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OB > Exam #1 > Flashcards

Exam #1 Flashcards

1
Q

perineum

A
  • skin colored muscular area that covers the pelvic structres
  • forms the base of the perineal body = a wedge-shaped mass that serves as an anchor for the muscles, fascia, and ligaments of the pelvis
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2
Q

squamocolumnar junction

A
  • where two types of cells meet and is located inside the cervical os
  • most common site for neoplastic changes
  • site where cells are scraped for pap smear
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3
Q

ovulation

A
  • the release of a mature ovum from the ovary at intervals, usually monthly
  • two fxns of ovaries: ovulation and hormone production
  • estrogen, progesterone and androgen are hormones produced by ovaries
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4
Q

breast self exam

A
  • systemic palpation of breasts to detect signs of breast cancer or other changes
  • best time to do it: 5-7 days after menstruations stops because physiologic alternaions in breast size and activity reach a minimum at this time
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5
Q

menarchy

A
  • first menstruation

- marked increase of estrogen between 8-11 years of age

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6
Q

puberty

A
  • broad term that denotes the entire transitional stage between childhood and sexual maturity
  • increasing amounts and variations in gonadotropin and estrogen secretion develop into a cyclic pattern at least a year before menarche
  • normally occurs in north america around age 13
  • initially periods are irregular, unpredictable, painless and anovulatory
  • after about a year of periods the hypothalmic pituitary rhythm develops and the ovary produces adequate cyclic estrogen to make a mature ovum
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7
Q

menstruation

A
  • periodic uterine bleeding that begins approximately 14 days after ovulation
  • controlled by a feedback system with 3 cycles: endometrial, hypothalmic-pituitary, ovarian
  • avg length is 28 days, first day of bleeding is day 1 of cycle
  • ## menses = day 1 of menstrual cycle, normally bleeding lasts 5 days with avg blood loss of 50mls
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8
Q

climacteric

A
  • transitional phase during which ovarian fxn and hormone production decline
  • this phase spans the years from the onset of of premenopausal ovarian decline to postmenopausal time when symptoms stop
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9
Q

menopause

A
  • the last menstrual period
  • can only be dated with certainty only 1 year after menstruation ceases
  • avg age is 51.4 years, can be 35-60
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10
Q

perimenopause

A
  • period preceding menopause that lasts about 4 years
  • ovarian function declines
  • ova slowly diminish and menstrual cycles may be anovulatory, resulting in irregular bleeding
  • ovary stops producing estrogen and eventually menses no longer occur
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11
Q

sexual response cycle

A
  • four phases: excitement, plateau, orgasmic, resolution
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12
Q

preconception care

A
  • about 50% of all pregnancies in the US are unintended
  • preconception care targets all women of reproductive age from menarche to menopausal transition
  • critical fetal organ development between 17-56 days after fertilization. by the end of the 8th week and 1st trimester the major structural anomolaies in the fetus are already present
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13
Q

vulvar self exam

A
  • VSE
  • should be performed monthly between menses
  • most lesions, malignancy, wart growth, and cysts can be felt and easily treated if diagnosed early
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14
Q

kegel exercises

A
  • pelvic muscle exercises
  • ## help with urinary incontinence
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15
Q

conception

A
  • untion of single egg and sperm
  • marks the beginning of pregnancy
  • sequential process: gamete formation, ovulation, fertilizaion and implantation in uterus
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16
Q

mitosis

A
  • body cels replicate to yield two cells with the same genetic makeup as the parent cell
  • mitotic division facilitates growth and development or cell replacement
  • each daughter cell receives one copy of the genetic material
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17
Q

meiosis

A
  • germ cells divide and decrease their chromosomal number by half, produces gametes (sperm and eggs)
  • each pair of chromosomes contains one chromosome received from the mother and one from the father, and results in cells that contain one of each of the 23 pairs of chromosomes
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18
Q

oogenesis

A
  • process of egg formation, begins during getal life in the female
  • all eggs are contained in a woman’s ovaries at birth
  • 400-500 ovum mature during the 35 years of a woman’s productive life
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19
Q

zygote

A
  • when sperm is united with egg
  • ## at fertilization
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20
Q

spermatogenesis

A
  • spermatocytes undergo meiosis

-

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21
Q

fertilization

A
  • takes place in the ampulla (outer third) of the uterine tube
  • when a sperm successfully penetrates the membrane surrounding the ovum, both sperm and ovum are enclosed within the membrane and the membrane becomes impenetrable to other sperm (zona reaction)
  • cleavage: mitotic cellular replication begins as the zygote travels through the uterine tube into the uterus, takes 3-4 days
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22
Q

morula

A
  • solid ball of cells produced within 3 days of fertilization
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23
Q

