week 2 slides

Question 1

what is the goal of preconception care?

Answer 1

1. improve the health status of women and men before conception
2. reduce those behaviours, individual and environmental factors that could contribute to poor maternal and child health outcomes

Question 2

what is preconception care?

Answer 2

Preconception care involves identifying and modifying risk factors in individuals considering pregnancy in order to improve their health. Risk factors may include medical, behavioural, and social factors, many of which may be modifiable

Question 3

what are the recommendations of preconception?

Answer 3

1. 150 minutes per week of moderate to vigorous physical activity for adults aged 64 and under
2. no more than 2 drinks per day, with no more than 10 drinks per week for non- pregnant women to reduce long term health risks
3. all women who could become pregnancy should take a daily multivitamin containing 400 mcg (0.4 mg) of folic acid.

Question 4

preconception care and folic acid

Answer 4

reduces the risk of neural tube defects, including anencephaly and spina bifida and associated with lower risk for other birth defects including cleft palate anomalies, cardiovascular and urinary anomalies, and some pediatric cancers

Question 5

preconception care and healthy body weight

Answer 5

Both low and high preconception Body Mass Index (BMI) can negatively affect pregnancy outcomes. The preconception period is the ideal time to achieve (or progress towards) an optimal weight

Question 6

preconception care and mental health:

Answer 6

Maternal depression and anxiety has adverse effects on outcomes such as premature birth, birth- weight, breastfeeding initiation, and cognitive and emotional development of infants and young children.
*think postpartum depression

Question 7

preconception care and physical activity:

Answer 7

exercise contributes to overall health, decreasing the risk of chronic conditions, important for weight reduction and maintenance, and has a positive effect on mental health and well-being.

Question 8

preconception and environmental hazards:

Answer 8

A person’s environment includes their home, community, workplace, and other places where exposure to potential chemical and physical hazards may occur. The health impacts of preconception exposure to toxins are complex and difficult to verify

Question 9

preconception and nutrition:

Answer 9

Healthy eating is a key component to overall health, and the preconception period is an ideal time for women to improve their diet. Nutritional needs change in pregnancy, and a pre- existing pattern of healthy eating helps to optimize maternal and fetal health

Question 10

preconception and immunizations:

Answer 10

Immunization prior to pregnancy can prevent adverse pregnancy outcomes, prevent infections from being transmitted to the fetus and provide protection during early infancy

Question 11

preconception and smoking:

Answer 11

Quitting smoking during the preconception period can eliminate most of the negative impacts on future pregnancies, in addition to providing health benefits for the woman.

Question 12

what is antepartum?

Answer 12

Prenatal period; between conception & onset of labour (also called prenatal, antenatal)

Question 13

what is intrapartum?

Answer 13

Period from onset of true labour to delivery of baby & placenta

Question 14

what is postpartum?

Answer 14

6-week period between delivery of placenta & membranes and time body returns to nonpregnant state

Question 15

fetal and placental development

Answer 15

Blastocyst contains two distinct differentiated embryonic cell types:
* the outer trophoblast cells and the inner cell mass. The trophoblast cells form the placenta
* The inner cell mass forms the foetus and foetal membranes.
* Trophoblast cells differentiate into:
* Outer multinucleated syncytiotrophoblast, which
erodes maternal tissues maternal tissues allowing blood from uterine spiral arteries to enter the lacunar network.
* responsible for producing hormones such as Human Chorionic Gonadotropin (hCG)
* Inner mononucleated cytotrophoblast, which is actively proliferating.
* Cytotrophoblast cells invade the maternal spiral arteries and replace maternal endothelium

Question 16

what are the functions of placenta?

Answer 16

respiratory: exchange oxygen and carbon dioxide
excretory: excrete waste products
endocrine: functions as an endocrine gland that secretes four hormones necessary to maintain the pregnancy and support the embryo and fetus.
* human chorionic gonadotropin * Estrogen
* progesterone
* human placental lactogen (hPL)
nutrition: nutrients pass from the mother’s blood into the foetal blood
storage: Carbohydrates, proteins, calcium, and iron for ready access to meet fetal needs
barrier: functions as an efficient barrier harmful substances

Question 17

gravida

Answer 17

a person who is pregnant

Question 18

Gravidity

Answer 18

pregnancy

Question 19

nulligravida

Answer 19

a person who has never been pregnant and is not currently pregnant

Question 20

primigravida

Answer 20

a person who is pregnant for the first time

Question 21

multigravida

Answer 21

a person who has had two or more pregnancies

Question 22

parity

Answer 22

the number of pregnancies in which the fetus or fetuses have reached 20 weeks gestation, not the number of fetuses (e.g., twins) born

Question 23

nullipara

Answer 23

a person who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks gestation

Question 24

primipara

Answer 24

a person who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

Question 25

mulipara

Answer 25

a person who has completed two or more pregnancies to 20 weeks of gestation or more

Question 26

viability

Answer 26

Capacity to live outside the uterus; there are no clear limits of gestational age or weight. * Infants born at 22 to 25 weeks of gestation are considered to be on the threshold of viability.

