7- OB Flashcards
(90 cards)
1
Q
What does FDLMP mean
A
First day of last menstrual period
2
Q
What does GTPALM stand for
A
Gravies- # of pregnancies Term- # of term births (>37 weeks) Premature- # of births <38 weeks Abortion- Pregnancies before 20 weeks Living children- # of kids still alive Multiple pregnancies- # of times with multiple births
3
Q
What is the normal gestational period
A
40 weeks
4
Q
What is considered premature gestation
A
Less than 38 weeks
5
Q
3 important questions for a pregnant patient assessment
A
- Due date
- Urge to push
- Contraction length
6
Q
Does spotty, painless vaginal bleeding occur from egg implantation to the endometrium
A
Yes
7
Q
What is triggered to happen due to egg implantation in endometrium
A
- Development of placental tissue
- Release of human chorionic gonadotropin (hCG)
- Corpus luteum is signaled that pregnancy has begun
8
Q
What is the role of the corpus luteum for pregnancy
A
Produces hormones to support pregnancy until placenta sufficiently develops to assume this function
9
Q
What does placenta do at the beginning of pregnancy
A
Produces projections to tap into the external layer of the blastocysts where spaces called lacunae form, and are filled with maternal blood
10
Q
What happens when an egg becomes an embryo
A
Begins the process of forming specialized body systems
11
Q
At what week does the heart start in an embryo
A
Around the end of week 3
12
Q
At week 4 the placenta begins to develop and serves what key roles
A
- Respiratory gas exchange
- Transport nutrients
- Transfer heat from woman to fetus
- Hormone production
- Form barrier against harmful substances
13
Q
What is the umbilical cord
A
Connects the placenta to the fetus via the fetal umbilicus
14
Q
What do the umbilical vein and umbilical artery do
A
Umbilical vein- Oxygenated blood from placenta to fetus
Umbilical artery- Ateriovenous blood to the placenta
15
Q
Role of the ductus veinous
A
Connects the umbilical vein and the inferior vena cava
16
Q
Role of the ductus arterious
A
Connects the pulmonary artery and aorta
17
Q
What is the foramen ovale
A
An opening in the atrial septum of the fetal heart
18
Q
What is the amniotic sac
A
A membrane bag that encloses the fetus in a watery fluid of amniotic fluid
19
Q
What is the role of amniotic fluid and the typical amount
A
Provide fetus with a weightless environment to develop
Typically 500-1000 mL
20
Q
What can abnormal uterine size at length of time indicate
A
- Uterine growth problems
- Breech position
- Possibility of twins
21
Q
What changes are there to a woman in pregnancy (6)
A
- Possible constipation
- Decreased GI motility
- Increased risk of vomiting
- Kidney increase in size and volume
- Increased urinary frequency
- Pregnancy mask
22
Q
Circulatory system changes in women during pregnancy (6)
A
- Blood volume increases to meet new metabolic needs
- Red blood cell count increases
- White blood cell count increases
- Heart increases in size
- Cardiac output increases 30-50%
- HR increases 15-20 beats
23
Q
What happens to BP during pregnancy and when
A
0-24 weeks- Decrease
24 weeks to birth- Increase
After birth- Gradual return to normal
24
Q
What results from slowed venous return due to an enlarged uterus and what can result
A
- Pooling, defendant edema
- Hemorrhoids
- Vericose veins
-DVT and pulmonary embolism
25
What effect does slow venous return have on med administration
Delayed absorption of IM and SQ meds
26
What can increased workload on heart during labor cause (3)
- Ventricular failure
- Pulmonary edema
- Culminating heart failure
*Can result in cardia arrest
27
What happens to respiratory system during pregnancy (7)
- Abdominal muscles lose tones
- Respiration’s become more diaphragmatic
- Decreased airway resistance
- O2 consumption increases 20-40%
- Increased minute volume
- Resp alkalosis increases and is leveled by met acidosis
- RR increases
28
What occurs to the endocrine system during pregnancy (3)
- Pancreas secretes more insulin due to increased free cortisol and progesterone
- Estrogen can blunt the action of insulin
- Cellular sensitivity to insulin decreases
29
What do Primigravida/para, Multigravida/para, Grand Multipara and Nullipara mean
```
Primigravida- 1st time pregnant
Primipara- Has only had 1 delivery
Multigravida- 2 or more pregnancies
Multipara- 2-5 deliveries
Grand Multipara- More than 5 deliveries
Nullipara- Woman has never delivered
```
Ex- 4 pregnancies, 3 miscarriages = G4P1 or G4A3P1
30
What do gravita and parity mean
Gravita- Number of times pregnant
Parity- Delivery after 20 weeks and alive
31
Explain Braxton Hicks contractions
False labor, uterus working out to prepare for birth
