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Womens Health > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Normal Fasting glucose levels
In glucose intolerance

A

<90
100 - 125

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2
Q

Fetal/newborn complications of diabetes in pregnancy

A

Birth defects
Macrosomia (large birth weight)
Stillborn
Hypoglycemia
Respiratory distress syndrome
Higher lifetime risk of obesity & glucose intolerance

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3
Q

Insulin requirements during pregnancy
1st trimester
2nd & 3rd
Labor
hPL is

A

1st - decrease in need for insulin (minimal fetal needs & low hPL)
2 & 3 - increased insulin requirements (placental maturation & high hPL)
Labor - increased energy = increased insulin needs
Human placental lactogen

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4
Q

OGTT is
What levels indicate GDM
What HbA1C level is a risk for GDM

A

Oral glucose tolerance test
Fasting > 95
75g 1Hr GTT > 180
75g 2Hr GTT > 153

  • A1C greater than 7%
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5
Q

Maternal HIV transmission
How to treat HIV
Reduce instrumentation of what during labor

A
  • Vertical transmission to baby through pregnancy, birth & breastfeeding (perinatal transmission)
  • Treat with antiretroviral therapy AZT (start at 14 weeks till birth & IV during labor)
  • episiotomies & fetal scalp electrodes
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6
Q

Gestational HTN is
How to diagnose

A
  • Onset of HTN without proteinuria after 20th week (normal BP prior)
  • BP of 140/90 on 2 counts 4-6hrs apart
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7
Q

Preeclampsia is
Risk factors

A
  • HTN after 20 weeks with proteinuria
  • primigravidity, obesity, preexisting medical condition, multi fetal pregnancy
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8
Q

Severe preeclampsia is
Signs/symptoms
Treatment
Management

A

BP > 160/110
- headache, blurred vision, oliguria, pulmonary edema, Epigastric pain
- Control BP, prevent seizures (quiet environment, sedatives), mag sulfate for neuro protection (baby)
- Assess vision & LOC, DTRs, edema, lung sounds… protect from injury

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9
Q

What is eclampsia
Signs & symptoms
Management

A

Preeclampsia with seizure activity or coma
- headache, blurred vision, epigastric pain, altered mental status, tonic-clinic convulsions, coma
- ensure patent airway, administer O2, fetal monitoring, mag sulfate

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10
Q

HELLP syndrome stands for
What is it
Betamethasone indication

A

Hemolysis, elevated liver enzymes, low platelets
- life threatening (high death risk) obstetric complication, clinically progressive
Hepatic dysfunction
- used to stimulate lung maturity in fetus

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11
Q

Magnesium sulfate is
administered by & therapeutic lvl
Toxicity & Antidote
Signs & symptoms of toxicity

A

Used to prevent seizures
- always IVPB & maintain therapeutic level 4-7
- >8 meq & antidote is calcium gluconate
- hyporeflexia, respiratory depression, decreased urine output, hypotension, cardiac arrest

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12
Q

Alpha-Fetoprotein analysis (AFP) detects what problems
Elevated vs low

A

Elevated AFP - neural tube defects, hydrocephaly, Turners syndrome
Low AFP - Down’s syndrome (trisomy 21)

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13
Q

Amniocentesis is
Preparation
Management
Danger signs

A

Collection of amniotic fluid for analysis
- no special diet restriction, stop anticoagulant meds, empty bladder, fetal monitoring, rhogam (for rh-)
- monitor vitals & fetal monitoring, observe puncture site, rest
- fever, leak of amniotic fluid, vaginal bleeding

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14
Q

Chorionic villus sampling (CVS) is
Potential risk

A

Diagnostic test for chromosome abnormalities & other inherited disorders (cannot detect neural TD)
- bleeding & hemorrhage, miscarriage, infection, digital or limb deficiency

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15
Q

Nonstress test (NST)
Reactive
Non-reactive

A

Indirect measure of uteroplacental fxn
- 2 FHR accelerations from baseline of at least 15bpm for at least 15 seconds
- absence of 2 FHR accelerations using 15 by 15 criteria in a 20 min time frame

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16
Q

Biophysical test BPP is
Scoring based on
Interpretations

A

A screening for uteroplacental insufficiency made up of 5 components
- 5 components for total of 10 points
2 points if present / 0 points if absent
Body movements - 3 or more limb movements
Fetal tone - one or more full extensions or flexions of trunk or limb
Fetal breathing - one or more breathing movements of >30 sec
Amniotic fluid volume - one or more pockets of fluid measuring 2cm
NST - reactive (2pts) non reactive (0 pts)
- score of 8-10 is normal / 5-6 is suspicious indicating compromised fetus / <4 is abnormal

17
Q

Amniotic fluid analysis
How to confirm rupture of membranes

A

Cloudy or foul smelling indicates infection
Amniotic fluid is alkaline & a sample of fluid is taken w a nitrazine swab which turns blue if it is amniotic fluid

18
Q

Best location to auscultate FHR

A

Clearly heard in back of fetus
Cephalic presentation - lower quadrant of maternal abdomen
Breech presentation - on or above umbilicus

19
Q

Fetal monitoring
Intermittent vs continuous
Internal vs external

A

Intermittent : handheld (every 30 min low risk or 15 min high risk) / continuous : electronic monitor (10-20 minutes on entry into labor) to detect FHR changes & oxygenation

