Week 4- Antenatal Flashcards
1
Q
GDM risk factors
A
- fam history of DM
- High BMI >30
- previous unexplained still birth
2
Q
low pre-gestational folate levels risk for
A
NTD
3
Q
risks for gestational HTN
A
- previous HTN
- extremes of age (less than 19 or more than 40)
- obese
- multifetal pregnancy
- first pregnancy
- pregnancy with new partner
- chronic health disorders
4
Q
A pregnant woman is having lower abdominal pain, light vaginal bleeding, and has a history of endometriosis. What could these symptoms indicate?
A
ectopic pregnancy
5
Q
What symptoms of preterm labour should be taught to all pregnant women, regardless of risk factors?
A
- bleeding or spotting
- contractions
- menstrual like cramps
- persistent low back pain
- pelvic pressure
6
Q
symptoms of hypovolemic shock
A
- Anxiety, restlessness, and lethargy
- Tachycardia, narrow pulse pressure, and hypotension
7
Q
Adequate ________ can prevent congenital anomalies
A
folic acid intake
8
Q
Multigravida
A
A woman who has been pregnant be-fore, regardless of the duration of the pregnancy.
9
Q
Parity
A
The number of pregnancies that have reached 20 weeks’ gestation, regardless of the number of fetuses born and regardless of whether those children are now living.
10
Q
Primipara
A
- giving birth to first child (past point of viability) regardless of if born alive or child still living
11
Q
age of viability
A
22 weeks
12
Q
P and A in G T P A L
A
infants born after 20 weeks and before 37 weeks
aborted before 20 weeks
13
Q
term pregnancy=
A
40 weeks
14
Q
Nägele’s rule is used to
A
determine EDB
15
Q
The most accurate method to determine EDB
A
US if done accurately and before 23 weeks
16
Q
Nuchal translucency
A
US that measure thickness of the fluid under the skin at the back of the neck
- if thicker than normal, can be seen in early down syndrome, trisomy 18 or heart problems.
17
Q
schedule for prenatal visits
A
- Conception to 28 weeks— every 4 weeks
- 29 to 36 weeks— every 2 weeks
- 37 weeks to birth—weekly
Seen more often if complications
18
Q
Low pre pregnancy weight or inadequate gains are risk factors for
A
preterm birth, a low-birth-weight infant, and other issues.
19
Q
when do blood glucose screening
A
between 24-28 weeks
20
Q
Fundal height to determine
A
- enough amniotic fluid
- proper growth
21
Q
Leopold manoeuvre
A
presentation and position
22
Q
FHR assessed
A
at the end of the first trimester with doppler
23
Q
beating on the US can be seen
A
at 8 weeks
24
Q
for high-risk women fetal movement counting should be done
A
daily after 26 -32 weeks
25
FTS
US at 11-14 weeks including NT
Maternal serum biochemical markers- screens for down syndrome and trisomy 18
26
routine 1st 2nd and 3rd tirmester tests
1= FTS- us at 11-14 weeks (nclude NT)
maternal serum biochemical markers
2= 1-hour GTT
2 hour if required
US between 18-22 weeks
3= GBS (36-37 weeks) treated until birth with abx
27
pyridoxine/ doxylamine (dilectin)
delayed release tab for nausea given at bedtime
28
bladder changes common in early months
frequency and urgency of urination
enlarging uterus, increased blood supply exerts pressure
29
urinary frequency in the ___ trimester until
the uterus expands and becomes an abdominal organ in the second trimester
30
urinary frequency and urgency appear again in
third trimester when presenting part descends into uterus
31
quickening
fluttering in the abdomen
32
goodell sign is
softening of the cervix and vaginal mucosa caused by increased vaginal congestion
33
probable signs
provide stronger evidence of pregnancy and are mainly objective signs that can be observed by an examiner.
34
Chadwick sign is
is the purplish or bluish discoloration of the cervix and vaginal mucosa caused by increased vascular congestion.
35
hegar sign
softening of the lower part of the uterus
36
McDonald sign.
easy to flex the body of the uterus against the cervix
37
By the end of the twelfth week, the uterine fundus may be felt
just above symphysis pubis
38
Ballottement
is a manoeuvre by which the fetal part is displaced by a light tap of the examining finger on the cervix, and then the part rebounds quickly.
