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L&D > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

How long does pregnancy last?

A

40 weeks from first day of LMP

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2
Q

Nagele’s rule

A

add 7 days to LMP then subtract 3 months OR add 7 days and count 9 months forward
(assumes gestational age of 280 days)

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3
Q

gold standard diagnostic test for determining pregnancy

A

ultrasound

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4
Q

1st trimester

A

conception to end of week 12 (13 weeks)

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5
Q

2nd trimester

A

weeks 13-26

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6
Q

3rd trimester

A

weeks 27-40

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7
Q

gravida (GTPAL)

A

number of times a woman has been pregnant

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8
Q

term (GTPAL)

A

number of pregnancies DELIVERED at 37 weeks gestation and beyond

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9
Q

preterm (GTPAL)

A

pregnancies delivered from 20 weeks to 36w 6d

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10
Q

abortion (GTPAL)

A

pregnancies ending before 20 weeks

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11
Q

living (GTPAL)

A

number of currently living children

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12
Q

late preterm

A

babies born between 34 weeks and 36 weeks

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13
Q

parity

A

number of pregnancies carried to viable gestational age (20 weeks and on)

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14
Q

S/S of pregnancy

A

amenorrhea, breast tenderness, N+V

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15
Q

probably signs of pregnancy

A

positive pregnancy test (+HCG), chadwick’s sign

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16
Q

Chadwick’s sign

A

normal pink tinge of vagina/vulva is darkened or a bit blue

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17
Q

Goodell’s sign

A

softening of the cervix

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18
Q

3 positive signs of pregnancy

A

fetal movement, FHR, confirmed by ultrasound

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19
Q

progesterone in early stages of pregnancy

A

important for uterine relaxation so uterus does not shed lining to maintain pregnancy and helps prepare breasts for milk production

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20
Q

progesterone during pregnancy

side effets caused by it

A

relaxes muscles and acts as a stimulant to increase breathing to get more O2 into the body
- what causes constipation and heartburn

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21
Q

HCG

A
  • stimulates corpus luteum to secrete estrogen and progesterone until placenta takes over at week 14
  • indicator for being pregnant
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22
Q

HCG causes what symptom during pregnancy

A

morning sickness

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23
Q

Cause of fluid buildup/edema during pregnancy

A

vessel compression by baby

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24
Q

linea nigra

A

dark line on stomach caused by hormone induced excess production of pigment

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25
Q

chloasma

A

“pregnancy glow” brownish pigment production of the face and forehead beginning around 16th week of pregnancy and fades after delivery

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26
Q

urinary system

A

increase in urine production because kidneys work to filter mothers waste and fetus waste

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27
Q

physiological change in urinary system

A

increase in glomerular filtration rate due to increased renal plasma flow along with dilation of pelvis and ureters

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28
Q

lack of progesterone during pregnancy will cause…

A

preterm uterine contractions which may lead to miscarriage

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29
Q

GI changes

A
  • displacement of esophageal sphincter and progesterone relaxes it even more leading to heartburn
  • increase in gastric pressure due to mechanical compression
  • slowing of digestive system due to muscle relaxation causing constipation
  • increased calcium absorption
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30
Q

positive part of slowing of GI during pregnancy

A

allows for more nutrients to be picked up such as iron

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31
Q

respiratory changes

A

displacement of diaphragm due to uterus size
- ventilation increase around 50%
- increase in respiratory rate
- once baby ‘drops’ it is easier to breathe

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32
Q

cardiovascular changes

A

increased blood volume and enhanced coagulation due to demand from uterus, fetus, and placenta and to protect from bleeding at delivery
- volume is increased but very diluted
- cardiac output increases 50%

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33
Q

human placental lactogen is produced in which trimester

A

1st; just before week 13

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34
Q

prolactin

A

secreted from anterior pituitary to prepare breasts for lactation

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35
Q

insulin

A

production is increased in response to antagonistic effects of estrogen and progesterone

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36
Q

oxytocin

A

secreted from posterior pituitary to stimulate uterine contractions and milk ejection from breasts
- also helps control postpartum bleeding

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37
Q

estrogen functions during pregnancy

A
  • vascularizes uterus and placenta
  • transfers nutrients
  • support fetal growth
    (has antagonistic effect to insulin)
38
Q

progesterone as a medication

A

can be given to a mom who has had premature labor in the past to inhibit early contractions of uterus

39
Q

immune system during pregnancy

A

slightly lowered so it does not attack baby
- decrease is NK cells and increase in T cells

40
Q

insulin in early pregnancy

A

increased insulin sensitivity and glycogen content

41
Q

insulin in late pregnancy

A

decreased insulin sensitivity and glucogenogenesis

42
Q

bone thickness

A

decreased in early pregnancy and increased in late pregnancy

43
Q

primary level of prevention during pregnancy

A

focused on nutrition, comfort, knowledge

44
Q

secondary level of prevention during pregnancy

A

screening for maternal and fetal well being
- weight, urine, blood, HR, growth, movement

