UNIT 1 (A-F) Flashcards
1
Q
When does embryonic gender differentiation occur?
A
8 weeks gestation (reproductive organs present)
2
Q
What are the types of pelvis’s and the preferred?
A
**Gynecoid
Android
Anthropoid
Platypelloid
3
Q
What uterine muscles contract during labor? Prepare for implantation/pregnancy?
A
Myometrium
Endometrium
4
Q
What is the ph’s of the vagina, what do the changes provide? How are the veins located? What risk does this pose?
A
4-5 during reproductive life (acidic prevents infection, except candida)
7.5 during infancy to puberty and menopause (kills sperm at this level)
Bypass heart and lungs, straight to brain and spine. (Infection can cause meningitis)
5
Q
What are the phases of the menstrual cycle?
A
Menstrual phase (1-6) Proliferative phase (7-14) Ovulation phase (14) Secretory phase (15-26) Ischemic phase (27-28)
6
Q
When is the menstrual phase? What occurs?
A
Days 1-6.
Endometrial lining sheds, and glands regenerate.
Low estrogen levels.
scant, viscous, opaque cervical mucosa.
7
Q
When is the proliferative phase? What occurs in this time?
A
7-14
Increasing estrogen levels
Endometrial glands enlarge, tissue thickens
Blood vessels dilate
Cervical mucus stretchy, clear, thin, watery, alkaline
8
Q
What phase occurs on day 14? What happens during this time?
A
Ovulation phase
Mature ova release (due to FSH and LH) and viable 6-24 hours. Cervical mucosa-elastic-spinnbarkeit
Body temp drops prior to ovulation and inc. 0.5-1 at ovulation.
Mittelsschmerz (mild cramps)
(Born w/ 400,000. 30,000 by puberty)
9
Q
When does the secretory phase begin? What occur during this time?
A
15-26
Influenced by progesterone
Inc uterus vascularity
Inc myometrial gland secretion (prep for fertilized egg)
10
Q
What is the last menstrual cycle phase? What days will this occur? What changes occur?
A
Ischemic phase (if fertilization doesn’t occur)
27-28
Corpus lutes degenerates
Estrogen/progesterone levels decrease
Blood escapes via endometrial stromal cells (menstruation begins)
11
Q
What four factors encourage fertilization?
A
Fructose in semen provides sperm energy.
Prostaglandins in semen inc uterine muscle contractions to transport sperm.
High estrogen levels inc peristalsis in Fallop tubes and cause mucosa thinning.
Fallop tubes have cilia to move ovum and sperm.
12
Q
What factors makes fertilization difficult?
A
Ovum fertile for only 6-24 hours
Sperm live 48-72 hours (best for 24)
200-300 million sperm ejaculation but only hundreds reach ampulla (where fertilization occurs)
13
Q
Explain the cleavage - mitosis division cell stages. (3 days)
A
Blastomere-dividing cells (zygote rapid division as it moves along the fallopian tube via ciliated epithelium).
Morula:12-32 cells.
Blastocyst:inner mass of cells (develops into embryo/membrane)
Trophoblast:outer layer (replaces zona pellucida) develops into chorion.
14
Q
When is implantation complete? How does this occur?
A
Day 9
Trophoblast (chorion) attaches to endometrium burrowing into uterine lining becoming chorionic villi (helps supply nutrients to fetus). Secretes early preg protein. Progesterone helps thicken endometrium and prepare for implantation.
15
Q
When and what do blastocyst cells differentiate (3 different layers)?
A
10-14 days
Outermost is chorionic membrane w/ chorionic villi.
Inner chorion is thin amnion with amniotic fluid (except where umbilical connects)
16
Q
By when is the yolk sac and amnion well developed? What is the yolk sacs job?
A
4 1/2 weeks
Makes primitive RBC’s (until liver able)
17
Q
How much amniotic fluid is present by the 3rd trimester? Define too little or too much and those amounts. What are the amniotic fluids functions?
