Week 8 Prenatal Care Flashcards
the withdrawal of what hormone at term, leads to uterine contraction and the onset of labor
progesterone
what hormone doubles every 48-72 hrs in 1st trimester and is a good sign of pregnancy progressing?
human chorionic gonadotropin (HCG)
what week is when the organ does the most growing? what should you educate ?
10 week mark in embryonic period (organogenesis)
Teach pre conceptual care for healthy pregnancy bc exposure of toxins early in preg can affect fetus to prevent birth defects
when can a doppler be heard?
10-12 weeks
placenta function
major endocrine gland releasing and secreting hormones, growth factors, and other substances
Hcg, human placental lactogen, estrogen, progesterone
when can HCG be detected in urine?
14 days after fertilization or 4 wks after LMP/1st missed period
- can have false negative if taken before
the rise and fall of what hormone corresponds to nausea and vomiting in 1st trimester?
hCG
human placental lactogen
- essential to fetal growth by providing nutrition by altering mom’s protein, carbs, fat metabolism
- increases maternal plasma lvls of fatty acids, triglycerides for energy for mom
- increases mom’s insulin resistance, thereby reducing mom’s glucose uptake and reserves mom’s glucose for fetus
where does fertilization occur?
Fallopian tubes
which component of the zone pellucida establishes nutrient circulation between mom and embryo?
syncytiotrophoblast (endometrial covering of highly vascular embryonic placental villi)
syncytiotrophoblast
- burrows into the endometrium and becomes the primary source of HCG.
- some spotting or vaginal bleeding at this time = implantation bleeding or light menses by women who are unaware of their pregnancy.
amenorrhea, nausea and vomiting, fatigue, urinary frequency, changes in skin - chloasma, linea nigra, striae, breast changes, including fullness and tenderness or enlargement
signs of what?
presumptive signs (subjective; reported by pt)
- Breast changes, enlargement of the abdomen or the uterus, palpable fetal outline, (ballottement), Hagar’s sign, Goodell’s sign, and Chadwick’s sign, palpation of contractions,
- positive pregnancy test
what signs are these?
probable signs of pregnancy
what confirms pregnancy aka positive signs of pregnancy?
- Pregnancy on US or an intrauterine pregnancy seen an ultrasound
- audible fetal heart tones
- fetal movement by provider
when is Hcg detected in serum/blood?
blood/serum test:
- detects HCG 8-10 days after fertilization
why is it important to get an accurate gestational age?
- for screening and managing issues in prenatal care
- Inaccuracies = inappropriate timing for screening and misinterpretation of dates, unnecessary intervention, and failure to intervene when it may be necessary.
- predictor of infant health
Naegels rule
- based on reliable, 28 day cycle
- BC affects it (need to not be on BC last 3 months)
- 5 day margin of error
- 1st day of LAST menstrual period + 7 days - 3 months + 1 year
- earliest determination of pregnancy is most accurate - decreases with time
when would u use a transvaginal ultrasound confirmation of EDD?
- 1st trimester US discrepancy is > 7 days
- OR 2nd trimester US discep > 10 days different from calculation
- uncertainty of the last menstrual period due to lactation, amenorrhea, recent discontinuation
- or irregularities of hormonal contraceptive use
- MOST accurate
- measures crown to rump of embryo
what is a less reliable method for EDD than LMP?
fundal heigh measurement from pubis symphysis to uterine fundal peak (start feeling it at 12 weeks)
fundal height affected by:
- Bladder distention
- Maternal body mass
- Position of the uterus
- Position of the fetus
- Amniotic fluid volume
-quickening is another indicator but less reliable (fetal movement)
musculoligamentous changes
- an enlarging uterus, and laxity in joints and ligaments.
- gradual increase in lordosis and accentuated lumbosacral spine curvature
- posture change
- change in center of gravity, kyphosis, and altered gait.
- pelvic girdle loosens as the sacroiliac joint widens and has more mobility.
- pubic symphysis widens, and the pelvis tilts anteriorly (relaxin hormone).
- Separation of the rectus abdominis due to pressure from an enlarged uterus = diastasis recti
heart changes
- HR increases 10-20 bpm above baseline
- cardiac dilatation
- systolic murmur at wk 12-20 wks
- S1, S2 split, S3 normal (increased CO)
- abnormal: REFER
- murmurs louder > 2/6
- diastolic murmur
- S4
blood volume and blood pressure changes
- increases 30% to 50% as early as 6 weeks; peak at 32 weeks.
- provide adequate blood flow to the uterus, the fetus, and maternal tissues.
- hemodilution effect = decreased hemoglobin of 2% - 10%
- Physiologic anemia of pregnancy (2/3rd trimester)
- hemoglobin / hematocrit falls d/t fetal uptake
- maternal reserves cannot replace this.
- Further iron absorption improves in pregnancy, but not enough to account for the difference of mother’s reserves when they become depleted.
- hemoglobin / hematocrit falls d/t fetal uptake
- Blood pressure
- decreases slightly low in the 2nd trimester, then back to baseline 3rd trimester.