Question 27

preterm

Answer 27

A pregnancy between 20 weeks and 36 weeks 6 days of gestation

Question 28

late preterm

Answer 28

A pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days of gestation

Question 29

term

Answer 29

A pregnancy from the beginning of week 37 of gestation to the end of week 40 plus 6 days of gestation

Question 30

early term

Answer 30

A pregnancy between 37 weeks and 38 weeks 6 days

Question 31

full term

Answer 31

A pregnancy between 39 weeks and 40 weeks 6 days

Question 32

late term

Answer 32

A pregnancy in the 41st week

Question 33

post term

Answer 33

A pregnancy after 42 weeks

Question 34

GTPAL stands for

Answer 34

g: gravidity t: term p: preterm a: abortions l: living children

Question 35

Human chorionic gonadotropin (hCG)

Answer 35

is the easiest biochemical marker of pregnancy

Question 36

what is the most popular method of testing for pregnancy?

Answer 36

Enzyme-linked immunosorbent assay (ELISA) testing is the most popular method of testing for pregnancy. * ELISA technology is the basis for most over-the-counter home pregnancy tests.

Question 37

what are the presumptive signs of pregnancy?

Answer 37

-cessation of menses -nausea and vomiting -frequent urination -breast/chest tenderness -skin changes -quickening -fatigue "considered presumptive because there can be other causes"

Question 38

what are the probable signs of pregnancy?

Answer 38

-enlargement of abdomen -Braxton Hicks (end of 1st trimester) -skin changes- striae, increased pigment -positive pregnancy test -Hegar's sign -Goodell's sign -Chadwick's sign

Question 39

what is hegar's sign?

Answer 39

At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment (uterine isthmus) occurs -softening of the lower uterine segment

Question 40

what is Goodell sign?

Answer 40

is brought about by increased vascularity, slight hypertrophy, and hyperplasia (increase in number of cells). The glands near the external os proliferate beneath the stratified squamous epithelium, giving the cervix the velvety appearance characteristic of pregnancy. -softening of the cervix at 8 weeks

Question 41

what is Chadwick's sign?

Answer 41

Blue-violet hue from congestion on vulva, vagina, cervix (esp. vaginal opening) – 6-8 weeks

Question 42

what are the positive signs of pregnancy?

Answer 42

ULTRASOUND-fetal heart motion 4-8 weeks after conception; with doppler – 10-12 weeks fetal heart is heard -fetal movement felt by examiner -between 18-20 weeks Visualization of fetus through ultrasound – around 5-6 weeks

Question 43

what is Leukorrhea? adaptions to pregnancy

Answer 43

is a white or slightly grey mucoid discharge with a faint musty odour. This copious mucoid fluid occurs in response to cervical stimulation by estrogen and progesterone. The fluid is whitish because of the presence of many exfoliated vaginal epithelial cells caused by the hyperplasia of normal pregnancy. This vaginal discharge is never pruritic or blood stained.

Question 44

when does colostrum begin to start being produced?

Answer 44

during the third trimester

Question 45

what is Quickening

Answer 45

Quickening is the first recognition of fetal movements, or “feeling life.”

Question 46

breast changes in pregnancy

Answer 46

Fullness,heaviness * Heightenedsensitivityfrom tingling to sharp pain * Areolae become more pigmented * Montgomery's tubercles- small spacious gland around the areola they secrete fatty substances to lubricate the nipple.

Question 47

adaptions to uterus in pregnancy

Answer 47

Changes in size, shape, and position * Softening of lower uterine segment (Hegar’s sign) * Changes in contractility * Uteroplacental blood flow- placenta perfusion depends on the blood flow to the uterus. blood flow increases rapidly as the uterus increases in size * Cervical changes * Goodell sign * Changes related to fetal presence * Ballottement

Question 48

what is ballottement? "internal ballottement"

Answer 48

Around the 16th to 18th week of gestation, the fetus can be palpated by pressing a finger into the vagina and tapping gently. This action causes the fetus to move upward and then move back downwards to tap on the finger.