A
700-1000ml Oligohydramnios <400ml Hydramnios/polyhydramnios >2000ml Injury protection Temp control Permit growth/development Freedom of movement Prevent umbilical compression Fetal protection during labor Provides analysis fluid
18
Q
From what does the umbilical cord develop? Size? What does it contain? Function?
A
Amnion. 2cm X 50-60cm. Attaches embryo to yolk sac, fuses with embryonic portion of placenta. Provides path form chorionic villi to embryo.
2 arteries, 1 vein surrounded by Wharton jelly (protection).
Vein provides circulatory pathway to embryo. Artery carries away waste.
If only one artery present, look for GI, Renal, or cardiac issues.
19
Q
For identical twins, how does division effect number of chorionic/amnion?
A
Monozygotic (1 egg)
W/I 4 days:2 embryo, 2 amnion, 2 chorion.
4-8 days:2 embryo, 2 amnion, common chorion.
8-12 days: 2 embryo, 1 amnion, 1 chorion.
20
Q
For fraternal twins, how are the anatomy arranged?
A
Dizygotic (2 eggs) 2 placentas (sometimes fuse appearing as one), 2 chorion, 2 amnions
21
Q
How long does growth of placenta continue?
What are the two sides?
A
20 weeks and covers half of the uterus lining on Maternal side-cotyledons are the anchoring villi. If left behind during labor, causes hemorrhage.
Fetal side-chorionic villi w/ amnion.
First 3-5 months little nutrient exchange. Then thins and allows full exchange until too old to function (41 weeks).
22
Q
What are the 5 placental hormones?
A
HCG Progesterone Estrogen HPL Immunologic
23
Q
What are the functions of placenta hormone hCG?
A
Prevents involution of corpus luteum and abortion.
Causes CL to inc estrogen/progesterone levels.
Stims testes to produces testosterone to cause male organs to develop.
Immunologic capabilities keep placenta from rejecting placenta and embryo.
Used as basis for pregnancy test in blood at implantation (8-10 days after fertilization) and one month in urine.
24
Q
What are placental functions?
A
Fetal respiration
Delivery of nutrients, o2, waste excretion, stores glycogen/iron
Endocrine: corpus luteum works as temp placenta until it produces enough hormones alone.
25
What does the placental hormone progesterone do?
Inc secretions of Fallopian tube to provide nutrition for morula. Helps with implantation. Dec contractility of uterus to dec abortions.
26
What does the placental hormone estrogen do?
Enlargement of uterus and breast. Inc vascularity and vasodilation in end of preg. Production inc dramatically toward end of preg.
27
What does the placental hormone HPL do and immunilogic functions?
HPL:stim changes in mothers metabolic processes to ensure more protein, glucose, and minerals are avail for fetus.
Immune: due to placental production of progesterone, hcg, and chorionic villi.
28
When is the embryonic stage? What occurs each week in this stage?
Day 15-8 weeks
- Week 2-3:blood circulation begins, tubular heart forms (3rd week)
- Week 4:brain/spinal cord formed, tubular heart beats.
- Week 8: heart complete. (Heard w/doppler) Some movement, genitals all appear similar.
29
When is the fetal stage? What occurs in each of these weeks?
End of 8 weeks-birth
-End of 8th week:all organs present
-15-20 weeks:sex determination, scalp hair lanugo present.
-21-27 weeks:myelination of spinal cord, fetus sucks/swallows amniotic fluid, peristaltic movement begins, lanugo
-24 weeks: respiratory movements, alveoli appear produce surfactant, gas exchange possible, skin covered in vernix.
AGE OF VIABILITY!
-28 weeks: adipose, nails, eyebrows/eyelashes, testes descend, eyelids open.
-36 weeks: lanugo disappear (protective layer).
-38-40:Lecithin-sphingomylin ratio inc indicating dec risk of resp distress during birth.