- May decrease in the left lateral position
hematologic changes
- Decreased anticoagulant activity/fibrolysis ⇒ protective! Decrease risk of bleeding during birth/labor
- Hypercoagulable state due to increased clotting factors
- increase the risk of venous thrombus embolism and coagulopathies during & immediate PP
- Increased WBC 6,000 - 17,000 in the 3rd trimester (no infection; just physiologic stressed lol)
respiratory changes
- Diaphragm raises 4 cm from upward uterine pressure.
- AP diameter expands
- Tidal volume increases 35%.
- Respiratory rate unchanged
- The net effect of hyperventilation puts the woman in a state of compensated respiratory alkalosis, which improves carbon dioxide transfer from the fetus to the mother.
- Many women in pregnancy report dyspnea, or an increased awareness of their breathing, even while at rest. The etiology unclear. But it may be a sensation of hyperventilation effects of progesterone, which increases oxygen consumption and mechanical forces.
- Physiologic dyspnea vs pathologic dyspnea = check respiratory rate.
- Tachypnea = respiratory compromise.
renal changes
- From increased CO and arterial vasodilation = renal blood flow increases 80% in the 1st & 2nd trimesters
- Urinary stasis and increased risk for UTI
- From decreased bladder tone and stasis of urine
- Reabsorption of glucose and protein not as efficient
- glycosuria or proteinuria (normal)
- Glucose levels should be monitored by serum glucose.
- ureters, urethra, and bladder all dilate from progesterone
- preterm labor → Cover E coli or group b strep antibiotics
Chadwicks sign
- early preg: uterux/cervix more vascular and blueish purple
cervix changes
- chadwicks sign
- goodells sign
- Cervical glands produce a thick, tenacious mucus = plug
- this prevent bacteria and other substances from entering the uterine cavity during pregnancy.
- before labor, mucus plug is expelled
- can be confused with vaginal leaking of fluid or bloody show.
- Prior to labor, the cervix collagen becomes disorganized, and its mechanical strength weakens under the influence of falling progesterone and rising estrogen levels. Prostaglandin activity further facilitates cervical dilatation.
First trimester genetic screening options
-
Cell free DNA/NIPT 9-10 weeks screening
- Noninvasive blood test to see bb’s DNA via mom’s blood
- higher detection rate and lower false positives than quad screen
- cannot screen for neural tube defects
- can detect trisomies, sex chromosome abnormalities
- If +, can offer more dx testing
-
Nuchal translucency Ultrasound at 10 to 14 weeks
- Measure nuchal fold thickness for trisomy 21 /down syndrome
- False + rate high
-
Nasal bone calcification
- fewer false positives
- improved sensitivity and specificity when it’s combined with the other testing.
- A first trimester screen with nasal bone measurements improves the chance of catching Down syndrome baby is up to 95%. The first trimester screen with a quad screen ranges from 95% to 98%.
1st trimester diagnostic (after testing + from the screenings)
-
CVS, or chorionic villi sampling 10-14 wk/1st trimester
- karyotype screening of chromosomal abnormalities for Down syndrome.
- Invasive = risk of fetal loss
infection precautions in pregnancy
- Avoid cleaning litter boxes, or at least wear gloves and wash hands immediately thereafter.
- Wearing gloves or avoiding working in dirt, gardening
- avoid exposure to toxoplasmosis.
- Avoid sexual contact with active herpes lesions in partners
- varicella
leukorrhea
profuse, thin, sometimes thick, vaginal discharge produced by the epithelial cells in the vagina and the cervix
- 2nd trimester
- confused with vaginitis, STI discharge, bacterial vaginosis, or ruptured membranes leaking amniotic fluid.
- Normal
- Formation of mucus plug
- NO douching or using feminine hygiene sprays
- Water only.
- Unscented cotton panty liners and cotton underwear
round ligament pain
- Relaxin hormone
- Ligaments hypertrophy as uterus grows
- Lengthening and pressure causes pain
- During pregnancy, it hypertrophy and stretch as the uterus grows. Pain results from this lengthening and pressure of the increasingly heavy uterus on these ligaments. It can also be confused with pre-term labor, appendicitis, or inguinal hernia, muscle strain, GI pain, including constipation and gas.
lower back pain in preg
- lumbosacral area in the last half of pregnancy and intensifies with progression of pregnancy + increasing uterus weight and relaxation of the sacroiliac ligaments.
- The lordosis of pregnancy adds additional strain on the back muscles.
- From excessive bending and walking, without rest, and lifting.
- Low back pain can be a sign of early labor, pyelonephritis, a kidney stone, or GI conditions.
- neurologic evaluation should be performed with acute, severe, progressively or worsening pain, or radiation down the buttocks or legs, or any loss of function or sensation with numbness and paresthesias in the lower extremities, or loss of bowel or bladder function.
- Tylenol
- Good supportive shoes
Supine hypotensive syndrome
- lightheadedness and dizziness from supine & weight of the uterus resting on the inferior vena cava.
- reduces the amount of blood filling the heart,= lowers cardiac output.
- also enlarged uterus may compress the aorta = decreased arterial pressure
- fix: turn on her side or sit up. Reassurance and explanation
- Near syncope or syncopal very frightening.
