Flashcards in Jarvis Quiz 5 Deck (125):
What is the fertilized ovum called when it enters the uterus? What does it do?
blastocyst;produces human gonadotropin (hCG), which stimulates the corpus luteum to continue making progesterone. It causes a small amount of bleeding when it implants to the uterine wall.
Talk about the placenta and what it does at certain weeks
Week 7: it supports the corpus luteum with pregnancy by producing progesterone
Week 10: completely takes over the corpus luteum by producing progesterone
What type of organ is the placenta? What does the placenta produce?
Endocrine organ; produces several hormones to aid in growth and maintenance of the fetus and direct changes in the woman’s body to prepare for birth and lactation
What does hCG do? Name four things
1. Stimulates the rise in progesterone
2. Supports the corpus luteum
3. Supports deep implantation of the placenta into the uterine wall
4. Helps maintain viability of the fetus
What does progesterone do? Name three things
Maintains the endometrium around the fetus
Increases the alveoli in the breast
Keeps the uterus in a quiescent (inactive) state
What does estrogen do?
Stimulates the duct formation in the breasts, increases the weight of the uterus, and increases certain receptors in the uterus that are important at birth.
How long does pregnancy last?
280 days from the first day of the last menstrual period (LMP)
(40weeks), 10 lunar months/9calendar months
Why does pregnancy include 9 calendar months but 10 lunar months?
The 10 lunar months include the 2weeks when the follicle was maturing but before conception actually occurred.
How is pregnancy divided up?
1st: first 12 weeks
2nd: week 13-27
3rd week: 28 til delivery
What do you call a mama who is pregnant for the first time?
What do you call a mama who delivered her first baby?
What do you call a mama who is pregnant, but not for the first time?
What do you call a mama who delivered a child, but it isnt her first rodeo?
What does the GTPAL stand for?
Gravida= number of pregnancies
Term= babies born full term (37-42 weeks)
Abortion=missed, therapeutic, voluntary
What are the three types of s/s of pregnancy?
Presumptive: amenorrhea, n/v, breast tenderness, fatigue, urinary frequency
Probable: those detected by examiner (enlarged uterus)
Positive signs: direct evidence= fetal heart tones (FHT) or cardiac activity with ultrasound
How many days after conception before the hCG serum becomes positive after the blastocyst implants into the uterus?
8-11 days after conception
What s/s may a woman experience during the first trimester?
Breast tingling and tenderness with mammary growth, n/v, fatigue
What do estrogen and progesterone cause during the first trimester?
Hypertrophy of the uterine muscle cells, uterine blood vessels and lymphatics enlarge
What shape is the uterus during pregnancy? What causes urinary frequency?
Globular; the uterus compresses the bladder
What happens to the blood pressure during the first trimester?
Drops in the 7th week until midpregnancy r/t falling peripheral resistance.
Returns to baseline gradually by term
During which week of the embryonic period does the fetal period begin?
At which week range can FHT be heard? What device can you hear it with?
9-12weeks; Doppler imaging
At which week can the uterus be palpated just above the symphysis pubis?
At which weeks do the n/v subside? What does a woman experience during the second trimester?
After weeks 12-16, n/v improve.
Second trimester: women experience fetal movement (quickening), breast enlargement, colostrum from nipples, darkening of areole and nipples, linea nigra and striae gravidarum
When is quickening felt?
Talk about colostrum
The precursor of milk that may be discharged from the nipples during pregnancy. Yellow color and contains more minerals and protein, but less sugar and fat than mature milk. It also contains antibodies which are protective for the newborn during the first days of life until mature milk production begins.
What is blood pressure like during the second trimester?
May be 2-8mmHg lower (systolic)
5-15mmHg lower (diastolic)
The most pronounced drop is at 20weeks; may cause dizziness, faintness
What do a woman’s insides start to do during the second trimester?
Stomach displacement from enlarging uterus, altered esophageal sphincter and gastric bone (may cause heartburn), intestines are displaced by growing uterus, tone and mobility are decreased (constipation), gallstones may form from bile stasis and increased cholesterol
Talk about the respiratory system during pregnancy
Progesterone and estrogen cause increased respiratory effort by increasing tidal volume. HgB also increase with oxygen capacity increase, drop in PaCO2 (may cause dyspnea)
Talk about TSH and plasma iodine levels during the second trimester. What about the thyroid gland?
TSH decrease by week 8-14. Plasma iodine levels decrease.
Thyroid gland increases in 15% of women
What is epulis of pregnancy?
