutrition, excretion, and hormone regulation
What is the placenta composed of?
maternal and fetal tissues
The layers of fetal tissues form a placental barrier, what is the purpose of this barrier?
- Materials only exchanged via diffusion
- Prevents contact between fetal and maternal blood
What are the two different surfaces of the placenta?
- maternal surface (red/uneven) attaches to uterine wall
- outer fetal surface (gray/shiny) contains umbilical vessels and cord
What is the most crucial stage of development?
the embryonic stage
What is the “all or nothing” period?
Period between ovulation and implantation
Not yet sustained by mother; sustained by corpus luteum
No teratogens effect
Will die or live with no consequence
How much blood needs to go to the liver and lungs of a developing fetus?
Just enough to nourish the tissues
What are the 3 fetal shunts?
Foramen Ovale, Ductus Venosus, and Ductus Arteriosus
What is the Foramen Ovale?
A flap in the wall between the right and left atrium of the heart that allows a large percentage of oxygenated blood to go out into the body (blood goes from RA to LA and out into the body)
- will functionally close at birth with the change in pressure gradient that will occur with normal circulation
What is the Ductus Arteriosus?
A tiny, little shunt that connects the pulmonary artery and the aorta - some that is unnecessary in the lungs/pulmonary artery carries over to the aorta.
- will functionally close at birth d/t change in pressure gradient
What is the Ductus Venosus?
A special blood vessel that connects the umbilical vein to the inferior vena cava to allow blood to bypass the liver.
- Shunts a portion of that blood flow directly to the right atrium of the ♥ (allows blood to bypass the liver)
- Closes when umbilical cord is clamped
What is the duration of a pregnancy?
10 lunar months. 9 calendar months. 3 trimesters (3 month periods). 40 weeks. 280 days.
how is the due date computed?
It is computed from the 1st day of the last menstrual period (LMP).
when does actual conception occur?
It typically occurs closer to 2 weeks after the LMP
What are the 3 ways of estimating date of delivery?
Nagele’s Rule, Measuring fundal height, and ultrasonography
What is Nagele’s Rule?
Subtract 3 months (or add 9 months) to LMP then add one day
How is the fundal height measured?
Measure from top of pubic symphysis to fundus in centimeters - from 20 wks on, the height = the gestational week of pregnancy. example: 20 weeks = 20 cm.
T/F: ultrasound is used to confirm due date or to find a more accurate due date
TRUE
What hormone do pregnancy tests measure?
Human chorionic gonadotropin (hCG) - can be detected after implantation - approx. one week after conception.
T/F: urine and serum pregnancy tests aren’t equally accurate.
FALSE they are EQUALLY accurate - urine 95% and serum 99%
Can false positives occur? What can cause them?
Yes. False + can occur if blood/protein is in urine or d/t certain drugs like tranquilizers, anticonvulsants, and hypnotics
What are presumptive signs of pregnancy and list some examples.
they are subjective signs and symptoms that woman reports; may or may not be associated with pregnancy
- amenorrhea, nausea, fatigue, urinary frequency, breast changes, and quickening (fetal movement)
What are probable signs of pregnancy? List some examples.
they are objective signs of pregnancy noted by an examiner; may or may not be associated with pregnancy
- hegar’s sign (softening lower uterine segment)
- chadwick’s sign (bluish color of vaginal mucosa)
- goodell’s sign (softening of cervix “good & soft”)
- Braxton Hick’s contractions begin 2nd trimester
- pregnancy test
- abdominal enlargement
- ballottement (palpating technique to detect floating fetus - taps on cervix to feel fetus bounce back)
What are positive signs of pregnancy?
noted by an examiner; can only be caused by pregnancy
- see baby: ultrasound
- hear baby: auscultate fetal heart
- feel baby: palpate fetal movement
What are 8 basic physiologic changes during pregnancy??
- vaginal secretions ↑; candidiasis (yeast infection) is common
- breasts ↑ in size, sensitivity, and pigment
- colostrum (yellow creamy substance) by 3rd trimester - “normal”
- ↑ incidence periodontal disease → higher risk for preterm babies
- chest circumference, air intake, and RR ↑
- congestion/nasal stuffiness - “juicy” - ↑ vascularity - don’t take decongestives; just drink water
- Marked fatigue “sleep when toddler sleeps”
how can you prevent candidiasis?
by wearing cotton underwear and by rubbing corn starch externally
How much does blood volume increase by the 30th week?
by 50%
What cardiovascular characteristics increase??
