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antepartum (unit 1) Flashcards

1
Q

presumptive signs of pregnancy

A
  • subjective
  • breast/abdominal enlargement
  • skin changes
  • amenorrhea
  • N/V
  • fatigue
  • urinary freq.
  • quickening
  • breast tenderness
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2
Q

probable signs of pregnancy

A 
•objective (examiner)
•uterine enlargement
•cervical changes
•braxton hicks
•ballottement- push down and bounce back 
*positive preggo-test
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3
Q

false negative preggo test

A
  • too soon
  • urine dilute
  • ectopic PG
  • improper technique
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4
Q

fasle positive preggo test

A
  • UTI (protein/blood in urine)
  • recent pregnancy
  • drugs
  • tumor
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5
Q

positive signs of pregnancy

A
  • confirms presence of fetus
  • fetal HT 10-12 weeks
  • visual in abd. 5-6 wks
  • visual in vag. 16 days
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6
Q

LMP

A

•last menstrual period

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7
Q

CD

A

•conception date

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8
Q

EDD

A

•estimated date of delivery

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9
Q

EDC

A

•estimated date of confinement

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10
Q

EDB

A

•estimated date of birth

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11
Q

length of pregnancy

A 
•280 days (40 wks)
•3 trimesters
1. 1-13.9 wks
2. 14-26.9 wks
3. 27-40 wks
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12
Q

Nagele’s Rule for EDD

A
  • subtract 3 from the month # of LMP

* add 7 to the day # of LMP

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13
Q

gravida

A

•# of pregnancies

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14
Q

para

A

•# of pregnancies reaching 20 wks GA

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15
Q

term

A

•deliveries at 38-42 wks

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16
Q

preterm

A

•deliveries prior to 37 wks and after 20 wks

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17
Q

post-term/postdates

A

• > 42 wks GA

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18
Q

abortion (Ab)

A

•ETOP- elective termination of pregnancy
•SAB- spontaneous abortion
•TAB- therapeutic abortion (medical reasons)
*abortion at less than 20 wks

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19
Q

GTPAL system

A
  • gravida
  • term
  • preterm
  • abortion
  • living
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20
Q

pregnancy after twins

A
  • G2
  • T1
  • P0
  • A0
  • L2
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21
Q

safe category drugs

A
  • A

* B

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22
Q

questionable category drugs

A
  • C
  • weigh risks w/ benefits
  • Ex: Zoloft
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23
Q

contraindicated category drugs

A
  • D (seizure drugs)
  • X (NEVER give)
  • proven fetal harm
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24
Q

pancreas changes during pregnancy

A
  • 1st trimester: dec. insulin (fetus takes glucose)

* ⅔ trimester: mom inc. resistance to insulin (more supply glucose for fetus)

