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2ND YEAR- MCN LEC > Pregnancy and Labor Monitoring > Flashcards

Pregnancy and Labor Monitoring Flashcards

(76 cards)

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1
Q

Woman who currently is not pregnant & has never been pregnant

A

Nulligravida

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2
Q

Woman who is pregnant for the 1st time

A

Primigravida

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3
Q

Woman who has been pregnant more than once

A

Multigravida

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4
Q

Number of pregnancies that led to a birth > 20 wks AOG
(not by number of fetuses delivered)

A

Parity

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5
Q

Parity of each Para

A
  1. Nullipara- Woman who never completed a pregnancy >20 wks AOG
  2. Primipara- Woman who has delivered a fetus with an estimated AOG of at least 20 wks
  3. Multipara- Woman who has completed >2 pregnancies to >20 wks AOG
  4. Grand Multipara- Woman who has had at least 5 births (live or stillborn) that are at least 20 wks AOG
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6
Q

number of times a woman has been pregnant
(irrespective of outcome)

A

Gravidity

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7
Q

Obstetric Score

A

GP(T-P-A-L)

G Gravidity number of pregnancies regardless of outcome
P Parity number of past pregnancies that reached >20 weeks
T Term number of term infants delivered (>37 wks)
P Preterm number of preterm infants delivered (20- 36 6/7 wks)
A Abortion number of abortion/ miscarriage (<20 wks)
ectopic pregnancies as well as molar gestations are included
L Live Babies number of living children

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8
Q

Trimesters of Pregnancy and weeks

A

1st Trimester until 14 weeks AOG
2nd Trimester until 28 weeks AOG
3rd Trimester until 42 weeks AOG

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9
Q

Maternal Periods

A

Abortion- <20 wks AOG or <500g
Preterm- <37 wks AOG
Term- 37-42 wks AOG
Post-term- >42 wks AOG
Puerperium- time after delivery (4-6wks)

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10
Q

Pediatric Period

A

Perinatal Period- interval from birth to 28 days

Neonate- birth to 28 days

Infant- 29 days to 1 year

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11
Q
A
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A
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12
Q
A
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13
Q

Diagnosis of Pregnancy

A
  1. Amenorrhea
  2. Lower Reproductive Tract & Uterine Changes at 6-8 weeks age of gestation
  3. Breast and Skin Changes at 6-8 weeks age of gestation
  4. Fetal Movement
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13
Q

abrupt cessation of menstruation
highly suggestive in healthy reproductive-aged women with cyclical predictive menses

A

Amenorrhea

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14
Q

Lower Reproductive Tract & Uterine Changes
at 6-8 wks AOG

A

Chadwick sign
Goodell’s sign
Hegar’s sign
Cervical mucus changes

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15
Q

vaginal mucosa becomes dark-bluish red & congested

A

chadwick’s sign

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16
Q

cervical softening and change in position

A

Goodell’s sign

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17
Q

softening of isthmus

A

hegar’s sign

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18
Q

increased progesterone; ferning

A

cervical mucus changes

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19
Q

Breast and Skin Changes at 6-8 weeks age of gestation

A

Breast engorgement
Striae: increase MSH
Chloasma/Melasma: mask of pregnancy
Linea nigra: darkening of the linea alba
Striae Gravidarum: collagen breakdown
Spider Telangiectasia: increase estrogen