Gingivitis (gums bleed) as a result of capillary growth
Bloody noses may also occur with the 2nd trimester
Which device can you use (and at which week) during the 2nd trimester to listen to the FHT?
Fetoscope at 17-19weeks
When is the fetal outline palpable?
When does increasing blood volume peak during pregnancy? What happens to blood pressure?
Middle of the third trimester.greater with multiple gestation. BP begins to slowly rise again.
What does uterine enlargement do to the mama in the third trimester?
Causes the diaphragm to rise and the shape of the rib cage to widen at the base. Decreased space for lung expansion may cause SOB, the rising diaphragm displaces the heart up and to the left. CO, SV increase, pulse raises by 15-20bpm, a functional systolic murmur may be heard (grade 2/6 or less)
Describe edema in the mama during the third trimester
Edema of the LE may occur as the enlarging fetus impedes venous return and from lower colloid osmotic pressure. The edema worsens with prolonged leg dependency (standing).
Talk about vericosities in the mama during the third trimester
Familial tendency, form or enlarge from progesterone-induced vascular relaxation. Engorgement may occur with full uterus compressing the inferior vena cava and pelvic vessels. Hemorrhoids may occur as progesterone causes bowel relaxation and constipation
Describe progressive lordosis in the pregnant gal
Inward curvature of the lumbar spine to compensate for the shifting center of balance with the enlarging uterus. Backaches occur with this. Slumping of the shoulders, increased breast weight, and anterior flexion of the back may cause carpal tunnel
What is engagement in a pregnant woman? When does it occur?What are the symptoms of it?
Lightening/dropping; the fetal head moves down into the pelvis. Symptoms= lower appearing and smaller measuring fetus,urinary frequency, increased vaginal secretions from increased pelvic congestion, and increased lung capacity
What is effacing?
Thinning of the cervix
Talk about the mucous plug
Formed in the cervix as a mechanical barrier during pregnancy/ it is expelled at variable times before/during labor.
What is considered post-term pregnancy?
How do you calculate the EDD?
Nageles rule (280 days from the first day of LMP)
LMP + 7 days - 3mos
Besides nageles rule, how else can you accurately determine gestation?
Physical examination : measurement of hCG and ultrasound (most
What has the history of teen pregnancy incidences been like over the years?
The number has decreased since 1990 by 42% because of contraception improvements.
How many teens get pregnant each year and between which ages? How many are unplanned? Which groups have the highest pregnancy rates?
750,000teens between 15-19 get pregnant each year. 2/3rds of these occur at ages 18 & 19.
82% of them were unplanned. Most common in Africans and Latinas. (African rates have also decreased since 1990 by 48%)
What are teen mom babies most at risk for?
Toxemia and low birth weight
What are the pregnancy risks for teen mom?
Psychosocial problems; medical risks are usually r/t poverty, poor nutrition, substance abuse, STIs, emotional/physical abuse.
Talk about women who become pregnant after the age of 35
More often becoming pregnant nowadays. Usually more prepared emotionally and financially to become mamas. They are more at risk for infertility and baby anomalies. Risk for Down Syndrome increases
Why does risk for infertility increase with maternal age increase?
Decrease in the number of health of eggs to be ovulated, a decrease in ovulation, endometriosis, and early onset menopause
How does the risk for Down syndrome increase with maternal age increase? Give numbers
25yo: 1 in 1250
30yo: 1 in 1000
35yp: 1 in 400
40yo: 1 in 100
45yo: 1 in 30
What are two INVASIVE examples of prenatal diagnostic screening tests? Explain them
CVS (chorionic villi sampling): between weeks 11-13
Amniocentesis: between weeks 15-20
Both have small risk for complications and miscarriage
What are examples of noninvasive prenatal diagnostic tests?
US nuchal translucency (measures the clear space in the tissues of the back of the baby’s neck)
Fetal anatomy US: during the second trimester
Maternal serum marker screening
ALL should be an informed choice after pretest counseling
What are pregnant mamas older than 35 at risk for themselves?
HTN, obesity, hypertension, diabetes
HTN puts them at risk for abruption and preeclampsia and increases intrauterine growth restrictions
At risk for placenta previa, placental abruption, spontaneous abortion (r/t increase in genetically abnormal embryos), uterine rupture, c-sections
What are Jews and Eastern European peoples at risk for passing on to their babies geneticallly?
Tay- Sachs (a metabolic disorder)
What are African Americans at risk for passing to their babies genetically?
Sickle cell anemia
Talk about teen obesity in blacks vs. whites. How does this effect their babies?
