Week 1 Material Flashcards
5 minimum criteria for a home birth?
- informed consent
- singleton cephalic fetus at term
- absence of preexisting serious medical or obstetrical conditions
- absence of c/i to vaginal birth
- good communication & mutual respect b/w home birth providers and hospital staff (if a transport is necessary)
purpose of an epidural?
block labor painns w/o causing respiratory distress in the fetus
natural endorphin release is good for who and why?
good for mom & baby.
good for mom b/c blocks her pain and produces euphoria to process of childbirth.
good for baby b/c makes baby calmer.
why might an epidural ‘bad’ for mom?
no endorphin release in mom
can suppress UC’s–> now need pitocin
what two things do you have to do constantly after mom receives an epidural?
now need constant fetal monitoring= limits maternal mobility
also have to give mom a catheter= increases risk for UTI
what else can getting an epidural cause (besides blocking pain)?
can suppresses UC’s which means will then need pitocin
what can an epidural cause in relation to baby?
malposition which can lead to a C-section
what does a pitocin drip do?
stimulates oxytocin release to increase uterine contractions
where does oxytocin come from in the body?
posterior pituitary gland
in what type of cycle is natural oxytocin released in? why then are pitocin induced contractions so much worse (pain wise)?
normally released in a pulsatile pattern
pitocin contractions are much more painful b/c they spike (b/c mom is on a drip as opposed to her body producing it)
does oxytocin cross the BBB? does pitocin?
oxytocin does
pitocin does not- leads to no bonding effect or influence on behavior and can also cause fetal distress which can lead to C-sections
what are the 3 phases of uterine development?
- ovular
- embryonic
- fetal
when does the ovular phase occur?
first 4 weeks after fertilization
what happens during the ovular phase?
rapid mitotic divisions–> blastula which implants 5-7 d post fertilization and becomes a blastocyst
what is the difference b/w a blastula and a blastocyst?
blastula: sphere of cells w/central cavity filled w/fluid (from the morula)
blastocyst: similar to blastula but with inner cell mass, has recognizable body pole & preplacental zones & organ precursors are relatively positioned
when is the embryonic phase?
5th-8th weeks of pregnancy
what happens during the embryonic phase?
organ differentiation
when is and what happens during the fetal phase?
9th week-term
differentiation, growth & maturation occur
when is fetal age calculated from?
from date of conception
when is gestational age calculated from?
LMP (assuming a 28 d cycle)
before what day do you get the “all or none” effect?
day 15 of gestation
how many cells is a morula? how does it begin to implant? when is implantation completed by?
58 cells
puts itself under the endometria using enzymes
implantation complete by week 5
what weeks is the fetus the most sensitive to birth defects?
weeks 5-10
during what weeks would you see anencephaly develop? mental retardation?
CNS problems?
weeks 5-6
week 18
weeks 34-40
during what weeks would you see septal defects occur? heart defects?
weeks 5-8
weeks 8.5-10
during what weeks would you see upper and lower limb problems occur?
weeks 6-10
during what weeks would you see cleft lip develop? upper lip problems? cleft palate?
weeks 7-9
weeks 8-18
weeks 8.5-12
during what weeks would you see low or deformed ears or deafness occur? other ear anomalies?
weeks 5.5-10.5
weeks 10.5-33
during what weeks would you see microopthalmia, cataracts or glaucoma appear? other eye problems?
weeks 5.5-10
weeks 10.5-40
during what weeks would you see enamel hypoplasia & staining occur? other teeth problems?
weeks 8.5-10
weeks 11-40
during what weeks would you see masculinization of female genitalia? problems to external genitalia?
weeks 8.5-12
weeks 12-40
what are the 3 categories of congenital malformations?
malformations
deformations
disruptions
definition of malformation
alterations in normal development that occur as a result of an intrinsic abnormality in the developmental process
definition of deformations
abnormal mechanical force on an otherwise normal fetus
definition of disruptions
disruption of an otherwise normal developmental process
6 type of teratogens
- drugs
- environmental
- maternal medical d/o’s
- infections
- genetic conditions
- obesity
when is the BBB fully formed?
at 6 months
when is a person at the greatest risk for DNA damage? (5 ‘times’ in life)
as a fetus, neonate, infant, adolescent and as a women when you are in the luteal phase
5 maternal complications with smoking?
- COPD
- cervical CA
- infertility
- earlier menopause
- ectopic pregnancy
4 pregnancy complications with smoking (dose related)?
- SAB
- stillbirth
- perinatal death rate increases
- premature labor
smoking & it’s effects on the placenta (5)
- constriction of maternal vessels
- placental growth restricted
- placenta previa
- increased mineralization of placenta
- degradation of membranes leading to PROM
7 effects of nicotine on infants when exposed in utero?
- growth & intellectual deficiencies
- ADD, ADHD
- less responsive to sound & soothing sounds don’t comfort, hyper
- increased SIDs
- increased respiratory diseases
- increased childhood CA risk
- strabismus
6 pregnancy & EtOH complications
- 1st & 2nd trimester bleeding (3x’s as often)
- infection
- placental abruption
- SAB b/c placenta failing
- habitual SAB 2x’s increased
- messing w/hormonal balance & fetal development
Fetal Alcohol Syndrome dx requires one feature from each category; what are the 3 categories?
- prenatal or postnatal delay in child’s weight or head circumference
- distinct physical characteristics: at least 2 of the following- small head, small eyes or short eye openings or narrow lip w/o center groove, short upturned nose or flattened mid-facial area; males may have abn testes
- abnormalities of CNS, signs of brain dysfxn, delays in behavioral development &/or cognitive impairment
suggested limit caffeine in 1st trimester?
150 mg per day
radiation can increase risk for what dzs/infections/dz processes?
leukemia, asthma, eczema, urticaria, pneumonia, dysentery & rheumatic fever
drug of choice for pregnant women? (pain & fever control) what pain management OTC is c/i in pregnancy but recommended 1st all other times in life?
tylenol
NO IBUPROFEN in pregnancy
also need to avoid acetylsalicylic acid in pregnancy b/c affects formation of PGs & decongestants
what congenital d/o’s does one need to be aware of in FHx? other important FHx to know of?
PKU, NT defects, chromosomal abn
also need to know about birth defects, twins or multiple births, infertility issues
what 8 things do you need to know in regards to gyn hx?
- Birth control history
- Length of pregnancy attempts
- Hormonal status
- Risk factors for breast cancer
- Infections
- Treatments for STD’s before pregnancy
- Discuss high risk behaviors
- Offer HIV testing
OB hx you need to obtain?
a. History of premature labor
b. Incompetent cervix
c. Stillbirth
d. PIH/ gestational diabetes
pregnancy needs to be delayed 3 months after receiving what 3 vaccinations?
rubella
Hep B
teatanus/Tdap
what 4 things do you need to make sure mom is getting in pregnancy, nutritionally related?
no excess in fat soluble vitamins
adequate folic acid
iron
calcium
7 main c/i to having a home birth
- pre-eclampsia
- HIV/AIDS
- HBV
- chronic illness
- gestational diabetes & mom can’t control blood sugar w/meds
- severe cardiac problems
- liver damage
3 possible c/i to having a home birth
- pre-eclampsia you feel you can control
- smoker who won’t quit
- anything that makes you concerned about baby’s growth rate/development/pattern
