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Practice Topics Exam 5 > Pregnancy and Labor > Flashcards

Pregnancy and Labor Flashcards

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1
Q

Pregnancy is how long

A

38-42 weeks from conception to delivery
Counted from the first date of the last menstrual period
Typically 4 weeks pregnant when first positive test

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2
Q

Pregnancy - trimesters - total weight gain

A

3 trimesters

Total weight gain is 20-35 pounds (depends on BMI)

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3
Q

First trimester

A

Fertilized ovum implanted 7-10 days after fertilization

Majority of fetal systems formed but not function fully

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4
Q

First trimester is when

A

0-12 weeks

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5
Q

First trimester - symptoms

A

Emotional changes begin
Fatigue, n/v, inc urinary freq
MSK complaints may begin

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6
Q

First trimester - weight gain

A

0-3 pounds

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7
Q

Second trimester is when

A

13-27 weeks

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8
Q

Second trimester - symptoms

A

Begin to show

Most women feel great - more energy

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9
Q

Second trimester - fetus weight

A

1-2 pounds

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10
Q

Second trimester - fetus

A

Eyebrows, eyelashes, fingernails formed

Movement felt around 20 weeks

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11
Q

Third trimester is when

A

28-40 ish weeks

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12
Q

Third trimester - uterus

A

5-6 times its normal size and 20 times its normal weight
Contracts regularly
Pelvic organs become abdominal organs

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13
Q

Third trimester - common complaints

A

LBP, rib pain, freq urination, incontinence, fatigue, SOB, constipation, LE edema

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14
Q

Hormone charts

A

Day 21-28 drop in estrogen and progesterone

At ovulation, body temp rises about 1/2 degree

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15
Q

Endocrine changes - estrogen

A

Size inc in uterus and breasts
Contributes to CT changes
Estroiol inc to 1000x pre-pregnancy

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16
Q

Endocrine changes - relaxin

A

Peak level in 1st trimester and remains elevated
Inhibits uterine contraction, softens the cervix
Relaxes ligaments

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17
Q

Endocrine changes - progesterone

A

Smooth mm relaxation - GI constipation, uterus, veins have dec peripheral resistance
Inc sens to CO2 (hypervent)
Inc core temp 1/2 degree

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18
Q

CV changes - blood volume

A

BV 50%

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19
Q

CV changes

HR x SV = CO

A

HR x SV = CO (all inc and peak mid gestation)