30
What are the chromosomal genetic d/o categories? What occurs?
Monosomic-missing a chromosome, only 45, miscarry early on.
Trisomic-extra chromosome, 47, Down's syndrome, the lower the number the worse the condition.
Mosaicism-2genetic materials in same person, more common in sex chromosome, failure of some chromosomes to separate during fertilization. High functioning downs syn.
31
What are the monosomic/trisomic sex chromosome aneulpoidies d/o's?
Mono-turner syndrome 45 chromo X (females)
| Tri-klinefelter synd 47 XXY (Males)
32
What are other chromosomal abnormalities?
Inversion:loss or gain of chromo (causes: chemicals, smoking, drinking, drugs, radiation, viruses)*risk of leuk, ca, hemophilia.
Translocation:transfer of part/entire chromo. *risk of metal/phy disa.
Deletion:cri du chat syndrome 99%abort (missing on 5)
33
How are autosomal dominant and autosomal recessive different?
And the common d/o?
```
DOM: affected child has affected parent. No carriers. 50% chance of affected child.
Huntingtons (deg of brain C#4)
Polycystic kidney dz
Neurofibromatosis
Achondroplastic dwarfism
REC:both parents must be carriers.50% carrier, 25%affected.
Cystic fibrosis
Sickle cell (C#9)
Tay-sachs dz
Most metabolic d/o (PKU)
Albinism
```
34
When is genetic u/s best performed?
16-20 weeks
| Must have f/u screening
35
What is NTT nuchal translucent test? When is it best performed?
U/s that scans clear area on back of fetal neck. Excess fluid is representative of some genetic d/o's (downs). screens trisomy 13, 18, 21.
1st trimester 10-14 weeks.
False pos and false negs.
36
What is MSAFP? What is it sig for? When is it done?
Blood serum test. Elevated when neural tube defects. Low levels indicate downs.
15-18 weeks (important to know accurate dates)
High false positives.
(May check plasma at same time that helps with downs dx)
37
Describe the quad screen. What is indicated with inc/dec levels?
```
Maternal serum test.
AFP:alpha fetoprotein
hCG:human chorionic gonadotropin
UE3:unconjugated estriol 3
dim Eric inhibin-A (hormone from placenta)
```
High AFP-neural tube defects (or twins)
Low AFP-downs trisomy 18
High hCG and inhibin-A, low UE-downs
38
What is the purpose of the maternity 21/Harmony testing?
Blood testing. Screens for trisomy 13, 18, 21.
| Very effective. Can determine sex at 10 weeks.
39
When can an amniocentesis be performed? Why is it indicated?
```
For chromosomal after 15 weeks.
Age over 35
Prev child w/ chromosomal abnormal
Parent carrier
Mother w/ x linked
Parents w/inborn error of metab
Parents w/ autosomal recessive
Fam hx neural tube defect
Pos screen tests
```
40
What are PUBS and CVS testing used for? When can these be performed?
Pub-blood for rapid dx, genetics, RH. Blood from cord. After 18 weeks.
Cvs-sim to amnio. 8-10 weeks (cervically/abdominal)-cannot R/O neural tube defects-too early.
41
What does the doppler flow study look for? What can occur with poor result? How is this determined?
Umbilical velocimetry (blood flow between uterus and placenta)
Uteroplacental insuff-fetal anemia.
Inc press=placental d/o
S/D ratio 2.6 by 26wks, 3 at term.
42
How is amniotic fluid analyzed? For what? When?
```
Amniocentesis:
AFP early on-15-16 weeks.(Quad screen) Fetal abnormals/genetics/maturity.
3rd TRIMESTER:
L/S ratio
35 weeks:PG
LBC (lamellar body ct)
Delta OD 450: for fetal life threat anemia. Allows for transfusion (usually from rh- mom w/o rhogam shot)
15-20ml fluid.