trophoblast

A
  • gives rise to the placenta
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24
Q

embryonblast

A
  • gives rise to the embryo
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25
Q

blastocyst

A
  • whole structure of the developing embryo

- stem cells are derived from the inner cell mass of the blastocyst

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26
Q

implantation

A
  • blastocyst embeds in the endometrium
  • between 6-10 days after conception
  • the trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered
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27
Q

chorionic villi

A
  • finger-like projections develop out of the trophoblast and extend into the blood-filled spaces of the endometrium
  • vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood
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28
Q

decidua basalis

A
  • the portion directly under the blastocyst that has embeded in the endometrium of the uterus
  • decidua = implanted endometrium
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29
Q

embryo

A
  • the stage of the embryo lasts from day 15 to 8 weeks after conception
  • embryonic stage: most critical time in the development of the organ systems and the main external features
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30
Q

teratogens

A
  • substances or exposure that causes abnormal development
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31
Q

chorion

A
  • one of two fetal membranes that will surround the developing embryo
  • develops from the trophoblast and contains the chorionic villi
  • becomes the covering of the fetal side of the placenta
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32
Q

amnion

A
  • one of two fetal membranes that will surround the developing embryo
  • develops from the inner cells of the blastocyst
  • the developing embryo draws the amnion around itself, forming a fluid-filled sac
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33
Q

amniotic fluid

A
  • functions: helps maintain a constant body temperature, oral fluid, repository for waste ad assists in maintenance of fluid and electrolyte homeostasis, allows for movement, musculoskeletal development, cushions fetus from blunt trauma, acts as infection barrier, allows fetal lung development, facillitates symmetric growth
  • fluid amt: at full term it should be 700-1000mls of transparent liquid
  • contains: albumin, urea, uric acid, creatinine, lecithin, sphingomyselin, bilirubin, fructose, fat, leukocytes, proteins, epithelial cells, anzymes, lanugo hair
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34
Q

oligohydramnios

A
  • less than 300ml amniotic fluid

- associated with fetal renal issues

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35
Q

hydramnios (polyhydramnios)

A
  • more than 2 L of amniotic fluid

- associated with GI and other malformations

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36
Q

nuchal cord

A
  • when the cord is wrapped around the fetal neck
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37
Q

placenta

A
  • metabolic exchange
  • by 20 weeks the placenta covers half the uterus
    Functions:
  • endocrine gland function: produces 4 hormones = hCG (preserves corpus leutium so continuous supply of estrogen and progesterone can maintain pregnancy), hCS (stimulates maternal metabolism to supply nutrients for fetal growth), progesterone, estrogen
  • metabolic functions: respiration, nutrition, excretion, storage. o2 and co2 diffuse back and forth through placenta membrane. carbs, proteins, calcium and iron are stored in placenta for ready access and water, inorganic salts, carbs, protens and fats and vitamins pass through maternal blood supply. fetus demans lots of glucose because of high metabolic rate, higher than mothers glucose levels. fetal waste crosses placental membrane and is excreted in mothers renal system
  • maternal circulation: placenta depends on the maternal BP to supply circulation, 10% of mother’s cardiac output goes to fetus at term, vasoconstriction (HTN and cocaine) can decrease blood flow to uterus, decreased circulation can lead to intrauternine growth restriction of the fetus and small fetuses. best position for circulation is when woman is laying at rest on her side
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38
Q

fetus

A
  • lasts from 9 weeks until pregnancy ends
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39
Q

viability

A
  • capability of the fetus to survive outside the uterus and is usually defined by fetal weight and pregnancy duration
  • 20 weeks, birth weight of 350g, 400g, or 500g
  • infants who are 22-25 weeks of gestation are on the threshold of viability
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40
Q

ductus arteriosus

A
  • special circulatory pathway by passes the lungs due to fetal lungs not funcitoning for gas exchange
  • oxygen rich blood from the placenta flows rapidly through the umbilical vein into the fetal abdomen
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41
Q

ductus venosus

A
  • vein goes into the inferior vena cava, it mixes with deoxygenated blood from fetal legs and abdomen
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42
Q

foramen ovale

A
  • opening in left atrium
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43
Q

cephalocaudal

A
  • blood flows first to heart, head, neck, and arms

- head to rump development of embryo/fetus

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44
Q

hematopoiesis

A
  • the formation of blood
  • occurs in the yolk sac, beginning in the 3rd week
  • stem cells
  • blood type is determined after the 6th week, so RH factor can become an issue then
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45
Q

surfactants

A
  • the presence of surface active phospholipids in the amniotic fluid is used to determine the degree of fetal lung maturity or the ability of the lungs to function after birth
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46
Q