Cardiac output and pulse
What cardiovascular characteristics decrease?
vascular resistance (vasodilation) and diastolic BP in the 2nd semester
What is postural hypotension?
when a pregnant woman gets up too quickly from sitting or playing on the floor with children – light headed and dizzy
what is supine hypotensive (vena cava) syndrome?
low blood pressure when laying on back due to fetus laying on vena cava and restricting blood flow – causes light headed, dizzy, possibly faint.
What is pregnancy induced hypercoagulability?
↑ in clotting factor - body adapts in order to prevent postpartum hemorrhage
***increase risk of blood clots → postpartum
what does pelvic vein compression cause?
↓ blood flow to legs, causing venous stasis → edema, varicosities, hemorrhoids, cramps
What is physiologic anemia of pregnancy? What is considered WNL?
volume ↑ and RBC aren’t ↑ as fast as serum.
• hematocrit >/= 35 and hemoglobin >/= 10 considered to be WNL
how can women prevent clots?
exercise, elastic compression stockings, drink lots of water, avoid crossing legs, feet higher than ♥, and avoid tight clothing.
what is round ligament pain? musculoskeletal
sharp pain or jabbing feeling often felt in the lower belly or groin area on one or both sides - normal situation, rubbing helps, but nothing we can do about it
what happens to pelvic joints and the pubic symphysis?
pelvic joints relax and symphysis pubis separates by as much as 2 inches. - causes waddling gait
What is physiological lordosis?
inward curvature of the lumbar (lower) spine - counter balance - lower back pain common d/t this - make sure pain isn’t associated with labor
what is diastasis recti and when does it occur?
it is the separation of abdominal muscle and it can occur as uterus enlarges, sometimes with multiple pregnancies - can be painful and corrected by surgery
**avoid high heels and heavy lifting
What are 2 changes that occur with the GI system?
Morning sickness and smooth muscle relaxation
When is morning sickness common?
The first trimester; likely caused by hCG
What does smooth muscle relaxation cause>
It slows peristalsis and relaxes cardiac and pyloric sphincters causing constipation and heartburn
Education for GI problems?
- Don’t take antacids
- Chew on papaya enzyme to eliminate ♥ burn (chew before meal)
- Sit up for 30 min after eating
- Avoid greasy food/empty stomach
- Small meals, avoid liquid with meals
- Soda before rising
- Acupuncture
- Ginger tablet
What GU change occurs during 1st Trimester?
bladder pressure/frequency; void with the urge
What GU changes occurs during 2nd Trimester?
uterus moves out of pelvis (after 20 weeks) and GFR (Glomeralar Filtration Rate) increases, causing glycouria and UTI
What GU change occurs during 3rd Trimester?
Bladder pressure/frequency
What occurs when the ureters and renal pelvis relax?
urinary retention and UTIs
What are the 5 pregnancy pigmentation changes?
facial melasma, palmar erythema, vascular spiders,striae gravidarum, and linea nigra
What are the 8 hormones involved with pregnancy?
human chorionic gonadotropin (hCG), human placental lactogen, estrogen, progesterone, relaxin, prolactin, oxytocin, and cortisol
What is the role of human placental lactogen?
insulin antagonist (produced by placenta) that promotes lipolysis to increase the amount of circulating free fatty acids which can be used by the mother for energy so the fetus can use all of the glucose
What is the role of estrogen?
responsible for increased vascularity (Chadwick’s sign)
relaxation of ligaments
What is the role of progesterone?
relaxation of smooth muscle; **decreases uterine contractility
What is the role of relaxin?
pelvic and cervical expansion and relaxation; works along with progesterone
helps to soften cervix, inhibit contraction of uterus
found only in pregnant females
What is the role of prolactin?
stimulates milk production; produced in pituitary
- progesterone competes with prolactin; prolactin levels at peak at delivery and takes over once placenta is delivered and progesterone decreases
What is the role of oxytocin?
stimulate uterine contraction; given synthetically to woman trying to induce; responsible for the “let down” of milk; responsible for orgasms
What are the 7 ways that women face psychosocial adaptation during pregnancy?
ambivalence, role changes, well being of self, well being of baby, previous birth experiences, financial concerns, and the birthing process
How can women promote self care during pregnancy?
making changes to daily living (8 things)
- avoid hot tubs and saunas - ↑ risk of miscarriage + spina bifida - temp raises amn. fluid
- sexual activity may continue
- normal exercise can continue
- immunizations per CDC recommendations; live viruses contraindicated
- avoid skiing, horseback riding, contact sports
- If traveling:
- walk q2hr
- lap belt under abdomen
- lots of fluids
How much weight should a woman of normal weight gain?