Rhogam admined if RH-.
```
43
What indicates lung maturity in the amniotic fluid analysis?
L/S ratio (2:1)
PG presence
LBC count (30,000-40,000)
This is checked when looking to deliver early.
44
What is fetal fibronectin? (FFN) how is it performed? What do the results indicate?
A protein in fetal membrane and decidua. This leaks into vagina and cervical fluid near delivery.
Its used to predict preterm delivery. Cervix swab.
POS:risk for preterm at 22-37 weeks
NEG:low risk of occurring w/i 7-14 days
Also measure cervical length using prostaglandin gel
45
What is 17 alpha hydroxyprogesterone? What does it do? How is it used?
Progestin med. used for h/o preterm labor.
Relaxes uterine muscle.
Weekly injections starts 16-20 wks
AE: ha, nerves, dizzi, clot, wat reten, blur vision, rash, breast tender, vag bleed, allergy reactions.
46
What is a fetal non-stress test used for? When? And nurse duty?
Used to assess fetal status by electronic fetal monitor. 30-32 wks, high risk.
Void prior
Semifowler/sidelying
Tocodynamometer (on uterus upper)
U/s transducer and gel (on fetus back Lower)
Will push button when movement felt.
47
What are the results of fetal NST? What do these indicate?
INC HR w/ MOVEMENT IS GOOD!
Reactive: 2 accelerations FHR of 15 beats above baseline for 15 seconds over 20 min time.
Non Reactive: less than 2 accelerations FHR of 15 beats for less than 15 seconds over 40 min time. (Fetus may be sleeping).
Unsat: cannot interpret
If under 20wks use FHR of 10 beat increase.
Deceleration require further testing.
48
What are the NST interpretations? VEAL CHOP
Variable deceleration-cord compression
Early decels-head compression
Accelerations-oxygenated fetus
Late decels-uretoplacental insuff.
49
What is fetal stimulation and what is it needed for?
Acoustic or vibroacoustic stimulator.
To wake baby to perform testing.
apply to fetal head when nonreactive NST or dec variability for 2-5 seconds.
May reappear at 1 min intervals for up to 3 times.
50
What is included in a biophysical profile? How is it scored?
```
5 variables via u/s:
Fetal breathing movement
Fetal movement of limbs or body
Fetal tone (ext or flex)
Amniotic fluid vol
Reactive FHR w/ activity (reactive NST)
```
Scores 2 points for each (0 min=dead, 10 max)
51
Why would a biophysical profile be needed?
Threats to placental sufficiency. (Placenta delivs o2 to fetus)
52
What is a contraction stress test? (CST) What do the results indicate?
Admin of oxytocin to make contractions. Want to know if baby accel w/ contraction.
Positive test indicates decelerations w/ 50% (stressed baby). Labor will by hypoxic stress to baby.
Negative is GOOD! Accelerations! 3 contractions lasting atleast 40 seconds in 10 min w/o late decels. Placenta is functioning, fetal o2 good for labor.
Equivocal: non persistent late decels or decels w/ hyperstim of uterus. (Want to do BPP for more)
53
What will be f/u for all results to contraction stress test?
```
Neg: repeat w/i 7 days
Equivocal:respect w/i 24hrs-neg:rep w/i 7day, pos:immature-BPP
Pos:
reactive:immature-back up tests (BPP)
Nonreactive:delivery
```
54
What are the changes that occur to the uterus in pregnancy?
Estrogen allows fetus to enlarge myometrium for more space.
Size:60g-1100g
Capacity:10ml-5000ml
Hegars sign:softening of lower segment
End of preg: 1/6 maternal blood in uterus vascular system.
55
What changes occur in the cervix upon pregnancy?
Estrogen encourages inc discharge, mucus plug forms
Inc vascularity causing softening-Goodell sign
Bluish coloration-Chadwick sign(inc blood flow)
56
What respiratory changes occur in the pregnant woman?