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25
progesterone
``` •"hormone of pregnancy" •secreted from ovary/placenta •effects -maintains uterine lining -relaxes uterine smooth muscle -prepares breasts for lactation -maternal fat stores (w/ estrogen) ```
26
estrogen
``` •secreted from ovary/pl •effects -uterine, genital, breast growth -ducts for lactation -skin changes ```
27
human chorionic gonadotropin (hCG)
``` •first produced by fetus •effects -positive preg. test •prevents involution corpus luteum •hormone that makes people "feel" pregnant ```
28
hCG and progesterone
•work together to maintain pregnancy •hCG maintains corpus luteum •corpus luteum produces progesterone until placenta *drop of either results in miscarriage
29
relaxin
•from ovary and placenta •effects -softens muscles/joints of pelvis -inhibits uterine activity
30
oxytocin
•from post. pit •effects -uterine ctx -milk ejection (let down) reflex
31
prolactin
* from ant pit | * hormone of milk production
32
aldosterone
* from adrenals | * increases during pregnancy to conserve Na+ and maintain fld balance
33
thyroxin (T4)
•inc. when estrogen inc. •causes bigger thyroid •inc. BMR for 1st trimester *hyperactive thyroid during pregnancy (hard to regulate in 1st trimester if had previous issue and are on meds)
34
human chorionic somatommotropin (hCS)
* from placenta | * growth hormone affecting breast development and decreasing maternal metabolism
35
uterus growth during pregnancy
•12 wks: rise out of pelvis •16 wks: midway b/t symphysis and umbilicus •20 wks: umbilicus •38-40 wks: FSH dec -> lightening (feel better) *grows 1 cm/wk
36
funic souffle
* blood rushing through umbilical vessels | * sync w/ fetal heart beat
37
uterine souffle
* blood in uterine arteries | * sync w/ maternal pulse
38
Hegar's sign
* softening of lower uterine segment | * 6-8 wks
39
Goodell's sign
* cervical softening r/t congestion of blood | * 6 wks
40
Chadwick's sign
* bluish color of cervix r/t inc. vascularity | * 8-12 wks
41
mucus plug (operculum)
* barrier in cervix * protects baby from bacteria * sloughing of vaginal cells caused by progesterone
42
leukorrhea
* changes in vaginal acidity to protect against infection | * due to increased lactic acid production making mom more vulnerable to yeast infection
43
cardiovascular changes during pregnancy
``` •inc. clotting factors •dec. fibrinolytic (prevent clots from sticking) activity •inc. WBC and RBC •inc. blood vol. -> inc. CO •inc. pulse •inc. respirations •dec. BP during 2nd trimester *extremely high risk for blood clots ```
44
pseudo (physiological) anemia
•inc. in RBC, but diluted by expanded blood vol., so looks like anemia •Hct < 35% •Hgb < 10% *lower than normal H&H okay as long as they are tolerating it
45
why does BP decrease 5-10mmHg during 2nd trimester
•b/c have extra volume and body responds by signaling vasodilation to relax vessels and lower BP
46
dependent (physiologic) edema
* poor venous return d/t pressure of uterus * creates pooling/varicose veins in LE * pt should avoid tight clothing/shoes
47
urinary changes during pregnancy
* bladder capacity doubles * filtration rate inc. * inc. risk for infection * ketones/protein in urine bad
48
protienuria during pregnancy
•not good b/c can lead to irreversible kidney damage (too big to filter) •if in combo w/ HTN risk for preeclampsia *check at every appt.
49
integumentary changes during pregnancy
* chloasma (face pigment) * linea nigra * vascular spiders * palmar erythema (r/t estrogen) * striae gravidarum (collagen stretch) * epulis (gum hypertrophy) * acne
50
causes of leg cramps during pregnancy
* impaired circulation * low K+ * high P * low Ca++ * low Mg++
51
round ligament pain
* sharp pain in abd. extending to pelvis/vag * caused by stretching of ligaments as uterus grows * tx w/ Tylenol, NOT NSAIDs
52
causes of fatigue during pregnancy
* hypoglycemia * initial fall in BMR (1st tri) * progesterone
53
neurologic system changes during pregnancy
``` •sciatic nerve pain •sensory changes in legs •tension HA •carpal tunnel (r/t edema compression) •acrothesias (numb hands) •hypocalcemia (cramps) *nerve/sensory s/sx ```
54
ptyalism
•excessive secretion of saliva
55
morning sickness causes
* inc. hCG, estrogen, progesterone * hypoglycemia * altered carb metabolism * tx w/ gum, hard candy, oral care, etc
56
hyperemesis
•severe morning sickness •requires frequent monitoring of weight/electrolytes •may need hospitalization and IV tx *r/o appendicitis
57
pyrosis
* heartburn * caused by progesterone decreasing peristalsis and vasodilating smooth muscle * tx w/ anti-acids and diet modification
58
pica
* carving/eating abnormal things * ice is common in preggo * may indicate signs of anemia
59
constipation during pregnancy
``` •most common in 3rd trimester •d/t -dec. peristalsis -iron supplements -dehydration -dec. activity level •tx w/ H2O, fiber diet, colace ```
60
reason for hemorrhoids during pregnancy
* increased vascularity * increased pressure * constipation
61
nutrition increase requirements during pregnancy
* iron- O2 demands * vitamin C- absorb iron * calcium- teeth/bone formation * inc. caloric intake by ~300
62
nutrition during lactation
* inc. by 300 kcals/day for first 6 months | * inc. by 400 kcals/day after 6 months
63
adequate antepartum care
* 13 visits | * begin before 20 post-conception (later is high risk)
64
initial prenatal visit
