Week 1 Maternal/newborn Flashcards
Define Antepartum, intrapartum, postpartum
Antepartum - prenatal/pregnancy
Intrapartum- labor/delivery
Postpartum - after birth
What are the female reproductive structures?
-ovaries
-Fallopian tubes
-uterus
-cervix
-vagina
What is the function of the vagina?
It has 3 major functions:
1. It allows discharge/ menstrual flow
2. Female organ for sex
3. Allows passage for baby to be born
What is the function of the uterus?
-largest organ of the female reproductive system
-Carries the baby/forms placenta
-responsible for menstruation
-site of implantation for fertilization
What are the layers of the uterus?
-perimetrium (outer peritoneal layer of Serous membrane that covers most of the uterus)
-myometrium (middle layer of thick muscle. Most muscle fibers are concentrated in the upper uterus. contains 3 types of smooth muscle fiber - longitudinal, interlacing figure-8, circular)
-Endometrium (inner layer of uterus. Responds to cyclic variations of estrogen and progesterone during cycle. It has two layers- basal & functional)
What is the function of the Fallopian Tubes?
-pathway for released egg between ovary and uterus
-fertilization occurs here
-lined with cilia to propel egg through tube
What are the 4 divisions of the fallopian tubes?
- The interstitial portion runs into the uterine cavity and lies within the uterine wall.
- The isthmus is the narrow part adjacent to the uterus.
- The ampulla is the wider area of the tube lateral to the isth-mus, where fertilization occurs.
- The infundibulum is the wide, funnel-shaped terminal end of the tube. Fimbriae are finger-like processes that surround the infundibulum.
What is the function of the ovaries?
(1) sex hormone production
(2) maturation of an ovum during each reproductive cycle.
(3) secretes estrogen & progesterone during a woman’s reproductive cycle to prepare the uterine lining for pregnancy.
What is the function of the cervix (lowest part of the uterus)
-The cervix is the tubular “neck” of the lower uterus.
-During labor, the cervix effaces (thins) and dilates (opens) to allow passage of the fetus.
-The os is the opening in the cervix between the uterus and vagina.
-The upper cervix and lower cervix are marked by the internal os and external os.
What are the 3 phases of the ovarian cycle?
-Follicular
-ovulatory
-luteal
Describe the follicular phase
-Maturation of egg
-starts 1st day of menstruation, ends approx. 14 days later
Describe the ovulatory phase
-Near the middle of a 28-day reproductive cycle & about two days before ovulation, LH secretion rises.
-The mature follicle is a mass of cells with a fluid-filled chamber. A smaller mass of cells houses the ovum within this chamber. At ovulation a blister-like projection called a stigma forms on the wall of the follicle, the follicle ruptures, and the ovum with its surrounding cells is released from the surface
of the ovary, where it is picked up by the fimbriated end of the fallopian tube for transport to the uterus.
Describe the Luteal Phase
-Ovulation marks the beginning of the Luteal phase of the reproductive cycle and occurs 14 days before the next menstrual period.
-After ovulation and under the influence of LH, the remaining cells of the old follicle persist for approximately 12 days as a corpus luteum.
-The corpus luteum secretes estrogen and large amounts of progesterone to prepare the endometrium for a fertilized ovum.
-During this phase, levels of FSH and LH decrease in response to higher levels of estrogen and progesterone.
Phases of menstruation- uterine changes
•Menstrual Phase > 4-6 days, decreased levels of estrogen and progesterone.
• Proliferative Phase > 9 days, growth of endometrium stimulated by estrogen (ovulation 12-16 days)
• Secretory Phase > 12 days following ovulation, progesterone prepares uterus for embryo
Pelvis shapes
•Gynecoid-most favorable
(These 3 are hard deliveries)
• Anthropoid- narrow pubic arch
• Android- resembles male pelvis
•Platypelloid-short ant/post diameter
Where does fertilization occur?
The ampulla of the fallopian Tube
If a women has a missed period, and is pregnant how many weeks are they usually along?