Air intake inc 30-40%
Progesterone dec airway resis=inc O2 consumption, and inc CO2 production (5-20%), rate inc.
Chest circum inc.
Abd to thoracic breathing.
Nasal stuffy, epistaxis r/t estrogen, progest, prostaglandins causing edema, inc mucus, vascular congestion of nasal mucosa.
57
What cardiovascular changes occur during pregnancy?
Inc blood volume (50% until 30-34 wks)
CO inc (30-40% for breast, uterus, placenta)
Pulse inc 10beats, bp dec and returns to prev normal 3rd tri.
Progest dec vascular resist,murmur
Venous stasis (edema, hemmhor, varicos)
58
What occurs when laying flat during preg? S/s?
Vena canal syndrome/supine hypo syn.
Fetus press on aorta
(Clammy, dizzy, pale)
59
What blood changes occur during preg?
Anemia-plasma vol inc dil rbcs
If on iron, rbcs inc 30%, 18% if not
Wbc-ante 5600-12000, labor/PP 20-30 thousand
Fibrin/clot factors inc (coag inhibs dec)
60
What s/s would be used when looking for infection in the pregnant? Why wouldnt wbc's be a determinant?
Why do clot factors inc? And coag inhibs dec?
Temp, incision edema warmth pain erythema, vag odor.
WBC's are markedly inc in the preg woman, esp at labor.
Compensating for future blood loss (labor)
61
What GI changes occur in pregnancy?
N/V, inc CHOL, cholecystitis (Hcg, and Progesterone is a smooth muscle relaxant)
Displaced intestines-flatulence, abd distention, cramping, constipation, hemorrhoids.
Gums soften, bleed, periodontal dz (estrogen)
Ptalyism, pyrosis, pruritis.
62
What GU changes occur in pregnancy?
Urinary freq
GFR inc 50% (2nd/3rd tri)
Tubules inc absorption, cannot reabsorb glucose (issue for diabetics)
UTI-dec bladder tone, dilated renal pelvis, ureters (progesterone-smooth muscle relaxant)
63
What changes occur in the integumentary during pregnancy?
Pigmentation:
Linea Nigra, chloasma (estrogen, prog, melanocytes-stim hormone)
Striae (adrenacort-cause fragile elastic tissue)
Vascular spider nevi (estrogen)
Hair growth, acne, skin oily (androgen causing inc Seb gland secretion)
Inc body temp/perspiration/BMR (prog)
64
What musculoskeletal changes occur in the pregnancy?
Diastasis recti
Center of gravity change
Waddle gait, lordosis, back ache (prog, relaxin)
65
What weight gain is appropriate? When?
Normal 25-35
Overweight 15-25
Obese 11-20
Under 28-40
1st tri:1.1-4.4 lbs
2/3rd tri:1lb/week
66
What occurs in the thyroid gland and pancreas during preg?
Thyroid enlarges due to inc BMI of 20%
Pancreas releases more insulin d/t inc insulin need, body retains more carbs, can lead to GDM.
67
What pituitary endocrine changes occur in pregnancy?
```
FSH:ovum growth
LH:ovulation
Prolactin: lactation
Oxytocin:labor, letdown reflex
ADH: fluid balance, vasoconstriction
```
68
What endocrine changes occur in the adrenals during pregnancy?
Cortisol:reg protein, CHO, metab
| Inc aldosterone
69
What do the following endocrine hormones do w/i pregnancy?
HCG
HPL
Relaxin
Hcg:hormone released at implantation. Stims Estrogen/progesterone by corpus luteum until placenta takes over.
Hpl: inc free fatty acids (for maternal needs), dec glucose metab (to supply fetus)
Relaxin:inhibits uterine activity, softens cervix, helps uterus accommodate pregnancy.
70
What do the following endocrine hormones do w/i pregnancy?