39
adioimmunoassay (RIA)
blood test that accurately identifies pregnancy as early as 1 week after ovulation.
40
role of estrogen
bigger uterus breasts genitals
promotes fat deposits
melanocyte stimulating hormone causing pigmentation changes
relaxes pelvic ligaments
alters sodium and water retention
decreased ability to process insulin
41
progesterone role
- maintains endometrium for implantation
- prevents uterine contractions
- promotes secretory ducts of breasts
- stim sodium secretion
- reduced smooth muscle tone (constipation, heartburn, varicosities)
42
thyroxine role
increase thyroid gland size and activity
increase HR, BMR
43
HCG role
stimulates progesterone and estrogen by corpus luteum
used to determine pregnancy
44
hPL or human chorionic somatomamitropin
produced by placenta
affects glucose and protein metabolism
diabetogenic effect- increased glucose to stim pancreas and increase insulin level.
45
MSH role
produced by APG
darken skin
46
relaxin
produced by corpus luteum and placenta
soften CT
inhibits uterine activity
47
prolactin
prepares breasts for lactation
48
oxytocin
produced by PPG
stims uterine contractions
inhibited by progesterone during pregnancy
helps keep uterus contracted after birth
stimulates milk ejection reflex in breastfeeding
49
Bacterial vaginosis has been associated with
premature rupture of the membranes, chorioamnionitis, preterm labour, and post-Caesarean endometritis
50
colostrum is high in
low in
protein, fat soluble vitamins and minerals
calories, fat and sugar
51
edema or swelling of the mucous membranes of the nose, pharynx, mouth, and trachea caused by
estrogen
nasal stuffiness and epistaxis (nosebleeds)
52
why is there an increase in blood volume
* Exchange of nutrients, oxygen, and waste products within the placenta
* Needs of expanded maternal tissue
* Reserve for blood loss at birth
53
Supine hypotension, also called aortocaval compression, may occur
- what it causes
- how to fix
if the woman lies on her back
compression on IVC
can cause fetal hypoxia
laying on the left side relieves pressure
if must lay flat- put towel under hips
54
dilutional anemia or pseudoanemia
fluid component of blood increases more than erythrocytes
55
hematocrit level
may decrease to 0.33
56
GI changes
- increased salivary secretion
- tender mouth tissue
- increase appetite and thirst
- decreased acidity of gastric secretions
- slower motility
- constipation and hemorrhoids
- heartburn
- insulin resistance
- risk of gallstones
57
urinary system
increase GFR
- glucosuria, proteinuria
- decreased peristalsis to bladder
- urine stasis
- UTI risk
-
58
INTEGUMENTARY AND SKELETAL SYSTEMS
- active sweat glands to loose heat
- spider nervi
- striae
- pigmentation changes
- more prominent lumbar curve
- waddling gait from separation of the symphysis pubis
59
Taking ibuprofen in the third trimester can cause
early closure of ductus arteriosus
60
uring pregnancy and lactation, an adequate dietary intake of
DHA is essential for brain development
61
BMI considered to be healthy
18.5 to 24.9
62
general recs or weight gain who have normal BMI
up to 1-2 kg during the first trimester and approx. 0.4 kg/week during the rest of pregnancy
63
Four nutrients are especially important in pregnancy:
protein, calcium, iron, and folic acid.