L/S ratio

A
  • Lecithin: the most critical alveolar surfactant required for postnatal lung expansion. detectable at 21 weeks and increases in amt after week 24
  • Sphingomyelin: remains constant in amount
  • the L/S ratio: used to determine fetal lung maturity. 2:1 ratio the infant’s lungs are considered to be mature. occurs in the middle of the third trimester
  • infants born c-section may have respiratory difficulty at birth due to the lack of squeezing through the birth canal. if fluid remains in the lungs, it will be absorbed into the infant’s bloodstream within 2 hours of birth
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47
Q

vernix caseosa

A
  • white, cheesy material that protects the fetus’s skin
  • thick at 24 weeks and scant by the time of birth
  • cells of superficial layer mixed with sebaceous gland secretions
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48
Q

lanugo

A
  • very fine hairs appear first at 12 weeks on eyebrows and upper lip
  • by 20 weeks they cover the entire body
  • by 28 weeks the scalp hair is longer than the lanugo
  • lanugo may disappear by term gestation
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49
Q

dizygotic twins

A
  • two mature ova are produced in one ovarian cycle, both have the potential to be fertilized by separate sperm
  • result is two zygotes
  • two amnions, two chorions, and two placentas, that may be fused
  • fraternal twins
  • more often amoung AA women, less in Asian
  • increased frequency with advanced maternal age, parity, and use of fertility drugs
50
Q

monozygotic twins

A
  • identical
  • develop from one fertilized ovum, which then divides
  • same sex, same genotype
  • if division soon after fertilization…two embryos, two amnions, two chorions, two placentas
  • if division occurs 4-8 days after fertilization…two embryos, two amnions, one chorion, one placenta
  • if division after 8 days of fertilization…two embryos within a common amnion and a common chorion with one placenta (can be a major issue with unbilical chords that tangle together, one or both fetuses may die)
51
Q

4 weeks fetus

A
  • external appearance: body flexed, c shaped; arm and leg buds present; head at right angle to body
  • heart develops, double chambers visible, heart begins to beat
  • lung buds appear
  • uretal buds appear
  • genital ridge appears
52
Q

8 weeks fetus

A
  • external appearance: body fairly well formed, digits well formed, eyes/ears/mouth/nose/mouth recognizible
  • fetus capable of some movement
  • main blood vessels assume finale plan
  • brain and CNS form
  • testes and ovaries are distinguishable, external genitalia is sexless but begin to differentiate
53
Q

12 weeks fetus

A
  • nails appearing, resembles a human, head erect but disproportinately large, skin pink/delicate
  • bile secreted
  • blood forming in marrow
  • lungs aquire definite shape, vocal chords appear
  • kidneys secrete urine, blader expands as a sac
  • sucking present, cord developing
  • sex rexognizable, internal and external sex organs specific
54
Q

16 weeks fetus

A
  • face looks human, eyes, ears and nose approach typical appearance on gross examination; arm/leg ratio proportionate, scalp hair appears
  • muscular movements can be detected
  • heart muscle well developed, blood formation active in spleen
  • general sense organs differentiated
  • testes in position for descent into scrotum, vagina open
55
Q

20 weeks fetus

A
  • vernix caseosa appears, lanugo appears
  • fetal movements strong enough for mother to feel
  • nostrils reopen
  • cord myelination begins
  • nose and ears ossify
56
Q

24 weeks fetus

A
  • body lean but well proptortioned, skin red and wrinkled, vernix caseosa present, sweat glands forming
  • blood formation increases in bone marrow and decreases in liver
  • alveolar ducts and sacs present, lecithin begins to appear in amniotic fluid
  • can hear
57
Q

28 weeks fetus

A
  • lean body, less wrinkled and red, nails appear
  • fleeting movements, minimum tone
  • lecithin forming on alveolar surfaces
  • weak suck reflex, cry weak or absent
  • eyelids reopen, pupils capable of reacting to light
58
Q

30-31 weeks fetus

A
  • SQ fat beginning to collect, more rounded appearance, skin pink and smooth, assumed birth position
  • can turn head side to side
  • sense of taste present, aware of sounds outside mother’s body
  • testes descending to scrotum
59
Q