25.4% of African teens are obese, 15.4% of white teens are obese.
Postpartum hemorrhage occurred almost 2x as often in black obese teens than black healthy teens. both black and white obese teens had risk for gestational hypertension and infants complications increased with obese white teens.
Talk about pregnancy complications between different cultures
Asian (10%) and Hispanic (6.9%): gestational diabetes
Black women: higher risk of preeclampsia, neonatal hypoglycemia, and preterm delivery
Asians: lower risk of c-section, large babies, and neonatal respiratory distress
What might previous cervical surgery increase the risk for in pregnancy? What about previous uterine surgery?
Cervical surgery: Cervical insufficiency, preterm dilation, preterm delivery.
Uterine surgery: uterine rupture
What may be the result of women delaying childbearing?
An increase in gynecological cancers during pregnancy
Also, an increase in breast cancer with difficult t(x) options
What do STIs increase the risk for in regard to pregnancy/birth?
Premature ROM, preterm labor (PTL), preterm delivery (PTD), postpartum maternal and fetal infections, herpes in babies
Why must HIV screening be OFFERED to mamas? Can an HIV mama breastfeed?
Must be offered to decrease the risk of transmission to the fetus.
Breastfeeding in contraindicated for HIV-positive mother because the virus is in the breast milk
Why should you ask a woman her sexual preference?
Woman with same-sex partners may use assisted reproduction, they need your support.
What is a VBAC?
Vaginal birth after c-section
Talk about the risks certain c-section incisions may place on a mama who is pregnant again.
Vertical/classical incision: increased risk for rupture and mandates another c-section
Low transverse/horizontal incision: carries a low risk, subsequent births can be vaginal
The direction of the skin scar doesn’t necessarily tell you how the uterus was cut
What might vaginal bleeding indicate during pregnancy?
Threatened abortion, cervicitis, or ectopic pregnancy in 1st trimester. A friable cervix May bleed harmlessly after sex and not hurt the fetus
What may abdominal pain indicate in pregnancy?
Abdominal pain during early pregnancy may indicate spontaneous abortion, ectopic pregnancy, UTI, and round ligament discomfort. Late pregnancy causes are premature labor, placental abruption, and HELLP syndrome
When should a woman start counting fetal movements
Why would you want to know if a mama previously had German measles/rubella?
It is highly teratogenic, especially in the first trimester. Instruct the woman who has not had rubella to avoid small children who are ill
Why would you ask a mama if she’s ever had chicken pox?
Rarely varicella causes congenital anomalies. Nonimmune women should avoid exposure
What danger does smoking pose during pregnancy? What about alcohol? Cocaine? Narcotics?
Smoking: Low birth weight, abortion, ectopic pregnancy, premature ROM, HTN, placental abruption, SIDS
Alcohol: fetal alcohol syndrome
Cocaine: congenital anomalies, fourfold increased risk for abruptio placenta, fetal addiction
Narcotics: developmental delays, behavioral disturbances
What would regular exercise in pregnancy help avoid
Pregnancy induced HTN
Why should a mama take vitamin d?
Essential fo the maternal response to the calcium demands of the fetus for growth and bone development. Daily supplementation is recommended during pregnancy
What can poor dental health in moms cause in babies?
Neonatal death, low birth weight, PTD
What is a mama at risk for if she has renal disease or HTN?
If a mom is already diabetic, what is she at risk for?
Macrosomic infants and c-sections
Talk about having UTIs during pregnancy
The hormone craziness predisposes them to UTIs. Pregnancy may mask their symptoms. A serious UTI may irritate the uterus and threaten preterm labor
Why should you ask a pregnant lady if she has a history of mental disorders or depression
Could be increased risk for post-Partum depression
What does incest or abuse put the mom at risk for?
Dysfunctional labor and c-section
Which foods should a pregnant woman avoid?
Sea fish (swordfish/mackerel), raw eggs, soft cheeses, unpasteurized dairy foods, sliced meats
How should a pregnant woman wear her seatbelt?
Place the lap belt below the uterus
Use the shoulder strap just the same
When should you perform the pelvic exam on a woman?
What should you do before giving the woman a pelvic exam?
Ask her to empty her bladder, reserving a clean-catch specimen for dipping for protein and glucose and for urinalysis. Weigh her on the scale, compute the BMI, give her a gown and drape
How should you check the pregnant woman’s BP? At which angle should the mom be in bed during the 2nd and 3rd trimester and why?