Estrogen
Progesterone
Prolactin
Estrogen:uterine and breast development
Prog:maintain endo, inhib uterine contract (prevent spont abortion), prepare breast develop.
Prolactin: facilitates lactation
71
What is/the role of prostaglandins in pregnancy?
Lipid sub high in female reprod tract
Helps initiate labor
Dec levels contribute to htn, preeclampsia
72
Diff presumptive, probable, and positive changes of pregnancy.
Presumptive-subjective-pt says
Probable-objective
Positive-proof of pregnancy
73
What are presumptive changes in pregnancy?
Amenorrhea (could be nutrition, menopause related)
N/V (could be stomach bug)
Excessive fatigue (could be anemia, overworked)
Urinary freq (could be UTI)
Breast changes (could be cancer, cyst)
Quickening (could be gas)
74
What are probable changes in pregnancy?
Goodells sign (cervix softening)
Chadwick sign (bluish mucus membrane in cervix/vag/vulva)
Hegars sign (softening of isthmus of uterus)
Abd enlargement
Braxton hicks
Uterine soufflé (blowing sound heard over uterus-inc uterine blood flow)
Skin pigmentation changes
Fetal outline ID by palpation
Bellottement fetal movement when examiner inserts 2 glove finger into cervix
Preg test
75
What are positive changes r/t pregnancy?
Proof:
Fetal heart beat (10-12 wks)
Fetal movement by a trained professional at 20 wks
Fetus on U/S. Gestational sac at 4-5 wks. Transvaginal detects sac at 10 days.
76
What are the 4 psychological tasks of Rubin? What do accomplishing these mean?
1: ensuring safe passage through pregnancy
2: seeking acceptance of this child by others.
3: seeking commitment and acceptance of herself as mother to the baby.
4: learning to give of oneself on behalf of ones child.
Developers self-concept as a mother.
77
When should a female wanting to get pregnant receive MMR and stop hormone birth control?
3 months prior to pregnancy
78
How is abortion defined?
Birth that occurs before the end of 20 wks gestation or the birth of a fetus-newborn who weighs less than 500 g.
May occur spontaneously or induced.
79
When is "term"? When is "preterm" and "postterm"
Term:38-42 wks
Preterm (premature):labor that occurs after 20wks gestation but before completion at 36 wks
Post term:labor that occurs after 42 weeks
80
What is nulligravida, primigravida, multigravida?
| Para, Nullipara, primipara, multipara?
NG-never been pregnant
PG-pregnant for the first time
MG-in second or more pregnancy
Para-birth after 20wks regardless of alive or dead.
NP-no births after 20wks
PP-1 birth after 20wks
MP-2 or more births more than 20wks
81
What is GTPAL?
G-Gravida:number of preg (regardless of gestation time)
T-Term: number born after 37 wks
P-preterm:number born between 20-37 wks
A-abortions: spontaneous/thera ending (Before 20wks)
L-living children
82
What is Nageles rule?
Determines due date
Subtract 3 from month
Add 7 to days
Add one year (as appropriate)
83
What is the suggested weight gain for pregnancy?
Normal 25-35
Underweight up to 40
Overweight up to 15
1st tri 3.5-5
2nd/3rd 12-15 lbs (1lb/week)
84
What is hyperemesis gravidarum? S/s? Concerns? Tx?
Excessive vomiting
Hypovolemia, dehydration, hypoten, tachy, metab acidosis, potassium loss, cardiac issue, inc h and h, jaundice, muscle wasting, death.
Anti emetics, iv fluids, good nutrition, vit admin.
85
What defines Anemia in pregnancy? Causes? Tx?
Hb less than 11.
Plasma vol inc by 50% in pregnancy while RBCs only 18%. Diet dependent. Sickle cell. May trigger PICA.
Iron supp (causes constipation), diet change
86
What changes to the heart occur in pregnancy that can lead to heart dz's?
What 3 dz's are related and those concerns?