25 - 35 lbs
How much weight should an underweight (BMI < 18.5) woman gain?
28 - 40 lbs
How much weight should an overweight (BMI > 25) woman gain?
15 - 25 lbs
How much weight should an obese (BMI > 30) woman gain?
11 - 20 lbs
In the 1st/2nd trimester, the growth is primarily ____
maternal
In the 3rd trimester, the growth is primarily _____
fetal
What can occur if weight gain patterns are too high?
↑ risk high birth weigh infant and cephalopelvic disproportion (CPD)
what can occur if weight gain patterns are too low?
↑ risk of malnourishment and low birth weight (LBW) infant
What are the two influences of nutritional needs in pregnancy?
- pre-pregnancy weight
- age: teens need more calories because they are still growing themselves
what is there an increased need for nutritionally?
Calories, Protein, Calcium, Iron, Vitamin A, C, D, folate, and water (6-8 glasses/day)
Which foods are woman taught to avoid and why?
- fish at the top of the food chain like, shark, swordfish, ahi tuna, mackerel - ↑ mercury could result in severe nerve/brain damage or sight/hearing loss
- raw or undercooked meat or fish - listeria (can lead to early delivery or stillborn)
- hot dogs, deli meat unless heated until steamy - listeria
- unpasteurized cheese - blue, brie, feta - listeria
T/F: pregnant woman should follow the MyPlate dietary guidelines
TRUE. woman should eat fresh/frozen/↓Na canned veggies, more fruit than fruit juice, healthy proteins like grains, nuts, beans, seeds, and soy foods (vegan).
They should also have servings of low fat dairy, plant oils, and should drink water or milk over soda/caffeine and no alcohol
What is pica?
craving for non-food substances like clay, soil, laundry starch, ice, ashes, plaster, crayons, baking soda, cornstarch, and soap
What might pica indicate?
nutritional deficiencies or anemia
What is the difference between gravidity and parity?
Gravidity: # of pregnancies
Parity: # of pregnancies delivered >/= 20 weeks
What is GTPAL?
another method that provides details of OB hx
What does GTPAL stand for?
Gravidity: # of pregnancies
Term: # of pregnancies delivered 37 - 42 wks
Preterm: # of pregnancies delivered 20 - 36 6/7 wks
Abortion: # of pregnancies ending before 20 weeks
Living: # of current living children
A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?
G=7, T=4, P=1, A=1, L=5
What does TAB mean?
therapeutic abortion - intentional to terminate pregnancy = 20 weeks
What does SAB mean?
spontaneous abortion (miscarriage)
What does viability mean?
able to survive outside of the uterus
what is the difference between nulli, primi, and multi?
nulli: never
primi: first
multi: 2 or more
what does postdate/postterm mean?
pregnancy > 42 weeks
what do EDB, EDC, EDD mean?/
estimated date of birth, date of confinement, estimated due date
what occurs at a prenatal visit?
• a complete health hx - medical, surgical, OB, Exercise, nutrition, substance use, partner abuse, psychosocial
assessment, cultural preferences, economic support
• a physical assessment - routine physicall exam, OB assessment (fetal ♥ rate (FHR), fundal height, pelvimetru, breast and nipple exam), nutritionist, lab work
• can take 3 hrs
What are the 9 initial prenatal lab tests?
• CBC
• Blood type & Rh
• Urinalysis
• Rubella titer (if not, give after birth. could cause blind, deaf, etc)
• Hepatitis B
• HIV (potential impact on delivery)
• STI testing: syphilis (VDRL or RPR), gonorrhea,
chlamydia, herpes, human papilloma virus
• TB test (no harmful effects on baby)
• Glucose screening (fasting, HbA1c, or random)
How frequent are prenatal visits?
- First 28 weeks: q 4 weeks
– 28-36 weeks: q 2 weeks
– 37 weeks to birth: weekly
What is assessed during these visits?
– VS, weight, fundal height, nutritional intake
– Urine protein, glucose, ketones, nitrates
– Fetal heart rate, position, movement
– Adjustment to pregnancy
- Teaching of physical changes & warning signs
What follow up tests does a pregnant woman have to do?