Baseline HR inc about 12 bpm

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20
Q

CV changes - BP

A

Slight dec in BP initially then normal

Peripheral res dec, CO inc so BP doesn’t change much

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21
Q

CV changes - heart

A

Heart arrhythmias

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22
Q

CV changes - plasma and RBCs

A

40-60% inc in plasma, but only 30% inc in RBC

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23
Q

CV changes - venous pressure

A

Inc venous pressure in LE with standing
Varicose veins
Hemorrhoids

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24
Q

CV changes - IVC

A 
Pressure rises in IVC
Worse in late pregnancy
Worse in supine 
Worse in supine with ex
Leads to symptomatic supine hypotension
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25
CV changes - aorta
Can be partially occluded in supine
26
Pulmonary changes - ribcage
AP and transverse in all diameters (2cm each) Subcostal angle from 68 to 103 degrees Ribcage elevates and does not always come back down Diaphragm elevates passively 4cm
27
Pulmonary changes - Upper resp tract
Capillary dilation - inc secretions
28
Pulmonary changes - hyperventilation
Inc tidal volume | Steady freq
29
Pulmonary changes - oxygen
20% inc in oxygen consumption
30
Pulmonary changes - work of breathing
Inc and dec functional residual capacity - dyspnea with exercise early
31
Renal system changes
Micuration - detrusor relaxation, bladder is displaced ant and sup Inc urinary freq
32
Thermoregulatory changes
BMR inc Heat production inc 300 extra calories a day
33
Psych changes
Preg related depression Post partum depression Edinburgh postnatal dep scale can be used to screen
34
MSK changes - abdominal mm
Stretched to elastic limits Esp RA Can lead to diastasis Recti Reduced mechanical advantage
35
MSK changes - PFM
Stretched up to 30% from inc weight | Birth trauma - pudendal nerve stretch, tearing, episiotomy
36
MSK changes - CT and joint
Hypermobility
37
Postural and balance changes
``` COG shifts upward and forward Subocc tighten Lumbar paraspinals tighten Thoracic kyphosis inc Changes often persist into infant care@ ```
38
Labor - effacement
Thickness of cervix from 5cm to 1 mm
39
Labor - dilation
Opening of cervix from diameter of a fingertip to 10 cm
40
Labor - 3 stages
``` 1 = cervical dilation (labor) 2 = pushing and expulsion (delivery) 3 = placental expulsion and uterine involution (afterbirth) ```
41
Vaginal birth - possible complications
Compromise to pudendal Perineal tearing Episiotomy Inc strain against pelvic organs
42
Vaginal birth - possible complications - Episiotomy - what percentage of vaginal deliveries
51-75% Becoming less common Can be harmful in some cases Surgeons say easier to put back together - but worse because going through deeper layers than if were to just tear naturally
43
PT during labor and delivery
``` Is underutilized! Relaxation training Breath control Vasalva avoidance TENS for LBP Sacral mob for LBP Position changes for slow progression of labor Alternate positioning ```
44
Labor - important hx questions
``` How long was stage 2 Did they have episiotomy Did they have a tear Did they have a ceserian How was their recovery Any birth complications ```
45
Ceserean delivery - rates
rose by 53% from 96 to 2007 32% of all deliveries WHO recommends 10% though
46
Vaginal birth after cesarean
Some doctors will not allow it because higher chance of complications but ACOG says it is fine
47
Vaginal birth after cesarean - what does research show
Risk of uterine rupture after VBAC is less than 1% when birth is at least 18 months after initial C section Risk of fetal death in 6% of uterine ruptures
48
Ceserian delivery - afterwards
Extended recovery Major abdominal surgery Conflicting emotions/feelings of failure May offer protective effect for pelvic floor but not always! - still may have long stage 2 prior to C section and pregnancy itself is stressful to PFM
49
C delivery is necessary or not
Absolutely necessary and appropriate in many situations | Absolutely unnecessary in other situations
50
C delivery - reasons for unnecessary
Scheduled c sections for convenience of provider and mother Perceived risk and insurance company intervention VBAC
51
Ceserian indications
``` Genital or cervical disease Premature labor with fetal distress Fetal distress Chronic disease Malposition of placenta Issues with multipl birth Hemorrhage Placenta abruption Prolapsed umbilical cord Malpresentation Failure to progress Cephalopelvic disproportion ```
52
Professional communication - Gravida
Base word for number of times pregnant
53
Professional communication - Para
Base word for number of times given birth (alive or stillborn)
54
Professional communication - Or in order like this 4, 1, 1, 4
1st - number of term deliveries 2nd - number of preterm deliveries 3rd - number of abortions 4 - number of living children
55
Professional communication - Nullipara
No pregnancy beyond 20 weeks gestation
56
Professional communication - Primipara
1 delivery beyond 20 weeks gestation
57
Professional communication - Multipara
2 or more feliveries beyond 20 weeks gestation
58
Professional communication - nulligravida
Never been pregnant
59
Professional communication - Primigravida
Pregnant once, regardless of outcome
60
Professional communication - Multigravida
More than one pregnancy
61
High risk pregnancy
1 complicate dby disease | 2 pregnancy in which one is at inc risk of morbidiity or mortality before, during or after delivery
62
High risk conditions
``` Preterm rupture of membranes Premature onset labor Incompetent cervix Placenta previa Preeclampsia Multiple gestation Gestational diabetes ```
63
High risk conditions - incompentet cervix is what
cervix opens too soon
64
High risk conditioons - placent previa is what
Placenta implants low in uterus, may contribute to preterm labor or c section
65
High risk conditions - preeclampsia
gestational hypertension, water retention and protein in urine; progresses to headaches, blurred vision, fatigue, nausea, SOB = medical emergency
66
Acute care PT (1 to 3 days post partum)
``` Underutilized! Education Exercise sheet for HEP Initiation of PFM Pain control Posture and body mechanics Post surgical considerations for C Scar mobs Expectations for incontinence Return to exercise DR care ```

Practice Topics Exam 5 (13 decks)

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