36-40 weeks fetus

A
  • skin pink, body rounded, general lanugo disappearing, body usually plump
  • skin smooth and pink, scant vernix caseosa, lanugo on shoulders and upper body only
  • can turn and elevate head
  • active sustained movement, good tone
  • definite sleep-wake cycle
  • myelination of brain begins, patterned sleep-wake cycle wth alert periods, strong suck reflex
  • testes in scrotum, labia mahora well developed
60
Q

conjoined/siamese twins

A
  • type of monozygotic twins in which cleavage is incomplete and occurs late (13-15 days postconception)
61
Q

multifetal pregnancies

A
  • three or more fetuses

- increased with the use of fertility drugs and in vitro fertilization

62
Q

gravida

A
  • woman who is pregnant
  • gravidity: pregnancy
  • nulligravida: woman who has never been pregnant and is not currently pregnant
  • primigravida: woman who is pregnant for the first time
  • multigravida: woman who has had 2 or more pregnancies
  • parity: number of pregnancies in which the fetus(s) have reached 20 weeks gestation (not the number of fetuses, twins). not affected whether the fetus is born alive or stillborn
  • nullipara: woman who has not completed a pregnancy with a fetus beyond 20 weeks of gestation
  • primipara: woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks gestation
  • multipara: woman who has completed two or more pregnancies to 20 weeks of gestation
  • Post dates: > 40 completed weeks
  • Post term: >42 completed weeks.
  • Term: >37 weeks (so if she is at 37 0/7 weeks, she is term, even though your book defines that at “early term;” you will not see it talked about that way really, in the clnical or hospital settings).
  • Preterm:
63
Q

viability

A
  • capacity to live outside the uterus
  • no clear limits of gestational age or weight
  • infants born 22-25 weeks of gestation are considered to be on the threshold of viability and are especially vulnerable to brain injury if they survive
64
Q

presumptive signs of pregnancy

A
  • those changes felt by the woman: amenorrhea, fatigue, breast changes
65
Q

probable signs of pregnancy

A
  • changes observed by an examiner: hegar sign, ballotment, pregnancy tests
66
Q

positive signs of pregnancy

A
  • signs attributed only to the presence of the fetus: hearing fetal heart tones, visualizing the fetus, palpating fetal movements
67
Q

hegar sign

A
  • 6 weeks of gestation, softening and compressibility of the lower uterine segment occurs
  • results in exaggerated uterine antereflexion during the first 3 months of pregnancy
  • the uterine fundus presses on the urinary bladder, causing the woman to have urinary frequency
68
Q

braxton hicks

A
  • soon after 4th month of pregnancy
  • uterine contractions can be felt through the abdominal wall
  • irregular and painless contractions that occur intermittently throughout pregnancy
  • usually cease with walking or exercise, stronger after 28 weeks
69
Q

uterine souffle

A
  • bruit
  • rushing or blowing sound of maternal blood flowing through uterine arteries to the placenta that is synchronous with the maternal pulse
70
Q

funic souffle

A
  • syncrhonous bruit with fetal heart rate caused by fetal blood coursing through the umbilical cord and fetus’s heartbeat
71
Q

goodell sign

A
  • probable sign of pregnancy
  • softening of the cervical tip beginning at week 6
  • caused by increased vascularity, slight hypertrophy, and hyperplasia (increase in number of cells)
72
Q

friability

A
  • change during pregnancy
  • tissue is easily damaged
  • increased and can result in slight bleeding after vaginal examinaiton or after coitus with deep penetration
73
Q

ballottement

A
  • passive movement of the unengaged fetus
  • begins between 16th-18th week
  • technique of palpating a floating structure by bouncing it gently and feeling it rebound
  • examiner places a finger within the vagina and taps gently upward on the cervix, causing the fetus to rise. the fetus then sinks and a gentle tap is felt on the finger
74
Q

quickening

A
  • first recognition of fetal movements, “feeling life”
  • it can be detected by multiparous woman as early as 14-16 weeks
  • nuliparous women may not feel it until 18th week or later
75
Q

chadwick sign

A
  • violet-blue vaginal mucosa and cervix

- evident as early as 6th week and easily noted by 18th week

76
Q

leukorrhea

A
  • white or slightly gray mucoid discharge with a faint musty odor
  • occurs in response to to cervical stimulation by estrogen and progesterone
  • results in the formation of the mucous plug
77
Q

operculum

A
  • mucus plug

- acts as a barrier against bacterial invasion during pregnancy

78
Q

montgomery tubercles

A
  • hypertrophy of the sebaceous oil glands embedded in the primary areolae
  • may be seen around the nipples
  • secrete lubricating and antiinfective substances to help protect the nipples and areolae during breastfeeding
79
Q

striae gravidarum

A
  • stretch marks
80
Q

colostrum

A
  • yellow premilk fluid secreted during the second trimester

- may appear as early as 16 weeks gestation

81
Q

melasma

A
  • mask of pregnancy
  • blotchy, brownish hyperpigmentation of the skin over cheeks, nose, forehead
  • appears especially in pregnant women of dark complexions
  • appears in 50-70% of pregnancy women
82
Q

linea nigra

A
  • pigmented line extending from symphysis pubis to top of fundus in midline
  • in primigravidas the linea nigra begins in 3rd month and keeps pace with the rising height of the fundus
  • hair growth along the line can occur too
83
Q

palmar erythema

A
  • color changes of pinkish red, diffusely mottled or well-defined blotches over the palms of the hands in 70% caucasion and 30% AA women
  • related to increased estrogen levels
84
Q

pruritus gravidarum

A
  • itching over the abdomen
85
Q

pruritic urticarial papules and plaques of pregnancy (PUPPP)