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20
Q

increase MSH

A

Striae

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21
Q

mask of pregnancy

A

Chloasma/Melasma

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22
Q

darkening of the linea alba

A

Linea nigra

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23
collagen breakdown
Striae Gravidarum
24
increase estrogen
Spider Telangiectasia
25
Fetal Movement
Dependent of parity and habitus Primigravid- 18-20 weeks AOG Multigravid- 16-18 weeks AOG
26
Diagnostic Test
B-hcG Gestational Sac Pseudogestational Sac Transvaginal Sonography Yolk Sac Pregnancy of Unknown Location
27
basis for endocrine assays of pregnancy produced by syncytiotrophoblast main function is to prevent involution of corpus luteum Alpha subunit: identical to LH, FSH, TSH Beta Subunit: used for pregnancy detection
beta human chorionic gonadotropin
28
brightly echogenic ring with anechoic center confirms with certainty an intrauterine location for the pregnancy Seen at 5th week AOG
Yolk Sac
28
Small anechoic fluid collection 1st sonographic evidence at 4-5 weeks Implants eccentrically in endometrium
Gestational Sac
28
Fluid collection with in the endometrial cavity with an ectopic pregnancy
Pseudogestational Sac
29
If equivocal findings Serum serial hCG levels helps to differentiate
Pregnancy of Unknown Location
30
Embryo is seen as a linear structure adjacent to yolk sac with cardiac activity
after 6 weeks
31
Crown rump length is predictive of gestational age within 4 days
12 weeks
32
Symptoms- Nausea, vomiting Urinary frequency/ urgency Quickening Breast enlargement Signs- Amenorrhea Chadwick sign Chloasma or melasma Linea Nigra Striae gravidarum Spider telangiectasia Breast changes Thermal changes
Signs of Symptoms of Presumptive Evidence
33
Symptoms- Abdominal distention Braxton-hicks contraction Signs- + pregnancy test Abdominal enlargement Outlining of fetal parts Hegar sign Goodell sign BallotementSigns and Symptoms of Probably Evidence
Signs and Symptoms of Probable Evidence
34
Signs of Positive Evidence
Fetal heart tones Perception of fetal movement by examiner Ultrasound evidence
35
Determining AOG by LMP
add the number of days from LMP to date of consultation then divide by 7 days
36
Determining EDD using LMP
Jan - Mar : LMP + 9 mos + 7 days April - Dec : LMP - 3 mos + 7 days + 1 yr
37
Best heard along fetal back 110-160 BPM
Fetal Heart Tones
38
AOG AND METHODS
5-6 weeks- Transvaginal sonography 10 weeks- Doppler ultrasound 16 weeks- Earliest heard with a standard stethoscope 20 weeks- Stethoscope in 80% of women 22 weeks- Stethoscope in all women
39
Symphysis pubis to fundus Bladder must be emptied before measuring 20-34 wks gestation, fundic height correlates closely with gestational age in weeks
Fundic Height
40
Expected height of uterine fundus by month of pregnancy
AOG Fundic Height 12 weeks Uterus above pubic symphysis 16 weeks Midway bet umbilicus & pubic symphysis 20-22 weeks Level of umbilicus 28 weeks Bet umbilicus & xiphoid process 40 weeks Fundic height decreases
41
Labor Monitoring
1. Internal Examination 2. Electronic fetal monitoring
42
Internal Examination
Cervical dilatation Cervical effacement Station Membrane
43
ave diameter of cervical opening measured in cm admits tip - 10cm (fully dilated)
Cervical dilatation
44
degree of decrease in cervical length measured in % uneffaced-fully effaced
Cervical effacement
45
level of presenting part in relation to ischial spines (station 0) minus (-), zero, plus (+)
Station
46
bag of water unruptured / intact rupture
membrane
47
Phases of Uterine Contractions
Increment Acme Decrement
48
“building up” or increasing contraction; longest phase
Increment
49
peak of a contraction
acme
50
period of “letting up” or decreasing contraction
decrement
51
Characteristics of Uterine Contractions
DUration Frequency Interval
52
from beginning of one contraction to end of the same contraction
Duration
53
from beginning of one contraction to beginning of the next contraction
frequency
54
resting time between contractions to allow placental perfusion
interval
55
how to read a CTG
DR: Define risk C: Contractions BRa: Baseline rate V: Variability A: Accelerations D: Decelerations O: Overall impression
56
CTG define risks:
obstetric complications: Multiple gestation Post-date gestation Previous cesarean section Intrauterine growth restriction Premature rupture of membranes Congenital malformations Oxytocin induction/augmentation of labour Pre-eclampsia maternal medical illness: Gestational diabetes Hypertension Asthma other risk factors Absence of prenatal care Smoking Drug abuse
57
record number of contractions present in a 10/20 minute period individual contractions are seen as peaks on CTG strip assess & report contractions by duration, frequency & interval
contractions
58
average heart rate of the fetus within a 10/20-minute window normal FHB 110-160 BPM
baseline fetal heart rate
59
baseline heart rate greater than 160 bpm
fetal tachycardia
60
baseline heart rate less than 110 bpm
fetal bradycardia
61
eat to beat fluctuations from baseline heart rate result of interaction between nervous system, chemoreceptors, baroreceptors and cardiac responsiveness of fetus indicates how healthy a fetus is at a particular time
variability
62
variabilities
absent variability- amplitude range undetectable minimal- 5 bpm moderate- 6 to 25 bmp marked- 25 bpm
63
abrupt increase in baseline fetal heart rate of more than 15 bpm for more than 15 seconds
acceleration
64
abrupt decrease in baseline fetal heart rate of more than 15 bpm for more than 15 seconds
decelerations
65
early deceleration is due to
head compression
66
variable deceleration is due to
umbilical cord compression
67
late deceleration is due to
uteroplacental insufficiency
68
very concerning as it is associated with high rates of fetal morbidity and mortality indicates
sinusoidal pattern
69
sinusoidal pattern indicates
Severe fetal hypoxia Severe fetal anaemia Fetal/maternal haemorrhage
70
Reassuring overal impression
Baseline heart rate 110 to 160 bpm Baseline variability 5 to 25 bpm Decelerations None or early Variable decelerations with no concerning characteristics for less than 90 minutes
71
non reassuring variability
fetal tachycardia/ bradycardia absent variability minimal variability late deceleration
72

2ND YEAR- MCN LEC (4 decks)

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