Heart works harder, inc CO HR and blood volume.
Rheumatic heart dz:hemolytic strep infection-mitral valve stenosis, inc risk CHF.
Mitral valve prolapse:systolic murmur, inc arrhythmia
Peripartum cardiomyopathy: end of preg. L ventricle s/s sim to cold.
87
What fetal concerns are there for mom w/ heart dz?
| What testing/tx is used for her?
Dec fetal o2.
Echo, cxr, cath.
Antibiotics, anticoagulant (heparin), thiazides (lasix), dig, antiarrythmics.
Prefer natural induced labor with epidural. Get to 10cm before pushing, keep stress low.
88
What is the tx for spontaneous abortion?
```
Relief of cramping/backache:heating pad, pain meds
Hcg levels dec,
May need blood (blood loss during abort)
Dand C, iv fluid, antibiotics
Pelvic and bed rest
Rh immune if indicated
```
89
What is ectopic pregnancy?s/s? Concern? Tx?
Implantation of fertilized ovum in site other than endometrial lining. (Fallop tube most common)
Common preg s/s. When embryo outgrows area, tube ruptures: sharp one sided pain (implanted side), referred shoulder pain, syncope. Bleeding into peritoneal space. THESE INDICATE EMERGENCY!
Hemorrhage-death.
Medical-methotrexate (2 doses)1st day and 4th and additional on 7th day: check Hcg level decrease success. (Used for those wanting further pregnancies)
Surgical-2 types: save tube and remove tube.
90
What is gestational trophoblastic dz? Types?
Pathological proliferation of trophoblastic cells. Hydatidiform mole (molar preg):these cells result in the formation of a placenta with hydropic grape like clusters.
Complete: ovum w/ no genetic fertilized by normal sperm. Dies early no circulation (cancer more associated w/ this type)
Partial:69 chromosomes, normal ovum fertile by 2 sperm. Maybe a fetus w/ HR, usually dies.
Invasive:sim to complete but involves myometrium
91
What are s/s, tx of placenta previa?
Onset-quiet
Bleeding-external bright red
Pain only during labor
Presentation may be abnormal.
Don't want mom to labor-need c/s
92
What are s/s, tx for abruptio placentae?
Sudden onset
Dark blood external or hidden, anemia and shock worse than apparent blood loss.
Poss pre/eclampsia
Pain severe/steady, uterine tenderness
Tone firm/hard,enlarges,engagement may occur, FHR may become absent.
C/s, blood trans, abd girth
93
What is PROM/PPROM? Causes?Concerns?TX?
Premature rupture of membranes before onset of labor.(PPROM-before 37 weeks)
Incomplete cervix, infect, previo, amnio, prev hx, hydram, abrup, mult gest, LEEP, bleed.
Mom:Infect, abruption.
Baby:infect, malpres, non reas HR, resp dist, prolapse.
Deliver w/i 18 hrs (38wk)
Bedrest w/ antibiotic (PPROM)
94
When is preterm labor? Tests? Tx?
20-36wks
FFN, watch cervical length, tocolysis Beta mimetic (stop labor)
Terbutaline:dec uter contra, inc HR
Mag Sulf: dec bp/uterine cont (antidote:calcium gluconate), output must be good. SE:hot, nv, fatigue, consti, visual blur TOX:anura/olig
Nifedipine: ccb (don't use w/ mag)
SE:hypo, tachy, vasodil, flush
95
What is considered hydramnios/poly? What is normal? S/s?
More than 2000 ml amniotic fluid. 500ml normal.
Can be acute/chronic
Edema, sob, fullness, tight
96
What is oligohydramnios? Cause? Concerns? TX?
Less than 500ml amniotic fluid. Assoc w/ maternal htn, fetal renal malform, placenta d/o, can be leaking at end of preg.
Slows labor, limits fetal movement, adhesions, non reas FHR.
Amniofusion (instill 250ml, watch for too much)
C section.