45
Q

tertiary level of prevention during pregnancy

A

management of pregnancy related concerns, HTN/GDM screening

46
Q
  • 1st trimester prenatal tests
A
  • ABO/Rh, STI screening, urine for protein
47
Q
  • 2nd trimester prenatal tests
A

anatomy US, GDM (glucose screening), urine for protein

48
Q
  • 3rd trimester prenatal tests
A

administer Rh immunoglobulin AT 28 WEEKS and delivery, GBS culture

49
Q

ABO/Rh during pregnancy

A
  • if mom is negative and baby is positive give winrho so in future pregnancies mother immune system does not attack baby
  • fetus antigens can enter mothers blood during delivery
50
Q

Nuchal translucency screening

A

helps assess risk for down syndrome by assessing neck folds, extra fluid, and nasal bone
- can be completed from 11w 4d to 13w 6d

51
Q

safe vaccines for pregnancy

A

whooping cough, flu, covid

52
Q

*hyperemesis gravidarum

A

hyperemesis during 1st trimester to point of electrolyte imbalance which will cause increased HR and decreased BP
- decreased K
- increased Na

53
Q

hypertension in pregnancy

A

140/90 WITHOUT protein in the urine
- diagnosed at 20 weeks gestation or later

54
Q

preeclampsia definition

A

high BP with protein in the urine and causes damage to organs beginning after 20 weeks

55
Q

symptoms of preeclampsia

A

severe headaches, double or blurry vision, upper abdominal pain, N+V, SOB, decreased urine
- can lead to HELLP syndrome

56
Q

preeclampsia and birth

A

may lead to induction after 34 weeks

57
Q

preeclampsia management

A

magnesium sulfate, antihypertensives for BP greater than 160/110, fetal assessments

58
Q

HELLP syndrome acronym

A

Hemolysis (RBC destruction)
Elevated Liver enzymes
Low Platelet count

59
Q

S+S of HELLP syndrome

A

severe headache, fatigue, excess weight gain, nausea, abdominal pain, NOSE BLEED
- tell tale and emergency sign is nose bleed (may not be able to have an epidural due to low platelets)

60
Q

delivery of baby due to HELLP syndrome prior to 34 weeks

medication

A

give mom 2 doses of beta blockers given 24 hours apart to help with fetal lung development then deliver

61
Q

GDM

A

inefficient insulin resistance due to pancreas failing to produce insulin leading to hyperglycemic state and causes ketosis (body cannot keep up with changes when pregnant)

62
Q

effects of GDM on mom and baby

A
  • increase risk of uterine rupture
  • possibly not enough sugar for fetal brain development
  • can make baby be large for gestational age
63
Q
  • GDM diagnosis
A

test should be performed between weeks 24-28 and not at 35 weeks or more
- fasting blood glucose and/or hemoglobin A1C (HbA1c)
- 11.0 blood glucose and higher

64
Q
  • lab values of GDM test
A
  • if greater than 7.8 at 1 hour then a glucose tolerance test is needed
  • if value is 11 or higher then its GDM
65
Q

polyhydramnios

definition and complications

A

excess amniotic fluid
- can lead to preterm birth, PPH due to uterine distension, placental abruption

66
Q

polyhydramnios treatment

A

amnioreduction

67
Q

oligohydramnios

definiton and causes

A

low amniotic fluid volume
- can be caused by premature rupture of membranes, fetal anomalies, dehydration

68
Q

first sign of oligohydramnios

A

smaller than expected fundal height measurement

69
Q

treatment of oligohydramnios

A
  • sometimes drinking 2L of water in 2 hours helps
  • amnioinfusion
70
Q

5 P’s of labor

A
  • passenger
  • passageway
  • powers
  • position
  • psychological response
71
Q

passenger (5 P’s of labor)

A

fetus and placenta

72
Q

passageway (5 P’s of labor)

A

birth canal (pelvis and soft tissues)

73
Q

cervix during labor

A
  • changes from long thick structure to paper thin
  • moves from posterior to anterior
  • dilates from closed to 10cm
74
Q

pelvic joints during labor

A

become stretchy late in pregnancy and during labor

75
Q

gynecoid pelvis

A

optimal shape
- well rounded, wide

76
Q

android pelvis

A

wedge shaped, flat, narrow
- heart shaped

77
Q

anthropoid pelvis

A

long and narrow, straight side walls
- very long, looks like lion head

78
Q

platypelloid pelvis

A

oval shaped, very wide, round, flat
- looks more circular

79
Q

power (5 P’s of labor)

A

contractions, bearing down

80
Q

primary power

A

involuntary uterine contractions

81
Q

secondary power

A

voluntary action of pushing

82
Q

effacement

A

thinning and shortening of the cervix

83
Q

position (5 P’s of labor)

A

woman, fetus
- work with gravity, ambulation helps, birthing balls

84
Q

psychological response (5 P’s of labor)

A

knowledge, support, coping

85
Q

average labor length

A

10-18 hours

86
Q

inhaled anesthetic

A

nitrous oxide (laughing gas)
- good for early labor (latent phase)
- have nurse in room at all times
- metabolized by respiratory system so it cannot harm fetus

87
Q

systemic opioids

A

used when epidural is not an option
- affects baby; will come out stunned with decreased resps

88
Q

regional anesthesia (epidural)

A

best to give when patient is around 4 cm dilated
- only want it for 8-10 hours

89
Q

general anesthesia

A

used in emergency c-sections if no time for epidural

90
Q

primipara

A

giving birth for the first time

91
Q

multipara

A

has given birth to at least 1 viable baby

92
Q

nullipara

A

has never given birth

L&D (7 decks)

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