A
  • most common specific dermatosis
  • more common in multiple gestations
  • significant discomfrot but does not cause adverse outcomes for mom or baby
  • tx with: antihistamines, topical antipruritic, corticosteroid cream
86
Q

diastasis recti abdominis

A
  • muscles of abdominal wall stretch and lose tone
  • third trimester the rectus abdominals muscles can separate and allow abdominal contents to protrude at the midline
  • umbilicus flattens or protrudes
  • after birth the muscles gradually regain tone however separation of the muscles can persist
87
Q

carpal tunnel syndrome

A
  • edema involving the peripheral nerves can result in carpal tunnel syndrome during the last trimester
  • paresthesia (burning, tingling) and pain in the hand, radiatiing to the elbow
  • caused by edema that compresses the meian nerve beneath the carpal ligament of the wrist
88
Q

epulis

A
  • gingival granuloma gravidarum
  • red raised, nodule on the gums that bleeds easily
  • gums become more hyperemic, spogy, and swollen during pregnancy
  • increased levels of estrogen cause selective increaed vascularity and connective tissue proliferation
89
Q

ptyalism

A
  • excessive salivation
  • caused by unconscious decrease in swallowing by the woman when nauseated or caused by stimulation of salivary glands by eating starch
90
Q

pyrosis

A
  • acid indigestion, heartburn
  • beginning as early as the first trimester and intensifying through the third trimester
  • increased progesterone causes decreased tone and motility of smooth muscles, resulting in esophogeal regurgitation, slower emptying time of the stomach, reverse peristalsis
91
Q

trimesters

A
  • 1st: week 1-13
  • 2nd: week 14-26
  • 3rd: week 27-40
  • full term at 37 weeks
92
Q

presumptive signs of pregnancy

A
  • changes felt by the woman; these signs alone are not reliable for diagnosis of pregnancy
  • elevated BBT, breast and abdominal enlargement, changes in uterus and vagina, striae gravidarum, deeper pigmentation of areola, melasma, linea nigra
  • 3-4 weeks: breast changes
  • 4 weeks: amenorrhea
  • 4-14 weeks: nausea and vomiting/morning sickness
  • 6-12 weeks: urinary frequency
  • 12 weeks: fatigue
  • 16-20 weeks: quickening
93
Q

probable causes of prengnancy

A
  • changes observed by examiner
  • placental souffle
  • 5 weeks: goodell sign (softening of cervical tip)
  • 6-8 weeks: chadwick sign (violet-blue vaginal mucosa and cervix)
  • 6-12 weeks: hegar sign (compressibility of lower uterine segment. leads to urinary frequency)
  • 4-12 weeks: positive pregnancy test with serum
  • 6-12 weeks: positive pregnancy test with urine
  • 16 weeks: braxton hicks contractions
  • 16-28 weeks: ballottement
94
Q

positive signs of pregnancy

A
  • signs attributed only to signs of a fetus
  • 5-6 weeks: visualization of fetus by real time ultrasound
  • 6 weeks: fetal heart tones by ultrasound
  • 19-22 weeks: fetal movements palpated by examiner
  • late pregnancy: fetal movements visible to examiner
95
Q

Estimated date of confinement (EDC), estimated date of delivery (EDD), estimated date of birth (EDB)

A
  • accurate dating of prenancy and calculation of EDB have implications for timing of specific prenatal screening tests, assess fetal growth, and making critical decisions for managing pregnancy complications
96
Q

naegele’s rule

A
  • common method for calculating EDB
  • based on woman’s accurate recall of her LMP
  • assumes that woman has 28 day cycle and fertilization occured on the 14th day
  • EDB = first day of LMP - 3 months + 7 days
97
Q

couvade syndrome

A
  • couvade: in older societyies the man enacted the ritual couvade and behaved in specific ways and respected taboos associated with pregnancy and giving birth so his new status was recognized and endorsed
  • couvade syndrome: some men experience pregnancy-like symptoms - nausea, weight gain, and other physical symtoms
98
Q

supine hypotension

A
  • low BP that occurs when the woman is lying on her back, causing faintness
99
Q