Question 49

cardiac output in pregnancy

Answer 49

Slight or no change in diastolic pressure ∙ Slight decrease to mid-pregnancy (24–32 wk) and return to pre-pregnancy levels by end of pregnancy ∙ Blood volume Increases by 1 200–1 500 mL or 40–50% above pre-pregnancy level ∙ Hemoglobin level decreases -psychological anemia d/t increase in volume ∙ Haematocrit level decreases ∙ Red blood cell mass increases by 17% ∙ Cardiac output increases from 30 to 50% during pregnancy and half of this increase occurs by 8 weeks of gestation. A small decline occurs by term. Cardiac output in late pregnancy is appreciably higher when the patient is in the lateral recumbent position than when they are supine. In the supine position, the large, heavy uterus often impedes venous return to the heart and affects blood pressure. Cardiac output increases with any exertion such as labour and birth.

Question 50

blood pressure in pregnancy

Answer 50

-Blood pressure is influenced by two major factors: cardiac output (CO) and systemic vascular resistance (SVR). Although CO increases significantly during pregnancy, blood pressure remains the same or decreases slightly. This is due to reduced SVR caused primarily by the vasodilatory effects of progesterone, prostaglandins, and relaxin. -During the first trimester, systolic blood pressure usually remains the same as the prepregnancy level but can decrease slightly as pregnancy advances. Diastolic blood pressure begins to decrease in the first trimester, continues to drop until 28 weeks, and gradually increases, returning to prepregnancy levels by term

Question 51

respiratory system and pregnancy

Answer 51

-oxygen consumption increases during pregnancy by 20 to 40% above nonpregnant levels. ∙ Change from abdominal to thoracic breathing as pregnancy progresses ∙ Increased vascularization in upper respiratory tract due to increased estrogen ∙ Nasal and sinus stuffiness, nosebleeds, voice changes Maternal oxygen consumption increases during pregnancy by 20 to 40% above nonpregnant levels. This increase is necessary to support the needs of the fetus, placenta, and changes in maternal organs

Question 52

renal system in pregnancy

Answer 52

- Increased glomerular filtration rate * Increase frequency and Nocturia * Dilation of ureters & renal pelvis increase of pyelonephritis

Question 53

endocrine system in pregnancy

Answer 53

-Thyroid – may enlarge; total thyroxine (TT4) may increase * Adrenal – Cortisol & aldosterone increase * Pituitary – Gland enlarges; Prolactin levels increase. * Pancreas – fetus needs glucose ++ for growth and development * hyperglycemia & hyperinsulinemia occur after eating * Potential for gestational diabetes

Question 54

GI system in pregnancy

Answer 54

-Morning sickness due to hCG hormone * Constipation * Gas, general discomfort * Risk of gallstones * Heartburn * Hiatus hernia * Mouth, gum soreness and bleeding * Haemorrhoids

Question 55

musculoskeletal system in pregnancy

Answer 55

* Lumbar lordosis as uterus enlarges and moves upwards and outwands * Relaxation of motility of pelvic joints – creates “waddle” * Rectis abdominous muscle may separate – diastasis recti * Umbilicus protrudes

Question 56

neurological system in pregnancy

Answer 56

▪ Light headedness; fainting ▪ Carpaltunnel ▪ Sensory changes in legs ▪ Headaches ▪ Some women complain of decrease in attention, concentration and memory; resolves after pregnancy

Question 57

integumentary system in pregnancy

Answer 57

-Chloasma (mask of pregnancy) -Facial melasma (also called chloasma or mask of pregnancy) is a blotchy, brownish hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in pregnant patients with dark complexions -Linea negra -Striae gradarium (stretch marks) -Reduced connective tissue strength b/c elevated adrenal steroid levels -Thicker hair

Question 58

what is Nägele's rule?

Answer 58

-Determine first day of last menstrual period (don't care when you complete your cycle) (LMP), subtract 3 months, and add 7 days plus 1 year * Alternatively, add 7 days to LMP and count forward 9 months

Question 59

Uterine sizing – and fruit

Answer 59

-Non-pregnant or 5 weeks uterus – size of a small pear * 6 weeks – size of a small egg * 8 weeks – size of a large orange; 12 weeks – size of a large grapefruit

Question 60

what is the fundal height?