• Repeat Hct/Hgb (in 3rd tri, ↓ → pseudonemia)
• Antibody titer if Rh negative (already sensitized?)
• Group B strep screen (bacteria in vagina/anus, opportunistic pathogen can cause severe infection that effects blood, urine, and lungs of baby)
• Glucose screening 2nd trimester (GTT to test for gestational diabetes)
• Alpha fetoprotein (AFP)
• Ultrasound may be ordered at
any time for variety of reasons
What is a fetal movement count?
Inexpensive, noninvasive, convenient evaluation of fetal well-being after 28 weeks
what can fetal movement be affected by?
fetal sleep (babies can sleep for 45 minutes), time of day, & maternal drug use (stimulants vs sedatives)
what is the typical protocol for fetal movement count?
10 movements/2hrs
when is a woman advised to call her HCP?
– < 10 movements in 2 hours
– Fetus has not moved all day
– Noticeable change in quality
or quantity of fetal activity
what are the 8 indications for an ultrasonograph?
– Gestational age (12 wks/1st tri is optimal)
– Fetal growth pattern (when fundal height not right)
– Number of fetuses
– Fetal position (breech?)
– Fetal anomalies (higher level ultrasounds, can see ♥ valves or neck folds, done at any time)
– Length of cervix (4 cm)
– Amniotic fluid volume (how well placenta is working)
– Placental location (low attached placenta? triggers bleeding; placenta plebia: attached to the cervix→C section needed)
What types of ultrasonographs are there?
abdominal (full bladder needed) or transvaginal (1st trimester)
What is a non stress test?
Noninvasive assessment of fetal well-being that is valid after 28 weeks gestation. It evaluates fetal heart rate in
response to its own movement
What are indications of a non stress test?
post-term, diabetic woman, decreased fetal movement
What is the desired result of a nonstress test?
• NST reactive: – At least 2 accelerations at least 15 beats/min above baseline lasting at least 15 seconds in 20 min period – Normal baseline rate (110 -160bpm; average over 10 min period)
How can a NST nonreactive result be indicated?
NST nonreactive if criteria not met. Could be result of:
– Fetal acidosis
– Fetal sleep cycle`
What can be done if there is a nonreactive result during a NST?
can repeat the test again, juice/eating can wake the baby, if nonreactive again, move to another test.
What is a biophysical profile (BPP)?/
Real time ultrasound assessment of fetus with parameters that are evaluated and scored as either a 2 or a 0
What are the parameters that are assessed during the biophysical profile?
– NST – Fetal breathing movements(30-60bpm - prep for birth when lungs do have to work - smoking ceases these) – Fetal body movements (big movements) – Fetal tone (flexed) – Amniotic fluid volume
What are the score interpretation of the BPP?
8-10 = Normal
6 = Equivocal
≤ 4 = Abnormal; will have further tests or delivery ASAP
What is alpha-fetoprotein (AFP)?
AKA Maternal serum alpha fetoprotein (MSAFP) -
it is a screening test done on maternal blood 16 - 18 wks gestation - early screen, not perfect, but best we have recommended for woman
What does a low level alpha-fetoprotein indicate?
down syndrome
what does a high level alpha-fetoprotein indicate??
neural tube defect, like spina bifida
What is ordered if alpha-fetoprotein test results are abnormal?
- repeat the AFP test
- high level ultrasound
- amniocentesis (invasive)
What is a non-invasive prenatal test (NIPT)?
A screening for fetal chromosomal abnormalities associated with intellectual disability, completed by analyzing fetal DNA fragments in the maternal blood, that is recommended for high risk women ages 35 and older.
***can be requested in women < 35
How early can a non-invasive prenatal test be done?
Can be done as early as 10 weeks gestation
What can a NIPT predict?
It can predict risk of trisomy 21 (down syndrome) and two other syndromes; if results are positive, follow up recommended, such as amniocentesis
What is an amniocentesis?
Ultrasound-guided amniotic fluid collection for analysis
What are the indications for amniocentesis?
– Assess for genetic defects 2nd trimester (recommended ≥ age 35) – Assess fetal lung maturity 3rd trimester – Check for uterine infection – Monitor severity of maternal Rh sensitization in Rh negative woman (Rh negative women will receive RhoGAM post-procedure)
What is the complication rate for amniocentesis?
RARE (0.5%)