64
iron recs
all preg people take supplement
65
GDM management
- spread meals out throughout the day
- small frequent meals
- food with low glycemic index
- final bedtime snack of protein and complec CHO
66
Women with uncontrolled diabetes and high fasting blood glucose levels in the last trimester have an increased risk of
still birth
67
Many maternal health benefits are associated with exercise, including the following
* Decreased risk of pre-eclampsia
* Decreased gestational hypertension
* Decreased gestational diabetes
* Decreased rates of Caesarean birth
* Decreased rates of instrumental births
* Decreased urinary incontinence
* Improved mood and decreased depression
* Decreased severity of depressive symptoms
* Decreased total gestational weight gain
* Improved blood glucose
* Reduced feelings of stress
* Enhanced sleep
* Enhanced postpartum recovery
* Increased energy levels
* Reduced constipation
* Decreased back pain
68
Exercise can elevate the maternal temperature and result in
decreased fetal circulation and cardiac function
68
smoking during pregnancy may increase the risk of
vaginal bleeding
placenta previa
spontaneous abortion
placental abruption
68
exposure to second hand smoke can increase
risk for SIDS
68
Studies have shown a relationship between maternal smoking and psychiatric disorders in the offspring, such
as schitzo and ADHD
68
Vaccines contraindicated during pregnancy include
HPV
measles
mums
rubella
chicken pox
68
_____ vaccine is recommended in pregnancy
influenza
higher risk of complications
68
killed vaccines can be administered during pregnancy include
tetanus, diphtheria, recombinant hepatitis B, rabies vaccines, and most influenza vaccines
69
first trimester discomforts
- N with or without V
- breast tenderness
- urinary frequency
- nasal stuffiness, epistaxis
- fatigue
70
2nd and 3rd trimester discomforts
- heartburn
- constipation
- hemorrhoids
- backache
- round ligament pain
- leg cramps
- HA
- varicose veins
- edema in feet and ankles
- faintness and dizziness
- dyspnea
71
four maternal tasks that the woman accomplishes during pregnancy as she becomes a mother:
1. Seeking safe passage for herself and her fetus. This involves both obtaining health care by a professional and adhering to important cultural practices.
2. Securing acceptance of herself as a mother and for her fetus. Will her partner accept the infant? Does her partner or family have strong preferences for a child of a particular sex? Will the child be accepted even if he or she does not fit the ideal?
3. Learning to give of self and to receive the care and concern of others. The woman will never again be the same carefree woman she was before her infant's arrival. She depends on others in ways she has not experienced before.
4. Committing herself to the child as she progresses through pregnancy. Much of the emotional work of pregnancy involves protecting and nurturing the fetus.
72
partners phases
1. ambivalence
2. adjustment
3. focus "feeling like a parent"
73
prevention of low and high birth weight in utero is essential to reduce
cvd and stoke in adults
74
C section birth can be linked to _____ in the older child and adulthood
obesity
poor gut microbiome
75
oral microbes in the mother
travel to placenta by blood and has a relationship between periodontal disease and preterm birth as being due to the influence on placental functions
76
first trimester
- ______ occurs
- increased
- _____ retention increases
- ________ stores decrease
fertilization
progesterone levels result in amenorrhea
Na
Nitrogen
77
1st trimester
- _____ volume increases
- levels of relaxin and hCG _______
- pituitary releases
blood
increase
melanin stimulating hormone
78
important nutrients to increase
portein iron and folic acid
79
In true GDM, glucose usually returns to normal by
6 weeks pp
80
Maternal effects of diabetes in pregnancy
- spontaneous abortion
- G HTN
- preterm labour
- hydramnios
- infections
- ketoacidosis
81
fetal and newborn effect of diabetes in pregnancy
- congenital abnormalities
- macrosomia
- IUGR
- birth injury
- delayed lung maturity, RDS
- neonatal hypoglycemia, hypocalcemia
hyperbilirubinemia and jaundice, polycythemia
- perinatal death
82
increased hormones and enzymes in prganncy and insulin
* Increased resistance of cells to insulin
* Increased speed of insulin breakdown
83
The time of major risk for congenital anomalies to occur from maternal hyperglycemia is during
embryonic period of development in the first trimester.