- Irregularly spaced
- Remains long
- Constant intensity
- Analgesics often abolish the pain
- No cervical changes
32
What should be done if delivery is imminent
- Vitals
- Estimate gestational age
- Listen for fetal heart tones
33
What is “lightening” in pregnancy
Feeling of relief of pressure in upper abdomen before labor
34
What is the “bloody show”
Plug of mucous sometimes mixed with blood from uterus, possibly weeks before labor starts
35
What is the first stage of labor
Beginning of cramping and contractions until fetus is repositioned to cervical opening
-Amniotic sac should rupture, cervix fully dilates to 10 cm
36
What is effacement in labor
The less muscular lower segment of uterus is pulled up over the presenting part
37
What is the second stage of labor
Begins with head of fetus entering birth canal to newborn fully out (crowning)
-Fetus’ head goes chin to chest>Face to woman’s ass>Head to side>Shoulders pop out
38
What is the third stage of labor
Separation, and expulsion of the placenta. Lasts from delivery of newborn to delivery of placenta
39
What is fetal acidosis
Acid-base response to hypoxia and the build up of lactic acid due to complications of birth
40
Steps to assist with delivery (9)
1. Control w/ gentle pressure, support head
2. Check for nuchal cord w/ middle finger, slip over head or cut if needed
3. Clear airway
4. Guide head to get shoulders out
5. Prepare for shootout after shoulders are out
6. Maintain newborn at same or just below level of the mother
7. Clamp 4” and 6” from newborn
8. Wipe newborn clean, suction is needed
9. Wrap in blanket, record time of birth
41
When to record the APGAR score
1 and 5 min after birth
42
What is Mag sulfate for in pregnancy and dose
Eclampsia, seizures
2-5 grams IV, 1/2 dose in 2 syringes if IM
43
What is Calcium chloride for in pregnancy and dose
Hypocalcemia/Reverse Mag sulfate SFx
8-16mg/kg SIVP
44
What is Terbutaline for in pregnancy and dose
Suppress pre-term labor, possibly if cord prolapse, pregnancy induced asthma
.25mg SQ, .2-.5mg Neb
45
What is (Diazepam) Valium for in pregnancy and dose
Sedative/Anticonvulsant, eclampsia w/ anxiety
5-10mg SIVP
46
What is Diphenhydramine (Benadryl) for in pregnancy and dose
Allergic reaction, hyperemesis gravidarum
50mg IV
47
What is Ondansetron (Zofran) for in pregnancy and dose
Treat nausea and vomiting
.4mg IV/IO/IM
48
What is Oxytocin (Pitocin) for in pregnancy and dose
Control severe postpartum hemorrhage ONLY after all products of conception leave vagina
49
What is premature membrane rupture in pregnancy
Amniotic sac ruptures more than an hour before labor
- May self heal
- Risk of infection
50
What is preterm labor
Regular, intense uterine contractions accompanied by effacement, after 20 less than 37 weeks
51
What is fetal distress
| -Treatment
Distress form hypoxia, trauma, abruptio placenta, prolapsed cord
Best care is quality care for the woman
52
What is uterine rupture
- S/S
- Treatment
Uterus rupture during labor
S/S- Weak, dizzy, thirsty, weakening contractions, sharp/tearing pain, shock
Treatment- Shock management
53
What is post term labor
Fetus born after 42 weeks
54
What is meconium staining
| -S/S
Chemical pneumonia from ingestion of meconium in amniotic fluid
S/S-Green/black meconium, depressed newborn
Treatment- Suction as needed
55
What is Fetal macrosomia
- Complications
- S/S
“Big baby syndrome”- More than 9 lbs
Complications-Cephalopelvic distortion, shoulder dystocia
S/S-Check newborn BGL
56
What is Hydramnios
| -Complications
(Polyhydramnios) There is too much amniotic fluid
Complications-Possible prolapsed cord and abruptio placenta and increased chance of postpartum hemorrhage
57
What is brow presentation
Head extended slightly
58
What is Occiput posterior presentation
Face up, can prolong delivery
59
What is military presentation
Head in a more neutral presentation of only partially flexed
60
What is a breach presentation
Part of the body estimate first other than the head
61
What is Frank breech presentation
Hips flexed and knees extended, butt presents first
62
What is Incomplete breech presentation
One or both hips and knees extended, one or both feet at the presenting part
63
What is Complete breech presentation
Hips and knees flexed, butt as presenting part
64
Steps to follow if butt is being delivered first (7)
1. Position woman on edge of bed
2. Dont pull on newborn
3. Support body when legs clear
4. Lower newborn slightly
5. Lift newborn back up when you can see hairline
6. Create air gap if needed
7. Proceed the rest of delivery as normal
65
What is a transverse presentation
Fetus lies crosswise in the uterus and one hand may protrude