-4-5 weeks (your first week of bleeding -the missed period-counts as week one)
-the body also has protection in place from alcohol because it knows you don’t know you’re pregnant
Are the fallopian tubes a closed system?
NO- the egg can escape and implant/attach to the bladder, intestines and become an ectopic pregnancy which is not good
Describe the fetal environment
-Sterile, closed system
-Amnion (inner membrane that hold the amniotic fluid).
-Chorion (outer membrane becomes vascular and forms fetal side of the placenta)
-Amniotic fluid (around 1000ml, protects the fetus)
-Placenta (early=produces hormones), (late = immunoglobulin transfer)
Function of the placenta
-placenta takes over around 9-12 weeks (prior nutrients is from yolk sac)
-life line to the baby
-gives oxygen and blood to baby
-nutrients
What is a ruptured membrane ?
The moms water breaking!
Can be spontaneous or induced
Fetal blood circulation
•Umbilical Cord - 2 arteries, 1 vein
•Fetal Heart Rate (FHR) - 120-160 vein bpm, double maternal rate
Fetal Bypass -
• 1. ductus arteriosus connects pulmonary artery Placenta to the aorta, bypassing the nonfunctioning lung
•2. ductus venosus connect umbilical vein to inferior vena cava, bypassing liver
• 3. foramen ovale- opening between R&L atria bypassing the lungs
How many days from fertilization to delivery?
280 days
How do you calculate a due date? TEST
1st day of LMP(last menstrual period) + 7 days - 3 months + 1 year = estimated due date
What are the two criteria to calculate an accurate due date?
-Patient must have a regular 28 day cycle
-Most acuarate is a 1st trimester ultrasound
What does G & P mean?
Gravid = how many times you’ve been pregnant ever
Parity = # of births past 20 weeks (alive or demised)
Define Nullipara, Primipara, Multipara
Nullipara: never been pregnant
Primipara: 1st time pregnant
Multipara: had many births
How to calculate pregnancies (GP)
Mom has been pregnant 5 times. 4 were full term, 1 was preterm. What are the moms G&P’s?
G5, P4
Signs of pregnancy
•Presumptive-amenorrhea, n/v, breast changes, urinary frequency
•Probable-uterine enlargement,
Chadwick’s sign (bluish discoloration of vulva/vagina , +HCG (preg test)
•Positive-FHR (heartbeat) detection, fetus on ultrasound.
What is fundal height and how is it measured?
measurement from symphysis pubis to top of fundus in cm=weeks gestation
After 20 weeks, it’s pretty consistent with how many weeks to CM they are
*won’t work with obese patients
All 15 pregnancy pains
- Nausea and Vomiting
- Syncope
- Urinary Urgency and Frequency
- Breast Tenderness
- Constipation
- Increased Vaginal Discharge
- Nasal Stuffiness
- Fatigue
- Heartburn
- Backache
- Ankle Edema
- Varicose Veins
- Headaches
- Hemorrhoids
- Leg Cramps
Risk factors for pregnancy
-Advanced Maternal Age (AMA) 35yrs. + (HTN, Diabetes, chromosomal problems)
-Adolescent Pregnancy (signs own consents- anything dealing with pregnancy the kid makes her own choices)
-Nutrition
-Genetic Considerations (sickle cell, cystic fibrosis)
-Poor Health Care
-Abuse and Violence
-Preexisting Medical Conditions
-Substance Abuse
RH FACTOR TEST
Only applies to moms with ‘-‘ RH factor
If mom is A- and dad is O+
-Say baby inherits A- (no problem, same blood type)
-say baby inherits dads blood O+ ;mom will build antibodies against the blood. This will not effect pregnancy #1.
-pregnancy #2; say baby inherits dads blood again (O+), mom now has antibodies and attacks the baby (don’t make it past 1st trimester)
*med: Rhogram: given to ANY pregnant patient with - RH factor normally around 27-28 weeks.
*Babies blood is tested right after birth. If baby is RH+, mom will be given another dose before she goes home to stop production of antibodies and to protect future pregnancy.