BP while sitting
30-45 degree angle in 2nd and 3rd trimesters to increase comfort and avoid compression of the descending aorta and inferior vena cava by the pregnant uterus
What is a healthy BMI?
19-25. A weight loss of more than 5% during the first trimester is not good: hyperemesis gravidarum?
What is chloasma?
“Mask of pregnancy”
Butterfly-shaped pigmentation of the face
Where does linea nigra start/end? What is striae like during and after pregnancy?
Linea nigra starts at the bottom of the sternum and goes to the pubis.
Striae are bright red when they first form, but shrink, lighten, and turn to a silvery color after pregnancy
Talk about PUPPP
Pruritic urticarial papules and plaques of pregnancy!!
The most common itchy rash of pregnancy. More common in white, nulliparous women. Appears in late pregnancy in abdomen and thighs. Incidence is 1 in 200 pregnancies, but increases to 8 in 200 with multiple fetuses
What should a mouth look like in a pregnant woman? What are the abnormals?
Dark pink and moist, gum hypertrophy and pregnancy gingivitis may occur. Gums may bleed. Abnormals are pale mucous membranes (anemia) and poor dental hygiene
What should the thyroid feel like during pregnancy? What are the abnormals?
Might feel full and smooth and palpable.
Abnormal: solitary nodules (neoplasm), multiple nodules (inflammation/multinodular goiter), significant diffuse enlargement occurs with hyper/hypothyroidism, thyroiditis
What is a mammary soufflé?
Auscultation of the translucent blood vessels in the breast can be heard and may be mistaken for a heart murmur
What if a woman’s nipples are inverted or flattened? What are the bumps around the nipple called?
Flat/inverted nipples can be fixed with latch-on techniques or during pregnancy.
How should the breast tissue feel on palpation
Modular with alveoli hypertrophy. Teach mama to do self-exams (BSE) because lack of menses. Note any abnormal mass and refer for US
Where should you ausculate the heart in a pregnant woman and what might you hear?
4th intercostal space r/t growing fetus. She often has a functional, soft, blowing systolic murmur that occurs r/t increased volume. It requires no treatment and will resolve after pregnancy. Any other murmur should be refereed as prophylactics for valvular disease may be needed at delivery
Talk about edema in a pregnant lady
Edema with increased BP and proteinuria may indicate preeclampsia. Edema and pain in one leg occur with DVT and warrant Doppler studies. Carefully evaluate any redness, swelling, or hotness to r/o phlebitis. Should wear support hose and not wear restrictive clothing or sit for too long
What is it called when the abdominal muscles normally separate when the woman lifts her head?
On which side should you stand facing the pregnant ma whenpalpating her fundus?
Right side, aim higher than where you think the fundus is. Walk your hands until you feel it
After which week in pregnancy can you start measuring the fundus in which 1cm = 1wk gestation? What if the growth is below normal? What about above?
Fundal height more than two cm less than what it should be can indicate intrauterine growth restriction
Fundal height more than 4cm more than what it should be can indicate multiple babies, excess amniotic fluid, or uterine myoma.
Both indicate need for ultrasound
When can you start Leopolds maneuvers? What does it determine? Explain these things
Fetal lie: orientation of the fetal spine to the maternal spine (longitudinal, transverse, or oblique)
Presentation: the part of the fetus that enters the pelvis first (vertex=head, breech, foot)
Attitude: the position of the fetal parts in relation to each other (flexed, straight/military, extended)
Position: location of fetal part R or L of maternal pelvis
Engagement: widest diameter of the presenting part is descended into the pelvic inlet
Describe the leopolds first maneuver
Face the gravida’s head and place your fingertips around the top of the fundus. Note size, consistency and shape. Butt will feel soft, head will feel hard, ballotting/bobbing willl occur because the head moves easily
What is leopolds second maneuver?
Move your hands to the side of the uterus. The long, firm surface is the back, and the small parts (limbs) indicate a posterior position when they are palpable all over the abdomen. Note if the position is lateral, posterior (out of reach) or anterior.
What is leopolds third maneuver?
“Pawlik’s maneuver” ask the woman to Bend her knees up slightly. Grasp the lower abdomen just above the pubis and on top the fundus to determine the presenting part of the fetus. If the presenting part is beginning to engage, it will feel fixed
Describe leopolds fourth maneuver
It help determine engagement and differentiate shoulder from vertex. With her knees bent, face the mom’s feet, place your palms with fingers facing the feet on either side of the lower abdomen. Press your fingers firmly and slowly down toward the pelvis. If your fingers meet, the presenting part is not engaged. If your fingers diverge at the pelvis meeting a prominence on one side, the prominence is the head. If your fingers meet prominences on both side, the vertex is engaged as military or flexed.