cultural prescriptions

A
  • certain practices are expected of women of all cultures to promote a good outcome
  • tell woman what to do
100
Q

cultural proscriptions

A
  • establish taboos
  • purpose is to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus
  • regulate the womans emptional response, clothing, activity, rest, sexual activity, dietary practices
101
Q

doula

A
  • trained to provide physical, emotional, and informational support to women and their partners during labor and birth
  • are not involved with clinical tasks
  • provide labor support, popular
  • use of doulas for continuous labor support has lead to: decrease in use of pain meds, increase satisfaction, increase likelihood of a spontaneous vaginal birth
102
Q

birth plan

A
  • natural evolution of a contemporary wellness-oriented lifestyle in which women assume a level of responsibility for their own health
  • tentative plan because of realities of what is feasible may change due to actual labor and birth
  • preference list based on a best-case scenario
103
Q

home births

A
  • always been popular in the netherlands
  • home births may be necessary to people who don’t have access to hospitals
  • in the US, less than 1% take place in the home
104
Q

dietary reference intakes (DRIs)

A
  • increase in nutrient needs for mom: development and growth of the uterine-placental-fetal unit
  • increase in maternal blood volume and red blood cell produciton
  • maternal mammary development in preparation for lactation
  • 20% increase in metabolic rate during pregnancy
  • recommends: increase in water, fiber, iron, zinc, iodine, mag, and vitamins
105
Q

body mass index (BMI) and weight gain during pregnancy

A
  • BMI = weight in kg/ height in meters

1) underweight:

106
Q

physioligic anemia of pregnancy

A
  • relative excess of plasma causes a modest decrease in hemoglobin concentration and hematocrit
  • normal adaptation during pregnancy
  • iron: needed to allow transfer of adequate iron to the fetus and premit expansion of maternal RBC mass
  • puts mom at risk for preterm birth and hemorrhage at time of birth
107
Q

lactose intolerance

A
  • inability to digest milk sugar (lactose) caused by lack of the lactase enzyme in the small intestine
  • can cause abd cramping, bloating, diarrhea
  • alternate sources of calcium: fish/sardines, beans, tofu, collards, kale, waffles, figs, orange juice with calcium added
108
Q

pica

A
  • practice of consuming nonfood substances (clay, soil, laundry starch) or excessive amounts of foodstuffs low in nutritional value (cornstarch, ice or freezer frost, backing powder, backing soda) and often influenced by a woman’s cultural background
  • low iron and hemoglobin levels may be the cause
  • irregular and heavy consumption of low-nutrient products can cause more nutritious food to be displaced from the diet
  • african american women tend to eat a lot of cornstartch which is a source of empty calories and can contribute to gestational diabetes
  • pica items consumed can inhibit with absorption of nutrients, especially minerals
109
Q

anthropometric body measurements

A
  • provide short and long term information on a woman’s nutritional status and are essential to assessment
  • at minimum the womans height and weight should be taken initially and then at every visit
  • up to the provider to determine what are normal signs of pregnancy and what are abnormal or hint at nutritional deficiencies
110
Q

conception

A
  • union of single egg and sperm, marks beginning of pregnancy
  • includes gamete (sperm and egg) formation, ovulation (release of egg), fertilization (union of gametes), and implantation in uterus
  • high estrogen levels increate the motility of the uterine tubes so their cilia are able to capture the ovum and propel it through tht tube toward the uterine cavity. eggs are viable for 24 hours
  • sperm take about 4-6 hours to reach the site of fertilization, they are viable for 2-3 days.
  • when sperm penetates the egg: zona reaction closes out all other sperm
  • fertilization –> cleavage –> morula –> blastocyst –> implantation
  • between 6-8 days after conception is implantation
  • family planning: health promotion and teaching, exercise and rest, avoid smoking/acohol/recreatonal drugs, risk factors assessment, personal behavior modifications,
  • indications of ovulation: release of a mature ovum from the ovary monthly; rising basal body temperature, cervical mucous is thin and clear (spinnbarkeit), localized abdominal pain (mittelschmertz) coincides with ovulation
  • hormones needed: estrogen, progesterone, androgen produced by ovaries, prostaglandins (affect smooth muscle contractility, effect ovulation/fertility/changes in cervix/cervical mucous
  • ovarian cycle: primary follicle –> grafian follicle –> egg released –> corpus luteum –> degen of corpus luteum
111
Q