Answer 60

measures size of uterus from pubic symphysis to fundas (top of uterus). Between 22-34 weeks gestational age correlates well with measurements in cm., + or - 3 cm. * McDonald method – uses tape measure – cm from top of symphysis pubis to top of uterine fundus

Question 61

what is quickening?

Answer 61

awareness of fetal movements by the pregnant person- usually between 16-22 weeks gestation

Question 62

Oxytocin hormone

Answer 62

Produced by hypothalamus and secreted by posterior pituitary * Induces uterine contractions in labour * Responsible for “letdown” reflex during lactation -also given sometimes when we need the placenta to come out- a shot to the thigh or through IV fluids

Question 63

prolactin

Answer 63

Produced by anterior pituitary * By term: levels increase up to 10x greater than pre- pregnancy levels * Essential for milk production

Question 64

relaxin

Answer 64

-Produced 1st by corpus luteum then placenta after 6-8 weeks * Relaxes pelvic muscles & joints to prepare for birth

Question 65

inadequate nutrition can lead to an increase in

Answer 65

Low-birth-weight (LBW) infants (2500 g or less) * Preterminfants

Question 66

BMI less than 18.5

Answer 66

underweight/ low

Question 67

BMI 18.5 -24.9

Answer 67

considered normal

Question 68

BMI 25 to 29.9

Answer 68

considered overweight and high

Question 69

BMI of 30 and above

Answer 69

obese

Question 70

Recommended extra energy intake during pregnancy:

Answer 70

-1st trimester: same as nonpregnant -2nd trimester: additional 340 kcal -3rd trimester: additional 452 kcal

Question 71

how much should someone with a BMI of 18.5 gain weight during pregnancy?

Answer 71

0.5 kg/1pound a week 12.5-18/ 28-40 lb total weight gain

Question 72

how much should someone with a BMI of 18.5-24.9 gain weight during pregnancy?

Answer 72

0.4kg/1.0lbs 11.5-16kg/25-35 lbs total weight gain

Question 73

how much should someone with a BMI of 25.0-29.9 gain weight during pregnancy?

Answer 73

0.3kg/0.6lbs 7-11.5/15-25 lbs total weight gain

Question 74

how much should someone with a BMI of 30 or over gain weight during pregnancy?

Answer 74

0.2kg/0.5lb 5-9kg/ 11-20 lb total weight gain

Question 75

the first trimester is the most important for?

Answer 75

embryonic and fetal organ development

Question 76

folic acid (folate) intake

Answer 76

important for the periconceptual period. * Neural tube defects (NTDs) are more common in infants of patients with poor folic acid intake. * Low-risk clients: 0.4 mg daily for at least 2-3 months before **pregnancy, during pregnancy and postpartum if breastfeeding * Moderate or high-risk clients (diabetes, epilepsy, obesity, history of NTDs) – increase amount of folic acid (can be up to 1-4 mg/day)

Question 77

Nutrient Needs During Pregnancy

Answer 77

-Energy needs – vary during trimesters * Protein- for fetal growth * Fluids * Omega 3 fatty acids * Fat-soluble vitamins * VitaminsA,D,E,andK

Question 78

what water-soluble vitamins are needed in pregnancy?

Answer 78

* Folate or folic acid * Vitamin B6 (Pyridoxine) * Vitamin C (Ascorbic acid) * Vitamin B12 (Cobalamin)

Question 79

Minerals, vitamins, and electrolytes needed for pregnancy

Answer 79

-Iron: ↑ requirement * Calcium * Vitamin D * Magnesium * Sodium * Potassium * Zinc * Fluoride * Vitamin B12 (for vegan diets)

Question 80

what are common discomforts during pregnancy?

Answer 80

* Nausea and vomiting * Heartburn * Breast tenderness * Vaginal discharge/bleeding * Headaches * Nosebleeds * Gingivitis- swelling and inflammation of the gums * Abdominal pain/cramping * Fatigue * Constipation * Urinary frequency * Back pain * Skin changes (linea negra, chloasma, etc.) * Ptyalism- excessive saliva * Quickening *Pica- eating disorder of nonfood substances

Question 81

what is Pica?

Answer 81

Pica is an eating disorder characterized by the consumption of nonfood substances (e.g., clay, dirt, chalk, soap, and laundry starch) or excessive amounts of foodstuffs low in nutritional value (e.g., cornstarch, ice or freezer frost, baking powder, and baking soda). Pica has been associated with mineral deficiencies (e.g., iron deficiency).