How do obtain the fetal heart rate using the Doppler? What should be the normal rate. Talk about normals/abnormals
Count the FHTs for 6seconds and multiply by 10. Normal rate should be 110-160bpm. Spontaneous accelerations indicate fetal well-being. If no FHT is heard with Doppler at 12 wks, indicate fetal activity with ultrasound. Further investigate HR that are too low/high. Feel the mothers pulse while listening so you dont mistake a FHT with a uterine soufflé
Talk about the external genital findings that may be present in a pregnant woman
Labia Minora may be enlarged in multiparous women. Labial variscosities may be present. The perineum may be scarred from previous episiotomies or lacerations. Note any hemorrhoids or lesions. Lesions may indicate infection: herpes or chlamydia
What is the Chadwick’s sign
Bluish, purplish discoloration and congested look of the vag wall and cervix from increased vascularity and engorgement.
Talk about pregnant vaginal discharge
Should be heavier in amount, but should be similar in description to the nonpregnant woman. No itching, burning, unusual odor, or purulent drainage should be present. Perform a wet mount/culture if uncertain. Chapping may be found normally r/t excessive moisture
How should. The cervix look in a pregnant lady
Smooth, round with a dot like external os of the nulliparous mama or the irregular multiparous cervix with and external os that appears more like a crooked line, the result of cervical dilation from prev. Pregnancy. A friable cervix bleeds easily when touched with a cotton swab, cytobrush or speculum r/t increased vascularity. Obtain cultures if you suspect cervicitis
What is dextrorotation?
The pregnant uterus may be rotated toward the right side as it rises out of the pelvis because of the presence of the descending colon on the left.
What is the Hegar sign?
When the enlarged uterus bends forward on its softened isthmus between the 4th and 6th weeks of pregnancy
Talk about uterine size
Size of an avocado by 8wks (7-8cm)
12week: will fill the pelvis
What is the Goodell sign
Softening of the cervix
What are leiomyomas
Uterine fibroids (abnormal finding)
What should you assess with the cervix?
Position (anterior, midposition, posterior)
Degree of effacement/thinning (%)
Station of presenting part (cm above/below ischial spine)
What does a shortened cervix indicate?
Less than 2cm= preterm labor or possible cervical insufficiency
Talk about the ovaries during pregnancy
They rise with the growing uterus. Always examine the adnexa to r/o mass (ectopic pregnancy/ovarian mass). To determine tone, ask her to squeeze your fingers as yours rest in her vag. (Practicing Kegel exercises). Squeeeze for 8, release for 8. Perform 50-100x/day
When should you take the mama’s bp? What would be considered chronic HTN
When she is most relaxed.
Chronic HTN: a documented stage one HTN before pregnancy or a persistent elevation of more than 140/90 on two occasions more than a day apart before the 20th week gestation
What is the ultrasound most helpful for?
Showing the age of fetus, placenta location, fetal position, sex of fetus, number of babes, and certain birth defects.
When should cervical length be measured. What does it predict
18-22weeks. Measures to predict preterm labor
Talk about fetal macrosomia
A condition in which the infants weight is beyond 4000-4500g, regardless of gestational age. Occurs in less than 9% of tykes. Risk factors include obesity, diabetes, post term gestation, advanced mama age, prev. Chubby babies, racial/ethnic factors. Birth risks to mama =bladder trauma, and vagincal tissue trauma. Baby might have broken clavicle, brachial plexus nerve damage, bad APGAR scores, extended hospitalizations, and possible fetal mortality
What factors cause maternal preeclampsia?
Placenta implanted with abnormal trophoblastic invasion, immunologic intolerance, cardiovascular/ inflammatory changes, genetic factors
Previous preeclampsia, multifetal gestation, chronic HTN, obesity, 35 yo or more, and African Americans
What is preeclampsia characterized by
HTN and proteinuria.
Headaches, visual changes r/t cerebral edema, RUQ pain from liver enlargement
What would preeclampsia labs be like?
Elevated liver enzymes, increased hematocrit, platelet drop, increased in BUN/creatinine
(HELLP syndrome: hemolysis, elevated liver enzymes, and low platelets.....a serious variant of preeclampsia)
How can preeclampsia harm the fetus
Before it become clinically manifested, it affects the placenta thru vasospasm and a series of small infarctions. The capacity of the placenta to deliver oxygen and nutrients may be seriously diminished and fetal growth may be restricted.