97
What is considered pre-eclampsia? Eclampsia?
Inc in bp after 20wks w/proteinuria. Sudden edema.
Occurrence w/ sz.
98
What patho explains pre/eclampsia?
Woman's gradual loss of resistance to angiotensin 2. D/t ratio dec prostacyclin (vasodil, anti plate agg, inc uterine blood flow) and inc thromboxane (prod by platelets, constricts, clumps).
This vasospasm dec placental perfusion. (Also a dec in the vasodil NO)
GFR and output decreases, BUN/Creat and uric acid increase, sodium retention, cap wall stretch allowing loss of protein into urine, dec serum albumin, dec osmotic pressure allowing third spacing (edema) and viscous blood in inc Hemat.
99
What syndrome is sometimes assoc w/ pre/eclampsia? What occurs?
S/s?
HELLP
Hemolysis, elevated liver enzymes, low platelet count.
Rbcs fragment from passing thru damaged blood vessels. Blood flow is obstructed by fibrin deposits and inc liver enzymes. This will inc bilirubin and jaundice forms. Platelet aggregation at damaged vessel sites (from vasospasm) dec overall platelet count causing thrombocytopenia.
Epigastric pain, nv, flu s/s, dic can happen.
These pts should have baby asap.
100
What are the concerns w/ pre/eclampsia? Tx?
MOM: Hyperreflexia, ha, sz, thrombocytopenia, hypovolemia. Inc risks for abrupt, renal fail, dic, rup liver, PE.
Baby: hypoxia, malnutrition, low birth weight, premature, oversedation d/t maternal meds, hypermag d/t mag sulf.
101
What are the s/s for mild vs severe preeclampsia?
Mild: few symps, bp 140/90 or higher, proteinura 1+, inc liver enzymes, edema.
Severe:bp 160/110 or higher on 2 occasions atleast 6hr apart on bedrest. Proteinuria 5+ or 3+, oliguria (500ml/24hr)
Visual dist/HA (small vessels), edema, epigastric pain, thrombocytopenia.
Prevention of seizure! If occurs-emergent:start MAG, sedative, antihyper, c/s.
Mag: cns dep
Hydralazine:antihyperten
Labetalol:bb do not use w/asthma or heart fail.
Nifedipine:ccb
Methyldopa:antihyper long term use
102
What is considered chronic htn in pregnancy? Risks? Tx?
Bp 140/90 prepreg and before 20wks.
Risk for pre/eclampsia.
More prenatal visits, dec sodium intake, des stress, left lying.
Antihypers:labetalol (not w/asthma, heart fail), methyldopa, nifedipine.
103
What would indicate chronic htn w/ superimposed pre/eclampsia?
Women w/ chronic htn after 20wks and worsening and w/ onset of proteinuria and uric acid level rising.
This often occurs end of 2nd tri early 3rd.
Higher risk pt.
104
What differentiates gestational htn?
When htn occurs for the first time after mid preg. W/o proteinuria, w/o preeclampsia, and return to normal bp w/i 12 wk s postpartum.
105
What is DIC? When is it more common? Tx?
Overacting clotting process when something enters maternal circulation (amniotic, tissue). Imbalance between coag and fibrinolytic factors, leading to hemor and shock. Clots form and fibrin deposits in microcirculation making damaged cells, furthering coag. Depleting clot factors, making obstructions/infarction.
Occurs more often in pre/eclampsia, abrupt.
EMERGENCY, ICU, BLOOD INFUSION, POOR OUTCOME.
106
What is the risk w/ rh alloimmunization and ABO incompatibility? What risks does this pose?
What testing is done to check for either of these?
For ABO-who is this most common for?
Fetal rbc hemolysis. Hyperbilirubin, immature baby liver, jaundice. If baby not poop/pee or eat then can become serious for mental impairment.
Coombs test
O mom w/ a or b fetus.