Question 82

prenatal visits

Answer 82

-1 visit per month until 28 weeks -every 2 weeks: in weeks 28-36 -every week: in weeks 37-40 *** a high-risk pregnancy will require more frequent visits

Question 83

what are your assessments during the first initial visit with the pregnant person?

Answer 83

* Current pregnancy * Obstetric hx * Gynecological hx * Current & past Medical hx * Including RH incompatibility- bc we need to know if they need blood transfusion or if they will have a reaction * Family medical hx * Genetic hx * Surgical hx * Occupational hx * Medications * Allergies

Question 84

what are the assessments you will do every visit with a pregnant person?

Answer 84

* Weight * Vital signs * Fetal heart ▪ 160-170 beats/minute in early pregnancy ▪ 110-160 beats/minute in late pregnancy * Fundal size * Urine (protein, keytones, glucose, nitrates)--> this checks for Pre-eclampsia * Potential complications (bleeding, vomiting, headache, visual disturbances, epigastric pain) * Coping/adjustment; support; SDH * Domestic violence

Question 85

what are we screening during the 1st Trimester?

Answer 85

* Pap if needed * CBC * HIV * Urine culture * Rubella titre * ABO & RH typing * STI testing * Other relevant tests * E.g. sickle cell, thalasemia, tay sachs, TB if high risk * Ultrasound – for nuchal translucency (NT) (example Down syndrome) (11-14 weeks gestation) combined with serum screening for free B-hCG and for pregnancy associated plasma protein A (PAPP-A) * Increased NT, Elevated free B-hCG and reduced PAPP-A suggest aneuploidy * Women with these findings are offered genetic counseling and chorionic villus sampling, or 2nd trimester amniocentesis * If negative- no further testing

Question 86

what are we screening during the 2nd trimester?

Answer 86

* Quadruple screen: blood test – between 15-20 weeks * Levels of Alpha fetal proteins (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (UE), inhibin-A (placental hormone) * Maternal serum alphaproteins (MSAFP) for neural tube defects and open abdominal wall defects * Ultrasound- assess gestational age, growth; abnormalities; heart activity * Abdominal or transvagina

Question 87

fetal assessments

Answer 87

Ultrasound * First trimester – assess gestational age; number of fetuses, etc.) * Assess for problems (bleeding; ectopic) * Second/thirdtrimester * Confirm gestational age * Assess level amniotic fluid * Assess location of placenta * Identify presentation * Assess cause of bleeding; fetal death * Amniocentesis ( prenatal dx of genetic disorders or congenital anomalies)

Question 88

what is Amniocentesis?

Answer 88

Amniocentesis is performed to obtain amniotic fluid, which contains fetal cells. Under direct ultrasound visualization, a needle is inserted transabdominally into the uterus, amniotic fluid is withdrawn into a syringe, and various assessments are performed on the fluid sample Amniocentesis is possible after week 14 of pregnancy, when the uterus becomes an abdominal organ and sufficient amniotic fluid is available for testing

Question 89

what are we screening for during the 3rd trimester?

Answer 89

* Gestational diabetes – (24-28 weeks) * Group B streptococcus – Rectal and vaginal swabs – 35-37 weeks) * Tests as needed re fetal health * Fetal movement counts * Non-stress tests * Contraction stress test * Ultrasound

Question 90

what are the six practices for supporting culturally safe, humble, trauma-informed perinatal care?

Answer 90

-cultural safety and cultural humility -self-determination -trust through relationship -respect -anti-indigenous racism -strength an resilience- based practice

Question 91

perinatal education includes

Answer 91

-physical and emotional changes during pregnancy -breastfeeding/infant feeding -nutrition during pregnancy -working during pregnancy -safety- Zika virus, toxoplasmosis -pain management strategies during labour- pharmacological and non pharmacological -labour and birth process -becoming a parent -transition to parenting -newborn care

Question 91

perinatal education includes

Answer 91

-physical and emotional changes during pregnancy -breastfeeding/infant feeding -nutrition during pregnancy -working during pregnancy -safety- Zika virus, toxoplasmosis -pain management strategies during labour- pharmacological and non pharmacological -labour and birth process

Question 92

what is the goal to perinatal education?

Answer 92

Goal is to assist individual and family to make informed, safe decisions about pregnancy, birth, and early parenthood -well supported childbirth experience -health-promoting education -methods of childbirth education -birth plans -where they want to give birth, who will be at the birth, what forms of pain relief the person wishes, what type of medical interventions and practices they want/don't want, and what the person would like to happen immediately after the birth with the baby