pregnancy testing

A
  • knowing LMP, hormone tested for, medications that can cause false positive results or false negative results
  • human chorionic gonadotropin (hCG): earliest biological marker for pregnancy, pregancy tests recognize hCG; can develop within first day of implantation and found in maternal serum or urine 7-8 days before expected menses
  • normal hCG levels: double every 2-4 days and peak at 60-70 days then decline to low levels at days 100-130
  • abnormal levels of hCG may indicate down synfrome, gestional diseases
  • quantitative serum testing: high level of accuracy, detects exact amounts of hCG in blood, hCG levels > 25 units/L is definite positive
  • sandwich type immunoassay: basis for most home preg tests; uses a specific monoclonal antibody (anti-hCG) with enzymes that bond with hCG in urine, pee on a stick
  • false negative tests: doing the pregnancy test too early before a rise in hCG levels, diuretics and promethazine (motion sickness med)
  • false positive tests: anticonvulsants and tranqualizers
112
Q

fetal maturation

A
  • fetal stage: 9 weeks (looks like human) - end of pregnancy
  • viability: capability of the fetus to survive outside the uterus and defined by feta weight and pregnancy duration; 22-25 weeks of gestation are on the threshold; generally accepted that 24 weeks is viable
  • fetal circulatory system: first organ system to fxn in developing fetus; 4th and 5th week the heart develops into 4-chambered organ; lungs dont work so ductus arteriosus send o2 rich blood from placenta into fetal abdomen; highest amt of o2 and nutrients are first sent to head, neck and arms; fetuses get enough o2 from maternal blood due to higher affinity for o2 on hemoglobin, 50% more hemoglobin than mom, CO is higher than an adult
  • hematopoietic system: formation of blood occurs in the yolk sac beginning in the 3rd week, begins in the liver during the 6th week, stem cells between 8-11 weeks, RH appears at 6th week
  • respiratory system: development of resp tract at 4 weeks, 17 weeks have larynx, trachea, bronchi and lung buds; 16-24 weeks bronchi and primitive alveoli; 24 weeks and term more alveoli form; after 32 weeks sufficient surfactant is present in developed alveoli and give a good chance of survivial; lecithin (L)/sphingomuelin (S) ratio = 2:1, lecihin is more important; 2/1 = mature lungs, occurs in middle of third trimester ; increased fetal lung maturity can result from: decreased placental flow like maternal hypertension, corticosteroid use, infection; decreased lung maturity can result from: gestational diabetes, glomerulernephritis
  • GI system: yolk sac turns into GI system, during 5th month the fetus swallows amniotic fluid & gastric emptying and intestinal peristalsis occur, as the fetus nears term the fetal waste products accumulate in the intestines as dark green to black, tarry meconium; normally this substance is passed through the rectum within 24 hours of birth ; between 26-30 weeks the fetus grows brown fat in preparation for cold stress outside of the uterus; GI system is mature by 36 weeks
  • hepatic system: livery and bilary tract develop at 4 weeks, embryonic liver is prevalent and takes up majority of abdominal cavity, bile begins to form at 12 weeks, glycogen storage is high in fetus, iron stores in liver as long as mom’s intake is good enough, coagulation deficiencies after birth (give vit K)
  • renal system: kidneys form at 5th week and begin to fxn at 9th week, urine is excreted into the amniotic sac, renal issues can be diagnosed inutero, GFR is low and kidneys lack ability to concentrate urine right after birth, newborns are very susceptible to dehydration and overhydration, most newborns void within 24 hours
  • neurologic system: originates from the ectoderm during the 3rd week after fertilization; week 5 reflexes show; at term the brain is 1/4 adult size; neuro insul can result in CP, neuromuscular impairment, intellectual disability, learning disabilitiies; fetus can feel pressure and pain and may need anesthesia; responds to sounds at 24 weeks; can distinguish taste; can see by 7th months
  • endocrine system: screen for hypothyroidism; thyroid gland starts to fxn at 3rd-4th weeks; if not thryoid hormones then can result in congenial hypothyroidism and can result in intellectual disability; insulin produced at week 20; women with uncontrolled diabetes can cause the fetus to have diabetes and results in larger babies and risk for underdeveloped lungs
  • reproductive system: sex differentiation during 7th week, distinguishable genitalia after 9th week and fully differentiated by 12th week, fetues can excrete blood through vaginas and milk through ducts due to mom’s hormones
  • musculoskeletal system: bones and muscles develop from the mesoderm by the 4th week of embryonic development; spinabifida can occur; muscles contract spontaneously at 12 weeks; mother doesn’t perceie movement until 16-20 weeks
  • integumentary system: vernix is thick at 24 weeks; 32 weeks the skin has fat and is less wrinkled and red; lanugo appears at 12 weeks and covers entire body by 20 weeks; 32-36 weeks nails appear beyond fingertips
  • immunologic system: IgG is the only immuniglobulin to cross the placenta and provides passive aquired immunity, IgM is produced at end of first trimester, normal term neonate can fight infection but not a preterm baby
113
Q