* health hx * OB hx (GTPAL) * GYN hx (menstrual cycle; contraception; fertility; STDs) * family hx (mom primarily) * psychosocial profile * physical assessment
65
initial prenatal visit exam
•verify pregnancy and establish EDD *U/S most accurate method •establish baseline numbers (VS, weight, etc)
66
initial prenatal visit labs
* CBC- platelets; anemia * type Rh (redraw in L&D) * rubella titer * HBSaG * RPR or VDRL * HIV * gonorrhea/chlamydia cultrer * urinalysis/culture
67
ABO incompatibility
* A and B blood doesn't mix w/ O * if mom is O and baby is A or B, then mom can produce antibodies that attack baby * can cause fetal jaundice or anemia * no tx
68
Rh incompatibility
* Rh (D) negative women who give birth to Rh (D) positive infants may develop anti-D antibodies * These antibodies are made when the Rh negative blood is exposed to Rh + blood (exposed to the “D” antigen) * These antibodies then can attack the next fetus resulting in serious illness and death due to erythroblastosis fetalis
69
Rhogam
* drug that reduces # of anti-Rh antibodies that are a result of Rh+ fetal blood mixing w/ Rh- maternal blood * given at 28 wks for Rh neg mom * given 72 hrs postpartum after fetal type/Rh * w/ tx, very little chance of antibody production
70
erythroblastosis fetalis (hydrops)
•hemolytic anemia in fetus
71
rubella titer
* if non-immune and exposed to Rubella, can develop congenital rubella syndrome * if non-immune vaccinated postpartum
72
HBSaG
* hepatitis B surface ANTIGEN indicates current infection * surface ANTIBODIES indicate past infection/immunization * no tx for + during pregnancy, but can vaccinate fetus w/in 12 hrs of birth to reduce risk of infection
73
RPR/VDRL
* syphillis labs * tx w/ PCN during pregnancy * redrawn at L&D admit
74
HIV labs
``` •drawn at initial and on admit to L&D •don't need pt consent •tx available during pregnancy •viral count lower than ___ means can have vag. delivery *DONT breastfeed w/ HIV ```
75
+ gonorrhea/chlamydia screened
* tx during pregnancy w/ abx and TOC w/in 1 month | * infection increases risk for preterm delivery
76
initial urinalysis
* asymptomatic bacteria common | * tx w/ abx if count > 100,000
77
HPV positive
* doesn't affect outcome of pregnancy unless invasive cancer | * doesn't transmit to fetus
78
HSV
* herpes simplex virus * I: mouth * II: genitals * CANNOT have vag. delivery w/ active HSV lesions * preventative tx during pregnancy
79
HGB electrophoresis
* detects hemoglobinopathies (sickle cell, etc) | * only done in high risk pts
80
1st trimester ultra sound
•done to confirm dates (may have to chafe EDC to match sono)
81
smoking effects during pregnancy
* vasoconstriction in placental leads to decreased blood flow * placenta calcifies * thin umbilical cord * fetal growth abnormalities * high risk of SIDS b/c CO2 crosses placenta
82
2nd trimester visits
``` •BP •urine dip for protein, blood, ketones, glucose, bacteria •fundal ht •leopold's •FHT (doppler) •lower extremities *every 4 wks ```
83
2nd trimester labs
* GDM screening @ 24-28 wks * Rh antibody screening * CBC (r/o anemia) * genetic screening
84
2nd trimester ultrasound
* b/t 18-22 wks * assess anatomical structures * determine sex * if high risk, sent for further evaluation
85
3rd trimester visit
•same as 2nd, but add in cervical exams to assess for dilation * once get to 28 wks come every 2 wks * once get to 36 wks come every wk
86
3rd trimester labs
•group beta strep (GBS) -vaginal/rectal swabat 35-37 wks •Rh screen if was - before -admin Rhogam if still -
87
3rd trimester ultrasound
* not always performed | * offered for pt satisfaction of growth, size, etc
88
Who is at risk for Rh incompatibility?
•Rh negative mother w/ Rh positive fetus
89
fetal kick counts
•at least 3/hr •movement peaks 9 pm and 1 am -maternal glucose lowest *no movement for 12 hrs is an alarm
90
if pt calls about no fetal movement
* tell to go eat and drink and then lie down * should have at least 10 movements over the next 2 hours * if < 10 movements need to bee seen for further testing
91
pt 34 wks, what s/sx needs followup
•headache b/c possibly have hypertension
92
immunizations during pregnancy
* live virus contraindicated (MMR, polio, small pox, flu mist) * attenuated acceptable (flu, tetanus, dip, hep B, rabies)
93
TDAP recommendations
* vaccinate w/ EACH pregnancy | * given b/t 27-36 wks
94
cocooning
* vaccinating any child or adult that will have close contact w/ infant <12 months old * immunization that protects newborn
95
kegel exercises
•deliberate ctx/rlx of pubococcygeus muscle to improve muscle tone/strength of pelvis
96
couvade syndrome
•healthy man, whose wife is expecting, experiences pregnancy symptoms - loss of appetite - N/V - HA - fatigue - weight gain
97
common goal of all cultures during pregnancy
•seek to protect mom and baby
98
follicular phase
* variable | * before ovulation
99
"black box" layer of cells
* surround uterus and prevent placenta from embedding | * improvised if had cervical scrape
100
when do fundus measurements line up w/ pregnancy
•20 weeks
101
how to rule out getting mom HB instead of fetus
•take radial pulse or use pulse ox
102
underweight BMI
* <18.4 | * should gain 27-40 lbs
103
normal weight BMI
* 18.5-24.9 | * should gain 25-35 lbs
104
overweight BMI
* 25-29.9 | * should gain 15-25 lbs
105
obese BMI
* >30 | * minimal gain

OB (17 decks)

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