84
high risk for GDM
* Body mass index (BMI) ≥30 kg/m~
* History of macrosomic infant (>4 000 g or about 9lb
* Maternal age greater than 35 years
* Previous unexplained stillbirth or infant having congenital abnormalities
* History of GDM in a previous pregnancy
* Family history of DM
* Using corticosteroid medication
* Glucose challenge test (50 g glucose) results: 7.8 to 11.0 mmol/L
85
oral hypoglycemic in pregnancy
glyburide does not cross placenta
injectables are preferred
86
Hbg and hct tests in HDP
severity of HDP
87
platelets test in HDP
thrombocytopenia suggests pre-eclampsia
88
protein in urine in HDP
confirms pre-eclampsia
89
serum creatinine in HDP
elevated and oliguria suggest pre-eclampsia
90
serum uric acid in HDP
elevates suggest pre-eclampsia
91
serum transaminase test in HDP
elevated= confirms liver involvement in pre-eclampsia
92
pre= eclampsia
- increased BP after 20 weeks
- proteinuria
- normal BP before or preexisting HTN
93
RF for pre-eclampsia
* Pregnancy at extremes of maternal age (adolescents or women >40 years)
* Obesity, pre-existing hypertension
* Diagnosis of pre-eclampsia in a previous pregnancy
* Diabetes or renal disease
* Nulliparity, or pregnancy with a new partner
* Multiple gestation
* Pre-existing autoimmune diseases such as antiphospholipid antibody syndrome
94
non severe Pre E
- BP ≥140/90 mm Hg x two readings 15 minutes apart
- proteinuria 1+
- Presence of one or more adverse conditions (e.g., possible headache, visual problems, epigastric pain, elevated creatinine, low platelets)
95
Severe pre-eclampsia is defined as the following:
* BP reading ≥160/110 mm Hg on two separate readings 15 minutes apart
* Presence of proteinuria: a urine dipstick results of 2+ to 3+ or greater on two separate urine specimens
* Presence of one or more severe complications (e.g., severe headache; blurred vision, photophobia, blind spots on fundoscopy, elevated creatinine, platelets <50 × 10'/L, hepatic dysfunction, decreased placental function which can result in an intrauterine growth-restricted [IUGR] fetus)
96
Pre-eclampsia progresses to eclampsia when
convulsions occur
97
manifestations of severe pre E linked to
decreased blood flow and edema of the organs involved
98
CNS effects of severe Pre E
- severe unrelenting HA from brain edema and small cerebral hemorrhages
- can precede convulsion
- hyperactive DTR
99
eyes effects of severe Pre- E
- visual disturbances (blurred vision or double vision)
- can precede a convulsion
100
urinary tract effects form severe pre- e
- decreased blood flow to kidneys causing oliguria , worsens HTN
101
resp effects with severe pre-eclampsia
pulmonary edema
102
Gastrointestinal system and liver effects with severe pre-eclampsia
- epigastric pain/ nausea (liver edema, ischemia and necrosis)
- increased liver enzymes
103
HEELP syndrome
- variant of GH
- hemolysis
- elevated liver enzymes
- low platelets
104
signs that HEELP could be developing
- RUQ pain or epigastric pain
- N/V
- malaise
105
care for someone with HEELP
- may be monitored in Critical care unit
- given magnesium sulphate to prevent convulsions
- antihypertensive meds
106
Effects on the fetus for pre-eclampsia
- Pre-eclampsia reduces maternal blood and nutrition flow through the placenta and decreases the oxygen available to the fetus.
- Fetal hypoxia may result in meconium (first stool) passage into the amniotic fluid.
- The fetus may have IUGR and at birth will be small for gestational age.
- Fetal death or stillbirth is a higher risk with pre-eclampsia.
- In women with pre-existing or GH, administration of magnesium sulphate should be considered for fetal neuroprotection if imminent preterm birth will occur (at ≤31 + 6 weeks)
107
An eclamptic seizure may result in
cerebral hemorrhage, placental abruption, fetal compromise, or death of the mother or fetus.
108
recommendations to decrease the risk of pre-eclampsia:
- improving diet
- prenatal care
- calcium sup if low
- no alc
- exercise
- folate
- no smoking
-
109
_________started between 12 and 14 weeks' gestation, has anticoagulant and anti-inflammatory properties that aid in the prevention of pre-eclampsia for patients with a high risk of developing eclampsia
low dose aspirin
110
Initial therapy in pregnancy with HTN
one of the following antihypertensives: methyldopa, labetalol, other beta blockers (acebutolol, metoprolol, pindolol, and propranolol), and calcium channel blockers (nifedipine).
111
ACE and ARBS
should not be used in pregnancy
112
Treatment of pre-eclampsia focuses on
(1) maintaining blood flow to the woman's vital organs and the placenta
(2) preventing convulsions.
113
cure for pre-eclampsia
birth
114
excess magnesium in pre-eclampsia caused from, signs and symptoms
- decreased urine output
- first causes loss of the deep tendon reflexes, which is followed by depression of respirations; if levels continue to rise, collapse and death can occur.
115
Calcium gluconate
reverses the effects of magnesium and should be available for immediate use when a woman receives magnesium sulphate
116
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