Internal : spiral electrode / external : ultrasound transducer (FHR) & tocotransducer (contractions)

20
Q

Criteria for using internal monitoring of FHR

A

Ruptured membranes
Cervical dilation at least 2cm
Presenting fetal part low enough to place scalp electrode
Skilled practitioner to insert spiral electrode

21
Q

Normal FHR
Bradycardia & causes
Tachycardia & causes

A

110-160 bpm
< 110 : heart block, maternal hypotension or hypothermia, severe hypoxia, maternal HR, 2nd stage labor, hypoglycemia,

> 160 : prematurity, maternal fever, fetal anemia, cardiac arrhythmias, maternal hyperthyroidism, drugs, fetal hypoxia

22
Q

Variability of FHR
Absent
Minimal
Moderate (normal)
Marked

Why is variability important
Causes of decreased variability

A

Irregularity fluctuations of baseline FHR
-Fluctuation undetectable
-Fluctuation range < 5bpm
-Fluctuation range between 6-25bpm
-Fluctuation rate > 25bpm

Reflects intact neuro system & optimal fetal oxygenation
MOST important factor of FHR
- hypoxia, drugs, fetal sleep, prematurity, congenital abnormalities

23
Q

FHR accelerations
Sign of

Interpreting fetal heart rate patterns
Category 1
Category 2
Category 3

A

Abrupt increase in FHR above baseline ; more than 15bpm above baseline lasting >15sec but < 2 min
Sign of fetal well being

1 - normal tracing (normal fetal acid-base balance)
2 - indeterminate tracing
3 - an abnormal tracing (predictive of abnormal fetal acid-base status)

24
Q

Early deceleration
Late deceleration & intervention
Variable deceleration & intervention

A
  • Response to fetal head compression (mirrors contraction ; no intervention required)
  • caused by uteroplacental insufficiency (begins AFTER peak of contraction & returns to baseline AFTER end of contraction ; notify provider, reposition, discontinue pitocin, provide O2, IV fluid bolus)
  • umbilical cord compression (V U or W shaped, abrupt onset, followed by an acceleration, often falls below 100bpm ; reposition, increase IVF, provide O2, vaginal exam)
25
Q

What is pitocin used for
Indicated

A

It is used to stimulate uterine contractions
Indicated for initiation or improvement of contractions for reasons of maternal or fetal concern

26
Q

Involution is 
Fundus descends
Cervix

A

Contraction of muscle fibers, regeneration of uterine epithelium
- descends 1-2cm every 24hrs (12hrs PP @ umbilicus)
end of 10 days fundus is fully descended
- returns to pre-pregnancy state by week 6

27
Q

Lochia rubra
Lochia serosa
Lochia alba

Lochia amount
Scant
Light/small
Moderate
Large/heavy

A
  • 3-4 days after birth (bright red)
  • 3-10 days after birth (pinkish brown)
  • 10-14 days after birth (white / light brown)

1-2 inch (10ml)
4 inch (10-25ml)
4-6 inch (25-50ml)
Pad saturated within 1 hr

28
Q

Cardiovascular adaptations
Cardiac output
Bradycardia
WBC count
Coagulation factor & assessment
Temperature

A
  • Cardiac output remains high for first few days PP & gradually returns to normal within 3 months
  • 40-60 bpm first 2 weeks PP
  • WBCs elevated for first 4-6 days PP
  • hypercoagulable state = risk for thromboembolism (assess w homans sign)
  • slightly elevated first 24hrs PP
29
Q

Urinary adaptations PP
Urinary retention
Displacement of uterus

A

Must urinate within 12 hours & diuresis (increased urination) present 2-3 days
- retention is a major cause of uterine atony which allows excessive bleeding
- upward & to the side

30
Q

Breast assessment PP
Secretions occur
Prolactin & oxytocin
Engorgement relief if breast feeding
Engorgement relief if not feeding

A

Size, contour, engorgement
Check for cracks or redness
Presence of colostrum
-Secretion typically appears 4-5 days after childbirth
- Prolactin AP initiates milk production
Oxytocin PP promotes milk letdown
- frequent emptying, warm showers & compresses b4 feeding, cold compress between feedings
- tight bra, ice, avoid stimulation

31
Q

Stages of attachment
Proximity
Reciprocity
Commitment

A
  • physical & psychological experience of parent being close to infant (contact, emotional, individualization)
  • infants behaviors initiate parental response ; complimentary behavior & sensitivity
  • enduring nature of the relationship
32
Q

Engrossment : partner physiological adaptation includes

A

Visual awareness of newborn
Tactile awareness of newborn
Perception of newborn as perfect
Strong attraction to newborn
Awareness of distinct features of NB
Extreme elation by father
Increased self-esteem

33
Q

Factors affecting attachment

A

Parents background
Infant health at birth
Care practices
Separation immediately after birth
Intensive care environment

34
Q

What are postpartum blues
Characterized by
When do symptoms begin
When does it become PP depression

A

Transient emotional disturbances
- anxiety, irritability, insomnia, crying, sadness, loss of apetite
- begin 2-4 days PP & resolve by day 8
- if emotional disturbances last more than 10 days

35
Q

Ovulation & return of menstruation
Nonlactating women
Lactating women

A
  • menstruation returns 7-9 weeks PP
  • anywhere from 2-18 months (depends on breastfeeding pattern)
    Breastfeeding not a form of contraception

Womens Health (3 decks)

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