Exam 1 Flashcards
Why is supplemental iron usually prescribed during antempartum?
to meet the hemoglobin needs of the expanded RBC volume.
How much does plasma volume increase by during antepartum?
plasma volume increases by 50% (is greater than RBC increase)
Physiologic anemia of pregnancy
Hct is slightly lower in pregnancy. Anemia is defined as <10.5 mg/dL during 2nd trimester
Effects of pregnancy on WBC count
WBC increases 5-12,ooo during pregnancy, and gets as high as 30,000 during labor and postpartum
When does CO peak during pregnancy?
CO peaks at about 25-30 weeks at about 30-50% above prepregnant levels
Why does n/v happen during first trimester?
increased hCG secretion and changes to carb metabolism
cholestasis of pregnancy
intense itching could signal a serious disorder called cholestasis of pregnancy which requires medication and/or delivery of baby at 37 weeks. Characterized by generalized itching starting with palms of hands and soles of feet. No long term sequelae for mom, but can cause sudden fetal death.
Why do gums bleed more during pregnancy?
increased estrogen
ptyalism
increased saliva production
cholasma
mask of pregnancy
how does pregnancy affect metabolism?
BMP increases by 20-25% due to increased oxygen consumption.
weight gain recommendations
25-35 lbs overall
1-4 lbs in first trimester
1 lb/week during second and third trimesters
**sudden, rapid weight gain is a concern
underweight weight gain recommendations
if BMI <18.5, then recommend 28-40 lbs
overweight weight gain recommendations
if BMI 25-29.9, 15-25 lbs
obese weight gain recommendations
BMI >30 then 11-20 lbs
What happens to T4 during pregnancy?
vascularity and hyperplasia of thyroid cause T4 to increase
What happens to the pituitary gland during pregnancy?
Pituitary gland enlarges and prolactin supports initial lactation while oxytocin supports uterine contractility and milk ejection from the breasts. Insulin needs increase (hormones of pregnancy cause insulin resistance). DONT TREAT HYPERTHYROIDISM DURING PREGNANCY-BAD FOR BABY. ok to treat hypothyroidism with synthroid.
What hormone causes insulin resistance during pregnancy?
Human placental lactogen produced by the placenta. If the woman is diabetic, she will need more insulin as the pregnancy progresses.
naegles rule aka LMP to calculate EDB
first day of LMP, subtract three months, add 7 days. Ultrasound to date EDB is GOLDSTANDARD
when do you screen for gestational diabetes?
between 24-28 weeks. retest a CBC and an indirect Coob’s (if Rh neg) at this time as well.
when do you screen for syphylis?
RPR between 32 and 33 weeks
When do you screen for GBS?
between 35-37 weeks. swab vagina, if present, treat with Abx during labor to prevent infection of the fetus.
CRL
crown, rump length during ultrasound 6-12 weeks accurate +/-3 to 5 days
BPD
bipareital diameter measured during ultrasound 14-26 weeks and accurate +/- 7-14 days
fundal height
accurate during 22-34 weeks
when can you perform a Maternit21 blood test?
as early as 10 weeks. Do this if quad screen comes back positive. Safer than amniocentesis
what might visual disturbances or dizziness indicate during pregnancy?
preeclampsia
what might a severe headache indicate during pregnancy?
preeclampsia
What might seizures or convulsions indicate during pregnancy?
preeclampsia turning into eclampsia
what might epigastric pain indicate during pregnancy?
preeclampsia, or just acid reflux due to progesterone and upward pressure on ABD from large uterus
What is the best indicator of fetal well-being?
KICK COUNTS!! start counting everday at 28 weeks. count to 10. if it takes longer and longer to count 10 movmts, that is a BIG RED FLAG. (Count after a meal-that’s when baby is most likely to be active).
why might a women experience SOB during pregnancy?
Hyperventilation of pregnancy caused by increased VC and TV due to increased oxygen needs and mild resp alkalosis. reaasure mom its normal.
abortion
elective or spontaneous delivery that occurs before 20 weeks gestation or birth of a fetus weighing less than 500 grams.
preterm
birth after 20 weeks but before 37 weeks
post-term
birth after 42 weeks
gravida
any pregnancy, regardless of duration, including the current one
nulligravida
a woman who has never been pregnant
primigravida
a woman who is pregnant for the first time
multigravida
a woman who is in her second or any subsequent pregnancy
Para
birth after 20 weeks gestation, regardless of whether the infant is born alive or death
Primipara
a woman who has had one birth at more than 20 weeks gestation, regardless of whether the infant is born alive or death
nullipara
a woman who has not given birth at more than 20 weeks gestation
multipara
a woman who has had two or more birhts at more than 2 weeks gestation
GTPAL
gravida (#pregnancies) Term (deliveries at 37 weeks or after) Preterm (deliveries between weeks 20-37) Abortions Living (the # of currently living children to whom the woman has given birth).
chadwicks sign
purple/bluish discoloration of cervix; increased vascularization thanks to estrogen
goodells sign
softening of cervix
quickening
fetal mvmts felt by mother: 18-20 weeks for most primigravidas, but as early as 16-22 weeks for multigravidas.
EDB
estimated date of birth
EGA
estimated gestational age
hegars sign
softening of the isthmus of uterus
FHR
fetal heart rate can doppler at 10-12 weeks
Pregnancy affects on the heart
systolic murmur can be heard in 90% of women.
CO increases by 30-50% by 25-30 weeks (BP should remain less than 135/85
erythrocytes volume increases (due to increased need to transport add’l oxygen)
Plasma volume increases by 50%
Hct is slightly lower during pregnancy (relative anemia of pregnancy)
WBC increases
Certain blood clotting factors increase resulting in a hypercoagulable state
venous stasis in late pregnancy places the pregnant woman at increased risk for venous thrombosis
Why do you perform AROM
artificial rupture of membranes to induce or accelerate labor (AROM aka amniotomy). Cervix must be dilated 1 cm at least. Allows internal fetus and uterine monitoring. Allows provider to assess color of amniotic fluid. If umbilical cord prolapses–>emergency c- section!!
CAN
Nuchal cord around neck
CPD
cephalopelvic disproportion is a condition where the baby’s head or body does not fit through the mother’s pelvis. CPD is often diagnosed when a woman’s labor fails to progreess to delivery, the cervix has stopped dilating, or the baby does not descend through the pelvis. In cases of actual CPD, a C-section is usually indicated.
Cx
cervix
EDC
estimated date of confinement: due date
EDD
estimated date of delivery
EFM
electronic fetal monitoring.
FSE
Fetal Scalp electrode
GBS
group B strep
IUGR
intrauterine growth retardation: fetus who is at or below the 10th percentile in weight for its gestational age. There are two factors necessary to define an IUGR: Fetal weight is bottom 10% AND there is a pathological process present that prevents expression of normal growth potential.
IUP
intrauterine pregnancy=normal pregnancy