| *DO NOT ATTEMPT DELIVERY
66
What is shoulder dystocia
Difficulty delivering the shoulders as they get stuck behind the pelvic bone
67
What maneuvers are there to widen a woman’s pelvis during birth
Push down on pelvis or have woman hyperflex into abdomen
68
What is a nuchal cord and a problem with it
Umbilical cord wrapped around the newborns neck, can result in cord compression causing fetal distress
69
What is a prolapsed umbilical cord and the problem associated
Umbilical cord presents before the fetus and can’t shunt off blood to the fetus if pressure is applied to it
70
Treatment of prolapsed umbilical cord (5)
```
1-Woman supine, hips elevated a lot
2- O2 via NRB
3-Have woman pant breath
4-2 fingers gently push presenting part off cord
5-Keep pressure of umbilical cord
```
71
What is a problem of substance abuse in pregnancy
| -Signs a newborn is born an addict (5)
Fetus can develop birth defects and become an addict
Signs
-Respiratory depression, BradyC, TachyC, Seizures, Cardiac arrest
72
Placenta previa
S/S
Treatment
Placenta is implanted low in uterus, partial or complete block of cervix
S/S-Painless bleeding, soft/tender uterus, Grey turner or cullens sign, recent sex
Treatment-Shock management
73
Abruptio Placenta
S/S
Treatment
Premature separation of placenta from uterus
S/S- Sudden, sharp/tearing pain, a lot to no bleeding, stiff abdomen
Treatment-L lateral, treat for shock
74
Three degrees of uterine inversion, explain each
1st- Cervix drops, remains in vagina
2nd- Cervix lies at the opening to vagina, body of uterus is in the vagina
3rd- Uterus and cervix protrude through vaginal opening
75
Uterine Inversion
S/S
Cause
Treatment
S/S
- Tissue protrusion
- Heaviness or fullness feeling
- Fatigue
- Lower back pain
Cause
Pulling on umbilical cord
Treatment
- One attempt to replace
- Cover with sterile, moist gauze
- Treat for shock
76
Ectopic Pregnancy
S/S
Treatment
Ovum develops outside of uterus
S/S
- Rapid onset, unilateral pain
- Radiation to shoulder
- Amenorrhea >5 was since LMP
Treatment-Treat for signs of shock and pain meds
77
Preeclampsia
S/S
Treatment
HyperT with onset of edema, HyperT and protein in urine after 20th wk of gestation predisposing seizures, can progress to eclampsia
S/S
Systolic over 160 or Diastolic over 110
Headache, dizzy, nausea, vomiting, spots in vision
Treatment
Mag Sulfate 2-5 grams
Labetalol, Hydralazine
78
Eclampsia
| Treatment
Seizures with present S/S of preeclampsia. Usually resolves from 0-10 days after birth.
Treatment
Mag Sulfate 2-5 grams
Other Hypertensive meds
79
Gestational diabetes
S/S
Complications
Treatment
Inability to process carbs, insulin increase
S/S-Polyuria, polydipsia, polyphagia
Complications- Oral glucose crosses placental barrier
Treatment- O2, BGL, Fluids
80
Pregnancy Asthma
Complications
Treatment
A common condition to complicate pregnancy, can produce progressive hypoxia to both
Complications- Preature labor, preeclampsia, resp failure, vag hemorrhage, eclampsia, low birth weight, retardation, potential fetal death
Treatment- Asthma protocol
81
Findings in injured pregnant women from truama
Abnormal fetal position, easily palpated fetus, unable to palpate fundus, vaginal bleeding
82
What % of blood loss do signs of Hypovolemic present in pregnant patients
About 40%
83
What is the best treatment for the fetus in trauma
Care for the mother
84
How should you transport a pregnant patient on a back board
Elevate right hip 6 inches
85
Treatment for pregnant trauma patient
```
1-Airway, early ET if needed and O2 NRB
2-Control bleeding ASAP
3- 1 or 2 IV lines and bolus if needed
4-Notify ER
5-Tilt backboard 30* left
```
86
CPR differences in pregnant patients
- Left lateral uterine displacement
- Hands 5-7” below angle of Louis for CPR
- Can do CPR on dead woman to save baby
87
Potential causes for maternal cardiac arrest
| BEAUCHOPS
- Bleeding/DIC
- Embolism
- Anesthetic complications
- Uterine Antony
- Cardiac disease
- Hypertension
- Other Hs and Ts
- Placenta abruptio/previa
- Sepsis
88
Maternal arrest treatment
- IV above diaphragm
- Assess for hypovolemia
- Anticipate difficult airway
- Stop mag is used (calcium to reverse)
- Continue CPR
89
Full APGAR scoring system
Appearance: 2- Pink, 1-Acrocyanosis, 0-Cyanotic
Pulse: 2->100, 1-<100, 0-No pulse
Grimace: 2-Great, 1-Poor, 0-None
Activity: 2-Resistant, 1-Some, 0-None
Respirations: 2-Strong cry, 1-Weak, 0-None
90
Postpartum bleeding
Causes
Treatment
>500 mL blood loss, can last up to 24 hrs
Causes-Ineffective contractions, retaining placenta pieces, vag/cervix tears
Treatment- Control bleed, massage uterus, encourage breast feeding, fluid, oxytocin