antepartum testing

A
  • schedule of prenatal visits: every 4 weeks for first 28 weeks, every 2 weeks for 28-36 weeks, every week 36-40 weeks/childbirth
  • at visits monitor: weight gain (25-35 normal), BP (Hypertension, perfusion issues), urine (protien = preeclampsia, ketones = diabetes/vomiting, sugar = diabetes), fundal height (grows 1 cm / week after 20 weeks), fetal heart (110-160 normal)
  • urine C&S: 12-16 weeks
  • cycstic fibrosis higher in whites
  • quad or triple screen marker: down syndrome, neural tube defects, blood draw
  • GTT glucose tolerance test: 26-28 weeks if: black, hispanic, obese, first degree relative with
  • group B strep: 35-37 weeks - inreases baby’s risk of sepsis by 50%
114
Q

signs of potential complications

A
  • first trimester
  • severe vomiting = hyperemesis gravidarum
  • chills/fever = infection
  • buring on urination = infection
  • abd cramping/vaginal bleeding = miscarriage, ectopic pregnancy
  • 2nd & 3rd Trimesters
  • presistent, severe vomiting = hyperemesis gravidarum, hypertension, preeclampsia
  • sudden discharge of fluid from vagina prior to 37 weeks = PROM premature rupture of membranes
  • vag bleeding, severe abd pain = miscarriage, abruptio placenta
  • severe backache = kidney infection
  • visual disturbances = preeclampsia
  • headahces = hypertension, preeclampsia
115
Q

discomforts related to pregnancy

A
  • FIRST TRIMESTER*
  • breast changes: wear supportive bra
  • urgency and frequency or urin: emtpy bladder regularly
  • malaise, fatigue: rest as needed, eat well to prevent anemia
  • n/v: avoid empty or overloaded stomach, eat dry carbs upon awakening, remain in bed until feeling goes away, drink fluids, small meals
  • pytalism: excessive salivating, mouthwash, chew gum
  • gingivitis: well well, brush teeth gently
  • nasal stiffness and nosebleeds: humidifier, use saline drops
  • leukorrhea: white discharge from vagina, report if itchy or smells fowl
  • mood swings: preg support group, communicate
  • 2ND TRIMESTER*
  • pigmentaiton deepens, linea nigra, melasma, acne, oily skin - not preventable
  • spider angiomas over neck, thorax, face, arms - not preventable
  • pruritus - baths, not preventable
  • supine hypotension: side laying
  • palpitations - not preventable, contact provider if accompanied by symptoms of cardiac decomposition
  • faintness/syncope: moderate exercise, deep breathing
  • heartburn - limit large meals
  • constipation - drink lots of fluids
  • flatulence and bloating: chew foods slowly and thoughroughly
  • carpal tunner
  • numbnress
  • round ligament pain
  • join pain
  • 3rd TRIMESTER*
  • SOB and dyspnea
  • insomnia
  • psychosocial responses, mood wings, increaesd anxiety
  • perineal discomfort
  • braxton hicks
  • leg cramps
  • ankle edema
116
Q

First trimester tests

A
  • ultrasound: establish gestational age, crown to rump length, heart beat heard around 10-12 weeks
  • nuchal translucency testing: marker for downs, combined with ultrasound and serum testing, 11-16 weeks
  • serial quantitative serum beta hCG testing: threatened miscarriage
  • Progesterone
117
Q

2nd trimester ultrasound

A
  • full anatomy scan
  • check amniotic fluid
  • learn sex of baby
  • check for placenta previa
118
Q

non-stress test

A
  • establish fetal HR, look for accelerations (>32 weeks 15/15,
119
Q

Vibroacoustic Stimulation (VAS)

A
  • application of sound and vibration to stimulate fetal movement, used to facilitate Nonstress test
  • if baby continues to move after this test then it is ok, if it slows down again it may not be ok
120
Q

amniotic fluid

A
  • 700-1000ml at term
  • fetus swallows fluid, it flows in and out of lungs, at 11 weeks the fetus urinates into the fluid
  • fxns: maintain body temp, oral fluid, repository for waste, freedom of movement, msk development, cushions from trauma
121
Q

placenta

A
  • produces hormones: hCG, hCS, estrogen, progesterone
  • respiration, nutrition, excretion and storage
  • blood supply
122
Q

uterus

A
  • corpus = upper triangular portion
  • cervix = lower cylindric portion
  • fundus = fallopian tubes enter here, top of uterus
  • fxns: reception, implantation, retention and nutrition of the fertilized ovum, cyclic menstruation, expulsion of fetus during labor, home to fetus during pregnancy

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