PATH 161 - Pregnancy and Disease Flashcards
(28 cards)
Fetal Development
8個步驟
- Fertilization, result in zygote
- rapid mitosis
- implantation in uterus
- placental development
- embryonic stage (3-8 weeks)
- development of major organs
- fetus term applied after 8 weeks
- continuation of development
- important for regular prenatal care during
pregnancy
Diagnosis of Pregnancy
- Based on hCG level in blood or urine
- Absolute sings occur later in pregnancy
- ultrasound evidence
- auscultation of fetal heart
- fetal movements
Gestation
- duration of pregnancy
- normal length is 40 weeks / 280 days
- divided into three, 3-month trimesters
EDC
- estimated date of confinement
- calculated based on lst day of LMP
LMP = last menstrual period
Gravidity
- nulli
- primi
- multi
refers to number of pregnancies
- NULLIgravida
never been pregnant - PRIMIgravida
currently pregnant, for the first time - MULTIgravida
currently pregnant for the 2nd, 3rd, etc
time
Parity
- nulli
- primi
- multi
viability (常指胎兒, 嬰兒的)成活力
refers to number of pregnancies in which the fetus has reached viability approx 22 weeks gestation
1. NULLIpara
never borne a viable infant
2. PRIMIpara
has completed one pregnancy to the point
of viability
3. MULTIpara
has completed two or more pregnancies
to the point of viability
TPAL
term deliveries
preterm deliveries
abortive outcomes
living children
Physiological Changes of Pregnancy
Hormonal Changes
1. increase estrogen & progesterone
essential for:
- development of uterus
- maintenance of pregnancy
- preparation of breasts for lactation
2. increase thyroxine 甲狀腺素
due to thryoid hyperplasia 畸形生長Physiological Changes of Pregnancy
Reproductive System
- increase size of uterus
pressure on surrounding structures - increase vascularity and blood flow to
uterus, cervix & vagina - increase amount and thickness of cervical
mucus - increase vaginal secretions, with increase
acidity - breast enlargement
Physiological Changes of Pregnancy
Weight gain and nutritional requirements
- avg weight gain 25-30 lbs mostly in 3rd
trimester - increase demand for (protein, minerals,
(especially iron) fat, and carbohydrates - Ca+ important for development
- food cravings may occur
- risk for development of gestational diabetes
Physiological Changes of Pregnancy
Digestive System
- nausea & vomiting in 1st trimester
- hyperemesis 劇吐 gravidarum 妊娠期
- reflux and bloating 膨脹
- constipation and hemorrhoids
Physiological Changes of Pregnancy
Musculoskeletal System
- relaxation of pelvic joints
2. lordosis 脊柱前彎症 and backache
Physiological Changes of Pregnancy
Cardiovascular System
1. increase BV (fluid & electrolytes)
congestion and edema in tissues
2. increase blood supply to uterus and
kidneys
3. decrease vascular resistance
4. decrease hgb due to increase need for
iron
5. varicose veins
increase risk for thrombus formation
restricted venous blood flow in legs
6. supine position
decrease venous return to heart and COPotential Complication of Pregnancy
Abortive Outcomes - 2 types
- Spontaneous Abortion
2. Induced / therapeutic Abortion
Spontaneous Abortion
6 types
- Threatened abortion
- Inevitable abortion
- Incomplete abortion
- Complete abortion
- Missed abortion
- Habitual abortion
Induced / therapeutic Abortion
the termination of pregnancy before fetal viability in order to save the life of the mother
- surgical therapy
- medical therapy
Potential Complication of Pregnancy
(Placental problems:
Previa vs Abruptio)
1. Placenta Previa placenta is implanted the lower or over the cervical 2. Abruptio Placenta premature separation of normally implanted placenta
Potential Complication of Pregnancy
(Blood Clotting problems:
Thrombus vs embolus)
- postpartum 產後的 complications
- thrombophlebitis [醫]血栓(性)靜脈炎
- thromboembolism [醫]血栓栓塞
1. thrombus
blood clot attached to the wall of a blood
vessel
2. embolus
may be a blood clot or other material
flows in the circulation until it comes to a
point where it lodges and obstructs blood
flow
Potential Complication of Pregnancy
Rh Incompatibility
- Results when mom is Rh- and fetus is Rh+
- mom forms antibodies to Rh+ cells during
1st pregnancy - subsequent pregnancies - maternal Rh
antibodies cross to fetus, causing
destruction of feta RBCs - hemolytic 參與溶血的 disease of newborn
aka erythroblastosis fetalis
胎兒、嬰兒成紅血細胞增多症
Potential Complication of Pregnancy
Ectopic Pregnancy
異位的
- fertilized ovum implants outside the uterus
- most common site is Fallopian tube
- fetal grow 6-8 wks but not viable
Potential Complication of Pregnancy
Ectopic Pregnancy
Manifestation 表現形式
similar to threatened abortion
1. may have positive pregnancy text
2. spotting and cramping after first missed
period
3. Unilateral pelvic pain, at site of mass
4. if rupture 破裂
- sharp, lower abdominal pain to shoulder
and back
- hemorrhage and shock
- peritonitis [醫]腹膜炎 (life-threatening!)
Potential Complication of Pregnancy
Ectopic Pregnancy
Disgnosis
- must rule out other causes
- spontaneous abortion
- ovarian cyst
- torsion 【醫】捩轉 of ovary
- salpingitis [醫]輸卵管炎
- appendicitis (if pain is in RLQ)
- Pregnancy test for hCG level
- Pelvic exam
- tender, boggy uterus
- extreme pain on palpation of adnexa
adnexa = 解附件; 胚外結構
- U/S (ultrasound)
Potential Complication of Pregnancy
Ectopic Pregnancy
Treatment
- Medical therapy methotrexate (抗腫瘤藥)
- destroys rapidly dividing cells
- useful in early stages only
- Surgical excision may be required
- affected tubes
- try to save ovary on affected side
- try conserve tube with microscopic
repair 如果之後還想要懷孕
- Supportive therapy
- analgesics 鎮痛藥
- supplemental iron
- blood transfusions if needed
- antibiotics, if rupture with peritonitis
Potential Complication of Pregnancy
Infections
- localized wound infections
- episiotomy [醫]外陰切開術
- vaginal / cervical laceration 裂[傷]口
- C-section incision
- puerperal sepsis
因生產導致的 / 分娩的, 產後的 [醫]敗血症- infection of reproductive tract
- endometritis [醫]子宮內膜炎
- placental tears
- retained placenta
- may lead to pelvic cellulitis [醫]蜂窩織炎,
peritonitis, abscess 膿瘡