*if Rhogram is skipped during 1st pregnancy around 27-28 weeks, there’s no going back. The antibodies will be produced and every future pregnancy will probably be a miscarriage.
S/s of congenital Rubella
•TORCH pathogen (toxoplasmosis)
• Congenital Rubella Syndrome (ie, infection before birth)
• occurs when a non-immune pregnant woman contracts virus immediately prior to conception or during the first trimester
• virus spreads to fetal blood supply
the nature of the birth defect depends on the tissue(s) affected and the stage of fetal development disrupted
• eye and ear defects are the most common
Explain rubella immunity
If patient is immune they’re fine.
If mom is tested and is not immune or equivocal she needs another rubella shot.
*cannot be given when pregnant
*cannot get pregnant again for 30 days
*getting the shot protects future pregnancy from contracting congenital rubella complications
What labs are pertinent for L&D?
-Blood type
-Rubella (immune or equivocal)
-HIV
-Hep B
-STDs
-Group beta strep
-H&H (less than 10 = anemia; less than 30% = anemia)
Explain gestational glucose challenge test
Around 27-28 weeks: Mom drinks 50g of super sugary oral glucose.
It’s positive if :
1 hour later it’s > 140 (if it’s less than 140 you don’t have GDM)
Or 3 hours later > 130-140
If + controlled through diet/exercise or meds like metformin or insulin
Explain Alpha- Fetoprotein screening
Blood draw on mom:
•Taken between 16 and 18 weeks
•Excess levels indicate possibility of open neural tube and abdominal wall defects
•Helps with the screening to diagnose
Spina Bifida and Down Syndrome (if + just means at RISK, test is not definitive)
*false + are very common
What is Genetic testing and what are the three tests?
•DNA Test: not definitive *
Maternal blood sample that determines how at risk the
fetus is for having down syndrome (trisomy 21), Edwards Syndrome (trisomy 18), or Patau Syndrome (trisomv 13), Can be done as early at 7 weeks
Definitive **
•Chorionic Villi Sampling (CVS): detects genetic abnormalities, performed at 10-13 weeks (small needle through abdomen, takes sample from where umbilical cord is)
•Amniocentesis: Aspiration of amniotic fluid to determine genetic defects, definitive, 15-20 weeks (through abdomen and into amniotic sac and takes a fluid sample)
What is spina bifida?
Opening in spinal column, cord bulges out onto external back side. Function normally however usually in wheelchair because legs are effected.
What is a kick count?
At 28 weeks, Pt needs to monitor kicks. make sure the baby has kicked 10 times an hour (if not, baby needs to be evaluated)
What are variability accels in fetal heart tracing?
This test assesses placental function and oxygenation (2 or more accels in 20 mins) -heart rate going above baseline
What is the expected weight gain on a healthy Pt when pregnant?
25-35 lbs (increase caloric intake by 300 per day)
If overweight try to keep it 15lbs
Pt education: Folic Acid & dehydration
Folic Acid supplements should be taken by all woman of childbearing age to prevent neural tube defects or orofacial clefts
The pregnant patient must be educated to consume 8-10 (8oz) glasses of WATER each day. Can cause UTI & pre-term labor
Neural Tube Defects
-these defects happen d/t low folic acid levels. The defects happen in the 1st couple weeks of pregnancy when mom doesn’t even know she’s pregnant)
-Spina bifida (lower back, spinal cord bulge)
-anencephaly (top of spine doesn’t close and brain doesn’t form. Function with mom, pass after birth).
explain PICA
Consumption of non-food substances while pregnant.
Intense cravings for dirt, starch, play dough/clay, ice, etc. normally people are anemic and in need of minerals
Rhogam
•Class: immune globulin
•Side effects: *hemolysis, anemia, ARDS, renal problems, HTN, Headache
•Given: 27-28 weeks of 1st pregnancy if mom has (-) RH blood. If baby has (+) blood mom gets second shot before going home.
•Route: shot given IM
